Consultations with patients who bring drugs, especially on the high risk drug list, to a hospital is an important role of pharmacists. However, many incident reports occur though pharmacists generally make an effort to check such medications. In Japan, incidents are mostly reported just in terms of numbers but not in terms of the prevalence of a target group. We aim to reveal the prevalence of incidents related to medicine brought-in by patients undergoing surgery in National Hospital Organization (NHO) hospitals. For our study, we extracted patients undergoing surgery who were prescribed antidiabetic agents from the Medical data bank (MIA) in NHO. Chart reviews were performed on patients to evaluate the number of incidents in relation to brought-in medicine. The prevalence of incidents of interest was 4.4% (41/931, 95%CL : 3.2-5.9%). Pre-avoidable incidents represented 56.1% (23/41, p<0.0001). We found that pharmacists play a role in making incidents less severe.

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated. METHODS: We aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database. RESULTS: In total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045). CONCLUSIONS: Severe bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.
Blood Transfusion/statistics & numerical data ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*adverse effects ; Female ; Fibrinolytic Agents/adverse effects ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Pancreatic Neoplasms/*pathology

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.

OBJECTIVESWith greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).

METHODSThis study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.

RESULTSFrom 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system.

CONCLUSIONSThis study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.