Publications by authors named "Kenji Fujimori"

79 Publications

Insufficient persistence to pharmacotherapy in Japanese patients with osteoporosis: an analysis of the National Database of Health Insurance Claims and Specific Health Checkups in Japan.

Arch Osteoporos 2021 Sep 13;16(1):131. Epub 2021 Sep 13.

Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka Sayama City, Osaka, Japan.

In Japan, persistence and the 2-year MPR were inadequate in increasing fracture control efficacy despite a high adherence rate during the treatment period. Both factors were higher in females and those with polypharmacy but worsened with increasing age.

Purpose: Only a few large-scale studies have examined the care gap between the patients who need osteoporosis treatment and those who receive them in Japan. The aim of this study was to investigate the persistence and adherence to osteoporosis pharmacotherapy in Japan.

Methods: Continuation (persistence) rates and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, between April 2012 and March 2019.

Results: The study included 528,806 male and 3,064,410 female patients. Persistence proportions were 56.6% in the first year and 46.3% in the second year. The medication possession ratio (MPR) from start to discontinuation of treatment (MPR) was 94.5%, and 92.7% of patients had an MPR ≥ 80%. The 2-year MPR (MPR) was 61.9%, and 49.6% of patients had an MPR ≥ 80%. Both the persistence proportion and MPR were higher in females than in males, whereas MPR was higher in males. The persistence proportion and MPR were highest in the 70-79 years age group, whereas MPR improved with increasing age. The MPR and MPR were higher in the mixed-fracture and vertebral-fracture groups, respectively. The persistence proportion, MPR, and MPR were higher in patients with polypharmacy than in those without.

Conclusion: In Japan, persistence and the 2-year MPR were inadequate in increasing fracture control efficacy despite a high adherence rate during the treatment period. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those without polypharmacy.
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http://dx.doi.org/10.1007/s11657-021-00993-8DOI Listing
September 2021

Insufficient increase in bone mineral density testing rates and pharmacotherapy after hip and vertebral fracture: analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

Arch Osteoporos 2021 Sep 12;16(1):130. Epub 2021 Sep 12.

Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka Sayama city, Osaka, 589-8511, Japan.

Test and treatment rates for osteoporosis in Japan aimed at preventing secondary fragility fractures were insufficient. Those who suffered hip fractures had approximately half the rates of those who suffered vertebral fractures, with such rates being lower among those over 80 years old and males.

Purpose: The present study aimed to examine the care gap for secondary fracture prevention in Japan given the few large-scale studies regarding the matter.

Methods: Changes in bone mineral density testing (test rate) and osteoporosis pharmacotherapy administration (treatment rate) rates before and after hip and vertebral fracture registration were examined using medical insurance data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan issued from April 2012 to March 2019.

Results: The hip fracture group comprised 677,480 women and 264,003 men, the vertebral fracture group comprised 703,247 women and 251,542 men, and the mixed fracture group comprised 3614 women and 1055 men. Test rates were 14.1%, 25.3%, and 17.6% prior to fracture registration (pre-registration) and 22.3%, 43.6%, and 28.1% after fracture registration (post-registration) in the hip, vertebral, and mixed fracture groups, respectively. Moreover, pre-registration treatment rates were 21.2%, 33.5%, and 30.7%, while post-registration rates were 31.6%, 61.7%, and 46.6% in the hip, vertebral, and mixed fracture groups, respectively. All fracture groups showed a tendency for decreased post-registration test and treatment rates among those aged over 80 years old, with men having lower rates. Moreover, 184,180 (19.4% of whom received new treatment) and 707,263 (23.8% of whom received new treatment) patients with and without polypharmacy underwent treatment after registration, respectively.

Conclusion: To bridge the care gap following fractures, medical professionals should change their perception regarding osteoporosis treatment in patients with hip fractures, elderly individuals undergoing polypharmacy, and males.
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http://dx.doi.org/10.1007/s11657-021-00992-9DOI Listing
September 2021

The clinical practice of ulcerative colitis in elderly patients: An investigation using a nationwide database in Japan.

JGH Open 2021 Aug 4;5(8):842-848. Epub 2021 Apr 4.

Division of Gastroenterology Tohoku University Hospital Sendai Japan.

Background And Aim: The number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non-elderly patients with UC.

Methods: We collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non-elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments . surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in-hospital death in each group.

Results: The rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in-hospital death in elderly patients was higher than that in non-elderly patients (2.7% . 0.19%,  < 0.0001). Multivariate analysis revealed that lower body mass index, treatment at an academic hospital, smoking history, molecular targeting drug use, and treatment with systemic steroid injection affected the rate of surgery in the elderly group. Multivariate analysis also revealed that male and older age affected the rate of in-hospital death in the elderly group. Similar tendencies were also recognized in the non-elderly group.

Conclusions: The clinical practice of treating elderly patients with UC is overall not different from treating non-elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non-elderly patients, the rate of in-hospital death for elderly patients is higher.
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http://dx.doi.org/10.1002/jgh3.12541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341191PMC
August 2021

Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study.

BMC Psychiatry 2021 05 5;21(1):235. Epub 2021 May 5.

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan.

Background: Consultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.

Methods: We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.

Results: Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).

Conclusions: Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.
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http://dx.doi.org/10.1186/s12888-021-03241-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097923PMC
May 2021

Effects of polymyxin B hemoperfusion in patients with sepsis requiring continuous hemodiafiltration: Analysis of a nationwide administrative database in Japan.

Ther Apher Dial 2021 Aug 2;25(4):384-389. Epub 2021 May 2.

Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

This study investigated sepsis patients' current status with continuous hemodiafiltration (CHDF) with or without polymyxin B hemoperfusion (PMX). We identified 17 367 adult sepsis patients treated with CHDF and PMX using the Japanese diagnosis procedure combination (DPC) database from April 2016 to March 2019. More than half of the patients in this category resulted in death in the hospital, which means that patients in this group were critically ill. Among the patients who received CHDF, the 28-day survival rate of PMX-treated patients was significantly higher than that of non-treated patients, after adjusting the patient background by propensity score matching (69.5% vs. 65.4%, p < 0.0001). Furthermore, the length of hospital stay and intensive care unit stay was significantly shorter in PMX-treated patients than that of non-treated patients. These results suggest that PMX may provide benefits to patients with severe sepsis requiring CHDF.
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http://dx.doi.org/10.1111/1744-9987.13655DOI Listing
August 2021

Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment.

J Gastroenterol 2021 Jul 19;56(7):640-650. Epub 2021 Apr 19.

Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.

Background: Delayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET). We aimed to investigate the efficacy of vonoprazan, which is the novel strong antisecretory agent, to reduce the risk for delayed bleeding in comparison with proton pump inhibitors (PPIs) in UGET.

Methods: This retrospective population-based cohort study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. The primary outcome was delayed bleeding. We conducted propensity score matching to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes.

Results: We enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80), consistent with sensitivity analysis results. In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in esophageal endoscopic submucosal dissection (E-ESD) (OR, 0.71; 95% CI, 0.54-0.94) and gastroduodenal endoscopic submucosal dissection (GD-ESD) (OR, 0.70; 95% CI, 0.65-0.75), although correction for multiple testing of the outcome data removed the significance in E-ESD. These results were also consistent with sensitivity analysis results. In the five other procedures, no significant advantage was found.

Conclusions: This nationwide study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.
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http://dx.doi.org/10.1007/s00535-021-01781-4DOI Listing
July 2021

A new SOFA score calculation to improve the predictive performance for mortality in sepsis-associated disseminated intravascular coagulopathy patients.

J Crit Care 2021 Aug 22;64:108-113. Epub 2021 Mar 22.

Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address:

Purpose: The change in the sequential organ failure assessment (SOFA) score from the entry day, a delta-SOFA (SOFA), has been proposed as a better indicator for predicting mortality, and potentially as an endpoint in clinical trials. However, there are some concerns that the value of the absolute SOFA score has not been considered. The purpose of the study is to examine whether the addition of an absolute SOFA score can increase the predictive performance of SOFA.

Materials And Methods: Data obtained from 297 patients with sepsis-associated disseminated intravascular coagulopathy (DIC) in multiinstitutional post-marketing surveys were analyzed retrospectively. The SOFA (SOFA score + absolute SOFA score) and SOFA were calculated, and the performance of each indicator was analyzed in terms of predictive ability for 28-day mortality.

Results: The area under the receiver operating curve (AUC) for the mortality of SOFA on day 2, 4, 7 were significantly greater compared to those of SOFA (P <0.001, =0.002, <0.001, respectively). In addition, the accuracy [(True positive + True negative) / total number at the best cutoff points] of SOFA was better than that of SOFA.

Conclusions: SOFA is simple to calculate and provides better predictive performance compared to SOFA for predicting mortality.
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http://dx.doi.org/10.1016/j.jcrc.2021.03.008DOI Listing
August 2021

Risk factors leading to trabeculectomy surgery of glaucoma patient using Japanese nationwide administrative claims data: a retrospective non-interventional cohort study.

BMC Ophthalmol 2021 Mar 29;21(1):153. Epub 2021 Mar 29.

Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.

Background: Early recognition and management of baseline risk factors may play an important role in reducing glaucoma surgery burdens. However, no studies have investigated them using real-world data in Japan or other countries. This study aimed to clarify the risk factors leading to trabeculectomy surgery, which is the most common procedure of glaucoma surgery, of glaucoma patient using the Japanese nationwide administrative claims data associated with the diagnosis procedure combination (DPC) system.

Methods: It was a retrospective, non-interventional cohort study. Data were collected from patients who were admitted to DPC participating hospitals, nationwide acute care hospitals and were diagnosed with glaucoma between 2012 to 2018. The primary outcome was the risk factors associated with trabeculectomy surgery. The association between baseline characteristics and trabeculectomy surgery was identified using multivariable logistic regression analysis by comparing patients with and without trabeculectomy surgery. Meanwhile, the secondary outcomes included the rate of comorbidities, the rate of concomitant drug use and the treatment patterns of glaucoma eye drops at the index admission. Among patients with trabeculectomy surgery, the risk factors leading to cataract surgery were also evaluated as subgroup analysis.

Results: A total of 29,599 patients included in the analysis, 12,038 and 17,561 patients were in the glaucoma surgery and non-glaucoma surgery cohorts, respectively. The factors associated with the increase in trabeculectomy surgery were having allergies, taking concomitant drugs including cancer, depression, ischemic heart disease and peptic ulcer, being diagnosed with primary open-angle glaucoma and longer length of stay in hospital. In contrast, the factors associated with the decrease in trabeculectomy surgery were having hypertension, taking hypertension drug, age ≥ 80 and female.

Conclusions: Special focus on Japanese patients with glaucoma who have allergy-related comorbidities or take immune, nervous, circulatory or gastrointestinal system-related concomitant drugs seems to be desirable.
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http://dx.doi.org/10.1186/s12886-021-01897-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008563PMC
March 2021

Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database.

Head Neck 2021 07 2;43(7):2002-2012. Epub 2021 Mar 2.

Department of Otolaryngology Head and Neck Surgery, Kansai Medical University, Hirakata, Japan.

