This review addresses the prevalence of glaucoma in Japan, where it affects around 5% for those aged 40 years and over, a large proportion of whom are not aware of their disorder and thus remain untreated. Glaucoma is one of the known causes of “health-related traffic accidents,” and it is important to screen drivers with possible glaucoma who are not aware of their visual field abnormalities. We propose that CLOCK CHART^® be employed as a tool that even non-ophthalmologists could use to screen the visual fields of drivers, leading to possible diagnosis and treatment of glaucoma. This will promote safe driving.

Objective To elucidate the impact of activity restrictions associated with the pandemic on diabetes management.

Materials This study evaluated all patients visiting our facility who were determined to have diabetes during the observation periods. To determine the impacts of the emergency declared on April 7, 2020, we examined 345, 1109, and 752 patients whose hemoglobin A1c (HbA1c) levels were measured in March and April, May, or in June, respectively. Patients were compared to data from other subjects evaluated in 2019 under the same conditions. The 2019 subjects included 469, 1315, and 783 patients whose HbA1c levels were measured in March and April, May, or June, respectively.

Methods Comparison of the HbA1c levels in April, May, and June minus the HbA1c levels in March of both 2019 and 2020 were used to assess the impact of pandemic-related activity restrictions on diabetes management. HbA1c levels greater than 0 were defined as patients who “worsened”, while differences in HbA1c levels ≤0 were defined as patients who conditions were “not worsened”. Comparisons of the deterioration/improvement rates for the HbA1c levels in 2019 and 2020 were then performed.

Results Compared to 2019, the number of patients exhibiting a worsened diabetes management increased from March to April 2020 [122 (26.0%) vs. 137 (39.7%), p<0.01], while the number of patients with worsened diabetes management decreased from March to June 2020 [305 (39.0%) vs. 240 (31.9%), p<0.01].

Conclusions When compared to 2019, there was no sustained increase in patients with worsening diabetes management during the 2020 observation period.

Objective To identify pulmonary thromboembolism (PTE) using the thrombus attenuation value on unenhanced computed tomography (CT).

Design Single-center retrospective study (January 2015-Marcg 2020).

Methods Patients who underwent both unenhanced and enhanced CT for suspected PTE were enrolled. Patients with a hyperdense lumen on unenhanced CT and thrombi in the peripheral pulmonary artery (PA) were excluded. Patients were classified into two groups: thrombi (thrombi detected in PA by enhanced CT) and non-thrombi (attenuations of the main PA evaluated as thrombi). Mean CT attenuation values of the thrombi, main PA, and pulmonary trunk (blood pool) were measured. The attenuation values of the thrombus (T) and the thrombus to blood-pool (T/P), thrombus to hemoglobin (T/Hb), and thrombus to hematocrit (T/Ht) ratios were evaluated. The cut-off attenuation value of the thrombus was calculated by a receiver operating characteristic curve and its accuracy in detecting PTE was determined.

Results Of the 260 patients enrolled, 40 were included, of whom 24 had confirmed PTE. The mean T was 27.25 Hounsfield units(HU) and 36.66HU (p<0.001), and the T/P ratio was 0.74 and 0.99 (p=0.004) in the PTE and non-PTE groups, respectively. The thrombus cut-off value for PTE diagnosis was 30.85 HU. The sensitivity and specificity were 79. 9% and 87.5%.

Conclusions Measuring and evaluating the attenuation value for the central PA and T/P ratio on unenhanced CT improves the diagnostic ability of central PTE in patients suspected to have PTE but cannot tolerate contrast medium.

