Usability of the evidence-based Japanese integrative medicine (eJIM) information site: analysis with focus group discussion and internet survey on the general population

Yoshiharu Motoo,Keiko Yukawa,Kazuho Hisamura,Ichiro Arai 한국한의학연구원 2018 Integrative Medicine Research Vol.7 No.3

Background: The information site for evidence-based Japanese Integrative Medicine (eJIM) was launched by the Japanese Ministry of Health, Labour and Welfare to enable patients, medical staff, and others to obtain appropriate information, but it has not been objectively evaluated by users. The present study aimed to assess the usability of the eJIM website from the viewpoint of the general population. Methods: We held a focus group discussion with 12 persons in November 2016, conducted an Internet survey of 1107 people (general population) in February 2017, and assessed their understanding of basic concepts of complementary and alternative medicine and usefulness of the contents after browsing the eJIM website. Levels of functional, communicative, and critical health literacy were also assessed. Results: Most patients had never visited the eJIM website, because basic terms such as “integrative medicine” and “evidence” were not fully understood. Most overseas information in English was difficult to understand for the general Japanese population, although approximately 50% of the information was translated into Japanese. The degree of appropriate responses depended on health literacy level. Conclusion: The usability of eJIM website was low, because the currently available information did not meet the needs of the general population. Moreover, simpler expressions and visual tools would help the general population to understand the website contents more easily. A further survey that considers cultural and quantitative perspectives is warranted.

Physician perspectives on traditional, complementary, and integrative medicine and the national evidence-based Japanese integrative medicine information website: A mixed-method study

Yoshiharu Motoo,Keiko Yukawa,Kazuho Hisamura,Ichiro Arai 한국한의학연구원 2021 Integrative Medicine Research Vol.10 No.1

Background: The evidence-based Japanese integrative medicine (eJIM) website was launched by the Japanese government in 2014 to provide information on integrative medicine to the general public and physicians. While Japanese physicians discourage the use of traditional, complementary, and integrative medicine (TCIM), there are very few reports that explore this issue. We aimed to understand the attitudes of Japanese physicians towards TCIM and evaluate the usability of the eJIM website according to physicians. Methods: We conducted a two-staged, mixed-method study with interviews and an internet-based survey. Face-to-face interviews were conducted with 12 physicians who worked for large-scale hospitals in two different areas of Japan. We assessed their understanding of TCIM and the usability of the eJIM website. Based on the interviews, the internet survey was developed and was conducted in February 2019. Results: In the interviews, 12 physicians provided their opinion on TCIM and highlighted important areas, such as increasing the resources available for patients, and ensuring more information on TCIM is available. The internet survey of 231 physicians showed that 35% of the physicians used or advised on TCIM in clinical practice. Kampo medicines (87.8%) and dietary supplements (24.7%) were common. The physicians did not use TCIM primarily because of concerns regarding its efficacy, safety, and cost. Most physicians were not aware of which TCIM their patients used. Conclusion: Physicians in Japan may not have comprehensively understood TCIM and do not actively use TCIM. The eJIM website could help physicians to gain a better understanding of TCIM if improvements are made.

Poster Session : PS 0336 ; Hematology : Hodgkin`s Lymphoma in Our Hospital

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: In Japan, ML is hematological malignancies with much number of cases. non-Hodgkin`s lymphoma(NHL) is more than 90%. There is extremely little number of patients Hodgkin`s lymphoma(HL). In Europe, the rarion between NHL and HL, is almost half and half. So we paid attention to HL and examined. Methods: We intended for patient which ML was diagnosed in our hospital from January 2003 to December, 2012. We studied and reported 38 cases about age, gender, pathological fi ndings, therapy, median survival time, 5 years survival rate. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. Results: All cases were 38 cases, gender ration was male 23 cases, female 16 cases. Median age was 45 years, pathological fi ndings, L-D 1 case, L-P 1 case, L-R 6 cases, MC 15 cases, PHL 1 case, NS 14 cases. About clinical stage, I was 5 cases, II was 15 cases, III was 10 cases, IV was 7 cases. Adult patients were 25 cases, elderly patients were 13 cases. About therapy, more than 65 years old that assumed Bleomycine skipped. ABVD therapy performed 26 cases, ABVD therapy + RTx 1 case, AVD therapy 8 cases, C-MOPP therapy 3 cases. Median survival time was 84 months, and 5 years survival rate was 79. 6%. About age, less than 60 years group did not reach median survival time, median survival time of more than 60 years group was 76 months. There is no signifi cant difference between 2 group. 29 cases were survivor and death cases were 9 cases. Cause of death, 8 cases due to original disease, 1 case another reason( because of lung cancer). Conclusions: HL is good prognosis disease in hematological malignancies, but in more than 60 years patients, there is many problem.

