| 複合語 | スコア |
|---|---|
| uncomplicated diverticulitis | 520.80474927208 |
| acute diverticulitis | 418.81479435056 |
| complicated diverticulitis | 248.2289508251 |
| recurrent diverticulitis | 127.61545808739 |
| complicated disease | 111.42002809531 |
| acute colonic diverticulitis | 100.72226537515 |
| uncomplicated disease | 86.580881619622 |
| abdominal pain | 76.911661151322 |
| inflammatory bowel disease | 73.842824849867 |
| increased risk | 65.214963143546 |
| diverticular disease | 59.390784046077 |
| incident diverticulitis | 49.45317468774 |
| abdominal imaging | 47.23175211037 |
| colonic diverticulitis | 45.118877898911 |
| history of diverticulitis | 44.338210423658 |
| symptomatic uncomplicated diverticular disease | 38.955277706314 |
| strate ll | 38.359328358189 |
| am j gastroenterol | 37.152951337623 |
| acute episode | 35.382742924933 |
| sigmoid diverticulitis | 35.151543534868 |
| suspected diverticulitis | 34.725385463817 |
| severe diverticulitis | 34.275883049016 |
| recurrent disease | 33.414187838691 |
| american society of colon | 33.07927853605 |
| dis colon rectum | 31.175046758317 |
| diagnosis of diverticulitis | 30.073065967872 |
| elective surgery | 29.842768221688 |
| abdominal ct | 28.833736969617 |
| low-fiber diet | 28.761380723141 |
| clin gastroenterol hepatol | 28.491801279155 |
| colon cancer | 28.136031705246 |
| percutaneous drainage | 26.958995747902 |
| perforated diverticulitis | 26.044039097863 |
| br j surg | 26.010395580964 |
| bowel habits | 25.744787543708 |
| risk of diverticulitis | 25.427668301235 |
| disease severity | 23.932331536252 |
| irritable bowel syndrome | 23.321049637337 |
| antibiotic treatment | 23.140060868153 |
| immunocompromised patients | 22.840524575036 |
| high-fiber diet | 22.304567212867 |
| surgical intervention | 21.686448086636 |
| acute uncomplicated diverticulitis | 21.457232736063 |
| initial episode of diverticulitis | 20.596397618848 |
| clear liquid diet | 20.045605887726 |
| physical examination | 19.720768992425 |
| american gastroenterological association | 19.718763332722 |
| red meat | 19.027313840044 |
| bowel obstruction | 18.448253771601 |
| cases of diverticulitis | 18.172404327683 |
| diverticulitis treatment | 17.362692731908 |
| mild diverticulitis | 17.362692731908 |
| acute uncomplicated sigmoid diverticulitis | 17.346633172924 |
| risk of incident diverticulitis | 17.338968240675 |
| acute complicated diverticulitis | 17.156138686604 |
| episode of diverticulitis | 17.084799980876 |
| acute sigmoid diverticulitis | 17.056092941653 |
| risk factors | 16.9443127662 |
| incident episode | 16.71181620517 |
| recurrent episodes | 16.486177230327 |
| diverticular bleeding | 16.431676725155 |
| diverticulitis present | 16.420620960903 |
| clinical diagnosis | 16.214401857684 |
| management of diverticulitis | 16.157806223411 |
| giovannucci el | 15.874507866387 |
| risk factor | 15.577291619844 |
| family history of diverticulitis | 15.175555517272 |
| large abscesses | 15 |
| colonic resection | 14.757049888818 |
| low vitamin d levels | 14.653432934541 |
| mild abdominal pain | 14.324702914937 |
| elevated leukocyte count | 14.217014705099 |
| surgical risk | 14.119453697294 |
| crp levels | 14.042083915924 |
| elective resection | 13.953485904069 |
| low fiber intake | 13.94327126918 |
| other causes | 13.8654187622 |
| acute abdominal pain | 13.819656392708 |
| comorbid conditions | 13.817338054791 |
| studies of diverticulitis | 13.808041302263 |
| stage ib disease | 13.70815986105 |
| moderate disease | 13.63463239761 |
| clinical trial | 13.558244897081 |
| complicated colonic diverticular disease | 13.274289840469 |
| recurrent sigmoid diverticulitis | 13.261380785769 |
| clinical diagnosis of diverticulitis | 13.035979826083 |
| management of patients | 13.027111248653 |
| randomized trials | 12.520676640586 |
| second episode | 12.485374350864 |
| acute left-sided colonic diverticulitis | 12.331129506591 |
| intravenous antibiotics | 12.320281152964 |
| sigmoid colon | 12.29453329824 |
| magnetic resonance imaging | 12.237893415933 |
| biliary disease | 12.12309302806 |
| clinical guidelines | 12.10960041614 |
| symptoms of diverticulitis | 11.958114544265 |
| j gastrointest surg | 11.943790305691 |
| ann surg | 11.771323825531 |
| inflammatory markers | 11.618950038622 |
| episodes of diverticulitis | 11.611132432748 |
| medical treatment | 11.570030434076 |
| studies of incident diverticulitis | 11.540915938253 |
| incident disease | 11.509839833591 |
| ct-proven uncomplicated acute diverticulitis | 11.437219095645 |
| diverticulitis severity | 11.425294349672 |
| acute mild-to-moderate colonic diverticulitis | 11.307695614824 |
| presence of complications | 10.843224043318 |
| comorbid disease | 10.779123358892 |
| abdominal rigidity | 10.669676460234 |
| treatment approach | 10.63659179389 |
| management of acute complicated | 10.508684854699 |
| severe signs | 10.498906534742 |
| prospective diverticulitis diet study | 10.445350291082 |
| nonsteroidal anti-inflammatory drugs | 10.414240341373 |
| signs of diverticulitis | 10.323918866196 |
| ct-proven uncomplicated diverticulitis | 10.213093392106 |
| differential diagnosis of acute colonic diverticulitis | 10.186395610963 |
| sigmoid colectomy | 10.182919580087 |
| outpatient setting | 10.182919580087 |
| emergency surgery | 9.9085018560689 |
| primary anastomosis | 9.7979589711327 |
| acute diverticulitis ranges | 9.7878329518942 |
| colonic diverticular abscess | 9.7552358675619 |
| physical activity | 9.7155955213931 |
| reduced risk of diverticulitis | 9.7060537262749 |
| oral antibiotics | 9.603257618831 |
| uncomplicated diverticulitis report | 9.5457215127482 |
| gastroenterology consultation | 9.4868329805051 |
| systematic review | 9.3613892772829 |
| liu yl | 9.3613892772829 |
| perforated colonic diverticular disease | 9.2884370061669 |
| first episode | 9.2115587031938 |
| presumed acute diverticulitis | 9.1482496032301 |
| prophylactic surgery | 9.1091108301324 |
| studies of incident disease | 9.0831785199042 |
| j clin gastroenterol | 9.0526458194936 |
| chronic abdominal pain | 9.0239973680098 |
| clear recurrent diverticulitis | 8.9617026317507 |
| peery af | 8.9442719099992 |
| first episode of diverticulitis | 8.9419411546424 |
| pain management | 8.8011173679339 |
| positive predictive value | 8.7125736655226 |
| colorectal dis | 8.7117543493857 |
| randomized trial | 8.662947082672 |
