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.

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.

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]