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Background: From the late 1960s, physician's appearance has been actively studied in the West, and until the early twenty-first century, patients tended to prefer “formal dress” attire along with white coats for physicians. However, people’s attitudes today toward dress code has not been clarified while it may have changed.Objective: This study aimed to investigate the acceptability of dress codes from the patient’s perspective to suggest the future of dress codes.Methods: Outpatients and their families in a university hospital and small-to medium-sized hospital were surveyed. We inquired which of the different styles of white coats and different colors of scrubs were most desirable for male and female physicians. We used Scheffet’s pair-comparison method to show the rankings.Results: Patients and their families expected their physicians to wear white coats rather than scrubs. Furthermore, the more traditional and formal dress code was preferred. The least preferred color of scrubs was yellow.Conclusion: The study found that patient’s preference for a traditional, conservative appearance has not changed over time. It did not match today's perspective on infection prevention. Although, both perspectives, patient preferences and infection prevention are important for education and gaining patient trust.

Duodenal duplication cyst is not a common congenital anomaly and the pathophysiology may become very complicated if the cyst is situated at the ampulla of Vater. Here we report a very rare female case of duodenal duplication cyst at the ampulla of Vater, which caused acute pancreatitis due to massive protein plaques in the pancreatic duct. She had a past history of double duodenal atresia and underwent surgery as a neonate. The correct diagnosis could not be determined before the second operation at four years of age and the exact pathophysiology finally became apparent during the operation with a contrast medium study and duodenotomy. We discuss the complicated clinical features and diagnostic and treatment procedures before and during the operation.

Background: With the rapid aging of the population, collaboration among the various medical professions throughout the country is becoming increasingly indispensable in Japan. To promote collaboration in medical care, it is necessary to introduce the concept of collaboration to students at an early stage of their professional education. Despite this need, there are no core medical, healthcare and welfare education curricula in Japan that include interprofessional education (IPE). Therefore, the status of IPE in Japanese schools of medicine and other healthcare-related services is unclear. Methods: We sent 3,430 questionnaires to 13 schools of medicine and related healthcare providers: doctors, nurses, physical therapists, registered dieticians, dentists, dental hygienists, social workers, pharmacists, occupational therapists, clinical psychologists, medical administrators, certified care workers, and speech therapists. The items addressed implementation rate of IPE, teaching methods and grading methods. Results: Of the 3,430 surveys distributed, 572 completed surveys were returned (response rate 17%). Of the completed surveys, 493 qualified as valid, resulting in a final response rate of 14%. Only 19% (n = 93) of the analysed medical educational institutions included IPE instruction in their curricula. Conclusion: While many educational institutions were conducting IPE, there were important inter-institutional differences with respect to attitudes towards IPE, teaching methods, and evaluation methods. This study was unprecedented in scale, and provides important basic information for the future development of IPE in Japan.

Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains,, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1-3. Finally, our competency framework included two core domains of "Patient-/client-/family-/community-centered" and "Interprofessional communication", and four peripheral domains of "Role contribution", "Facilitation of relationships", "Reflection" and "Understanding of others". We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of "high-context" and "relationalism" in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.

Congenital esophageal stenosis (CES) is rare, and the available clinical data are limited. We explored the current diagnosis, treatment and outcomes of CES. A questionnaire survey was performed using medical records at pediatric surgical centers in the Kyushu area. Over 10 years, 40 patients (24 males) had CES. The incidence of associated anomalies was 52.5% (21/40), and that of esophageal atresia was 20.0% (8/40). The mean age at the diagnosis was 12.0 months (range, 1 day–8.8 years). Seven (17.5%) patients were diagnosed in the neonatal period. Ten (25.0%) developed CES due to tracheobronchial remnants, 27 (67.5%) due to fibromuscular stenosis (FMS) and 1 (2.5%) due to membranous stenosis + FMS. Thirty-six (90.0%) were treated by balloon dilatation (mean, 3 times; range, 1-20). Perforation at dilatation occurred in 7 (17.5%) patients, and all were diagnosed with FMS. Eighteen (45.0%) patients underwent radical operation (3 primary, 15 secondary to dilatation). Our study clarified the characteristics and outcomes of CES, including neonatal diagnoses. CES occurred in 1 in every 33,000 births in the Kyushu area. Careful attention should be paid, even in cases of dilatation for FMS. CES requires long-term follow-up for symptom persistence after adequate and repeated treatment.

