June 2010アーカイブ

Medical institution..enter..Osakashi..poor..business..clarification.
Osakashi assisted to "Poor business" that exploited public assistance expense from the recipient on the 29th, and decided the policy of the on-the-spot inspection of the Osaka Prefecture internal medical institution where the possibility of demanding "Medical Assistance" of the safeguard expense and the medical treatment fee in excess existed on the basis of Daily Life Security Law. 

The examination and administering are received free of charge, and the municipality is bearing the public assistance recipient as a Medical Assistance. The city holds the meeting of the task force that discusses the increase countermeasure of the safeguard expense on the same day. The entry object is consulted, and the realities clarification is advanced. 

The city is analysis as for November last year of the recept (certificates of medical remuneration) that about 13,000 in prefecture medical institutions fil to Social Insurance Medical Fee Payment Fund - January this year. It has been understood that there are 34 medical institutions whose hospitalization or all outpatients are the public assistance recipients. 

Also in the medical institution where patients other than the recipient existed, the medical treatment fee for the recipient projected and there was a high case. 

The Medical Assistance expense of Osakashi in fiscal year 2008 is about 112.9 billion yen, and half of the entire public assistance expense the vicinity is occupied. 

On the other hand, the city clarified that accusation and the damage reports of illegal recipience of public assistance expense of eight only every about three months of ten fiscal years were fil to Osaka prefectural Police. Aggressive posture of the city for the illegal recipience exclusion is eighthly a year remarkable in fiscal year 2009. 

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The support company in government and the people to "Medical treatment tourism" enlargement. 

Ministry of Economy, Trade and Industry decided the policy of establishing the new company where the patient acceptance for the enlargement of "Medical treatment tourism" in which a domestic medical institution provided an advanced medical service for the foreigner patient was supported by the government and the people capital contribution in 2011. 

The full-scale business is started at as many as 12 fiscal years. Foreigner patient's acceptance enlargement is a measure included in the Shinsei head strategy that the government announced on the 18th to activate domestic medical industry. 

The new company does the Pulmonary regurgitation in cooperation with medical institutions such as China, Russia, and the Middle East, and bears the bridge person with a domestic hospital. The direction where capital contributions such as medical institutions and travel agencies are raised from the private organization besides the capital contribution by the government agency is discussed. 

The multipara ministry sums up the budget of about 100 million yen as preparation expense for the incorporation at current year. A special interpreter etc. are recruited in July, and the investigation of a domestic hospital that requests foreigner patient's acceptance is started. 

Ardent Singapore and Thailand to the medical treatment tourism accept several hundred thousand -one million patients a year from the Middle East etc. , and are contributing to the earnings enlargement of the travel and the hotel industry segments. The multipara ministry set up "Medical industry society" by specialists last autumn, and has been discussing the concrete measure for the enlargement of the medical treatment tourism in Japan. 

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Helicobacter Pylori carcinogeneses mechanism clarification

Helicobacter pylori that caused the stomach cancer clarified and the research team of Masanori Hatakeyama and the professor of University of Tokyo (microbiology) clarified the mechanism that sent the carcinogen to the intracellular of the stomach. The bacterium reverses like "..endurance.." of the cytoplasmic membrane of the stomach, and when the carcinogen is made to be bonded, it is Iu on the other side of the appearing cytoplasmic membrane. It announced to the U.S. science magazine. 

Person's cytoplasmic membrane consists of a double lipid, and an inside membrane is made of the lipid of phosphatidylserine. 

Hisako Kamiya associate Oshie of the research team went out to Helicobacter Pylori, and only the part of the cytoplasmic membrane to which the bacterium contacted went out to turn around Shite and the phosphatidylserine went out to the table when the infection lingua cell was observed. The carcinogen secreted from the bacterium bonds there. It carried to turn around Shite and the intracellular again and it crowded as it was. 

Prof. Hatakeyama「It was unclear Helicobacter Pylori made the invasion of the carcinogen to the intracellular very. This time, it has been understood to adopt a method as skillful as the ninja. 」With Iu. The success rate is 7-80 percent, and it is thought that it wants to tie to new prevention and the development of the method of treatment though Helicobacter Pylori is good at the sterilising with the antibiotic. 

