Upper gastrointestinal endoscopy is a procedure that puts the patient under great stress as the unique bitterness of xylocaine used as the pharyngeal anesthetic enhances discomfort and pain. To alleviate this problem, we added substances to impart different flavors and scents to this pharyngeal anesthetic. The study included 500 patients who had undergone upper gastrointestinal endoscopy since January 2016. We added 2mL of scented simple syrup to 5mL of viscose xylocaine and froze the mixture. To experience a variety of tastes, patients chose from five types of the pharyngeal anesthetic mixture for the test: a fragrance-free mixture and four mixtures with general scents, namely strawberry, melon, coffee, and orange; subsequently, a questionnaire survey was distributed among the participants. As per the questionnaire responses, the flavors selected in descending order of preference were coffee, strawberry, orange, and melon. The effect on mood was improved in 90% of patients, 70% of patients tasted reduced bitterness, and 30% of patients felt that the mixture had a pleasant taste. The coffee-scented mixture received the highest evaluation, and 99% of patients expressed their desire for the scented frozen anesthesia for the next time. It is thought that the reason why the effect on mood was improved in 90% of subjects was the presence of a scent and flavor in the anesthetic as well as the availability of the option for them to actively select one specific mixture from several as per their preference. Furthermore, it is possible that selecting a mixture from a list of mixtures by consulting with a nurse led to relaxation of the patients. Because 99% of patients wished for the same mixture for the next time, we believe that the utilization of scented and flavored anesthetics is worth pursuing in the future. The coffee mixture received the most favorable reviews, which suggested that the scent of coffee, which is bitter by nature, reduced the bitterness of the anesthetic. We hope to devise more mixtures of different flavors and scents and investigate whether powdered green tea has a similar effect, with the aim of reducing stress by providing more acceptable pharyngeal anesthetics.
Background Measurement method of serological anti-H. pylori antibody test was changed from Enzyme immune assay (EIA) to Latex agglutination turbidity (LA) recently. We evaluated the problem related to the change of measurement method in follow-up patients. Subjects and Methods 1,345 patients who were conducted serological H. pylori test using LA method from Sept.2015 to March 2016. We compared diagnosis of H. pylori infection using H. pylori antibody between LA method and EIA method in the same patients. The patients were conducted serological H. pylori test using EIA method previously. The cut-off titer of serological H. pylori test was 10 U/mL in LA and EIA. We also checked H. pylori infection using Endoscopic and X-ray finding or past history of H. pylori eradication. Result The coincidence rate of H. pylori infection between LA method and EIA method was 92.7%. But, the coincidence rate was increased 95.3% excluding patients who were successfully eradicated after the previous EIA positive. But, we checked EIA re-examination in thirteen LA positive patients who had normal finding in gastroscopy and no history of eradication. All patients were negative. Conclusion It is important that diagnosis of H. pylori infection should be conducted using not only anti-H. pylori antibody but also other H. pylori examination (ex. urea breath test),endoscopic finding and past history of H. pylori eradication.
There has been increased demand for team medicine through collaboration of physicians and non-physician healthcare professionals (non-physicians) to promote (1) higher quality of medical care, (2) reduced burden on physicians, (3) improved medical safety, and (4) reduced medical expenses. The Ministry of Health, Labor and Welfare has adopted various renewal plans designating the specific roles of non-physicians that can be carried out under the current healthcare system. It can be said that the heath evaluation is a common area for conducting team medicine as interprofessional collaboration. In primary preventive health evaluations (disease prevention, enlightenment of health, health promotion), especially for examinees with ‘mibyou’, guidance in dietary education (nutritional guidance), physical education (exercise therapy), and intellectual education (motivation, behavior change, stress management, sleep guidance) is of great importance, and this will become a crucial role for non-physicians. Furthermore, in examinees with metabolic syndrome, providing effective suggestions for prescription drugs and recognizing its side effects can also be expected to become the role of pharmacists and nurses. In particular, clinical reasoning (medical interview and physical assessment) may be required in some situations to recognize side effects in those who undergo drug therapy. However, despite such attempts to expand the current role of non-physicians, Article 17 of the Medical Practitioners’ Act, which limits medical practice by non-physicians, has raised various differences in opinion regarding the extent to which non-physicians can deliver such explanations, guidance and suggest prescription drugs; therefore, a consensus has yet to be obtained. Additionally, efforts must be made to obtain sufficient understanding and consent from examinees. Future reforms to the educational program (graduation curriculum, national licensing exam, post-graduate training and lifelong education system) to help non-physicians acquire more sophisticated knowledge, skills and attitudes, in addition to changes in legislation, are essential in promoting role expansion of non-physicians in health evaluations.