Backgrounds: Data on risk factors for deep neck infection including descending necrotizing mediastinitis (DNM) have been limited. Using a nationwide database, the aim was identifying the factors related to patient death and delay in recovering oral intake.

Methods: Data of 4949 patients were extracted from a Japanese inpatient database between 2012 and 2017. The main outcome was survival at discharge. In a subgroup analysis of the 4949 patients with survival, the second outcome was delay in the interval between admission and full recovery of oral intake.

Results: Only a few factors (advanced-age, ventilation) were associated with both mortality and delayed oral dietary intake by logistic regression analyses. Conversely, several factors including DNM (adjusted-odds ratio [OR] 1.41) and repeated surgery (adjusted-OR 1.70) were significantly related only to delayed oral dietary intake.

Conclusions: Although DNM was not necessarily related to mortality, patients with DNM should receive careful attention to avoid delayed oral dietary intake.
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http://dx.doi.org/10.1002/hed.26660DOI Listing
July 2021

Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan.

Blood Purif 2021 12;50(4-5):560-565. Epub 2021 Feb 12.

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan.

Introduction: Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients' blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial.

Methods: Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28.

Results: Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (p < 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (p < 0.0001), 2 days (p < 0.0001), and 6 days (p < 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose <20 mg/day but not in the noradrenaline group dose ≥20 mg/day.

Conclusion: Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.
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http://dx.doi.org/10.1159/000513213DOI Listing
February 2021

Insufficient persistence of and adherence to osteoporosis pharmacotherapy in Japan.

J Bone Miner Metab 2021 May 5;39(3):501-509. Epub 2021 Jan 5.

Department of Public Health, Faculty of Medicine, Kinki University, 377-2, Oono-Higashi, Osaka Sayama City, Osaka, 589-8511, Japan.

Introduction: Only a few large-scale studies have examined the care gap in Japan. The aim of this study was to investigate the persistence of and adherence to osteoporosis pharmacotherapy in Japan.

Materials And Methods: The rates of continuation (persistence) of and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data, issued from July 2013 to December 2018, from the medical care system for elderly individuals in Hokkaido, Japan.

Results: The study included 7918 male and 52,585 female patients. Persistence rates were 62.1% in the first year and 45.3% in the second year. There were 33,096 patients who discontinued medication; 8296 patients resumed medication during the observation period of 730 days. The median time to the discontinuation of medication for all the patients was 702 days. The 2-year medication possession ratio (MPR) was 63.8%; 30,989 patients (51.2%) had an MPR ≥ 80% and 20,788 (34.4%) had an MPR < 50%. Both the persistence and adherence were better in females than in males and worsened with increasing age. Comparisons of fracture history showed that persistence and MPR were higher in the no hip or vertebral fracture group, followed by hip fracture, vertebral fracture, and hip and vertebral fracture groups. Meanwhile, more patients in the hip fracture group had an MPR ≥ 80%.

Conclusion: Persistence of and adherence to osteoporotic pharmacotherapy are not very high in Japan. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those with a history of vertebral fracture.
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http://dx.doi.org/10.1007/s00774-020-01188-wDOI Listing
May 2021

Efficacy of urgent colonoscopy for colonic diverticular bleeding: A propensity score-matched analysis using a nationwide database in Japan.

J Gastroenterol Hepatol 2021 Jun 20;36(6):1598-1604. Epub 2020 Nov 20.

Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

Background And Aim: Although colonic diverticular bleeding (CDB) is considered to have good prognosis with conservative therapy, some cases are severe. The efficacy of urgent colonoscopy for CDB and clinical factors affecting CDB prognosis are unclear. This study aimed to evaluate the efficacy of urgent colonoscopy for CDB and identify risk factors for unfavorable events, including in-hospital death during admission, owing to CDB.

Methods: We collected CDB patients' data using the Diagnosis Procedure Combination database system. We divided eligible patients into urgent and elective colonoscopy groups using propensity score matching and compared endoscopic hemostasis and in-hospital death rates and length of hospital stay. We also conducted logistic regression analysis to identify clinical factors affecting CBD clinical events, including in-hospital death, a relatively rare CDB complication.

Results: Urgent colonoscopy reduced the in-hospital death rate (0.35% vs 0.58%, P = 0.033) and increased the endoscopic hemostasis rate (3.0% vs 1.7%, P < 0.0001) compared with elective colonoscopy. Length of hospitalization was shorter in the urgent than in the elective colonoscopy group (8 vs 9 days, P < 0.0001). Multivariate analysis also revealed that urgent colonoscopy reduced in-hospital death (odds ratio = 0.67, 95% confidence interval: 0.46-0.97, P = 0.036) and increased endoscopic hemostasis (odds ratio = 1.84, 95% confidence interval: 1.53-2.22, P <  0.0001).

Conclusion: Urgent colonoscopy for CDB may facilitate identification of the bleeding site and reduce in-hospital death. The necessity and appropriate timing of urgent colonoscopy should be considered based on patients' condition.
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http://dx.doi.org/10.1111/jgh.15316DOI Listing
June 2021

Recombinant Human Soluble Thrombomodulin Contributes to a Reduction In-Hospital Mortality of Acute Cholangitis with Disseminated Intravascular Coagulation: A Propensity Score Analyses of a Japanese Nationwide Database.

Tohoku J Exp Med 2020 09;252(1):53-61

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences.

