DPC in acute-phase inpatient hospital care. Visualization of amount of nursing care provided and accessibility to nursing care.

OBJECTIVE: The purpose of this study was to improve accessibility to nursing care by clarifying the relationship between patient characteristics and the amount of nursing care for the Diagnosis Procedure Combination system (DPC). METHOD: The subjects included 528 lung cancer patients; 170 gastric cancer patients; and 91 colon cancer patients, who were hospitalized from July 1, 2008, to March 31, 2010, at a university hospital. The patients were categorized into groups according to factors that could affect the amount of nursing care. Next, the relationship between the patient characteristics and the amount of nursing care was analyzed. Then the results from this study were used to classify patient characteristics according to the patient type and the amount nursing care required. RESULTS: The patient characteristics, which affected the amount of nursing care, varied according to each DPC code. The major factors affecting the amount of nursing care were whether the patient had received a surgical (under general anesthetics) treatment or a non-surgical treatment and the level of activities of daily living (ADL) of the hospitalized patients. For those who had received a surgical operation for colon cancer, the patient's age also affected the amount of nursing care. CONCLUSIONS: The findings show that the method for the visualization of the amount of nursing care based on the classification of patient characteristics can be implemented into the electronic health record system. This method can then be used as a management tool to assure appropriate distribution of nursing resources.

Development of hospital data warehouse for cost analysis of DPC based on medical costs.

OBJECTIVES: To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. METHODS: We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. RESULTS: The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. CONCLUSIONS: These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

Status and perspective of hospital information systems in Japan.

Questionnaire surveys were sent to hospital managers, designed to shape the policy for future hospital information systems in Japan. The answers show that many hospitals use dedicated management systems, especially for patient registration and accounting, and personnel, food control, pharmacy and financial departments. In many hospitals, order-entry systems for laboratory tests and prescriptions are well developed. Half of the hospitals have patient databases used for inquiries of basic patient information, history of outpatient care and hospital care. The most obvious benefit is the reduction of office work, due to effective hospital information system. Many hospital managers want to use the following sub systems in the future for automatic payment, waiting time display, patient records search, automatic prescription verification, drug side-effect monitoring, and graphical display of patient record data.

[Construction of an MRI reporting system using the Internet].

Out university hospital, includes a LAN (Local Area Network) and uses network services such as WWW(World Wide Web). We have constructed an MRI diagnostic reporting system on the Internet in which interactive date management was established on WWW by using CGI (Common Gateway Interface) software. Linking database information such as MRI reports with WWW browsers using by CGI provides easy data access to the database and offers hypertext and searching. This system suggests the possibility of creating a cheaper and more flexible network using Internet technology.

Soluble intercellular adhesion molecule-1 in serum in chronic hepatitis B and C.

Intercellular adhesion molecule-1 (ICAM-1) is expressed on the hepatocyte membrane in patients with chronic hepatitis B and C. We assayed levels of the soluble form of this molecule (sICAM-1) in serum by an enzyme-linked immunosorbent assay method; we then analyzed the results in relation to hepatitis activity. Fifty-one patients with chronic hepatitis (22 with type B and 29 with type C) and 10 normal controls were examined. The serum levels of sICAM-1 in hepatitis B and C were significantly higher (P < 0.01) than in normal controls. The serum level of sICAM-1 was correlated with serum glutamic-pyruvic transaminase level (P < 0.01), and the level of sICAM-1 in patients in whom exacerbation was seen was significantly higher (P < 0.05) than that in patients in a remission. There was no relationship between the serum level of sICAM-1 and the degree of ICAM-1 expression on the hepatocyte membrane. These results suggest that the serum level of sICAM-1 reflects the degree of activity of chronic hepatitis B and C.

Development of total medical material distribution management system.

Since September 1992, attempts have been made at Kagoshima University Hospital to develop the Medical Material Distribution Management System which helps to realize optimal hospital management as a subsystem of the Total Hospital Information System of Kagoshima University (THINK). As this system has been established, it has become possible for us to have an accurate grasp of the flow and stock of medical materials at our hospital. Furthermore, since September 1993, the Medical Material Distribution Management System has been improved and the Total Medical Material Distribution Management System has been smoothly introduced into the site of clinical practice. This system enables automatic demands for fees for treatment with specific instruments and materials covered by health insurance. It was difficult to predict the effect of this system, because no similar system had been developed in Japan. However, more satisfactory results than expected have been obtained since its introduction.

A case report of drug-induced allergic hepatitis probably due to the N-methyltetrazolethiol group cephalosporin.

Drug-induced allergic hepatitis occurred in a patient being treated with cefpiramide sodium. A lymphocyte blast transformation test suggested that the N-methyltetrazolethiol group of the drug was responsible for the induction of acute hepatitis. A detailed case report and discussion of the relevant literature are presented in this paper.

Hepatitis C virus plus- and minus- strand RNA in hepatocellular carcinoma and adjoining nontumorous liver.