Poster Session : PS 0335 ; Hematology : Study of Non-Hodgkin`s Lymphoma Diffuse Large B Cell Cases That are Treated without Rituximab

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: The strategy of non-Hodgkin`s lymphoma changed dramatiscally, especially in B cell type by rituximab. The pathological fi ndings which showed immunochemical stain CD20 positive cases, rituximab is effective agent about. Some cases did not treat without rituximab several reasons. Methods: From 2003 to 2012, 9 years, we intended for 446 patients whom malignant lymphoma was diagnosed in detail by histopathology. Clinical stage is determinded by Ann Aobor classifi cation. We investigate the cases who do not treat without rituximab about the reason, age, clinical stage, therapy and prognosis. Results: All cases are 69 cases, about gender, male 42 cases, female 27 cases, median age is 71 years ranged 22-89 years. Perfomance Status at diagnosis, 0 grade 20 cases, 1grade 17 cases, 2grade 4 cases, 3grade 10 cases, 4grade 18 cases. About clinical stage by Ann Aobor classifi cation, I is 14 cases that included L-I(Lugano classifi cation), II is 5 cases, III is 9 cases, IV is 41 cases. Strategy of therapy, best supporting care 17 cases, aim to cure 42 case, palliative 11 cases. The reason without rituximab, bestsupporting care 18 cases, another standard therapy 13 cases, CD20 negative 3 cases, Hepatitis B virus active infection 6 cases, Hepatitis C virus active infection 2 cases, palliative therapy 12 cases, infusion reaction 9 cases, much tumor burden 2 cases, avoiding gastrointestinal perforation 2 cases, leukemic state 1 case. Median survival time is 12 months ranged 1-111 months. Conclusions: Rituximab is remarkably improved prognosis about non-Hodgkin`s lymphoma.

Poster Session : PS 0334 ; Hematology : Retrospective Study of the Follicular Lymphoma

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: The malignant lymphoma is the ninth place cause of death in Japan. A ratio of non-Hodgkin`s lymphoma(NHL) is overwhelmingly big in malignant lymphoma in Japan. Follicular lymphoma was rather small ratio, not only Asian area but also European area. So we reviewed and report our experience of follicular lymphoma patients. Methods: In periods from 2003 to 2012, 446 patients whom malignant lymphoma was diagnosed in our hospital, we extracted follicular lymphoma. We reviewed gender, clinical stage, chemotherapy, clinical outcome, and prognosis. Results: During studied periods, eligible data for investigation was 58 cases, including female 36, male 22, median age was 62 years. About clinical stage, I 2 cases, II 8 cases, III 14 cases, IV 34 cases, advanced stage was dominant. In treatment strategy, aim to cure standard therapy that rituximab + CHOP or rituximab + CHOP like regimen performed 51 cases, RCHOP regimen 39 cases, RCHO regimen 9 cases, RCHOP like regimen 1case, RCVP regimen3 cases, radiation therapy alone 3 cases. About median survival time dose not reach, 5 years overall survival rate is 85. 8%. Compared between up to stageIII versus IV, each group dose not reach median survival time, and there is not signifi cant difference about survival. 5 years survival rate are 83. 2%, 88. 8% respectively. Cause of death, 7 cases were death, consist of cause of death, 5 cases were due to original disease, 1 case due to heart attack, 1 case due to gastric cancer. Conclusions: The clinical outcome of follicular lymphoma improved by rituximab. But some cases do not effect chemotherapy and not reach complete remission, especially in elderly, organs disfunction are trouble about anti-cancer agent dosage, so insuffi - cient therapy performed. We must manage such cases using new strategy.

