Clinically important issues might be addressed more comprehensively by analyzing microbiological data assembled from several institutions instead of from a single one. Microbiology laboratory databases collected from six collaborative hospitals (A–F) between 2003 and 2013 were converted into WHONET files and analyzed. Three important areas of investigation are presented in this article including early warning of the emergence of resistant bacteria, evaluation of a new susceptibility testing method, and establishment of strategies for identifying patients harboring resistant organisms. Combined databases from microbiology laboratories of a collaborative hospital network might help in developing integrated responses to prevent infection, decrease transmission, and ensure that appropriate antibiotics are selected for patients with infectious diseases.

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Influenza virus infection in hospitals is a very important clinical issue. The objective of this study was to describe the effect of oseltamivir in controlling a nosocomial influenza virus infection with an observational study and case report. Intervention was carried out in a ward of the University of the Ryukyus Hospital. Symptomatic staff members were sent home for one week, and the infected inpatients were isolated. In addition, in an episode of influenza infection among the staff members and inpatients, oseltamivir (75 mg once a day for 7 days) was administered to all staff members as well as inpatients who had had close contact with the influenza patients. In the hospital ward, eight staff members (nurses and doctors) and ten hospitalized patients were definitively diagnosed with influenza A viral infection based on results of a rapid diagnostic test. Although a relatively large number of the staff members and inpatients had an influenza virus infection, it was possible that the use of oseltamivir efficiently minimized a nosocomial outbreak. It was very difficult to diagnose influenza A virus infection based on clinical symptoms. It was possible to minimize and end the outbreak immediately by using oseltamivir prophylaxis. With a review of the literature, it is considered that prophylaxis with anti-influenza drugs are highly recommended in hospital settings.

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The term “Hospitalist” has become very popular in USA already, ever since this concept was first introduced in 1996. The critical role of the hospitalist has been well-recognized among all of the US hospitals and it is clearly distinct from the traditional model of “hospital patient care” provided by primary care physicians. Recently, the concept of “Hospitalist” has been introduced in Japan, and there is increasing recognition of it as a “new subspecialty”. However, the role of this newly emerging physician’s group is not as clear as the one in USA, and the adoption rate has been still slow in Japan. It would be worthwhile to review the history of hospitalist movement in US and its evolution to help better understand the concept. Then, I would like to define the roles of “J-Hospitalist” in this article.

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The therapeutic history of asthma is divided into a period before and after the advent of inhaled corticosteroids (ICS). Before the advent of ICS, bronchodilators such as β₂-agonists and anti-cholinergic agents were the main drugs used for asthma therapies. ICS were firstly launched in the market in 1978. Their effectiveness and safety have been recognized over time. Consequently, ICS were positioned as gold standard drugs for asthma therapy in the 1980s in Europe and North America and in the late 1990s in Japan. This review addresses the paradigm shift of the drug therapy for asthma.

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It has been suggested that diabetes mellitus is associated with an increased risk of cancer. Epidemiological data in Japan demonstrate that diabetes is associated with increased risk for total cancers and site-specific cancers at colorectum, liver, and pancreas. Insulin resistance with subsequent hyperinsulinemia is the most frequently proposed hypothesis to explain this link. In addition, several facets of lifestyle including obesity, smoking, and lack of exercise, and treatment for diabetes may also affect the risk of cancer. In light of the exploding global epidemic of diabetes, even a modest increase in the cancer risk will translate into a substantial socioeconomic burden, which led to a joint committee being formed, enlisting experts from the Japan Diabetes Society and the Japanese Cancer Association to address this issue. The current insights underscore the need for clinical attention and better-designed studies of the complex interactions between diabetes and cancer.

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Background: Despite emerging national interest in training family physicians to improve access to medical services in health care shortage areas, empirical data on inpatient resident learning experiences in rural community settings has been lacking. This research sought to understand the breadth of diagnoses, patient demographics, and comorbidities experienced by family medicine residents while training in a newly launched family medicine training program in a rural area in Shizuoka prefecture.
Methods: The design employed secondary dataset analysis from a 260-bed hospital in rural Shizuoka. Using the hospital administrative database, a dataset was developed of all patient admissions from 9/1/2011 to 8/31/2012 including the Diagnosis Procedure Combination (DPC) code, patient age and gender, and the physician of record. The main outcome measures were frequency and distribution of diagnostic groups and diagnoses in family medicine residents. Secondary outcomes included three or more comorbidities and hospital readmissions.
Results: There were 3474 admissions (males/females 1867/1607) and 8 residents who were the physician of record for 220 cases (mean 27.5 cases/resident, range 10–56), about 6.3% of the total hospital admissions during this timeframe. The mean age of resident cases was 71 years of age (range 0–101 years). Distribution by diagnostic groups included: gastrointestinal (61), pulmonary (41), cardiovascular (28), and neurological (25). The most common diagnoses included: pneumonia (34), congestive heart failure (21), stroke (16), intestinal obstruction (15), and urinary tract infection (10). Seventy-seven percent (170/220) of cases had one or more comorbidities and 36% of cases had three or more comorbidities which were significantly less than hospital as a whole (46% of cases with three or more comorbidities).
Conclusions: The community hospital setting provides an excellent training environment for family medicine residents because the setting and the care experienced reflects content of what the training program aspires for the residents to provide in the future. Community hospital training serves policy maker’s agenda for developing a systematic primary care training system appropriate for health care shortage area community-based care.

