Publications by authors named "Shosuke Ohtera"

12 Publications

  • Page 1 of 1

Maternal near-miss attributable to haemorrhagic stroke in patients with hypertensive disorders of pregnancy in Japan: A national cohort study.

Pregnancy Hypertens 2021 Aug 23;25:240-243. Epub 2021 Jul 23.

Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan. Electronic address:

Objectives: To investigate the epidemiologic and clinical characteristics of maternal near-misses attributable to haemorrhagic stroke (HS) occurring in patients with hypertensive disorders of pregnancy (HDP), with a focus on severe neurological morbidity.

Methods: A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2010 to 2017. The subjects were all insured women with a diagnosis of both HDP and HS. Severe neurological morbidity requiring rehabilitation, types of HDP, types of HS, and magnesium sulphate use were tabulated.

Results: The number of women with HDP who were diagnosed with HS was 3.4 per 100,000 deliveries between 2010 and 2017. Forty percent of HDP-related HS cases had neurological morbidities requiring rehabilitation (1.4 per 100,000 deliveries), and 4.4% were in a persistent vegetative state after HS. Of the HDP cases who developed HS, 69.2% were severe HDP, of which 55.6% were without eclampsia. The most common type of HS was intracerebral haemorrhage (2.5 per 100,000 deliveries), followed by subarachnoid haemorrhage due to cerebral aneurysm (1.2 per 100,000 deliveries). The frequency of magnesium sulphate use increased in all patients with HDP-related HS in the second half of the study period (2014-2017) compared with the first half (2010-2013) (p < 0.0001). This was more evident in cases of HDP-related HS with eclampsia (31.9% to 83.8%) compared to those without eclampsia (25.0% to 42.9%).

Conclusion: Of the maternal near-miss cases due to HDP-related HS, 40.0% were rehabilitated and 69.2% were HDP without either eclampsia or severe hypertension.
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August 2021

Incidence of central serous chorioretinopathy (2011-2018): a nationwide population-based cohort study of Japan.

Br J Ophthalmol 2021 Jul 14. Epub 2021 Jul 14.

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.

Aims: The aim of this study was to elucidate the epidemiological background of central serous chorioretinopathy (CSC), including its incidence and treatment pattern.

Methods: This was a population-based longitudinal cohort study using a nationwide health insurance claims database of the Japan Ministry of Health, Labour and Welfare (MHLW). As Japan employs universal health coverage, the database covers more than 95% of claims issued in Japan. We accessed all data stored in the database with permission from the MHLW. We traced all individuals aged 30 years or older and identified individuals with new onset of CSC between January 2011 and December 2018. CSC cases were categorised by age and sex for each year, and incidence rate was calculated. We also identified major treatments for CSC to elucidate the initial treatment pattern.

Results: During the 8-year period, 247 930 incidences of CSC were identified, among which 75.9% were men. The crude incidence rate (per 100 000 person-years) in the general population aged 30 years or older was 34.0 (95% CI 33.9 to 34.2), in men was 54.2 (95% CI 53.9 to 54.4) and in women was 15.7 (95% CI 15.5 to 15.8). The mean age of onset was lower in men than in women (50.5±12.5 years vs 54.7±13.5 years). Most of the patients with newly diagnosed CSC (86.8%) did not receive major treatment.

Conclusions: The current study provides the nationwide population-based evidence to clarify the detailed epidemiology of CSC. These results could help to understand the pathogenesis and mechanisms of CSC in the future.
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July 2021

Decreased Administration of Life-Sustaining Treatment just before Death among Older Inpatients in Japan: A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative Sample.

Int J Environ Res Public Health 2021 03 18;18(6). Epub 2021 Mar 18.

Department of Health Informatics, Kyoto University School of Medicine and Public Health, Kyoto 606-8501, Japan.

The administration of intensive end-of-life care just before death in older patients has become a major policy concern, as it increases medical costs; however, care intensity does not necessarily indicate quality. This study aimed to describe the temporal trends in the administration of life-sustaining treatments (LSTs) and intensive care unit (ICU) admissions just before death in older inpatients in Japan. We utilized the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Inpatients who were aged ≥65 years and died in October of 2012, 2013, or 2014 were analyzed. The numbers of decedents in 2012, 2013, and 2014 were 3362, 3473, and 3516, respectively. The frequencies of receiving cardiopulmonary resuscitation (CPR) (11.0% to 8.3%), mechanical ventilation (MV) (13.1% to 9.8%), central venous catheter (CVC) insertion (10.6% to 7.8%), and ICU admission (9.1% to 7.8%), declined between 2012 and 2014. After adjusting for age, sex, and type of ward, the declining trends persisted for CPR, MV, and CVC insertion relative to the frequencies in 2012. Our results indicate that the administration of LST just before death in older inpatients in Japan decreased from 2012 to 2014.
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March 2021

Preliminary Evaluation of Market Mechanism-Based Bed Allocation System.

