JapanMed

OSCE July 23rd

2009-07-09T06:36:00.002+09:00

On July 23rd at 6PM we will convene for an OSCE, Objective Structured Clinical Exam. We are fortunate to have several native English speakers who have agreed to be "mock" patients. Please contact Sasamoto san at #3396 or by email at ksasamoto@kameda.jp. We welcome non Kameda participants, but Kameda residents have priority.

DG

EBM Online Tutorial

2009-06-07T11:02:00.000+09:00

The University of NC and Duke University have sponsored an online EBM tutorial. Access is at the following URL. Just paste into your browser then follow the controls at the right.

http://www.japanmed.com/resident/

Natto!

2009-06-04T07:19:00.005+09:00

Natto beans are an amazing health food. Introduced in the Yayoi period (over 2300 years ago) they are now known to be beneficial for heart disease and have significant antibiotic effects!

1. Nattokinase is an enzyme discovered in 1990 by
Dr. Hiroyuki Sumi .

"This is a powerful dissolver of blood clots and fibrin in the arteries. To give you some idea of how powerful Nattokinase is, drug companies sell the enzyme urokinase to dissolve clots and present it in a product that sells for about JPY20,000 per dose. It lasts for just 30 minutes in the body after ingestion. 100gm of Natto on the other hand can be bought from the supermarket for a paltry JPY100, it is just as efficacious, and yet it remains effective in the body for around 8 hours."

2. Natto apparently also protects us
against salmonella and other enteric pathogens.

"Some readers may recall the June 1993 Tajimi City, Gifu schools mass poisoning of 2,700 students with E-coli O-157 virus, caused by contaminated school lunches. It was a big scandal at the time, with lots of finger pointing about what/who caused it.
A study was done later on the students who were affected versus those who were not, and the researchers found that those kids who ate Natto at least 1-3 times a week had a far lower incidence of infection by E-coli than those who ate none." quoted items from Terrie's Take

Wow! How can something that smells so bad be so good?

For more information do a google search for "Terrie's take natto" June 2 issue.

Dr. O'Rourke

2009-06-01T10:46:00.001+09:00

Ken arrived a day late at Narita Airport due to a delayed departure from Charlotte, NC on Friday. He was not quarantined but he enjoyed the Narita Hilton Hotel. He is looking forward to his time at Kameda Medical Center. Enjoy!

DG

Rebecca's Blog

2009-05-31T10:46:00.003+09:00

Sushi Chaz
Everyone enjoyed Rebecca Chasnowitz's visit to Kameda Medical Center in April 2009. Rebecca will be a final year medical student at UNC in July. Now you can enjoy her observations in blog style.

http://sushichaz.blogspot.com

Also, you may not have seen Annie's Blog:

http://summeratkameda.blogspot.com/

Or Priya's blog:

http://hellokittyelective.blogspot.com/2008/12/sayonara-kameda.html

Weber Sensei - September

2009-05-28T21:26:00.005+09:00

Dr. Weber has agreed to cover the Kameda faculty role from Sept 8 thru Sept 23. He is a specialist in Pediatrics Infectious Diseases and nosocomial infections.

David J. Weber

Assistant Dean, UNC School of Medicine

Assoc. Chief of Medical Staff
Medicine and Pediatrics

Campus Box 7030
T: 919-966-2536
F: 919-966-1451

Education
1977	University of California, San Diego
1985	Harvard University

Research Ineterests: Epidemiology, Nosocomial infection

Key publications

Rutala WA, Barbee SL, Aguiar NC, Sobsey MD, Weber DJ (2000)
Antimicrobial activity of home disinfectants and natural products against potential human pathogens.
Infection Control and Hospital Epidemiology: vol.21, p.33-8.

Rutala WA, Weber DJ (1999)
Infection control: the role of disinfection and sterilization.
Journal of Hospital Infection: vol.43 Suppl, p.S43-55.

Weber DJ, Raasch R, Rutala WA (1999)
Nosocomial infections in the ICU: the growing importance of antibiotic-resistant pathogens.
Chest: vol.115, p.34S-41S.

Weber DJ; Rutala WA (1999)
Zoonotic infections..
Occup Med: vol.14, p.247-84.

Weber DJ; Rutala WA; Blanchet CN; Jordan M; Gergen MF (1999)
Faucet aerators: A source of patient colonization with Stenotrophomonas maltophilia..
Am J Infect Control: vol.27, p.59-63.