In patients with type 2 diabetes, proteinuria is generally considered to be a major factor in the progression to end-stage kidney disease (ESKD) and cardiovascular events. The exacerbation of proteinuria is mainly associated with high blood glucose, hypertension and dyslipidemia. This study is a single-center retrospective cohort study using a large number of patients with type 2 diabetes to investigate the correlation among proteinuria, blood glucose, blood pressure and renal function based on the standard treatment. Patients with type 2 diabetes (n=739) were divided into three groups according to their HbA1c levels, such as HbA1c < 7% ; Group L, 7%≤ HbA1c < 8% ; Group M, and 8% ≤ HbA1c; Group H. A multiple logistic regression model was used to identify the risk associated with those parameters in type 2 diabetes. There was a significant relationship between the increase of proteinuria and the unsatisfactory control of blood pressure (systolic blood pressure of more than 130 mmHg) in all patients with type 2 diabetes. Under the satisfactory control of blood glucose (HbA1c < 7% ; Group L), the annual change of proteinuria (ΔuACR/year) and renal function (ΔeGFR/year), in the patients with an sBP of less than 130mmHg with or without renin-angiotensin system inhibitor (RASI) were milder than in those patients with an sBP of more than 130 mmHg. Therefore, simultaneous strict control of HbA1c and blood pressure with or without renin-angiotensin system inhibitor (RASI) administration are essential in for maintaining renal function in patients with type 2 diabetes.

Objective A hospital clerk developed whooping cough and its infectious condition throughout the work place was investigated to clarify the spread of pertussis infection using highly sensitive Loop-mediated isothermal amplification (LAMP).

Materials and Methods LAMP for pertussis was performed against all employees in the personnel division of general hospital, then respiratory symptoms were noted in 12 (57%) of 21 clerical employees.

Results LAMP for pertussis was positive in 7 (58.3%) of the 12 employees. The judgment was indeterminate in the first test in one employee, but it became negative later. An asymptomatic LAMP-negative employee subsequently developed cough and turned to positive in the second LAMP test 20 days after the first test. Cough was not noted even in positive cases in the third LAMP test 35 days after second test, or thereafter, and conversion to LAMP-negative took 76 days on average. No outbreak of whooping cough occurred in any of the other departments in the hospital throughout the course, and no transmission of infection occurred.LAMP methods were useful for grasp of the situation of asymptomatic persons as well as symptomatic patients.

Conclusions It is difficult to diagnose whooping cough based on cough symptoms alone. The LAMP test was useful for understanding the spread of pertussis infection. To prevent outbreak of whooping cough in adults, periodic administration of DTap vaccine is desired.

Objectives The purpose of this study is to examine the relationship between psychological safety, job resources, and work engagement among fitness club employees.

Materials and Methods The survey included 427 fitness club employees (147 men and 280 women) in Japan. A web-based questionnaire survey was used in the study. The survey period was from August to September 2020. The team psychological safety scale, the Utrecht work engagement scale (short version with 9 items), and items related to work resources in the Brief Job Stress Questionnaire were used in the study.

Results Correlation and multiple regression analyses revealed that work engagement was significantly positively associated with employees’ job satisfaction and rewarding job, job aptitude, and psychological safety.

Conclusions Results suggest that increasing job satisfaction and rewarding job is important for fitness club employees and an increase in employees’ psychological safety enhances their work engagement. Furthermore, the study indicated that psychological safety is mediated by work engagement and the support provided by colleagues and supervisors.

Objective Through a peer-assisted learning conference in pediatric bedside learning (BSL), we investigated how providing lectures to and receiving lectures from colleagues affects learning in medical students.

Design Ninety medical students were asked to participate in a pediatric BSL course at Juntendo University.

Methods A “medical student peer-assisted learning conference” was held, and medical students were given the opportunity to present lectures. One student played the role of a lecturer, and the other students acted as students. All the students took turns playing the role of the lecturer. A questionnaire survey was conducted on the participants to allow them to reflect on their own presentations.

Results Many students who played lecturers provided lively presentations. For them, listening to the excellent presentations of their colleagues was a stimulus for learning. Altogether, 25.6% students realized that their own lectures should be improved, and this awareness may have made them more interested in their colleagues’ lectures. Many students had positive opinions about the choice of themes. The Department of Pediatrics, with its wide variety of fields, also seemed to contribute to the students’ active choice of themes.

Conclusions The conference was very effective as an educational opportunity that not only piqued the interest of students but also provided a good opportunity for them to reflect on and recognize deficiencies in their own presentations. However, this study did not obtain sufficient evidence that demonstrated a continuous increase in the motivation to learn among students. Continuously increasing such opportunities is essential in medical education.