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.)

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.

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.

Purpose：To explore a methodology for evaluating end-of-life （EOL） cancer care using diagnosis procedure combination （DPC） administrative data. Methods： We investigated care provided to inpatients whose deaths were attributed to cancer and occurred between August 2010 and December 2012. We measured the quality of palliative care by dividing the decedents into two groups： those who died in the palliative care unit （PCU） and those who died in the general wards（GW）. Results： A total of 311 inpatient deaths were identified as cancer deaths. Of these, 147 patients were included in the PCU group and 164 in the GW group. We calculated the DPC data as follows： the rates of chemotherapy administered within 30 days before death （PCU 0％, GW 27％） and within 14 days before death （PCU 0％, GW 10％）, admission to the intensive care unit （PCU 0％, GW 2％）, life-sustaining interventions （PCU 0％, GW 3％）, rehabilitation sessions （PCU 10％, GW 26％）, emergency admission （PCU 2％, GW 27％）, and antibiotics （PCU 32％, GW 28％）. In the PCU group, rates of chemotherapy and emergency admission were significantly lower（＜0.0001；＜0.0001, respectively）, and rehabilitation sessions were significantly higher （p＝0.0002） than in the GW group. Conclusion： EOL care in a university hospital can be easily investigated using DPC data. Some limitations are the single-site study design, the health insurance system, and secondary use of administrative data. However, this methodology may be adapted to investigate the entire Japanese claim database and to evaluate EOL cancer care.