In order to carry out high-quality complete medical checkups, the accuracy of the examination technique and diagnosis is essential. Whenever possible, it is also necessary to conduct interviews regarding the results on the day of the medical examination, in addition to providing precise guidance that leads to improvement of the health condition. However, it is difficult to explain all items in detail within the limited time available during the interview with doctors following a complete medical checkup. Multi-occupational cooperation is easier in the medical examination department than the medical treatment department. Our health examination center has strived to carry out medical examinations with high satisfaction of examinees through cooperation with co-medical staff. For some tests, such as tests for body composition, blood pressure and pulse wave, and bone density, whenever possible, an examiner such as a public health nurse explains the results immediately following the examination. In addition, during interviews with doctors regarding the results, an explanation is given with all images provided for review, for which the selection of key images by radiologists and ultrasonographers is useful. In making these efforts, we conducted a questionnaire survey to confirm the intentions of examinees of the medical examination. Almost 90% of all examinees were positive when it comes to occupations other than doctors providing an explanation regarding the results, regardless of age and gender.
Changes in the social environment accompanying the declining birthrate and aging birthrate in Japan are inevitably coming to bear a burden on health care workers. Such as home medical care and nursing care, the need of strengthening of the health care and medical support is growing steadily. Under such circumstances, I believe that the role of preventive medicine and medical examination is momentous. On the other hand, the exhaustion of health care workers due to an excessive work environment is serious. How to allocate limited medical resources is an important issue, I feel the necessity of multi-occupation collaboration and of expansion of co-workers authority of work. We were involved in the creation of a “Comprehensive Counseling and Support Center” that is a medical support department that has integrated many professions, at Tokyo Medical University Hospital, and I am involved in studying on the dilemma related to work at the “Clinical Ethics Study Group”. Based on these experiences, I think that there is a problem for individuals with professional, educational and personal backgrounds to work together. On the other hand, I think that, considering the current state of our facilities, at present medical examination facilities, rather than expanding the scope of authority, each department should demonstrate their abilities and aims for progress. However, modern medical technology, artificial-intelligence and information-technology are progressing at an accelerating pace. I believe that, considering the inevitable change in the medical examination system accompanying the progressing, it is necessary to draw a future image of us, such as expansion of the scope of authority.
The Japan Revitalisation Strategy announced in June 2013 discusses the future roles of insurance-covered pharmacies in establishing new systems to advance disease prevention and health management. It emphasizes the necessity of promoting the effective use of insurance-covered pharmacies and pharmacists as a foundation for the community-based provision of health information, advice, and consultation, with the goal of expanding a healthy lifespan nationwide. Based on this and toward the realization of a society that allows the majority of elderly persons to receive consultation in familiar medical institutions or home medical/care services within their communities, the Japanese government launched the Community-based Integrated Care System. It also newly established the Health Support Pharmacy System, and started its operation, aiming at the integrated provision of housing, medical, care, preventive, and life support services. During this period, the importance of family pharmacists and pharmacies was also re-evaluated, for possible revision of the medical fee system in 2016. In the Community-based Integrated Care System, health support and family pharmacies are expected to serve as bases for multi-professional collaboration in their communities, and contribute to primary and secondary disease prevention through health evaluation and promotion. Pharmacists may be able to use their occupational skills particularly effectively in the following areas: 1) improving lifestyles through nutritional guidance and exercise therapy, 2) improving medication adherence, involving behavioral change, 3) monitoring medication-related adverse events, and 4) avoiding duplicate medication orders and reducing unused drugs. On the other hand, there has been criticism about pharmacists, as the integrated collection of medication-related information and the provision of services based on it by them, represented by pharmacological management/guidance, are not necessarily sufficient, making patient-centered role-sharing between medical and pharmacy services difficult. Such criticism indicates pharmacists’ insufficient knowledge and technical skills. Therefore, as a challenge of pharmacist education based on the new 6-year curriculum, it may be necessary to actively provide clinical education, focusing on the contribution to health evaluation and promotion through multi-professional collaboration.
