A follow up study was made on patients who were admitted into our hospital because of stroke or fracture of the neck of the thighbone before and after the Nursing Care Insurance Law was enforced. The study found that there was a salient tendency for the number of days the patients stayed in hospital to increase and for the rate of discharge from hospital to the patients home to decrease.
As the nursing care insurance system came to stay, one local government after another was pulling out the functional training work which had been conducted as one from of the rehabilitation projects. In place of municipalities, nursing care service contractors were taking on such health service work as home visits for rehabilitation, and outside visits for nursing and rehabilitation. In the future, it would be necessary to establish a network enouth to promote health and welfare services including the provision of medical and rehabilitation equipment and the repair of houses.

Backgraund/Aim/Method: Hepatocellular carcinoma (HCC) is a serious life-threatening disease. When HCC is advanced, moderate to severe pain is frequently found due to bone metastasis, requiring the administration of opioids. However, HCC develops in cirrhotic liver in most cases those are decreased in drug metabolism. Careful monitoring is therefore required when opioids are administered to patients with cirrhosis or HCC because guidelines about the administration of opioids are not established in Japan. In this report, we retrospectively analyzed cases treated by opioids and discussed about problems in current opioid treatment for advanced HCC cases. Results: The median duration of opioid treatment is about two months, and seems to be prolonged in cases with treatment of HCC. Prophylaxes for hepatic encephalopathy were done in about 10% of cases, and hepatic encephalopathy was developed in about 40% of cases after opioid treatment. Conclusion: In administration of opioids for advanced HCC, we should consider the onset of hepatic encephalopathy and make an effort to prevent it.

Objective : To evaluate the necessity to complement the information obtained from pharmacists in the community pharmacy by that from the hospital pharmacy in Prescription-Event Monitoring in Japan (J-PEM) by using data in a J-PEM pilot study.
Methods : For each patient, two questionnaires were sent to the prescribing doctor and the pharmacist who registered the patient ID code in the pilot study. If the patient ID code was registered by the pharmacist in the community pharmacy and if a pharmacist inside the hospital where the prescription was issued was willing to co-operate, a third questionnaire for the same patient was sent to the pharmacist in the hospital pharmacy. The information given by pharmacists was analyzed for 150 pairs of questionnaires (on 150 patients) sent back from pharmacists in both community and hospital pharmacies. The questions in the questionnaire were categorized into [1] those on drugs used by patients (concurrent drugs, daily dose of the drug monitored, and compliance), [2] those on events which the patient had experienced after the prescription of the drug monitored, [3] those on patients (the first date of prescription, reason of prescribing the drug monitored, initial date when the disease developed, underlying diseases or complications and whether and when the patient was lost to follow-up). The questionnaires were examined to determine whether the answer was given to each question. When the answer was given, its quality and quantity were then assessed. The answer to each question given by the pharmacist in the community pharmacy (C) and that by the pharmacist in the hospital pharmacy (H) were compared by the McNemar test after the pairs of answers were classified into the following categories : [1] C is better than H, [2] H is better than C, [3] C and H are similar to each other, and [4] impossible to classify. The difference was considered to be significant where p<0.05.
Results and conclusion : For the initial date when the disease developed and 'underlying diseases or complications', H was significantly better than C. However, for concurrent drugs, compliance and events, C was significantly better than H. Otherwise, the difference was not statistically significant. Being compatible with the superiority of C over H in regard to concurrent drugs and events, the fraction of patients lost to follow-up during the observation period was small not only in H but also in C. This observation may be associated with the fact that almost all prescriptions were issued by a single hospital in more than 60% of community pharmacies in the pilot study, and most patients identified in the study were probably a regular visitor to one of such community pharmacies. The most important information to be provided by the pharmacists in J-PEM is that on events and drugs used by patients. It is thought to be not necessary to complement the information obtained from the community pharmacy by that from the hospital pharmacy.