Effectiveness of Leakage Prevention System in Communicating Important Diagnostic Information

In Japan, oversights of imaging or pathology examination results and diagnoses provided to patients have become a major problem because they affect patient prognosis. We have jointly developed and used the "Anti-Impact Information Leakage Prevention System (AiR)" since December 2019. This system works effectively because its introduction, which uses a data warehouse, has increased versatility and considerably improved the situation of confirmation and communication. We believe this system is working effectively.

The working experience of medical staff in the hospital-wide bed-sharing mode: A qualitative study

AIM

The purpose of this study was to provide a comprehensive understanding of the attitudes and experiences of the medical staff regarding the hospital bed-sharing model.

DESIGN

The present research was a qualitative study.

METHODS

This qualitative study used in-depth individual interviews with 7 doctors, 10 clinical nurses and 3 head nurses, which were then transcribed and analysed thematically.

RESULTS

The study identified six overall themes. Issues were raised about the efficient utilization of hospital bed resources, greater challenges for nursing work, adjustment of doctors' work modes, barriers to communication between doctors, nurses, and patients, potential medical risks, and differentiation of patients' medical experience.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators and nurse managers should work together to solve the challenges that medical staff face, including strengthening nursing training, improving medical-nursing collaboration models, standardizing and effective communication strategies, and improving patient experiences.

[Education Aimed at Patient Safety Management of Chemotherapy Conducted at University Education Sites]

The School Education Law was revised in 2006, and the university pharmacy education system and the national pharmacist examination system were changed. In line with the advancement of medical technology and the division of labor, 16 years have passed since the length of undergraduate pharmacy education was extended from 4 to 6 years in order to foster highly qualified pharmacists. During this period, the curriculum for practical training has been revised, and lectures and exercises focused on clinical education have been incorporated to foster pharmacists who can be useful in the medical field. In the area of cancer drug therapy, the university provides students with opportunities to learn about the basic mechanisms of action and side effects of anticancer drugs, but there is little coverage of clinical guidelines and pharmacological management of the latest therapies, such as cancer immunotherapy. Prior to my arrival at Hoshi University, I was involved in clinical work and clinical research at an oncology hospital for 13 years. Since my arrival, I have been exploring the gap between oncology pharmacotherapy and pharmacy education, and have been working to fill it. We have incorporated new curricula, such as exercises in formulation suggestions, lectures to deepen understanding of guidelines and supportive care, and information on the latest cancer drug therapies, such as cancer immunotherapy. This paper outlines the pharmacy education required to produce pharmacists who can practice safe cancer drug therapy.

Trends and Characteristics in Health Care-related Deaths Investigated through Medico-legal Autopsies after System Changes in Japan

In Japan, a new cause-of-death investigation system and related new laws were enacted in the mid-2010s. These laws provided for an autopsy system for non-criminal unnatural deaths and a medical accident investigation system outside the criminal justice process for health care-related deaths. We retrospectively explored changes in the number and characteristics of medico-legal autopsy cases of health care-related deaths in Chiba Prefecture, Japan, and examined trends over time during these reforms. We found that the percentage of forensic autopsies based on the Code of Criminal Procedure for health care-related deaths had decreased significantly. The number of autopsies of accidental and unintentional deaths in nursing homes, which are not covered by the newly established medical accident investigation system, has been increasing, reflecting the ageing of society. The trend toward decriminalisation of health care-related deaths was expected to contribute more to medical safety if the scope was expanded and a system for disclosure of autopsy information was established.

Analysis of Incident Reports of a Dental University Hospital

Incident reports are important for improving the quality and safety of medical care. Healthcare workers with less than one year of work experience have been reported to cause the most incidents, and the most common incident is “drug-related”. However, few studies have comprehensively analyzed incidents in dentistry, and the characteristics of dental incidents have not been understood. In this study, to understand the characteristics of dental incidents, we comprehensively analyzed 1291 incident reports submitted to the Tokyo Medical and Dental University Dental Hospital from April 2014 to March 2019. As a result, dental outpatient and dental wards had different types of incidents. In outpatient wards, incidents included many dentistry-specific incidents related to “procedures”. Among them, “poor physical condition of the patient during dental treatment” was the most common incident. In contrast, the most common incident from subjects with less than one year of work experience was “damage to soft tissues around the teeth”. Thus, to improve the quality and safety in dentistry, it is was considered necessary to analyze and understand the characteristics of dentistry-specific incidents and to take appropriate measures and educate dental professionals.

