In order to reduce the medical expenditures, the Japanese government facilitates more use of generic drugs. In order to prepare a concrete data for such a program, we have done a situation analysis about generic use among the cataract surgery patients. Data for this study were extracted from the Japanese inpatient administrative claims database, the DPC database. We have extracted 58,750 surgical cataract cases from this database (1st July 1 2010 to 31st October 2010). In total, studied cases used 20,946,838 points (209 million JPY) for antibiotics of which 1,359,864 (13.6 million; 6.5%) was for generic. The most used antibiotics was CFPN-PI (5,741,156 points) followed by FMOX (3,872,562 points) and CFDN (3,651,493 points). These three antibiotics correspond to 63.3% of total use (monetary base) and do not have any equivalent generics. It is interesting that hospitals with larger cases used less generics. The present analysis has clarified that there is a still room for cost containment concerning the pharmaceutical use in Japan.

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Background: The appropriate duration of fasting therapy after endoscopic hemostasis for the prevention of recurrent bleeding from non-variceal upper gastrointestinal bleeding (NVUGIB) remains unclear.
Objective: To determine the appropriate duration of fasting therapy using a national administrative database.
Design: Retrospective cohort study. Setting: 475 hospitals between April and December in 2008.
Patients and interventions: 3254 patients with endoscopic hemostasis for NVUGIB.
Main outcome measurements: Patients were divided into 5 groups according to duration of fasting therapy, namely 1, 2, 3, 4, and 5 d or more. We compared the risk-adjusted rate of recurrent bleeding in relation to the duration of fasting therapy. Odds ratio (OR) and their 95% confidence intervals (CI) for recurrent bleeding after fasting therapy were estimated using a multiple logistic regression model.
Results: Recurrent bleeding rate after fasting therapy significantly differed by fasting duration, at 21.7% of patients with 1 d of fasting therapy, 12.3% with 2 d, 4.8% with 3 d, 4.6% with 4 d, and 3.0% with 5 d or more (p<0.001). Multiple logistic regression analysis showed no significant difference in the risk of recurrent bleeding between fasting for 3 or 4 d and 5 d or more (OR of fasting for 3 d 1.635, 95% CI 0.793–3.366, p=0.182; and OR of fasting for 4 d 1.548, 95% CI 0.705–3.402, p=0.276).
Limitations: Use of claims data lacking clinical detail.
Conclusions: 3 d of fasting therapy seems to be suitable for the prevention of recurrent bleeding from NVUGIB.

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Previous literatures have clarified that cancer patients tend to have depressive feelings and that they require supportive care for depression. We have tried to describe the actual situation of psychiatric care for the breast cancer patients among the acute care hospitals in Japan based on the DPC data. For this study, we have extracted 28,995 breast cancer cases (female patients only) from the DPC database (1st July 1 2010 to 31st October 2010). Based on this data set, we have counted the cases with depression and anxiety symptom as comorbidity or complication. Then we analyzed the depressive symptom related cares from the detailed process data (F file). Patient of 60–69 yr old is the largest population (7,985 cases; 27.5%) followed by 50–59 (6,791; 23.4%), 70 yr old and more (6,523; 22.5%) and 40–49 (5,804; 20.0%). The highest prevalence of depression related symptom was observed for young patient under 40 yr old (depression 3.6% and anxiety 3.2%). The percentages of patients with depression received psychiatric liaison care, antidepressants, and palliative care were 9.9%, 18.7% and 2.0%, respectively. These figures were 8.0%, 4.3%, and 0.7% for patients with anxiety symptom. The results have suggested that the Japanese breast cancer patient could not receive appropriate clinical services for mental problems.

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In this article, the authors tried to clarify the importance of accurate coding for appropriate evaluation under the casemix scheme. For this study, we have extracted 28,995 stroke cases with sufficient information of ICD coding from the DPC database (1st July 2008 to 31st October 2008). Based on this data set, we have classified the cases into following 3 types: atherothrombotic, thrombus and lacna type using the ICD coding information. Then we analyzed the differences in these 3 types for demographic factors (age), clinical outcome (ADL status at admission and discharge), and cost (charged cost based on F file). Results showed that clinical characteristics and resource consumptions have been different among the stroke type even though the 3 types (atherothrombotic, lacunar and embolic) are classified into the same base DPC (010060). Embolic type of stroke cases showed longer length of stay, heavier level of ADL decline and larger cost consumption with statistical significance (p<0.01). The present results have indicated the importance of accuracy of ICD coding under the casemix based evaluation system.

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