We analyzed dispensing receipt data in the medical treatment in October 2019 using the Receipt Information/Specific Medical Examination Information National Database (NDB), extracted the cases of multiple combinations of Kampo prescriptions, and analyzed their frequencies. Of the 536,524 receipts, 44,731 (8.3%) included Kampo and non-Kampo crude drug preparations. Of the receipts that included Kampo and non-Kampo crude drug preparations, 38,032 receipts (7.1%) included single Kampo or non-Kampo crude drug preparation. There were 6,699 receipts (1.2%) that included multiple Kampo and non-Kampo crude drug preparations. There were 187 receipts for the decoctions containing multiple rude drugs without Kampo preparations, and the ratio was 0.035% of all receipts and 0.42% of the receipts containing Kampo and non-Kampo crude drug preparations. There was one receipt containing eight Kampo preparations, three receipts containing seven Kampo preparations, and a total of 84 receipts containing five or more Kampo preparations. Although it is unclear how many multiple Kampo preparations were prescribed at the same time, this investigation indicates the actual duplication of multiple Kampo preparations.

The Medical Safety Committee has conducted various activities for patient safety in Japanese traditional Kampo medicines. In this study, we conducted a questionnaire survey to promote the prevention of medical accidents and their recurrence. We received responses from 15 of 19 facilities specializing in Kampo medicine and collected a total of 247 incident and accident cases in the field of Kampo medicine. Cases of side effects included interstitial pneumonia caused by Kampo prescriptions containing Scutellariae Radix, aconite poisoning, and licorice-induced pseudoaldosteronism. Furthermore, we also collected decoction-specific cases, which are unique to facilities specializing in Kampo medicine, for the first time. From the results, we included the following seven points for risk management in the field of Kampo medicine : 1) insufficient recognition to the side effects of Kampo medicines, 2) misunderstanding of the dosages of Kampo products, 3) errors due to similarities in Kampo formulas and crude drug names, 4) preconception of frequently used Kampo prescriptions, 5) contamination in the decoctions, 6) errors related to crude drug items and their dosages that are frequently added or subtracted, 7) errors in hospital wards.

Purpose: Distress screening is mandated by Ministry of Health, Labor and Welfare of Japan, however there is few data available on its effect in actual practice. We examined the impact of distress screening on palliative care referral at Hyogo Prefectural Amagasaki General Medical Center in Japan. Materials and Methods: We implemented distress screening on cancer patients who were given chemotherapy from February 2018. Patients were referred to the palliative care team when the physicians judged the need on the basis of the screening results or when the patients themselves wanted to receive the palliative care service. We examined the number of the patients referred to the palliative care team, then we researched the changes of the number after implementation of the screening, using the regression discontinuity analysis. Results: The distress screening didn’t increase the number of the patients who were referred to the palliative care team: the estimated difference of the number was 3.32 (95% confidence interval: −3.19〜9.82). Conclusion: We implemented distress screening at our hospital but it didn’t increase palliative care referral. Only a few studies have examined how routine screening impacts clinical outcomes. We expect our study helps to research the effectiveness of screening in each healthcare facility.

The Medical Safety Committee analyzed the case reports of minor incidents from the pharmacies last time as part of an activity to promote patient safety in Japanese traditional Kampo medicine. This time, we analyzed the case reports of medical accidents and minor incidents from the medical institutions. We extracted 626 reports related to Kampo products from the public database, which the Japan Council for Quality Health Care has established based on the collected information related to the medical accidents and minor incidents. The medical accident information includes case reports related to drug-induced liver injury. The minor incident reports include prescribing error due to misinterpretation related to the quantity of one sachet of Kampo extract product, dispensing error due to similarity of product appearance, number or name, and administration error due to judging the medicine only by Kanji characters or product company names without checking the Kampo formula name. Additionally, the minor incidents were often discovered by people belonging to different professions or patients themselves. In order to promote patient safety, knowledge about these incidents should be shared among the people involved in the same or different professions.

Background/Aims: Dual red imaging (DRI) is a new, image-enhanced endoscopy technique. There are few reports about the usefulness of DRI during gastric endoscopic submucosal dissection (ESD). We aimed to examine the usefulness of DRI in endoscopic hemostasis during gastric ESD. Methods: We enrolled a total of 20 consecutive patients who underwent gastric ESD. Five endoscopists compared DRI with white light imaging (WLI) for the visibility of blood vessels and bleeding points while performing endoscopic hemostasis. Results: The visibility of blood vessels was increased in 56% (19/34) of the cases, and the visibility of bleeding points was improved in 55% (11/20) of the cases with the use of DRI compared with the use of WLI. Conclusions DRI improved the visibility of blood vessels and bleeding points in cases with oozing bleeding, blood pooling around the bleeding points, and multiple bleeding points.

