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Objective: to determine whether computerized reminders during the process of prescribing can improve the use of drugs requiring prior laboratory testing according to the indications listed in the Drug Package Insert. Measures: Change in proportion of appropriate prescribing and frequency of severe hepatotoxicity between pre- and post-intervention. Methods: etretinate, a medication indicated for psoriasis, was selected as a monitored drug because it was the most prescribed of all the identified drugs that require specific prior laboratory tests. Computerized reminders are designed to alert a physician who is about to prescribe etretinate either without the alanine aminotranceferase (ALT) test or the aspartate aminotransferase (AST) test within 3 months or despite abnormality in ALT or AST. Data on alerts were gathered by using electronic mail whenever alerts occurred. Results: prescriptions of etretinate with normal ALT or AST results within the previous three months increased suddenly from 25.9% (127/491) in the pre-intervention period to 66.2% (353/533) in the post-intervention period (P

A WWW-based, on-line, data-entry system for the collection of statistical data on the management of Japanese national university hospitals has been developed. Trial operation of the system showed that it can reduce the labour and budgetary costs of data collection and also demonstrated that an on-line, data-entry system is feasible in Japan. In April 1997, we began production use of the system, and we are to develop another WWW-based data-entry system that can deal with all other statistics on hospital management.

The World Wide Web-based form is a promising method for the construction of an on-line data collection system for clinical and epidemiological research. It is, however, laborious to prepare a common gateway interface (CGI) program for each project, which the World Wide Web server needs to handle the submitted data. In medicine, it is even more laborious because the CGI program must check deficits, type, ranges, and logical errors (bad combination of data) of entered data for quality assurance as well as data length and meta-characters of the entered data to enhance the security of the server. We have extended the specification of the hypertext markup language (HTML) form to accommodate information necessary for such data checking and we have developed software named AUTOFORM for this purpose. The software automatically analyzes the extended HTML form and generates the corresponding ordinary HTML form, 'Makefile', and C source of CGI programs. The resultant CGI program checks the entered data through the HTML form, records them in a computer, and returns them to the end-user. AUTOFORM drastically reduces the burden of development of the World Wide Web-based data entry system and allows the CGI programs to be more securely and reliably prepared than had they been written from scratch.

The rational use of medications has been a serious social problem since the Sorivudine accident occurred. One of the reasons why the use of medications is not always correct is that the presentation of medical information is sometimes insufficient.We performed another questionnaire survey mainly for outpatients at other hospitals to obtain the status of drug consultation. According to the survey at other hospitals (80 hospitals surveyed, 59 responded, rate of retrieval 73%), drug consultation to outpatients is done at 29/59 (49%) hospitals, and thus only half of all hospitals provide drug consultation to inpatients.We performed a questionnaire survey for outpatients at the University of Tokyo Hospital to find out the type of information and communication method requested by patients. In the study at the University of Tokyo Hospital, the patients wanted information regarding drug effects, adverse reactions, and directions for use. Furthermore, an explanation with pictures or samples of the tablets was also desired.These studies suggested that it is necessary to illustrate serious drug adverse reactions and interactions with pictures or samples using lay terms, and in addition, such consultations should be individualized for each patient.

In developing a large-scale Hospital Information System (HIS), a client-server architecture has been gaining in popularity. It is important to introduce a standard message protocol that is independent both on the database structure and on the vender's proprietary platform. We introduced Health Level Seven (HL7) to our hospital information system. From our experiences, although we had to modify the original HL7 specifications in order to introduce the protocol to a client-server HIS especially in the area of order entry and record-oriented query, it was found that HL7 can be adopted in a client-server HIS.

Gerontology is a new field including various disciplines such as medicine, engineering science, social science etc, and is sometimes called as "longevity science". Because of the wide area of the field, it is important to show the scope of the science and the development of its thesaurus contributes to this end. We developed a relevant thesaurus based on the research funded by Longevity Science Promotion Organization, and using the thesaurus, we also developed a database and retrieval system of the gerontology research. This system can be accessed on the Internet.