| uncomplicated hinchey stage ia diverticulitis | 8.4966700909043 |
| hinchey stages | 8.4852813742386 |
| exacerbation of pain | 8.3235829005756 |
| american college of gastroenterology | 8.2813616669306 |
| elective colectomy | 8.2390685756285 |
| pelvic examination | 8.1698094459945 |
| resolution of incident diverticulitis | 8.1606599210425 |
| severe presentation | 8.1072009288422 |
| severity of presentation | 8.1072009288422 |
| severe disease | 7.9774438454175 |
| computed tomography | 7.9774438454175 |
| other causes of pain | 7.8331299233844 |
| other risk factors | 7.7482600954267 |
| moderate abdominal pain | 7.7459666924148 |
| colon resection | 7.7113082540691 |
| location of diverticulitis | 7.640554827845 |
| predictors of diverticulitis | 7.640554827845 |
| imaging-confirmed diverticulitis | 7.640554827845 |
| refractory diverticulitis | 7.640554827845 |
| colon wall | 7.5585334178227 |
| unrestricted diet | 7.5023322452342 |
| incident event | 7.4737514124485 |
| natural history of diverticulitis | 7.2325505782833 |
| lifestyle factors | 7.200411487357 |
| high risk | 7.1242059320178 |
| increased likelihood of diverticulitis | 7.0491001548477 |
| abdominal quadrant | 7.0210419579621 |
| patient information | 6.9282032302755 |
| development of diverticulitis | 6.9040206511316 |
| aspects of diverticulitis | 6.9040206511316 |
| called diverticulitis | 6.9040206511316 |
| risks of diverticulitis | 6.9040206511316 |
| diagnosed diverticulitis | 6.9040206511316 |
| possible diverticulitis | 6.9040206511316 |
| prevalence of diverticulitis | 6.9040206511316 |
| probability of diverticulitis | 6.9040206511316 |
| area of diverticulitis | 6.9040206511316 |
| am j surg | 6.87767482356 |
| abdominal lavage | 6.817316198805 |
| dutch diverticular disease | 6.7807496594118 |
| chronic abdominal symptoms | 6.7807496594118 |
| galanko ja | 6.6400915182019 |
| prospective study | 6.5934915059146 |
| surgical risk profile | 6.5571773235281 |
| acute setting | 6.5189768155556 |
| clinical presentation | 6.4474195909412 |
| rectal surgeons | 6.4021717458874 |
| urgent surgery | 6.3559436556225 |
| diverticular complications | 6.3442275806434 |
| quality of life | 6.3442275806434 |
| chan at | 6.3442275806434 |
| case-by-case basis | 6.3442275806434 |
| colonic inflammation | 6.3205987620538 |
| scand j gastroenterol | 6.276754041649 |
| pelvic inflammatory disease | 6.269858125439 |
| crp level | 6.2603383202932 |
| severe pain | 6.2233297728848 |
| prospective study of patients | 6.1981751306029 |
| selected patients | 6.160140576482 |
| immunocompetent patients | 6.160140576482 |
| ill patients | 6.160140576482 |
| significant comorbid disease | 6.147977838025 |
| surgical resection | 6.1212733961481 |
| elective surgical resection | 6.0805789927024 |
| oral intake intolerance | 6.0364780843227 |
| other potential risk factors | 6.0226744921886 |
| aldoori wh | 6 |
| andeweg cs | 6 |
| absence of vomiting | 6 |
| opiate analgesics | 6 |
| van goor h | 5.9875903310478 |
| entire sigmoid colon | 5.9792452101027 |
| unstable comorbid disease | 5.8601559088987 |
| urgent surgical management | 5.8204206926748 |
| laparoscopic approach | 5.7850152170382 |
| short-term risk | 5.764242834204 |
| surgical infection society | 5.7538760949966 |
| iv disease | 5.7326567532262 |
| liquid intake | 5.7326567532262 |
| aggressive disease | 5.7326567532262 |
| surgical approach | 5.7326567532262 |
| stage ii disease | 5.7072770564551 |
| complicated recurrence | 5.6842755776622 |
| american gastroenterological association institute guidelines | 5.6621318851915 |
| recurrent symptoms | 5.6596143646095 |
| subsequent episodes | 5.6568542494924 |
| small abscesses | 5.6346264945225 |
| west j | 5.6346264945225 |
| segal j | 5.6346264945225 |
| mortensen j | 5.6346264945225 |
| fiber intake | 5.6346264945225 |
| clinical trial of antibiotics | 5.6251079610849 |
| healthy lifestyle | 5.5663153674275 |
| important risk factor | 5.5567769900768 |
| biliary causes of pain | 5.4940016093908 |
| laparoscopic lavage | 5.4711295994695 |
| initial evaluation | 5.4711295994695 |
| severe clinical presentation | 5.4400868459948 |
| intestinal diversion | 5.4216120216591 |
| medical management | 5.3835632709553 |
| elective sigmoid colectomy | 5.3778905874053 |
| abdominal radiography | 5.3348382301168 |
| imaging-confirmed disease | 5.3348382301168 |
| nonsurgical treatment | 5.318295896945 |
| role of diet | 5.3049500053196 |
| urinary causes of pain | 5.2934292577264 |
| hospital readmission | 5.26429605181 |
| feinberg r | 5.26429605181 |
| several studies | 5.26429605181 |
| bolus r | 5.26429605181 |
| long-term risk | 5.2085813742804 |
| decreased risk | 5.2085813742804 |
| keeley br | 5.1800401282227 |
| quadrant tenderness | 5.1800401282227 |
| severe presentations | 5.1800401282227 |
| red meat intake | 5.1395931737013 |
| colonic diverticula | 5.1140388795202 |
| klausner j | 5.0914597900437 |
| clinical setting | 5.0914597900437 |
| warusavitarne j | 5.0914597900437 |
| burcharth j | 5.0914597900437 |
| winkelhagen j | 5.0914597900437 |
| groenewoud j | 5.0914597900437 |
| surgical treatment algorithms | 5.0846058136676 |
| prospective cohort study | 5.0712776148561 |
| other sources of pain | 5.0607888021286 |
| syngal s | 4.9979987988788 |
| biondo s | 4.9979987988788 |
| american gastroenterological association institute guideline | 4.995433437493 |
| int j surg | 4.9726966324974 |
| prophylactic colonic resection | 4.9561149113536 |
| int j colorectal dis | 4.9541639996482 |
| nonsurgical management | 4.9492320038398 |
| comorbid diseases | 4.9492320038398 |
| large diverticular abscesses | 4.9426469173262 |
| potential gynecologic causes of pain | 4.9353485907905 |
| bowel continuity | 4.890452073807 |
| common complication of diverticulitis | 4.8875730663905 |
| american gastroenterological association guideline | 4.8817587550099 |
| inflamed colon | 4.8294728055328 |
| abdominal distention | 4.8205705136679 |
| abdominal ultrasonography | 4.8205705136679 |
| surgical consultation | 4.8205705136679 |
| cardiovascular disease | 4.8205705136679 |
| antimicrobial therapy | 4.7935634538569 |
| mainstay of therapy | 4.7935634538569 |
| several other diseases | 4.7911558306184 |
| complicated cases | 4.7798869565704 |
| acute cholecystitis | 4.7660920451877 |
| acute pancreatitis | 4.7660920451877 |
| acute gastroenteritis | 4.7660920451877 |
