Governor's Newsletter for All ACP Members

26 Pages·2016·3.46 MB·English

November 2016
GGoovveerrnnoorr’’ss NNeewwsslleetttteerr ffoorr AAllll AACCPP MMeemmbbeerrss
Table of Contents
Governor: Fumiaki Ueno
MD, MACP
■Governor's Message ／ Fumiaki Ueno 2
ACP Japan Chapter Meeting 2016
■Message from ACP Leaders ／ Thomas S Inui 3

■Recipients of Best Abstract Award of Japan Chapter Meeting 2016
　　　　　　　　　／ Toshihiko Takada , Tomofumi Takayoshi , Hirotaka Mori 5
■Winner of Dr’s Dilemma of Japan Chapter Meeting 2016
　　　　　　　　　　　　　　　　　　／ Masaaki Sugino,Tatsuaki Naganawa 11
Internal Medicine 2016
■Session Report of Internal Medicine 2016 ／ Kenji Maeda 13
■Convocation Ceremony ／ Satoru Joshita 15
Reports from ACP Japan Chapter
■From Members ／ Hiroshi Ono 16
■Student Committee ／ Sho Fukuoka 19
■International Exchange Program Committee ／ Harumi Gomi , Natsuko Ishitobi 20

■Committee Members of ACP Japan Chapter 2016 23
■Profiles of Committee Members (International Exchange program Committee, 24
Finance Committee, Public Relations Committee)
■Editor’s Postscript 26

cover
Governor’s Newsletter
F u m i a k i U e n o , M D , M A C P
Governor, ACP Japan Chapter
　I was in London on 23 June 2016, the day of certain country, we feel borderless and enjoy
the UK’ s referendum. The city center was quiet almost everything from outside. Then, why not to
and nothing unusual was happening. The result establish a nation with historical and ethnical
of the referendum, however, was astonishing! UK homogeneity? We do not know about future
decided to leave from EU. Two years ago, health care policy of the next president of USA,
Scotland finally remained in UK by their but globalization is by no means retractable,
referendum, but the vote was very close. particularly in health science. All members of
Balkanization is a term to describe division of a ACP Japan Chapter will continue to enjoy many
multinational state into smaller ethnically benefits for members, including excellent resource
homogeneous entities. These decisions might be for internists. Invite your friend to join ACP, in
due to today’s wind of Balkanization. order to become a global internist!
　Globalism is a keyword for today. Many
people in many countries can share culture,
science, economics, industrial products by virtue
of developed transportation and information
technology. While in Japan, we can share
information for health care instantly with other
countries, and we can enjoy most of technology
and products for health care from overseas, and
vice versa.
　My point is that Balkanization of nations is a
reflection of globalization. Even though we live in
2
○ Message from ACP Leaders
An American General Internist’s Engagement with
the American College of Physicians Japan Chapter
Meeting in Kyoto.
Thomas S. Inui,
ScM, MD, MACP
Professor of MedicineIndiana University School of Medicine
　On the 4th and 5th of June 2016, it was my the health of the two most powerful countries in Asia
distinct pleasure and privilege to be a participant in will thereby be improved. Other countries in the
the activities of the American College of Physicians world will be interested in progressive actions taken
Japan Chapter Annual Meeting held at the Kyodai in Japan and China because these two countries are
Clock Tower Centennial Hall in Kyoto (1). The certainly not the only nations globally who face
topic of the JACP meeting was one that would have maldistribution and absolute deficiencies in primary
resonated strongly within my own professional home care workforce to serve the needs of aging societies.
Society of General Internal Medicine (SGIM) in
North America – “Raising Generalist Medicine: To
Improve Health and Health Care in Japan.” My
gracious hosts were Dr. Fumiaki Ueno, MD, MACP,
MACG, AGAF, Governor of the ACP Japan Chapter
and Dr. Yugo Shibagaki, MD, FACP, Chairman of
the 2016 Annual Meeting.