The anti-DIC biological agent, recombinant human soluble thrombomodulin (rhTM), is being used clinically for DIC treatment in Japan. Patients with acute cholangitis associated with DIC are severe and require improved treatment. In addition, although clinical efficacy of rhTM in patients with acute cholangitis and DIC is expected, its efficacy is controversial. Thus, it is useful to evaluate rhTM in patients with acute cholangitis with DIC. This study aimed to validate the hypothesis that rhTM use improves in-hospital mortality in patients with acute cholangitis with DIC. A propensity score-matching analysis using a nationwide administrative database, the Japanese Diagnosis Procedure Combination Inpatient Database from April 2012 to March 2018, was performed. This database includes administrative claims data for all inpatients discharged from more than 1,000 participating hospitals, covering 92% of all tertiary-care emergency hospitals in Japan. Eligible patients (n = 2,865) were categorized into the rhTM (n = 1,636) or control groups (n = 1,229). Propensity score-matching created a matched cohort of 910 pairs with and without rhTM. In-hospital mortality between the groups in the unmatched analysis showed no significant difference (rhTM vs. control; 10.8% vs. 12.2%; p = 0.227). However, in-hospital mortality between the groups in the propensity score-matched analysis showed a significant difference (rhTM vs. control; 9.5% vs. 12.9%; p = 0.021). These results demonstrated that the rhTM group had significantly lower in-hospital mortality for patients with acute cholangitis with DIC. We propose that rhTM should be used for the treatment of patients with acute cholangitis with DIC.
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http://dx.doi.org/10.1620/tjem.252.53DOI Listing
September 2020

Gastric cancer deaths by age group in Japan: Outlook on preventive measures for elderly adults.

Cancer Sci 2020 Oct 18;111(10):3845-3853. Epub 2020 Aug 18.

Department of Internal Medicine, Hakodate National Hospital, Nagakute, Japan.

In February 2013, Japan became the first country in the world to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system. Now that eradication therapy is covered by NHI, its usage has increased dramatically, and gastric cancer deaths have begun to decrease. We undertook a detailed epidemiological analysis to investigate effects of expanded NHI coverage for H. pylori eradication therapy on gastric cancer deaths in specific age groups. Numbers of gastric cancer deaths were determined by referencing data from Ministry of Health, Labour and Welfare reports and "Cancer Statistics in Japan - 2018" published by the Foundation for Promotion of Cancer Research. Gastric cancer deaths across all age groups have been clearly decreasing since 2013, but deaths of people aged 80 years and older are still increasing. The number of gastric cancer deaths in people aged in their 80s was 2 times higher than in people aged in their 70s and 4 times higher than in people aged in their 60s. The number of people in their 80s who had an endoscopy was less than half that of people in their 60s and 70s. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing in Japan. However, this decrease in deaths has not extended to elderly adults aged in their 80s, which suggests that measures to prevent gastric cancer in people aged 80 years and older will be critical to achieving the mission of eliminating gastric cancer in Japan.
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http://dx.doi.org/10.1111/cas.14586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540974PMC
October 2020

Effectiveness of Hospital Discharge Support by Medical and Nursing Care Workers in Reducing Readmission Rates of Patients in Long-Term Care Wards: An Observation Study in Japan.

Tohoku J Exp Med 2020 07;251(3):225-230

Department of Health Administration and Policy, Tohoku University Graduate School of Medicine.

For increasing medical care demand by aging population, the Japanese government is shifting to home medical care for treatments that do not necessarily require hospitalization. It is therefore essential to identify factors involved in improving the quality and outcomes of home medical care. This study examined the effect of hospital discharge support in long-term care wards on readmission rates. We used medical insurance and the Long-Term Care Insurance data of patients aged ≥ 65. Participants were patients who discharged between April 2012 and March 2016 from long-term care wards that did not require 24-hour monitoring and had no specific incurable diseases. Participants were divided into two groups according to hospital discharge support, defined by medical fee incentives for discharge planning and coordination of medical and nursing services after discharge. We explored the association between hospital discharge support and risk-adjusted readmission based on patient characteristics for one year beginning the month after patient discharge. This study involved a total of 10,998 patients: 2,563 patients with hospital discharge support and 8,435 patients without relevant support. In the group with hospital discharge support, there was a significant reduction in readmission rates. When examined by patients' characteristics, this association was significant in groups with age ≥ 85, care needs levels 1 to 2 (conditions requiring partial care for daily living), dementia or fracture. Our results suggest that hospital discharge support by medical and nursing care workers is effective in reducing readmission rates. Moreover, patients' age, care needs, and underlying disease should be considered.
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http://dx.doi.org/10.1620/tjem.251.225DOI Listing
July 2020

Insufficient increase in bone mineral density testing rates and pharmacotherapy after hip fracture in Japan.

J Bone Miner Metab 2020 Jul 7;38(4):589-596. Epub 2020 Mar 7.

Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka Sayama City, Osaka, 589-8511, Japan.

Introduction: Only a few large-scale studies have examined the care gap in Japan. The present study aims to examine the care gap for secondary fracture prevention.

Materials And Methods: Changes in the rates of bone mineral density testing (test rate) and osteoporosis pharmacotherapy administration (treatment rate) before and after hip and vertebral fracture registration were examined based on medical insurance data from the medical care system for elderly individuals in Hokkaido, Japan, issued from July 2013 to December 2018.

Results: The hip fracture group comprised 18,258 women and 4162 men, whereas the vertebral fracture group comprised 34,907 women and 9958 men. Test rates were 0.2% and 1.4% prior to fracture registration (pre-registration) and 19.9% and 40.5% after fracture registration (post-registration) in the hip and vertebral fracture groups, respectively. Moreover, pre-registration treatment rates were 18.3% and 28.2% and post-registration rates were 32.7% and 61.0% in the hip and vertebral fracture groups, respectively. The vertebral fracture group had a significantly higher post-registration test and treatment rates than the hip fracture group. Moreover, the post-registration test and treatment rates in the hip fracture group tended to increase over the years. Both fracture groups showed a tendency for decreased post-registration test and treatment rates as age increased, with lower rates observed among men.