| diffuse peritonitis | 4.7568284600109 |
| healthy body weight | 4.75235359513 |
| university of washington school of medicine | 4.7259408183398 |
| wu k | 4.6806946386414 |
| intravenous treatment | 4.6806946386414 |
| laurell h | 4.6806946386414 |
| predominant risk factors | 4.6648137477995 |
| population-based study | 4.6057793515969 |
| monitoring of vitamin d levels | 4.5823370750615 |
| gynecologic causes | 4.5799756509618 |
| consumption of nuts | 4.5590141139096 |
| vu m | 4.5590141139096 |
| cross-sectional imaging | 4.5590141139096 |
| nonsteroidal anti-inflammatory drugs increases risk | 4.5572590051374 |
| kreisler e | 4.4267276788013 |
| clinical findings | 4.4267276788013 |
| feculent peritonitis | 4.4267276788013 |
| clinical evaluation | 4.4267276788013 |
| cohen e | 4.4267276788013 |
| generalized peritonitis | 4.4267276788013 |
| clinical features | 4.4267276788013 |
| further intervention | 4.4267276788013 |
| risk factor models | 4.4104168198003 |
| other conditions | 4.4093335205248 |
| missed colon cancer | 4.4088173933227 |
| bowel wall abnormalities | 4.3594283666312 |
| hospitalization management | 4.3558771746929 |
| outpatient management | 4.3558771746929 |
| imaging tests | 4.3558771746929 |
| chronic symptoms | 4.3558771746929 |
| biliary imaging | 4.3558771746929 |
| high red meat intake | 4.3534525243937 |
| chronic intestinal symptoms | 4.3177997910652 |
| complicated intra-abdominal infection | 4.29347189977 |
| leukocyte count | 4.2813902858562 |
| hjern f | 4.2813902858562 |
| fuller g | 4.2813902858562 |
| patient factors | 4.2813902858562 |
| emergency department | 4.2813902858562 |
| several guidelines | 4.2813902858562 |
| appropriate treatment | 4.2294850537623 |
| recent studies | 4.2294850537623 |
| am surg | 4.2128659306105 |
| location of pain | 4.1617914502878 |
| clinical presentation ranges | 4.1601676461038 |
| urgent surgical intervention | 4.1601676461038 |
| misdiagnosed colon cancer | 4.1207243899042 |
| lam?ris w | 4.1195342878142 |
| multivariate analysis of risk factors | 4.116347017223 |
| percutaneous abscess drainage | 4.0810664157777 |
| red meat consumption | 4.079297805311 |
| one study | 4.0536004644211 |
| inflammatory mass | 4.0536004644211 |
| neumann i. american gastroenterological association institute | 4.0479034640508 |
| aggressive surgical approach | 4.0356543087298 |
| multicenter randomized clinical trial | 4.0154154577774 |
| young age | 4 |
| high-quality colonoscopy | 4 |
| serum levels of vitamin d | 3.9943569808963 |
| population-based cohort study | 3.9924777441758 |
| urgent sigmoid colectomy | 3.9895148616825 |
| oral intake | 3.9842826037303 |
| uncontrolled prospective study | 3.9468319327726 |
| humes dj | 3.9359793425309 |
| daniels l | 3.9359793425309 |
| guide management | 3.9359793425309 |
| gastrointestinal condition | 3.9359793425309 |
| wu aw | 3.9359793425309 |
| multiple recurrent episodes | 3.923519405471 |
| out-patient management of patients | 3.9148676411689 |
| hinchey stage iv | 3.8883225944793 |
| hinchey stage iii | 3.8883225944793 |
| external validation study | 3.8467222990467 |
| imaging test | 3.8336586254776 |
| surgical input | 3.8336586254776 |
| several observational studies | 3.8127371719878 |
| other medications | 3.8067540958393 |
| anti-inflammatory drug | 3.8067540958393 |
| other forms of colitis | 3.8027429028336 |
| rosenberg j. treatment of patients | 3.7969551597047 |
| role of surgery | 3.7792667089114 |
| elevated crp levels | 3.7719455481171 |
| lower-abdominal pain | 3.7606030930864 |
| pain relief | 3.7606030930864 |
| pain control | 3.7606030930864 |
| suprapubic pain | 3.7606030930864 |
| persistent pain | 3.7606030930864 |
| stomach pain | 3.7606030930864 |
| special diet | 3.7511661226171 |
| whole grains | 3.7224194364084 |
| clinical scenarios | 3.7224194364084 |
| clinical judgment | 3.7224194364084 |
| clinical criteria | 3.7224194364084 |
| golda t | 3.7224194364084 |
| secondary prevention | 3.7224194364084 |
| nonaspirin nsaids | 3.7224194364084 |
| large abscess | 3.7077927510673 |
| clin infect dis | 3.7062880231628 |
| chronic intestinal inflammation | 3.6889272467625 |
| large prospective study of men | 3.6852485896495 |
| elective open surgery | 3.6711480767753 |
| such patients | 3.6628415014847 |
| role of antibiotics | 3.6628415014847 |
| elective basis | 3.6628415014847 |
| alternative diagnosis | 3.6628415014847 |
| differential diagnosis | 3.6628415014847 |
| anti-inflammatory medications | 3.6371357625641 |
| missed case of colon cancer | 3.6182542628146 |
| other features | 3.6002057436785 |
| family history | 3.6002057436785 |
| chronic onset of symptoms | 3.5953592505049 |
| infectious causes | 3.5840246342157 |
| common causes | 3.5840246342157 |
| multidetector-row abdominal computed tomography | 3.5803086727106 |
| gunnarsson u. acute | 3.5682199372844 |
| alcohol use | 3.5676213450082 |
| follow-up treatment | 3.5565588200778 |
| delayed treatment | 3.5565588200778 |
| appropriate initial imaging method | 3.5314980576952 |
| small trial | 3.5227366699756 |
| initial therapy | 3.5227366699756 |
| third episode | 3.4996355115806 |
| population-based case-control study | 3.4877505632064 |
| several classification systems | 3.4877505632064 |
| multiple comorbid conditions | 3.4877505632064 |
| c-reactive protein | 3.4641016151377 |
| hartmann pouch | 3.4641016151377 |
| martin cf | 3.4641016151377 |
| cao y | 3.4641016151377 |
| et al | 3.4641016151377 |
| bleichrodt rp | 3.4641016151377 |
| clinical decision rule | 3.4641016151377 |
| hemodynamic instability | 3.4641016151377 |
| stages ib | 3.4641016151377 |
| free perforation | 3.4641016151377 |
| lidor ao | 3.4641016151377 |
| yu q | 3.4641016151377 |
| liver dis | 3.4641016151377 |
| vrouenraets bc | 3.4641016151377 |
| united states | 3.4641016151377 |
| organ transplant | 3.4641016151377 |
| elective segmental colectomy | 3.4641016151377 |
| functional bowel disorders | 3.4600805875852 |
| plain abdominal radiography | 3.4270399652625 |
| successful nonsurgical treatment | 3.4199518933534 |
| fiber-rich diet | 3.3895612242702 |
| diet modification | 3.3895612242702 |
| other forms of immunosuppression | 3.3878587775517 |
| other pathologic conditions | 3.3878587775517 |
| favorable risk profiles | 3.3727537590827 |
| stage iii | 3.3635856610149 |
| collaborative study group | 3.3604214537127 |
| inflammatory colitis present | 3.3604214537127 |