　My personal contribution to the meeting was a
plenary address on residency reform changes now 　I should highlight other elements of the meeting as
taking place in the People’ s Republic of China ones I greatly enjoyed. A “Learning Clinical
( “Residency Reform in China: Major Developments Reasoning in English” (3) diagnostic case discussion
in Asia’ s Largest Health Care System,”（ 2）available presided over by Harumi Gomi and Noriaki Santo
on the Japan ACP meeting program website). These and was fascinating and mystified all participants
reflections on graduate medical education in China until the chest x-ray with a widened mediastinum
were intended to highlight parallels in Japan’ s and was revealed in the late stages of the patient’ s
China’ s educational program reforms, underlying evaluation. A Nihongo session on the first North
challenges driving these changes, and the relevance of American internist Sir William Osler, with
changes in China to the evolving health workforce comparisons to Shigeo Okinaka at the University of
issues in Japan. Some of the medical workforce Tokyo, provided a historic platform for a broader
challenges these two countries have in common are a discussion of the place of generalism past, current,
deficiency of well-trained primary care physicians in and future in Japan (4). This presentation dealt in an
rural settings, lack of a consensus on general medicine excellent fashion with site-based, relational
core knowledge/skills/competencies, and the need for (patient-centered, community-centered), and
public and professional policies to enhance the population-focused medical and health care
careers of generalist physicians everywhere, but in dimensions of practice that will require new emphasis
rural areas in particular. If Japan and China can going forward. A third session in which I participated
learn from one another’ s approaches as well as was “End-of-Life Discussions: Japan’ s New
consider policy changes in their two different Challenge” by Drs. Shadia Constantine, Sandra
environments that are affordable and sustainable, Moody, Ryuichi Sekine, and Koichi Kuramoto (5).
3
○ Message from ACP Leaders／ Thomas S. Inui
　This extraordinary, lecture and small group-based <Reference>
session used a Nihongo version of “Go Wish” cards, (1) ACP Japan Chapter Annual Meeting 2016,
materials used to facilitate discussions about values available at http://acp2016.org/index.html
near the end of life now in active use in my home (2) Thomas S. Inui, “Residency Reform in China
state of Indiana in North America. 2016: Major Developments in Asia’ s Largest Health
It was good to see resident physicians be very active Care System” ACP Japan Chapter Annual Meeting
participants in the JACP meeting. A vigorous 2016, Kyoto, 4 June 2016, available at
“Doctor’ s Dilemma” competition featured their http://acp2016.org/pdf/program/Plenary.pdf
knowledge and abundant enthusiasm. Their poster (3) Harumi Gomi, “Learning clinical reasoning in
sessions were a spectacularly successful element of the English” ACP Japan Chapter Annual Meeting 2016,
meeting. These sessions were enormous and Kyoto, 4 June 2016, available at
generated vigorous participant discussion at many http://acp2016.org/pdf/program/1-6-1b.pdf
posters. I loved seeing the young presenters explain (4) Hiroyasu Ishimaru, “Generalism and Internal
and defend their work. All posters were in English. Medicine past, present, future - From the perspective
so I was able to get a glimpse of the diversity of the of hospital based generalist” ACP Japan Chapter
work, including applications of new technology, Annual Meeting 2016, Kyoto, 4 June 2016, available
clinical epidemiology, health services research, case at http://acp2016.org/pdf/program/1-6-2.pdf
discussions, and still others. I would have personally (5) Shadia Constantine, Koichi Kuramoto,
given a “humor in medicine prize” to the poster that Sandra Moody, Ryuichi Sekine, “End of Life
summarized resources needed for successful tourist Discussions: Japan’ s New Challenge” ACP Japan
medicine in Sapporo – (1) trauma management Chapter Annual Meeting 2016, Kyoto, 4 June 2016,
knowledge, (2) gastrointestinal disease knowledge, available at
and (3) Chinese language interpreter (6) ! http://acp2016.org/pdf/program/1-7-3c.pdf
(6) Nobutaka Masui, Shoji Onishi, Tomimichi
Matsuda, Kentaro Tamiya, Kenji Taki, “Outcomes
of Medical Emergencies About Foreign Tourists in
Sapporo” ACP Japan Chapter Annual Meeting 2016,
Kyoto, 4 June 2016
Photo by Dr Inui
　This brief description of the Japan ACP Chapter
annual meeting is merely a glimpse of the richness of
activities within the meeting. I encourage all my
internist colleagues in Japan to attend these meetings,
make your voice heard in the affairs of internal
medicine in japan, and contribute your own
presentations to the meeting next year!