For a hospital information system, object-oriented methodology plays an increasingly important role, especially for the management of digitized data, e.g., the electrocardiogram, electroencephalogram, electromyogram, spirogram, X-ray, CT and histopathological images, which are not yet computerized in most hospitals. As a first step in an object-oriented approach to hospital information management and storing medical data in an object-oriented database, we connected electrocardiographs to a hospital network and established the integration of ECG storage and retrieval systems with a hospital information system. In this paper, the object-oriented analysis and design of the ECG storage and retrieval systems is reported.

The circumstances when physicians want to exchange information are analyzed and the necessary requirements for workstations are discussed. Although there are many requirements, it will not be necessary to incorporate every requirement onto a single workstation. In the international setting, the capability of handling non-alphabetic characters is also important. The requirements for image display should be classified for those physicians who make their diagnosis primarily on the basis of images and those who use images as additional diagnostic information. On the basis of these discussions, the system of the University of Tokyo Hospital, which is now being implemented, is described. The system will be a network of approximately 300 workstations with one mainframe computer.

The studies of Iglehart, Ikegami, and Yoshikawa1-3 have described the Japanese health care financing and delivery system. However, answers as to why Japan only spends 6.8% of its gross domestic product on health care,4 while having more hospitals and beds than the United States, no apparent limits on universal access to care, and maintaining a mostly private fee-for-service provider system, have remained largely speculative. To begin to shed light on differences between Japan and the United States at a institution-specific rather than national

University Medical Information Network (UMIN) has been developed by connecting all of the national university hospital host computers. Through this network, hospital personnel share in the benefits of various medical information services. We attempted to send/receive MSDOS drug information system files by UMIN. UMIN does not accept binary data, but the “ish file converter” has enabled us to convert binary data files to text files for uploading and downloading. New ADMICS (Advanced Drug Mixture Information & Consultation System) has been developed on FMR (Fujitsu) personal computers by investigating ADMICS files on PC-9800 (NEC) personal computers. A batch file made it possible to update ADMICS automatically and immediately with files downloaded from UMIN. UMIN is expected to facilitate collaboration among university hospitals in utilizing application programs and databases originally developed on MS-DOS at each university hospital.

Although many machine-translation programs are currently available, few evaluation methods of such translation exist for any given application area. It is difficult to evaluate machine-translation systems objectively because the quality of a translation depends on the combination of three factors: the translation program, the dictionary, and the original document. In this study, we developed a quantitative evaluation method for assessing machine translation, which evaluates these three factors separately. We applied this method to the translation of English to Japanese for medical literature and the method proved to be a good indicator for further system improvement. Using this method we also discovered other important points for machine translation, such as the examination of target documents for the construction of a better application dictionary.

EBM is a cyclic process. Medical evidences are created in clinical trials, which are published in medical literatures. The medical literatures are converted to literature database, from which clinical practice guidelines are made. They are provided to the clinicians, from whom a new clinical research is born again. Information technology, especially the use of internet has deeply related to every process of EBM, which is shown above. In clinical trials, data are accumulated through internet and the process is controlled by a coordinator using internet. In Japan, University Hospital Medical Information System (UMIN) has successfully provided such a tool to the clinical researchers. For the literature search. IT is mandatory and clinical practice guidelines are created on the base of various secondary information database, which are edited using advanced information technology Clinical practice guidelines are provided to hospitals through internet and they reach to the clinicians using a function of hospital information system, especially electronic medical record. In recent days, IT is an indispensable tool for daily practice of evidence-based medicine. However, in Japan the evidence has not been accumulated in national level, and for the future, the creation of national database of medical data should be explored.