Interprofessional education (IPE) for healthcare professionals is important in Japan because of its rapidly aging population and increasingly complex healthcare needs. However, no tools have been validated in the Japanese context to evaluate healthcare professionals' attitudes towards, or readiness for, IPE. The professional version of the Readiness for Interprofessional Learning Scale (RIPLS) with 23 items was selected for cross-cultural adaptation because it has been widely used internationally and a Japanese edition of the student version has already been developed. We followed a guideline for cross-cultural adaptation and subsequently conducted factor analysis with 368 responses from over 16 professions. Face and content validity was confirmed through the translation process. We obtained four factors with good internal consistency (Cronbach's alpha > 0.7). These results were similar to those of the original UK study, apart from one factor being divided into two different factors in this study. Studies are required to further confirm the rigor and generalisability of the results; however, the Japanese RIPLS can be used to evaluate healthcare professionals' attitudes towards IPE, which can eventually lead to a better IPE development for healthcare professionals in Japan.

Papillary cystadenomas of the salivary gland are uncommon, benign, encapsulated or well-circumscribed, multicystic tumors with intracystic papillations. In a large review, papillary cystadenoma constituted 2% of all minor salivary gland tumors. The present study reports an extremely rare case of a papillary cystadenoma arising from the palate that demonstrated oncocytic features. A 60-year-old man was referred by his dentist to the Second Department of Oral and Maxillofacial Surgery at Osaka Dental University Hospital for the diagnostic evaluation of a mass of the left palate. An incisional biopsy was performed and the microscopic findings were interpreted as consistent with a papillary oncocytic cystadenoma. Therefore, the lesion was excised under general anesthesia. The post-operative course was uneventful and no recurrence had developed 5 years subsequent to surgery.

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.

Background In medical practice, obtaining information regarding patients’ undisclosed “feelings of anxiety” or “depressive feelings” is important. The purpose of this study was to determine which interview skills are best suited for eliciting verbal indications of undisclosed feelings, for example anxiety or depressive feelings in patients. Methods Our group videotaped 159 medical interviews at an outpatient department of the Department of Family Medicine, Mie University Hospital (Mie, Japan). Physicians’ medical interview skills were evaluated using a Medical Interview Evaluation System and Emotional Information Check Sheet for assessing indications of “feelings of anxiety” or “depressive feelings”. We analyzed the relationship between the interview skills and patients’ consequent emotional disclosure using generalized linear model (GLIM). Results The usage of interview skills such as “open-ended questions” “asking the patient’s ideas about the meaning of illness” “reflection” and “legitimization” were positively associated with the number of anxiety disclosure, whereas “close-ended questions” and “focused question” were negatively associated. On the other hand, only “respect” was positively associated with the number of depressive disclosures, whereas “surveying question” was negatively associated. Conclusions The results revealed that there are several interview skills that are effective in eliciting verbal indication of undisclosed “feelings of anxiety” or “depressive feelings”.

The PSL method is useful as a screening technique of irradiated foods to support efficient uses of TL analysis. Recently, there has been the growing need for the system check or calibration using the standard materials with spread of domestically-produced PSL detector. In this research, we characterized the PSL of several types of glass fiber filters and compared the cumulate photon counts of a selected filter of them (GA-100) with those of the SUERC paprika standard for PSL measurements. GA-100 filter showed a linear relationship between cumulate photon counts and irradiation doses, and the cumulate photon counts in the first 2 months after gamma rays irradiation (261Gy) were markedly decreased and reduced to about 5000 counts (the upper threshold of PSL) after 4 months. However, further long-term storage and dose increase was necessary to produce the filters with more adequate PSL property as a standardmaterial. Light exposure (630Lux) within 3 minutes to GA-100 had little effect on the cumulate photon counts. GA-100 showed relatively less variation in cumulate photon counts compared with the paprika standard in a series of studies.

Our study demonstrated that the effects of the several temperature ranges for integrating TL glow intensity on the TL glow ratios by using spice-set purchased at a Turkish air port. The spice set had no labeling of irradiation foods, but nine of 12 spices were judged as irradiated food in this study. Those temperature ranges were defined by evaluating the glow curves of irradiated TLD-100 chip (167-230°C), TLD-100 disc (177-238°C) and Dolomite element (145-258°C). Those are relatively stable and the difference of typical glow peak temperatures of TLD-100 disc in two institutes was less than 2%. On the other hand, Those of TLD-100 tip was shift to higher temperature side at about 4°C because of declining of thermal conductance. The temperature ranges defined by TLD-100 were showed that discriminate more clearly between irradiated and nonirradiated spices compared with the full temperature range of TL measurement (70-400°C). With the exception of low glow intensity, background measurement for estimating net glow intensity was not necessary because TL glow ratio was hardly influenced whether the background measured or not.

