This Juntendo Medical Journal has been published under the Japanese name Juntendo Igaku (順天堂医学) from 1964 to 2012.However, the origin of Juntendo Medical Journal dates back to the oldest medical journal in Japan, Juntendo Iji Zasshi (順天堂醫事雑誌), which had been published between 1875 and 1877 (total of 8 issues). Between 1885 and 1886, Juntendo issued a limited release of a research journal titled Houkoku [Juntendo Iji Kenkyukai] (報告) for a total of 39 issues. In 1887, Juntendo Iji Kenkyukai Houkoku (順天堂醫事研究曾報告) was published with the government's approval and we used to regard this as the first issue of Juntendo Medical Journal. Since then, Juntendo Medical Journal has undergone a series of name changes : Juntendo Iji Kenkyukai Zasshi (順天堂醫事研究会雑誌), Juntendo Igaku Zasshi (順天堂医学雑誌), and Juntendo Igaku (順天堂医学). Now in commemoration of the 175^th anniversary of Juntendo University, starting with the first volume issued in 2013 (Volume 59 Number 1), we return to Juntendo Medical Journal's original Japanese title in 1875-Juntendo Iji Zasshi (順天堂醫事雑誌). We also reconsidered the numbering of the journal and set the first issue in 1875 as the initial publication of Juntendo Medical Journal. The Volume-Number counting system and the English name Juntendo Medical Journal started in 1955 from the January 10 issue. Although this is not our intension, we will retain the Volume-Number counting system to avoid confusion. However, Volume 59 Number 1 will be the 882 ^nd issue, reflecting the sum of all issues to date : 8 issues of Juntendo Iji Zasshi (順天堂醫事雑誌), 39 issues of Houkoku [Juntendo Iji Kenkyukai] (報告) (47 issues combined), and 834 issues from Juntendo IjiKenkyukai Houkoku (順天堂醫事研究曾報告) in 1885 to the present.

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Objective : In recent times, hospitals have adapted to changing trends in the service industry. Being flexible has proven necessary in order to provide excellent patient care and meet productivity and efficiency goals. Juntendo University Urayasu Hospital routinely conducts surveys to obtain voluntary patient responses on treatment provided and patient satisfaction. The surveys encourage patients to share their opinions, which are crucial to improving the quality of medical service. Methods : 1) We analyzed the data from patient satisfaction surveys collected from the outpatients of Urayasu Hospital over three years. 2) We further analyzed the voluntary opinions collected at Urayasu Hospital over about four years. The opinions forms have five fields : operation system, facilities, reception, medical treatment, and others. Opinions were also compared based on survey month and year 3) We also examined the effects of interventions resulting from complaints that were reported in the surveys. Measurement and Result : The number of patient satisfaction surveys returned showed almost no chanfes year to year. The voluntary opinions submitted increased over the four years. The surveys results mainly showed complaints. A trend was noted in that the complaints about reception and medical treatment decreased as Urayasu Hospital reacted by providing more employee orientation. On the other hand, the number of complains about the hospital's operating system, facilities and the start of the fiscal year increased over the years that the survey was taken. These points had not been addressed with intervention. Conclusions : The survey results showed that obtaining voluntary opinions from patients is crucial to improving hospital medical services, and the items in the patient satisfaction surveys were found to be effective for monitoring the processes and systems of medical service. These findings demonstrated that hospitals should take a flexible approach to administration that allows evolution in patients' attitudes and expectations. We found that surveys are an effective tool for monitoring the results of chanfes in the administration of medical services.

