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Author: Oshima

Posted on September 15, 2018

High Value Care の Question をやってみました

Eliminate Healthcare Waste

American College of Physicians (ACP) 会員の先生方が無料で利用できる、ACP が提供する教材には様々なものがあります。その中の一つに High Value Careというものがあります。一言でいうと限られた医療資源(端的にはお金とヒトですね)をもっとも効率的に活用するためのアプローチです。

Home > Clinical Information > High Value Care > Resources for Clinicians > Online Interactive High Value Care Cases

この教材では、まず症例が提示され、検査や治療の方針を4つの選択肢から答えさせる形式です。はじめの「Eliminate Healthcare Waste」をやってみましたので、その感想を述べさせていただきます。

まず、尿検査ひとつ出すにもコスト意識を求め、自分自身の感覚が高コスト体質だったことに気づかされます。私的には「ひっかけ」じゃないかと思う様な設問もありました。ネタバレになるのが心配ではありますが、設問の中で自身の施設ではMRIが$4000だというのを確認させて、その上で、検査を選ばせます。それまで、高額な検査を選んで「不正解」を選んできていますので、金額にひるんでしまい、より安価な単純Xp撮影で後日フォローしようと思ったところ、その設問はもっとも高額なMRIが正解でした。他の検査をしても結局MRIをしないと結論が得られないので、初めからMRIで検査するのが最も効率的にリソースを使う事につながるという考え方の様です。それにしても、さまざまな面で環境の違いを感じる事が出来ました。

(PRC委員長 大島)

Posted on August 29, 2018August 31, 2018

支部長挨拶

ACPは地球を救う!

 

ACP日本支部長 上野文昭

いまさらですが,ACPの存在価値はどこにあるのでしょうか.ACPには多くの優れた内科医,研修医,医学生が入会し,世界最大の医学系学術団体を構成しています.ACPはその会員に対し,豊富な教育リソースを提供しながら内科系医学の知識と技術の向上に寄与し,高い水準の医療で社会に貢献することを責務と考えています.ACPのミッションを達成するために,7つの具体的なゴールが明記されています.いずれも内科医の質の向上を目指したものですが,うち3つに”public”や”patients”というキーワードが含まれています.すなわちACPは会員だけを考えているわけではなく,よい内科医を育んで社会全体の健康を改善しようという意図を明らかにしています.最近変わったACPのロゴに,Leading Internal Medicine, Improving Livesというコピーがあります.後半部分にACPの強い意志が感じ取れます.

ほかの学会だって同じではないかという反論もあるでしょう.最先端の治療技術を開発し,学会員を適切に教育しているではないか.これが世の中のためでなくて何なんだという反論です.決定的に異なる点が2つあります.一つには他の学会はACPほど明確に社会のために活動するという意識や行動を前面に出していません.学会は学会員がその領域の学問を研究する場であるという認識が主体ではないでしょうか.ですから時折市民公開講座を主催することや患者向けガイドラインを作ることなどで,お茶を濁しているわけです.ACPの役員会議の議題の約半分は社会に関連したもので,少なくともACPのリーダーたちはこのゴールをしっかりと把握しています.

もう一つ忘れてはならない点があります.世界の医療はValue Based Medicineへと急速に舵を切り始めました.患者の価値観は重視されて当然ですが,患者を含めた社会の価値観も同様に大切です.つまりコストの問題です.医療資源は有限です.患者の自己負担だけでなく,社会全体の負担を真剣に考えないと,国の財政が破綻する恐れが出るほど医療費は高騰しています.これは一つの国だけでなく,われわれの地球が破滅する危険さえ感じられます.世の中の学会は新規診療技術の開発に没頭しています.一部の患者はその恩恵にあずかっていることは喜ばしいのですが,臨床応用された新しい高価な技術が医療費高騰の一因でもあります.多くの学会はそれぞれの分野の新規技術を何とか承認させて国庫負担にさせることで,学会の存在感をアピールしようとしているだけです.世の中も「新しい医療=よい医療」という勘違いに気づいていません.ACPの示している姿勢は正反対です.Value Based MedicineのACP流解釈がHigh Value Careであり,ここでは患者のアウトカム改善と同時にコスト意識が重視されています.ACPのHigh Value Care Initiativeは臨床医,教育者,患者に具体的なウェブ情報を提供し,コストを抑えたよい医療(多くは新しくはない)を実践することを支援しています.

