Objective: Medical information databases provide useful Real World Evidence (RWE) and a comprehensive view of medical activities. However, since each database has limited coverage and cannot be self-sufficient, combining information from multiple databases is a useful research technique. In this study, we examined methods of estimating patient numbers by combining information from multiple databases in order to assess the respective databases and identify the respective characteristics, biases and idiosyncrasies. This process also allowed us to propose improvements in the grand design of medical information databases in Japan.
Design: Retrospective observational cohort study
Methods: We attempted to estimate the numbers of patients treated for certain diseases and the numbers prescribed a drug by three methods: i) We estimated patient numbers for seven diseases using an insurance claims database, adjusting the proportion of elderly patients according to a hospital medical records database; ii) Sales information for drug X was combined with the prescribed volume per person estimated from pharmacy claims databases to estimate the number of patients administered X; this number was divided by the prescription rate obtained from a medical claims database to calculate patient numbers for the associated disease; and iii) We examined two surveys of the National Institute of Infectious Diseases (NIID) for timely estimation of patient numbers for influenza, referring to estimates from an insurance claims database.
Results: In Method i)-iii), we proved that it is possible to estimate patient numbers for many diseases and administered drugs by effectively combining multiple medical information databases. Validation could be claimed when multiple methods lead to similar results.
Conclusion: These databases provided by government agencies and private corporations are separately managed, and there is no grand plan to integrate them into one platform. It is crucial that databases, rather than being designed to stand alone, are standardized according to widely used systems under a solid master data management strategy. This will make it easier to combine information from multiple databases and to maximize their values. Mutual use of these databases by academic researchers for epidemiological and clinical studies and by government policy makers and data scientists of pharmaceutical companies may improve the usefulness of these databases and expand their application in research.

To demonstrate the quality assurance of the comprehensive examination of sixth-year students at Nippon Medical School, 4 undergraduate examinations were compared with the national examination for medical practitioners (NEMP) using scatter graphs and Pearson's correlation coefficient. Of the 93 sixth-year students at Nippon Medical School, 57%(n=53) reported their scores on the NEMP in response to a request from the Academic Quality and Development Office. Correlation coefficients of the grade point average (years 1 to 5), average scores on graduation examinations of 24 subjects, scores on the trial examination of NEMP, and scores on the sixth-year comprehensive examination with overall scores on the NEMP were 0.62, 0.46, 0.68, and 0.63, respectively. These results suggest that the sixth-year comprehensive examination is more suitable than are graduation examinations for predicting the NEMP score.

To demonstrate the quality assurance of comprehensive examinations for fourth-year students at Nippon Medical School, scores on comprehensive examinations were compared with those on a trial of computer-based testing (CBT) of a nationwide medical and dental student evaluation system in 2003. Pearson's correlation coefficients between scores of two comprehensive examinations and the CBT score were 0.45 and 0.67, and the correlation coefficient between the average score of the two comprehensive examinations and the CBT score was 0.55. Fourth-year comprehensive examinations are useful tools for summative evaluation and prediction of CBT performance.

The aim of this study was to evaluate the association between a number of variables and the smokingbehavior of students at 2 medical and 4 nursing schools. Multivariate analysis was applied to clarify theassociation between the Brinkman index and 12 other independent variables.
The study population consisted of 1, 207 medical and 682 nursing students in Japan.
1) 35.4% of medical students (1-6th grades), 12.5% of nursing students and 28.7% of medical students (1-3rd grades) smoked. Medical students in the 5th or 6th grade smoked more frequently than the otherstudents.
2) Smokers in medical school and those giving up smoking in nursing school had more knowledge aboutsmoking and its physical effects than the others.
3) Multiple regression analysis showed that the coefficients of determination for the Brinkman indiceswere 0.197 in medical school (1-6th grades), 0.055 in nursing school and 0.106 in medical schools (1-3rd grades). The main independent variables were age, sex and maternal smoking history.

BACKGROUNDThe endoscopic surgery for inner-side cancer of the breast is usually performed by periareolar approach, but it often makes deformation or malposition of nipple and areola. The trans-axillary approach is favorable without making any injuries on breast skin. Furthermore, we devised a new approach of retro-mammary route without subcutaneous exfoliation, from axillary skin incision, to preserve skin touch sensation.

METHODSWe have performed video-assisted breast surgery (VABS) on 200 patients since December 2001. The newly devised trans-axillary retromammary-route approach (TARM) was performed on 12 patients of early breast cancer. After endoscopic sentinel lymph node biopsy, we lengthened the axillary skin incision to 2.5 cm, and dissected retromammary tissue from superficial pectoral fascia onto major pectoral muscle below the tumor. The working space was made by lifting traction sutures through the gland. We cut the gland vertically at free margin 2 cm apart from the tumor edge, and dissect skin flap over the tumor. The breast reconstruction was done by filling absorbable fiber cotton.

RESULTSTraction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like burn. All surgical margins were negative. The operation time was needed longer but the blood loss was not different. The postoperative esthetic results were good. The sensory disturbance was minimal. All patients were satisfied with this operation.

CONCLUSIONThis newly devised TARM approach need no injury on whole breast, and can become a single standard method for breast conserving surgery wherever the cancer situated.

Adult ; Breast Neoplasms ; surgery ; Endoscopy ; methods ; Female ; Humans ; Mastectomy, Segmental ; methods ; Middle Aged ; Video-Assisted Surgery ; methods

Today, well over 160, 000 patients undergo dialysis throughout Japan. The number of patients who are newly required to receive it is increasing year by year. Given that situation, our hospital has annually held a seminar since October 1994 for patients with renal diseases. The purpose is to slow the deterioration of renal function and to delay the introduction of dialysis by encouraging the patients to acquire a habit of taking high calory, low protein food.
This seminar must have help the patients get more knowledgeable about morbidity and learn the benefit of low protein rice-based diet. Now that three years have passed since the opening of the course, we reviewed the outcome, comparing the effects of old and new restrict diets.
A difference began to appear 9-2 months after the lst seminar between the seminar participants and the non-participants (control group) who received guidance only at the outpatient ward. The average rate of decrease in the serum creatine level of those participants who eated lowprotein rice was 0.029 and that of those participants who did not eat the restricted food was 0.166 (p<0.05), compared with 0.262 in the control group. We concluded that the difference is ascribable to the effect of the seminar. We would like to contribute to the well-being of the patients by enriching the content of the seminar and continuing to hold it.

No abstract available.
Dermatitis* ; Epinephrine* ; Eyelids*

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.
Breast Implants ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap* ; Reconstructive Surgical Procedures ; Silicon* ; Silicones* ; Skin ; Superficial Back Muscles* ; Surgery, Plastic ; Tissue Expansion Devices* ; Tissue Transplantation

No abstract available.
Breast ; Female ; Mammaplasty ; Tissue Expansion Devices