4
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016
Many thanks to all involved in the study!
Toshihiko Takada,
MD, MPH, PhD
Assistant Professor, Department of General Medicine
Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University
Acknowledgement the study. For cooking classes, three dietitians gave us
　It is a great honor for me to receive the Best Abstract their support. Ms. Masako Uchida, Ms. Yumiko Miura
Award in ACP Japan Chapter Annual Meeting 2016. (Nutrition Division, Institute for Biomedical Research
This research was supported by so many people. I and Innovation Hospital)and Ms. Sayuri Yamada
really appreciate all of their cooperation. (Shirakawa Kousei General Hospital). For research
design and statistical analysis, we were supported by
Background Dr. Sho Sasaki (Center for Innovative Research for
　Shirakawa STAR is an endowed department jointly Communities and Clinical Excellence (CIRC2LE),
founded by Fukushima Medical University and Fukushima Medical University), Dr. Shingo Fukuma,
Fukushima Public Welfare & Agricultural Dr. Yosuke Yamamoto, and Prof. Shunichi Fukuhara
Cooperatives Association. Its clinical activities and (Department of Healthcare Epidemiology, Kyoto
education are based at Shirakawa Kosei General University). We really appreciate their cooperation.
Hospital. Japan Agricultural Cooperative Shirakawa And we also thank the Japan Agricultural Cooperative
branch and Shirakawa Kosei General Hospital Shirakawa branch and the Administration Division,
periodically hold projects for health promotion in our Shirakawa Kousei Hospital for the management of the
local community. I am grateful for being able to project; all participating housewives and their family
receive this kind of opportunity. members involved in the study.
　We decided the theme of our project as salt
reduction, which we considered the most relevant issue Future Prospects
in our community. 　While our result revealed significant effect of the
　We corporated with Ms. Miyuki Imamoto, associate cooking classes in 2 months, the effect for longer term
professor, Department of Food and Nutritional
Science, Kobe Women’ s Junior University. She
planned the contents of salt reduction cooking classes.
The research design was cluster randomized trial, for
investigating the effect of cooking classes for
housewives on salt reduction in family members. We
emphasized that giving feedback of the project to
particpants.
Randomized Controlled Trial
　We made our best effort for providing participants
with sufficient information about aim of the project, to
avoid annoying them with experimental design of
5
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016／Toshihiko Takada
6
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016
Very honored to receive the Best Abstract Award
at the ACP Japan Chapter 2016 Annual Meeting
Tomofumi Takayoshi,
MD
Kita-Harima Medical Center
Iʼ m most grateful to the ACP Japan Chapter for giving me the diabetes and endocrine disease. Thus, we got interesting in
very exciting experience for me. the relationship between stress-induced hyperglycemia and
I received the information about the ACP Japan Branch annual mortality in our hospital. We happened to find that
meeting through Facebook by chance, and a supervisory doctor stress-induced hyperglycemia was associated with the
recommended me to submit an abstract. Since it was the first increased risk of 30-days mortality whereas known diabetes
experience for me to write an abstract in English, it was a very was not.
tough work. With support of my supervisory doctors, I was 　I was very impressed by a variety of stimulating lectures
finally able to finish writing the abstract before the extended and useful discussions in the ACP meeting which I attended
deadline. Though I had thought that I just had to write the for the first time. Iʼ m thinking to attend the meeting with
abstract and making a poster in English, unexpectedly, I got an younger new residents in our hospital next time.
opportunity to the present my data in English. Since I had never
had the chance to perform presentation in English, I became very In closing, Iʼ d like to express my sincere appreciation to the
nervous about that. Iʼ m not sure whether I got along well, ACP Japan branch for giving me such a valuable experience,
however the English presentation in a big hall became a valuable and to my supervisory doctors, Dr. Yoshiro Yasutomo, Dr.
experience for me. Kenta Hara, Dr. Arai Takashi, and many staffs in out hospital
for supporting me in many ways.
