A medical team consist of various professionals―physicians, nurses, clinical laboratory technicians, physiotherapists, occupational therapists, clinical engineers, radiological technicians, pharmacists, caregivers, and social welfare workers. Furthermore, patients and their families have the right to participate in determining the patient’s therapeutic process. For medical professionals with various values to function as a team that provides therapy to a single patient, they must be aware of the commonalities and discrepancies between their perspectives and those of others. They must seek to make the best decision for the patient from a panoramic perspective. When teaching this panoramic perspective, the concept known in psychology as metacognition might be effective. Therefore, this study discusses the four-box method for decision making in medical ethics from the viewpoint of metacognition and proposes the effect of the metacognition education in an individual level and a group level, and the effect of the metacognition education in expertise.
[Aim] To assess differences between outpatients and inpatients with schizophrenia, we evaluated the relationship among their demographic characteristics, psychopathological symptoms and neurocognitive functions by testing the influence of the inpatient/outpatient status. [Method] The subjects were 129 outpatients and inpatients with schizophrenia in two psychiatric hospitals. We conducted a demographic survey and assessed psychopathological symptoms using the Positive and Negative Syndrome Scale (PANSS) and neurocognitive functions using the Cog Health software. The study protocol was approved by the ethical committee of Kyorin University and the psychiatric hospitals. [Result] Among outpatients, there was little or no association among demographic characteristics, psychopathological symptoms and neurocognitive functions, although inpatients showed strong associations.Outpatients and inpatients aged ＜45 years whose duration of hospital stay was ＜60 months were compared. Although there were no significant differences in demographic characteristics and psychopathological symptoms, the outpatients showed shorter reaction time and better accuracy of working memory. [Conclusion] The differences between outpatients and inpatients in the associations among demographic characteristics, psychopathological symptoms and neurocognitive functions suggest that the inpatient/outpatient status has a strong influence.
Coronary artery bypass grafting (CABG) is an effective strategy for surgical revascularization of the coronary arteries. This operation is widely recognized as a standard operation, as it is safe and provides excellent long-term results. Currently, CABG is performed utilizing on-pump arrest CABG with cardiopulmonary bypass (CPB), on-pump beating CABG with CPB, or off-pump CABG without CPB. CABG uses venous grafts (greater saphenous vein) and arterial grafts (internal thoracic artery, radial artery and right gastroepiploic artery). This report provides an overview of the characteristics and indications for these operations over time, followed by a review of the comparative literature. We also discuss future prospects for CABG.