著者

Daisuke Shigemi Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.1, no.1, pp.11-17, 2019 (Released:2020-06-12)

参考文献数

23

被引用文献数

2

---

BACKGROUNDAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease with multiple neurologic symptoms with or without a tumor, including ovarian teratoma. In the present study, a national inpatient database in Japan was used to investigate the characteristics, treatment, and outcomes of hospitalized patients with anti-NMDAR encephalitis who received initial treatment.METHODSUsing the Diagnosis Procedure Combination database, we identified all patients who were diagnosed with anti-NMDAR encephalitis and received initial first-line treatments (methylprednisolone, intravenous immunoglobulin, plasma exchange, and tumor removal) and second-line treatments (cyclophosphamide and rituximab) from July 2010 to March 2017. We excluded patients who received no immunotherapy or surgical treatment and those for whom data were missing. We investigated the characteristics, treatment, and outcomes of eligible patients.RESULTSIn total, 163 eligible patients were identified. Of these patients, 116 (71%) were female and 44 (28%) were ≤19 years of age. Among the female patients, 44 (38%) had a tumor. Thirty-nine patients (24%) were admitted to the intensive care unit during their hospitalization. Methylprednisolone, intravenous immunoglobulin, and plasma exchange were used as initial therapy in 82%, 56%, and 34% of patients, respectively. Second-line treatments were rarely used. Most patients were alert or had a slight disturbance of consciousness upon discharge. The proportion of patients discharged to home was 55%.CONCLUSIONSThe results of this Japanese study on anti-NMDAR encephalitis suggest that patients’ characteristics and outcomes including the male-to-female ratio, proportion of associated tumors, treatment options, and consciousness disturbance may differ from those in previous reports from other countries.

著者

Kenshi Hayashida Genki Murakami Shinya Matsuda Kiyohide Fushimi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.1, pp.1-11, 2021-01-05 (Released:2021-01-05)

参考文献数

32

被引用文献数

151

---

DPC, which is an acronym for “Diagnosis Procedure Combination,” is a patient classification method developed in Japan for inpatients in the acute phase of illness. It was developed as a measuring tool intended to make acute inpatient care transparent, aiming at standardization of Japanese medical care, as well as evaluation and improvement of its quality. Subsequently, this classification method came to be used in the Japanese medical service reimbursement system for acute inpatient care and appropriate allocation of medical resources. Furthermore, it has recently contributed to the development and maintenance of an appropriate medical care provision system at a regional level, which is accomplished based on DPC data used for patient classification. In this paper, we first provide an overview of DPC. Next, we will look back at over 15 years of DPC history; in particular, we will explore how DPC has been refined to become an appropriate medical service reimbursement system. Finally, we will introduce an outline of DPC-related research, starting with research using DPC data.

著者

Gojiro Nakagami Kojiro Morita Hiroki Matsui Hideo Yasunaga Kiyohide Fushimi Hiromi Sanada

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.2, pp.38-50, 2020 (Released:2020-04-28)

参考文献数

31

被引用文献数

2 7

---

BACKGROUNDSThe presence of pressure injuries may affect patient discharge destination; however, no related large-scale survey has been conducted in Japan. This study aimed to evaluate the association between pressure injury status and discharge to home from Japanese acute-care hospitals.METHODSThis retrospective observational cohort study used the Japanese Diagnosis Procedure Combination database from July 1 to 31, 2014. We assessed 340,124 inpatients aged 65 years or older admitted from home. To examine the association between pressure injury status (none, healed, healing, stable, worsened, or developed) and home discharge, we employed multivariable logistic regressions; these were adjusted for patient characteristics and within-hospital clustering using generalized estimating equations.RESULTSThe prevalence of pressure injuries on admission was 1.9%; the overall proportion of hospital-acquired pressure injuries was 1.1%. The logistic regression analyses showed patients with superficial or deep pressure injuries were less likely to be discharged to home. Furthermore, poor pressure injury status (developed < worsened < stable < healing < healed) was associated with lower likelihood of discharge to home.CONCLUSIONSPoor pressure injury status negatively affected hospital discharge destination among elderly patients admitted from home.