| natural history | 3.3503689588345 |
| other reasons | 3.3503689588345 |
| unstable comorbid conditions | 3.3244690547396 |
| aga institute clinical guidelines committee | 3.317096083012 |
| several medications | 3.3097509196469 |
| severe infection | 3.3097509196469 |
| nonoperative management | 3.3097509196469 |
| hinchey stages iii | 3.3019272488946 |
| imaging method of choice | 3.3019272488946 |
| genitourinary causes | 3.2385318404644 |
| clinical scoring system | 3.2377408137211 |
| increased crp level | 3.2377408137211 |
| use of aspirin | 3.2237097954706 |
| aspirin use | 3.2237097954706 |
| use of nsaids | 3.2237097954706 |
| intestinal tract | 3.2237097954706 |
| extent of colon involvement | 3.2070432430251 |
| dietary recommendations | 3.2010858729437 |
| high rate of recurrence | 3.1664800441388 |
| nonsurgical approach | 3.1622776601684 |
| chronic obstruction | 3.1622776601684 |
| strate le | 3.1543421455299 |
| dr. strate | 3.1543421455299 |
| routine elective resection | 3.1276103486556 |
| population-based study of twins | 3.1072325059539 |
| laparoscopic resection | 3.0885906193877 |
| several decision tools | 3.0861636884341 |
| feingold d | 3.080070288241 |
| elderly patients | 3.080070288241 |
| uncertain diagnosis | 3.080070288241 |
| colorectal cancer | 3.080070288241 |
| hinchey classification scheme help | 3.080070288241 |
| black d | 3.080070288241 |
| dose of antibiotics | 3.080070288241 |
| individual patients | 3.080070288241 |
| inflammatory response | 3.080070288241 |
| prior diagnosis | 3.080070288241 |
| stable patients | 3.080070288241 |
| park d | 3.080070288241 |
| modified hinchey classification scheme | 3.080070288241 |
| gastrointestinal symptoms | 3.080070288241 |
| western dietary pattern | 3.0717076619745 |
| other immunosuppressive medications | 3.0717076619745 |
| other diagnoses | 3.0274001040351 |
| such factors | 3.0274001040351 |
| other measures | 3.0274001040351 |
| clinical slide set | 3.0261714988458 |
| high rate of complications | 3.0182390421613 |
| heavy use | 3 |
| avod study group | 2.9937951655239 |
| low recurrence rates | 2.9937951655239 |
| potential benefit of antibiotics | 2.9937951655239 |
| rectal examination | 2.9622566376653 |
| laparoscopic drainage | 2.9622566376653 |
| other worrisome features | 2.9595672453546 |
| normal leukocyte count | 2.9595672453546 |
| other important confounders | 2.9595672453546 |
| two recent cross-sectional studies | 2.9515681170161 |
| patient preference | 2.9129506302439 |
| ovarian conditions | 2.9129506302439 |
| urinary symptoms | 2.9129506302439 |
| actual intake | 2.9129506302439 |
| several reasons | 2.9129506302439 |
| western dietary pattern increases | 2.9027111225923 |
| small peridiverticular abscess | 2.8944289122796 |
| dietary patterns | 2.8925076085191 |
| prudent dietary pattern | 2.8709877393707 |
| one trial | 2.8502698827718 |
| new theories of disease pathogenesis | 2.8473146873576 |
| ecological studies | 2.8284271247462 |
| stool studies | 2.8284271247462 |
| retrospective studies | 2.8284271247462 |
| abscess formation | 2.8173132472613 |
| high likelihood | 2.8173132472613 |
| kaiser am | 2.8173132472613 |
| heavy alcohol use | 2.8039657955522 |
| post-transplant patients | 2.7831576837137 |
| obese patients | 2.7831576837137 |
| increased morbidity | 2.7831576837137 |
| gastrointestinal diseases | 2.7831576837137 |
| many patients | 2.7831576837137 |
| adherent patients | 2.7831576837137 |
| informed patients | 2.7831576837137 |
| numbers of patients | 2.7831576837137 |
| proportion of patients | 2.7831576837137 |
| short-term antibiotic therapy | 2.7803981823681 |
| clear evidence of inflammation | 2.766175108537 |
| image-guided percutaneous drainage | 2.7578805125536 |
| nonstandardized surgical technique | 2.7494592739972 |
| rectal surgeons guideline | 2.736580418555 |
| fiber supplements | 2.7355647997348 |
| fiber supplementation | 2.7355647997348 |
| medical prevention | 2.7355647997348 |
| van dieren s | 2.7322193018926 |
| infectious diseases society of america | 2.7231572672423 |
| pericolonic inflammatory changes | 2.7200434229974 |
| nsaid use | 2.7108060108295 |
| corticosteroid use | 2.7108060108295 |
| such complications | 2.7108060108295 |
| regular use | 2.7108060108295 |
| refractory symptoms | 2.7108060108295 |
| van randen a | 2.6960123091946 |
| postoperative intra-abdominal abscess | 2.6889452937027 |
| such chronic manifestations | 2.66716827534 |
| moller h. association | 2.66716827534 |
| rectal surgeons practice parameters | 2.6617978356723 |
| other racial groups | 2.6366746651365 |
| segmental colitis | 2.632148025905 |
| number of episodes | 2.632148025905 |
| role of immunosuppression | 2.632148025905 |
| several days | 2.632148025905 |
| patient stability | 2.632148025905 |
| west j. role | 2.6207413942089 |
| concurrent drug use | 2.6207413942089 |
| adequate medical therapy | 2.5987138004586 |
| positive predictive values | 2.5873402367724 |
| high-quality examination | 2.5755095769014 |
| diver trial | 2.5755095769014 |
| physical inactivity | 2.5755095769014 |
| controlled trial | 2.5755095769014 |
| basic patient information | 2.5697965868507 |
| useful imaging alternatives | 2.5697965868507 |
| in-depth patient information | 2.5697965868507 |
| several adjacent diverticula | 2.5697965868507 |
| distant abscess | 2.5457298950218 |
| individual factors | 2.5457298950218 |
| genetic factors | 2.5457298950218 |
| morris am | 2.5457298950218 |
| lisa l. strate | 2.5327985825943 |
| broad regional dietary habits | 2.5302513206967 |
| left-sided tenderness | 2.5148668593659 |
| ct findings | 2.5148668593659 |
| vigorous physical activity | 2.4569922134182 |
| readmission rates | 2.4494897427832 |
| kaiser a | 2.4494897427832 |
| external validation | 2.4494897427832 |
| predictors of recurrence | 2.4494897427832 |
| diverticulitis?clinical presentation | 2.4494897427832 |
| postsurgical recurrence | 2.4494897427832 |
| likelihood of diverticulosis | 2.4494897427832 |
| rectal bleeding | 2.4322992790978 |
| role of decision-making tools | 2.401873910352 |
| first-line therapy | 2.3967817269284 |
| shah r | 2.3784142300054 |
| greenberg r | 2.3784142300054 |
| ricciardi r | 2.3784142300054 |
| boushey r | 2.3784142300054 |
| lavage group | 2.3784142300054 |
| austin r | 2.3784142300054 |
| frago r | 2.3784142300054 |
| modi r | 2.3784142300054 |
| pendlimari r | 2.3784142300054 |
| gregersen r | 2.3784142300054 |
