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Background/Purpose: The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). Methods: In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled‐off necrosis (WON), imaging costs for follow‐up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. Results: Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P <.01]. Severity on admission and imaging costs for follow‐up in ANC patients were significantly higher than those in APFC (P <.01). However, regarding mortality, there was no significant difference between patients with ANC and APFC (P =.41). Adjusting severity, it was revealed that rTM administration significantly reduced the risk of ANC developed WON (OR = 0.23, P =.01). Conclusions: While ANC had a higher clinical impact than that of APFC, we found that early administration of rTM may reduce the impact. [ABSTRACT FROM AUTHOR]

Objectives: To provide updated clinico-epidemiological information on chronic pancreatitis (CP) in Japan. Methods: We conducted a two-stage nationwide epidemiological survey; the number of CP patients was estimated in the first-stage survey, and their clinical features were examined in the second-stage survey. We surveyed patients with CP who had visited hospitals in 2016 and were diagnosed according to the Japanese diagnostic criteria 2009 (DC2009). Furthermore, we validated the new Japanese diagnostic criteria (DC2019) in patients with early CP diagnosed according to DC2009. Results: The number of patients with definite/probable CP in 2016 was 56,520 (prevalence, 44.5 per 100,000 persons), and that of early CP was 4470 (prevalence, 3.5 per 100,000 persons). We obtained detailed clinical information of 2150 patients with definite/probable CP and 249 patients with early CP. Compared with the early CP cases, the definite/probable CP cases had higher proportions of male (4.8 vs. 1.3), alcohol-related etiology (72.0% vs. 45.8%), smoking history (69.6% vs. 41.0%), diabetes mellitus (42.3% vs. 19.3%), and past history of acute pancreatitis (AP) (50.4% vs. 22.1%). Among the patients with early CP diagnosed according to DC2009, 93 (37.3%) were diagnosed with early CP according to DC2019, but the diagnosis of the remaining 156 (62.7%) patients was downgraded. Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019. Conclusion: We clarified the current status of CP in Japan. Further validation studies are warranted to clarify the diagnostic utility of DC2019. [ABSTRACT FROM AUTHOR]

Background: Selective biliary cannulation (SBC) is the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially for trainees, and a rotatable sphincterotome may be useful to guide the directional axis of the scope and SBC.Methods: We performed a prospective randomized single-center trial, enrolling 200 patients with a native papilla who required therapeutic biliary ERCP. Patients were randomly assigned to the rotatable sphincterotome group (n = 100) or the conventional sphincterotome group (n = 100). The primary endpoint was successful SBC by the trainees within 10 minutes.Results: The early and late cannulation success rates did not differ significantly between the groups (P = 0.46 and P > 0.99, respectively). For the patients in whom trainees failed to achieve SBC, the rotatable sphincterotome was used as a rescue cannulation technique in four patients from the conventional group; in no patients in the rotatable group was the conventional sphincterotome used for SBC. Post-ERCP pancreatitis (PEP) occurred in 11 patients (5.5 %; 6 mild, 5 moderate); the incidence did not differ significantly between the two groups (rotatable group 3 %, conventional group 8 %; P = 0.21). The two groups were thus combined for evaluation of the factors relating to cannulation difficulty for trainees, which revealed that orientation of the papilla was a significant factor (P < 0.001).Conclusions: The type of sphincterotome used did not affect the success of SBC by trainees. However, orientation of the papilla was revealed to be a significant factor relating to cannulation difficulty for trainees overall. [ABSTRACT FROM AUTHOR]

Nursing students must develop their abilities to provide appropriate nursing services. They need to acquire the level of nursing knowledge to pass the national examination according to Japanese law. Moreover, even if the awareness of the rights of people who receive nursing services increases, students must not have a sense of resistance toward those rights. Therefore, we investigated the factors associated with students' motivation to pass their examination and such a sense of resistance. We produced items related to reasons students wanted to become registered nurses with reference to job satisfaction and their learning environment (e.g., teachers' manners and school events unrelated to the examination). There were 3,417 female nursing students analyzed in 29 vocational schools that allow graduation after a 3-year study period (average age, 21.93 years [standard deviation, 5.44]). Older and third-year students had a stronger motivation to pass the examination and a weaker sense of resistance to people's rights compared with younger and first- to second-year students. Students who answered a "Lack of enthusiasm for becoming a registered nurse" had a weakened motivation and a strengthened sense of resistance. Factors enhancing students' motivation to pass their examination were "Professional commitment," "Desire for companionship," and "School events unrelated to the national examination." Factors strengthening students' sense of resistance to people's rights were "Living stability" and "Social appraisal." Teachers must develop methods to teach ethics so that their students respect the rights of people who receive nursing services and to ensure that they acquire the necessary nursing knowledge. [ABSTRACT FROM AUTHOR]