Poster Session : PS 0339 ; Hematology : Study of Multiple Neoplasms Including Hematological Malignancies and Lung Cancer

( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ),( Kazuhiko Natori ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: It is a well-known fact that the prevalence of malignancy increases year by year. In addition, other malignancies may be found in the systemic screening before treatment or after several therapy during observation. Malignant lymphoma is often the most number of patients. We reviewed the complication with lung cancer that was a poor prognosis. We look for possibility of the prognosis improvement by determining a characteristic. Methods: In 290 cases multiple cancer including hematological malignancy in our department, we examined 20 cases that including lung cancer & malignant lymphoma. Reviewed the following is gender, age, outbreak style, strategy of therapy, clinical income, and overall survival. Diagnostic criteria of multiple cancer is according to Warren&Gates. It was distinguish synchronous and metachronous that synchronous double cancer diagnosed interval of 6 months. Results: The subjects were 20 patients, median age was 70 years. Synchronous cancer was found in 5 patients and metachronous in 15 patients. Malignant lymphoma was non-Hodgkin`s lymphoma in 11 patients, Hodgkin`s lymphomain 2 patients and lymphoma- stage mycosis fungoides in 1patient. Acute myelogeneous leukemia 3 cases, myelodysplastic syndrome 3 cases. All of the patients with ML underwent chemotherapy (CTx) and 8 and 4 of them achieved completeand partial remission, respectively, while 2cases had progressive disease. In 20 cases with LC, operation (Ope) alone was conducted in 6 cases, Ope+ adjuvant therapy in 3 cases, radiation therapy (RTx) in 1case, RTx + CTx in 1case, and CTx alone in 7 cases, non therapy 2 cases. The median survival was 11 months. Conclusions: For metachronous type, there is chance to fi nd second cancer, if they observed long time. I think that we must understand he has or will have another cancer. Prognosis improvement of the advanced lung cancer is expected.

Poster Session : PS 0328 ; Hematology : Metachronous Double Cancer Included B-Cell Chronic Lymphocytic Leukemia and Pancreatic Cancer That Diagnosed After Progression of Diabetes

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Among the gastrointestinal cancers, pancreatic cancer has the poorest prognosis. It is important to diagnose patients when the pancreatic cancer is still operable, which remains the only effective procedure. The initial manifestations of pancreatic cancer include abnormal glucose tolerance and onset of diabetes. Methods: We experienced a patient with B-cell chronic lymphocytic leukemia (B-CLL) who was diagnosed with pancreatic cancer after progression of diabetes. Results: A 74-year-old man was diagnosed with B-cell chronic lymphocytic leukemia and was followed up at our outpatient department. In March 2011, he suffered from deterioration of diabetes (HgbA1c: 7. 6%) and underwent detailed examination. After examination, patient was diagnosed with Stage IV pancreatic cancer and is treated with gemcitabine monotherapy. Conclusions: The incidence of diabetes and abnormal glucose tolerance complicated with pancreatic cancer is relatively high. It has been shown that diabetes correlates positively with the risk of onset of pancreatic cancer. However, it has also been demonstrated that diabetes is the result rather than the risk factor of pancreatic cancer onset. Although abnormal glucose tolerance and diabetes onset are important as the initial manifestations of pancreatic cancer. It is necessary to diagnose patients in the early stage of pancreatic cancer, when it is still operable. In comparison with the conventional risk factors of smoking and diabetes, a family history of pancreatic cancer and various hereditary syndromes are much superior risk factors. Patients with pancreatic cancer who have at least 2 fi rst-degree relatives are considered to have familial pancreatic cancer.

Poster Session:PS 0224 ; Gastroenterology : HBV Infection Screening for Malignant Lymphoma

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Malignant lymphoma(ML) is the ninth place cause of death in Japan and chemotherapy(CTx) is fi rst choice. Side effect of CTx, rituximab, reactivation of the Hepatitis B type virous(HBV) is serious problem. We reviewed the situation of the HBV infection check of patients that was performed CTx. Methods: We intended for patient which ML was diagnosed in our hospital from January 2003 to December, 2012. The pretreatment HBV check factor is hepatitis B surface antigen(HBsAg), hepatitis B surface antibody(anti-HBs), antihepatitis B core antibody(anti-HBc). When either anti-HBs or anti-HBc is positive, we measure viral amount by HBV-DNA Taqman. In the case of HBV check is imcomplete, additional HBV check followed as much as possible. We reviewed positive rate of HBsAg, anti-HBs, anti-HBc. Also we investigated HBV reactivation rate of R+CTx. Results: All cases were 446 cases, about type of malignant lymphoma, Hodgkin`s lymphoma(HL) 39 cases, non-Hodgkin`s lymphoma(NHL) 401 cases, Adult T cell Lymphoma( ATL) 6 cases. Among 446 patients, 411 cases received CTx or CTx+radiation therapy(RTx). HBsAg was examined in all cases, anti-HBs, anti-HBc was 351 cases, 261 cases respectively. The case searched three factors before CTx was 150 cases. 30 cases were searched HBV-DNA Taqman that indicated anti-HBs and/or anti-HBc were positive. In theses cases, treatment needed situation were 5 cases. These 5 cases treated by entecavir and after 2 weeks, CTx performed. The case that already given an antiviral drug with HBsAg positive for treatment was 4 cases. 107 cases were searched anti-HBs, anti-HBc or either after CTx. 2 cases was revealed to have needed the administration of antiviral drug. HBV reactivation rate was 0%. Conclusions: Only 2 cases needed therapy for HBV infection that were revealed after CTx. We do check in all cases and try for safe chemotherapy especially rituximab including regimen.

