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1.
Article in English | WPRIM | ID: wpr-51899

ABSTRACT

OBJECTIVES: The purpose of this survey was to explore physicians' opinions to identify an adequate time range for clinical information to be provided with a referral that would help minimize wasteful retesting. METHODS: In 2011, we conducted a questionnaire survey of 193 physicians. Examining the degree of utilization of provided medical information, we determined the range of clinical information of referral documents. RESULTS: Less than three months of prescription history and blood sample test results in patient referral was most frequent. Less than one year of image information was most frequent. Most doctors answered there is no need to repeat the same type of blood test in their institute when they had information less than half a month old. Less than half to one month of image information was most frequent. Also, it appeared many doctors think “fundamentally they do not change their mind from their own medical department standpoint.” At the actual site, those who would even review referral clinical notes accounted for about 30% of all participants. CONCLUSIONS: Medical referral eventually takes place after the establishment of mutual communication and should consider the workflow and system environment of the receiver of the information.


Subject(s)
Asian Continental Ancestry Group , Hematologic Tests , Hospital Information Systems , Humans , Prescriptions , Referral and Consultation , Surveys and Questionnaires
2.
Article in Japanese | WPRIM | ID: wpr-374840

ABSTRACT

The Standardized Structured Medical record Information eXchange (SS-MIX) was started in 2006 as the project supported by the Ministry of Health, Labour and Welfare (MHLW) for promoting the exchange of the standardized medical information. Free soft wares developed in the project allow the storage of medical information to receive HL7 messages for prescription, laboratory test results, diagnoses and patient demographics in the hospital information system (HIS). We encourage the use of the SS-MIX standardized storage for postmarketing surveys and clinical studies. The recommendations consist of the following 7 parts. [1] In surveys and clinical studies, the information of drugs and laboratory test results in the SS-MIX standardized storage can be directly transferred to the electronic questionnaire and the investigators may obtain the information with high accuracy and granularity. [2] The SS-MIX standardized storage works as the backup system for the HIS because it can provide the minimum information essential in patient care even under the disastrous condition like earthquake or unexpected network failure. [3] The SS-MIX standardized storage may be useful to conduct a good pharmacoepidemiology study not only because it provides the information in the storage efficiently but also it can be used to identify “new users” who started the drug after some period of non-use.The “new user” design is often essential to have the unbiased results. [4] When the drug company conducts postmarketing surveys according to the current regulation, the use of the SS-MIX standardized storage will facilitate the fast and efficient collection of data to develop the timely measure to minimize the drug-related risk. With the SS-MIX standardized storage, it is also expected that many types of study design can be employed and the quality of data is improved in the survey. [5] The SS-MIX standardized storage maybe also useful to evaluate the risk minimization action plan by comparing the prescription pattern or incidence of the targeted adverse event between two periods before and after the implementation of the action plan. [6] In planning clinical trials, the SS-MIX standardized storage may be used to estimate the size of eligible patients. The storage may also allow conducting cross-sectional studies to know characteristics of diseases or drug treatment. In addition, cohorts of those who had coronary artery angiography, new users of a drug and those with a rare disease may be readily identified. Using such cohorts, investigators can initiate a case-control study nested within the cohort, pharmacogenomic studies and comparative effectiveness researches. [7] The SS-MIX standardized storage may be used as the formal data source in clinical trials in the future when some conditions are satisfied. For instance, the formal agreement should be reached between industry, government and academia on the use of standards of data structure in Clinical Data Interchange Standards Consortium (CDISC) and on the operation of computerized system validation (CSV) in the clinical trials.

