With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

Objective: Human papillomavirus subtypes are predictive indicators of cervical intraepithelial neoplasia (CIN) progression. While colposcopy is also an essential part of cervical cancer prevention, its accuracy and reproducibility are limited because of subjective evaluation. This study aimed to develop an artificial intelligence (AI) algorithm that can accurately detect the optimal lesion associated with prognosis using colposcopic images of CIN2 patients by utilizing objective AI diagnosis. Methods: We identified colposcopic findings associated with the prognosis of patients with CIN2. We developed a convolutional neural network that can automatically detect the rate of high-grade lesions in the uterovaginal area in 12 segments. We finally evaluated the detection accuracy of our AI algorithm compared with the scores by multiple gynecologic oncologists. Results: High-grade lesion occupancy in the uterovaginal area detected by senior colposcopists was significantly correlated with the prognosis of patients with CIN2. The detection rate for high-grade lesions in 12 segments of the uterovaginal area by the AI system was 62.1% for recall, and the overall correct response rate was 89.7%. Moreover, the percentage of high-grade lesions detected by the AI system was significantly correlated with the rate detected by multiple gynecologic senior oncologists (r=0.61). Conclusion Our novel AI algorithm can accurately determine high-grade lesions associated with prognosis on colposcopic images, and these results provide an insight into the additional utility of colposcopy for the management of patients with CIN2.

Prophylaxis is sometimes offered to inpatients who share a room with, or individuals who have been in close contact with, patients who have contracted influenza. In our hospital, 5-day prophylactic oseltamivir has been used as a standard procedure. Here, we investigated the effectiveness of this post-exposure prophylaxis for inpatients and healthcare professionals, as well as its effect on hospital management. The study period was 5 years from fiscal year 2013 to fiscal year 2017, and the effectiveness outcome was the secondary infection rate. Medication costs for this prophylaxis were compared with those for oseltamivir used according to the package insert. The secondary infection rates were 3.0% and 0.5% in 133 inpatients and 434 healthcare professionals who had received post-exposure oseltamivir, respectively. The medication costs were reduced by 50% compared with the estimated costs for 10-day oseltamivir administration. The effectiveness of 5-day prophylactic oseltamivir was similar to or higher than that reported previously, indicating that this prophylaxis was effective. Moreover, 5-day post-exposure prophylactic oseltamivir is expected to reduce the prolongation of hospital stay and influenza outbreaks and thus contribute to hospital management.

This study investigated the characteristics of emergency patients, including walk-in patients and those brought in by ambulance, who visited Akita Kousei Medical Center in the 6 months from April 2019, and the clinical features of elderly patients with heart failure. Elderly patients above 70 years of age accounted for 38.7% of emergency cases and up to 61.7% of ambulance cases. The most common diseases and disorders were orthopedic, digestive, otorhinolaryngeal, respiratory, neurological, dermatological, and cardiovascular disease, in that order. In total, 56 patients with heart failure were admitted during this period (age 83.5±8.3 years, male: female ratio, 1:1.67). Hospitalization from homes accounted for 66.1% of admissions, with the remainder from nursing homes. After treatment, 35.7% of patients moved to nursing homes and 19.6% died despite in-hospital care. Because heart failure is one of the most common conditions in elderly patients, it is pertinent to recognize the importance of quality of outpatient care to prevent hospitalization and also to preserve quality of life by focusing on alleviating overall pain and discomfort.