Tetsuhiro Maeno

Universal problems during residency: abuse and harassment

Objectives  Perceived abuse or harassment during residency has a negative impact on residents’ health and well‐being. This issue pertains not only to Western countries, but also to those in Asia. In order to launch strong international preventive measures against this problem, it is necessary to establish the generality and cultural specificity of this problem in different countries. Therefore, we investigated mistreatment among resident doctors in Japan.

The effect of stress‐related factors on mental health status among resident doctors in Japan

Medical Education 2010: 44: 826–834

Palliative care physicians' practices and attitudes regarding advance care planning in palliative care units in Japan: a nationwide survey.

To clarify physicians’ practices and attitudes regarding advance care planning (ACP) in palliative care units (PCUs) in Japan, we conducted a self-completed questionnaire survey of 203 certificated PCUs in 2010. Ninety-nine physicians participated in the survey. Although most Japanese palliative care physicians recognized the importance of ACP, many failed to implement aspects of patient-directed ACP that they acknowledged to be important, such as recommending completion of advance directives (ADs), designation of health care proxies, and implementing existing ADs. The physicians’ general preference for family-centered decision making and their feelings of difficulty and low confidence regarding ACP most likely underlie these results. The discrepancy between physicians’ practices and their recognition of the importance of ACP suggests an opportunity to improve end-of-life care.

Japanese students' perception of their learning from an interprofessional education program: a qualitative study

Objectives The aim of this study was to explore students’ perception of their learning from the interprofessional program implemented in Japan where the implementation and evaluation of interprofessional education is behind that of western countries. Methods We conducted a qualitative research of opinions of students who participated in the interprofessional program implemented in the University of Tsukuba. The participants were 105 medical, 65 nursing, and 35 medical science students. At the completion of the program, we asked that the participants write their opinion on what they gained by participating in the program. From their responses, significant descriptions were extracted, coded by content, and then grouped into subcategories. These subcategories were then separated into main categories based on their emergent themes. Results The main categories identified were such as “understanding of medical professionals,” “interprofessional work,” “holistic care,” “communication,” “sharing,” and “empowerment.” Conclusions The categories extracted in our study, for the most part, matched previous studies, suggesting that the program helped students enhance their understanding of interprofessional work. Although the Japanese health care system and medical education system are different from those of western countries, this suggests that the benefits of interprofessional education in Japan will be similar to those of western countries.

Can we predict future depression in residents before the start of clinical training

Depression among medical residents is a very serious problem. It is, however, very difficult to detect signs of depression early, despite the severity and frequency of depression. We designed a nationwide longitudinal study to investigate whether the Sense of Coherence (SOC) Scale, an indicator of ability to cope with stress, could predict future depressive symptoms among medical residents.

Under-diagnosis of alcohol-related problems and depression in a family practice in Japan.

AimThe aim of this survey was to assess the accuracy of a family physicians diagnosis of depression and alcoholism.MethodsConsecutive new adult patients attending a family practice in Japan between April 2004 and August 2006 were enrolled. Excluded were those with dementia or visual disturbance, and emergency cases. Participants completed a questionnaire regarding their complaints and socio-demographics. A research nurse conducted the Japanese version of the Mini-International Neuropsychiatric Interview (J-MINI) in the interview room. The doctor independently performed usual practice and recorded his own clinical diagnoses. A researcher listed the clinical diagnoses and complaints, including J-MINI or clinically-diagnosed alcoholism and depression, using the International Classifications for Primary Care, Second Edition (ICPC-2) and calculated kappa statistics between the J-MINI and clinical diagnoses.ResultsOf the 120 adult first-visit patients attending the clinics, 112 patients consented to participate in the survey and were enrolled. Fifty-one subjects were male and 61 female, and the average age was 40.7 ± 13.2 years. Eight alcohol-related disorders and five major depressions were diagnosed using the J-MINI, whereas no cases of alcoholism and eight depressions were diagnosed by the physician. Clinically overlooked patients tended to have acute illnesses like a common cold. Concordance between the clinical and research diagnosis was achieved only for three episodes of Major depression, resulting in a kappa statistic of 0.43.ConclusionAlthough almost half of the major depressions were identified, all alcoholism was missed. A mental health screening instrument might be beneficial in family practice, especially to detect alcoholism.

Usefulness of Palliative Prognostic Index for patient with advanced cancer in home care setting.

Aims: This study aimed to clarify the accuracy of the Palliative Prognostic Index (PPI) for advanced cancer patients in home care settings. Method: The study included 65 advanced cancer patients who received home visiting services between April 2007 and June 2009, and who died at home or in the hospital. Using the medical records from initial home visits, we retrospectively calculated PPI scores along with sensitivity and specificity. Results: For 3- and 6-week survival, prognostic prediction demonstrated respective sensitivities of 55% and 63%, and specificities of 79% and 77%. Conclusion: The sensitivity of the PPI for advanced cancer patients in home care settings was lower than reported for those in palliative care units. Development of prognostic tools suitable for home care settings is needed.

Experiences of alcohol-related harassment among medical students

Medical Education 2010: 44: 1213–1223

Indicators of a Major Depressive Episode in Primary Care Patients With a Chief Complaint of Headache

Objective.—To identify the indicators of major depressive episode (MDE) in primary care patients with a chief complaint of headache.

Prospective Clarification of the Utility of the Palliative Prognostic Index for Patients With Advanced Cancer in the Home Care Setting

Aims: This study aimed to prospectively clarify the accuracy of the Palliative Prognostic Index (PPI) for advanced cancer patients in home care settings. Method: The study included 66 advanced cancer patients who received home visiting services between April 2010 and June 2012, and who died at home or in the hospital. Using medical records from initial home visits, we prospectively calculated PPI scores along with sensitivity and specificity. Results: For 3- and 6-week survival, prognostic prediction showed respective sensitivities of 60% and 70.6%, and specificities of 87.0% and 71.9%. Conclusion: The sensitivity of the PPI for advanced cancer patients in home care settings was lower than that reported for patients in palliative care units. Development of prognostic tools suitable for home care settings is needed.