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Role of neurosurgeons in Japan
THE LANCET
reference to similar studies, the acknowledgement of shortcomings in the research, and the recommendations. Incidentally, “I” occurs just once in our analysis, but “we”—and after all, most papers have several authors—occurs 279 times. So perhaps we are indeed allowed to draw attention to ourselves. *John Skelton, Richard Lilford, Sarah Edwards Departments of *General Practice, and Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
1
2
3
4
5
Gilbert G, Mulkay M. Opening Pandora’s box: a sociological analysis of scientific discourse. Cambridge: Cambridge University Press, 1984. Sinclair J. Collins COBUILD English language dictionary. London: Collins, 1987. Coulthard M. On beginning the study of forensic texts: corpus, concordance, collocation. In: Coulthard M (ed). Techniques of descriptions: spoken and written discourse. London: Routledge, 1993. Sinclair J (ed). Looking up: an account of the COBUILD project in lexical computing and the development of the Collins COBUILD English language dictionary. London: Collins, 1987. Skelton J. Analysis of the structure of original research papers: an aid to writing original papers for publication. Br J Gen Prac 1994; 44: 455–59.
Role of neurosurgeons in Japan SIR—There is an abundance in Japan of well qualified neurosurgeons. More than 4000 certified neurosurgeons work in tertiary and secondary care hospitals, whereas neurologists number less than half of these.1 Only 46 of the 80 medical colleges have a neurological department, but all have a neurosurgical department. These allocations of human resources should be changed so as to improve the health status of the population, with emphasis on primary and secondary prevention, and pertinent care for patients with cerebrovascular diseases. In Japan, cerebrovascular diseases became the second-to-largest cause of mortality (after cancer) in 1995, the number of deaths counted as 146 542).2 There are two medical colleges in Tochigi prefecture (80 km north of Tokyo), and neurosurgeons are available in 31 community hospitals which serve the population of about 2 million. Yet there is a scarcity of neurologists at the primary and secondary care hospitals, which means that the neurosurgeons must work at the front line, taking care of patients with stroke even though most such patients do not need neurosurgical
140
intervention. Furthermore, the prevalence of cerebrovascular disease in this prefecture has been the highest throughout Japan during the past several years. My experience as a community hospital neurosurgeon for 2·5 years encourages belief in the need for reallocation of more than 4000 certified neurosurgeons among the primary and secondary care hospitals. Also, the medical colleges should guide and distribute their neurosurgeon graduates to each level of the healthcare pyramid, according to capabilities—sophisticated tertiary care neurosurgeons going to university and general hospitals, secondary care neurosurgeons to community hospitals, and primary care neurosurgeons or surgical neurologists to clinics. Tertiary neurosurgeons should be reserved for treating patients with brain tumours, cerebral aneurysms, arteriovenous malformations, central nervous system anomalies, severe head injuries, and spinal cord and other complicated conditions. The major intracranial and spinal conditions for elective surgery should be sent to the tertiary care hospitals. Secondary neurosurgeons should be reserved for neurosurgical emergencies (eg, traumatic intracranial haematomas, hypertensive intracerebral haemorrhage). The primary care neurosurgeons or surgical neurologists are expected to be gatekeepers, and to care for patients with cerebrovascular disease in cooperation with primary care physicians. Preventative interventions for cerebrovascular diseases at community hospitals and clinics are required as an important step towards improving the health status of the Japanese people. In 1995, there were about 1·4 million patients with cerebrovascular diseases—more than 1% of the whole population.2 Regardless of category, every neurosurgeon should be aware of what is going on at each level. Primary and secondary neurosurgeons should receive several years of training at a tertiary care hospital before assuming responsibilities elsewhere. On the other hand, tertiary care neurosurgeons should gain real-world experience at a secondary care hospital. Secondary and primary neurosurgeons might also be appropriate for neurosurgical care in developing countries.3,4 Susumu Wakai Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi 321-02, Japan
1
Biannual survey on the number of physicians, dentists and pharmacists.
