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Naoto Shimetani

Publications and source records attributed to Naoto Shimetani.

15 recordsLinked to original sources
PubMed2006

[The current status of home medical treatment and its development in the future].

In this aging society, life-style diseases, chronic diseases, and disorders related to aging comprise a considerable share of the diseases treated medically. The importance of home treatment has consequently increased. Compared to patients treated in the hospital, those treated at home usually cannot receive sufficient treatment at present, and may impose a burden of care on family members. However, the cost of treatment at home including medical expenses is generally smaller than that in the hospital. In addition, treatment at home has the advantage that patients can be treated and cared for without reservation by their family members in the dwelling where they have used to living their lives. In Japan, home treatment has been performed by general practitioners making home visits. In response to the increased and diversified needs of community residents, new types of home treatment have also been explored recently, and even clinics specialized in home treatment have been opened. Not only medical doctors but also various medical workers, such as nurses, pharmacists, and physical therapists participate in home treatment at present, and medical instruments and methods of telecommunication have been developed. These circumstances are expected to improve the quality of medical treatment at home. In particular, recent advances in techniques and deregulation have exceeded previous expectations as exemplified by the increased number of downsized mobile and portable medical instruments and by the development of devices that allow diagnostic imaging to be performed at home.

Forecasting↗
PubMed2006

[Controversies in the determination of serum albumin concentration in chronic liver diseases].

OBJECTIVE: It is known that there is quantitative alteration in serum albumin in the patients with chronic liver diseases. To clarity the quantitative alteration of serum albumin, serum albumin levels were measured by the Bromcresol green (BCG) method, the modified Bromcresol purple (BCP) method and immunoassay. METHODS: We enrolled 313 patients with chronic hepatitis, 74 cirrhotic patients and 36 healthy subjects. Serum albumin levels were measured by immunoassay, the BCG method and the modified BCP methods. RESULTS: The measurement of immunoassay showed a significant correlation in the measurement of the modified BCP method in the patients with chronic liver diseases. With the progress of chronic liver diseases, the serum albumin levels by the BCG method and electrophoresis were higher than the levels by the modified BCP method. In other hands, it was 0.07 g/dl higher level in chronic hepatitis and 0.18 g/dl higher in liver cirrhosis. And the serum albumin levels by the BCG method and electrophoresis were higher than the levels by the new BCP method in the patients with leg edema and ascites. In the malnourished patients Subjective global assessment (SGA-B), the serum albumin levels by the BCG method and electrophoresis were higher than the levels by the modified BCP method. CONCLUSIONS: Serum albumin levels were different by the method for measurements. The clinical implications of quantitative changes in albumin should be investigated in consideration of the microheterogeneity of albumin. The modified BCP method is superior method to evaluate the serum albumin levels.

Aged↗
PubMed2005

[Clinical evaluation of ECG at the onset subjective symptoms using real-time analysis electrocardiograph (event recorder)].

Examination of patient complaining of palpitation, chest pain and chest discomfort is usually performed by 12-lead electrocardiograph. However, the recording time is short and there are few opportunities to capture an ECG demonstrating conditions during subjective symptoms. To investigate the cause, we need to obtain an ECG during subjective symptoms. Thus, we frequently use a Holter ECG, which can be recorded for 24 hours. However, some patients have a low frequency of subjective symptoms, which may not appear during a 24-hour examination. We used a real-time electrocardiograph (Event Recorder CG-6106 made by Card Guard Scientific Survival Limited) as a monitor during subjective symptoms. Thereafter, ECG findings at the onset of subjective symptoms could be analyzed in 30 patients who did not have a clear cardiac disease. In this examination, arrhythmia was recorded in 25 of 30 cases. Although in these cases ECG during subjective symptoms could not be captured even when Holter examination was performed several times ECG during subjective symptoms was captured using an Event Recorder. This method using an Event Recorder is simple and convenient, moreover, is considered very useful for investigation of subjective symptoms. In the future, the use of an Event Recorder for heart-health-care in the daily life of healthy people and/or cardiac disease patient is highly anticipated.