| hompes r | 2.3784142300054 |
| erichsen r | 2.3784142300054 |
| national institute of diabetes | 2.376176797565 |
| results of laboratory tests | 2.376176797565 |
| holmer c. outcome of patients | 2.3593040006382 |
| broad-spectrum antibiotics | 2.3403473193207 |
| used antibiotics | 2.3403473193207 |
| low exposure | 2.3403473193207 |
| recent interest | 2.3403473193207 |
| overall approach | 2.3403473193207 |
| jama surg | 2.3403473193207 |
| laboratory tests | 2.3403473193207 |
| specific antibiotics | 2.3403473193207 |
| chronic renal failure | 2.3299861015014 |
| same hospitalization resection | 2.3201751253057 |
| hinchey-based classification systems | 2.3050581003335 |
| medical options | 2.3003266337912 |
| antibiotic regimens | 2.3003266337912 |
| current guidelines | 2.3003266337912 |
| intraoperative factors | 2.3003266337912 |
| van de wall bj | 2.2944053808798 |
| body mass index | 2.2894284851067 |
| complete blood count | 2.2894284851067 |
| major complications | 2.2795070569548 |
| dharmarajan s | 2.2581008643532 |
| spring s | 2.2581008643532 |
| lee s | 2.2581008643532 |
| haapaniemi s | 2.2581008643532 |
| arnold s | 2.2581008643532 |
| hendren s | 2.2581008643532 |
| kaneda s | 2.2581008643532 |
| shaukat a | 2.2133638394006 |
| mizuki a | 2.2133638394006 |
| lifestyle interventions | 2.2133638394006 |
| ben-yehuda a | 2.2133638394006 |
| aggressive care | 2.2133638394006 |
| rickenbacher a | 2.2133638394006 |
| schneider e | 2.2133638394006 |
| artinyan a | 2.2133638394006 |
| stroux a | 2.2133638394006 |
| practice parameters | 2.2133638394006 |
| wolk a | 2.2133638394006 |
| heart rate | 2.2133638394006 |
| gynecologic disorders | 2.2133638394006 |
| tursi a | 2.2133638394006 |
| kidney diseases | 2.2133638394006 |
| chabok a | 2.2133638394006 |
| fecal peritonitis | 2.2133638394006 |
| international registry results | 2.1822472719434 |
| completion of therapy | 2.165736770668 |
| standard therapy | 2.165736770668 |
| pericolonic inflammation | 2.1406951429281 |
| past several decades | 2.1398263878673 |
| diffuse tenderness | 2.1147425268811 |
| wasvary h | 2.1147425268811 |
| recent u.s | 2.1147425268811 |
| ishii h | 2.1147425268811 |
| lippert h | 2.1147425268811 |
| vital signs | 2.1147425268811 |
| nagata h | 2.1147425268811 |
| t?nnesen h | 2.1147425268811 |
| low threshold | 2.1147425268811 |
| liver function tests | 2.0757816311124 |
| evidence-based step-up approach | 2.0757816311124 |
| world gastroenterology organisation | 2.0757816311124 |
| khatib m | 2.0597671439071 |
| first time | 2.0597671439071 |
| blood pressure | 2.0597671439071 |
| special monitoring | 2.0597671439071 |
| frank blood | 2.0597671439071 |
| picchio m | 2.0597671439071 |
| tatemichi m | 2.0597671439071 |
| lehmann k | 2.0597671439071 |
| baron ja | 2.0597671439071 |
| song m | 2.0597671439071 |
| millan m | 2.0597671439071 |
| penna m | 2.0597671439071 |
| popcorn consumption | 2.0597671439071 |
| primary care practitioners | 2.0396489026555 |
| tatme registry collaborative | 2.0396489026555 |
| right upper quadrant | 2.0396489026555 |
| ovarian torsion | 2 |
| practice improvement | 2 |
| van der wilt gj | 2 |
| little evidence | 2 |
| brandimarte g. moderate | 2 |
| subset analysis | 2 |
| low-fiber cereals | 2 |
| left-sided predominance | 2 |
| clear liquids | 2 |
| low-quality evidence | 2 |
| espin e | 2 |
| appropriate alternative | 2 |
| multivariable analysis | 2 |
| young persons | 2 |
| van gulik tm | 2 |
| important contributors | 2 |
| nizri e | 2 |
| postsurgical morbidity | 1.9679896712654 |
| major morbidity | 1.9679896712654 |
| genetic markers | 1.9679896712654 |
| parthasarathy g | 1.9343364202677 |
| scheirey c | 1.9343364202677 |
| mucosal inflammation | 1.9343364202677 |
| k?ckerling f | 1.9343364202677 |
| gonzalez-ruiz c | 1.9343364202677 |
| vallribera f | 1.9343364202677 |
| wald c | 1.9343364202677 |
| wynn g | 1.9343364202677 |
| degree of inflammation | 1.9343364202677 |
| engholm g | 1.9343364202677 |
| ault g | 1.9343364202677 |
| emergency reoperation | 1.9343364202677 |
| turfah f | 1.9343364202677 |
| schug-pass c | 1.9343364202677 |
| oteiza f | 1.9343364202677 |
| small amounts | 1.9343364202677 |
| buchli c | 1.9343364202677 |
| high specificity | 1.9343364202677 |
| addamo c | 1.9343364202677 |
| small pouches | 1.9343364202677 |
| rates of stoma reversal | 1.9063685859939 |
| separate validation cohorts | 1.9063685859939 |
| urinary tract infections | 1.9063685859939 |
| such antispasmodics | 1.8612097182042 |
| first-line agents | 1.8612097182042 |
| presence of fecaluria | 1.8612097182042 |
| two tools | 1.8612097182042 |
| dairy products | 1.8612097182042 |
| white persons | 1.8612097182042 |
| elisei w | 1.8612097182042 |
| proposed anastomosis | 1.8612097182042 |
| single agents | 1.8612097182042 |
| elderly persons | 1.8612097182042 |
| smalley w | 1.8612097182042 |
| procedure of choice | 1.8612097182042 |
| technical review | 1.8612097182042 |
| shahedi k | 1.8612097182042 |
| detailed information | 1.8612097182042 |
| positive effects | 1.8612097182042 |
| first step | 1.8612097182042 |
| open-label trials | 1.8612097182042 |
| scoring nomogram | 1.8612097182042 |
| broeders ia | 1.8612097182042 |
| pregnancy test | 1.8612097182042 |
| professional societies ' recommendations | 1.8612097182042 |
| beauregard w | 1.8612097182042 |
| similar results | 1.8612097182042 |
| subacute onset | 1.8612097182042 |
| smedh k | 1.8612097182042 |
| wegdam ja | 1.8612097182042 |
| benefit of mesalamine | 1.8612097182042 |
| liu ph | 1.8612097182042 |
| subsequent advancement | 1.8612097182042 |
| careful monitoring | 1.8612097182042 |
| sixth decade of life | 1.8493111942973 |
| national institutes of health | 1.8171205928321 |
| ruptured ovarian cyst | 1.7817974362807 |
| length of hospital stay | 1.7817974362807 |
| willis dj | 1.7782794100389 |
| pavia at | 1.7782794100389 |
| knobben l | 1.7782794100389 |
| p?hlman l | 1.7782794100389 |
| associated morbidity | 1.7782794100389 |
| ahnen dj | 1.7782794100389 |
| dr. swanson | 1.7320508075689 |
| diagnostic uncertainty | 1.7320508075689 |
| of nonaspirin | 1.7320508075689 |
| baron ej | 1.7320508075689 |
| overall health | 1.7320508075689 |
| segal jb | 1.7320508075689 |
| low?radiation dose protocols | 1.6983813295649 |
| h?kansson n. smoking | 1.6983813295649 |
| sophia m. swanson | 1.6983813295649 |
| fatty dairy foods | 1.6983813295649 |
