Japan's declining birthrate and aging population are serious problems. The elderly population will eventually begin to decline, but the rapid decline in the productive and child populations will greatly exceed this. At the same time, advances in medicine and the increasing demand for safety management will lead to an increase in healthcare and welfare costs, further widening the gap between the demand and response capacity for these services. In the city of Sado, where the proportion of the elderly population exceeds 43%, the number of hospitals is decreasing, and the number of long-term care facilities is also beginning to decline, providing a glimpse into Japan's not-too-distant future. 　The present healthcare and long-term care insurance systems cannot be maintained without an increase in the proportion of the productive population. Two possible countermeasures are to respond with fewer resources by better sharing and utilizing information, efficiently using local resources, and preventing serious illness through early intervention, and to prevent an increase in the demand for healthcare and welfare services by raising people's awareness of maintaining good health, with the goal of creating a well-being-oriented community. 　The “Sado Himawari Net” information-sharing platform was launched in 2013 to share residents' healthcare information with medical institutions, long-term care facilities, and the local government. At present, 30% of residents and 60% of healthcare and welfare facilities have registered with the platform. Information that is directly linked to people’s lives, such as family structure, decision-makers, and living abilities, is more valuable to share than healthcare information, and a system to share such information and promote communication is currently under development. In addition, an AI-based system to assist in the selection of long-term care facilities that match the needs of each resident is also being developed as part of the plan to promote the efficient and effective use of local resources. (View PDF for the rest of the abstract.)

A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

　In this study, we report a new network system to facilitate functional cooperation between medical and long-term care providers in the progressively aging society of Japan.Currently, medical and long-term care resources are not sufficient to meet the needs of the entire population and this presents a very serious problem. Sado City, on Sado Island in Niigata Prefecture, has a remarkable aging society, with elders accounting for 36.8% of the population. This is because both the patients and medical staff are aging. To conserve the limited medical resources of the island, a new system for inter-regional medical cooperation was initiated in April 2013. In this network system, the patient’s diagnosis, prescription, treatment, examination, and imaging results can be shared with all medical institutions that are part of the system. Every participating medical institution can either opt to introduce the electronic medical records system or use an alternative recording system, because the data for this inter-regional medical cooperation is extracted from medical treatment fees data. Nursing facilities can also access the data. Nursing care staff have information on their patient’s activities of daily living, routine vital signs, and other important data. In December 2013, a new initiative was started where nursing staff can not only receive their patients’ data, but also send data such as those mentioned above. To achieve functional cooperation between medical and long-term care providers, it is important to have access to all data and to communicate openly. The established system easily and effectively facilitates communication among staff and participating institutions.

In Japanese traditional medicine, “ganmenshin” (facial diagnosis), which means assessment of a patient's health based on the color of his/her face, is frequently used in a clinical setting. However, little scientific evidence is available to substantiate such diagnoses. In the present study, we investigated the relationship between skin color and patient's health status to ascertain the clinical usefulness of the “ganmenshin” technique. We evaluated the color of the cheeks and forearms of 30 healthy study participants and also administered questionnaires to determine their health. A correlation was observed between skin color and work efficiency and the inkyo (yin-fluid deficiency) scores in all subjects. In male subjects, skin color was correlated with their bodymass index (BMI), self-rated health status, work efficiency, and suitai (fluid stagnation) scores. In female subjects, skin color was correlated with the patient's age, work efficiency, and inkyo scores. These results suggest that “ganmenshin” may be clinically useful because of the correlation between skin color and the health of patients.

Purpose: This survey aimed to develop a methodology for measuring the quality indicators of end-of-life care for cancer patients using the Japanese National Database, which was comprised of the health insurance claim data of all Japanese people. Methods: Life-sustaining treatment (LST) and chemotherapy near the time of death are accepted as reliable indicators of poor quality end-of-life care. To measure these, the Sampling Data Set (SDS) from the National Database (NDB) was used. Results: 1,233 cancer patients were studied, who had died from 14th to 31st October, 2012. The rates of LST and chemotherapy in the final 14 days of life were 8.2% (95%CI 6.7-10.1), 3.5% (2.6-4.8) for inpatients (n=1,079) respectively. In the SDS, 27-70% of chemotherapy drugs were not named, in order to prevent identification of patients receiving rare treatment. Discussion: The figures for rates of chemotherapy might be underestimated in the sampling data set, because of the anonymization of rare treatment. And in-patient and out-patient data may in some cases have been duplicated when entries applied to the same person. In the future using the NDB, it might be possible overcome some of these limitations.