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Background: A lack of ambulatory care training has been reported in the literature despite the fact that many health and medical issues are handled in the ambulatory care setting. An appropriate curriculum for ambulatory care training is also yet to be established in Japan.
Objective: We aimed at surveying competence in ambulatory care skills through a self-administered questionnaire and satisfaction toward the ambulatory care training to fill the knowledge gap between ideal training and current training in the ambulatory setting.
Method: We recruited all of the first year postgraduate trainees (N = 45) who rotated to the ambulatory care training program provided by the Department of General Medicine at the National Defense Medical College Hospital. Participants were asked to evaluate six skills in ambulatory care (interview, physical exam, diagnostic reasoning, therapeutic reasoning, counseling, and overall skill) and satisfaction toward the training.
Results: Statistically speaking, all skills significantly improved after three months of training while some of the skills (diagnostic and therapeutic reasoning and counseling skills) improved less than the others.Satisfaction tended to be higher in the group who experienced a high number of cases.
Conclusions: Ambulatory care training in a university hospital increases the ambulatory care skills by self-administered questionnaire. A higher number of cases, supervised by faculty physicians, appears to be correlated with a higher satisfaction level to the training.

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Object: Clarify the commonalities and differences in perspective toward physicians and medical care between patients and physicians.
Methods: 9 items questionnaires, created in a previous study regarding physicians and medical care, were sent to primary care physicians to compare the perspective of physician and medical care by patients which became clear in previous study.
Results: Among the 408 questionnaires sent, 301 responses were received (response rate 73.8%). Physicians thought that the profession of physicians is a pressing job and hence physicians can be trusted similar to tendency of patients in past research. As for the state of the profession of physicians, the tendency among physicians to consider the profession as that of service industry not as a scared profession was indicated.
Discussion: For both patients and physicians, it was indicated that common awareness exits in them regarding the labor and behavior of physicians. Although there was an awareness that there is a tendency for physicians to consider the profession as part of service industry and for patients to consider being a physician as a sacred profession, it was indicated that the viewpoint toward physicians was not uniform for both groups.
Conclusions: It can be thought that it is important to understand that there are differences in sentiment among physicians and patients regarding physicians and medical care for building a better relationship between patients and physicians.

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Advances in interferon (IFN)-based therapy for chronic hepatitis C have led to a high rate of sustained virological response (SVR), which means viral clearance. However, some cases have been reported to develop hepatocellular carcinoma (HCC) over 10 years after achieving the SVR. Here, we report two patients who developed HCC 20 years after SVR with IFN therapy. Both of the patients were male and achieved SVR at the age of 46 years and 61 years, respectively. These cases suggest the need for long-term follow-up in patients with chronic hepatitis C even if SVR is achieved.

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Chikungunya virus infection (CVI) typically manifests via a “two-phase” presentation: most patients develop acute fever and some patients subsequently develop arthralgia that can persist for years. Many patients visit clinics during the second phase, for relief of the arthralgia, but not during the acute febrile phase. We report a 25-year-old Japanese man infected with CVI in Jamaica who presented with chronic disabling peripheral-dominant symmetric polyarthralgia without fever, which affected the neck, knees, elbows, wrists, and fingers. Given the recent emergence of dengue fever in Japan, clinicians should consider CVI as a differential diagnosis of dengue fever when examining travelers complaining of persistent arthralgia, regardless of their countries of origin.

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Crusted or Norwegian scabies is characterized by erythematous patches with diffuse hyperkeratotic plaques over palmar and plantar regions. It is commonly seen in patients with immunocompromised states or in the elderly who are bed-ridden. We report a case of crusted scabies that clinically mimicked bullous pemphigoid. Steroid therapy as treatment of presumptive bullous pemphigoid led to a worsening of crusted scabies and its subsequent outbreak involving patients nearby and staff in our hospital.

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