| short 4-day course | 1.6983813295649 |
| peritoneal findings | 1.6817928305074 |
| liver enzymes | 1.6817928305074 |
| child-bearing age | 1.6817928305074 |
| hartmann's procedure | 1.6817928305074 |
| ewelukwa o | 1.6817928305074 |
| differential diagnostics | 1.6817928305074 |
| significant hematochezia | 1.6817928305074 |
| read t | 1.6817928305074 |
| university of california | 1.6817928305074 |
| significant sepsis | 1.6817928305074 |
| multiple comorbidities | 1.6817928305074 |
| transanal total mesorectal excision | 1.6817928305074 |
| asymptomatic diverticulosis | 1.6817928305074 |
| tsukada n | 1.6817928305074 |
| ectopic pregnancy | 1.6817928305074 |
| sanford guide | 1.6817928305074 |
| h?gel o | 1.6817928305074 |
| incidental diverticulosis | 1.6817928305074 |
| symptom resolution | 1.6817928305074 |
| refined grains | 1.6817928305074 |
| korte n | 1.6817928305074 |
| kadro o | 1.6817928305074 |
| stollman n | 1.6817928305074 |
| three agents | 1.6817928305074 |
| postrecovery colonoscopy | 1.6817928305074 |
| definition of immunosuppression | 1.6817928305074 |
| aliment pharmacol ther | 1.5874010519682 |
| receiver-operating characteristic curve | 1.5874010519682 |
| enough exercise | 1.5650845800733 |
| avoidance of smoking | 1.5650845800733 |
| mean time | 1.5650845800733 |
| gradual advancement | 1.5650845800733 |
| mortensen lq | 1.5650845800733 |
| boermeester ma | 1.5650845800733 |
| respiratory impairment | 1.5650845800733 |
| geers p | 1.5650845800733 |
| pedersen jk | 1.5650845800733 |
| villiger p | 1.5650845800733 |
| surgeon preference | 1.5650845800733 |
| jiang jk | 1.5650845800733 |
| stricture formation | 1.5650845800733 |
| number of recurrences | 1.5650845800733 |
| 7-day course | 1.5650845800733 |
| radiation exposure | 1.5650845800733 |
| hansson le | 1.5650845800733 |
| white bread | 1.5650845800733 |
| raptis da | 1.5650845800733 |
| lehmann ks | 1.5650845800733 |
| rothenberger da | 1.5650845800733 |
| oor je | 1.5650845800733 |
| fecal calprotectin | 1.5650845800733 |
| single agent | 1.5650845800733 |
| bradley js | 1.5650845800733 |
| mazuski je | 1.5650845800733 |
| fleming km | 1.5650845800733 |
| kiewiet jj | 1.5650845800733 |
| reitsma jb | 1.5650845800733 |
| ritz jp | 1.5650845800733 |
| rigorous exercise | 1.5650845800733 |
| eliopoulos gm | 1.5650845800733 |
| progressive changes | 1.5650845800733 |
| respiratory compromise | 1.5650845800733 |
| lake jp | 1.5650845800733 |
| diagnostic accuracy | 1.5650845800733 |
| conflicts of interest | 1.5650845800733 |
| giorgetti gm | 1.5650845800733 |
| hardiman km | 1.5650845800733 |
| goldstein ej | 1.5650845800733 |
| typical manifestations | 1.5650845800733 |
| schneider eb | 1.5650845800733 |
| solomkin js | 1.5650845800733 |
| hunt sr | 1.5650845800733 |
| atema jj | 1.5650845800733 |
| steele sr | 1.5650845800733 |
| stable outpatients | 1.5650845800733 |
| colovesical fistula | 1.5650845800733 |
| considerable uncertainty | 1.5650845800733 |
| stam ma | 1.5650845800733 |
| professional organizations | 1.5650845800733 |
| colovaginal fistula | 1.5650845800733 |
| wheat cl | 1.4142135623731 |
| buhr hj | 1.4142135623731 |
| frericks b | 1.4142135623731 |
| sandler rs | 1.4142135623731 |
| busch or | 1.4142135623731 |
| serious events | 1.4142135623731 |
| 21st century | 1.4142135623731 |
| visceral hypersensitivity | 1.4142135623731 |
| ultraviolet light | 1.4142135623731 |
| luminal contrast | 1.4142135623731 |
| stockmann hb | 1.4142135623731 |
| madoff rd | 1.4142135623731 |
| consten ec | 1.4142135623731 |
| key points | 1.4142135623731 |
| close attention | 1.4142135623731 |
| few data | 1.4142135623731 |
| unnecessary work-ups | 1.4142135623731 |
| tech coloproctol | 1.4142135623731 |
| microbial dysbiosis | 1.4142135623731 |
| good ability | 1.4142135623731 |
| barrett pr | 1.4142135623731 |
| pommergaard hc | 1.4142135623731 |
| chambers hf | 1.4142135623731 |
| kwaan mr | 1.4142135623731 |
| result of scarring | 1.4142135623731 |
| social support | 1.4142135623731 |
| mental status | 1.4142135623731 |
| pus aspiration | 1.4142135623731 |
| roberts pl | 1.4142135623731 |
| buie wd | 1.4142135623731 |
| bossuyt pm | 1.4142135623731 |
| mutch mg | 1.4142135623731 |
| borao jl | 1.4142135623731 |
| end colostomy | 1.4142135623731 |
| familial aggregation | 1.4142135623731 |
| relevant overview | 1.4142135623731 |
| regenbogen se | 1.4142135623731 |
| certain medicines | 1.4142135623731 |
| birnbaum eh | 1.4142135623731 |
| maguire lh | 1.4142135623731 |
| hall jf | 1.4142135623731 |
| nonconsecutive enrollment | 1.4142135623731 |
| anaerobic coverage | 1.4142135623731 |
| interventional radiologist | 1.4142135623731 |
| loop ileostomy | 1.4142135623731 |
| permanent stomas | 1.4142135623731 |
| cooked fruits | 1.4142135623731 |
| drain placement | 1.4142135623731 |
| huang es | 1.4142135623731 |
| spiller rc | 1.4142135623731 |
| draaisma wa | 1.4142135623731 |
| bharucha ae | 1.4142135623731 |
| low-grade fever | 1.4142135623731 |
| rodvold ka | 1.4142135623731 |
| san francisco | 1.4142135623731 |
| oberkofler ce | 1.4142135623731 |
| reports grants | 1.4142135623731 |
| passage of gas | 1.4142135623731 |
| diverticulitis?reported sensitivity | 1.4142135623731 |
| anorectal stump | 1.4142135623731 |
| sudden diarrhea | 1.4142135623731 |
| belzer ge | 1.4142135623731 |
| frequency of attacks | 1.4142135623731 |
| hendriks jc | 1.4142135623731 |
| fleshman jw | 1.4142135623731 |
| asian populations | 1.4142135623731 |
| 1-year mortality | 1.4142135623731 |
| tool kit | 1.4142135623731 |
| green beans | 1.4142135623731 |
| gilbert dn | 1.4142135623731 |
| inpatient settings | 1.4142135623731 |
| rogers aj | 1.4142135623731 |
| ticarcillin?clavulanic acid | 1.4142135623731 |
| temporal trends | 1.4142135623731 |
| involved segments | 1.4142135623731 |
| main indications | 1.4142135623731 |
| gaertner wb | 1.4142135623731 |
| saag ms | 1.4142135623731 |
| riis ah | 1.4142135623731 |
| urine sample | 1.4142135623731 |
| fletcher jg | 1.4142135623731 |
| extraluminal air | 1.4142135623731 |
| .0 b013e3182113614 | 1 |
| .0 b013e31828545e3 | 1 |
| .0 b013e31827324ba | 1 |
| .0 b013e3182028576 | 1 |
頻出語ITC102
| 抽出語 | 出現回数 | 抽出語 | 出現回数 | 抽出語 | 出現回数 | ||
|---|---|---|---|---|---|---|---|
| diverticulitis | 196 | approach | 13 | fistula | 8 | ||
| patient | 148 | examination | 13 | greater | 8 | ||
| disease | 60 | history | 13 | immunocompromised | 8 | ||
