JOURNAL OF THE KYORIN MEDICAL SOCIETY
Online ISSN : 1349-886X
Print ISSN : 0368-5829
ISSN-L : 0368-5829
Volume 38, Issue 1
Displaying 1-3 of 3 articles from this issue
Review Article
  • Yumi SHIMOJIMA, Thomas R. McCORMICK, Shinobu GAMOU
    2007 Volume 38 Issue 1 Pages 2-10
    Published: March 30, 2007
    Released on J-STAGE: November 22, 2007
    JOURNAL FREE ACCESS
    One of the major roles of healthcare ethics is to provide clinical case consultation when ethical conflicts or dilemmas arise within the healthcare team or between the team and the patient-family. To understand the concept of healthcare ethics, the seminar entitled “Teaching ethics in a clinical setting: Using the 4 box method” by Doctor Thomas R. McCormick, University of Washington, was held in March 2006 at Kyorin University. The mission in this seminar was: (1) to focus on case studies involving ethical issues in the clinical setting, (2) to develop a common language and conceptual framework for the study and analysis of the cases, (3) to use the seminars as “practice sessions” for discussing ethical issues, speaking, and listening to the perspectives of others, (4) to aim for openness in sharing our values, our ideas and our feelings about the cases and the relationships involved, and (5) to better understand ourselves and our values. Some clinical cases were analyzed and discussed using the four box method. This helpful tool in constructive ethical decision making is composed of four topics: Medical indications for intervention, Preferences of the patient, Quality of life, and Contextual issues. Using the classical case of Baby Doe, it was shown that the judgment about refraining from medical intervention for this handicapped baby might vary in the surrounding conditions, i.e. social welfare system, legal frame work, or the values of the infant's family. The second case of 87-yrs-old male with COPD, indicated the problems of autonomy and QOL, which might be common not only in the US but also in Japan. The case showed how to make autonomous decision for the life in the US. The third case of 17 yrs-old Jehovah's Witness with terminal renal failure involved the conflict between the patient's decision and parent's decision. Although it is possible to get a legal intervention for the 17 year-old patient, this may not be a good choice for the family. From this case, we discovered that the process of decision-making is as important as the result of the decision. These case studies, together with the principles and the four box paradigm used to analyze them, provided a helpful method and disclosed how healthcare professions make constructive bioethical decision when we are faced with an ethical dilemma.
    Download PDF (578K)
Original Articles
  • Takuma YOKOYAMA, Yoshifumi NISHI, Mitsuhiro OKAZAKI, Hiroo WADA, Haruy ...
    2007 Volume 38 Issue 1 Pages 11-20
    Published: March 30, 2007
    Released on J-STAGE: November 22, 2007
    JOURNAL FREE ACCESS
    Despite the advent of potent antimicrobial agents, some bacteria obtained resistance to these antimicrobial agents, like methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE), and thus the significance of the surveillance over the resistance to antimicrobial agents has been emphasized world-wide. We analysed seven Gram-positive bacteria as to their resistance to antimicrobial agents in our hospital for recent five years from 1999 to 2003. MRSA was frequently detected as high as 73% of total isolates of S. aureus. They were multiply resistant to penicillins, cefalosporins and imipenem (IPM), although they were still sensitive to vancomycin (VCM) and teicoplanin (TEIC). The ratio of MRSA isolates originating from outpatients was increased from 3% to 6.5%, suggestive of the increased prevalence of MRSA in the community which our hospital belongs to. S. epidermidis isolates that were resistant to MPIPC have increased from 73 to 83%. S. epidermidis that was resistant to erythromycin (EM), clindamycin (CLDM), levofloxacin (LVFX) and fosfomycin (FOM) also increased. E. faecalis was mostly resistant to EM and FOM, while E. faecium was highly resistant to LVFX, FOM and IPM. The ratio of the isolates that were resistant to minocycline (MINO) among these enterococci decreased during the five years. Resistance to penicillins and EM among S. pneumoniae isolates was detected in 49-64% and 64-79% of all the isolates, respectively. On the other hand, resistance to LVFX was around 3% through the five years. S. pyogenes was generally sensitive to penicillins and cephalosporins.
    Download PDF (1025K)
  • Yohsuke KAWASAKI, Jyunichi OHTAKI, Kenji TOBA, Yoshihiko KOGA
    2007 Volume 38 Issue 1 Pages 21-28
    Published: March 30, 2007
    Released on J-STAGE: November 22, 2007
    JOURNAL FREE ACCESS
    There are many reports from brain function image studies of Alzheimer disease (AD) that hypoperfusion of brain blood flow in the parietal-temporal association cortex is a characteristic of AD and that hypoperfusion spreads to the frontal cortex with progress of AD. 99mTc-ECD SPECT brain blood flow examinations of AD patients ranging from very early stage AD including amnestic mild cognitive impairment (aMCI) that is defined as precursor to AD to severe AD were conducted. The relationship between severity based on mini-mental state examination (MMSE) score and brain blood flow was assessed. Relative hypoperfusion of the posterior cingulate, precuneus, and right hippocampus was observed in very early AD but correlation with AD severity was not observed. However, a positive correlation was observed between the score for MMSE and brain blood flow of the bilateral basal forebrain and orbital gyri. These results suggest that brain blood flow SPECT examination is useful for diagnosis of the stage of AD and predicting the progress of AD.
    Download PDF (1184K)
feedback
Top