Poster Session : PS 0327 ; Hematology : Multiple Neoplasms Including Myelodysplastic Syndrome

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: The myelodysplastic syndrome is blood stem cell disease and in many cases, have cytogenetic abnormality. And myelodysplastic syndrome has characteristic that there is defi ection in elderly. But progress of therapy and supporting therapy improved a prognosis. The possibility that a survivor had the second malignancy rise. we reviewed multiple neoplasms including the myelodysplastic syndrome and we report. Methods: In the case that hematologic malignancy was diagnosed in our hospital from 1988 to 2012, we intended for double cancer 271 cases including hematological malignancy. We reviewed 43 multiple neoplasms including the myelodysplastic syndrome. The examination factors are type of the hematological malignancy, treatment, gender, interval with the second cancer. Results: All cases are 43 cases, including male 29 cases, female 14 cases, type of multiple neoplasms, double 40 cases, triple 3 cases, kind of multiple neoplasms, metachronous 31 cases, synchronous 12 cases. The malignancies to constitute multiple neoplasms with myelodysplastic syndrome are gastric cancer 11 cases, esophangeal carcinoma 5 cases, breasr cancer 3 case, multiple myeloma 6 cases, non-Hodgkin`s lymphoma 3 cases, colon cancer 5 cases, lung cancer 4 cases, renal carcinoma 2 cases, urinary bladder carcinoma 2 cases, prostate carcinoma 1 case, thyroid cancer 1 case, pharyngeal cancer 1 case, laryngeal cancer 1 case, angiosarcoma 1 case. On the other hand, acute myelogeneous leukemia, therapy-related leukemia are11 cases, de novo myelodysplastic syndrome 32 cases. Conclusions: The survivors by the fi rst cancer therapy are paid attention to therapy- related myelodysplastic syndrome.

Poster Session : PS 0338 ; Hematology : The Multiple Neoplasms Consist of Colon Cancer and Hematological Malignancy

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Yukitoshi Toyoda ),( Akiko Shibuya ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Colon cancer accounts for number of cases, a superior of the cause of death like gastric cancer, lung cancer. Wereport aggregates the multiple neoplasms including hematological malignancy and colon cancer. Methods: In the case that hematologic malignancy was diagnosed in our hospital by 1988 from 2013, The multiple cancer including colon cancer and the hematologic malignancy was 45 cases. So we reviewed and reported. Results: All cases are 45 cases, including female 14 cases, male 31cases, synchronous type 15 cases, metechronous type 30 cases. Multiple neoplasms consist of double cancer 33 cases, triple cancer 11 cases, quadrop cancer 1case. The median interval period in double cancer is 58 months. Hematological malignancy consist of non-Hodgkin`s lymphoma 24 cases, Hodgkin`s lymphoma 1 case, myelodysplastic syndrome 6 cases, chronic myelogeneou leukemia 3 cases, multiple myeloma 5 cases, macroglobrinemia 2 cases, acute lymphoblastic leukemia 3 cases, acute myelogeneous leukemia 2 case. Chronic lymphocytic leukemia 1 case. The sites of colon cancer studied 41 cases and results were that ascending colon 7cases, transverous colon 3cases, descending colon 2cases, sigmoid colon 9cases, rectum 8 cases. In a double cancer, 12 cases were preceding colon cancer and 9 cases were preceding hematological malignancy, an interval of the colon cancer precedence cases, the median time was 83M, hematological malignancy precedence cases was 42M. Median survival time is 15M, about cause of death, 21 cases still alive and 24 cases are dead. In 24 cases, hematological malignancy 17 cases, colon cancer 7 cases. Conclusions: In the case of hematological malignancy precedence case, 4 of 9 colon cancer occurred within three years. We should take attention about incidence of other malignancies, particularly those that occur from gastrointestinal tract and serious observation about distant metastasis site, such as liver and lung.