著者

Michimasa Fujiogi Nobuaki Michihata Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga Jun Fujishiro

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.2, pp.61-68, 2020 (Released:2020-04-28)

参考文献数

23

---

BACKGROUNDOmphalocele is frequently detected prenatally worldwide. Nevertheless, little is known about patient demographics, practice pattern and outcomes.METHODSWe examined patient demographics, treatment options, and outcomes for patients with omphalocele with and without severe chromosomal abnormalities (trisomy 13 and 18), July 2010–March 2016, using a nationwide database in Japan.RESULTSOf 399 patients with omphalocele, 89 had trisomy 13 or 18. The average birthweight was 2,449 g, and the average gestational age was 35 weeks; 65% had other congenital associated anomalies, including circulatory and chromosomal anomalies. About 85% of the patients received abdominoplasty. The median length of mechanical ventilation was 5 (0–30) days. The median length of stay (interquartile range) was 45 (21–94) days. Overall, 52% of the patients were discharged to home without home medical care; this percentage was 65% among those without trisomy 13 or 18. In-hospital mortality was 20% for the total sample of patients, while it was 49% for those with trisomy 13 or 18.CONCLUSIONSThe present study revealed the patient demographics, treatment practices, and discharge status of infants with omphalocele in Japan. This information is useful in aiding decision making on therapeutic strategies by medical staffs and the families of patients with omphalocele.

著者

Yuki Miyamoto Hiroyuki Ohbe Miho Ishimaru Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4308-19, (Released:2020-04-23)

参考文献数

13

被引用文献数

5

---

Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.

著者

Taisuke Jo Daisuke Shigemi Takaaki Konishi Hayato Yamana Nobuaki Michihata Ryosuke Kumazawa Akira Yokoyama Hirokazu Urushiyama Hiroki Matsui Kiyohide Fushimi Takahide Nagase Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1946-23, (Released:2023-07-26)

参考文献数

24

被引用文献数

1

---

Objective The effect of Rikkunshito, a Japanese herbal Kampo medicine, on chemotherapy-induced nausea and vomiting (CINV) has been evaluated in several small prospective studies, with mixed results. We retrospectively evaluated the antiemetic effects of Rikkunshito in patients undergoing cisplatin-based chemotherapy using a large-scale database in Japan. Methods The Diagnosis Procedure Combination inpatient database from July 2010 to March 2019 was used to compare adult patients with malignant tumors who had received Rikkunshito on or before the day of cisplatin administration (Rikkunshito group) and those who had not (control group). Antiemetics on days 2 and 3 and days 4 and beyond following cisplatin administration were used as surrogate outcomes for CINV. Patient backgrounds were adjusted using the stabilized inverse probability of treatment weighting, and outcomes were compared using univariable regression models. Results We identified 669 and 123,378 patients in the Rikkunshito and control groups, respectively. There were significantly fewer patients using intravenous 5-HT3-receptor antagonists in the Rikkunshito group (odds ratio, 0.38; 95% confidence interval, 0.16-0.87; p=0.023) on days 2 and 3 of cisplatin-based chemotherapy. Conclusion The reduced use of antiemetics on day 2 and beyond of cisplatin administration suggested a beneficial effect of Rikkunshito in palliating the symptoms of CINV.

著者

Michimasa Fujiogi Takaaki Konishi Nobuaki Michihata Yohei Hashimoto Hiroki Matsui Tetsuya Ishimaru Kiyohide Fushimi Hideo Yasunaga Jun Fujishiro

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

pp.23004, (Released:2022-09-29)

---

Background: Little is known about perioperative outcomes after pediatric thyroidectomy. This study was performed to compare perioperative outcomes between children and adults undergoing thyroid cancer surgery using a nationwide inpatient database in Japan.Methods: Using the Japanese Diagnosis Procedure Combination database, we identified patients aged 0 to 40 years with thyroid cancer who underwent thyroidectomy from July 2010 to March 2020. To compare the occurrence of in-hospital morbidities including local complications (e.g., recurrent laryngeal nerve paralysis, postoperative bleeding), duration of anesthesia, postoperative length of stay, and total hospitalization costs between children (0–18 years) and adults (19–40 years), we used multivariable logistic regression analysis for the occurrence of in-hospital morbidities and linear regression for other outcomes. Results: For 16,016 eligible patients (666 children vs. 15,350 adults), no significant differences between the two groups were found in any in-hospital morbidity (5.4% vs. 5.9%; adjusted odds ratio [OR], 0.80; 95% confidence interval [CI], 0.57–1.14; P=0.23), local complications (5.0% vs. 5.5%; OR, 0.80; 95% CI, 0.55–1.15; P=0.22), recurrent laryngeal nerve paralysis (2.1% vs. 2.4%; OR, 0.78; 95% CI, 0.45–1.35; P=0.37), or postoperative bleeding (1.7% vs. 1.4%; OR, 0.99; 95% CI, 0.53–1.87; P=0.98). Children showed a longer duration of anesthesia (difference, 20 minutes; 95% CI, 13–27; P<0.001) and higher total costs (difference, 445 US dollars; 95% CI, 239–651; P<0.001) than adults.Conclusion: This large nationwide cohort study showed no significant difference in perioperative complications between children and adults undergoing thyroid cancer surgery.

