BACKGROUND : In Japan, clinical ethics support services are only available at certain institutions. The actual conditions surrounding ethics consultation are unclear with few resources available for determining its efficacy. The object of this study is to clarify the expected outcome of ethics consultation and identify the appropriate mode. We also aim to elucidate the ideal consultant and the obstacles to achieving full utilization of ethics consultation.
METHODS : Eighteen medical practitioners participated in the study. We held semi-structured interviews and analyzed these interviews by qualitative content-analysis technique.
RESULTS : This study suggests that specific advice, new insights from outside parties, emotional support, and an appropriate process based on a division of labor between medicine and ethics all contribute to a team-based practice of medicine that avoids the arbitrariness and dogmatism of single practitioners. It is also indicated that timeliness and swift answers are required. Knowledge of medicine and ethics, communication skills, a close familiarity with actual conditions in medical practice, and empathy toward the medical staff were found to be as important as the qualifications of consultants. Contrarily, the participants suggested that the busy pace, lack of psychological breathing room, medical practitioners' pride, lack of awareness of ethical issues, and the negative image of the word “ethics” were significant impediments to achieving full utilization of ethics consultation.
CONCLUSIONS : The present study is the first of its kind to reveal the views of medical professionals regarding clinical ethics consultation in Japan. Further research is required to identify the features of a consultation system that can be easily accessed and effectively utilized in Japan.

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BACKGROUND : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.
OBJECTIVE : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.
DESIGN : Prospective observational study based on a daily questionnaire.
PARTICIPANTS : Residents of postgraduate year 1 and 2.
MEASUREMENTS : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).
RESULTS : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.
CONCLUSIONS : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.

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ABSTRACT : Both primary biliary cirrhosis (PBC) and autoimmune hemolytic anemia (AIHA) are uncommon diseases. Immunological dysregulation is suggested as a causative factor for both diseases. We report a 77-year-old woman who suffered from warm type AIHA complicated by PBC. Her direct antiglobulin test was positive for IgG, and negative for C3. Both anti-mitochondrial antibody and its M2 component were detected. Both alkaline phosphatase (Alp) and IgM were elevated in the serum. She was initially treated with steroids for 8 months. Her steroids were discontinued when she underwent a laparoscopic splenectomy. Ursodeoxycholic acid was discontinued due to an allergic skin reaction. Her Alp improved with bezafibrate.

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BACKGROUND : This survey examined how a physician's specialty may influence attitudes towards blood glucose control in diabetic patients.
METHODS : A questionnaire was mailed to all members of the Ishikawa Medical Association (n=1,610) as well as diabetic specialists (n=36) querying their specialties, confidence in offering diabetic treatment, and treatment goals/change levels of plasma glucose levels for 5 theoretical cases.
RESULTS : 301 physicians responded. The percentage answering treatment goal/change levels was 93% of internal medicine physicians (n=145), 72% of surgeons (n=29), 52% of pediatricians (n=23) and 20% in other specialties (n=99). The percentage answering “I am confident in offering diabetic treatment” was 57% of internal medicine physicians, 14% of surgeons, 13% of pediatricians and 3% in other specialties. There were significant differences among specialties in the fasting plasma glucose levels in the treatment goal, and the postprandial plasma glucose change levels. Internal medicine specialists tended to give higher glucose levels than other specialties.
CONCLUSIONS : The majority of physicians interested in diabetes care appear to be internal medicine specialists. Physician's specialty may influence their attitude toward glucose control in diabetic patients.

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