Fujita Medical Journal
Online ISSN : 2189-7255
Print ISSN : 2189-7247
ISSN-L : 2189-7247
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Editorial
Original Article
  • Mihoko Ito, Takeshi Hida, Kazue Goto, Michiko Goto, Yoshikiyo Kanada, ...
    Type: Original Article
    2020 Volume 6 Issue 4 Pages 93-101
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: July 14, 2020
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    Supplementary material

    Objectives: The current study sought to understand the learning outcomes experienced by students and to explain their learning process in detail using interpretive data analysis.

    Methods: A qualitative study examined students who participated in a multidisciplinary course in a ward. This study investigated latent meanings rather than factual information, using an interpretive paradigm. Data were collected via focus groups and analyzed using Steps for Coding and Theorization (SCAT).

    Results: Students in the Assembly IV trial (interprofessional education in actual medical settings) experienced a process of transition from a competing (exclusive) mode to a mutual-understanding mode when communicating with people in other professions, and they acquired the perspective of an interactive (dialectic) link between involved communication (communication that attempts to connect directly with patients) and uninvolved communication (communication with patients indirectly through data and other methods) for patient communication. This enabled students to move beyond superficial communication while deepening their connections with people in other professions, complementing each other’s strengths, and learning about the possibilities inherent in the provision of collaborative medical practice.

    Conclusions: Students participating in interprofessional education within medical settings learned about the potential to achieve a circular realization of collaborative medical practice. A circular realization of collaborative medical practice involves incorporating diverse approaches into one’s own professional work via exposure to the viewpoints of other occupations and avoiding decision-making based on assumptions that are only valid within one’s own profession. This process enables the discovery of better methods and perspectives and the achievement of effective medical practice by moving beyond superficial communication.

  • Sayuri Nakamura, Mihoko Itoh, Yoichiro Miki, Toshiaki Kido, Hiroyuki K ...
    Type: Original Article
    2020 Volume 6 Issue 4 Pages 102-109
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: July 14, 2020
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    Objective: This study aimed to clarify the relationship between interprofessional self-evaluation and peer evaluation during interprofessional education (IPE) using team-based learning (TBL). We also aimed to clarify differences in interprofessional cooperation between students with high and low peer evaluation scores.

    Methods: In total, 483 students (grades 3–5) from nine faculties at three universities participated in a TBL-based IPE program. The students completed five interprofessional self-evaluation domains (the modified Tsukuba IPE model) before and after IPE. Students also completed peer evaluation after IPE. Students were divided into three groups by peer evaluation scores (low, middle, high), and the post-class self-evaluation scores of these groups were compared using a Kruskal–Wallis test. Multiple regression analysis was also performed. Peer evaluation comments were analyzed using a qualitative inductive method.

    Results: Students in the low peer evaluation group had significantly lower scores in the “Regarding participation in group work” domain than students in the high group (P<0.05). Students in the high group received positive comments, such as [good communication] and [working cooperatively], whereas students in the low group were required to improve in two areas: [speaking up more] and [need more communication].

    Conclusions: There was a significant relationship between peer evaluation by team members and self-evaluation for “Regarding participation in group work.” Students with high peer evaluation scores participated with active attitudes, whereas students with low scores were considered passive. This study suggested that using peer evaluation may enhance students’ professional cooperation by improving their communication and attitudes toward active participation.

  • Nozomi Odo, Kei Ohtsuka, Yukari Suzuki, Fumihiro Matsuda, Soichiro Koy ...
    Type: Original Article
    2020 Volume 6 Issue 4 Pages 110-116
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: March 25, 2020
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    Objectives: This study aimed to determine the effects of clinical clerkship in physical and occupational therapy students’ education on their stress, sleep, and technical skill acquisition.

    Methods: We compared responses to the Brief Job Stress Questionnaire and the Athens Insomnia Scale, and students’ clinical training grades between a traditional clinical training group (n=48) and a clinical clerkship group (n=48).

    Results: Compared with the traditional group, the clinical clerkship group showed significantly higher scores on the Brief Job Stress Questionnaire for quantitative and qualitative burden, and significantly lower scores for the extent of control over tasks, irritability, fatigue, depression, and physical ailment. Scores for vitality and supervisor support were also significantly higher in the clinical clerkship group than the traditional group. The median Athens Insomnia Scale score was significantly lower in the clinical clerkship group. Clinical training grades for fundamental attitude and treatment techniques were significantly higher in the clinical clerkship group than in the traditional group.

    Conclusions: Students that experienced clinical clerkship perceived quantitative and qualitative burdens, which may be attributable to the level of interaction with patients during training. Their perception of low control over tasks may be because their supervisors described tasks specifically. However, the clinical clerkship group showed lower mental and physical stress than the traditional group. These students perceived they had supervisor support, which may be attributable to increased communication with their supervisor. Clinical clerkship was also linked to better sleep status than traditional training. Continuing clinical clerkship is necessary to develop students’ technical clinical skills.

  • Miyo Murai, Takashi Higashiguchi, Akihiko Futamura, Hiroshi Ohara, Nor ...
    Type: Original Article
    2020 Volume 6 Issue 4 Pages 117-121
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: March 25, 2020
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    Objectives: Prognostic prediction is a significant tool for selecting appropriate treatment in advanced cancer patients with cachexia, at a time when it is important to offer high-quality palliative care and improve quality of life until death. In this retrospective study, we investigated the prognostic potential of serum cytokine level and various clinical symptoms by analyzing the pathological conditions and metabolic dynamics of cachexia in advanced cancer patients.