[Standardization of Hypnotic Agents for Prevention of Falls: A Pharmacoeconomic Study]

To reduce the number of falls caused by hypnotic agents, the standardization of insomnia treatment was carried out at Yamaguchi University Hospital from April 2019. There were concerns that medical costs would increase due to the selected medicines-suvorexant and eszopiclone-being more expensive than conventional benzodiazepines. In this study, the standardization of insomnia treatment was evaluated by pharmacoeconomics. The costs of the hypnotic agents was considered, as was the cost of examination/treatment following falls. Effectiveness was evaluated as the incidence of falls within 24 hours of taking hypnotic agents. This analysis took the public healthcare payer's perspective. Propensity score matching based on patient background, showed that, per hospitalization the medicine costs of the recommended group increased by 1,020 yen, however, the examination/treatment costs following falls decreased by 487 yen when compared with the non-recommended group. Overall, the recommended group incurred costs of 533 yen more per hospitalization for patients prescribed hypnotic agents compared to the non-recommended group, but the incidence of falls for the recommended group was significantly lower than that in the non-recommended group (1.9% vs. 6.3%; p<0.01). These results suggest that in order to prevent the incidence of falls by 1 case, it is necessary to increase costs by 12,086 yen which is the subthreshold cost for switching to the recommended medicine as standardization. The selection of recommended medicines may be a cost-effectiveness option compared with non-recommended medicines.

[Current Issue of Information Management about Pharmaceutical and Medical Device Interaction in Hospital]

Contact between plastic medical devices and medicine causes damage to the medical device and liquid medicine leakage because of physicochemical reactions. These phenomena are listed as contraindications and precautions on individual package inserts of medical devices and drugs; medical device package inserts draw attention to such as interactions. We carried out a questionnaire survey of medical-, drug-, and device-safety managers in hospitals that examined the management system for medical device package inserts, responsibility for dealing with the occurrence of drug and medical device interactions, and at desirable system to avoid such occurrence. Drug package inserts are managed by pharmacists. The medical device package inserts are managed mainly by the device safety managers, as well as by other personnel, including the clinical engineer, doctor, nurse, and clinical radiographer. The survey confirmed that interactions occurred at many phenomena; the procedure involved detailing such occurrences by various medical staff to a medical-safety manager in an incident report. Our study revealed that there were many problems with the package inserts management system for medical devices. Cooperation between safety managers within hospitals is necessary to avoid such incidents.

Fatal airway obstruction due to Ludwig's angina from severe odontogenic infection during antipsychotic medication: A case report and a literature review

Ludwig's angina is characterized by inflammation of the sublingual and submandibular spaces and is mainly caused by odontogenic infection, which leads to cellulitis of the soft tissues of the floor of the mouth and the neck. This causes asphyxia due to elevation and posterior deviation of the tissues of the floor of the mouth. We report a fatal case of airway obstruction due to Ludwig's angina. A woman in her forties who had no physical complications, but had a mental illness, was undergoing outpatient dental treatment for caries in the first premolar of the left mandible. She was admitted to a psychiatric hospital because of insomnia caused by pain, where she developed cardiopulmonary arrest while sleeping and died 14 days after onset of the dental infection. Postmortem computed tomography (PMCT) prior to autopsy showed swelling of the soft tissues-from the floor of the mouth to the oropharyngeal cavity, the supraglottic larynx, and the prevertebral tissue. Autopsy revealed a markedly swollen face and neck, an elevated tongue, and a highly edematous epiglottis and laryngopharyngeal mucosa. There was also cellulitis and abscess of the facial, suprahyoid, and neck musculature, which suggested that the cause of death was asphyxiation due to airway obstruction. This was an alarming case, with mental illness leading to risk of severe odontogenic infection, and in which obesity and use of antipsychotic medication might have acted synergistically leading to airway obstruction. This is also a case of Ludwig's angina captured by PMCT, which has rarely been reported.

Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study

Background

Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy.

Objective

In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being.

Methods

This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared.

Results

Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021.

Conclusions

iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers.

