Kazunobu Yamauchi

In this paper, the new method to support the communication between doctors and patients using computers is proposed. The method is aimed at visualization of topic structure to contribute to "narrative-based medicine(NBM)". NBM becomes emphasized in the clinical medicine. The dialogue between a doctor and a patient is segmented into blocks, the text objects. Correlations between each text object are calculated using the numbers of common words in text objects. The dialogue is visualized by drawing lines of the thickness according to strength of correlation between text objects. The methods were applied to two dialogues. One of them was introduce as proper, and the other was inappropriate. It was naturally thought that there were patters of lines between text objects in each step in NBM. In the former dialogue, it was observed that the patterns which appear when NBM was practiced appropriately. While the patterns was not observed in the latter one. As a result, the effectiveness of the proposed method was confirmed.

Healthcare is in a area of service from the standpoint of marketing. However, medical service has several points that distinguish themselves from other services. The characteristics are as follows; 1) the asymmetry of information is very huge, 2) the outcome of medical service is uncertain, 3) the service is demanded only when consumer needs it.<BR>However, the medical service providers have to take consumer (patient) satisfaction into considerationnowadays. In this paper, how to adapt marketing to medical service is investigated. Then, differentiationstrategy is emphasized.

<p> Objective: To reveal consumer's idea about drug information.</p><p> Subjects and Methods: Study 1 was made by targeting general population males and females 15 to 65 years old. Extraction method was stratified bi-level extraction by resident registry. Survey method was Questionnaire left for resident by survey staff during home visit. Study 2 was made directly to 409 male and 422 female.</p><p> Results: Collection rate was 45.7%. Study 1 revealed consumer's idea about which information is most important about drug information, how drug information should be delivered. Study 2 revealed the perceptual difference between prescription drug, OTC, and Viagra.</p>

広告や情報提供は、消費者の必要に対応しなければならない。しかしながら、消費者や患者がどんな情報を必要としているか、という調査は少ない。今回われわれは消費者に対して、医療情報についてのアンケート調査を実施したので報告する。<BR>信頼できる情報源について「第三者機関」を望む意見が大きかった。これは、消費者が客観的な評価を期待していることの現れであろう。たとえば、日本では1995年から日本医療機能評価機構が医療機能評価をはじめているが、認定を受けた病院数が日本の全病院の1割にも満たない状況である。<BR>また希望する医療情報提供については、医療機関からの情報を望むものが圧倒的多く、医療機関の広告・広報活動に対する期待の大きさを裏付けた。日本でも医療機関の広告規制緩和は徐々に進みつつある。しかし、一方で広告は、無駄な医療需要を作り出す恐れもある。適切な広告規制緩和が望まれる。

<p> Objective: The Internet literacy of Japanese medical doctors (MDs) is investigated in this study.</p><p> Subjects and Methods: A survey was made by mail to 60,000 medical doctors in Japan. The number of respondents was 14,105 (response rate 23.5%).</p><p> Results: The ratio of medical doctors having PCs was relatively high. The access to Internet was not good as the MD was elder. The access place of salaried physician for Internet was 50 : 50 between at home and at workplace, and that of self-employed physician was higher at home than at workplace. MDs obtain medical information through Internet by 80%. Interactive communication between MDs and patients was done by 20%.</p>

Many players, such as the Ministry of Health, Labour and Welfare, the Japanese MedicalA ssociation, and the Ministry of Finance, have separate opinionsa bout healthcarere form. However, all playersa gree that hospitals shouldp rovide more in formation to stakeholders.<BR>Here, we have investigated the 2588 hospitalsw hichmake up the Japan Hospital Administratiocno ncernintghe of fering of medicailn formation. The number of respondenwts as 743( responsrea te 27.8%).<BR>There were some differences in the attitude toward of medicail information amongo wners or governments However, the hospitals run forprofit did not show anys pecial characteristics.