3.
Article in Japanese | WPRIM | ID: wpr-374837

ABSTRACT

SS-MIX is a product of Ministry of Health's healthcare information exchange promotion project. Its standardized storage stores prescription orders, laboratory test results, diagnosed disease classifications in HL7 v2.5 format. This can be connected to any vendorʼs hospital information system, provided that the system can export these information in HL7 format. The storage software can be downloaded from site of SS-MIX consortium. The stored standardized information can be used in many effective ways. Providing the information of the patient in a referral document form is easy. The server can be set in another place for the purpose of providing backup in case of disaster, natural or man-made, like system down, or network failure. Filling case card, like adverse event report, is also easy, by picking up the prescription, lab results, etc. and filling them into appropriate space, which are formerly filled by human hand, on paper, or through EDC. In Japan, SS-MIX standardized storage is in service at more than 116 hospitals (by March 2012). The coverage of patients by these hospitals are estimated around 1,500,000 people. Hospital information system in Japan must comply safety guideline by the Ministry, so that the electronic medical records can be used instead of paper records. Audit trails are mandated, and many human factors are recommended. As most hospital information systems in Japan are complying this Ministry guideline, gap between complying 21 CFR Part 11 is not a hard task for them. (Jpn J Pharmacoepidemiol 2013;18(1):49-56)

5.
Article in Japanese | WPRIM | ID: wpr-376021

ABSTRACT

<b>Objective:</b> Standardized clinical data are invaluable for secondary use of medical information. We constructed a standardized database and a data warehouse called D*D, based on the Standardized Structured Medical Information Exchange(SS-MIX)scheme. D*D enables physicians and researchers to perform complex searches with combined conditions, e.g. time to event. It contains data from 1999 for approximately 400,000 individual patients. The objective of this study was to provide an overview of the features of this database system, especially from the perspective of drug safety research.<br><b>Methods:</b> Three models of research questions were identified from established drug-risk combinations:1)gatifloxacin and hypoglycemia;2)statins and rhabdomyolysis;and 3)oral 5-fluorouracil S-1 and hepatotoxicity. D*D was searched using predefined keywords and conditions.<br><b>Results:</b> 1)A total of 3,635 patients were treated for diabetes. Among 20 diabetic patients prescribed gatifloxacin, hypoglycemia was recorded in one patient(1/38 prescriptions). 2)Among 5,926 patients who had been prescribed any statin within 10 years in our hospital, 6 patients(0.1%)experienced rhabdomyolysis. The incidence was similar to that for fibrate (1/740, 0.1%). The most confounded diagnosis was stiff shoulder. 3)Among 244 patients prescribed S-1, 19 patients(7.8%) experienced hepatotoxicity higher than CTCAE grade3 within 2 months from the prescription.<br><b>Conclusion:</b> With limited data items and search keys in standardized data storage, definitions of exposures and outcomes require careful assessment during protocol development. Considering that the system can be implemented at more than half of the hospitals that have already installed ordering systems, D*D can be one of the Japanese models for distributed research network.

6.
Article in Japanese | WPRIM | ID: wpr-366779

ABSTRACT

Myocardial oxidative stress during retrograde continuous blood cardioplegia (RCBC) was evaluated in 35 patients undergoing elective aortocoronary bypass surgery. The patients were divided into three groups: Group C (<i>n</i>=12) received cold (20°C) RCBC, Group T (<i>n</i>=11) received tepid (30°C) RCBC, and Group W (<i>n</i>=12) received warm (36°C) RCBC. Myocardial oxidative stress was assessed by measuring the release of oxidized glutathione (GSSG), malondialdehyde (MDA), and myeloperoxidase (MPO) in the coronary sinus plasma before aortic clamping, at 1, 5, and 10min after unclamping. Myocardial oxygen uptake and lactate release were assessed at the same times. Both the hemodynamic recovery and the creatine kinase MB (CKMB) activity were measured perioperatively until 24h after unclamping. In Group C, a significant coronary sinus release of GSSG was found in the early reperfusion period in comparison to Groups T and W. However, the peak CK-MB activity was significantly lower in Group T than in Group W. No significant difference in the release of MDA or MPO was noted in the three groups. The recovery of oxygen uptake after unclamping was rapid in Group T. The recovery in the left and right ventricular functions and the myocardial lactate release were similar in the three groups. In conclusion, tepid RCBC is considered to protect the myocardium from ischemia-reperfusion injury better than cold or warm blood cardioplegia under retrograde continuous perfusion.