Trial Registration

UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284

International Registered Report Identifier (IRRID)

DERR1-10.2196/24799

Enhancing the blood safety program in Myanmar: Report on projects of global extension of medical technologies of Japan

The National Center for Global Health and Medicine has long collaborated with the blood program in Myanmar, and the Center started a new project in 2015 to enhance blood transfusion safety as part of a new set of projects of global extension of medical technologies that aims to improve public health and medicine in developing countries under public-private partnerships. The project resulted in remarkable achievements, including maintaining a high proportion of voluntary blood donations despite a rapidly growing demand for blood, ensuring blood safety from the donor to the recipient, and creating public-private partnerships. The project supported the introduction of blood grouping using the tube method at hospital blood banks, safety measures during blood transfusions, and effective use of blood products including component blood. The project identified the need for medical devices such as leukocyte filters, serofuges, and refrigerators to store blood products. The success of the project may depend on mutual understanding and trust based on the duration of collaboration, improvement of the requirement for medical safety (including blood safety) in the country, and shifting the mindset of partner companies in public-private partnerships to create new demand by encouraging improvement of the quality of care and requiring the safety of medical care. In this era of sustainable development goals, the hopes are that these experiences will help other countries seeking to improve their public health through public-private partnerships.

Development of a Surgical Sponge Counting System Using Radiographic Images

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Risk of Overdose with Exposure to Prescription Opioids, Benzodiazepines, and Non-benzodiazepine Sedative-Hypnotics in Adults: a Retrospective Cohort Study

BACKGROUND

Concurrent use of benzodiazepines in opioid users has been linked to a higher risk of an emergency room visit or inpatient admission for opioid overdose and death from drug overdose. Further research is needed to confirm the findings and analyze contributing risk factors for opioid overdoses in a large commercially insured population.

OBJECTIVES

To estimate the risk of opioid overdose associated with opioid users exposed to various combinations of opioid, benzodiazepine, and non-benzodiazepine sedative-hypnotic therapy. To identify other factors that are associated with increased risk for opioid overdose.

DESIGN

Retrospective cohort study.

PATIENTS

New start adult users of opioids, defined as naïve to opioids for 6 months, in Kaiser Permanente California regions from January 2013 through September 2017.

MAIN MEASURES

Inpatient or emergency department admissions due to opioid-related overdose.

KEY RESULTS

A total of 2,241,530 patients were included in this study. Patients exposed to opioids, benzodiazepines, and non-benzodiazepine sedative-hypnotics at any point during their follow-up were 60% more likely to overdose than those who were only exposed to opioids (p < 0.0001). Those exposed to opioids and benzodiazepines were 20% more likely to have an opioid-related overdose than those exposed to opioids only (p < 0.0001). Significant risk factors for opioid overdose included exposure to all three medication classes, higher opioid dosage strengths, elderly age (age ≥ 65 years), history of previous overdose, and substance use disorder.

CONCLUSIONS

Results from this study demonstrate a significant increase in risk of opioid overdose in patients exposed to combinations of sedative-hypnotics with opioids compared to those only taking opioids. Findings from this study provide evidence that opioids should be avoided in combination with benzodiazepines and non-benzodiazepine sedative-hypnotics, used at the lowest dose possible, and used with caution in the elderly, those with previous history of overdose, and those with substance use disorder at baseline.

Classification of the appropriate behaviors of Patients for Patient Safety against the Chinese cultural background, based on grounded theory

OBJECTIVES

The purpose of this research is to explore the appropriate behaviors and characteristics of Patients for Patient Safety (PFPS) against the Chinese cultural background, especially the types and internal logical relationships of behaviors of PFPS.

MATERIAL AND METHODS

In this research, Glazer's methodology principle of the traditional grounded theory was adopted, and the methods of objective sampling, theoretical sampling and snowball sampling were employed. Considering the diversity of the interviewed subjects' gender, age, professional title, qualification and demographic characteristics, representatives of hospital management staff, doctors, nurses, patients and their family members from different provinces and cities across the country were selected for semi-structured in-depth interviews to assess the behaviors of PFPS against the Chinese cultural background. In addition, some PFPS reports were collected from network media to supplement the interview data. All interviews were recorded and collated into Word text documents. Qualitative research data analysis software Nvivo 12 was used to sort out the collected data, and the theme was separated out through the strategy of substantive coding and theoretical coding.

RESULTS

In this research, the appropriate behaviors of PFPS were taken as the research content; 6 categories of appropriate behaviors of PFPS were separated out; and a model diagram of PFPS was constructed accordingly.

CONCLUSIONS

A model diagram of the appropriate behaviors of PFPS against the Chinese cultural background was constructed to provide theoretical guidance for relevant research and practice. Int J Occup Med Environ Health. 2020;33(3):263-72.