2 3
4
Tokyo Ministry of Health and Welfare, 1994, Health and Welfare Statistics Association. J Health Welfare Stat 1996; 43: 42–87. de Villiers JC. A place for neurosurgery in a developing country? Surg Neurol 1996; 46: 403–07. Wakai S. Foundation for international education in neurosurgery. J Neurosurg 1994; 80: 352.
Potential antitussive effects of a computer antivirus program SIR—Our son contracted what seemed to be an acute viral upper respiratory infection with pronounced cough. We had no antitussive drugs at home and opted for more conventional home remedies (eg, chicken soup, tea and honey, paracetamol) each of which failed to resolve his severe coughing. We noticed that while our son Michael was playing with his computer games the frequency and severity of his symptoms decreased. His coughing resumed during family activities such as meals, but abated when be began playing again. To us, this was the equivalent of a clinical trial in a single patient in which repeated changes in therapy and observation of effect could be observed. When an association became evident, we contemplated a possible mechanism for this therapy. The “Myst” game that our son enjoyed was neither humid nor inhaled. The “Raptor” and “Warcraft” games were equally therapeutic. This suggested that no single program was better in therapeutic effect. However, we realised that the software contained a special antivirus program that may, somehow, have relieved symptoms of the respiratory viral infection. Although a deleterious influence of computer games on children has been widely discussed, the therapeutic benefit we describe may be helpful knowledge to other parents seeking novel home remedies for this common affliction of children. Since our son’s recovery, we have, unfortunately, noticed that he often will feign coughs in order to increase the time we allot him for playing computer games. We are carefully monitoring him for early signs of Munchausen’s syndrome. Readers should note that this letter is not meant to endorse any individual computer product for a medicinal use for which it has not been licensed. *Barbara J Stoll, Roger I Glass *Department of Paediatrics, Emory University School of Medicine, Grady Memorial Hospital, Box 26015, Atlanta, Georgia 30335, USA; and Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Vol 349 • January 11, 1997
reference to similar studies, the acknowledgement of shortcomings in the research, and the recommendations. Incidentally, “I” occurs just once in our analysis, but “we”—and after all, most papers have several authors—occurs 279 times. So perhaps we are indeed allowed to draw attention to ourselves. *John Skelton, Richard Lilford, Sarah Edwards Departments of *General Practice, and Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
1
2
3
4
5
Gilbert G, Mulkay M. Opening Pandora’s box: a sociological analysis of scientific discourse. Cambridge: Cambridge University Press, 1984. Sinclair J. Collins COBUILD English language dictionary. London: Collins, 1987. Coulthard M. On beginning the study of forensic texts: corpus, concordance, collocation. In: Coulthard M (ed). Techniques of descriptions: spoken and written discourse. London: Routledge, 1993. Sinclair J (ed). Looking up: an account of the COBUILD project in lexical computing and the development of the Collins COBUILD English language dictionary. London: Collins, 1987. Skelton J. Analysis of the structure of original research papers: an aid to writing original papers for publication. Br J Gen Prac 1994; 44: 455–59.