照射香辛料と非照射香辛料を混合した混合香辛料を, 黒コショウとパプリカについてそれぞれ5検体ずつ作製した。5.4kGy照射した黒コショウを2% (w/w) 混合した混合香辛料では照射による発光極大が認められなかった。照射したものを5又は10%混合した場合では, 「照射」, 「一部照射」, 「どちらでもない」と判定された。照射したものを20%混合したすべての試料は「照射」と判定された。5.0kGy照射したパプリカを5.0%混合した混合香辛料はすべて「照射」と判定された。照射試料を0.2%以上混合したものでは, すべての試料では150～250℃の範囲に発光極大が認められた。以上の結果では, スパイスの種類によって「照射」と判定できる混合割合が異なることを示した。TL発光量の積算温度範囲を70～400℃とTLD100に基づく約150～250℃に近い範囲にすると, TL発光比は後の方が低くなるが, 「照射」と判定される試料はほぼ同じ判定であった。放射線を照射していない黒コショウとパプリカに紫外線を照射しても, 放射線を照射したと判定されることはなかった。

In medieval Japan the household became the basic social unit among all classes. In the process, a division of roles also came about: the household head and husband represented the ie to the outside world, while the wife was in charge of its running. The wife's role was highly regarded in the medieval period, but its details have yet to be fully examined. This paper attempts to shed light on how medieval women lived by studying the role of wives and their integral place in ie management. To do this, it is also necessary to examine the relationship between the father's wife and the son's wife, in other words, the mother-in-law and the daughter-in-law. I will look at women from various classes, to the extent the documentation allows, utilizing the diaries of the court nobility, literary works and other documentary, graphic and material evidence.

Meats, for example, lamb, razorback, wild duck and turkey were irradiated by gamma ray, and the amounts of hydrocarbons formed from fatty acids were measured. Since C20: 0 was found from wild duck and turkey, C1-18: 1 was recommended for internal standard. Good correlation was found between the amount of hydrocarbons and the doses of gamma irradiation. This study shows that such hydrocarbons induced after radiation procedure as C1, 7-16: 2, C8-17: 1, C1-14: 1and C15: 0 may make it possible to detect irradiated lamb, razorback, wild duck and turkey.

Photostimulated luminescence (PSL) method provides a rapid and markedly sensitive technique to detect of any irradiated food that contain minerals. This method is also convenient as a first screening means in comparison with thermoluminescence (TL) method which requires separating minerals from the food materials. The present study reports the results of PSL measurements for both irradiated and non-irradiated powdered dry leaf vegetable obtained with the prototype of PSL system developed by our groups. This PSL system consists of pulsed Infra-Red (IR) source for photostimulation, single photon counting system for high sensitive detection of luminescence, and computer for data treatments. The PSL intensity of the leaf vegetable increased with increase of gamma radiation dose and show a linear relationship up to a dose of 1kGy. The PSL intensities after four months of storage under light shielding following gamma irradiation (0.49-3.1kGy) decreased to less than half of initial intensities. The PSL intensities of those decreased rapidly for 60 seconds and reached a steady level close to intensity of non-irradiated sample after 300 seconds following photostimulation. We used the information on the shape and slope of PSL intensity curve as a criteria to discriminate whether irradiated foods or not, and possible to detect the irradiation history of food irradiated with a 0.49kGy dose after four months of storage.

As paper has high content of cellulose, sensibility of ESR measurements of paper should be high. We examined stability of ESR signals in irradiated recycled copying paper, and estimated the possibility to utilize ESR measurement of paper for the detection of irradiated food. Cellulose radicals in paper irradiated at 1kGy and stored at 40°C in water was detected for 20 days. Cellulose radicals in irradiated paper stored at 90°C in water were more stable than that stored in air. ESR measurements of 50mg paper are simple and easy, so ESR measurement of rapping paper or corrugated box is good screening method for the detection of irradiated food.