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The mutual agreement of the cancellation of one new vaccine penalty is 9.2 billion yen. 

Ministry of Health, Labour and Welfare announced that it agreed to cancel about 8.38 million batches that hit about 33.5% among 25 million batches when the Novartis Co. in Switzerland had been connected with the purchasing contract on the 28th with this company the import vaccine of a new influenza that went around from last year to this year. 

The penalty is about 9.22 billion yen. The expense reduction forehead that subtracted this becomes about 1.56 billion yen. It has already been delivered, and this ministry discusses the disposal time and method to face the expiration date by the 30th this month at about 16.62 million batches (correspond 21.4 billion yen) other than the cancellation. The vaccine made of this company, and the circulation lingua is 2465 batches in the country slightly by April. 

Moreover, it agreed to secure the frame that did the priority supply to Japan until 40 million batches when a new influenza would go around in the future and the vaccine of this company was needed. Free of charge and it is Iu this time though it usually costs 10 billion yen or more to secure the frame. 

France is this company and agrees on the cancellation of about 44% in foreign countries according to Ministry of Health, Labour and Welfare. Italy is be in terms, and the Netherlands is the cancellation none. 

Japan agrees on a part of of the purchasing contract cancellation with British Glaxo Group Ltd. and Smith Clein that is another import origin in March. The amount of payment to two companies became about 85.3 billion yen in total including this penalty for about 112.6 billion yen of the first schedule in total. 

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Yokohama City University medical center suicide prevention"Formulation care Shite of medicine"
Kokoro is saved: Yokohama City University medical center suicide prevention. "Formulation care Shite of medicine"

 - To emergency patient's attending physician

"Could try to think about the formulation of the medicine. "Yokohama City University attachment citizens General Hospital (same city Minamiku) is pressing care to the destination of going to hospital regularly of the patient to whom it attempts suicide by taking medicine the overamount about the psychotropic drug and the emergency is transported by the document. If the same formulation is repeated, it is because the fear connected with Fcashi of the suicide already becomes strong, and "Discontinuance of the formulation" might be requested unusually. The psychiatrist at the same center is alerting though such suicide prevention is unusual also in the whole country, "The doctor who doesn't know the side reaction when the overamount is taken is the majority". 【 Esashi Sanoyomis ]

The same center is the third emergency hospital of the severely ill person specialty. The psychiatrist besides the surgeon and the physician resides, and it undertakes treatment and caring after lifesaving. There are several Lifesaving First Aid Center that leaves the psychiatrist on the site of the emergency also in the whole country. The purpose is to think that a prompt attempted person caring by the psychiatrist is effective to the suicide prevention. The psychiatrist catches whether to have attempted suicide in the modality, the amount, and the past of the taken medicine after patient's restitution. It informs the medical institution to which the patient went of such information with the document, and it uses it to treat afterwards. 

In this case, to the attending physician at the destination of going to hospital regularly when judging that the low medicine is comparatively formulated to safety or the possibility of attempting suicide again by taking medicine the overamount is high「When the same medicine is drunk too much again, the possibility that the hazard reaches the life is high. It will be able to ask for the reconsideration of the formulation. 」With the report. It is requested that it take account to the modality and the amount of the prescribed drug. Still, when the patient is transported formulate of the same medicine being repeated, requesting, "Could you discontinue the formulation of this medicine?" is Iu unusually when it is. 

Doctor Tomoki Yamada at the center「The psychiatrist is studying the side reaction when the usage and the dose are defended and the medicine is taken. However, there is not so much knowledge because the hazard when the overamount is taken is hardly being taught by the university. 」With the indication. It proposes, "It is necessary to teach first of all more neatly in Department of Medicine". 

There were a lot of men and women and an overamount taking medicine (man 36% and woman 57%) when having brought it together about 320 people corresponding to doctor's interview in the patient who attempted suicide from 03 to 05 years the same center and was transported according to the means. 