Stud Health Technol Inform 2020 Jun;270:1363-1364

Kyoto Univerisity Hospital, Kyoto, Japan.

Effective bed management is important for hospital management. Until now, bed allocation process is generally controlled by administrative staffs in centralized manner but it is not always effective. In the present study, we proposed and evaluated new method for bed allocation applying market mechanism via token. Evaluation was performed with newly-developed game-type simulation. Nurse managers as research participants played it and answered for survey. The result showed that the proposed method can be useful with appropriate operational design.
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June 2020

Detecting Severe Incidents from Electronic Medical Records Using Machine Learning Methods.

Stud Health Technol Inform 2020 Jun;270:1247-1248

Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Japan.

The goal of this research was to design a solution to detect non-reported incidents, especially severe incidents. To achieve this goal, we proposed a method to process electronic medical records and automatically extract clinical notes describing severe incidents. To evaluate the proposed method, we implemented a system and used the system. The system successfully detected a non-reported incident to the safety management department.
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June 2020

Obstacle avoidance training for individuals with stroke: a systematic review and meta-analysis.

BMJ Open 2019 12 16;9(12):e028873. Epub 2019 Dec 16.

Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan.

Objectives: To accumulate evidence that obstacle avoidance training alone is effective in improving the locomotor ability of individuals with stroke.

Design: Systematic review and meta-analysis.

Setting: MEDLINE, EMBASE, CENTRAL, ICTRP and PEDro were searched for related information until December 2018. Two independent reviewers extracted data. Outcome measurement data were subjected to meta-analyses using random-effects models. Data syntheses were conducted using RevMan V.5.3, and the certainty of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Participants: Participants with various types and phases of stroke were included.

Intervention: The usual gait training including obstacle avoidance training (interventions of any type, intensity, duration and frequency).

Primary And Secondary Outcome Measures: Primary outcomes were gait speed, composite gait ability and objective balance ability. Secondary outcomes were subjective balance ability, gait endurance and fall incidence.

Results: Two randomised controlled trials with a total of 49 participants were used as data sources for this study. The obstacle avoidance training (training) group had lower gait speed than the control group (mean difference (MD) 0.03, 95% CI -0.11 to 0.16, p=0.51). Further, the certainty of evidence was very low. The subjective balance ability (Activities-specific Balance Confidence scale) was not significantly different between the training and control groups (MD 6.65, 95% CI -7.59 to 20.89, p=0.36), and it showed very low certainty of evidence.

Conclusions: Obstacle avoidance training may have little or no effect on individuals with stroke. The failure to find the effectiveness of obstacle avoidance training alone is possibly attributable to the insufficient amount of training in the intervention and the lack of well-designed studies that measured relevant outcomes.

Prospero Registration Number: CRD42017060691.
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December 2019

Absolute risk of acute coronary syndrome after severe hypoglycemia: A population-based 2-year cohort study using the National Database in Japan.

J Diabetes Investig 2020 Mar 7;11(2):426-434. Epub 2019 Nov 7.

Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan.

Aims/introduction: Although the epidemiological relationship between hypoglycemia and increased risk of acute coronary syndrome (ACS) has been well established, the time period for increased risk of ACS after a severe hypoglycemic episode remains unknown. The present study aimed to determine the ACS risk after a severe hypoglycemic episode.

Materials And Methods: We carried out a retrospective population-based cohort study based on national claims data in Japan. We retrieved data of diabetes patients aged ≥35 years collected from April 2014 to March 2016. The absolute risk of ACS was defined as the occurrence of an emergency percutaneous coronary intervention after a severe hypoglycemic episode.

Results: In total, data of 7,909,626 patients were included in the analysis. The absolute risk of ACS was 2.9 out of 1,000 person-years in all patients. ACS risk in patients with severe hypoglycemic episodes was 3.0 out of 1,000 person-years. Severe hypoglycemic episodes increased the absolute risk of ACS in patients aged ≥70 years, but not in patients aged <70 years. The absolute risk of ACS was 10.6 out of 1,000 person-years within 10 days of a severe hypoglycemic episode. There was a significant trend between shorter duration after an episode and higher ACS risk.

