436 research outputs found
A Questionnaire Study of Leadership in General Medicine: General Physicians in Japan are Facing Challenges in Education and Research [Response to Letter]
No full textRisa Hirata,1 Masaki Tago,1 Hiromizu Takahashi,2 Takashi Watari,3 Kiyoshi Shikino,4,5 Yosuke Sasaki,6 Taro Shimizu7 1Department of General Medicine, Saga University Hospital, Saga, Japan; 2Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; 3Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan; 4Department of General Medicine, Chiba University Hospital, Chiba, Japan; 5Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan; 6Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan; 7Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, JapanCorrespondence: Masaki Tago, Department of General Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan, Tel +81 952 34 3238, Fax +81 952 34 2029, Email [email protected]
Precise Classification of Generalists is Necessary to Establish Evidence in General Medicine [Response to Letter]
No full textRisa Hirata,1 Masaki Tago,1 Kiyoshi Shikino,2,3 Takashi Watari,4 Hiromizu Takahashi,5 Yosuke Sasaki,6 Taro Shimizu7 1Department of General Medicine, Saga University Hospital, Saga, Japan; 2Department of General Medicine, Chiba University Hospital, Chiba, Japan; 3Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan; 4Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan; 5Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; 6Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan; 7Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, JapanCorrespondence: Masaki Tago, Department of General Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan, Tel +81 952 34 3238, Fax +81 952 34 2029, Email [email protected]
The Future of Hospital Medicine in Japan: Lessons From the United States Hospital Medicine System
No full textTomoharu Suzuki,1,* Kohta Katayama,2,* Nathan Houchens,3,4 Sarah Hartley,3,4 Yasuharu Tokuda,5,6 Takashi Watari7,8 1Department of Hospital Medicine, Urasoe General Hospital, Urasoe, Okinawa, Japan; 2Department of General Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; 3Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; 4Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 5Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan; 6Tokyo Foundation for Policy Research, Tokyo, Japan; 7Kyoto University Hospital, Integrated Clinical Education Center, Kyoto, Japan; 8General Medicine Center, Shimane University Hospital, Shimane, Japan*These authors contributed equally to this workCorrespondence: Takashi Watari, Shimane University Hospital, General Medicine Center, 89-1 Enya, Izumo city, Shimane prefecture, Shimane, Japan, Email [email protected]: To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan’s emerging hospital medicine program.Methods: A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions. Data were collected through direct observation and structured discussions focusing on care-team structures, workflows, multidisciplinary collaboration, educational approaches, and quality improvement activities. The authors subsequently developed a comparative analysis report of Japan-US differences. Guided discussions based on this report were conducted with experienced US hospitalists and a pioneer physician of General Medicine in Japan to obtain expert commentary on the analyses. No quantitative data analysis or specific analytical software was utilized for this narrative comparison.Results: The US hospitalist model demonstrated group practice approaches with shift-based schedules supporting work-life balance. Multidisciplinary teams actively incorporated residents and students in patient care, quality improvement, and teaching. Japan’s traditional attending physician model emphasized continuity of care but showed high workloads and limited multidisciplinary integration. Japanese hospitalists faced challenges including extensive work hours, fewer specialized training opportunities in quality improvement and patient safety, and less robust team-based learning environments.Conclusion: Incorporating elements from the US model—such as group practice with shift-based systems, enhanced multidisciplinary collaboration, and structured educational and quality improvement initiatives—could address workload issues and foster professional development in Japan’s hospital medicine system while preserving valued aspects of continuity of care. These findings provide specific actionable guidance for healthcare administrators, medical education directors, and policymakers involved in developing Japan’s hospitalist system, as well as to practicing Japanese hospitalists seeking to enhance their professional practice environments and educational frameworks.Keywords: health systems comparison, quality improvement, medical education, multidisciplinary car
Abstract LB-323: Comparative miRNA microarray profiling indicates miR-363 promotes chemoresistance in ovarian cancer cells by targeting the Hippo member, LATS2
No full textAbstract
Ovarian cancer is the most aggressive female reproductive tract tumours. Taxane (TX) is widely used for ovarian cancer treatment. However, ovarian cancer often acquire chemoresistance. MicroRNAs (miR) have been reported to regulate many tumours’ chemoresistance. Here, we investigated the comparative microRNA expression profile between the ovarian cancer cells and their taxane-resistant counterpart, KF-TX to get novel markers for taxane resistance in ovarian cancer. The array data revealed that miR-486, miR143,miR145 and miR363 are the most upregulated miRNAs in association with TX resistance. However, miR-155, miR-100, miR-31 and miR-629 are the most significantly downregulated miRNAs after resistance development. We then focused on the role of miR-363 in chemoresistance of the ovarian cancer. qRT-PCR indicated that miR-363 was upregulated in KF-TX cells, confirming the array data, and introduction of miR-363 into sensitive ovarian cancer cells confers TX-resistance and significantly inhibited the expression of the Hippo member, LATS2, as indicated by viability, clonogenic assays and expression analysis. Furthermore, we validated the role of LATS2 in the TX-response by sh-based silencing, which also confers TX-resistance in the responsive ovarian cancer cells. On the other hand, specific inhibitor against miR-363 restored the response to TX. In addition, miR-363 was found to bind to the 3′-UTR of LATS2 mRNA, confirming that miR-363 directly targets LATS2 as indicated by dual luciferase assay. RT-PCR-based evaluation of miR-363 in a panel of human ovarian tumours revealed its upregulation in most of the tumour tissues identified as resistant while downregulation of the same gene in most of the tissues identified as sensitive ones. Moreover, higher levels of miR-363 in human ovarian cancer specimens were significantly correlated with TX chemoresistance and poor prognosis. Taken together, our study reveals the involvement of miR-363 in chemoresistance by targeting LATS2 in ovarian cancers, raising the possibility that combination therapy with a miR-363 inhibitor and TX may increase TX efficacy and reduce the chance of TX-resistance.
Note: This abstract was not presented at the meeting.
Citation Format: Noriaki Sakuragi, Mohamed Kamel Farah, Zeinab Mohamed, Safwat Okasha, Hidemichi Watari, Takashi Mitamura, sherif El Khamisy, Yusuke Ohba. Comparative miRNA microarray profiling indicates miR-363 promotes chemoresistance in ovarian cancer cells by targeting the Hippo member, LATS2 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-323. doi:10.1158/1538-7445.AM2017-LB-323</jats:p
Key concepts for improving primary care diagnosis in Japan: Diagnostic error in primary health care
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