| risk | 58 | incident | 13 | large | 8 | ||
| not | 47 | level | 13 | most | 8 | ||
| acute | 41 | particularly | 13 | obstruction | 8 | ||
| pain | 38 | basis | 12 | outpatient | 8 | ||
| uncomplicated | 36 | intake | 12 | quadrant | 8 | ||
| study | 33 | older | 12 | resolution | 8 | ||
| antibiotic | 32 | several | 12 | therapy | 8 | ||
| abdominal | 29 | severity | 12 | age | 7 | ||
| abscess | 29 | small | 12 | antibiotic | 7 | ||
| surgery | 29 | stage | 12 | clinician | 7 | ||
| colon | 28 | therefore | 12 | constipation | 7 | ||
| episode | 28 | colonoscopy | 11 | count | 7 | ||
| symptom | 27 | drainage | 11 | dietary | 7 | ||
| complicated | 26 | generally | 11 | first | 7 | ||
| you | 26 | lower | 11 | inflammation | 7 | ||
| also | 25 | perforation | 11 | information | 7 | ||
| diet | 25 | they | 11 | intravenous | 7 | ||
| clinical | 22 | use | 11 | low-fiber | 7 | ||
| diagnosis | 22 | when | 11 | meat | 7 | ||
| imaging | 22 | case | 10 | more | 7 | ||
| other | 22 | cause | 10 | oral | 7 | ||
| bowel | 21 | how | 10 | presence | 7 | ||
| treatment | 21 | necessary | 10 | red | 7 | ||
| complication | 20 | often | 10 | role | 7 | ||
| it | 20 | physical | 10 | sign | 7 | ||
| management | 20 | setting | 10 | 9 | 6 | ||
| recurrence | 20 | sigmoid | 10 | anti-inflammatory | 6 | ||
| recurrent | 20 | that | 10 | approximately | 6 | ||
| factor | 19 | -rsb-_NN | 9 | consultation | 6 | ||
| however | 19 | chronic | 9 | datum | 6 | ||
| such | 19 | common | 9 | drug | 6 | ||
| who | 18 | high | 9 | emergency | 6 | ||
| condition | 17 | higher | 9 | evaluation | 6 | ||
| elective | 17 | I | 9 | evidence | 6 | ||
| what | 17 | intervention | 9 | fiber | 6 | ||
| diverticular | 16 | low | 9 | gastroenterologist | 6 | ||
| trial | 16 | mild | 9 | immunosuppression | 6 | ||
| colonic | 15 | more | 9 | initial | 6 | ||
| guideline | 15 | percutaneous | 9 | j.gastro | 6 | ||
| presentation | 15 | prospective | 9 | laparoscopic | 6 | ||
| severe | 15 | usually | 9 | leukocyte | 6 | ||
| surgical | 15 | addition | 8 | lifestyle | 6 | ||
| year | 15 | agent | 8 | medical | 6 | ||
| diverticulosis | 14 | american | 8 | most | 6 | ||
| inflammatory | 14 | cancer | 8 | rate | 6 | ||
| peritonitis | 14 | clear | 8 | recently | 6 | ||
| resection | 14 | colectomy | 8 | rectal | 6 |
Governor’s Message
暑かった夏が終わろうとしています。初夏の頃の欧州の猛暑、インドの豪雨等々の異常気象の夏でもありました。
私にとっても初めての支部長としての暑い夏でした。私の使命の一つとして会員増加を目指す目論見があり（具体的にはまだ明かせませんが）これからさらに力を尽くしていきたいと思っています。会員の増加だけでなく、一旦会員になって頂いた方が会を離れていかれないような魅力作りも必要でしょうし、FACPになる方も増やさなければなりません。
今のところはまだ構想だけですが、会員数がまとまった数になれば地域別に区分けをしてその地域内で活躍されているFACPやMACPの先生方に次の世代の新FACPの推薦をして頂けるシステムを作ったり、地域の組織単位で会員の皆さんとつながりが持てるようになると良いのではないかと考えています。
日本支部はアメリカ大陸以外の支部としては一番最初に出来た支部ですが、その後アジアにはインド、バングラデシュ、東南アジア（現在の支部長担当はシンガポール）、サウジアラビアと支部が出来て現在アジア地区に計5つの支部が存在し、それぞれの支部で支部総会が行われています。これらの支部の支部長とは既に何度かお話をしており、将来アジアの支部合同で合同支部総会や何か催し物ができないかと構想中です。
さらに魅力ある支部にするために会員の皆様のご理解とご協力を頂きながら、さらに前進したいと思います。なにとぞよろしくお願い申し上げます。
2019年夏
前田 賢司
Winner of Dr’s Dilemma
Shogo Shirota
Tochigi Medical Center
I am honored to report that Dr. Kawaguchi and I won the first prize in the American College of Physicians (ACP) Doctor’s Dilemma competition 2019.
I have participated in ACP Japan Chapter(JC) since I was a medical student. Each year, I took a lot of interesting and interactive workshops, and got to know many outstanding medical students and doctors. Doctor’s Dilemma is one of the most interesting program, but I could not take part in it, because I was not able to get a partner.
There were the largest number, 35, of participating teams from various hospitals this year. In the Preliminary, we used smartphones to answer multiple choice questions. The questions are not so difficult, which made us nervous because losing even one question would be critical. We got 6th place and cleared the Preliminary.
The Final started after two-hour break. There were buzzer quiz at first, then more difficult, multiple choice questions from every areas of internal medicine. It was difficult to get point at first, because other team pressed the buzzer while we are discussing whether our answer was absolutely correct. Once we were able to select the multiple choice questions that every team had the right to answer but lost points with each incorrect answer, we could get almost all of the answers right. They were questions that were directly connected to what we do every day, and some of them we knew from MKSAP. That’s how we won the championship.
There are several reasons why we won this year. In addition to working up many MKSAP questions by ourselves, we see a variety of patients every day as a GIM physician. Moreover, we have various kinds of study sessions in our hospital which vary from day to day. These include clinical reasoning conference, learning how to make clinical question and search for it, introducing several papers in a short time, and so on. They made us deepen our medical knowledge very efficiently.
Finally, I would like to express my heartfelt gratitude to the attending doctors who mentored us, the colleagues and friends who congratulated us, and every staff who helped holding the ACP Japan chapter.
ACP日本支部総会2019 Dr’s Dilemma優勝者のことば
この度、京都大学で開催されたACP JC年次総会2019のDr’s Dilemmaにおいて、優勝させていただきましたのでご報告致します。
私は学生の頃からACP JCに参加しており、毎年様々なレクチャーやワークショップに参加して新しいことを学んだり、同じように頑張っている仲間に出会い刺激を受けていました。Dr’s Dilemmaはいつも楽しみにしていた企画ではありましたが、なかなか相方がいなかったので、今回が初参加でした。
本年度は35チームと過去最多の参加数であり、予選から熾烈な戦いが予想されました。予選はスマートフォンを利用して出題される多肢選択問題であり、正答数だけでなく回答にかかった秒数も加味されるため、緊張感のある中解いていきました。問題はそれほど難しくなく、数問の差で大きく順位が変わってしまうことが予測されました。問題文の読み間違えなどもあり、21問中18問正解で6位通過でしたが、なんとか予選を乗り切りました。
2時間ほど休んで決勝です。決勝は早押し問題の低得点問題と、高得点で全員回答の問題の2種類でした。間違えるとその分点数が引かれてしまうため、回答は慎重にならざるを得ませんが、考えすぎると他チームが回答してしまうため、その駆け引きが難しかったです。しばらくして高得点問題が解除されると、MKSAPや日々の診療で学んだことが多く出題されており、運良く8割程度は正解したためく、他チームに大きく差をつけることができ、優勝できました。
今回優勝することができたのは、MKSAPを自分で毎日数問ずつ解いていたことに加え、日々の研修で多種多様の疾患の患者を診ているからであったと思います。当院の後期研修では専門科があまりいない中規模病院の総合内科として横断的に幅広い疾患を扱っています。また論文を何本も紹介する抄読会や臨床疑問の立て方勉強会、症例報告検討会など毎日違う種類の勉強会をすることで広く深い知識を得ることができています。
日々我々を教育してくださった指導医の方々に改めて感謝申し上げます。また、このような貴重な機会をいただくことができましたACP 日本支部の諸先生方に感謝を申し上げ、優勝報告といたします。
栃木医療センター
城田祥吾
Winner of Kurokawa Prize in Students section
Comments on receiving the Kurokawa Prize (Medical Student branch) at the ACP Japan Chapter Annual Meeting 2019
Medical Student, Juntendo University School of Medicine
Saki Fukumoto
I am very honored to be awarded the Kurokawa Prize at the American College of Physicians (ACP) Japan Chapter Annual Meeting 2019 in Kyoto.