Thermoluminescence method makes it possible to detect accurately irradiated food. It is necessary to isolate the minerals contaminated in the food prior to thermoluminescence measurement. The procedure for isolation of minerals usually requires large amount of sodium polytungstate which is harmful and expensive. Therefore we tested other safe and inexpensive chemical reagents for pre-isolation such as sodium tungstate (ST), potassium carbonate (K2CO3) and potassium iodide (KI). TL glow ratios and the patterns of glow curves were approximately same between minerals isolated using sodium polytungstate and those pre-isolated using saturated solutions of ST, K2CO3 or KI. Among them, KI was recommended to be the best because of its ease of handling.

脂肪の放射線分解生成物である炭化水素 (HC) と2-アルキルシクロブタノン (RCB) の連続分析 (GC/FID) 法を用い, 同一の照射ニジマスから生成する9種のHCおよび2種のRCBの生成量を定量し, それらの照射検知への適用の可否を検討した。照射ニジマスでは照射により生成するHCは複雑であり, 飽和炭化水素は未照射試料にも多く含まれるので, HC生成量を照射の指標とすることは不適当である。また, 照射の判定に, 放射線誘導Cn-1: 0とCn.2: 1の比を用いることも, 問題がある。Cn-2: 1の1, 7-ヘキサデカジエンは未照射試料にも検出されず, 1-11kGyの範囲で線量と直線関係にあった。DCBおよびTCBは同じ親の脂肪酸からのCn-2: 1のHCに比べて約半量生成し, 線量との関係も直線関係にあった。HCおよびRCBの連続分析 (GC/FID) 法を用い, 同一の試料から生成する, 不飽和脂肪酸の放射線分解生成物であるHC (Cn-2: 1) および2種のRCBの生成量を定量することによって, 照射の検知判定が可能であることが明らかになった。さらに, 採取する骨の部位に注意し, より硬い骨のESR法による線量付加法により, 照射線量の推定が可能であることがわかった。

Relative ESR strength of rib, backbone and opercular bone from irradiated culture rainbow trout was direct proportional to dose between 0.56kGy and 5.7kGy. Relative ESR strength of rib was higher than that of backbone. Although only 5mg of otolith was obtained from one rainbow trout, bone density of otolith is so high that relative ESR strength of otolith showed about 20-fold higher value than that of rib.In GCMS-SIM analysis of RCB, radiolyticompounds of lipid of fish meat, the amount of both DCB and TCB formed, estimated from ion concentrations of m/z98, were direct proportional to dose between 1.1kGy and 11.1kGy. Neither DCB nor TCB was detected in unirradiated sample. The ratio of amount of DCB formed to amount of TCB formed was nearly 4.4, which is the ratio of palmitic acid content to stearic acid content in rainbow trout, denoted in Standard Tables of Food Composition in Japan; Lipid composition of Foods.Finally, we propose to use detection of radiolytic compound, RCB, and measurement of ESR of high-density bone together for reliable identification of irradiated fish.

A procedure was established for the detection of irradiated chicken by GC/FID analysis of2- alkylcyclobutanones (RCBs) and hydrocarbons (HCs) using cleanup by Soxhlet extraction and Florisil chromatography.Fat extract was obtained from irradiated chickens by a Soxhlet apparatus. A concentrated fat extract containing200 mg of fat with 2 μg of n-eicosane as internal standard (IS) was applied to Florisil columns, which were deactivated by adding 17parts of water to 100 parts of adsorbent. The HCs were eluted in 60 ml of n-hexane. This eluate was concentrated and analyzed by GC/FID. After 150ml of n-hexane was eluted from the same column, RCBs were eluted with 120ml of 1% diethyl ether solution in n-hexane. This eluate was concentrated to 0.2ml and 0.1μg of 2-cyclohexylcyclohexanone (IS) was added to the mixture, which was analyzed by GC/FID. This process rendered it possible to detect HCs and RCBs efficiently and simultaneously.HCs and RCBs were detected in chicken meat irradiated at 0.5 kGy by GC/FID.

The method of detecting low-dose irradiated strawberries by identifying ESR peak of irradiated cellulose component was studied. Ratio of peak height (S) of high magnetic field cellulose component, and noise width (N) of either irradiated or unirradiated seeds of strawberries were compared. In this study, sample was identified to be irradiated when S/N ratio of ESR spectrum of 4 min. sweep time was above 0.7. In the case of S/N ratio below 0.7, when the S/N ratio of integrated ESR spectrum, obtained from measuring 10 times with 1 min. sweep time was above 1.0, the sample was identified to be irradiated. The result suggests that S/N ratio is a good marker to detect the irradiation. The strawberries irradiated above 0.5kGy was able to bedetected after 3 days storage at room temperature, after 21 days refrigeration and after 60 days freezing, respectively.