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Valproic acid, congenital malformation risk advance, and relation of the 13th pregnancy half year
Source on June 14, 2010: NEJM (thesis list) category: Nerve internal disease (related paper) - obstetrics and gynecology trouble (related paper) and - problem (related paper) document related to administering: Jentink J et al. Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations. NEJM. 2010;362:2185-2193

The relation to the congenital malformation of 14 specified from the valproic acid use and eight cohort studies at the 13th pregnancy half year is discussed by the case contrast research by using the data base of the antiepileptic research of Europe. A significant relation was seen about congenital malformations (spina bifida, atrial septal defect, uvula bifida, hypospadia, polydactyly, and craniosynostosis)14 inside 6 in the valproic acid monotherapy and the risk advance.

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The source for bread Demick (H1N1), 2009, and 15 days June, the lapse and 2010 the Hong Kong survey similar to the seasonality influenza A: NEJM (thesis list) category: infectious disease (related paper) document: Cowling BJ et al.    Comparative Epidemiology of Pandemic and Seasonal Influenza A in Households. NEJM. 2010;362:2175-2184

The comparison of bread Demick (H1N1) 2009 and influenza A of seasonality in the epidemiology and virological for 348 beginning patients who consulted a physician due to acute respiratory disease on 2009.7. - 2009.8. and the family. As for the difference, it was not seen, and beginning patient's virus excretion pattern and the lapse of the trouble were also similar in both viruses at the secondary infection rate between families.

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It is a black, it is a white, and the threshold in the HbA1c value to the difference and the glucose tolerance abnormal detection.
- Source on June 17, 2010: Ann Intern Med (thesis list) category: Internal secretion and metabolic disease (related paper) Problem of related to inspection(related paper)
Document: Ziemer DC et al. Glucose-Independent and BlackWhite Differences in Hemoglobin A1c Levels: A Cross-sectional Analysis of 2 Studies.    Ann Intern Med. 2010;152(12):770-777

The analysis backwards and horizontal of the relation between the HbA1c value and the blood glucose for two examinations (18-87 years old 1581 people and 40 1967 years old or more) intended for non-hysteria panic system black and the white. In a normal glucose tolerance and the pre-diabetes and the sugar diabetes Noi slippage, the HbA1c value after the adjustment was higher than the white in the blood glucose etc. the black. Authors are specifying for the threshold to exist in the glucose tolerance abnormal detection by the HbA1c value.

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Ministry of Health, Labour and Welfare's assuming "Seirei Yokohama hospital"'s of Kanagawa Prefecture Yokohamashi of Hodogaya Ward, (director Shigeki Iwazaki and 300 alcoves) making the patient the load of the charge of aids virus (HIV) antibody inspection done for all inpatients to be inappropriate, and having been requesting the amelioration in February this year have understood the tenth.

The indication is perceived in this hospital, and inspection expense is repaid to about 5000 patients of the object.

Before operative by the patient charge and HIV antibody test when hospitalized were started in August, 2006 according to this hospital for the nosocomial infection prevention. When the purpose of the inspection is described on the patient side because the insurance is not applied, and it obtains and agreement including the chargeout was executed, it is Iu.

It comes to light there are at the right time a lot of antibody inspections by the patient charge in the investigation January this year the execution of the Kanto Shinetsu public welfare bureau Kanagawa office of Ministry of Health, Labour and Welfare by the rate once 1-3 year for all hospitals when it enters this hospital. The amelioration was pressed with the document , saying that "The inspection was the one for the hospital affiliate, and the charge was not perceived to be collected from the patient" in February this year.

In this hospital that received the indication, the method of restoring the survey fee of about 1300 yen is assumed to be "The restoration method etc. will be announced on congressional and the homepage by the end of June" by the under discussion once.

In a series of this hospital inspection, HIV-positive of several samples is affirmed also in the world as the first Japanese infected person of the HIV2 type with few examples of the infection is discovered. This hospital synthesis Policy Planning Office「The inspection is necessary as not only the medical follower but also measures against nosocomial infection to the patient. It will continue in the future. 」It makes, and it ..inspection.. continues by the hospital burden from April.