At the meeting, I made a presentation entitled “Unaware of glaucoma and traffic accidents: a proposal to detect visual field defects by CLOCK CHART”. I presented this issue, because I believe that it is clinically and socially significant for us to screen for glaucoma using CLOCK CHART, considering that this pathological condition is related to traffic accidents.
One of main research themes at the Department of Public Health, Juntendo University, is “health-related traffic accidents”, which include the effects of obstructive sleep apnea, hay fever and glaucoma. Among these, the prevalence of glaucoma is around 5% for those aged 40 years and over in Japan, whereas 90 percent of those affected are not aware of their disorder and remain untreated. Numerous previous studies reported the association between glaucoma and traffic accidents. Thus, there will be many latent patients with glaucoma who need appropriate diagnosis and treatment.
To address this, I collected 5 cases with glaucoma and examined their visual fields using both a Humphrey Field Analyzer and CLOCK CHART, the latter of which is a handy visual field screening tool. I found that the agreement rate between the Humphrey Field Analyzer and CLOCK CHART was substantially high. Therefore, it is concluded that screening visual fields using CLOCK CHART by general physicians would enhance the detection of glaucoma, leading to its early diagnosis and treatment, and reducing “health-related traffic accidents”.
I am also on a team investigating over 2000 commercial drivers. While still in progress, we are now analyzing the inter-relationships between traffic accidents and visual field defects detected by CLOCK CHART.
Finally, I would like to express my gratitude to Professor Tanigawa, Dr. Wada and all other teachers for their kind advice.
ACP日本支部総会2019 黒川賞（学生部門） 受賞者のことば
ACP日本支部年次総会・講演会2019 黒川賞(医学生部門)受賞のご報告
順天堂大学医学部6年生
福本咲季
ACP(米国内科学会)日本支部年次総会・講演会2019において黒川賞をいただき、大変光栄に存じます。
この度、私は交通事故の一因である緑内障に対するクロックチャートを用いたスクリーニングの有用性について、「Unaware of glaucoma and traffic accidents: a proposal to detect visual field defects by CLOCK CHART」という演題名で発表を行いました。
私が所属する順天堂大学の公衆衛生学講座では、以前よりいわゆる健康起因事故に注目して研究しており、その原因疾患の例として睡眠時無呼吸症候群、花粉症、緑内障などが挙げられます。この中で緑内障は40歳以上の日本人の20人に1人が患っており、その9割が未治療・無自覚であると考えられています。多数の論文で緑内障と交通事故の関連が報告されており、多くの人が緑内障の適切な診断や治療を必要としています。
そこで、緑内障の視野欠損を簡単にスクリーニングできるクロックチャートを緑内障患者5名に用い、症例発表をさせていただきました。一般的に用いられているハンフリー視野検査の結果と高い一致率が認められ、全ての医師がクロックチャートで患者様の視野のスクリーニングを行うことで、緑内障の早期診断・早期治療、そして交通事故の防止を期待できると考えられました。
更に現在、タクシー・トラック運転手約2000名を対象としたクロックチャートによる検査結果、交通事故経験のデータを解析中です。
最後になりましたが、常日頃から熱心にご指導いただいた谷川教授、和田先生をはじめ本発表に際し大変お世話になりました皆様に心より御礼申し上げます。
Dr. Yuichiro Matsuo, Winner of Kurokawa Prize in Early Career Physicians section
Yuichiro Matsuo
Tokyo Bay Urayasu Ichikawa Medical Center, Department of Internal Medicine
I am grateful that I could receive the Kurokawa Prize in the Annual Meeting of ACP Japan 2019. The basic idea of our study “Japanese people tend to overestimate their future cardiovascular risk” originated from the question, “aren’t people unnecessary worried about developing cardiovascular disease (CVD)?” In Japan, the risk of developing CVD in a patient with a slightly elevated LDL cholesterol is relatively low, in most cases, only a few percent in 10 years. Our impression was that people seem to be much more worried about developing CVD.
In our study, we could show that patients undergoing routine health check-up in our center significantly overestimated their risk of developing cardiovascular disease. Patients estimated their 10-year CVD risk as around 30%, compared with the calculated risk of 3%. From this result, we can make a hypothesis that CVD risk management in Japan may be conducted based on this misunderstanding.
We are planning for further research on this field. Will this misunderstanding affect the patient’s health seeking behavior, satisfaction, outcome, and will there be a positive effect of correcting this misunderstanding?
I would like to thank my boss, Dr. Eiji Hiraoka for supporting the whole work, and I would also like to thank all the people who were responsible for preparing this meeting.
ACP日本支部総会2019 黒川賞（若手医師部門）受賞者のことば 松尾裕一郎
ACP日本支部 2019年次総会 黒川賞（若手医師部門）受賞によせて
東京ベイ・浦安市川医療センター 総合内科 松尾裕一郎
この度は、栄誉ある黒川賞をいただき、大変光栄に思います。今回の私達の研究「健康診断を受診する患者は、自身の心血管病リスクを過大評価する」は、私達が普段の外来診療で感じていた疑問、違和感を検証したものです。健康診断では、一般にLDLコレステロールが120mg/dLを超えると「軽度の異常」という判定になります。では実際に、それらの患者がその後10年でどのくらいの確率で心血管病を発症するかというと、問題が軽度の高LDL血症だけであれば数%以下程度です。しかしながら、患者自身はリスクがもっと高いと考えており、心血管病発症を必要以上に心配しているのではないか？というのが私達の疑問です。結果は私達の予想通り、Suita Scoreにより計算される患者の心血管病リスクは3%程度であるのに対し、患者自身が予測するリスクは30%程度である、というものでした。このことから、日本における脂質異常症などの生活習慣病診療が、患者の誤解のもとに行われている可能性、自身のリスクについて医療者と話をする機会の無い患者が、不必要な不安を抱えている可能性などを、間接的に示すことができたと考えています。
今後、このリスクのずれが患者の受療行動、意思決定、満足度、予後などの重要な指標とどのように関連するか、より臨床場面に直結する疑問に答えていけるよう、検証を進めていきたいと考えています。
改めましてこの場をお借りし、今回の研究の立案、計画、発表に至るまで多大なるご指導をいただいた当科部長の平岡栄治先生に御礼を申し上げ、私に発表の機会を与えていただいた米国内科学会日本支部総会の関係者の皆様に感謝の意を表したいと思います。
Dr. Mai Okamoto, Winner of Kurokawa Prize in Resident/Fellow section
I am very honored to receive the Kurokawa Prize at the ACP Japan 2019. I greatly appreciate the support of attending doctors.
History of research
I have been interested in the appropriate antibiotics in my medical student days, but It was different from what I imagine in clinical settings. One of the reasons was that it needs several days to identify bacteria from specimens. Although the antimicrobial agent is determined on the assumption of the microbes, it does not always proceed as expected. In some cases, empirical treatment has failed to cover, on the other hand, I tended to use inappropriate broad-spectrum antibiotics.
The turning point of research
In July 2018, when I was the second year of residency, “FilmArray multiplex PCR” was introduced in our hospital. This machine can identify bacteria in the blood more rapidly than the conventional method. When the blood culture becomes positive, the FilmArray can detect in about one hour. This system has already been introduced abroad, and some studies have shown efficacy for antimicrobial stewardship. There are few experiences in our country and the microbiology laboratory setting is different from that high volume centers in prior reports. So, I decided to examine the change in the usage of antimicrobial agents before and after introducing FilmArray system.
Future expectations
This study showed that the time to start anti-MRSA drug for MRSA was shortened, and furthermore, 28-days overall survival was improved in the Gram-positive cocci baceteremia group by using FilmArray. The improvement of the survival rate is different from the prior studies, and it is considered that further study is necessary. However, our study suggested that the use of FilmArray may help the appropriate use of antibacterial agents. We hope further research will progress and would like to contribute to ASPs.