Adult↗
PubMed2005

[The assessment of arteriolosclerosis by serum lipids data, and carotid ultrasonography and pulse wave velocity, and its evaluation as a tool for preventive medicine: II. Carotid ultrasonography and pulse wave velocity for hyperlipemia and diabetes mellitus].

We studied the test results of carotid ultrasonography and pulse wave velocity against a sample of hyperlipemia and diabetes mellitus. Sixty four hyperlipemia samples (HL), 85 diabetes mellitus samples (DS), and 27 complicated samples (CS) were compared with 56 healthy samples (HS). Hyperlipemia samples were selected from cholesterol under 300 mg/dl, and neutral fat under 300 mg/dl. Diabetes mellitus samples were selected from fasting plasma glucose (FBS) under 200 mg/dl. Samples from severe conditions with various disease were excluded. Ratio over 1.1 mm intima-media thickness (IMT) was 0% in HS, 48% in HL, 40% in DS and 33% in CS. PWV value was max 1896cm/s in CS. There was no significant correlation within IMT, serum lipid(Total Cholesterol, Neutral Fat, HDL-Cholesterol, LDL-Cholesterol) and FBS. For early treatment or accurate diagnosis of arteriosclerosis in hyperlipemia or diabetes mellitus patients, who are at high risk of developing arteriosclerosis, to vital function tests (carotid ultrasonography and pulse wave velocity) should be performed, in addition to normal blood tests.

Adult↗
PubMed2003

[Communication of useful information from laboratory physicians to clinical physicians].

In recent years increasing importance has been placed on the role of hospital clinical research, such as the promotion of intra-laboratory human, material and informational resources, previously restricted to the laboratory, to the whole hospital system, and the appropriate usage of laboratory findings via common consultation systems, or specialized informational consultants in the clinical laboratory department. The volume of clinical laboratory information, which plays an important role in the decision-making process of routine clinical practices, is enormous for each individual hospital, and appropriate use of this information has a major influence on institutional clinical practice efficiency. In response to the need for the communication of useful laboratory information to clinical physicians, departments of laboratory research consultants have been organized in individual hospitals as a way forward. In the near future, laboratory physicians will play a leading role in the communication of research information from the viewpoint of EBLM (evidence-based laboratory medicine). From the work of these laboratory research consultants, it becomes possible to obtain relevant EBLM-related information, such as frequently asked questions and opinions, from their users. By replying to these questions and opinions appropriately, laboratory research consultants can provide information that is both advantageous and useful, and which meets the needs of the clinical physician side. Effective communication of useful laboratory research information should not be restricted to either the laboratory physicians or the technicians; it is a job that needs the cooperation and teamwork of both sets of people. Also, they should always keep in mind that communication by itself is not sufficient; they should not assume the useful evaluation of information by the users, but rather ensure that they are presented with information that precisely meets their needs.

Clinical Laboratory Information Systems↗
PubMed2003

[Status quo of tumor markers and important points in medical practice].

Tumor markers is a term describing substances produced by tumor cells or in response to tumor cells, and new tumor markers have been found with the progress of examination modalities. Not only Bence-Jones protein and M protein by immunoelectrophoresis, and AFP and CEA by immunochemical analysis, but also hormones, enzymes, and embryonal cancer related substances have been employed for a long time. Recently, a variety of new tumor marker tests have been developed, such as those using monoclonal antibodies that recognize carbohydrate antigens, bone metabolism markers to evaluate bone metastasis of cancer by the type I collagen metabolites, and gene markers to examine oncogenes and tumor suppressor genes by gene cloning and the PCR method. Early detection and diagnosis are keys to countermeasures against cancer, and tumor markers are regarded as a powerful tool for early detection of cancer. However, any tumor marker can be positive without cancer. In addition, problems arise because tumor markers often show negative for early cancer or even advanced cancer. As a result, no ideal tumor marker has been found. Tests of tumor markers aim to screen high-risk patients, differentiate tumor types, monitor therapeutic efficacy, and detect recurrences early. It is important to raise the diagnostic efficiency by avoiding the selection of similar markers in antigenicity, and instead combining two to three markers with little association.

