The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 55, Issue 4
Displaying 1-4 of 4 articles from this issue
COMMEMORATIVE LECTURE
REVIEW
  • 3. Reforming medical education to change healthcare practice in Japan
    R Harsha Rao
    2006 Volume 55 Issue 4 Pages 141-148
    Published: 2006
    Released on J-STAGE: April 09, 2007
    JOURNAL FREE ACCESS
    The enviable health status of Japanese citizens is one of the reasons for obdurate opposition to reform of Japanese healthcare practice. Change is widely believed to be unnecessary for a system that is both successful and profitably exploited to universal benefit. However, societal trends are conspiring to make current healthcare practice patterns and expenditures unsustainable in the future. In particular, Japan has undergone an unprecedented demographic shift from a society of young (and healthy) workers to one of older retirees with a higher prevalence of obesity. As a result, an equally dramatic future increase can be anticipated in the prevalence of age- and obesity-related disorders. The traditional paradigm of Japanese healthcare is not conducive to the restraint necessary for preserving its future viability, given these trends. Japanese healthcare does not reward clinical problem-solving skills, values specialists over generalists, places a heavy reliance on expensive technology, does not require interventions to be evidence-based, and provides no incentives to improve quality or efficiency. If this paradigm endures, Japanese healthcare faces the real prospect of bankruptcy. The failure of Japanese medical education to inculcate clinical skills and stress evidence-based medical practice lies at the heart of the impending crisis in healthcare. To solve the crisis, medical education in Japan must change its focus to training and developing a cadre of physicians with the broad-based expertise and clinical skills to make evidence-based decisions in a medically and fiscally responsible manner. The future health of the system and of the Japanese people depends on it.
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  • Roger W. Byard
    2006 Volume 55 Issue 4 Pages 149-152
    Published: 2006
    Released on J-STAGE: April 09, 2007
    JOURNAL FREE ACCESS
    The pathological examination and assessment of inflicted head injuries in infants and young children are often complicated by the subtle nature of the injuries, the non-specificity of lesions, and the lack of experimental data that can be used to clarify possible forces and mechanisms of damage. Opinions often have to be given on a number of issues, with a paucity of information in the literature and lack of specific individual experience. The following paper reviews some of the problems that are currently found in the medicolegal evaluation of infants and young children with inflicted craniocerebral trauma and issues that consequently arise in court.
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ORIGINAL ARTICLE
  • Harumasa Takano, Motoichiro Kato, Ataru Inagaki, Koichiro Watanabe, Ha ...
    2006 Volume 55 Issue 4 Pages 153-160
    Published: 2006
    Released on J-STAGE: April 09, 2007
    JOURNAL FREE ACCESS
    Although electroconvulsive therapy (ECT) has been employed for treating depression for more than 60 years, its mechanisms of action are yet unknown. To clarify the ECT effects on brain function, we examined cerebral blood flow (CBF) using single photon emission computed tomography at 3 time points-few days before an ECT course (Pre) and approximately 5 days (Post 1) and 1 month (Post 2) after the last ECT session. Eight depressive patients completed the study. In all the patients, the depressive symptoms improved after the ECT course, and major cognitive impairment was not observed at any time point. At Pre, the regional CBF (rCBF) in the widespread areas in the frontal lobe and limbic regions including cingulate cortex and parahippocampal gyrus was lower in the patients than in the normal controls. At Post 1 and Post 2, the rCBF in the frontal and limbic regions continued to be lower in the patients than in the controls although the successive recovery of decreased rCBF in the frontal region was observed. Regarding the time course among the patients, the rCBF in the right medial frontal region significantly increased (toward normal) at Post 2, not at Post 1. These findings suggest that depressive patients have decreased CBF in the frontal and limbic regions, and the medial frontal region plays a crucial role in ECT and recovery from depression. Further, patients who have undergone ECT treatment for depression should be carefully observed because brain functions continue to change even after a successful ECT course.
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