In environments in which professional nurses do simple tasks, e.g., laundry, cleaning, and waste disposal, they cannot concentrate on technical jobs by utilizing their expertise to its fullest benefit. Particularly, in Japan, the nursing shortage is a serious problem. If professional nurses take their time to do any of these simple tasks, the tasks should be preferentially allocated to nursing assistants. Because there has been no descriptive study to investigate the amount of time Japanese professional nurses spent doing such simple tasks during their working time, their actual conditions remain unclear. Professional nurses recorded their total working time and the time they spent doing such simple tasks during the week of the survey period. The time an individual respondent spent doing one or more simple tasks during that week was summed up, as was their working time. Subsequently, the percentage of the summed time he or she spent doing any of those tasks in his or her summed working time was calculated. A total of 1,086 respondents in 19 hospitals that had 87 to 376 beds were analyzed (response rate: 53.3%). The average time (SD) that respondents spent doing those simple tasks and their total working time were 2.24 (3.35) hours and 37.48 (10.88) hours, respectively. The average percentage (SD) of the time they spent doing the simple tasks in their working time was 6.00% (8.39). Hospital administrators must decrease this percentage. Proper working environments in which professional nurses can concentrate more on their technical jobs must be created. [ABSTRACT FROM AUTHOR]

Nursing assistants can work without a professional certification to help registered nurses and licensed practical nurses. Nursing assistants engage in various tasks, e.g., washing laundry, cleaning up, and clerk tasks regarding nursing. Enhancing work motivation among nursing assistants is essential for every hospital, because when nursing assistants do their jobs well, it allows registered nurses and licensed practical nurses to complete their own specialized jobs. We examined the predictors significantly associated with nursing assistants' work motivation. For those predictors, we produced items to examine job satisfaction. Those items are classified into intrinsic and extrinsic facets. The subjects for this study were Japanese nursing assistants working in 26 hospitals with 62-376 beds (4 public and 22 private hospitals). A total of 516 nursing assistants were analyzed, with the average age and standard deviation of 42.7 ± 12.9 years; the age of 456 female subjects was 43.8 ± 12.7 years and that of 60 male subjects was 34.3 ± 11.0 years. Our results show that "work motivation" is significantly associated with "free time to do one's own things," "nursing assistants as important partners on the job," "feeling helpful to patients," "participating in decision making," and "job-skill improvement." Free time to do one's own things is an extrinsic item. Hospital administrators must monitor the workload and their quality of life among nursing assistants. All the other significant items are intrinsic. Nursing assistants are not only motivated by money. They highly value the intrinsic nature and experience of their jobs. [ABSTRACT FROM AUTHOR]

In medical education, it is important for medical students to develop their ethics to respect patients' rights. Some physicians might make light of patients' rights, because the increased awareness of such rights might make it more difficult for them to conduct medical practice. In the present study, predictors significantly associated with "a sense of resistance to patients' rights" were examined using anonymous self-administered questionnaires. For these predictors, we produced original items with reference to the concept of ethical development and the teachings of Mencius. The subjects were medical students at the Kitasato University School of Medicine, a private university in Japan. A total of 518 students were analyzed (response rate, 78.4%). The average age of enrolled subjects was 22.5 ± 2.7 years (average age ± standard deviation). The average age of 308 male subjects was 22.7 ± 2.8 years, while that of 210 female subjects was 22.1 ± 2.5 years. The item, "Excessive measures to pass the national examination for medical practitioners," was significantly associated with "a sense of resistance to patients' rights." However, other items, including basic attributes such as age and gender, were not significant predictors. If students spent their school time only focusing on the national examination, they would lose the opportunity to receive the ethical education that would allow them to respect patients' rights. That ethical development cannot easily be evaluated with written exams. Thus, along with the acquisition of medical knowledge, educational programs to promote medical students' ethics should be developed. [ABSTRACT FROM AUTHOR]