In Japan telepathology systems have been developed in medical or pathological environment such as a shortage and an uneven distribution of pathologists. More than 100 telepathology terminals are working mainly for intraoperative quick diagnosis. They cannot communicate with different types each other. In March 2000 the Medical Information System Development Center(MEDIS-DC) successfully demonstrated the interconnection between different types of telepathology terminals based on the Standard for Image Collaboration Command Protocol (SICCP). Nikon, NTTdata and Olympus had joined the development. In February 2002 MEDIS-DC examined these systems for pathological consultations in the fields of Okinawa-Kyoto, Kyoto-Mie and Mie-Okinawa. These successful examinations let us know that telepathology systems need new observation methodologies for telecytology and teleconsultation in addition to the flow for intraoperative quick diagnosis, new GUI guidelines for telepathology terminal design and, education and support for users of their smooth operation. Outcomes of MEDIS-DC activities encourageed us to challenge the next generation telepathology. We found some new trends in telepathology or pathology informatics such as virtual slide technologies and the internet applications in US and Europe. In order to keep Japanese priority, MEDIS-DC telepathology comittee has started investigations to construct a strategy for development of Japanese next generation telepathology.

We have designed "C-HTTP" which provides secure HTTP communication mechanisms within a closed group of institutions on the Internet, where each member is protected by its own firewall. C-HTTP-based communications are made possible by the following three components: a client-side proxy, a sewer-side proxy and a C-HTTP name server. A client-side proxy and server-side proxy communicate with each other using a secure, encrypted protocol while communications between a user agent and client-side proxy or an origin sewer and sewer-side proxy are performed using current HTTP/1.0. In a C-HTTP-based network, instead of DNS, a C-HTTP-based secure, encrypted name and certification service is used. The aim of C-HTTP is to assure institutional level security and is different in scope from other secure HTTP protocols currently proposed which are oriented toward secure end-to-end HTTP communications in which security protection is dependent on each end-user.

There is an ever-increasing demand for statistical information in health-care societies, and voluminous statistics are collected every year. When one needs information on survey results, it is generally not allowed to access the original data, and the summary tables are the most important source of information which can be shared. In order to store summary tables as a well-organized database and to perform flexible retrieval, a formal study has been made on the structure of summary tables. We introduce the notion of summary table scheme and define the operations called table transformation. A statistical database management system has been implemented based on the study. In our study, a statistical database is a collection of summary tables obtained from a survey. If a survey is conducted periodically, a database consists of all the tables obtained in the past. System utilities have been implemented for handling time-oriented information.

WWW-based user interface is presented for secure electronic mail service for healthcare users. Using this method, communications between an electronic mail (WWW) server and users (WWW browsers) can be performed securely using Secure Socket Layer protocol-based Hypertext Transfer Protocol (SSL-HTIP). The mail can be encrypted, signed, and sent to the recipients and vice versa on the remote WWW server. The merit of this method is that many healthcare users can use a secure electronic mail system easily and immediately, because SSL-compatible WWW browsers are widely used and this system can be made available simply by installing a WWW-based mail user agent on a mail server. We implemented a WWWbased mail user agent which is compatible with PEM-based secure mail and made it available to about 16,000 healthcare users. We believe this approach is effective in facilitating secure network-based information exchange among medical professionals.

The nature and problems of the linguistic representation of clinical data are discussed, using the linguistic theory of Ferdinand de Saussure. Based on the conclusions, a methodology for the construction of a disease nomenclature and a classification system, suitable for use in clinical information systems, is developed using set theory.