7.
Article in Japanese | WPRIM | ID: wpr-366757

ABSTRACT

The Immunosuppressive effects of prostaglandin E<sub>1</sub> (PGE<sub>1</sub>) used in cardiopulmonary bypass (CPB) operation were studied. We examined 30 patients, with ischemic heart diseases. The patients were divided into 3 groups: 11 patients given PGE<sub>1</sub> in group PG (G-PG), 10 patients given amurinon, a phosphodiesterase inhibiter, in group A (G-A), and 9 patients not given either of those drugs in the control group (G-C). Immunologically, lymphocyte subpopulations, and adhesion molecule expression on cell membrane and phagocytosis of neutrophils were analyzed before, at the time of, and after the operation until POD 7. The prominent effects of PGE<sub>1</sub> were observed on neutrophils. The expression of CD 62L, an adhesion molecule designated as L-selectin, on the cell surface membrane of neutrophils significantly increased during and after CPB in G-A and G-C, but it remained unchanged in G-PG during the observation period. Moreover, CPB caused an enhancement of the phagocytic activity of neutrophils in all groups, but its degree was much less in G-PG than in the other two groups. Among lymphocyte subpopulations, the number of CD 3<sup>+</sup>T-cells in G-PG rather than that of CD 20<sup>+</sup>B-cells reduced more greatly than those values observed in G-A and G-C. The decrease of T-cell number, throughout the observation period, in G-PG seemed to be mainly due to the decrease of the number of CD 4<sup>+</sup>T-cells designated as helper T-cells, although the number of CD 8<sup>+</sup>T-cells esignated as killer/suppressor T-cells slightly decreased on PODs 3 and 7. Amurinon, as a whole, did not exert any significant effect either on lymphocytes or on neutrophils in our experiments. Taken together, these results show that the treatment of patients with PGE<sub>1</sub> during CPB causes suppressive effects on immunorelevant cells. It may mitigate the activity of neutrophils, which are suspected as a possible culprit causing reperfusion injury. However, these suppressive effects, including the lowered numbers of CD 4<sup>+</sup>T-cells, may render the patients more vulnerable to infection. Much more intensive cares is required in these patients after operations.

8.
Article in Japanese | WPRIM | ID: wpr-366751

ABSTRACT

A 45-year-old man was admitted with several histories of cerebral infarction. Transesophageal echocardiography showed a small tumor on the anterior mitral leaflet. Open heart surgery was performed. The tumor was removed including a part of the anterior mitral leaflet and mitral valve plasty was done. The post-operative course was uneventful. Papillary fibroelastoma was diagnosed pathologically. To avoid embolic complication, an early surgical procedure is recommended.

9.
Article in Japanese | WPRIM | ID: wpr-366687

ABSTRACT

A 47-year-old man was admitted with symptoms of angina pectoris. After evaluating the patient, coronary artery bypass grafting (CABG) was performed. First, the left internal thoracic artery (LITA) was grafted to the obtuse marginal branch (OM), and then the right gastroepiploic artery (RGEA) was grafted to the posterior descending branch (PD). Just after completing anastomosis, we performed intraoperative thermal coronary angiography. The RGEA-PD was patent. However, the LITA-OM was not patent on thermal coronary angiography. After a re-anastomosis was done at the LITA-OM, thermal coronary angiography was again performed and the LITA-OM was found to be patent. The postoperative course was uneventful, and all grafts were patent on postoperative angiography. In conclusion, intraoperative thermal coronary angiography was found to be useful for CABG.