Medical English Podcasts

2007-04-27T15:12:00.000+09:00

Medical podcasts are now available on iTunes. Go to iTunes online store .... podcasts ... enter medical issues in search engine. Download to your MP3 player then listen on the Tokyo Metro.

dg

Mexican Dinner at the Sanno

2007-04-15T10:50:00.000+09:00

Yoko and Shumei (both residents heading to NYC for Internal Medicine Residency) will join Dr. G and several NMS medical students for a Mexican Buffet at 7 pm at the New Sanno Hotel. Picture ID's required. www.thenewsanno.com.

dg

Medical Japanese Podcast

2007-01-04T08:25:00.000+09:00

Learning Medical Japanese is Challenging.

It just became much easier with the recorded mp3 podcasts of discussions with Mari Ouchi, Kayo Sasamoto and Mari Shigetome. We hope to expand this over the next few weeks to include many more anatomical and medical terms. Now it is just in the developmental stage. Try the link below to see if it works on your computer.

http://japanmed.com/documents/Japanese101_podcast.mp3

dg

Answers to Abdominal Pain

2007-01-04T05:14:00.000+09:00

1. Ika
2. None, treatment is with endoscopic removal.
3. No change in risk with subsequent exposures.

This abdomen is from a famous ID doc here in Japan who went out to dinner with his family. No family members were affected.

dg

Abdominal Pain In Kamogawa

2006-12-06T12:48:00.000+09:00

A 34 YO male presents with severe abdominal pain 6 hours after eating a sushi meal with his family. Endoscopy findings are shown at left.

Questions:

1. What was the type of sushi eaten?
2. What is the antimicrobial treatment of choice?
3. Is recurrence more or less likely after an episode of infection?

Medical Japanese !!

2006-11-29T15:41:00.000+09:00

The education department and Mari O'uchi have started a program of Japanese language education for visitors. The goal is to give visiting students and guest faculty
basic instruction in Japanese conversation and medical terms. This will facilitate their experiences in the hospital and help with their interaction with hospital staff, residents and patients. Thanks to Mari Shigetomi, Jessica Colin-Durand (McGill University), and Hiroshi Nishino for their efforts to get the program going. This is a "first of its kind" program and will help visitors to feel welcome.

DG

Multiple Myeloma Case

2006-11-29T12:40:00.000+09:00

The patient in our last blog was diagnosed with multiple myeloma. When considering the diagnosis remember the CRAB mneumonic.

Great recent review available online :

Sirohi B, Powles R, Lancet, Vol 363, March 13, 2004 (www.thelancet.com) (available online with Kameda password).

73 yo -elevated calcium and back pain

2006-11-27T12:55:00.000+09:00

73 YO male presents with back pain and hypercalcemia. Vital signs normal ... Calcium elevated.

Diagnosis?

(see next post)

DG

Travel Medicine Guidelines

2006-11-20T12:45:00.000+09:00

Clinical Infectious diseases has just published the long awaited Guidelines for practice of Travel Medicine. This is a wonderful resource for physicians helping patients (or themselves) prepare for international travel. Best of all ... it's free in pdf format.

ThePracticeofTravelMedicine:GuidelinesbytheInfectious Diseases SocietyofAmerica.David R. Hill et al. Clinical Infectious Diseases. 2006;43:1499-1539.

Rabies Case near Kyoto

2006-11-17T15:52:00.000+09:00

A patient returning from the Philippines presented with a flu like illness and demonstrated strange behavior. This behavior included aversion to water and light breezes. He was diagnosed as Japan's first Rabies case in 37 years by a graduate of Kameda's Infectious Diseases fellowship program.

Japan has been rabies free but is surrounded by countries with rabies. In addition, there are many vectors available in Japan including the raccoon. Very few countries are rabies free. These include Taiwan, Japan, UK, Switzerland, Australia, New Zealand, and Iceland. For ideas on prevention and recognition, click here.

Clinical Skills Resources Online

2006-11-02T08:23:00.000+09:00

Clinical skills development requires continuous attention to self directed learning. Self directed learning is important in Japan where the infrastructure for teaching clinical skills is limited (but improving rapidly). Two great online resources are available:

http://medicine.ucsd.edu/clinicalmed/introduction.htm

http://www.meddean.luc.edu/lumen/medcurr.htm

Poking around on these sites will reward students with visuals, techniques and attitudes for self-directed development of their clinical skills.

Headache mnemonic

2006-10-31T10:06:00.000+09:00

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

2006-10-25T11:24:00.000+09:00

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

2006-10-23T17:27:00.000+09:00

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!

2006-10-19T06:09:00.000+09:00

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

2006-10-17T16:35:00.000+09:00

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?

2006-10-15T21:35:00.000+09:00

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

2006-10-13T16:41:00.000+09:00

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 !

