九州大学 研究者情報
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後 信(うしろ しん) データ更新日:2020.07.23

教授 /  九州大学病院 医療安全管理部


原著論文
1. 後 信, 患者安全の基本と国際潮流, 日本頭頚部外科学会雑誌, 30, 1, 第30巻1号掲載予定, 2020.08, 医療の質を高めることには益々関心が高まっている。その中でも、医療安全(患者安全)を確保する取り組みは、その中心的な位置を占める。診療業務の中に次々と医療安全の取り組みが導入されてきた中で、それらが医療の質や安全の確保の全体的な枠組みの中でどのような位置を占めるのか解説する。特にインシデント報告について述べたい。演者は日本医療機能評価機構やISQua(国際医療の質学会)における活動を通じて、医療の質・安全が我が国における重要な課題となっているだけでなく、グローバルイシューとなっていることを感じてきた。このような医療の質・安全に関する国際潮流についても併せて解説する。.
2. Ushiro S, Suzuki H, Ueda S., Japan Obstetric Compensation System for Cerebral Palsy: Strategic system of data aggregation, investigation, amelioration and no-fault compensation., J Obstet Gynaecol Res., 10.1111/jog.13906. , 45, 3, 493-513, 2019.03, The Japan Obstetric Compensation System for Cerebral Palsy (JOCS-CP), which investigates, develops preventive mechanisms and awards monetary compensation, to cases of cerebral palsy was urgently introduced in 2009 in response to growing concern about Japan's deteriorating perinatal care and low birthrate. Under the political leadership, the Japan Council for Quality Health Care launched the JOCS-CP with support of various stakeholders. The JOCS-CP features of no-fault-based compensation which was discussed decades ago in the Japan Medical Association aiming at financial aid to patient and family and early settlement of dispute. As of 2017, 2233 petitions had been approved by the Review Committee for compensation. All the approved cases were consecutively put on analysis in the Investigation Committee which has compiled more than 1000 Investigative Reports. The reports were delivered not only to the childbirth facility but to the guardians/families. Survey revealed that most of childbirth facility and the guardians/families responded in favor of the reports. With regard to amelioration of profound cerebral palsy, the Prevention Report has been published on annual basis through analysis of all the Investigative Reports. The Prevention Reports and other educational materials were produced and distributed not only among medical professionals but among pregnant women. It is notable that the number of lawsuit filing related to obstetrics demonstrated rapid decrease compared to that of other medical specialties. The JOCS-CP could be described as a social experiment. It was overhauled in 2015 but deserves further discussion on reform for evolving into better system..
3. SHIN USHIRO, Analysis of antenatal-onset cerebral palsy secondary to transient ischemia in utero using a national database in Japan

, The Journal of Obstetrics and Gynaecology Research, 10.1111/jog.13046, 2016.06.
4. SHIN USHIRO, COMPENSATING CEREBRAL PALSY CASES: PROBLEMS IN COURT LITIGATION AND THE NO-FAULT ALTERNATIVE, World Association for Medical Law, 34, 2, 335-356, 2015.06, Children having cerebral palsy will incur life-long disabilities, which require high costs of medical and nursing care. This imposes a tremendous burden on the families of the affected children, whether financially or emotionally. It is understandable for the affected families to initiate court litigation in order to alleviate the financial burden and at the same time to overcome the emotional pain associated with the permanent and lifetime implications which cerebral palsy entails. However, suing for such injuries in court and identification of medical malpractice is not an easy task for the families.
Further, court litigation tends to be tedious, lengthy and unpleasant. The hazards of litigation have prompted several countries to find an available alternative to court litigation, such as the implementation of a no-fault compensation system, to settle these types of claims. Thus, it is much applauded that the Japan Obstetric Compensation
System for Cerebral Palsy was established in January 2009, with the aim of helping children with such disabilities to improve their quality of life and to provide monetary compensation in order to lessen the economic burden on the family. The system features two vital pillars; that is, compensation and causal analysis prevention. The system aims at improving the quality of maternity care and analyzing the causes of accidents in order to prevent similar cases from happening in the future. Overall, the system clearly depicts social solidarity in encouraging collective responsibility for the mishaps suffered by the community..
5. 後  信, 厚生労働省の糖尿病対策ム健康日本21を中心にー, 日本臨床, 60巻 増刊号 10「新時代の糖尿病学(4)」、10:599-607, 2002.01.
6. Ushiro, S., Ono, M., Kawahara, N., Nakayama, J., Fujiwara, T., Komatsu, Y., Sugimachi, K., and Kuwano, M., New Nortriterpenoid Isolated from Anti-rheumatoid arthritic Plant, Tripterygium wilfordii, Modulates Tumor Growth and Neovascularization., Int. J. Cancer, 72(4):657-63, 1997.01.
7. Ushiro S., Mizoguchi K., Yoshida S., Jimi S., Fujiwara T., Yoshida M., Wei E. T., Kitabgi P., Amagaya S., Ono M., and Kuwano M., Stimulation of cell-surface urokinase-type plasminogen activator activity and cell migration in vascular endothelial cells by a novel hexapeptide analogue of neurotensin., Febs Letters, 418: 341-345, 1997.01.
8. Ushiro S., Ono, M., Izumi, H., Kohno, K., Taniguchi, N., Higashiyama, S. and Kuwano, M., Heparin-binding epidermal growth factor-like growth factor: p91 activation, induction of plasminogen activator / plasminogen activator inhibitor, and tubular morphogenesis in human microvascular endothelial cells., Jpn. J. Cancer Res., 87: 68-77, 1996.01.

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