In recent years, importance of multi-disciplinary cooperation advocated by the government has been increasing not only for improving the quality and safety of medical care but also for smooth implementation of sophisticated, complicated work. Items related to nutrition have been formulated in policies related to health promotion such as Health Japan 21 (the second term), and nutritionists and registered dietitians must actively make approaches. Of course, in addition to treatment-related nutrition management, nutritional management in maintaining and promoting health is also considered important in disease prevention. In 2006, Tokai University Tokyo Hospital launched an anti-aging health check-up system in addition to general health check-ups, which detects aging related signs using various tests, then gives medical guidance to combat abnormalities associated with aging. In anti-aging health check-ups, registered dietitians actively provide nutritional support for the recipients. After undergoing a check-up, an Anti-Aging Meal that uses many ingredients with antioxidative effects planned by registered dietitians is provided for lunch. Guidance is also given regarding the relationship between the condition of the recipient’s health and nutrition, based on his/her answers to a medical questionnaire survey and test results. As nutritional advice, advice based on a hearing survey using a food frequency questionnaire (FFQg) and answers to questions regarding meals and supplements from the recipient are provided. In such a way, creative approaches are being made so that we can make more progress in anti-aging, by enhancing awareness through taste and sight, rather than by simply undergoing tests. To extend healthy life expectancy and realize “successful anti-aging,” it is indispensable to effectively use meals that are a central aspect of one’s life. Nutritional support is possible from a variety of angles through specialist teams and industry-academia-government cooperation. In the future, effective methods for each health check-up recipient will be examined from various angles regarding policies for nutritional support, and future ideals for registered dietitians.
The name of this society at the time of its founding in 1973 was translated into English as “Multiphasic Health Testing and Services” (MHTS). As is clear from the name, the comprehensive medical examination business is a multiphasic service. The necessity of a team medicine in order to get a diversified and comprehensive understanding of various health levels of consumers, and provide effective support to each individual for improving health was recognized from the start. Time has passed and today, 45 years later, peoples lifestyles have diversified and we are now in an era of intense change, with globalization of social structures and working environments. Within this, the risk factors that inhibit health are also becoming increasingly diverse and complex. In order to overcome this era of increased risks, a comprehensive medical examination cannot be carried out by a doctor’s specialized treatments. It is necessary to operate a system with collaboration and organic mutual trust with the addition of professionals other than doctors. Within this, the need for various job categories and cooperative ways of effective duties expansion are sought. Regarding the roles and tasks of clinical laboratory technicians in Health Evaluation and Promotion, the author even more positively presents the effective use of clinical examination data, and we believe that the most important efforts are those on the side of those who use medical examinations, such as efforts to link behavioral changes that can contribute to improving health promotion to businesses local communities. In modern times, the emphasis and general role of the comprehensive medical examination are shifting from conventional secondary preventive health examinations to the type of health examinations that emphasize primary preventive measures. In order to welcome this new stage in comprehensive medical examinations, it is even more desirable to examine the use of clinical examinations with an awareness of “Mibyou (cure pre-illness condition rather than treating illness after it appears).” Using the “comprehensive medical examination supervisor” and “business administrator” accreditation system which is a feature of this society, there may be many ways to contribute to modern preventive medicine by taking up the mission and challenge of a new clinical laboratory technician. Because we are clinical examination professionals we can, and we want to act as a standard for valuable laboratory medical support based on the characteristics of examinations and accuracy and significance. We hope for examination knowledge and skills that can accumulate evidence such as new biomarkers and genome data to contribute to prediction before the onset of illness, as well as professional occupational training that has individuality.
The main theme of the 46th annual meeting of Japan Society of Health Evaluation and Promotion is application of “Comprehensive risk management chart for the prevention of cerebro-and cardiovascular diseases” to health evaluation and promotion. Upstream of the cerebro- and cardiovascular disease is lifestyle related diseases such as diabetes, dyslipidemia, hypertension and so on. The most upstream of those diseases is disturbance of lifestyle such as overeating, low physical activity and so on. What happens next is weight gain and obesity, especially accumulation of visceral fat, furthermore obesity disease and metabolic syndrome, eventually heart disease occurs. Next, obesity, accumulation of visceral fat, further obesity disease and Metabolic syndrome, and ultimately cerebro- and cardiovascular disease occurs. The reason why “the specific health examination and guidance” succeeded is not because instruction of weight reduction uniformly to obese people, but because selection of abdominal obese persons and intervention focusing on visceral fat merging diabetes, dyslipidemia, hypertension, etc. In preventive medicine such as health evaluation and promotion, and Ningen-dock, the subjects are persons mainly healthy or with mild abnormal findings, the object is maintaining or recovering their health. Therefore, prevention of obesity and metabolic syndrome is important to prevent the development of cerebro- and cardiovascular disease by suppressing the onset of diabetes, hypertension, dyslipidemia, etc. Prevention and improvement of obesity, obesity disease, and metabolic syndrome are important issues in preventive medicine for prevention of the onset of cerebro- and cardiovascular disease.