ACPの活動は,医師を適切に教育し,患者と社会に貢献するだけでなく,さらに地球を救うことに繋がるのではないかという気がしてなりません.

 

Posted on July 19, 2018

Annals of Internal Medicine

2018年7月17日発行のAnnals of Internal Medicine誌に、ACP日本支部から投稿した記事が掲載されました。インパクトファクターの高いジャーナルですので、なかなか得難い名誉なことです。今回は元記事をFacebookに紹介してくださいましたPRCの委員の先生の他に、コメントを寄せてくださいました萩野昇先生にもAuthorとしてご参加いただきました。一方でLetterのAuthorは人数が限られていますので、公開後に議論にご参加いただいた先生のみで議論内容を確認して投稿いたしました。

(PRC 委員長 大島康雄)

Posted on July 14, 2018

Security update of WordPress

WordPress 4.9.7へアップデートしました

このサーバーはWordpressと言うソフトウェアで運用しています。今回サーバーのホストであります大学病院医療情報ネットワーク研究(UMIN)センターより、セキュリティアップデートを依頼するお知らせが参りましたので、対応いたしました。

まずは、アップデート前にデータのバックアップを行い、バックアップファイルをGoogleのクラウドディスクにコピーしました。(UMINのサーバーにも直近10回分ほどのバックアップデータは残しています。)

データをコピーしながら、プラグインの対応状況を見ましたら一つのプラグインが新しいWordpressへの対応を表明していません。常時稼働していて、ホームページ全体に影響のあるようなプラグインなので心配です。不具合が出ると困るのですが、今回はセキュリティアップデートと言う事ですので、そこは問題が起きても対応していただけるだろうと見切って、アップデートを実行しました。

今回のWordPress 4.9.6で明らかにされた脆弱性は、投稿権限者が本来編集できない筈の初期設定ファイルを削除したり、任意のコードを実行したりできるという事のようです。投稿権限者としてログインできるユーザーのみが攻撃者になりうる、という事です。現在それ以上の権限を有しているのはPRCの一部のメンバーのみです。この問題が解ってから手当てするまで、半年間ほど放置されていたようですが、権限を付与されたユーザーが適切にパスワード等を管理している限りは攻撃にさらされる危険はなかっただろうと思われます。

(PRC委員長 大島)

 

Posted on July 4, 2018July 14, 2018

acp-exchange 514 事務局交代のご挨拶とご連絡

事務局変更のお知らせです。
​(PRC 原 眞純​)

ACP日本支部会員各位

平素より大変お世話になっております。
このたび、ACP日本支部の事務局を7月1日より、ReasonWhy様より
引き継がせていただくことになりました、有限会社ビジョンブリッジの田野と申します。
どうぞよろしくお願いいたします。

事務局の担当は以下の通りでございます。

窓口:槇本香月(Kazuki Makimoto)
補佐:津村プリヤ(Priya Tsumura)
統括:田野紀子(Noriko Tano)

連絡先については、以下の通りでございます。

電話番号:03-5946-8576
E-mail:office
※メールアドレスにつきましては、変更はございません。

以上、今後とも何卒よろしくお願い申し上げます。

田野紀子(Noriko Tano)

***********************************************************
ACP Japan Chapter

Shin-Kagurazaka Building 2F, 43 Tansumachi, Shinjuku-ku
Tokyo 162-0833, Japan
Phone: +81 3 5946-8576 Fax: +81 3 5229-6889

一般社団法人米国内科学会日本支部事務局
〒162-0833 東京都新宿区箪笥町43 新神楽坂ビル2階
有限会社ビジョンブリッジ内

E-mail:office
http://www.acpjapan.org
***********************************************************

Posted on June 21, 2018November 5, 2018

Public Relations Committee welcomes new members!

New members joining on upcoming fiscal year!

Hi all,

I am very pleased to announce that our team is growing. Upcoming fiscal year, following four members will be joining us. Please join me in welcoming our new team members!

