[Hokkaido igaku zasshi] The Hokkaido journal of medical science最新文献

Adrenomedullin (ADM) is a novel potent vasodilatory peptide that was isolated from human pheochromocytoma cells in 1993. It consists of 52 amino acids with 1 intramolecular disulfide bond and a C-terminal amide structure. The vasodilatory effect of ADM is mediated by the activation of secondary messengers, including cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) that are induced by nitric oxide (NO). The objective of the present study was to ascertain the protective effect of ADM against ischemia/reperfusion (I/R) injury on isolated perfused rat liver (IPRL) model after 60 min of warm ischemic preservation and identify the pathways involved. Administration of ADM in the perfusate during initial perfusion and in the preserving fluid during reperfusion after preservation augmented portal flow by 1.3-fold (p < 0.01), increased bile production by 2.3-fold (p < 0.01), reduced the release of lactate dehydrogenase (LDH) to 0.73-fold (p < 0.05), increased oxygen consumption by 1.28-fold (p < 0.01), and augmented tissue cAMP by 1.8-fold (p < 0.05) those observed in the absence of ADM. However, ADM administration did not increase tissue cGMP and the uptake of hyaluronio acid, which are the functions of endothelial cells. Histological examination revealed that ADM administration resulted in an improvement in the structural changes induced by the I/R insult; however, it could not prevent the destruction of the sinusoidal endothelial cells. These results indicated that the ADM-mediated increased portal flow in the liver under an I/R insult is not induced by the NO-cGMP pathway but by the activation of cAMP.

In light of Japan's aging society, the number of homebound people is expected to increase, and health care services for such patients will need to expand. The authors implemented a one-month pilot program in a rural hospital, which uses home care as an educational tool to further resident interns' understanding in community medicine. The program was conducted for nine medical residents. Each resident was involved in a series of eight home visits, accompanied by an experienced nurse. Upon completion, to investigate the effect of the training program, the residents were interviewed about their experiences. Responses were analyzed by using qualitative methodology. Six categories for residents' learning emerged from the analysis. They included: fostering good doctor-patient relationships while recognizing psychosocial aspects, decision-making in view of ethics and patients' preferences, the value of teamwork, medical knowledge in geriatric care, consideration of the notion of home care itself, and the significance of local characteristics. It was found that home care experience with a geriatric team can not only help deepen the residents' knowledge and skills regarding geriatric care at home, but also foster the residents' attitude toward consideration of psychosocial aspects. It was concluded that initiating a home care program is both a valuable and useful educational tool for residents in managing chronic elderly patients. Residents achieved a new viewpoint which integrated both patients' and physicians' perspectives while witnessing patients' daily lives in the community.

Background: Supporting the patient's right to participate more actively in medical encounters is recommended. However, the physician-patient relationship in the context of the respect for patient participation is unclear.

Objective: To reveal the factors affecting the physician-patient relationship regarding patient participation in medical encounters in primary care.

Methods: A qualitative study incorporating a focus group interview with five female participants. They belonged to a consumer organization, which represents patients who actively participate in medical consultations. Patient behaviors, which constitute active participation, are designated as expressing their concern, asking questions, and stating their expectations in medical consultations. The recorded interview was transcribed, and analyzed with a constant comparison method.

Results: Four categories explaining the physician-patient relationship were extracted: Physicians' attitude; Patients' attitude; Other medical professionals' attitudes; Time environmental factors. Story lines were described; Other Medical professionals' attitudes and Time environmental factors were involved in the physician-patient relationship in accordance with the situation; Physicians' attitude and Patients' attitude had borne some mutual relations; when Patients' attitude to consultation had been active, physicians sometimes could have an aversion to these patients.

Conclusions: The patients' behaviors of active participation in medical encounters contributed to physicians' aversion to patients and lead the physician-patient relationship in an unfavorable direction. Physicians' attitude is of central concern for establishing the physician-patient relationship.

To achieve good care for stroke patients in the Hokumou Secondary Medical District, we reaffirmed the current status of the services, discovered the keypoints and issues, and searched for solutions to the current problems. The population, its age composition and the number of beds occupied by stroke patients--stratified in acute, convalescent and maintenance stages-were surveyed. The number of patients suffering from stroke under the jurisdiction of this district was compiled, by using the "regional alliance path for stroke," and the severity and outcome of each case were evaluated by using the mRS (modified Rankin Scale). We held seminars for citizens' on the prevention and management of stroke and the attendees were asked to fill out questionnaires, and were organized: networks for medical care and nursing in the Okhotsk Sea area and people's voices were heard at the network meetings; and at the town meetings held at Kitami, Abashiri and Bihoro, the challenges and problems in each area were discussed. The findings obtained from these activities were compiled for the current study. The rate of release of the patients to their home environment was high in the acute stage but low in the convalescent stage. To substantiate the regional management of stroke patients, it is essential that one be familiar with the availability of the limited medical recourses for and dynamics of patients. And yet, there is a limit to the efforts that the medical profession alone can make for the acute and convalescent stages. It is necessary that the health services assist in solving the problems, with the cooperation of the citizens and the nursing network that is involved in homes and nursing facilities for the care of patients in the maintenance stage.

Overactive bladder syndrome (OAB) is a chronic and distressing condition characterized by urinary urgency and increased frequency of micturition with or without urge incontinence. Such symptoms can exert a negative impact on many aspects of quality of life, including social function and interaction, physical activity and psychological well-being. In a survey of some 4500 people aged more than 40 years old in Japan, the prevalence of OAB was 12.4%. Even though OAB is prevalent and troublesome, many patients with OAB never seek medical help for their symptoms because of embarrassment and misconception about bladder control problems. Thus, it is important to broaden the actual knowledge about OAB among community-based people. We hope that this citizen joint symposium would help the participants to understand the useful information about OAB.