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112. Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States.

Author

Ruhnke GW, Wilson SR, Akamatsu T, Kinoue T, Takashima Y, Goldstein MK, Koenig BA, Hornberger JC, Raffin TA, Ruhnke, G W, Wilson, S R, Akamatsu, T, Kinoue, T, Takashima, Y, Goldstein, M K, Koenig, B A, Hornberger, J C, and Raffin, T A

Abstract

Background: Patient-centered decision making, which in the United States is typically considered to be appropriate, may not be universally endorsed, thereby harboring the potential to complicate the care of patients from other cultural backgrounds in potentially unrecognized ways. This study compares the attitudes toward ethical decision making and autonomy issues among academic and community physicians and patients of medical center outpatient clinics in Japan and the United States.Methods: A questionnaire requesting judgments about seven clinical vignettes was distributed (in English or Japanese) to sample groups of Japanese physicians (n = 400) and patients (n = 65) as well as US physicians (n = 120) and patients (n = 60) that were selected randomly from academic institutions and community settings in Japan (Tokyo and the surrounding area) and the United States (the Stanford/Palo Alto, CA, area). Responses were obtained from 273 Japanese physicians (68%), 58 Japanese patients (89%), 98 US physicians (82%), and 55 US patients (92%). Physician and patient sample groups were compared on individual items, and composite scores were derived from subsets of items relevant to patient autonomy, family authority, and physician authority.Results: A majority of both US physicians and patients, but only a minority of Japanese physicians and patients, agreed that a patient should be informed of an incurable cancer diagnosis before their family is informed and that a terminally ill patient wishing to die immediately should not be ventilated, even if both the doctor and the patient's family want the patient ventilated (Japanese physicians and patients vs US physicians and patients, p < 0.001). A majority of respondents in both Japanese sample groups, but only a minority in both US sample groups, agreed that a patient's family should be informed of an incurable cancer diagnosis before the patient is informed and that the family of an HIV-positive patient should be informed of this disease status despite the patient's opposition to such disclosure (Japanese physicians and patients vs US physicians and patients, p < 0.001). Physicians in both Japan and the United States were less likely than patients in their respective countries to agree with physician assistance in the suicide of a terminally ill patient (Japanese physicians and patients vs US physicians and patients, p < 0.05). Across various clinical scenarios, all four respondent groups accorded greatest authority to the patient, less to the family, and still less to the physician when the views of these persons conflicted. Japanese physicians and patients, however, relied more on family and physician authority and placed less emphasis on patient autonomy than the US physicians and patients sampled. Younger respondents placed less emphasis on family and physician authority.Conclusions: Family and physician opinions are accorded a larger role in clinical decision making by the Japanese physicians and patients sampled than by those in the United States, although both cultures place a greater emphasis on patient preferences than on the preferences of the family or physician. Our results are consistent with the view that cultural context shapes the relationship of the patient, the physician, and the patient's family in medical decision making. The results emphasize the need for clinicians to be aware of these issues that may affect patient and family responses in different clinical situations, potentially affecting patient satisfaction and compliance with therapy. [ABSTRACT FROM AUTHOR]

Published
2000
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125. Helicobacter pylori eradication prevents the development of gastric cancer - results of a long-term retrospective study in Japan

Author

KATO, M., primary, ASAKA, M., additional, NAKAMURA, T., additional, AZUMA, T., additional, TOMITA, E., additional, KAMOSHIDA, T., additional, SATO, K., additional, INABA, T., additional, Shirasaka, D., additional, OKAMOTO, S., additional, TAKAHASHI, S., additional, TERAO, S., additional, SUWAKI, K., additional, ISOMOTO, H., additional, YAMAGATA, H., additional, NOMURA, H., additional, YAGI, K., additional, SONE, Y., additional, URABE, T., additional, AKAMATSU, T., additional, OHARA, S., additional, TAKAGI, A., additional, MIWA, J., additional, and INATSUCHI, S., additional

Published
2006
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128. [Efficacy of acellular pertussis vaccine]

Author

Takaaki Gonda, Takashi Iwata, Tatsuo Aoyama, Yamshita N, Saito T, Yuji Murase, H. Iwai, and Akamatsu T

Subjects
Male, Bordetella pertussis, Dtp vaccine, Pediatrics, medicine.medical_specialty, biology, business.industry, Whooping Cough, Secondary infection, Significant difference, Outbreak, Infant, General Medicine, biology.organism_classification, Disease Outbreaks, Rate of development, Child, Preschool, Medicine, Humans, Female, Prospective Studies, business, Acellular pertussis, Diphtheria-Tetanus-Pertussis Vaccine
Abstract

An outbreak of pertussis occurred in one room of a residential facility where 19 children aged 5 to 36 months were residing. They were prospectively surveyed to estimate the efficacy of acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular DTP vaccine and 10 were unimmunized. The spread of pertussis was surveyed bacteriologically and serologically for 2 months. Among the 9 immunized, 7 children acquired the laboratory-confirmed pertussis and 1 of the 7 developed the typical symptoms (whooping or paroxysmal coughing attack lasting for 14 days or more). Among the 10 unimmunized, 7 children acquired the laboratory-confirmed pertussis and 6 of the 7 developed the typical symptoms. There was no difference in the rate of secondary infection (7/9:7/10), but there was a significant difference in the rate of development of the typical symptoms (1/7:6/7 p less than 0.05). The point estimate of protective efficacy of the acellular DTP vaccine against typical pertussis was (6/10 - 1/9)/(6/10) x 100 = 81%. It was concluded from these findings that acellular DTP vaccine could not prevent the infection of Bordetella pertussis, but could prevent the development of the typical symptoms.

Published
1990

149. TERUMO IMPLANTABLE LEFT VENTRICULAR ASSIST SYSTEM(T-ILVAS) WITH A MAG-LEV CENTRIFUGAL PUMP

Author

Nojiri, C., primary, Kijima, T., additional, Mori, T., additional, Yaegashi, M., additional, Maekawa, J., additional, Horiuchi, K., additional, Kido, T., additional, Sugiyama, T., additional, Sugiura, N., additional, Tsubouchi, T., additional, Asada, T., additional, Hill, B., additional, Mazur, D., additional, Umemural, W., additional, Akamatsu, T., additional, Ozaki, T., additional, and Suzuki, M., additional

Published
2001
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