Best regards,

PRC chair Yasuo Oshima MD PhD FACP

Public Relations Committee
Member

Kiyoshi Shikino MD, PhD

Institution
 
Chiba University Hospital
Department/Division
 
General Medicine
Job Title
 
Project Assistant Professor
Message
 
Where there's a will, there's a way.
1
Public Relations Committee
Member

Mao Otake MD

Institution
 
Tokyo Medical and Dental University Hospital
Job Title
 
Resident
Message
 
We fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal. (Corinthians 4:18)
1
Public Relations Committee
Member

Kazuhiro Yasuo MD, FACP

Institution
 
Sapporo Higashi Tokushukai Hospital
Department/Division
 
General Internal Medicine
Job Title
 
Director
Message
 
Be ambicious.
Public Relations Committee
Member

Tomokiyo Yamamoto MD

Institution
 
Aizawa Hospital
Department/Division
 
General Internal Medicine
Job Title
 
Chief
Message
 
Rome was not bulit in a day
Posted on June 19, 2018June 23, 2018

Welcome Five New Chairs

Dear Colleagues,

 

The activity of Japan Chapter is supported by voluntary work of committee members.  As of 30 June, the chairs of 5 among 11 committees will accomplish their terms.  I want to thank all outgoing chairs for their contribution. At the same time, I would like to welcome five new chairs.

 

Fumiaki Ueno, MD, MACP

Governor for ACP Japan Chapter

 

New Chairs:

Scientific Program Committee

Sugihiro Hamaguchi MD, PhD, ACP member

Chair
Institution
 
Fukushima Medical University
Department/Division
 
Department of General Internal Medicine
Job Title
 
Professor
Message
 
People don't buy what you do; they buy why you do it.
Local Nominations Committee

Masao Nagayama MD, PhD, FACP, FAAN, FNCS

Chair
Institution
 
International University of Health and Welfare Graduate School of Medicine
Department/Division
 
Department of Neurology
Job Title
 
Professor
Message
 
Never give up !
Resident Fellow Committee

Yoshito Nishimura MD, ACP member

Chair
Institution
 
Okayama University Hospital
Department/Division
 
General Medicine
Job Title
 
Clinical Fellow
Message
 
Respect, trust, and work with empathy and passion in mind.
International Exchange Program Committee

Tetsuya Makiishi MD, FACP, FASN

Chair
Institution
 
Saiseikai Shiga Hospital
Department/Division
 
Division of Nephrology and Dialysis
Job Title
 
Chief
Message
 
Think big, start small, move fast!
Credentials/Membership Committee

Koichiro Yuji MD, PhD, FACP

Chair
Institution
 
The Institute of Medical Science, The University of Tokyo
Department/Division
 
Project Division of International Advanced Medical Research
Job Title
 
Project Associate Professor
Message
 
The Singularity Is Near

 

Posted on June 18, 2018

Chapter Business Report 2017-2018: ECPC

Early Career Physicians Committee

Chair: Akihito Kawashima, MD

Report:

  • At the ACP Japan Chapter Annual Meeting 2018, we held a lecture session on “how to train speaking skills in English” for young doctors and medical students who have difficulty speaking out at international conferences because of language barriers.
  • To facilitate active discussions inside our committee, we made a SNS group account for the members.

Plan:

  • This fall we’re planning to hold a spin-off workshop of the lecture session in the Annual Meetig 2018 in the Kanto area. This time, the focus will be on “how to read medical English efficiently”.
  • We’re also interested in advancement of technology in medicine. We’re now discussing ideas about holding an event featuring deep learning and application of AIs to medicine.
Posted on June 9, 2018June 9, 2018

Kurokawa Prize in Early Career Physician

Section: Recipient’s Remarks

Kiyoshi Shikino, MD

Department of General Medicine, Chiba University Hospital

I am honored to have received the Kurokawa Prize at the ACP Chapter Annual Meeting, 2018. The “Best Abstract Award” was named as the “Kurokawa Prize” beginning in 2018, I am especially honored to be the first person to be awarded this prize.

Research particulars

What triggered this research was that I felt that there were few physicians who could perform the fundus examination confidently. Even when I observed others, few doctors were using the ophthalmoscope with confidence in actual medical practice, except for my mentor, Professor Masatomi Ikusaka. Makoto Kikugawa (Department of Medical Education, Kyushu University), one of the co-researchers, reported that approximately 90% of junior residents, senior residents, and fellows in internal medicine performed the fundus examination less than once in a few months. He also reported that the reason for the problem was mostly that they were not proficient at the fundus examination.

When I taught residents the fundus examination, I discovered why observing the fundus was difficult for them. Funduscopy is inherently difficult to teach because there is no way to verify that the learners have obtained a proper view of the fundus. The teacher cannot give students feedback on whether what they are seeing or the teacher is seeing.Furthermore, it is extremely difficult for the teachers to point out why learners cannot observe the fundus. It was such a dilemma.