Conclusions: Severe hypoglycemia was associated with an increased risk of ACS in elderly diabetes patients. ACS risk increased with a shorter period after a severe hypoglycemic episode, suggesting that severe hypoglycemia leads to an increased risk of ACS in diabetes patients. These findings show that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.
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March 2020

Early Nephrosis Detection Based on Deep Learning with Clinical Time-Series Data.

Stud Health Technol Inform 2019 Aug;264:1596-1597

Graduate School of Informatics Kyoto University, Kyoto-City, Kyoto, Japan.

Nephrosis is disease characterized by abnormal protein loss from impaired kidney. We constructed early prediction model using machine learning from clinical time series data, that can predict onset of nephrosis for more than one month. Long short-term memory capable of recognizing temporal sequential data patterns, was adopted as early prediction model for nephrosis. We verified our proposed prediction model has higher accuracy compared with those of baseline classifiers by 5-fold cross validation.
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August 2019

Updating quality indicators for low-risk labour care in Japan using current clinical practice guidelines: a modified Delphi method.

BMJ Open 2019 02 27;9(2):e023595. Epub 2019 Feb 27.

Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan.

Objectives: Quality indicators are measurable elements widely used to assess the quality of care. They are often developed from the results of systematic reviews or clinical practice guidelines. These sources are regularly updated in line with new clinical evidence, but there are few articles on updating quality indicators based on clinical practice guidelines. This study aimed to update the quality indicators developed for low-risk labour care in Japan in 2012, mainly drawing on new or updated clinical practice guidelines, and making the process clearly visible and assessable.

Design And Setting: We used a modified Delphi method for the update. The procedure included four steps: (1) updating the definition of low-risk labour; (2) reviewing the literature published between June 2012 and December 2015 using five guidelines and two quality indicator databases to extract potential candidate indicators; (3) formation of a multidisciplinary panel including mothers and (4) panel ratings (two rounds between February and April 2016) on the validity of the candidate indicators, and judging the validity of the previous quality indicators drawing on the new evidence.

Participants: A multidisciplinary panel of 13 clinicians, including obstetricians, paediatricians and midwives, plus 3 non-clinician mothers.

Results: The literature review identified 276 new recommendations from 27 clinical practice guidelines including 2 published in Japan and 21 quality indicators. We developed 13 new candidate indicators from these sources and panel recommendations, 12 of which were approved by the multidisciplinary panel. The panel also accepted all 23 existing quality indicators as still valid, resulting in a total of 35 quality indicators for low-risk labour.

Conclusions: We successfully updated the quality indicators for low-risk labour care in Japan. The procedure developed may be useful for updating other quality indicators based on new clinical practice guidelines.
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February 2019

Designing an Authorization System Based on Patient Privacy Preferences in Japan.

Stud Health Technol Inform 2018 ;247:71-75

Dept. of Social Informatics, Graduate School of Informatics, Kyoto University, Japan.

High accessibility of Electronic Health Record systems can increase usability but creates simultaneously patients' anxieties about privacy issues. In order to reduce the privacy concerns, we focused on control and awareness, and designed an approach that can provide availability of patient's clinical data to doctors in two scenarios; (S1) direct control by the patient when they are conscious, (S2) control by a trusted representative when the patient is unconscious. In this paper, we show further analysis in a survey (n = 310, age range: 19-91) done to test the acceptability of our concept of a using a trusted representative and to further understand the concerns of Japanese citizens to improve our system design. These results in S1 suggest that patients concerned about control have a stronger inclination to also choose full awareness. We found also that patients tended to choose the same level of awareness for the representative as they did for themselves in S2. In addition, patients who chose awareness in S1 tended to choose the same for their representative in S2 and themselves after recovery from unconsciousness. We also discuss the significant differences found between the age-groups 20-39 and 60-79. We conclude that the system design of privacy aware EHR systems must be improved to consider patients who want to preserve their choice of control in the event they become unconscious but do not want to use a representative to maintain control.
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June 2018

Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

BMC Pregnancy Childbirth 2017 Sep 22;17(1):315. Epub 2017 Sep 22.

Department of Health Informatics in the School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.

Background: In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan.

Methods: We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012.

Results: The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively.

Conclusions: We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.
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September 2017

Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test.

BMJ Open 2017 01 27;7(1):e013036. Epub 2017 Jan 27.

Department of Health Informatics, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan.

Objectives: Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice.

Design And Setting: This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan.

Participants: 10 professionals in cardiac rehabilitation for the consensus panel.

Results: In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively).

Conclusions: A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation.
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January 2017