Conclusions: Test and treatment rates after hip fracture registration remain lower compared with those after vertebral fracture registration. To bridge the care gap following fractures, medical professionals need better awareness regarding osteoporosis treatment for hip fractures among elderly individuals and males.
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http://dx.doi.org/10.1007/s00774-020-01093-2DOI Listing
July 2020

Application of Large Electronic Medical Database for Detecting Undiagnosed Patients in the General Population.

Tohoku J Exp Med 2019 10;249(2):113-119

Department of Surgery, Tohoku University Graduate School of Medicine.

Clinical application of accumulated medical big data is a hot topic in medical informatics. Not only for suggesting possible diagnoses in each individual, large medical database can be possibly used for detecting undiagnosed patients in the general population. In this study, we tried to develop a computerized system of detecting overlooked undiagnosed patients with rare chronic diseases in the community population by utilizing the uniformed national medical insurance record database. A cumulative total of 489,823 hospital visits at one tertiary medical center were collected for this project. As the target disease, we selected esophagogastric junction outflow obstruction (EGJOO), including achalasia, which is known to be easily overlooked without performing a barium swallow test. Patient selection software automatically picked out 17,814 individuals with the given suspected diagnoses that could be misdiagnosed in patients with the target disease, from which the software further picked out 526 individuals who underwent upper endoscopy but did not undergo barium swallow test. Of them, the hospital medical records suggested that 39 people still suffered from prolonged symptoms lasting for more than 6 months after the first hospital visit. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO, possibly based on some undiagnosed connective tissue diseases. An automated computerized detection system with uniform big medical data would realize more efficient and less expensive screening system for undiagnosed chronic diseases in the general population based on symptoms and previously performed examinations in each individual.
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http://dx.doi.org/10.1620/tjem.249.113DOI Listing
October 2019

Risk factors for early unplanned readmission in patients with bipolar disorder: A retrospective observational study.

Gen Hosp Psychiatry 2019 May - Jun;58:51-58. Epub 2019 Mar 18.

Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School, Japan. Electronic address:

Objectives: Evidence regarding the relationships between patient, hospital, and regional factors and early unplanned readmission (short-term outcome) in patients with bipolar disorder is lacking. This study aimed to examine risk factors associated with early unplanned readmission in patients with bipolar disorder.

Method: We retrospectively analyzed adult bipolar patients (ICD-10; F31) between April 2012 and March 2014 in the Japanese Diagnosis Procedure Combination database. We examined factors affecting the 30-day unplanned readmission using multivariable logistic regression analysis.

Results: A total of 2688 patients admitted to psychiatric beds were included. Multivariate analysis showed that unchanged or exacerbation discharge outcome (adjusted odds ratio [aOR]: 1.93; 95% confidence interval [CI]: 1.06-3.51, p = 0.031), unplanned or urgent admission settings (aOR: 1.51; 95% CI: 1.00-2.26, p = 0.048), physical comorbidity (chronic pulmonary disease) (aOR: 4.74; 95% CI: 1.30-17.29, p = 0.018), presence of psychiatric acute-care beds (aOR: 1.72; 95% CI: 1.02-2.87, p = 0.040), and intermediate-level hospital psychiatric staffing (aOR: 1.82; 95% CI: 1.14-2.91, p = 0.012) were significantly associated with higher early unplanned readmission, while higher density of psychiatrists in the area (aOR: 0.50; 95% CI: 0.29-0.87, p = 0.014) was significantly associated with lower early unplanned readmission.

Conclusions: The results suggest that not only careful management of high-risk patients but also consideration of functional differentiation in psychiatric inpatient care, psychiatric resource allocation, and follow-up support for patients with bipolar disorder are needed for reducing the early unplanned readmission rate.
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http://dx.doi.org/10.1016/j.genhosppsych.2019.03.003DOI Listing
January 2020

End-of-life care for cancer patients in Japanese acute care hospitals: A nationwide retrospective administrative database survey.

Jpn J Clin Oncol 2018 Oct;48(10):877-883

Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.

Background: End-of-life (EOL) cancer care in Japanese acute care hospitals has not been well described.

Methods: We aimed to assess the aggressiveness of EOL care and examine common treatments administered to cancer patients using a health administrative database. Subjects are adult cancer patients who died at acute care hospitals between April 2011 and March 2014. Data from the Japanese Diagnosis Procedure Combination database were analysed to measure the aggressiveness of care (chemotherapy, intensive care unit [ICU] admission and cardiopulmonary resuscitation [CPR]) and describe procedures and prescriptions administered in the last 14 and 30 days of life, disaggregated by hospital case volume: high, intermediate and low volumes.

Results: Of 248,978 cancer decedents, 170,024 died in high-, 70,231 in intermediate- and 8,723 in low-volume hospitals. Aggressive treatment in the last 14 days of life included chemotherapy (9.4%, 7.3%, and 5.4%, respectively), ICU admission (3.0%, 2.0%, and 2.4%) and CPR (5.8%, 6.4%, and 8.3%). Opioids were administered to 66.0%, 59.0% and 49.4% patients, while Palliative Care Team intervention was performed for 8.5%, 2.2% and 2.0% of patients, respectively in the last 30 days. In high-volume hospitals, radiotherapy and certified outpatient chemotherapy fees were more frequent. Catecholamines and hyperalimentation were more frequently administered in low-volume hospitals.