10.
Article in Japanese | WPRIM | ID: wpr-366603

ABSTRACT

We herein review the early results of minimally invasive coronary artery bypass (MIDCAB). From April 1994 to November 1998, 23 patients underwent MIDCAB, and 12 patients underwent coronary artery bypass grafting with cardiopulmonary bypass (CABG). We compared and analyzed the findings of these two groups. Regarding preoperative factors, the MIDCAB group included elderly patients, while the CABG group consisted of younger patients. However, the frequency of hemodialysis, respiratory disorders and cerebral vascular accidents did not differ significantly between the 2 groups. Regarding perioperative factors, the MIDCAB group needed a shorter operation time, and also had a lower bleeding volume, and a low incidence of blood transfusion. Regarding the postoperative course, the MIDCAB group needed a shorter artificial respiration time, and a shorter postoperative hospital stay, and no mortality was observed. The graft patency of the MIDCAB group was lower (88%) than the CABG group (100%). However, the graft patency of the MIDCAB group reached 94% after we used a stabilizer in the operation. In conclusion, the operation results of the MIDCAB group were comparatively better than those of the CABG group. Thanks to recent technological advances, the results of MIDCAB continue to improve. Though MIDCAB remains an invaluable operative modality for the treatment of one-vessel disease, surgeons must be careful to select appropriate candidates for this operative method.

11.
Article in Japanese | WPRIM | ID: wpr-366554

ABSTRACT

A 45-year-old woman with an 8-year history of systemic lupus erythematosus (SLE) was admitted with complaints of sudden onset of chest and back pain and syncopal attack. Aortography showed DeBakey type I acute aortic dissection. She has been maintained on a small dose of corticosteroids (prednisone 5mg/day). After antihypertensive drug treatment, a replacement of the total aortic arch and arch vessels was successfully performed. The postoperative course was uneventful and she has had no relapse of SLE.

12.
Kampo Medicine ; : 1-7, 1995.
Article in Japanese | WPRIM | ID: wpr-368106

ABSTRACT

The effects of Qi Gong health maintenance exercises were compared with a control group of walkers considered to have an equivalent amount of exercise, by measuring the changes in the pulse, systolic blood pressure, diastolic blood pressure and peripheral circulation.<br>Although no significant differences were seen in either the pulse or blood pressure of the control group of walkers when the before and after exercise values were compared, in the Qi Gong group, a decrease in these values was seen over time, with significant decreases from the pre-exercise values indicated in all values 30 minutes after exercise. This is consistent with the findings in a previous report that there was a significant reduction in catecholamine in the Qi Gong group 30 minutes after performing Qi Gong exercises.<br>When the flow rate of the peripheral circulation was measured using Doppler ultrasound equipment, in comparison with the lack of notable change over time seen in the control group, a significant improvement in the peripheral circulation was suggested for the Qi Gong group when the pre- and post- exercise values were compared. It has also been suggested that Qi Gong health maintenance exercises lower stress hormones and act to improve the peripheral blood circulation; a discussion of which is also included in this paper.

13.
Article in Japanese | WPRIM | ID: wpr-365842

ABSTRACT

We performed tricuspid annuloplasty aggressively in association with mitral and combined mitral and aortic valve disease. Because tricuspid regurgitation (TR) may produce significant morbidity if not corrected. From March 1986 to September 1990, for the purpose of studying the clinicopathology of the biopsied right ventricular myocardium in 54 patients with mitral valvular disease, the diameter of right ventricular myocardial cells and diffuse interstitial fibrosis of biopsied myocardium were measured quantitatively. The degree of diffuse interstitial fibrosis was assessed by the point-counting method, and mean percentage fibrosis (% fibrosis) was noted as 16.1%, % fibrosis was correlated with the severity of TR (<i>r</i>=0.36). Mean diameter of right ventricular myocardial cells was 19.3μm in size. The diameter of right ventricular myocardial cell was correlated with pulmonary arterial pressure (<i>r</i>=0.51). More aggressive narrowing of tricuspid valve ring using DeVega's method was performed on 39 of 54 patients. The evaluation of TR was done by Doppler echo. Postoperative residual TR was observed in four patients of total postoperative patients within mean follow-up period of 41.0 months. In the 4 patients, % fibrosis were in high % fibrosis (>20%). In comparison to the group with low % fibrosis (<15%) (<i>n</i>=27), the group with high % fibrosis (>20%) (<i>n</i>=9) was more serious in severity of TR by Doppler echo (2.4 vs. 1.7), age (58.2 vs. 51.6), NYHA classification (3.2 vs. 2.6) before surgery. In conclusion, open right ventricular myocardial biopsy findings suggest that the degree of myocardial fibrosis is correlated with severity of tricuspid regurgitation. And the patients whose % fibrosis are more than 20% are presumed poor right ventricular function. The diameter of right ventricular myocardial cell is correlated with pulmonary arterial pressure, that is, right ventricular hypertrophy is associated with pulmonary hypertension.

