Headache mnemonic

mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If a headache patient presenting to the ER has 4 out of 5 of these historical features, the LR (Liklihood Ratio) =24 for migraine.


Does this patient with headache have a migraine or need neuroimaging? JAMA 2006; 296(10):1274-83

For this and other recently discussed articles, go to the japanmed.com journal club link.

http://www.japanmed.com/journal.html

Resident Match Results

Kameda Medical Center has an excellent starting class for March 2007! We cannot release the names yet but I have reviewed the selections and I have compared them with my notes and I am very pleased. There are many very good medical students who were not able to come this year and that was a source of disappointment but keep us in consideration for senior residency in two years.

Welcome from your friends at Kameda!!

Clinical Skills Teaching

Shimane University students attend a recent seminar on the value of clinical skills in medicine.



Medical students throughout Japan are begining to sense the excitement of learning and using their clinical skills. And guess what ... they are good at it. Students at Shimane, Nippon, Taienei Kaijenki, Kameda and other sites have started the clinical training process and their enthusiasm is growing daily. The revolution in Japanese Medical Education has just begun. These are exciting times to be a medical resident or student in Japan.

Seafood Diet Works!

The health advantage of the Japanese diet has been confirmed. In a large meta-analysis, researchers document the exceptional benefits of a seafood diet.

nReduces risk of coronary death by 36% (95% confidence interval, 20%-50%; P<.001). nTotal mortality by 17% (95% confidence interval, 0%-32%; P = .046). When you add these findings to prior studies on tofu, green tea etc. a clear picture emerges.

Sushi anyone?

Japan Doctor Shortage

Yoshihiro Kumasaka recently wrote convincingly in the Asahi Shimbun (10-16-06) that Japan faces a serious physician shortage. It is not uncommon for ob-gyn and pediatric departments in rural areas to close because of a shortage of full-time specialists. Primary care similarly faces shortages in rural areas. Japan has limited the number of students at medical schools based on a 1982 Cabinet decision and concerns about a potential rise in medical expenses. Rising elderly populations need more health care than could have been predicted in the past.

It is clear to visiting faculty from Western Countries that the shortage is even more serious than perceived locally. If it were not for the industriousness, high productivity and strong work ethic of Japanese physicians the health system would already be in serious trouble. The “burnout” is high among young physicians because of this intense workload and these shortened careers will further complicate the problem. New medical schools and increased class size will help but this benefit will not be felt for more than a decade. An expansion of the roles of nurses and adoption of a “physician extender” program may help but these are unlikely because of cultural considerations.

http://www.asahi.com/english/Herald-asahi/TKY200610160094.html

Why Medical English?

One of the common questions following my lectures in Japan goes like this: Why should I study medical English if I am not planning to train or practice in America?

There are many reasons of course. Principal among them:

1. English is the international language of medicine. All significant advances appear eventually if not initially in English. Even advances in Japan. This does not mean that Western medicine is necessarily the best, just well documented.

2. The NLM (pubmed.com) has over 6 million citations in digital format and is adding to this searchable database at a record clip of over 600,000 per year. English.

3. CME offerings by teleconference, internet, satellite are generally in English.

4. Travel abroad for conferences will usually be more rewarding for physicians with some clinical fluency in English.

5. Direct contact with colleagues abroad is facilitated by English fluency.

As "globalization" of medical knowledge progresses, isolation by language or other barriers will ultimately result in inferior clinical care. For better or worse the currency of this information exchange is English. Recognition of this has produced rapid advances in the West in "alternative" therapies ... thanks to our Asian colleagues who are willing to share their insights in English.

New Uploads to www.Japanmed.com

Presentation slides - Nippon Medical School, October 12, 2006
http://japanmed.com/Lecture.html

Click on link below to see new articles reviewed through the week of October 13, 2006. (Acupuncture works. Lasix does not help in acute renal failure. Sexual orientation history frequently misleads).

http://japanmed.com/journal.html

Acupuncture Works !

Investigators compared traditional accupuncture, sham accupuncture and conventional therapy with NSAIDs in 1007 patients with knee arthritis. Accupuncture (both traditional and sham) had a success rate of 53.1% compared to only 29.1% success with medical therapy. There were far fewer side effects with accupuncture.

Annals of Int Med 145:12-20. July 4,2006.

Small world - now smaller

It really is a "small world" at least as regards epidemics and outbreaks. Google maps has a health map updated continuously with reported epidemics and other serious health problems. Clicking on a map "pin" allows you to zoom into the neighborhood where the epidemic is occurring.

http://www.healthmap.org/

Izumi no Sanyaku

Autumn and harvest festivals are everywhere in rural Japan. "Aki" or fall is dry and cool in Japan ... near perfect weather. One of our local events is izumi no Sanyaku. It is very colorful, loud and exciting. Some of our neighbors (the Takahashi family) were participating and invited me to help pull the mikoshi with a rope. Very interesting and fun.

The Japanese cultural heritage is deep, rich, mystical and very healthy. Most of their highly regarded longevity can be attributed to their culture and not necessarily their health care.

Thanks Naguwa sensei

Thanks once again to Dr. Stanley M. Naguwa University of California, Davis. Stan just completed his 3rd trip to Kameda Medical Center as visiting professor. He was joined on this trip by his wife Jan and son Scott.

Stan is a favorite teacher and mentor and will return to Kamogawa in May 2007. Jan enjoyed stimulating the local economy with her "shopping" excursions and Scott enjoyed surfing with residents from Kameda.

Staying Connected

For expats teaching medicine in Japan, staying connected to our "home" culture is important for several reasons. (1) Prevents burnout. (2) Makes us a better resource for our Japanese students and residents. (3) Produces cultural insights.

60 Minutes ... News broadcasts ... National Geographic ... Nova ... frontline (Many many more).

Did you know that NEJM.org
has pod casts of recent articles?

http://www.apple.com/itunes/

Nippon Medical School Presentation

Dr. G will conduct clinical rounds and present the following lecture at 3pm on October 12, 2006. If you wish to attend, send an email to my .jp address.

Western Medicine and the value of Medical English

How Clinical skills and EBM can make you a better physician.

“Globalization” is a frequently used term in commerce, finance, exports and imports. This term can also be used to describe the movement of ideas, infections and people as well. Since the Meiji restoration and the end of 300 years of isolation, Japan has been a leader in this process … with one important exception … medicine. Medical globalization began with the creation of the library of medicine in the 1960s and has accelerated with digitalization of literature and the growth of the Internet. Dr. Gremillion will discuss the Japanese language and other barriers, which are now ending thus propelling Japanese medicine into a new and highly rewarding era for students, residents and practicing physicians.

Taiiku no Hi

National holiday - Monday October 9, 2006.

National Sports Day was established in 1966 to promote healthy life styles. The original date was timed to correspond with the opening ceremony of the Tokyo Olympics on October 10, 1964. Now it is always held on the 2nd Monday in October.

Japan News Sources

Keeping up to date with Japanese current events, news and culture can be a challenge for gaikokujin who are teaching in Japan. Three good sources are available online.

1. Daily Yomiuri http://www.yomiuri.co.jp/dy/

2. Asahi Shimbun http://www.asahi.com/english/

3. Japan Times http://www.japantimes.com/