著者

Natsuko Kanazawa Norihiko Inoue Takuaki Tani Koichi Naito Hiromasa Horiguchi Kiyohide Fushimi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220031, 2022 (Released:2022-06-24)

参考文献数

36

被引用文献数

1

---

Objectives: This study investigated the impact of the initial outbreak of coronavirus disease (COVID-19) on rehabilitation and functional outcomes of patients in Japanese hospitals.Methods: The study subjects were hospitals belonging to Japan’s National Hospital Organization that provided inpatient care for patients with coronavirus COVID-19 during March–May 2020. We specifically focused on patients who were hospitalized for acute diseases, such as stroke, hip fracture, acute myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease, and received rehabilitation during hospitalization. Data were sourced from Japanese administrative data. The primary outcome was rehabilitation provision time in the target hospitals. The secondary outcomes were patient outcomes: rehabilitation participation time, length of hospital stay, 30-day readmission rate, and improvement of activities of daily living. Interrupted time series analysis was performed to evaluate the trend of rehabilitation provision time. Patient outcomes were compared with those for 2019.Results: The rehabilitation provision time for outpatients declined by 62% during the pandemic, while that for inpatients declined temporarily, and then increased. Compared with 2019 outcomes, rehabilitation participation time was longer and hospital stay length was shorter for stroke and hip-fracture patients, the 30-day readmission rate was increased for hip-fracture patients, and improvement of activities in daily living was less for patients with congestive heart failure who were totally dependent at admission. Other outcomes did not change.Conclusions: The findings suggest that during the initial COVID-19 pandemic, resources for rehabilitation were quickly reallocated to inpatient care, and the impact on inpatient outcomes was minimized.

著者

Natsuko Kanazawa Sumio Yamada Kiyohide Fushimi

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.3, no.10, pp.569-577, 2021-10-08 (Released:2021-10-08)

参考文献数

37

被引用文献数

11

---

Background:Despite the prognostic effectiveness of cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD), it has been underutilized. Understanding the trend of dissemination of CR over the years would help provide a perspective of CR in Japan.Methods and Results:A retrospective epidemiological survey between fiscal years 2010 and 2017 was conducted using the diagnosis procedure combination database (a Japanese administrative database). Data on 2,046,302 patients with CVD from 1,632 hospitals were extracted. The proportion of CR-certified hospitals among hospitals treating patients with CVD increased from 31.6% in 2010 to 56.6% in 2017. Over the same period, the participation rate in inpatient CR (ICR) increased from 18.3% to 39.0%, but the participation rate in outpatient CR (OCR) remained low (from 1.4% to 2.5%). The CR participation rates varied widely according to the main disease group. Approximately 95% of ICR participants did not continue CR after discharge.Conclusions:The number of CR-certified hospitals increased from 2010 to 2017, leading to increased ICR participation across patients with CVD; however, OCR has remained extremely underutilized. Immediate action is urgently required to increase the use of OCR.