[The Actual Condition of Fall Accident and Suggestion of Improvement for Accident Prevention in the Department of Radiology]

We conducted a questionnaire survey (situation, patient factor, environmental factor, operator factor, degree of disability, countermeasure etc.) on cases that occurred up to the present to investigate the actual situation of the medical accidents that occur in the radiological examination department of medical institutions. There were 373 questionnaires collected. Among them, there were 197 cases of falls. In this study, we examined the age of patients who fell, the background of the accident, and factors. As for the accident, 11.7% of accidents with risk impact level 3b or higher occurred including the fatal accident. Of the accidents, 44.2% were foreseeable and 55.8% were unforeseeable. The most accident-prone age was elderly in their 60s to 80s. As the causative factor for the accident, the patient factor was the largest at 63.5%. We can prevent about 30% of the accident by improving the operator factor and the environmental factor which are parts other than patient factor. It is important for us to understand what kind of people tend to fall. Among foreseeable accidents, the causes of patient factors can be reduced.

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases

AIM

To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital.

METHODS

The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative best-corrected visual acuities (BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed.

RESULTS

A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73% (2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1d, 1wk, and 1mo post-surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12% (171/4151) had posterior capsule rupture, 0.79% (33/4151) had iris or ciliary body injury, and 0.048% (2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38% (182/4151) had cornea edema, 7.78% (323/4151) had intraocular hypertension, 0.096% (4/4151) had IOL toxicity syndrome, 0.28% (12/4151) had retained lens cortex, and 0.048% (2/4151) had hyphema. The delayed discharge rate was 0.82% (44/4151) and the unplanned re-admission to the hospital was 0 (0/4151). The patient satisfaction rate was 91.42% (3795/4151).

CONCLUSION

Day-case cataract surgery is safe and effective with good prospects for development.

Regulation on introducing process of the highly difficult new medical technologies: A survey on the current status of practice guidelines in Japan and overseas

Since serious problematic cases regarding the technical safety of technically demanding operations were reported in Japan, the Ministry of Health, Labor and Welfare issued new regulations on June 10, 2016 requiring each hospital to check the status of informed consent, skill of surgery team and governance system of the surgical unit, when the highly difficult new medical technologies were introduced to a hospital. In order to firmly establish this new system for highly difficult new medical technologies, it is very important and informative to survey the current situation for guidelines and consensus regarding introduction of medical technology with special skills in Japan and overseas. Based on the survey of questionnaires, document retrieval, and expert interviews, we found that documentation related to the introduction process of highly difficult medical technologies is very rare, and the regulations were mainly issued by academic societies. Moreover, even if such documentation existed, the quality of the regulations is poor and not sufficient enough to perform surgical practice safely. Therefore, for medical practitioners, comprehensive and concrete regulations should be issued by the government or ministry to legally follow in regard to technically demanding operations. A new practice guideline was proposed by our special research group to regulate the introduction process of highly difficult new medical technologies in hospitals in Japan. This guideline, gained understanding from relevant academic societies, provided a comprehensive view on the interpretation of "high difficulty new medical technology" prescribed by the law and show the basic idea at a preliminary examination from the viewpoints of "Surgeon's requirement", "Guidance system", "Medical safety" , and "Informed consent". These efforts will contribute to the improvement of the quality of guidelines regarding "highly difficult new medical technology".

The Swiss Cheese Conference: Integrating and Aligning Quality Improvement Education With Hospital Patient Safety Initiatives

The Accreditation Council for Graduate Medical Education requires integration of quality improvement and patient safety education into graduate medical education (GME). The authors created a novel "Swiss Cheese Conference" to bridge the gap between GME and hospital patient safety initiatives. Residents investigate a specific patient safety event and lead a monthly multidisciplinary conference about the case. Resident presenters introduce the Swiss cheese model, present the case and their findings, and teach a patient safety topic. In groups, participants identify contributing factors and discuss how to prevent similar events. Presenters and stakeholders immediately huddle to identify next steps. The Swiss Cheese Conference has increased participants' comfort analyzing safety issues from a systems perspective, utilizing the electronic reporting system, and launching patient safety initiatives. The Swiss Cheese Conference is a successful multidisciplinary model that engages GME trainees by integrating resident-led, case-based quality improvement education with creation of patient safety initiatives.

[The Prevention of the Root Accident in the Department of Radiological Examination Room -Analysis of the Results of Questionnaire Survey about Medical Accident to Many Hospital]

PURPOSE

The purpose of this paper is to analyze the characteristics of incidents related to routes and drains that occur in the radiological examination room for the prevention of these incidents.

METHODS

We conducted a questionnaire survey on incident cases that occurred in the radiological examination room. There were 373 responses, of which 76 responses were related to routes and drains. The question contents were the number of hospital beds, radiology department of occurrence, time of occurrence, patient's situation, method of visiting, years of experience of the radiological technologists, and countermeasures, and so on. Based on these answers to these questions, we analyzed which factors were involved in the occurrence of the incidents.