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The second new full Dipterocarpus tuberculatus wave is Kuniko of Shindo medical affairs government of "Interview" - World Health Organization (WHO) as for the vaccine thoroughness such as certain pregnant womens.

World Health Organization (WHO) declares for worldwide Onagare of a new influenza (bread Demick) and one year every 11 days. The current state and the difficulty were heard from Kuniko of Shindo (halberd of -) medical affairs government of WHO.

 -In WHO, Iu in further directions is large across-the-board consciousness of crisis and is the retrusion linguas for Onagare.

 「There was a wave of a big fashion that did not exist in a usual seasonality influenza in the northern hemisphere this time last year. It has not gone out up to the present this year. Perhaps, new H1N1 will become the virus of the mainstream by the fashion period in the southern hemisphere in the future. 」

 「In the data that we collected from a lot countries, it is presumed that the person of 20-30% is already infected up to now after the accrual. The second wave and the third wave will surely come because 7 80 percent yet are infected (fashion). Especially, care like the thoroughness in vaccination etc. is necessary for the person who has the undorlying disease of the pregnant woman, the heart, and lungs (old ailment). 」

 -The criticism of ..commotion.. passing by the mistake is also persistent.  declare for Onagare mainly Europe

 「H1N1 must be and there be ..Onagare.. ..executing.. in a scientific manner. In the meaning of the impact, all over the world used to be a prepared first case for Onagare and it is difficult to compare it for past Onagare. An actual death toll (Estimate from death statistics) is not understood if it doesn't assess it by the method of 'Excess death' though remains by the dead who can have done the confirmation directly up to now in 18,000 people or more in the world. It might be equal to Asian flu and the Hong Kong cold in the 50-60's though the Spanish flu in about 1918 did not influence. 」

 「The criticism of ..commotion.. passing seems to be few in the United States etc. that became centers of a first accrual. The difference of sensorium to the crisis management is also large because of the country. At first, where the situation worsens cannot be expected about become popular. The consequence theory (When you neglected an early alarm) and it is very more serious to receive an opposite criticism. 」

 -Is WHO in the standpoint where a scientific judgment can be purely done?

 「The judgment that there are adverse effects in the policy of each country authorities is difficult because supranational agencies for the member state. For instance, the judgment that exceeded recent 'Season' was difficult. The declaration to loosen the feeling tense at the stage of being start vaccinating in the future in Africa etc. is not put out easily though the greater part of countries and regions have passed the infection peak. 」

 「The infection enclosure was done hard in Britain etc. though it was thought that it was necessary already to declare the declaration for last year's Onagare in the judgment (It was about one month or more actually earlier) as the specialist in May. I think the very worry about the WHO governing body. How is the judgment of the phase rule shown in the most in the world while the situation is different in the country and each region, and the discussion difficulty when the future. 」

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Japanese Medical Society of Primary Care, the Japanese home medical treatment society, and three societies of Japanese, integrated diagnosis and treatment Medical Science Association were born and merger Shite and the Japanese primary care union society were born in this April. The 1st science meeting is held in this June. The activity of the inside and this academic society to which integrated medicine and family physician's materiality is specified as a supporter of the primary care in the future is paid to attention.
The specialist system related to the problem of a current medical treatment and the primary care was started, and I asked Mr. Masatsugu of Maesawa who assumed the position of the founder president of the union society the ideal way of the society management in the future.
About when was the merger of three societies discussed to begin with?

The 30th science meeting of Japanese Medical Society of Primary Care was held in May, 2007. The Japan Medical Association was discussing the review of the continuing education for pharmacists system, and there was a cooperation request at three societies. I think that it is a start that the story that three societies are asunder and good came out by the process of the argument.

 ――" "When the president of the Japanese primary care union society is assumed the position, and it exists , saying that "Attained to the merger by sinking one's differences and attaching to Daido" (The homepage of this academic society is seen). "Minor difference" Or, what is "Daido"?

In the medical treatment, a special differentiation advances more and more. The resident also has the desire "If he or she is not a serious illness academy where the specialist becomes complete, it is not possible to look after scrupulously". The medical treatment field cannot also appeal to this for the materiality of the primary care. The desire that the common point on these medical practices should appeal a little more might be the strongest though various languages like the home medical treatment, the community medicine, and the comprehensive medical care, etc. are used.