Hydrocarbons produced from two main fatty acids (oleic acid and palmitic acid) are useful marker for detection of irradiation treatment. The main products, 1-C14: 1, 1, 7-C16: 2, C15: 0 and 8-C17: 1 were measured and their ratios were calculated to identify irradiated meat. As the value of 1-C14: 1/1, 7-C16: 2 was nearly equal to ratio of original fatty acids, the sample was easily detected as irradiated meat. The value of C15: 0/8-C17: 1 can be also used for identification, when the background in nonirradiated meats are low and dose is high enough to be detected hydrocarbon.As range of electron beam is shorter than that of gamma-ray, distribution of hydrocarbons in sample irradiated with electron beam was examined.Cylindrically trimmed ground beef meat with the sizes of 70 mm in diameter and 30 mm in height was irradiated with 5 MeV electron beam at surface doses of 5 and 10 kGy. After irradiation, the cylinder was sliced, and hydrocarbon contents were measured in each slice. Amount of hydrocarbon was maximum in the slice obtained at 7-10 mm depth from the surface. Hydrocarbon formation was very few in the slice obtained at 25-30 mm depth of the central part. The study shows depth profile of hydrocarbon formation with 5 MeV electron beam agreed to theoretical depth-dose curve. On the other hand, profound effect of irradiation was observed in peripheral part of the slice of 20-30 mm depth.

Chicken meat with bone was irradiated by gamma ray at -19-10°C, and both amount of hydrocarbons formed from fatty acids and intensity of ESR signals in bone fragments were measured. Very good correlation was found between the amount of hydrocarbons and the intensity of ESR signals.The amount of hydrocarbons (Cn-2: 1), had 2 carbon atoms less than the original fatty acids and an additional double bond, was almost constant irrespective of the irradiation temperature. The amount of hydrocarbons (Cn-1: 0), had 1 carbon atom less than the original fatty acids, increased as the irradiation temperature raised. As the ratio between corresponding fatty acids, theratio between hydrocarbons (Cn-2: 1) is a suitable index in the detection of the irradiation. On the contrary, the ratio of hydrocarbons from same fatty acid, (Cn-2: 1)/(Cn-1: 0), varied according to the kind of fatty acid and temperature used at the irradiation.It was found that under the irradiation temperature of -19-10°C, intensity of ESR signals of bone is not affecte by the irradiation temperature.

Reconstruction of a Blauth type-IIIB hypoplastic thumb with use of a free vascularized metatarsophalangeal joint was performed in four patients (four hands). Several tendon transfers also were performed, either primarily or secondarily, to mobilize the reconstructed thumb. Three patients (three hands) were followed for at least two years after the reconstruction; the results for these three patients were compared with those for four patients (six hands) who had been managed with pollicization of the index finger because of a similar deformity of the thumb. The patients were evaluated with regard to grip strength, key-pinch strength, and the range of motion of the joints of the thumb in the operatively treated and contralateral hands as well as with regard to skill in performing activities of daily living as assessed with use of the Kobe hand-function test. Although the appearance of the thumb was closer to normal in the group that had had the pollicization procedure, total function of the hand and grip strength were greater in the group that had had the transfer procedure. We believe that reconstruction of an unstable hypoplastic (Blauth type-IIIB) thumb with use of a vascularized metatarsophalangeal joint is an acceptable alternative to pollicization of the index finger.

Background Patients cannot always share all necessary relevant information with doctors during medical consultations. Regardless, in order to ensure the best quality consultation and care, it is imperative that a doctor clearly understands each patient’s agenda. The purpose of this study was to analyze the process of developing a shared-agenda during family physician consultations in Japan. Methods We interviewed 15 first time patients visiting the outpatient clinic of the Department of Family Medicine in the hospital chosen for the investigation, and the 8 family physicians who examined them. In total we observed 16 consultations. We analyzed both patients’ and doctors’ narratives using a modified grounded theory approach. Results For patients, we found four main factors that influenced the process of making a shared-agenda: past medical experiences, undisclosed but relevant information, relationship with the family physician, and the patient’s own explanatory model. In addition, we found five factors that influenced the shared agenda making process for family physicians: understanding the patient’s explanatory model, constructing the patient-doctor relationship, physical examination centered around the patient’s explanatory model, discussion-styled explanation, and self-reflection on action. Conclusions The findings suggest that patient satisfaction would be increased if family physicians are proactive in considering these factors with respect to both the patient’s agenda, and their own.