Turning point

The turning point of our research was a visit to the Department of Internal Medicine, Stanford University Medical School in March 2017 where I met Dr. Errol Ozdalga and learned the educational method using the iExaminer system for fundus examination. I talked with him about implementing this educational method in Japan as well as to conduct research on its educational effect. He approved of it pleasantly.

Introduction to Clinical Clerkship at Chiba University School of Medicine

First, because of actual instruction in using this iExaminer system, student satisfaction was high, and I heard students saying that they wanted to use it actively even in future clinical training. Next, in order to confirm whether the skill really improved, I asked for the cooperation of the fundus examination simulator at the Chiba Clinical Skills Center. To evaluate the educational effects, we assessed fundus examination skills in a pre-test and a post-test. Discussions between co-researcherswere intense, raising questions such as what to make the subject matter, how many cases we must prepare, and so on. Since we were particularly interested in evaluating skills in “observing fundus,” I was keen to prevent the evaluation of skills in “interpreting fundus.” In addition,to minimize the influence of teachers’ educational skills, we developed an instructional design, led the faculty development, and randomly assigned the teachers.

Future expectations

In this study, the diagnostic accuracy of a fundus examination improved by using the iExaminer system and the time taken to identify funduscopic findingswas shortened. The iExaminer system can be implemented immediately because it can be used for free if you have the adapter and an iPhone. By spreading this teaching method, I hope that more internists can examine the fund us with confidence.

Poster_ACP Japan 2018_Shikino

 

Posted on June 9, 2018June 9, 2018

Chapter Business Report 2017-2018: IEPC

International Exchange Program Committee

Chair: Harumi Gomi MD, MPH, FACP

Report:

What We Accomplished

  • Clinical observership at Olive View Medical Center, University of California, Los Angeles (UCLA) was initiated in 2012, and ended as of August 2017. Since 2012 until the end of the program, there had been a total of sixteen observers through this program.
  • Masayuki Nogi and Jinichi Tokeshi, and other supportive local physicians at Department of Medicine, University of Hawaii kindly offered clinical observership for our two members in November 2017 and February 2018, respectively.
  • The committee has created evaluation criteria (evaluation sheet) for the candidates’ CVs and personal statement.
  • Mentorship has been introduced for each observer before, during, and after the observership.
  • An Email list serve for the alumni members of this program, committee members, and the ACP council members has been launched for a weekly report from the Olive View Medical Center by observers.

What We Were Already Working On

  • Revision of credential evaluation/support for the candidates

 

What We Initiated

  • More strategic recruitment for the candidates of the observership.
  • New members who are still early in their career (such as Drs. Yuji Yamada, Emily Muranaka) joined this committee to support the members to obtain international medical experiences.
  • After the obsevership at Olive View Medical Center, University of California, Los Angeles ended, our committee tried to find any new programs for clinical observership and Dr. Takahiko Tsutsumi has significantly contributed to explore and support the clinical observership program at University of Hawaii.
  • The committee will organize a seminar to help early career physicians understand clinical and research experiences they could have in international settings for physicians in early career at the annual meeting of ACP Japan Chapter in June 2018.

Plan:

What We Plan To Work On

  • discussion on how this committee could explore or continue any exchange programs or international exchange activities after the UCLA program ended. This includes accepting students/residents/fellows from other countries.
  • How to disseminate the experience report to the younger ACP members and non-members, and those who are interested in the clinical observership in the United States.
  • More comprehensive recruitment and support systems for the program applicants.
  • Creating alumni members activities and leadership to share and sustain learning experiences after the observership.

Seminar Notice

International Exchange Program Committee

ACP Japan Chapter Annual Meeting

Luncheon seminar

Time: 11:40-12:40, Saturday, June 2, 2018

“Why not pursue a global career path?”

Held by International Exchange Program Committee

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Shin-kagurazaka building 2F
43 Tansu-machi, Shinjuku-ku, Tokyo 1620833 Japan

E-mail
office@acpjapan.org

 

Disclaimers

The findings and views expressed in the submitted article are his or her own and not an official position of the institution or the college.

Unless otherwise stated, this website and all content within this site are the property of the authors and are licensed under a Creative Commons BY Attribution 4.0 International license.

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