Biomarkers, Tumor↗
PubMed2002

[Laboratory information and consultation service with a ordering system].

We built a laboratory information system that does not require resident medical technologists or medical doctors. The laboratory information system used the following two methods. In the first method, the receiver of questions/complaints/consultations about laboratory tests used e-mail carried by an ordering system. In the second method, the Web utilized a laboratory test information retrieval system by intranet. As for e-mail inquirers, doctors made up 76.7%(46/60), and other types of job were office workers 11.7% (7/60), nurses 8.3%(5/60), and pharmacists 3.3%(2/60). The question(consultation) contents were test methods 30.0%, demands/complaints 28.3% for ordering, specimen saving requests 13.3%, consultations 11.7%, and other 16.7%. Since introducing this system, compared to previously telephone inquiries have by about 60% decreased, and basic questions such as reference intervals or containers have decreased even more. The system operates 24 hours a day and dose not increase the current workload, thus allowing the accumulation of a laboratory information system.

Clinical Laboratory Information Systems↗
PubMed2002

[Laboratory tests for infectious diseases and medical reimbursement].

Emerging and reemerging infectious diseases, drug-resistant bacteria and nosocomial infection are becoming increasingly serious social problems. To control infectious diseases, it is important to develop effective therapies and to achieve complete prevention of pathogen transmission. For these purposes, rapid detection of pathogenic microorganisms is essential. Recent development and technical innovation in laboratory tests and diagnosis for infectious diseases are remarkable. New techniques such as antigen detection and genetic diagnosis, neither of which require conventional culture, have been intensively developed and introduced into clinical practice. These methods are now widely accepted as effective diagnostic tools because of their high specificity, high sensitivity and rapidity. In this article, we describe the burden of medical expenses under the law on novel infectious diseases and medical reimbursement for diagnostic tests for these diseases.

Clinical Laboratory Techniques↗
PubMed2002

[Hematologic and hemostatic tests availability in view of remuneration for medical services].

Hematologic and hemostatic tests are important and indispensable for diagnosing any kind of hematologic disease. Recent advances in hematologic tests are seen in automation of the blood cell counts and morphological analyses that are required for diagnosing hematologic diseases, and in the accumulation and availability of genetic and chromosomal examinations related to their diagnosis. Although hemostatic tests used to be mainly aimed at checking bleeding tendency, they are now being directed toward diagnosing thrombotic tendency. Medical expenses have hardly been increased in past revisions of reimbursement schedules for medical services, which has driven hospital management into an even tighter corner. In the field of laboratory examination, test fees were heavily slashed and calculated on an all-inclusive basis, forcing budgetary restrictions on the management of test laboratories. I discuss the medical reimbursement for hematologic and hemostatic tests, focusing on the fiscal 2002 revision of the medical service fee schedule implemented in April.

Blood Coagulation Tests↗
PubMed2002

[The current method of handling of test samples and medical reimbursement for POCT in Japan].

Point of care testing(POCT) is defined as clinical testing done at or near the site of patient treatment and care in the medical field, and includes all clinical test other than those performed at hospital laboratories and outside testing centers. Home testing is also a form of POCT relating to residential medical care. The ratio of clinical tests based on POCT has not tended to increase as rapidly in Japan, although such tests are greatly increasing in the US while clinical tests performed at hospital laboratories are decreasing. POCT products are generally applied to direct analysis of test samples obtained from patients. Since storage, transportation or pretreatment after sampling is not necessary in POCT, test data can be obtained in real time. Therefore, it is important to complete testing immediately after obtaining samples without transporting or storing them, when handling POCT samples. Consideration of POCT as a part of health care services covered by health insurance is the same as in the case of conventional testing. Recent technological innovation has provided a wide variety of POCT products that do not require medical equipment or reagents. Further development of novel, innovative POCT procedures in the near future is promising.

Autoanalysis↗