    Methods: One hundred and fifty-three advanced cancer patients who underwent palliative care and died at the Department of Surgery and Palliative Medicine, Fujita Health University Nanakuri Memorial Hospital between 1 January 2004 and 30 June 2007 were eligible for the study. We simultaneously assessed their blood factors and clinical symptoms at admission. All patients were divided into two groups according to median survival time to analyze the risk factors for prognosis.

    Results: Multivariate analysis revealed the following independent prognostic factors: interleukin (IL)-8 (odds ratio [OR]=4.17, 95% confidence interval [CI]=1.52–11.41, p=0.002), general fatigue (OR=1.22, 95%CI=1.03–1.45, p=0.019), anorexia (OR=1.19, 95%CI=1.04–1.37, p=0.008), dyspnea (OR=1.19, 95%CI=1.02–1.38, p=0.024), depression (OR=1.28, 95%CI=1.11–1.47, p<0.001), nausea (OR=1.25, 95%CI=1.05–1.48, p=0.007), dry mouth (OR=1.19, 95%CI=1.01–1.40, p=0.032), and overall assessment score (OR=1.05, 95%CI=1.02–1.09, p<0.001). Patients with low IL-8 (<1.347 pg/ml) and low overall assessment score (<26) had significantly better prognosis (both p<0.0001).

    Conclusions: High IL-8 level and clinical symptoms can be prognostic indicators for advanced cancer patients with cachexia.

  • Kosuke Tajima, Masahiro Yoshida, Daiki Murakami, Tomoyuki Nishimura, A ...
    Type: Original Article
    2020 Volume 6 Issue 4 Pages 122-127
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: March 25, 2020
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    Objectives: Management of unstable intertrochanteric fractures is challenging, especially in patients with osteoporosis. Comminuted unstable intertrochanteric fractures require postoperative immobilization. Several recent reports have recommended hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for unstable intertrochanteric fractures in older persons.

    Methods: Sixty patients aged over 75 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the standard posterolateral approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated. Clinical evaluation was based on Harris Hip Scores.

    Results: The cohort comprised 16 men and 44 women (aged 75–96 years). According to the Jensen classification, 24 fractures were type III, 14 type IV, and 22 type V. Cement was used in 24 patients. At 12 months follow-up, Harris Hip Scores were excellent in 18%, good in 42%, fair in 25%, and poor in 15%. No radiological abnormalities were detected.

    Conclusions: Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

Short Report
  • Megumi Ozeki, Hitoshi Kagaya, Yoko Inamoto, Tomoko Iizumi, Seiko Shiba ...
    Type: Short Report
    2020 Volume 6 Issue 4 Pages 128-131
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: March 25, 2020
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    Objective: The “chin-down” posture involves tucking the chin to the neck. However, clinicians and researchers have their own forms of the chin-down posture: some consider it to be head and neck flexion, whereas others consider it to be head flexion alone. The purpose of this study was to evaluate the effects of head, neck and combined head-and-neck flexion postures separately.

    Methods: Ten healthy volunteers participated in the study. The head and neck were set in neutral (N), head flexion (HF), neck flexion (NF) or combined head-and-neck flexion (HFNF) positions. Participants were instructed to swallow 4 ml of thick barium liquid in an upright sitting position. Head and neck angles at rest, distances in the pharynx and larynx at rest, and duration of swallowing were measured. Statistical analysis was performed with a paired t-test with Bonferroni correction.

    Results: Head angles in HF, NF and HFNF positions were significantly greater than in the N position. Neck angles were significantly greater in the NF position than in the N position. The distance between the tongue base and the posterior pharyngeal wall, the vallecular space and the airway entrance were smaller in the HF position than in the N position. The tongue base was in contact with the posterior pharyngeal wall longer in the HF position than in the N position.

    Conclusion: Because HF, NF and HFNF positions have different effects, we recommend the use of these terms instead of “chin-down position.”

Case Report
  • Masahiro Yoshida, Kosuke Tajima, Koji Sato
    Type: Case Report
    2020 Volume 6 Issue 4 Pages 132-136
    Published: 2020
    Released: November 01, 2020
    [Advance publication] Released: March 25, 2020
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    Introduction: Low-energy trauma fractures of older people cause fragility fractures of the pelvis (FFPs), and secondary amenorrhea triggers osteoporosis that might lead to FFPs. Anorexia nervosa is a major causative factor in secondary amenorrhea, thus, FFPs might be a problem for young anorexia nervosa patients as well as older people. Here, we report a rare case of a young woman with anorexia nervosa who had an FFP, followed by gradual progression of severe sacral deformity.

    Case: A 49-year-old woman with hypothalamic amenorrhea (a subtype of secondary amenorrhea) caused by anorexia nervosa fell from a chair. She visited a nearby hospital and was diagnosed with an undisplaced sacral fracture; however, she chose to stay at home since the pain was slight and she could still walk. She fell to the floor several times while injured, and 3 months later, she had walking difficulty accompanied with severe pain, and was admitted to our facility. On radiological examination, she was diagnosed with FFP with severe sacral deformity, and was treated surgically. Because of the severe sacral deformity, a computed tomography (CT)-3D-fluoroscopy matching navigation system was used during surgery to support appropriate placement of percutaneous iliosacral (IS) and transiliac–trans-sacral (TITS) screws.

    Discussion: To our knowledge, this is the first report of FFP caused by amenorrheic osteoporosis, treated by matching navigation. This matching navigation could be a supportive tool in inserting IS and TITS screws during surgery for FFPs, especially in cases with severe deformity.

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