2006-10-13T16:12:00.000+09:00

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

2006-10-09T21:18:00.000+09:00

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

2006-10-09T20:53:00.000+09:00

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

2006-10-07T11:38:00.000+09:00

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

2006-10-07T11:16:00.000+09:00

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

2006-10-06T06:27:00.000+09:00

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

2006-10-05T09:25:00.000+09:00

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

2006-10-01T09:23:00.000+09:00

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/

Kampo

2006-09-29T21:34:00.000+09:00

Understanding Kampo Medicine is important for foreign physicians teaching in Japan. Many patients are concurrently using both traditional and kampo medicine and this complicates the interpretation of therapeutic and toxic effects. Resources for English speaking academics are limited. Two useful resources are listed below:

1. The Practice of Chinese Herbal Medicine in Japan. http://www.itmonline.org/arts/kampo.htm Authoritative –historical review

2. Evidence-based Complementary and Alternative Medicine (eCAM) http://ecam.oxfordjournals.org/. Up to date articles in digital format. eCAM is an international, peer-reviewed journal that seeks to understand the new, yet ancient world of complementary and alternative medicine..

Rash and Fever -answer

2006-09-28T20:53:00.000+09:00

Kawasaki disease. First identified in the '60s in Chiba, Japan it is now recognized worldwide. Rates in Asians are much higher. Treatment with IV IG reduces the rate of coronary aneurysms. Cause of the erythema at BCG site is unknown.

DG

Japanese Access to Health Care Highest

2006-09-27T21:34:00.000+09:00

Longevity as a function of access to health care was reviewed by the WHO in several populations. Japanese at age 60 had the highest. USA ranked 18th. See the full report at: http://www.cmwf.org/publications/publications

USA leads in cost however, with the cost of family coverage up 87 percent since 2000 to an average $11,481. For details see: http://www.nytimes.com/2006/09/27/business/27insure.

Rash and Fever

2006-09-26T22:34:00.001+09:00

6-year-old boy presented recently with fever, rash, redness of the palms and desquamation of the skin of his fingers. His site of BCG vaccination became bright red during the febrile episodes.

Questions.
1. Diagnosis?
2. Treatment of choice?
3. Cause of change in his BCG site?

Answers tommorow!

New ACP and IDSA Associates

2006-09-24T09:20:00.000+09:00

Over 30 residents at Kameda signed up to be associates with the American College of Physicians. For an annual fee of $40 they recieve all online journals and discounts on all ACP programs and resources. Go to (www.acponline.org) and check out the associates membership section.

Dr Hosokawa is now an associate of the IDSA and Asako Doi is a member in training.

DG

Asian American longevity

2006-09-20T20:34:00.000+09:00

Asian Americans keep their longevity advantage even after moving to America. The gap between Asian females and Black males is an astonishing 20.7 years!! They seem to maintain their culture of health (diet, activity, low violence) even after moving to America.

Chart shows Asian males (America 1) and 7 other ethnic groups. The full report is available at: http://www.globalhealth.harvard.edu/

American Medical Educator Experience

2006-09-20T13:09:00.000+09:00

Insight into the expatriate medical educator experience.

"How lucky we are to be able to take the best of both cultures and incorporate those traits into our lives. "
Joel Barish, TMDU

How true! As educators we are observing and learning as well as teaching. Thankfully, we have access to the best of both worlds.

Green Tea Works!

2006-09-13T10:51:00.000+09:00

40,530 Japanese adults were studied. Those who drank lots of green tea were less likely than those who drank only a little tea to die from cardiovascular disease and other causes.

Journal of the American Medical Association, Sept 13, 2006. Dr. Shinichi Kuriyama of Tohoku University in Sendai.

DG

Japan on Google Maps!

2006-09-13T10:41:00.000+09:00

Google maps now has NASA satellite images of Japan!! Roads are up to date and terrain photos are superb!

Google.com
maps section
Type .... kamogawa japan
Experiment with navigation, size and detail. It is truly fantastic!

DG

Answer to last photo

2006-09-13T10:29:00.000+09:00

Sting ray envenomation!!

Venom is deactivated by heat. Soak sting site in hot water. Use lidocaine for local anesthesia.

http://www.emedicine.com/EMERG/topic556.htm

2006-09-09T08:33:00.000+09:00

I evaluated this interesting patient recently in NC. 56 YO female while walking in surf 16cms deep experienced severe-sudden-sharp pain on the dorsum of her left foot.

Clue, a famous TV personality recently died of this envenomation.
Answer in tomorrow's blog entry.

Japan Med goes live!!

2006-09-09T00:23:00.000+09:00

The internet is grand! It allows rapid communication among like minded people and creates an instant sense of community and comaraderie.

For those who are isolated, either by geography, culture or other factors, the blog is a convenient antidote.

In the future we will post significant events, and clinical observations.

Dr. G
Japanmed.com