14.
Article in Japanese | WPRIM | ID: wpr-370713

ABSTRACT

The examinations of essential oils in highest-, high-, and regular- grade commercial moxa were carried out by gas-liqiud chromatography. These results showed that highest grade-moxa contains lower alkanes but high and regular moxa contain higher alkanes in high and regular moxa.<br>On the quality control of moxa, it is necessary to examine how components contain in moxa.

15.
Article in Japanese | WPRIM | ID: wpr-370712

ABSTRACT

In previous report, we showed that moxa inhibit generation of superoxide as one of active oxygen species.<br>In present study, we investigated on radical scavenging effects of various moxas with DPPH-method.<br>These results showed that various moxas have radical scavenging effects and the difference of radical scavenging activities. The difference of activities should be due to the difference of grade of moxas.

16.
Article in Japanese | WPRIM | ID: wpr-370711

ABSTRACT

In the previous paper, we reported that the indirect moxibustions (ginger- or garlic-moxibustions) kept high-temperature rather than those of the diathermic moxibustions. However, the effects of the indirect moxibustions include not only thermal stimulations but also medicinal actions of the materials. In this study, we found the effects of radical scavenger in ginger and garlic with ESR spin trapping technique. This suggested that ginger- or garlic-moxibustions were available to treatment of disease caused by the radicals.

17.
Article in Japanese | WPRIM | ID: wpr-370692

ABSTRACT

In present study, the moxa and moxibustion-products inhibited production of superoxide.<br>These results suggested that moxa and moxibustion-products had a scavenger like effects on superoxide.

18.
Article in Japanese | WPRIM | ID: wpr-370654

ABSTRACT

In previous report, we investigated temperature-changes <i>in vivo</i> with diathermic moxibustions (scarring moxibustions), and showed that the temperature in the subcutaneous layer rised over 50°C. In present study, it was recognized that indirect moxibustions (ginger or garlic moxibustions) kept longer high-temperature than those of diathermic moxibustions. Therefore, it is possible that indirect moxibustions, although it seemed to be weakly stimulation, have stronger stimulation than diathermic moxibustions. In addition, the temperature-changes <i>in vivo</i> with indirect moxibustion seemed to be influenced by water contents of materials for indirect moxibustion and organism skin.

19.
Article in Japanese | WPRIM | ID: wpr-370636

ABSTRACT

Indirect moxibustion has been found to have the effects of thermal stimulation and pharmacological effects as we analyzed the intercalated substance with thin layer chromatography, 6-gingeol from zingiberis Rhizoma and allicin from Allis Bulbus were detected.<br>It is suggested that pharmacological effects of intercalated substance were significant in indirect moxibustion.

20.
Article in Japanese | WPRIM | ID: wpr-370622

ABSTRACT

It is necessary to research constituents of moxa on the studies of moxibution.<br>As we analyged the essential oil in moxa with gas liquid chromatography, n-nonacosane and n-hentriacontane were detected. Several compound (ex.: tricosanol, hentricontane, arachinakohol, thujone) have been already detected in moxa. But n-nonacosane and n-hentriacontane are newly detected constituents in moxa.

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