Etiology of QT prolongation and T wave high voltage was studied in 90 chronic alcoholics in relation to history of alcoholism, blood chemical values, heart rate and QRS voltage with a technic of multiple regression analysis. Incidences of QT prolongation (22%), T wave high voltage in lead V2 (9%), hypopotassemia (23%), hypocalcemia (26%) and hypomagnesemia (28%) were high, despite these examinations were done after relatively long abstention period (35 days on average). Sinus tachycardia (19%) and QRS high voltage (SV1 + RV5 exceeding 4 mV, 41%) were also frequent. Unexpectedly, QT interval did not correlate to serum electrolytes, including calcium. Major factors associated with QT prolongation were sinus tachycardia, longer abstention period and larger amount of daily alcohol consumption. Although the reason of each association was not quite clear, alcoholic myocardial damage may be a cause of QT prolongation. Voltage of T wave in lead V2 was sensitive to serum potassium level, but the observed tendency of hypopotassemia acted to the direction against high voltage of T wave. The sole factor positively associated with high voltage of TV2 was high QRS voltage, which may be a manifestation of left ventricular hypertrophy.

A medical interview is a very important part of medical treatment since it is conducted when a patient is first admitted to a hospital and treatment is decided afterwards. However, these interviews are not always carried out in sufficient detail because physicians have very heavy work-loads. The development of automated medical questioning equipment which tabulates the answers to questions into a form easily understood by physicians, which enumerates data on doubtful diseases and which indicates pertinent medical examinations may come to the aid of patients and physicians. This paper presents a new diagnostic theory for the design of automated medical questioning equipment. Diagnostic theories can be classified into batch and sequential theories; the authors have investigated the sequential one, because decisions are made using minimal data. The techniques supporting this theory are multi-class recognition systems based on independently designed dual-class recognition systems and Wald's Sequential Probability Ratio Test. To discuss the properties inherent in the present theory, classification of three pattern classes was made. These were normal, hypertension and myocardial infarction classes of patients. The mean error probability of classification was found to be 3.08%.

An analysis of the variations in the clinical course of hepatitis B (HB) was attempted with mathematical simulation. Hepatitis B could be regarded as an ecosystem consisting of liver cell, hepatitis B virus and immunity, which were integrated by Dudley's hypothesis. The reason for the variations in the clinical course of hepatitis B were found to be the variations of immunological power destroying liver cells and of the absorption of HB virus. Non-A non-3 hepatitis with recurrent aggravation was also studied. The effect of treatment with transfer factor and interferon for chronic hepatitis were simulated, and the dynamics of these treatments were analyzed.

Clinical trials on investigational drugs (IND) are conducted in many hospitals. The drug information center in the hospital pharmacy receives inquiries as to the contents and/or the availability of the IND from health care professionals because of scarcity of sources of well arranged information. We answer the inquiries by the use of accumulated up-to-date IND information which has been collected directly from journals in our pharmacy. However, it is difficult to supply our data all over the country by current system.We developed the IND data base which contains the following 8 items: ID number, generic name, investigational number, commercial name, company, use, references, and comment. Further, we examined on-line retrieval, distribution of magnetic tape, and bookbinding of the print-out of this dath base. The results indicated that this data base could provide many health care facilities with up-to-date IND information rapidly.

Regional pulmonary blood flow was determined by measuring the amount of accumulation of I131 labelled macroaggregated albumin using modified quantitative scanning method. With this method, the regional pulmonary blood flow can be measured with simple procedure, at any posture or condition of the subject.By this method, it was demonstrated that in normal subjects supine position produced almost even distribution of blood flow to the entire lung, whereas upright position increased the flow in lower portion of the lung. Marked increase of pulmonary blood flow in the upper region of both lungs was observed in patients with mitral stenosis as well as certain case of congestive heart failure.

Serum arginase concentration was measured in 28 acutely intoxicated alcoholic males at the time of admission and one week later. Results were compared to measurement of serum LDH, SGOT, serum bilirubin values and to bromsulphalein retention. In 22 of the 28, serum arginase was significantly elevated, which was as high a percentage of abnormals as with any of the other tests of liver function. Arginase concentrations correlated better with BSP retention than with serum albumin, bilirubin, SGOT or LDH. One surprising finding was that during convalescence serum arginase rose in ten patients. This raised the interesting hypothesis that serum arginase concentrations may be related to repair as well as injury.