 ――Then, , saying that "Minor difference". The difference of three societies is whereabouts?

Japanese Medical Society of Primary Care starts the internal medicine department and the pediatrics department by the mother's body by the gathering for the spot medicine person, includes the ophthalmology department, dermatology, and the otorhinolaryngology, etc. , and teachers of a variety of diagnosis and treatment departments belong though it relates to details of the establishment of each academic society. There is a difference in the method of the diagnosis and treatment though there is a common point "Tomohito medical treatment". Next, show and educating for a young person such as medicals and resident doctor as "Specialist of the primary care" and "Family physician" started from the idea of necessity though the Japanese home medical treatment society though the expression "Specialist of the horizontal type" had been done to "Specialist of the vertical type according to the organ".

 ――It originally has the expertise in Japanese Medical Society of Primary Care, and there are a lot of teachers that the way of expanding skirts of a mountain to the occasion is done as for the practice etc.

This is more abundant. Though it is certain that the desire that the common point looks after not only the body in an Tomohito medical treatment but also the mind is very strong.

 ――However, the methodology to inherit it to the next generation is difficult.

Yes. "Primary care medicine" and "Family physician" It cannot be understood that the doctor view is not presented easily. It was a current vulnerability.

 ――There is a difference by the hospital in the role that "Integrated diagnosis and treatment part" plays though at the Japanese, integrated medical treatment society, there seem to be a lot of teachers of the hospital work.

The specialist becomes complete in the hospital. The role that "Integrated diagnosis and treatment part" plays there has "Minor difference" by the hospital ..the difference, and waiting there... If there is a hospital that examines all patients of the first medical examination, it is various as the patient with whom a patient alone who doesn't understand the department that doesn't have the letter of introduction and consults a physician is examined or the diagnosis doesn't take side by other diagnosis and treatment departments is examined. Moreover, the example of the integrated diagnosis and treatment part's bearing an educational function such as Osamu I is not few.

 ――Then, at when that the evil of a special differentiation has occurred do you think?

Is the 1990's though it thinks the evil to have gone out in the 1980's though it is difficult to say a clear punctuation?It thinks in having actualized specialist's arrogance in such shape though the medical error came to be put in question in the latter half of the especially 1990's.

There is a problem of "Take care" when seeing from another angle. I think the proportion became in halves almost though the death is received by either the hospital or staying 1976. The hospital intention on the patient side became strong since those days. "Family function" weakened on the other hand, and the family nursing was not able to be expected. In addition, the weariness of the system was made alive and well though the new medical practice training system started in 2004.

 ――How do you see the training system as an ideal way of the training of doctors?

The number of my dispensary members is seen to be increased and the diagnosis and treatment results and idea's of connecting with the raise research bottom line are seen by the university dispensary. There was sensorium "Select a big tree for your shelter" also on resident doctor's side.

I graduate in 1971. 「Is it in the university hospital, and does really become study of the medical practice?I want to experience a lot of cases in the training hospital. 」It went out of the desire at once besides the university though it was unusual at that time. A present young doctors also had been holding the doubt in the training of the university hospital before making to requiring, and the matching system might be introduced by the new medical practice training system, and it be made alive and well all at once.

I think that the place in which it changes too much a little rapidly is a problem though there is no new medical practice training system as an idea when it makes a mistake in it. It fell into the doctor deficiency at the university, and doctor's "Repatriation" etc. occurred.

However, two years of initial training were the methods in Touhoku University and Nagoya University trained in the hospitals other than the university conventionally. It is desirable in the meaning of putting initial technology for the resident doctor to train in abundant points of the case. Is it not a problem and Sho that it is therefore ..current medical practice training system.. suddenly for the reason "..university hospital.. very" negative?

 ――Then, how do you think an evil advanced by a special differentiation to be appearance now though it asks again?