Role of neurosurgeons in Japan SIR—There is an abundance in Japan of well qualified neurosurgeons. More than 4000 certified neurosurgeons work in tertiary and secondary care hospitals, whereas neurologists number less than half of these.1 Only 46 of the 80 medical colleges have a neurological department, but all have a neurosurgical department. These allocations of human resources should be changed so as to improve the health status of the population, with emphasis on primary and secondary prevention, and pertinent care for patients with cerebrovascular diseases. In Japan, cerebrovascular diseases became the second-to-largest cause of mortality (after cancer) in 1995, the number of deaths counted as 146 542).2 There are two medical colleges in Tochigi prefecture (80 km north of Tokyo), and neurosurgeons are available in 31 community hospitals which serve the population of about 2 million. Yet there is a scarcity of neurologists at the primary and secondary care hospitals, which means that the neurosurgeons must work at the front line, taking care of patients with stroke even though most such patients do not need neurosurgical
140
intervention. Furthermore, the prevalence of cerebrovascular disease in this prefecture has been the highest throughout Japan during the past several years. My experience as a community hospital neurosurgeon for 2·5 years encourages belief in the need for reallocation of more than 4000 certified neurosurgeons among the primary and secondary care hospitals. Also, the medical colleges should guide and distribute their neurosurgeon graduates to each level of the healthcare pyramid, according to capabilities—sophisticated tertiary care neurosurgeons going to university and general hospitals, secondary care neurosurgeons to community hospitals, and primary care neurosurgeons or surgical neurologists to clinics. Tertiary neurosurgeons should be reserved for treating patients with brain tumours, cerebral aneurysms, arteriovenous malformations, central nervous system anomalies, severe head injuries, and spinal cord and other complicated conditions. The major intracranial and spinal conditions for elective surgery should be sent to the tertiary care hospitals. Secondary neurosurgeons should be reserved for neurosurgical emergencies (eg, traumatic intracranial haematomas, hypertensive intracerebral haemorrhage). The primary care neurosurgeons or surgical neurologists are expected to be gatekeepers, and to care for patients with cerebrovascular disease in cooperation with primary care physicians. Preventative interventions for cerebrovascular diseases at community hospitals and clinics are required as an important step towards improving the health status of the Japanese people. In 1995, there were about 1·4 million patients with cerebrovascular diseases—more than 1% of the whole population.2 Regardless of category, every neurosurgeon should be aware of what is going on at each level. Primary and secondary neurosurgeons should receive several years of training at a tertiary care hospital before assuming responsibilities elsewhere. On the other hand, tertiary care neurosurgeons should gain real-world experience at a secondary care hospital. Secondary and primary neurosurgeons might also be appropriate for neurosurgical care in developing countries.3,4 Susumu Wakai Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi 321-02, Japan
1
Biannual survey on the number of physicians, dentists and pharmacists.
2 3
4
Tokyo Ministry of Health and Welfare, 1994, Health and Welfare Statistics Association. J Health Welfare Stat 1996; 43: 42–87. de Villiers JC. A place for neurosurgery in a developing country? Surg Neurol 1996; 46: 403–07. Wakai S. Foundation for international education in neurosurgery. J Neurosurg 1994; 80: 352.
Potential antitussive effects of a computer antivirus program SIR—Our son contracted what seemed to be an acute viral upper respiratory infection with pronounced cough. We had no antitussive drugs at home and opted for more conventional home remedies (eg, chicken soup, tea and honey, paracetamol) each of which failed to resolve his severe coughing. We noticed that while our son Michael was playing with his computer games the frequency and severity of his symptoms decreased. His coughing resumed during family activities such as meals, but abated when be began playing again. To us, this was the equivalent of a clinical trial in a single patient in which repeated changes in therapy and observation of effect could be observed. When an association became evident, we contemplated a possible mechanism for this therapy. The “Myst” game that our son enjoyed was neither humid nor inhaled. The “Raptor” and “Warcraft” games were equally therapeutic. This suggested that no single program was better in therapeutic effect. However, we realised that the software contained a special antivirus program that may, somehow, have relieved symptoms of the respiratory viral infection. Although a deleterious influence of computer games on children has been widely discussed, the therapeutic benefit we describe may be helpful knowledge to other parents seeking novel home remedies for this common affliction of children. Since our son’s recovery, we have, unfortunately, noticed that he often will feign coughs in order to increase the time we allot him for playing computer games. We are carefully monitoring him for early signs of Munchausen’s syndrome. Readers should note that this letter is not meant to endorse any individual computer product for a medicinal use for which it has not been licensed. *Barbara J Stoll, Roger I Glass *Department of Paediatrics, Emory University School of Medicine, Grady Memorial Hospital, Box 26015, Atlanta, Georgia 30335, USA; and Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Vol 349 • January 11, 1997