In 5 anesthetized dogs, "carbonized microsphere" labeled with Sr-85 was injected into left atrium, and then the heart was excised and divided into 4 heart chambers and interventricular septum. Total and regional myocardial blood flow was calculated from the relative distribution of radioactivity, the weight of each myocardium samples and cardiac output, by the principle that the injected microspheres are distributed in the heart in proportion to the distribution of the regional myocardial blood flow. Total myocardial blood flow was 5.35±1.00% of the cardiac output, and the average myocardial flow per 100Gm. of the myocardium was 76.3±15.5ml./min./100Gm. Right ventricle was supplied significantly less blood flow than left ventricle. The blood flow in the basal portion of right ventricle was less than that in the apical. There was no significant difference among the perfusion areas of left ventricle, but endocardial side of left ventricle was supplied with more flow than epi-cardial side. Interventricular septum had a similar pattern of flow distribution to left ventricular free wall. The total coronary sinus flow was collected during the injection of the microspheres using a cannula introduced into coronary sinus via right auricular appendage, and no significant coronary arteriovenous shunt was found.

A radioisotopic method of assay of arginase activity is reported. The method is based on the hydrolysis of labeled substrate (arginineguanido- 14 C). The labeled urea developed is hydrolyzed by urease and the 14 CO 2 released is measured in a liquid seintillation counter as a measure of arginase activity. Advantages of the method are sensitivity and accuracy derived from the absence of interference by nonradioactive urea in the incubation mixture. The procedure is simple and easily applicable to a large number of samples.

Regional myocardial blood flow was studied in the anaesthetized dog by determining the distribution of 15 and 50μ radioactive microspheres after left atrial injection. Doses of the 15μ spheres below 4 × 106 did not significantly alter coronary or systemic haemodynamics. Larger doses produced a significant increase in mean aortic pressure. Less than 1% of the 15μ spheres delivered to the heart passed into the coronary sinus. The myocardial distribution of 15 and 50μ spheres was not significantly different except for the ratio of left ventricular endocardium to epicardium (1·12 for 15μ and 1·45 for 50μ, P

Nach einer kurzen Diskussion des Unterschiedes von “oberflachlichem” und “tiefem” Wissen wird ein Ansatz beschrieben, das “tiefe” anatomische Wissen in eine Wissensbasis abzubilden. In drei Ebenen werden Topologie, Funktionen und Geometrie neuroanatomischer Strukturen dargestellt.Als Werkzeuge dienen PROLOG bzw. hierarchische Symbol-Binar-Koordinaten. Das Verfahren hat sich in der Praxis bewahrt.

A case of constrictive pericarditis with hypoproteinemia was reported with the demonstration of gastrointestinal protein loss and lymphangiectasia of the intestinal mucosa. From these facts hypoproteinemia in cardiac diseases was revealed to be due to gastrointestinal protein loss caused by a disorder of the lymphatic vessels of the small bowel.

This is the study attempting to clarify quantitatively the regional disturbance of ventilation-perfusion relationships in pulmonary diseases. Measurements were made on 7 normal subjects, 16 cases with pulmonary parenchymal diseases and 4 cases with pulmonary vascular diseases. Perfusion and inhalation scintigrams were taken in sitting position and were divided into 9 horizontal zones in order to know relative values of regional pulmonary blood flow (Q) and alveolar ventilation (VA). Cardiac output and minute alveolar ventilation were also obtained at the same time. Using these data, absolute values of regional VA, Q and VA/Q of 9 zones were analyzed from the base to the apex of both lungs. In 7 normal subjects the average regional VA /Q ratio was 0.64 at the base and increasing 1.35 at the apex. In 20 patients the ratio ranged between 0 and 11.2, and even in the parts of parenchymal disorders the ratio was generally higher than normal since the decrease of regional perfusion was more remarkable than that of regional ventilation. Discussions were made on the usefulness as well as limitations of this scintiscanning method in approaching ventilation-perfusion unevenness topographically and quantitatively.