Conclusion: This is the first study to assess EOL care among Japanese acute care hospitals. More frequent use of chemotherapy at high-volume hospitals may reflect a well-established cancer treatment system. The approach for low-volume hospitals might improve the EOL care for all cancer patients in Japan.
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http://dx.doi.org/10.1093/jjco/hyy117DOI Listing
October 2018

Effect on Helicobacter pylori eradication therapy against gastric cancer in Japan.

Helicobacter 2017 Oct 3;22(5). Epub 2017 Aug 3.

Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Background: In Japan, there have been approximately 50 000 deaths from gastric cancer annually for over 40 years with little variation. It has been reported that most gastric cancers in Japan are caused by Helicobacter pylori infection. H. pylori eradication therapy was approved for patients with chronic gastritis by the Japanese national health insurance scheme in February 2013 for patients with an endoscopic diagnosis of chronic gastritis is positive for H. pylori. We examined the effect on gastric cancer death rate 4 years after expansion of health insurance coverage.

Aim: We conducted an epidemiological study and analyzed trends in prescription for H. pylori eradication therapy. We used the electronic medical claims database from Hokkaido, Japan to evaluate the impact of expansion of national health insurance coverage for H. pylori eradication therapy on deaths from gastric cancer.

Methods: Data on deaths from gastric cancer were obtained from the Japanese Ministry of Health, Labour and Welfare and the Cancer Statistics in Japan (2015). Analysis of electronic claims records was performed using the National Database, mainly focusing on Hokkaido. Prescriptions for H. pylori eradication therapy and the number of patients treated for gastric cancer were also extracted from the Hokkaido database.

Results: Approximately 1.5 million prescriptions for H. pylori eradication therapy were written annually. Gastric cancer deaths fell each year: 48 427 in 2013, 47 903 in 2014, 46 659 in 2015, and 45 509 in 2016, showing a significant decrease after expansion of insurance coverage for H. pylori eradication therapy (P<.0001).

Conclusions: Prescriptions for H. pylori eradication therapy increased markedly after approval of the gastritis indication by the national health insurance scheme and was associated with a significant decrease in gastric cancer deaths.
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http://dx.doi.org/10.1111/hel.12415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655764PMC
October 2017

Factors affecting prolonged length of stay in psychiatric patients in Japan: A retrospective observational study.

Psychiatry Clin Neurosci 2017 Aug 10;71(8):542-553. Epub 2017 May 10.

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

Aim: Hospital length of stay (LOS) is one of the stratified measures of health-care efficiency and is commonly used to assess performance of psychiatric care. The aim of this study was to identify risk factors for prolonged LOS of psychiatric patients.

Methods: We retrospectively analyzed adult psychiatric patients (ICD-10; F00-F99) between April 2012 and March 2014 in the Japanese Diagnosis Procedure Combination database. We examined factors affecting prolonged LOS using multivariable logistic regression analysis. Subgroup analyses of the logistic regression were undertaken according to two diagnostic groups (F20-F29 and F30-F39).

Results: A total of 34 326 patients admitted to and discharged from psychiatric beds were included. Older age, lower Global Assessment of Functioning score, involuntary commitment, several psychiatric services, certain other patient factors, academic hospitals, public hospitals, and higher density of psychiatric beds were significantly associated with prolonged LOS. Hospital patient volume was significantly associated with shorter LOS. In the subgroup analyses, most of these factors were consistent although some were not associated with prolonged LOS.

Conclusion: Not only clinical factors but also institutional characteristics were associated with prolonged LOS. Our study provided useful information for improvement in psychiatric services and indicated the need to consider the division of roles between healthcare/welfare institutions and psychiatric-related resource allocation. Interventions should be considered for achieving shorter LOS for psychiatric patients.
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http://dx.doi.org/10.1111/pcn.12521DOI Listing
August 2017

The Impact of Opportunistic Infections on Clinical Outcome and Healthcare Resource Uses for Adult T Cell Leukaemia.

PLoS One 2015 14;10(8):e0135042. Epub 2015 Aug 14.

Department of Health Administration and Policy, Tohoku University, Miyagi, Japan.

We examined the impact of opportunistic infections on in-hospital mortality, hospital length of stay (LOS), and the total cost (TC) among adult T-cell leukaemia (ATL) patients. In this retrospective cohort study, we identified 3712 patients with ATL using national hospital administrative data. Analysed opportunistic infections included Aspergillus spp., Candida spp., cytomegalovirus (CMV), herpes simplex virus (HSV), pneumocystis pneumonia (PCP), tuberculosis, varicella zoster virus (VZV), Cryptococcus spp., nontuberculous mycobacteria, and Strongyloides spp. Multilevel logistic regression analysis for in-hospital mortality and a multilevel linear regression analysis for LOS and TC were employed to determine the impact of opportunistic infections on clinical outcomes and healthcare resources. We found ATL patients infected with CMV had significantly higher in-hospital mortality (adjusted odds ratio (AOR) 2.29 [1.50-3.49] p < 0.001), longer LOS (coefficient (B): 0.13 [0.06-0.20] p < 0.001) and higher TC (B: 0.25 [0.17-0.32] p < 0.001) than those without CMV. Those with CAN and PCP were associated with a lower in-hospital mortality rate (AOR 0.72 [0.53-0.98] p = 0.035 and 0.54[0.41-0.73] p < 0.001, respectively) than their infections. VZV was associated with longer LOS (B: 0.13 [0.06-0.19] p < 0.001), while aspergillosis, HSV, or VZV infections were associated with higher TC (B: 0.16 [0.07-0.24] p < 0.001, 0.12 [0.02-0.23] p = 0.025, and 0.17 [0.10-0.24] p < 0.001, respectively). Our findings reveal that CMV infection is a major determinant of poor prognosis in patients affected by ATL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135042PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537272PMC
May 2016

Quantification of the effect of chemotherapy and steroids on risk of Pneumocystis jiroveci among hospitalized patients with adult T-cell leukaemia.