RESULTS

Incidents related to routes and drains often occur when moving examination table or transferring the patients to the examination table using the slider. On the other hand, the years of experience of the radiological technologists hardly participated in the factor of these incidents. From these answers to questions, 75% of incidents might predictable, and these incidents could be prevented by improvement of human factors accounted for the majority rather than that of physical factors.

CONCLUSION

The number of incidents related to routes and drains may reduce by that all staff involved in the radiological examination recognizing the characteristic of these incidents.

[Visualization of Effectiveness of the Medical Safety Measures -Suggestion of the Evaluation Technique for Rare Medical Incident]

For events with a low occurrence rate, such as medical incidents, we were able to determine the evaluation before and after taking medical safety measures by statistical methods (testing for differences in population rate). The point of this method is that we evaluated the occurrence rate of incidents to the total number of examinations (number of incident occurrence real number plus number of examinations carried out without any problems). Our results suggest that this technique becomes the evaluation technique as the effective method of medical safety measures. The present studies demonstrated that the evaluation technique by the testing for differences in population rate become the indicator to judge the effectiveness of the medical safety measures in the following cases. (1) When we evaluate the decrease in incident for the long term before and after safety measures. (2) When we evaluate the effectiveness of measures in the middle evaluation after safety measures.

Tomojiro Nagai, founder of the Association of the Medical Practitioners (Jicchi ika no tame no kai) in Japan

Obituary: Tomojiro Nagai, founder of the Association of the Medical Practitioners (Jicchi-ika no tame no kai) in Japan.

Study of Safety Evaluation in Dispensing of Medicines-Analysis of Relationship between Dispensing Error Rate, Inspecting Error Rate, and Malpractice Rate

In this study, we established a methodology to calculate the rate of overlooking a dispensing error (inspecting error rate) as a new index for the purpose of determining dispensing error and malpractice rates. Using data obtained from analyses of these error rates at our and two other hospitals, an inspecting error rate was calculated for each institution. Our results showed that inspecting errors occurred at a frequency 3-5 times greater as compared to dispensing errors at each of the examined hospitals. We concluded that construction of a higher quality safety management system would be enabled by incorporation of an inspecting error rate as a new index to evaluate medical safety in regard to dispensing of medicines and managing inspection accuracy.

Attitudes toward pharmacological cognitive enhancement-a review

A primary means for the augmentation of cognitive brain functions is “pharmacological cognitive enhancement” (PCE). The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals. With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, i.e., in groups outside of the academic debate. In this review, we provide an overview of the 40 empirical studies published so far, reporting both their methodology and results. Overall, we find that several concerns about the use of PCE are prevalent in the public. These concerns largely match those discussed in the normative academic debate. We present our findings structured around the three most common concerns: medical safety, coercion, and fairness. Fairness is divided into three subthemes: equality of opportunity, honesty, and authenticity. Attitudes regarding some concerns are coherent across studies (e.g., coercion), whereas for others we find mixed results (e.g., authenticity). Moreover, we find differences in how specific groups—such as users, nonusers, students, parents, and health care providers—perceive PCE: a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users. We discuss potential psychological explanations for these differences.

Analysis on descriptions of precautionary statements in package inserts of medicines

Background

To prevent medical accidents, users must be informed of the cautions written in medical package inserts. To realize countermeasures by utilizing information systems, we must also implement a drug information database. However, this is not easy to develop, since the descriptions in package inserts are too complex and their information poorly structured. It is necessary to analyze package insert information and propose a data structure.

Methods

We analyzed the descriptions of ‘precautions for application’ in package inserts via text mining methods. In order to summarize statements, we applied dependency analysis to statements and visualized their relations between predicate words and other words. Furthermore, we extracted words representing timing to execute the order.

Results

We found that there are four types of statements: direct orders such as “ ” (use), causative orders such as “ ” (make someone use), direct interdictions such as “ ” (do not use), and causative interdictions such as “ ” (do not make user use). As for words representing timing, we extracted six groups: ”at the time of delivery,” “at the time of preparation,” “in use,” “after use,” and “at the time of storage.” From these results, we obtained points of consideration concerning the subjects of orders in the statements and timing of their execution.

Conclusion

From the obtained knowledge, we can define the information structure used to describe the precautionary statement. It should contain information such as the actions described in the statement, the flag to express an order or interdiction, the subject to be ordered, and the timing.