The article offers information on a study based on a questionnaire survey which discusses the lifestyle of Japanese Workers for preventing the metabolic syndrome. The result of the study was analyzed with the help of two models that is Health belief Model and the Multidimensional health locus of control. The study found that older workers, white-collar workers, and workers who had the metabolic syndrome had appropriate lifestyles

Proper work environments are important for nurses to feel motivated. We examined the associations between work motivation and job satisfaction among Japanese nurses to improve their motivation. In Japan, relatively small and medium-sized private hospitals play a central role in the healthcare industry. In the present study, the subjects were nurses working in 23 small and medium-sized private hospitals that had 65 to 326 beds. We analyzed 1,116 registered and licensed practical female nurses (average age, 38.3 years; standard deviation, 11.3 years). Many nurses with their specialized nursing skills dedicate themselves to patient care. However, many of these nurses may not be interested in contributing to their hospitals. Nurses may have different opinions regarding dedication to patient care and contribution to their hospitals. Therefore, concerning work motivation, we produced these two different items, "Nurses' dedication to patients" and "Nurses' contribution to their hospitals." We also produced our own original new job satisfaction questionnaire. We found 7 facets of job satisfaction: "Work as specialists," "Workplace safety," "Relationships with superiors," "Work-life balance," "Relationships among nurses," "Communications with physicians," and "Salary." Multiple linear regression analyses show that both "Nurses' dedication to patients" and "Nurses' contribution to their hospitals" were significantly associated with "Work as specialists." Nurses feel their jobs of protecting people's lives and health are valuable. They do not feel motivated only by money. They value the intrinsic nature of their jobs. Creating proper work environments is important for nurses to be able to work as specialists. [ABSTRACT FROM AUTHOR]

Japanese law stipulates that workers undergo worksite health checkups. If workers do not use their results of those checkups in their daily health management, the merit if this law will not be realized. Therefore, it is important to identify the predictors to improve their motivation to use the results of health checkups. We investigated those predictors by using a questionnaire survey. Multiple linear regression analysis was conducted for 1,791 subjects (1,520 males and 261 females) at a Japanese manufacturing plant. The average age of enrolled subjects was 42.0 years (standards deviation [S.D.], 13.4 years). The average age of male subjects was 42.3 (S.D., 13.8) years and that of the female subjects was 39.9 (S.D., 10.4) years. The results revealed that as workers advanced in age, they maintained their motivation more to use those results. Women maintained their motivation more than men. Workers who believe that their health depends on the influence from physicians and healthcare providers in hospitals felt motivated. Workers who realized the effectiveness of those checkups to maintain good health, who knew how to adopt an appropriate lifestyle, and who are given consultations with physicians when they received their health checkups, felt motivated. Regarding the healthcare organizations' and occupational health staffs' responsibilities, only detecting illness early in not sufficient. Those healthcare providers must value more primary prevention. Our findings can be applied to a various occupational health activities, including health consultations, health education seminars, and providing appropriate instruction on how to interpret the results of the worksite health checkups. [ABSTRACT FROM AUTHOR]

The article discusses the satisfaction of workers in Japan with their Annual Health Checkups. The authors point out the factors that are associated with the degree of satisfaction such as the good manners of a receptionist, cleanliness of the examination site, and privacy invasion issues. Multiple linear regression analysis was used in determining the factors.

The article presents a study which determines the relationship between the dimensions of safety climate and the motivation of nurses toward patient safety in Japan. The study distributed a questionnaire survey to nurses excluding nursing directors. The study revealed that the motivation of nurses to prevent mistakes is related to reporting, nursing conditions, and communications with physicians.

This paper analyzes the interactions between generic advertising, brand advertising, and firm profits when brand advertising is purely informative. We develop duopoly models with vertical and horizontal differentiation when brand advertising lowers consumer search costs of identifying brand characteristics. The model demonstrates that firms can benefit from investing in brand advertising that lowers consumer search costs as well as from brand advertising that is purely persuasive. In addition, the results demonstrate that regardless of whether brand advertising is persuasive or informative, the outcome is more likely to be symmetric with horizontal differentiation than with vertical differentiation. The key distinction between this model and that of previous studies is that brand advertising across rivals is a strategic complement when persuasive and a strategic substitute when informative. [ABSTRACT FROM AUTHOR]

The article discusses the mandatory annual health checkups in Japan under the Industrial Safety and Health Law (ISHL). It states that the results of these checkups are used as references for occupational health staff since many workers fail to accurately remember their results. Subsequently, one of the reasons why such instance happens is the workers' failure to understand it per se. Thus, giving of understandable instructions on reading and interpreting the results is highly recommended.