The Japan society of oriental medicine created a committee of medical safety in 2017. The first activity was to summarize the representative side effects of Kampo medicine and to enlighten members of our society about them. In this report, we documented the knowledge to keep in mind at present on pseudoaldosteronism, drug-induced liver injury, and drug-induced lung injury. Since these three major side effects may cause clinically severe conditions, it is very important to detect them early and take appropriate measures. Therefore, proper examinations at the right time are necessary while taking Kampo medicine.

We collected and analyzed the case reports of minor incidents in the preparation of Kampo products in Japanese pharmacies in order to manage the medical safety control in Japanese traditional Kampo medicine. We extracted 2,166 reports that are related to Kampo products from the database of minor incidents in pharmacies supplied from The Japan Council for Quality Health Care from 2009 to 2019. Among the reports, we found the cases that pharmacists could find the mistakes about the name, dosage and administration of Kampo products or could prevent the appearance of adverse reaction when pharmacists check the prescription and ask prescription question for doctors. It is suggested that the system of separation of dispensing and prescribing functions would be well working in medical safety control. At the same time, we also found many cases that pharmacists have actually made mistakes by confusing the name of Kampo products and dosage. In this report, we summarized the cases of these minor incidents and frequently appearing confusions about the names of Kampo products.

Chinese Medicine Questionnaire (CCMQ-J) consists of sixty independent questionnaires and 9 physical constitutions called subscales. One type is balanced constitution (i.e., gentleness), and the following eight types represent unbalanced constitution: Qi-deficiency constitution, Yang-deficiency constitution, Yin-deficiency constitution, Phlegm-dampness constitution, Damp-heat constitution, Stagnant Blood constitution, Stagnant Qi constitution, and Inherited Special constitution. In this study, we proposed to determine optimal number of groups in 851 participants recruited from crowdsourcing answered CCMQ-J questionnaire consisting of 60 questions. In the present study, we applied k-means clustering with gap statistics to the questionnaire data and the number of optimal groups was estimated by five. The five groups are mainly characterized by 3 subscales in CCMQ-J, i.e. (i) two subscales corresponding to Yang-deficiency and Qi-depress, (ii) three subscales corresponding to gentleness, Yang-deficiency and Qi-depress (iii) Yang-deficiency, (iv) gentleness, and (v) Qi-depress. In the crowdsourcing survey, two subscales, Yang-deficient and Qi-depress are the most frequently occurred in current Japanese people.

In this study, we proposed an approach to interpret the classification of body constitution based on the Japanese Version of Constitution in Chinese Medicine Questionnaire (CCMQ-J) in terms of an augmented questionnaire combining seven independent questionnaires. The augmented questionnaire consists of 254 questions in terms of seven categories of attributes, which are the (i) basic information (BI), (ii) disease (DI), (iii) social factors (SO), (iv) mental factors (ME), (v) dietary habits (DH), (vi) sleeping state (SL), and (vii) sub-health (SH). The partial least square (PLS) regression has been adopted to model the correlations between the scores of body constitutions and the questions, and their results show that the body constitution can be represented by the linear combination of the questions substantially (correlation coefficients between the true and predicted constitutions are all above 0.7). Moreover, by using the crowdsourcing technique in data collection, a total of 851 samples (350 males and 501 females between 20 and 85 years old) samples with diverse geographical backgrounds in Japan have been collected, from which new medical implications have been extracted through the discussion in a Traditional Chinese Medicine standpoint. This study serves as a crucial step for validating the philosophy of ancient Chinese medicine by the state-of-the-art information science techniques and facilitating the use of the CCMQ-J in public healthcare.

Background: Adolescents and young adults (AYA) with cancer go through various life events during their illness trajectory, and there is often insufficient information on their diseases due to their rarity. Few chances are available for AYA patients to meet and share information with each other. Therefore, at the National Cancer Center Hospital in Japan we hold AYA Hiroba, a monthly get-together for AYA patients to communicate with each other. This study investigated satisfaction and effect with the activity. Methods: We have held the AYA Hiroba activity once a month since May 2016. We asked participants to complete a questionnaire at each session.Results: We held the activity 33 times between May 2016 and May 2019. A total of 130 patients participated, and 97 of them completed the questionnaire, including providing demographic data, since October 2017. The respondent demographics were as follows: sex (male/female), 38/59; median age, 29 years (range 14–39 years); outpatients/inpatients, 31/66; number of sessions attended (1/≥2), 42/55; and cancer type (sarcoma/malignant lymphoma/brain tumor/germ cell tumor/leukemia/melanoma/breast cancer/neuroblastoma/Wilms tumor/lung cancer/cervical cancer/nasopharyngeal cancer/tongue cancer/blank), 45/11/9/7/6/5/3/3/2/1/1/1/1/2). Many attendees perceived the activity favorably: “It was very satisfying” (61.7%), and “It was very helpful” (65%). The feedback was classified into three categories: “interaction with the same generation”, “diversion”, and “getting information”. Discussion: AYA patients have a great need to communicate with each other, and the feedback suggests that AYA Hiroba would be effective in interaction with the same generation, diversion and getting information. Most participants were very satisfied with the program.