著者

Yui Yamaoka Takeo Fujiwara Yoshihisa Fujino Shinya Matsuda Kiyohide Fushimi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20180094, (Released:2019-02-02)

参考文献数

34

被引用文献数

20

---

Background: Abusive head trauma (AHT) is the leading cause of fatal maltreatment among young children. The incidence of AHT in Japan, however, remains unknown. This study examined the incidence and distribution of age in months among young children under 12 months old hospitalized with intracranial injury in Japan.Methods: We conducted multicenter cross-sectional study for children under 36 months old admitted with intracranial injury to hospitals that employed the Diagnostic Procedure Combination (DPC) payment system between 2010 and 2013. Presumptive and possible AHT were defined by the combination of ICD-10 codes modified from the coding system recommended by the US Centers for Disease Control and Prevention.Results: The average incidence was 7.2 (95% confidence interval [CI]: 7.18-7.26) for presumptive and 41.7 (95% CI: 41.7-41.8) for possible AHT per 100,000 children less than 12 months old from 2010 to 2013. The distributions of age in months for both presumptive AHT and possible AHT had peaks at around two and eight months.Conclusions: This is the first study to report the incidence of hospitalized children with presumptive and possible AHT using population-based data. Further datasets are needed to evaluate the incidence and specific preventive strategies to prevent AHT in infants during the months of highest risk.

著者

Takahiro Inoue Hiroyo Kuwabara Kiyohide Fushimi

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.81, no.2, pp.195-198, 2017-01-25 (Released:2017-01-25)

参考文献数

16

被引用文献数

9

---

Background:Regional variations in health-care delivery, processes and spending have been reported across the world. Differences in revascularization procedures have been observed in the USA and Canada, but little is known about regional variation in revascularization procedures in Japan.Methods and Results:Diagnostic procedure combination summary tables for 2013 issued by the Japanese government were used. The rates of percutaneous coronary intervention (PCI) per 100,000 population aged ≥40 years in each prefecture were summarized by angina and myocardial infarction (MI). Linear regression analysis was performed to investigate the factors associated with regional variation in the rate of PCI for angina. The mean PCI rates were 189 and 67 per 100,000 population for angina and MI, respectively. The ratios between the highest and lowest regions were 4.9-fold in angina and 1.8-fold in MI. The factor most associated with generating regional variation in the use of PCI for angina was the rate of coronary angiography (CAG; P<0.001).Conclusions:Wide regional variation was observed in the use of PCI both for angina and for MI. The variation was larger for angina, in which PCI were mostly elective and positively associated with the use of CAG. Further research is needed to prevent overuse and underuse of PCI to ensure more appropriate health-care delivery and to control health-care expenditure.

著者

Keiji Muramatsu Hanaka Imamura Kei Tokutsu Kenji Fujimoto Kiyohide Fushimi Shinya Matsuda

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.32, no.4, pp.163-167, 2022-04-05 (Released:2022-04-05)

参考文献数

25

被引用文献数

4 9

---

Background: Food allergies are common among children, and food-induced anaphylaxis (FIA) is a serious disease with a risk of death; however, there is yet to be a large-scale epidemiological study on causative foods in Japan. The purpose of this study was to identify foods that cause FIA in Japan.Methods: We identified 9,079 patients from the Japanese Diagnosis Procedure Combination Database who were admitted for treatment for FIA from April 1, 2014 through March 31, 2017. We extracted data on patient sex, age, use of epinephrine injections on the first day, prescription for epinephrine self-injection on the day of discharge, length of stay, readmission, and causative foods.Results: The most common causative food was eggs, followed by wheat, milk, peanuts, and buckwheat. The most common causative food in each age group was eggs among 0–3-year-olds, milk among 4–6-year-olds, peanuts among 7–19-year-olds, and wheat among those aged 20 years and older. Epinephrine was used at admission among about 40%, 50%, and over 60% of cases in which the causative food was eggs; wheat, milk and peanuts; and buckwheat, respectively. The proportion of cases with a prescription for epinephrine self-injection at discharge was highest among those in which the causative food was wheat, followed by peanuts, buckwheat, milk, and eggs.Conclusions: FIA due to peanuts has become as common in Japan as it is in the West. These results suggest the importance of taking measures to prevent peanut allergies because children cannot make adequate decisions regarding food.

著者

Kunio Tarasawa Kenji Fujimori Kiyohide Fushimi

出版者

Tohoku University Medical Press

雑誌

The Tohoku Journal of Experimental Medicine (ISSN:00408727)

巻号頁・発行日

vol.252, no.1, pp.53-61, 2020 (Released:2020-09-03)

参考文献数

51

被引用文献数

10

---

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.

著者

Yuki Miyamoto Hiroyuki Ohbe Miho Ishimaru Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.15, pp.1789-1794, 2020-08-01 (Released:2020-08-01)

参考文献数

13

被引用文献数

5

---

Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.