著者

Kenzo Tanaka Koichiro Gibo Hiroko Watase Masaki Oohashi Carlos A. Camargo Kohei Hasegawa on behalf of the Japanese Emergency Medicine Network Investigators

出版者

日本プライマリ・ケア連合学会

雑誌

Journal of General and Family Medicine (ISSN:21896577)

巻号頁・発行日

vol.16, no.4, pp.281-287, 2015-12-20 (Released:2015-12-25)

参考文献数

14

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Background: Little is known about the extent that acute asthma is inappropriately treated with antibiotics in Japanese emergency departments (EDs).Objectives: We examined the proportion and predictors of inappropriate antibiotic use for adults with acute asthma in the Japanese EDs.Methods: We conducted a chart review study in 23 Japanese EDs. Subjects were ED patients aged 18 to 54 years with acute asthma between 2009 and 2011. To examine predictors of inappropriate antibiotic use, we performed multi-level logistic regression analysis at both the patient- and ED-level modeling EDs as a random variable.Results: Among 1380 patients in the overall study, the analytic cohort comprised 1311 patients. Overall, antibiotics were inappropriately prescribed for 4.4% (95% confidence interval [CI], 3.4%–5.7%). In the multi-level logistic regression analysis, higher annual ED asthma visit volume was significantly associated with a lower proportion of inappropriate antibiotic use (odds ratio per 100-visit increase, 0.3 ; 95%CI, 0.2–0.6).Conclusions: In this large multicenter study in Japan, we found that approximately 4% of ED patients with acute asthma were inappropriately treated with antibiotics. We also demonstrated that the inappropriate use of antibiotics largely differed across the EDs and was less common in EDs with a more annual ED asthma visits. Organized knowledge translation initiatives are warranted to address this gap in emergency asthma care.

著者

Sae X. Morita Yanling Zhao Kohei Hasegawa Michael A. Fifer Mathew S. Maurer Muredach P. Reilly Hiroo Takayama Yuichi J. Shimada

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.62, no.5, pp.1035-1041, 2021-09-29 (Released:2021-09-30)

参考文献数

32

被引用文献数

2

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Septal reduction therapy (SRT) -i.e. septal myectomy and alcohol septal ablation-has been performed to treat medically refractory hypertrophic cardiomyopathy (HCM) for decades. However, it is largely unknown whether SRT prevents HCM-related cardiovascular events or death. The objective was to examine the effects of SRT on acute cardiovascular events and all-cause mortality in HCM. We performed a propensity score (PS) -matched study using databases that capture all hospitalizations and outpatient visits in New York state. We identified patients with HCM who underwent SRT between 2007 and 2014 (i.e. the SRT group) and those who had never had SRT but had at least one hospitalization for HCM during the same period (i.e. the control group). We performed PS matching at a 1:1 ratio. The primary outcome was a composite of acute cardiovascular events and all-cause mortality during 0-180 days and 181-360 days. The secondary outcome was 180- and 360-day all-cause mortality. We included 846 patients with HCM (423 PS-matched pairs). Patients who underwent SRT had a lower risk of the primary outcome event (0-180 days: odds ratio [OR], 0.54; 95% confidence intervals (CI), 0.37-0.80; P = 0.002 and 181-360 days: OR, 0.33; 95% CI, 0.22-0.51; P < 0.0001). Furthermore, the risk of all-cause mortality was lower at 180 days (OR, 0.37; 95% CI, 0.22-0.63; P = 0.0003) and 360 days post-SRT (OR, 0.32; 95% CI, 0.20-0.51; P < 0.0001). In conclusion, our PS-matched study using population-based datasets demonstrated that SRT was associated with a reduced risk of a composite of acute cardiovascular events and all-cause mortality in HCM during the first post-SRT year.