Japan-hospitals : the journal of the Japan Hospital Association最新文献

Introduction: Countermeasures against cerebrovascular diseases (CVD) are one of the important health policies in Japan. This study proposes new indicators that are based on period and cohort effects in CVD mortality rates. The main aim of the study is to contribute to community diagnosis with the existing policies.

Methods: CVD mortality rates for all prefectures in Japan were analyzed according to age, time period, and cohort effects, using the Bayesian Poisson age-period-cohort model. Several indicators were extracted based on the principal component analysis of the estimates of the effects.

Results: Two indicators named the change-in-magnitude and the time-of-decrease were extracted from estimates of the period effects, and three indicators named the change-cohort-of-improvement were extracted from estimates of the cohort effects. These were considered to be related to the countermeasures against CVD.

Conclusion: Under the assumption that the new indicators reflect the result of past policies, the new indicators allow us to evaluate the validity of past policies, and to suggest the necessity for improvement in the conventional policies.

There is no perfect system and every health care system should change continually corresponding to the needs of its people. The current Japanese system of primary/secondary/tertiary care has greatly improved Japanese emergency care. However, further changes are needed. A national consensus on the definition of EM is required. Young physicians must receive training in skills for general emergency care. They also need to learn to develop strategies for changing our emergency medical system. Ultimately, we need to educate Japanese citizens about health issues so they can take more responsibility for their care.

Objective: To clarify actual drug expenditures used in ICUs, and to evaluate the relationship between these expenditures and therapeutic evidence. Test Sites: Ten university hospitals located in six different regions of Japan (Tohoku, Kanto, Chuubu, Kinki, Chuugoku and Kyuushuu areas).

Design: Cross-sectional surveys of drug expenditures in ICUs throughout Japan.

Method: The 10 leading pharmaceutical products, based on drug expenditures per month, were investigated. The ICUs at 10 facilities (national, public, and private university hospitals) were randomly selected from the attendees of the annual university training seminar. A postal questionnaire was sent to ten university hospitals located in six different regions (Tohoku, Kanto, Chuubu, Kinki, Chuugoku, and Kyuushuu areas) of Japan. The level of evidence was investigated to determine whether the use of the most expensive drug is rational or not.

Results: The response rate was 80% (8/10). Pharmacists in each hospital filled in the questionnaire to determine drug expenditure per ICU bed. The consumption of protease inhibitors based on drug expenditure per bed ranked the highest out of 14 different drugs used in the ICUs studied. The average drug expenditures ranked as follows: protease inhibitors > antithrombin III (AT III) > albumin-derived products > intravenous immunoglobulin > human haptoglobin. There was a 100-fold difference in the expenditures on protease inhibitor drugs between Nagoya university hospital and the hospital which consumed the most. It has been reported that there is little evidence of the effectiveness of protease inhibitors and AT-III for critically ill patients in the ICU.

Conclusion: We analyzed the data from a questionnaire about drug expenditures in ICUs, responded to by 8 Japanese university hospitals. Although protease inhibitors accounted for a large percentage of all drug expenditures in the ICUs, the evidence supporting their usage was insufficient. Therapeutic evidence is important for determining physicians' prescriptions.