Objective: Recently, the cost of medical care in Japan has increased as a result of an aging society.  In response to this reality, the Japanese government initiated a campaign to promote the use of generic drugs.  In spite of this campaign, Japanese consumers have doubts about the safety and reliability of generic drugs, resulting in lower usage of these drugs compared to usage in Europe and the US.
Methods: In order to clarify some of the factors that contribute to low rates of generic drug use, we carried out a survey of 400 pharmacies.  The survey data was analyzed using factor analysis and cluster analysis, which is a technique known as multivariate analysis.
Results: The results from factor analysis derived four factors: 1) generic drug usage related to generic drug prescription class, 2) the amount of generic drug prescriptions related to patient preferences, 3) patient willingness to use generic drug prescriptions, and 4) pharmacy willingness.  Cluster analysis was used to classify pharmacies participating in the survey.  The results of cluster analysis revealed three main pharmacy groups: a) low usage of generic drugs, b) moderate usage of generic drugs, and c) high usage of generic drugs.
Conclusion: The results of multivariate analysis showed that pharmacists are more willing to issue generic drugs unless doctors instruct them to use a brand-name drug.

A retrospective review was performed on 43 patients on hemodialysis undergoing valve surgery between May 1999 and August 2004. Ages ranged from 36 to 80 years (mean, 63.8 years). Twenty aortic, 9 mitral, 8 aortic and mitral and 6 valvuloplasties were performed. Twenty-three aortic mechanical valves, 5 aortic bioprosthetic valves, 13 mitral mechanical valves and 4 mitral bioprosthetic valves were implanted. Twenty-five of the 28 aortic valve replacement were hypoplasia of the aortic valve ring. There were 3 hospital deaths (heart failure, pneumonia and sepsis). There were 10 late deaths (2 heart failure, 2 pneumonia, wound infection, cerebral infarction, 2 cancer, arteriosclerosis obliterans and unknown death). Survival at 1, 3 and 5 years was 81%, 74% and 47%. There were three documented major bleedings or thromboembolisms in the 29 patients with mechanical valves (10%) and none in the 9 patients with bioprosthetic valves (0% no significance). Three reoperations were performed for premature degeneration of bioprosthetic valve (19, 24 and 50 months) due to accelerated calcification. These results demonstrate that the prosthetic valve-related major bleedings and strokes in hemodialysis patients are similar for both mechanical and bioprosthetic valves, and that bioprosthetic valves will undergo premature degeneration. Therefore, preference should be given to mechanical valve prostheses in hemodialysis patients.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.