Regional Clinical Alliance Path and Cardiac Rehabilitation After Hospital Discharge for Acute Myocardial Infarction Patients in Japan　- A Nationwide Survey.

BACKGROUND: The regional clinical alliance path (RCAP) after discharge from an acute-phase hospital is emerging as a tool for bridging acute-phase treatment and chronic-phase disease management. However, the optimal application of RCAP for acute myocardial infarction (AMI) remains unknown in Japan, and therefore a nationwide survey of hospitals was conducted. METHODS AND RESULTS: In 2009, questionnaires were sent to 1,240 cardiology training hospitals authorized by the Japanese Circulation Society. The response rate was 62.9% (780/1,240). Of the 780 responding hospitals, 708 treated AMI, and in these hospitals the number of AMI patients and percutaneous coronary intervention (PCI) procedures performed were, respectively, 59±52 and 200±206 per year. The implementation rate of emergency PCI was high (91%), but that of outpatient cardiac rehabilitation (OPCR) was very low (18%). The implementation rate of RCAP after AMI was significantly lower (10%) than after stroke (57%). Cardiac rehabilitation (CR) was adopted as part of RCAP in only 19% (13/70) of currently operating RCAP programs. CONCLUSIONS: This first Japanese nationwide survey of RCAP after AMI showed that in contrast to the broad dissemination of acute-phase invasive treatment for AMI, there was infrequent implementation of OPCR, RCAP after AMI, and RCAP including CR. It will be necessary to broaden the use of RCAP after AMI, including OPCR. (Circ J 2016; 80: 1750-1755).

[The Difference of CT Value Related to Monitor Position in the Head CT-angiography Bolus Tracking Method for Patients with Subarachnoid Hemorrhage].

The head computed tomography-angiography (head CT-A) examination is excellent for the detection and diagnosis of cerebral artery aneurysm. If we use bolus tracking method when implementing this examination, we must choose a monitoring point. We investigated the influence which the monitoring point (MCA or carotid-A) exerts on the CT value. As for the result, MCA monitoring point method was more excellent than the carotid artery monitoring point method. The CT value was higher about 50 HU in the MCA monitoring point than in the carotid artery monitoring point (average;carotid artery: 349.6±57.8 HU, MCA: 413.2±67.9 HU). So, we conclude that in the bolus tracking method of monitoring point of head CTA, MCA monitoring point should be used.

[Examination of the Validity of the Abdominal Circumference Measurement Method Used for Visceral Fat Evaluation Using Computed Tomography].

PURPOSE: The effects of obesity, including metabolic syndrome, on health are of concern around the world. In Japan, if the abdominal circumference of a man is 85 cm or more and the abdominal circumference of a woman is 90 cm or more, the visceral fat area is equivalent to 100 cm2 or more. The evaluation of visceral fat by abdominal circumference is based on the influence of tissues other than visceral fat. The purposes of this study were to compare the abundance of visceral fat area and subcutaneous fat area and to examine the validity of estimating the visceral fat area by the abdominal circumference measurement method. METHODS: We obtained data on visceral fat area, subcutaneous fat area, and abdominal circumference of 822 subjects. Next, we investigated the correlation between the abdominal circumference and the visceral fat area, the abdominal circumference and the subcutaneous fat area, and the visceral fat area and the subcutaneous fat area of the subjects. RESULT: The abdominal circumference and visceral fat area were highly correlated, but the sum of visceral fat area and subcutaneous fat area was more highly correlated. There was a low correlation between the visceral fat area and the subcutaneous fat area. When the abdominal circumference exceeded the standard value, there was no correlation between the visceral fat area and the subcutaneous fat area. We concluded that there is a correlation between abdominal circumference and BMI and visceral fat area, but when these are used for estimation of visceral fat area, they are not accurate due to many errors.

Japanese Community Pharmacists' Dispensing Influences Medicine Price Reduction more than Prescription Numbers.

This study examined the economic efficiency of the separation of prescription and dispensation medicines between doctors in medical institutions and pharmacists in pharmacies. The separation system in Japanese prefectures was examined with publicly available data (Ministry of Health, Labour and Welfare, 2012-2014; retrieved from http://www.mhlw.go.jp/topics/medias/year). We investigated whether the separation system reduces the number of medicines or the medication cost of a prescription because of separating the economic management between prescribing and dispensing and the effect of mutual observation between doctors and pharmacists. It is optional for Japanese medical institutions to participate in the separation system. Consequently, the spreading rate of the separation system in each administrative district is highly variable. We examined the separation system effect using the National Healthcare Insurance data for three years, 2012-2014. We tested whether the separation system ratio for each prefecture was significantly correlated to the medication price or the number of medicines on a prescription. If spreading the separation system influenced the price of prescribed daily medications or the number of medicines, the correlation would be significant. As a result, the medication price was significantly negatively correlated with the separation system ratio, but the number of medicines was not significant. Therefore, the separation system was effective in reducing daily medication cost but had little influence on reducing the number of daily medicines. This was observed over three years in Japan.

Prescription, Dispensation, and Generic Medicine Replacement Ratios: Influence on Japanese Medicine Costs.

This study used publicly available data to examine the effect of the separation of dispensing and prescribing medicines between pharmacists in pharmacies and doctors in medical institutions (the separation system) and the generic medicine replacement ratio on the cost of various medicines in Japanese prefectures. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each administrative district is highly variable. In our multiple regression analysis, the dependent variables were the costs of daily medicines, specifically, total, internal, external, and injection medicines, as well as medical devices, and the independent variables were the expansion rate of the separation system and generic medicine replacement ratio. The expansion rate of the separation system showed a significant negative partial correlation with the daily costs of total, internal, and injection medicines as well as medical devices. Moreover, the rate of replacing brand name medicines with generic medicines showed a significant negative partial correlation with the daily costs of total and internal medicines. However, external and injection medicines and medical devices did not because only a few or no generic products of these types were sold in the Japanese market. Otherwise, expansion of the separation system was effective in reducing medicine costs, except in the case of external medicines. This suggests that the cost efficiency effect of the separation system does not function all the time.

Influence of the separation of prescription and dispensation of medicine on its cost in Japanese prefectures.

We studied how the separation of dispensing and prescribing of medicines between pharmacies and clinics (the "separation system") can reduce internal medicine costs. To do so, we obtained publicly available data by searching electronic databases and official web pages of the Japanese government and non-profit public service corporations on the Internet. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each of the administrative districts is highly variable. The data were subjected to multiple regression analysis; daily internal medicines were the objective variable and expansion rate of the separation system was the explanatory variable. A multiple regression analysis revealed that the expansion rate of the separation system and the rate of replacing brand name medicine with generic medicine showed a significant negative partial correlation with daily internal medicine costs. Thus, the separation system was as effective in reducing medicine costs as the use of generic medicines. Because of its medical economic efficiency, the separation system should be expanded, especially in Asian countries in which the system is underdeveloped.