　As for the theme of my presentation; “Hyperglycemia and
30-days mortality in patients admitted through emergency
department: retrospective observational study” , I was very
fortunate to receive training in Kita-Harima Medical Center in
Ono-shi, Hyogo. The hospital is an ideal workplace for young
physician, because every resident is allowed to get training at
any department, if he or she wants. Therefore, I had an
opportunity to get training in emergency department for two
months, even though I was a resident in the department of
7
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016／Tomofumi Takayoshi
8
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016
The Quick Induction of Remission with Trans-anal
Administration of 5-Amino Salicylic Acid in
Ulcerative Colitis: systematic review
Hirotaka Mori
Undergraduate student, Shinshu University of Medicine
　It is a great honor for me to receive this award in effects between trans-anal and oral administration of
ACP Japan Chapter. 5-ASA at several time points unlike the previous study
I am grateful to Dr. Junichiro Mori and Dr. Ikuo only at 8weeks.
Shimizu, teachers of medical education center of 　I searched MEDLINE and Cochrane until February
Shinshu University, for devoting a lot of times to help this year. The selection criteria were as follows. The
me with the presentation. severity was mild or moderate because 5-ASA is first-line
　Abstract submission was recommended by Dr. Mori. treatment. A distal disease margin was less than 60 cm
　I was greatly impressed when I first saw him in an from the anal verge or distal to the splenic flexure,
interview at the entrance exam.After some interviewers because 5-ASA can also be administered rectally as a
asked me some stereotyped questions, he gave me a suppository, enema or foam. Outcome is remission. The
difficult question. I had difficulty in expressing myself purpose of this study is to evaluate not only at 8weeks
but it was original and stimulating my intellectual but also at several time points. Therefore there was no
curiosity. limitation of observation time.
　He seems to me to be a severe teacher. When I 　A total of 304 studies were retrieved and assessed for
discuss with him, he demands me to express myself in eligibility. Of these studies, 3 studies fulfilled the
my own words and will not allow me to use the words inclusion criteria. The duration of follow up ranged
of others. But his severity is connected with his from two to eight weeks. 2 studies including 95 patients
passionate love of truth and one aspect of his evaluated at 2 weeks. After 2 weeks, 3 studies including
educational honesty. 174 patients were evaluated. Rectal 5-ASA was superior
　Six years after first seeing him, I am glad to receive to oral 5-ASA for inducing remission, with risk ratio
this award and to say to him ' thank you.' two point ninety-nine. Rectal 5-ASA was no more
effective than oral 5-ASA from 2 weeks. But this study
　I conducted a systematic review of the therapy for shows that rectal 5-ASA provides earlier remission than
ulcerative colitis and the conclusion is that trans-anal oral 5-ASA.
administration of 5-Amino Salicylic Acid (5-ASA) I want to talk about the conclusion. Rectal 5-ASA
induces the quick induction of remission. induces earlier remission than oral 5-ASA at 2 weeks. Ａ
　Ulcerative colitis is clinically characterized by s I already talked, the standard therapy is the
abdominal pain, diarrhea, blood stool, and diarrhea and combination therapy with oral and rectal 5-ASA. In
decreases the quality of life. In patients with mildly or fact, patients prefer oral administration. And rectal
moderately active left-side colitis, the standard therapy is administration is frequently stopped over the therapy
the combination therapy with oral and rectal 5-ASA. period. But this study showing the time when rectal
But in fact, rectal 5-ASA is underused and frequently 5-ASA induces earlier remission is likely to be helpful in
stopped partly because according to a previous encouraging patients to use rectal 5-ASA and result in
systematic review, rectal 5-ASA were no more effective maintaining the combination therapy And general
than oral 5-ASA at 8 weeks although it is hard for conclusion is that it is important to report the time
patients to use rectal administration. But I doubted this course effects in systematic reviews.
result because rectal 5-ASA can be delivered I have a hypothesis that like this study, to consider the
site-specifically at high concentrations. So my research time course effects in a treatment may make it possible
question was ‘Does rectal administration induce early to find a new combination therapy.
remission?’ Therefore the purpose of this systematic If you are interested in me, please contact me anytime.
review is to evaluate the difference in the time course [email protected]
9
○ Recipients of Best Abstract Award of Japan Chapter Meeting 2016／Hirotaka Mori
10