Résumé
Purpose：To explore a methodology for evaluating end-of-life （EOL） cancer care using diagnosis procedure combination （DPC） administrative data. Methods： We investigated care provided to inpatients whose deaths were attributed to cancer and occurred between August 2010 and December 2012. We measured the quality of palliative care by dividing the decedents into two groups： those who died in the palliative care unit （PCU） and those who died in the general wards（GW）. Results： A total of 311 inpatient deaths were identified as cancer deaths. Of these, 147 patients were included in the PCU group and 164 in the GW group. We calculated the DPC data as follows： the rates of chemotherapy administered within 30 days before death （PCU 0％, GW 27％） and within 14 days before death （PCU 0％, GW 10％）, admission to the intensive care unit （PCU 0％, GW 2％）, life-sustaining interventions （PCU 0％, GW 3％）, rehabilitation sessions （PCU 10％, GW 26％）, emergency admission （PCU 2％, GW 27％）, and antibiotics （PCU 32％, GW 28％）. In the PCU group, rates of chemotherapy and emergency admission were significantly lower（＜0.0001；＜0.0001, respectively）, and rehabilitation sessions were significantly higher （p＝0.0002） than in the GW group. Conclusion： EOL care in a university hospital can be easily investigated using DPC data. Some limitations are the single-site study design, the health insurance system, and secondary use of administrative data. However, this methodology may be adapted to investigate the entire Japanese claim database and to evaluate EOL cancer care.
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Advanced Medicine such as IPS cell, STAP cell, Medical Megabank, BioBank, Robot Surgery, Remote Medical Care, and Future Medicine, has been emerging. China set Chinese medi-cine centered on herbal medicine as a part of national strategy, into which they put big money and many hands.<BR> How healthcare should be? How advanced technology should be utilized? Where the Med-icine should go? What are the difference between health promotion and healthcare? And how do the both exist together? How balneology should go with Genomic researches which has been actively conducted?<BR> Current genomic researches mainly focus on resolving the genomic design and cause-effect relationship between the design and substantial expressions. Considering that these ex-pressions come under the influence of internal and external environments spatially and temporally, the researches on interaction with environment have got to be important. Due to the rise in health care costs, keeping good health and avoiding diseases have been well recognized worldwide. Although both evidence based health promotion and evidence based medicine become standard practice already, can we say that EBM (Evidence Based Medi-cine) is scientific indeed?<BR> Balneology keeps and promotes good health reasonably using hot springs and natural environment surrounding the human body. It aims to avoid diseases or recover from dis-eases. In that sense, we can say that balneology is ahead of genomic researches. We, however, need more scientific support to prove that. In order to deal with a complex system interacting with external and internal environments, variables for analysis increase enormously.<BR> In response to this current situation, I would like to think once again with you about the essence of balneology: What is insufficient? What is needed? In which direction should we be heading?
Résumé
Advanced Medicine such as IPS cell, STAP cell, Medical Megabank, BioBank, Robot Surgery, Remote Medical Care, and Future Medicine, has been emerging. China set Chinese medi-cine centered on herbal medicine as a part of national strategy, into which they put big money and many hands. How healthcare should be? How advanced technology should be utilized? Where the Med-icine should go? What are the difference between health promotion and healthcare? And how do the both exist together? How balneology should go with Genomic researches which has been actively conducted? Current genomic researches mainly focus on resolving the genomic design and cause-effect relationship between the design and substantial expressions. Considering that these ex-pressions come under the influence of internal and external environments spatially and temporally, the researches on interaction with environment have got to be important. Due to the rise in health care costs, keeping good health and avoiding diseases have been well recognized worldwide. Although both evidence based health promotion and evidence based medicine become standard practice already, can we say that EBM (Evidence Based Medi-cine) is scientific indeed? Balneology keeps and promotes good health reasonably using hot springs and natural environment surrounding the human body. It aims to avoid diseases or recover from dis-eases. In that sense, we can say that balneology is ahead of genomic researches. We, however, need more scientific support to prove that. In order to deal with a complex system interacting with external and internal environments, variables for analysis increase enormously. In response to this current situation, I would like to think once again with you about the essence of balneology: What is insufficient? What is needed? In which direction should we be heading?
Résumé
The objective of this paper is to define the basis for the translational research and its knowledge framework in balneology aiming to approach the disease prevention. As a method to attain this objective, we advocate the knowledge framework that can bridge gene ontology (GO), balneologic ontology (BO), and clinical ontology (CO) virtually at a client site with three sided basic concepts as (1) the logically extended anatomical index from micro to macro, (2) the knowledge representation based on feature described logical conceptual unit, and (3) the EBM (Evidence Based Medicine) based quality evaluation of knowledge. As an result, the scheme and the prototype of the knowledge framework for the basic balneology was built. The logically extended anatomically hierarchical index could offer the seamless and logical continuity from genome to human/environment. The EBM based quality assessment enhanced the reliability of knowledge, and the knowledge representation based on the logical conceptual unit approach offered the unification of the different grain size knowledge.