The relationship between advertising and price is important because the welfare effect of advertising depends upon the price effect of advertising. We attempt to provide a better understanding of the theoretical relationship between advertising and price. We establish theoretical conditions sufficient for advertising to raise prices. This will occur, for example, when firms play a supermodular game - a structure that considers the type of advertising (i.e., persuasive, image creating, or informative) and the effect that advertising has on a firm's demand and costs. We also compare results from two simple duopoly models, one with horizontal and the other with vertical differentiation, and find that only the model with horizontal differentiation is supermodular for the forms of advertising that are thought to raise price (e.g., persuasive advertising). In consideration of these theoretical issues, we then develop an empirical model to determine whether advertising raises prices in the US brewing and cigarette industries. [ABSTRACT FROM AUTHOR]

The article reports on the survey in dimensions of safety climate among Japanese nurses. Five factors were extracted as a result of exploratory factor analysis namely, intellectual development regarding medical safety among nurses, accumulated fatigue, nursing conditions, attitude of supervisors, and communication with physicians. The value of the Goodness of Fit Index (GFI) was 0.868, Comparative Fit Index (CFI) was 0.943 and the Root Mean Square Error of Approximation (RMSEA) was 0.062.

The article presents a self-administered questionnaire survey on the measures of making clearer instructions on how to read the results of general health checkups in a workplace in Japan. Results of the multiple regression analysis of the responses of 984 male workers suggest that it is necessary to provide more detailed information to those with poor health and to promote awareness of lifestyle-related diseases targeting people unfamiliar with such diseases.

Sick house syndrome (SHS) is a Japanese concept derived from sick building syndrome (SBS), however SHS includes a broader scope of sickness than does SBS. Symptoms of SHS/SBS disappear after leaving the sick house/building, while symptoms of multiple chemical sensitivity (MCS) are elicited by the chance of chemical exposure after leaving the sick house/building. To establish the concept of SHS, we propose to introduce a new classification for SHS. A total of 214 patients complaining of SHS and/or MCS were independently classified using a new classification by clinical ecologists who are experienced physicians with expert knowledge of clinical ecology and general physicians according to disease pathogenesis from clinical records. The classification is as follows: type 1 (symptoms of chemical intoxication), type 2 (symptoms developed possibly due to chemical exposure), type 3 (symptoms developed not because of chemical exposure but rather because of psychological or mental factors), and type 4 (symptoms developed due to allergies or other diseases). The agreements on the classification made by clinical ecologists and general physicians reached 77.1% (Cohen's kappa = 0.631), suggesting that this new classification was both apt and accurate. Relations between SHS and allergy/MCS were also studied. The cases classified as SHS type 4 more frequently had allergic past histories than did other types. The proportion of possible MCS cases was higher in the chemical induced SHS group (types 1 and 2) than in other types among male patients. For the universal use in clinical practice, it is necessary to prepare helpful diagnostic criteria of this SHS classification based on pathogenesis and carry our study forward all over the country. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73 year old woman with hepatitis C virus (HCV). A single nodule in the fourth segment of the liver was found by the superparamagnetic iron-oxide-enhanced magnetic resonance imaging (MRI). She had a liver tumor and her B-cell lymphoma of the liver was diagnosed. She received three cycles of chemotherapy.The article discusses about the B-cell lymphoma and the HCV infections.

The article presents a case study of a 71-year-old woman with recurrent bile duct stones. Topics discussed include use of endoscopic papillary large-balloon dilation (EPLBD) treatment for removal of the stones, observation of bleeding after EPLBD, failure of balloon oppression and self-expandable metallic stent in hemostasis, presence of gastroduodenal artery pseudoaneurysm and extravasation into duodenum, and placement of coils for hemostasis. [ABSTRACT FROM AUTHOR]