<p> Recently, the consumer's consciousness to health care is increasing in Japan. The Ministry of Health, Labor and Welfare did the deregulation in terms of advertisement in health care in March 1st, 2001. On the other hand, the legal help, such as Health Insurance Portability and Accountability Act (HIPAA), has built in 1996 in the US. For example, the American people join in clinical trials easily. It is not only due to their volunteer spirits but also the literacy and infrastructure for healthcare information. The infrastructure for the consumers to get the correct health information should be built in Japan like that in the US.</p>

The clinical significance of beta-thromboglobulin (β-TG) and platelet factor 4 (PF-4) levels were evaluated in 26 patients with atrial fibrillation (af) complicated by valvular heart disease (VHD), 73 patients with of but without valvular heart disease and 57 normal subjects. The β-TG level was significantly higher in af patients without VHD than in normal subjects (49.4±35.8ng/ml vs 31.2±14.0ng/ml, p<0.01) and in af patients with VHD than in normals (64.1±52.8ng/ml vs 31.2±14.0ng/ml, p<0.01). Af patients with or without VHD tended to show high levels of PF4 compared with normals (af patients without VHD: 34.1±45.5ng/ml, af patients with VHD: 18.6±27.2ng/ml, normals: 11.6±8.2ng/ml). There was no correlation between β-TG levels and age in af patients without VHD or in normals. There was also no correlation between β-TG levels and heart rate in af patients without VHD.<br>The activation of platelets was suggested in patients with atrial fibrillation on the basis of increased levels of platelet releasing substances, especially in those with VHD. The high levels of β-TG and PF4 in patients with atrial fibrillation may be one explanation for the high incidence of thromboembolism in these patients, indicating the necessity of antiplatelet therapy.

Aging significantly increases the incidence of atrial fibrillation (AF) and premature contractions. Analysis of ECG recorded on approximately 240, 000 subjects who had medical health check for the past 10 years, showed that the incidence of AF was significantly higher in the elderly population of more than 70 years in age (2.5% for men and 0.3% for women) than in younger population. In geriatric clinics AF is much more frequently encounted, and its management constitute a major part of routine work. In a study of a smaller clinical cohort of elderly patients with AF, the three major underlying diseases were valvular, hypertensive, and ischemic heart disease, and 10% of patients showed no clinically recogniable heart disease (lone AF). Since no uniform atrial contraction exists in AF, ventricular filling and hence, stroke volume depend mainly on rapid ventricular filling, which is a function of R-R intervals and inflow resistance. The pulse Doppler technique showed that in individual patients LV inflow volume and the stroke volume of the immediately following beat seemed to solely depend on R-R intervals; they remained approximately constant when the R-R interval was longer than the threshold inherent in individual patients, and linearly decreased with progressive shortening of R-R interval when the R-R interval was shorter than the threshold. The threshold is determined by LV inflow resistance and becomes longer in patients with mitral stenosis or lowered LV compliance. Analysis of pulse Doppler tracings of mitral inflow velocity suggested that LV compliance decreased with aging in healthy men. This finding suggestes that AF imposes s greater hemodynamic burden on the elderly than the younger population, even if no significant heart disease exists. In patients with paroxysmal AF, the response of heart rate (HR) to treadmill exercise was remarkably greater in AF than in sinus rhythm, and this hyperresponsiveness of HR seems to be responsible for shorter exercise time observed in AF. Although digitalis alleviated the excessive response of HR to exercise and significantly improved exercise tolerance, the in-exercise HR seemed to be still inadequately high in many AF patients. A single oral dose of verapamil (80mg) or diltiazem (60-90mg) was shown to further suppress the in-exercise HR and prolong treadmill exercise time in AF patients on maintenance doses of digitalis. However, β-blockers on a similar test schedule showed no significant improvement in exercise tolerance in spite of marked suppression of HR. Additional use of these CA antagonists to digitalis was considered as an effective regimen for control of in-exercise HR in AF. Of 432 patients with acute cerebrovascular accident studied with brain CT, AF was significantly more frequent in 340 patients with cerebral infarction (18.8%) than in 95 with cerebral hemorrhage (2%). In another cohort of 72 concecutive patients with acute cerebrovascular accident studied with cerebral angiography, the incidence of AF was 2.7% in 37 patients with cerebral hemorrhage, 20.7% in 29 with cerebral thrombosis, and 80% in 5 with cerebral embolism, being significantly higher in cerebral embolism than in the former two. In a study population of 102 patients with cerebral embolism confirmed by cerebral angiography, AF was observed in 73 patients (71.6%), of whom 23 had lone AF. These our observations indicate that cerebral embolism is intimately related to AF and suggest that even lone AF can be the cause of systemic embolism. Detection of patients with high risk of cerebral embolism and its prevention are the urgent clinical problem in the management of AF patients.