Br J Haematol 2015 Feb 30;168(4):501-6. Epub 2014 Sep 30.

Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka, Japan.

This study aimed to quantify the risks of Pneumocystis pneumonia (PCP) among adult T-cell leukaemia (ATL) patients without prophylaxis. We used hospital administrative data collected nationwide in Japan over 4 years. The research design was a retrospective cohort study. Subjects were 4369 patients diagnosed with ATL aged 18 years or older. The subjects were categorized into four treatment groups: no agent, chemotherapy, chemotherapy + steroids and steroids. We described the risks of PCP among ATL patients without prophylaxis. Risks of PCP were 3·2% for the no agent group, 9·7% for the chemotherapy group, 10·0% for the chemotherapy + steroids group and 16·6% for the steroids group. Logistic regression analyses showed that the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risk of PCP than did the no agent group [adjusted odds ratio (AOR) 3·30 (1·55-7·02), P = 0·002 for the chemotherapy group; AOR 3·35 (2·18-5·17), P < 0·001 for the chemotherapy + steroids group; AOR 6·12 (3·99-9·38), P < 0·001 for the steroids group]. In conclusion, the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risks of PCP. Prophylaxis for PCP among ATL patients being treated with chemotherapy, chemotherapy + steroids and steroids is highly recommended.
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http://dx.doi.org/10.1111/bjh.13154DOI Listing
February 2015

Regional differences in performance of bone marrow transplantation, care-resource use and outcome for adult T-cell leukaemia in Japan.

BMC Health Serv Res 2014 Aug 8;14:337. Epub 2014 Aug 8.

Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

Background: Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians' experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan.

Methods: This was a cross-sectional study using a Japanese hospital administrative database in 2010, with a diagnostic-procedure combination/per diem payment system. We examined the association between BMT performance, resource use, outcomes and region.

Results: We analysed data for 712 subjects of whom 60.5% were Kyushu/Okinawa residents. Significantly more patients with ATL underwent BMT in Kanto (p = 0.018) and Kansai (p < 0.001) regions compared with the Kyushu/Okinawa regions. The lengths of hospital stay were longer in Kanto (p = 0.002) and Kansai (p = 0.006) regions than in the Kyushu/Okinawa region. Total health-care costs were higher in Kanto (p = 0.001) and Kansai (p = 0.005) regions than the Kyushu/Okinawa region. The risks of in hospital mortality were not significantly different between regions.

Conclusions: There were significant regional differences in BMT performance and resource use within Japan. ATL prevalence was not related to the performance of BMTs, resource use or outcomes. Factors related to regional socioeconomics might affect the performance of BMTs and care resource use within Japan.
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http://dx.doi.org/10.1186/1472-6963-14-337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127524PMC
August 2014

Body mass index influences the outcome of acute pancreatitis: an analysis based on the Japanese administrative database.

Pancreas 2014 Aug;43(6):863-6

From the *Third Department of Internal Medicine, and †Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; ‡Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo; §Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo; ∥Division of Medical Management, Hokkaido University Hospital, Sapporo; and ¶Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

Objective: This study aimed to investigate the relationship between body mass index (BMI) and risk of death in patients with acute pancreatitis (AP) using a Japanese national administrative database.

Methods: We analyzed a total of 6002 patients with AP. We collected patient information, including sex, age, BMI, severity of AP based on the Japan Pancreas Society scoring system, and prognosis. We classified BMI into 5 categories (underweight [BMI, <18.5], normal range [18.5-24.9], preobese [25-29.9], obese class I [30-34.9], and obese class II/III [>35]) and investigated the relationship between each category and risk of death in AP.

Results: There was a good correlation between the Japanese AP severity score and in-hospital mortality. Overall mortality of severe pancreatitis was 7.0% (n = 2245). Mortality in each BMI category was as follows: underweight, 6.4%; normal range, 3.6%; preobese, 2.4%; obese class I, 3.2%; and obese class II/III, 5.7%. Underweight and obese class II/III patients had significantly higher relative risk (RR) of death in AP compared with preobese patients after adjusting for sex, age, and severity of AP (RR, 2.7; 95% confidence interval, 1.6-4.5; and RR, 6.4; 95% confidence interval, 1.9-20.9, respectively).

Conclusions: Underweight or overweight was the independent risk factor for mortality in AP.
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http://dx.doi.org/10.1097/MPA.0000000000000137DOI Listing
August 2014

Association of early post-procedure hemodynamic management with the outcomes of subarachnoid hemorrhage patients.

J Neurol 2013 Mar 25;260(3):820-31. Epub 2012 Oct 25.