The presence of hepatitis C virus (HCV) RNA in serum and liver tissue was examined in seven patients with hepatocellular carcinoma (HCC), using the reverse transcriptase-polymerase chain reaction method with primers for the 5'-noncoding region. Plus-strand HCV-RNA was detected in the serum and liver tissue (both cancerous and noncancerous tissue) of all five patients who were positive for anti-HCV antibodies (C100-3 and P22) and was not detected in both of two patients who were negative for anti-HCV antibodies. Minus-strand HCV-RNA was only detected in the liver tissue (cancerous and noncancerous portion) of the five anti-HCV antibody-positive patients. The relative liver tissue content of minus-strand HCV-RNA ranged from 1 to 100 time less than that of plus strand HCV-RNA in cancerous and noncancerous tissue in each patient, respectively. There was no similar tendency in the HCV-RNA content between the cancerous and noncancerous portions of the liver in each patient. These results suggest that HCV exists and replicates in HCC tissue and may have some role in the development of HCC.

[Detection of minus strand HCV RNA in liver tissue by reverse transcriptase polymerase chain reaction (RT-PCR)].

Hepatitis C virus RNA in serum and liver tissue was examined in seven patients with liver cirrhosis by reverse transcriptase polymerase chain reaction method using primers for 5'-non-coding region. Plus strand HCV RNA were detected in serum and liver tissues in five of five patients who had HCV antibodies (C100-3 antibody and P22 antibody) and were not detected in two of two patients who do not have HCV antibody. Minus strand HCV RNA was detected in liver tissue of five HCV antibody positive patients. These results suggest that HCV are present and replicate in liver tissue in patients with liver cirrhosis.

The management of medical records.

An optical disk filing system is an efficient approach to storing medical records; however, this system has not yet been put to practical use because it is usually a "stand-alone" type indirectly connected to a hospital information system. We have developed a medical record management system with an optical disk filing system connected to the host computer in the hospital information system. We can retrieve and display the medical records through the CRT (Cathode Ray Tube) terminals of the hospital information system at every ward and outpatient clinic. The patient's clinical information can be sent to several areas in the hospital using the hospital information system.

Development of a hospital management system to analyze nursing information using a microcomputer.

We have developed a hospital management system to analyze the large amount of the nursing information using a microcomputer system. In this system, we have combined the information from the patient database and the nursing database in order to evaluate the quality of medical care in the hospital. The utilization of a microcomputer is useful for filing and analyzing it and presenting the results in a variety of formats, including graphic representations.

[Significance of anti-HTLV-I antibody in cerebrospinal fluid in diagnosis of HTLV-I associated myelopathy (HAM)].

Anti-HTLV-I antibody was measured in 69 cerebrospinal fluids (CSFs) of cases with typical HTLV-I associated myelopathy (HAM) and other disorders whose symptoms were similar to HAM in order to evaluate the diagnostic significance of anti-HTLV-I antibody in CSF. Both gelatin particle agglutination (PA; Serodia-ATLA) method and recombinant gag-env hybrid protein coated ELISA were employed simultaneously. Antibody titers of both methods showed linear correlation. Cases with typical HAM (24 cases) and HAM with additional neurological manifestations (7 cases) showed high positivity in both methods. Cases with other neurological disorders with possible HAM (11 cases, seropositive) and cases with other neurological disorders without HAM (12 cases, seropositive) showed low positivity with low titer in ELISA, on the other hand, 81% and 67% of those cases were positive in PA method. All cases with seronegative neuroimmunological disorders (15 cases) were negative in CSFs. These findings showed that anti-HTLV-I antibody in CSF is significant in diagnosis of HAM, and both PA and gag-env ELISA are useful to detect anti-HTLV-I antibodies in CSF.

The seroepidemiology of hepatitis A and B in a Japanese town.

Sera collected from 1,118 healthy children and adults aged between four years and 90 years during the period 1989 to 1990, were tested for serological markers of hepatitis A virus (HAV) [antibody to HAV (anti-HAV)] and hepatitis B virus (HBV) [hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBsAb)]. The overall prevalence rates of anti-HAV, HBsAg, and anti-HBV were 20.2%, 0.36%, and 5.1%, respectively. No body was found to be positive for anti-HAV below 30 years of age but more than 70% of the adults aged 50 years or over were positive for anti-HAV. The level of exposure of HAV infection is declining in Japan and paradoxically at the same time a vast majority of people are becoming susceptible to more severe illness. The fall in prevalence of HBsAg possibly represents the positive impact of ongoing vaccination programs and other preventive measures against HBV.

A total hospital information system at Kagoshima University Hospital.

At Kagoshima University Hospital, we have been developing the total hospital information system named THINK (total hospital information system of Kagoshima University), using a large-size computer system. In this system, the entry of data is done only once at the point of origin. The mutual use of data is done by various subsystems, and the user interface is uniformity. As a result of the speed, accuracy, and flexibility of the system's software, we have achieved efficient medical services and hospital management by a unified database; furthermore, we have improved medical care to patients and we can use this database for supporting not only medical education but also clinical research.

Computerized nursing system in hospital information system.

We have developed a computerized nursing system including a nursing information system, a nursing administration system and a nursing support system. This on-line nursing system is linked to the total hospital information system. This paper describes the purpose and concept of the system development. The nursing system can be utilized in the individualized planning, delivery and evaluation of patient care.