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In post-genome era, the greatest challenge of post-genome research is how we can apply genomic outcome to practical field like clinical medicine through discovering effective findings from its complex and meta-molecular network. From the viewpoint of reducing health care cost, preventive medicine that can avoid diseases should be essential target. Balneology that contains preventive medicine in part through unspecified bio-modulation effect should be a principal field of genome science based application. Balneology has expectations to be applied to practical clinical field or health promotion through translational research to modern medicine or health science. This translational research needs establishment of bridging knowledge and its bi-directional migration as the essence of translation. Integration of in silico knowledge among balneology, modern medicine, and genomic science is the fundamental basis of this translation. Single knowledge architecture that has anatomically hierarchical structure, logical conceptual unit and its supportive evidences makes integration logically seamless and establishes smooth translation. This paper reports knowledge architecture in balneologic translational research and its prototype.
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It is believed that one of the principal effects of negative air ion is refreshing human psychological condition. Negative air ion can be observed in natural environments such as forest, fountain, and hot spring. In order to elucidate scientific reason of psychological effects by negative air ions, quantifying psychological effects will be important.<br>Healthy sixteen examinees (8 young candidates around 20 years, 8 old candidates around 60 years) are tested by SRS-18, blood pressure, questionnaire, and electroencephalogram. SRS-18, blood pressure, questionnaire was performed before and after experiment. Electroencephalogram was continuously measured during whole experiment and used for emotional spectrum analysis method (ESAM) calculation. Experiment was divided into three conditions (initial normal condition, negative air ion boosted condition at middle concentration, after ventilated condition) and three phases (accommodation, rest, calculation) at each condition.<br>At young group, excessive negative air ions increased human psychological concentration which is calculated by ESAM. At calculation phase, psychological concentration has a positive correlation with psychological stress (correlation factor 0.505). Otherwise at old aged group, no significant change was observed. It shows that sensitivity of negative air ions at old persons will be reduced. It also suggests that human sensitivity for negative air ion decreases with aging.<br>At rest phase of young group in negative air ion boosted condition, elementary emotions are balanced at ESAM. This shows that balancing among four elementary emotions is related with psychological effects of negative air ions.
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Drinking of hot spring water containing sulfur or sodium bicarbonate is reported to be beneficial for diabetic patients. In the present study, sulfur spring water and water from simple thermals were chosen to examine their effects on glucose metabolism. Eleven volunteers including eight type 2 diabetic patients and three healthy subjects drank hot spring water from Kawayu Onsen (K-O, acid alum vitriol hydrogen-sulfide springs, pH1.98), and another six patients from Asukano-yu (A-Y, alkaline simple thermals, pH8.9). Oral glucose tolerance test (OGTT) was performed after drinking tap water (200<i>ml</i>) or K-O spring water (5 times diluted) at a week interval (short term effect). Increments in plasma glucose levels were significantly lower (p<0.05) with predrinking of spring water than those with pre-drinking of tap water. To know the long term effect of drinking, patients drank K-O water twice daily for 4 weeks or A-Y water twice daily for a week. Hemoglobin A<sub>1C</sub> levels decreased significantly (p<0.05) by drinking K-O water and the levels of 1.5-Anhydro-D-glucitol increased by A-Y water (NS). From these findings, it is suggested that drinking hot spring water from K-O and A-Y is beneficial for diabetic patients if they have no contraindications for drinking these kinds of spring water.
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Effect of foot bath on sleeping time in 3 old patients (70, 82, 84 years old) was investigated. After 2-days control period, feet were immersed in a water bath containing about 1, 000ppm CO<sub>2</sub> at 40-41°C for 15 minutes at 17:00 for 3 consecutive days. Wrist Mini-motion-logger actigraph was used for recording their activities. The hour for lights-out was 21:00 and that of rising was 06:00. They went to bed between 20:30-20:50 and woke up at 05:30 next morning. In 2 patients, sleeping time at night began to increase on the second immersion day, which continued even on the following 2 days without foot bath. All the patients showed no changes in daytime activities. They were satisfied with foot bath and felt warmth not only in their feet but also in their bodies. No remarkable side effects were observed in the present study. Foot bath is thought to be effective to treat insomnia.
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It is reported that changes in immunological system are one of the underlining mechanisms of balneotherapy effects. Since there is no study concerning the mechanisms how balneotherapy with a simple thermals works, we tried to examine both the changes of immunological functions and stress relieving effect of balneotherapy. Fourteen inpatients (mean age 63 years) suffering from such as cerebrovascular diseases participated in the present study. Before and after 6-week balneotherapy, lymphocyte subset counts, levels of cytokines (IL-4, IL-6, IF-γ etc.) were determined and lymphocyte blastogenetic tests were also performed. In addition, stress barometers (urinary 17-ketosteroidsulfate (17KSS)/17hydroxycorticosteroid (17OHCS)) were measured. As a result, no significant changes in cytokine levels were observed. Percentage of T cell count decreased and that of B cell increased. Percentage of suppressor T cell count decreased and that of helper and killer T cell tended to increase (not significant). Lymphocyte blastogenetic tests by ConA and PWM showed enhanced responses and urinary 17KSS/17OHCS levels increased after balneotherapy. From these findings, it is suggested that 6-week balneotherapy with a simple thermals has a potential of augmenting immunological functions and also possesses stress relieving effect.