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Objective: Recent studies have demonstrated the effectiveness of phosphodiesterase type 5 (PDE5) inhibitor, a known drug for erectile dysfunction, for treating lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). Smooth muscle relaxation mediated by the nitric oxide (NO) pathway has been considered to improve urinary symptoms. Hence, we examined whether the administration of L-arginine as a precursor of NO could improve urinary conditions via the NO pathway. We also studied whether the combination of tamsulosin hydrochloride (tamsulosin), a known therapeutic drug for prostatic hyperplasia, and L-arginine administered as therapeutic agents can provide synergistic effects on BPH. Materials and Methods: The study subjects comprised 21 patients who visited our hospital with the complaint of LUTS diagnosed as BPH, for which the patients received L-arginine at 1,200 mg/day. First, the changes in urinary symptoms associated with the L-arginine administration were evaluated. After a washout period, 0.1-mg/day tamsulosin was administered. Next, a combination of 0.1-mg/day tamsulosin and 1,200-mg/day L-arginine was administered to determine whether the combination therapy has a synergistic effect against LUTS. International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax), and residual urine volume were measured before and after the administration of each dose of L-arginine. Furthermore, to determine the role of L-arginine in LUTS, we examined the changes in serum cyclic guanosine monophosphate (cGMP) levels associated with the administration of L-arginine. Results: The mean values at baseline versus those after the administration of L-arginine alone were as follows: IPSS, 17.8±5.5 vs. 15.8±7.0;QOL score, 4.9±1.2 vs. 4.2±1.7;Qmax, 13.9±6.9 ml/s vs. 15.6±6.6 ml/s;and residual urine volume, 74.5 ±78.6 ml vs. 37.1±61.2 ml, respectively. Those of tamsulosin versus the combination therapy were as follows: IPSS score, 10.9±6.1 vs. 11.3±6.4;QOL score, 4.1±2.0 vs. 3.6±1.9;Qmax, 17.5±7.7 ml/s vs. 17.8±10.0 ml/s;and residual urine volume, 43.8±51.6 ml vs. 35.5±60.9 ml, respectively. L-Arginine alone significantly improved the IPSS for “weak stream” (p=0.027), QOL score (p=0.047), and residual urine volume (p=0.003). No significant difference was observed between tamsulosin therapy and the combination therapy. However, the differences between the serum cGMP levels before and those after L-arginine administration indicated significant increases ranging from 2.8±0.9 to 3.4±0.9 pmol/ml (p=0.011). Regarding the correlation of the IPSS with the serum cGMP levels, significant differences were observed in the “Intermittency” (r=-0.464, p=0.034) and “Irritable” IPSS subscores (r=-0.441, p=0.045). Conclusions: We suggest that L-arginine alone might mitigate BPH symptoms.

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Objective: When unexpected situations such as major disasters arise, operations in medical institutions cannot be interrupted, especially in ICUs. This study was designed to analyze the impact of interruptions of ICU operations by applying a Business Impact Analysis (BIA). Methods: The components of operations were examined employing a BIA questionnaire regarding all nursing operations. These components included the priority of operations as well as the time, number of staff, and utilities required for each. On the basis of priority, operations were classified into four ranks (S, A, B, and C). Next, nursing operations were monitored for one month, and the lengths of time required for specific operations were investigated. The total time per month required for each operation was calculated by multiplying the time required by the frequency of each operation. Results: Nursing operations had 65 components. The higher-level operations required more highly skilled nurses and more utilities. The S-ranked operations required 25% of the total time, and the A-ranked operations required 47%. Conclusions: Higher-priority tasks take a longer time, higher skills, and substantial resources. To maintain ICU operations, it is necessary to manage human resources and resource supplies. BIA should also be performed for other sections. It is necessary to establish a system that can be deployed with adequate staffing.

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Twenty-one patients with cirrhosis and ascites were studied to investigate the treatment of refractory ascites. Eleven patients had responsive ascites and six had refractory ascites. Despite medical treatment, including administration of diuretics, ascites became uncontrollable in five patients, and these patients underwent placement of a Denver peritoneovenous shunt. Comparison of pre and postoperative values showed significant weight decrease and reduced abdominal circumference. The Denver shunt was of great value in the management of intractable ascites with resultant improvement of quality of life. These results suggest that the Denver shunt is a useful measure for relieving ascites.

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Juntendo University holds faculty development workshops every year to improve faculty members' skills at writing examination questions. The 20th annual medical education mini-workshop was held on April 18, 2012. In this workshop, we learned the fundamentals of proper examination design through editing questions for CBT. At the end, a questionnaire survey of the faculty members who participated in this workshop was conducted, and it showed a lack of knowledge about the mini-workshop and CBT.

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