There is sized two horn Kina problem, and one is a medical care for the elderly. It has plural troubles, and "Ladder" does the senior citizen the medical practitioner. A day turns round plural diagnosis and treatment departments in the debt even if going to the hospital. The whole is looked after by the medical treatment of "Hashed". (It was introduced by the revision in 2008. )I think that there was a conception that synthesizes and is medical there though the criticism went out to "Senior citizen synthesis diagnosis and treatment fee of latter half of the year". One doctor examines the entire one patient even if it says from the point of the quality of medical care, the performance, and health care cost, and shape of consulting the specialist when it is necessary is still desirable.

It embarrasses it by doctor's repatriation sending it the doctor in a small and medium-sized hospital, and in particular, in the governmental hospital according to the university hospital though another relates to the problem of the doctor deficiency. For instance, the physician causes and the warpage is caused there in having arranged circulatory organs, the respiratory apparatus, digestive organs, etc. and the specialist one by one in the hospital of 5 or 6 people. Originally, it makes it to the weakness in such a small and medium-sized hospital though the outpatient and hospitalization should function in both syntheses and internal medicine departments. It can be said that the evil that doesn't neatly promote a doctor who synthesizes and is the internal medicine department will be caused around here.

 ――It is necessary that an advanced, special medical treatment and the supporter etc. of the rudimentary medicine also train furthermore while an integrated medicine the family physician is necessary. How do you think about the ideal way of training in that?

I think that gradual division of a specialist and an integrated medicine, etc. is necessary though it is necessary to esteem each doctor's idea even if it doesn't strictly decide it like Britain. The country discusses by the medical treatment field and I Soda, etc. , and decides that 30 percent, 40 percent, and an integrated medicine and the family physician are 50 percent, etc.

 ――Will do it to be graduate or be initial training completion time?

In the regimen, my specialty will be ascertained while experiencing variety widely in two years of initial training. It is possible to judge when graduating, and to train about two years after Sots and a special course, an integrated course, and to divide if the education in front of Sots is enhanced in the future.

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It was announced that the Bayer medicine (Osaka City) received the foot-and-mouth disease infection problem in Miyazaki Prefecture on the 20th, and had decided the emergency airlift of disinfectant "[Antekkubirukon] S" about 30 tons scattered in the pigpen and the cowshed.
It arrives at the Kansai airport until 20?23 day, and it ships it to Kyushu around Miyazaki Prefecture.

[Antekkubirukon] S is dissolved in water and lukewarm water with a powdery disinfectant and scattered on the floor and the wall etc. of penner [uchi] according to this company.
The infection spread was received and the airlift was decided further though the stock about 35 tons were lost after the problem came to light of April, and 50 tons were airlifted between the end of the same month and the middle of May.

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The Ministry of Health, Labour and Welfare announced the result of the survey of the established situation about a new sales system for the non-prescription pharmaceutical (over-the-counter drug) introduced by the revision drug legislation enforcement in June last year on the 18th.
The shop sold according to regulations remained in 50.5%, and there were 19.8% shop that had neglected explaining though one kind with a high risk obligated necessary information for the pharmacist to use the document and to be offered among 1?3 kinds divided according to the level of the risk of side-effect, too.

The investigation was executed by the mask investigation form that private trader's investigator was dressed a general guest for 3991 shops extracted from the drugstore and the apothecary in the whole country in March one ? and bought.

"It was an explanation only by oral" goes up and "There was no detailed account though the document was passed" has gone up to 7.1% by 22.5% also in the shop with the explanation when one kind was bought.
In the explanation, an uncertain qualification was 23.4% for the name tag to arrive though 70.4% was a pharmacist.
There were 3.3% case where the registration seller who did not have the sales qualification of one kind had corresponded, too.

The revision drug legislation prohibits the mail orders other than three kinds with a comparatively low risk.
It was possible to buy it by six as a result of investigating whether 1 and two kinds were able to be bought by calling for ten total of five high ranks of the shop and five subordinate positions that retrieved by the key word of "Mail order" and "Medicine" on the Internet and were displayed.

Ministry of Health, Labour and Welfare「A shop not thorough enough by the level either stood out from enforcement during half a year at the investigation time. It guides it to the shop that doesn't do appropriate sales through administrative divisions. 」It makes it.

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