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Post-procedure hemodynamic management for aneurysmal subarachnoid hemorrhage is controversial because of the paucity of studied patients. Using a Japanese administrative database, we tested whether increased albumin, catecholamine, and volumes of fluid administered between the procedure and the 4th post-procedure day would be associated with outcomes of mortality, consciousness deterioration at discharge and re-intubation between the 5th and 14th post-procedure days. Across 550 hospitals, 5,400 patients were identified who received clipping, wrapping and endovascular coiling within 48 h after admission in 2010. Patient characteristics and the administration of albumin, catecholamine, and volume of fluid normalized by body weight were analyzed among the groups and categorized according to the presence of albumin and catecholamine administered between the procedure and the 4th post-procedure day. The association of early hemodynamic management with outcomes was measured using logistic regression models, through controlling for the preference of early administration of albumin and catecholamine. For the patients, 9.3 % received albumin only, 14.4 % catecholamine only, and 4.9 % both between the procedure and the 4th post-procedure day, while 16.5 % received albumin or catecholamine on other days. Variation in albumin and catecholamine administration was observed. Higher normalized fluid volume, commenced before the 4th post-procedure day, was associated with increased mortality and re-intubation (although with decreased complications), and vice versa between the 4th and 14th post-procedure days. Catecholamine administration was associated with worsened outcomes. Hypervolemic and hypertensive therapies commenced before the 4th post-procedure day require further research to determine whether their associations with outcomes in this administrative data base are causal or not.
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http://dx.doi.org/10.1007/s00415-012-6710-4DOI Listing
March 2013

A community-based comparison of trauma patient outcomes between D- and L-lactate fluids.

Am J Emerg Med 2013 Jan 20;31(1):206-14. Epub 2012 Sep 20.

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.

Purpose: Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, D- and L-lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d-lactate on vital organs. Using an administrative database, we examined whether D- or L-lactate volume was associated with mortality in patients with trauma.

Basic Procedures: The Trauma and Injury Severity Score could be calculated in 24,616 of 528,219 patients admitted in 2006 to 2009. Demographic characteristics, the use of blood products, mechanical ventilation, and mortality were compared among the following 3 groups of patients administered Ringer's lactate: group 1, fluids other than Ringer's lactate; group 2, fluids including Ringer's DL-lactate; and group 3, no D-lactate. The mean volume (in millimoles per day) of D- and L-lactate administered was calculated. Multivariate analyses were used to measure the impact of lactate volume on mortality, and mechanical ventilation started more than 48 hours after admission.

Main Findings: Groups 2 and 3 consisted of 2,827 (11.5%) patients (88 hospitals) and 12,036 (48.9%) patients (145 hospitals), respectively. The use of mechanical ventilation best explained the variation in mortality. Greater d-lactate volume, but not fluid management category or L-lactate volume, was associated with mortality. L-Lactate decreased and D-lactate increased the use of mechanical ventilation more than 48 hours after admission.

Conclusions: Because early administration of D-lactate was associated with mortality and ventilation, physicians and policy makers should recognize the advantages of L-lactate and encourage research on the quality of d- and l-lactate in case mixes beyond trauma.
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http://dx.doi.org/10.1016/j.ajem.2012.07.013DOI Listing
January 2013

Association between hospital volume and outcomes of elderly and non-elderly patients with acute biliary diseases: a national administrative database analysis.

Geriatr Gerontol Int 2013 Jul 18;13(3):731-40. Epub 2012 Sep 18.

Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.

Aim: This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non-elderly patients with acute biliary diseases using data from a national administrative database.

Methods: Overall, 26720 elderly and 33774 non-elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low-volume, medium-volume and high-volume. We compared the risk-adjusted length of stay (LOS) and in-hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases.

Results: Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non-elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in-hospital mortality in elderly patients. The odds ratio for high-volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533-0.847, P=0.001) and 0.715 in those with invasive treatments (95% C, 0.566-0.904, P=0.005). However, no significant differences for in-hospital mortality were seen in non-elderly patients with and without invasive treatments.

Conclusion:   This study has highlighted that higher volume hospitals significantly reduced LOS and in-hospital mortality for elderly patients with acute biliary diseases, but not non-elderly patients. The current results are of value for elderly healthcare policy decision-making, and highlight the need for further studies into the quality of care for elderly patients.
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http://dx.doi.org/10.1111/j.1447-0594.2012.00938.xDOI Listing
July 2013

Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy.

Case Rep Gastroenterol 2012 May 26;6(2):400-9. Epub 2012 Jun 26.

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka.

Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.
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http://dx.doi.org/10.1159/000339715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398071PMC
May 2012

Contribution of the administrative database and the geographical information system to disaster preparedness and regionalization.

Am J Disaster Med 2012 ;7(2):95-103

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Objective: Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based approach to disaster preparedness. Using the Japanese administrative database and the geographical information system (GIS), the interruption of hospital-based mechanical ventilation administration by a hypothetical disaster in three areas of the southeastern mainland (Tokai, Tonankai, and Nankai) was simulated and the repercussions on ventilator care in the prefectures adjacent to the damaged prefectures was estimated.

Design, Setting, And Patients: Using the database of 2010 including 3,181,847 hospitalized patients among 952 hospitals, the maximum daily ventilator capacity in each hospital was calculated and the number of patients who were administered ventilation on October xx was counted.

Interventions: Using GIS and patient zip code, the straight-line distances among the damaged hospitals, the hospitals in prefectures nearest to damaged prefectures, and ventilated patients' zip codes were measured. The authors simulated that ventilated patients were transferred to the closest hospitals outside damaged prefectures.

Outcomes: The increase in the ventilator operating rates in three areas was aggregated.

Results: One hundred twenty-four and 236 patients were administered ventilation in the damaged hospitals and in the closest hospitals outside the damaged prefectures of Tokai, 92 and 561 of Tonankai, and 35 and 85 of Nankai, respectively. The increases in the ventilator operating rates among prefectures ranged from 1.04 to 26.33-fold in Tokai; 1.03 to 1.74-fold in Tonankai, and 1.00 to 2.67-fold in Nankai.

Conclusion: Administrative databases and GIS can contribute to evidenced-based disaster preparedness and the determination of appropriate receiving hospitals with available medical resources.
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http://dx.doi.org/10.5055/ajdm.2012.0085DOI Listing
September 2012
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