記述言語：英語  

DOI： 10.3961/jpmph.24.355

PubMed

記述言語：英語   出版者・発行元：BMC Public Health  

In the original publication of this article the author names were in the incorrect order. In addition: an incorrect version of figure 2 was published. The incorrect and correct information is shown in this correction article, the original has been updated. Okui Tasuku & Nakashima Naoki Tasuku Okui & Naoki Nakashima

DOI： 10.1186/s12889-024-19870-3

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PubMed

記述言語：英語   出版者・発行元：Studies in health technology and informatics  

Telehealth systems in underserved countries leverage various low-cost portable medical sensors to transmit patients' vital information to remote doctors, facilitating timely diagnoses and interventions. However, the potential risks associated with inaccurate data pose considerable threats to the health of individuals. This study focuses on identifying high-quality portable hemoglobin sensors, employing the Japanese clinical pathology laboratory as a gold standard. Out of the eight sensors evaluated in this study, four were found to be highly erroneous.

DOI： 10.3233/SHTI240436

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PubMed

出版者・発行元：Applied System Innovation  

Capturing patients’ medical histories significantly influences clinical decisions. Errors in this process lead to clinical errors, which increase costs and dissatisfaction among physicians and patients. Physicians in developing countries are overloaded with patients and cannot always follow the proper history-taking procedure. The challenges have been acknowledged; however, a comprehensive understanding of the status and the remedies has remained unexplored. This paper aims to investigate the workload, history-taking challenges, and the willingness of the physicians to accept digital solutions. A cross-sectional online survey was conducted on 104 physicians across Bangladesh, featuring 22 questions regarding their professional environment, workload, digitization status of health records, challenges in history taking, and attitudes toward adopting digital solutions for managing patient histories; 92.67% of the physicians face high workloads, 88.46% struggle in medical history taking, and only 4.81% use digital medical records. About 70% struggle to complete the necessary history-taking steps, emphasizing the urgent need for solutions. A novel visualization system, the Smart Health Gantt Chart (SHGC), has been introduced for their instant feedback. A total of 93.27% of physicians expressed their willingness to use such a system. The proposed SHGC has the potential to enhance healthcare efficiency in developing nations, benefit physicians, and improve patient-centered care.

DOI： 10.3390/asi7040069

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記述言語：英語   出版者・発行元：British Journal of Pharmacology  

Background and purpose: Maintaining mitochondrial quality is attracting attention as a new strategy to treat diabetes and diabetic complications. We previously reported that mitochondrial hyperfission by forming a protein complex between dynamin-related protein (Drp) 1 and filamin, mediates chronic heart failure and cilnidipine, initially developed as an L/N-type Ca2+ channel blocker, improves heart failure by inhibiting Drp1-filamin protein complex. We investigated whether cilnidipine improves hyperglycaemia of various diabetic mice models. Experimental Approach: Retrospective analysis focusing on haemoglobin A1c (HbA1c) was performed in hypertensive and hyperglycaemic patients taking cilnidipine and amlodipine. After developing diabetic mice by streptozotocin (STZ) treatment, an osmotic pump including drug was implanted intraperitoneally, followed by weekly measurements of blood glucose levels. Mitochondrial morphology was analysed by electron microscopy. A Ca2+ channel-insensitive cilnidipine derivative (1,4-dihydropyridine [DHP]) was synthesized and its pharmacological effect was evaluated using obese (ob/ob) mice fed with high-fat diet (HFD). Key Results: In patients, cilnidipine was superior to amlodipine in HbA1c lowering effect. Cilnidipine treatment improved systemic hyperglycaemia and mitochondrial morphological abnormalities in STZ-exposed mice, without lowering blood pressure. Cilnidipine failed to improve hyperglycaemia of ob/ob mice, with suppressing insulin secretion. 1,4-DHP improved hyperglycaemia and mitochondria abnormality in ob/ob mice fed HFD. 1,4-DHP and cilnidipine improved basal oxygen consumption rate of HepG2 cells cultured under 25 mM glucose. Conclusion and implications: Inhibition of Drp1-filamin protein complex formation becomes a new strategy for type 2 diabetes treatment.

DOI： 10.1111/bph.16487

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PubMed

記述言語：英語   出版者・発行元：Therapeutic Innovation and Regulatory Science  

Background: The Medical Information Database Network (MID-NET®) in Japan is a vast repository providing an essential pharmacovigilance tool. Gastrointestinal perforation (GIP) is a critical adverse drug event, yet no well-established GIP identification algorithm exists in MID-NET®. Methods: This study evaluated 12 identification algorithms by combining ICD-10 codes with GIP therapeutic procedures. Two sites contributed 200 inpatients with GIP-suggestive ICD-10 codes (100 inpatients each), while a third site contributed 165 inpatients with GIP-suggestive ICD-10 codes and antimicrobial prescriptions. The positive predictive values (PPVs) of the algorithms were determined, and the relative sensitivity (rSn) among the 165 inpatients at the third institution was evaluated. Results: A trade-off between PPV and rSn was observed. For instance, ICD-10 code-based definitions yielded PPVs of 59.5%, whereas ICD-10 codes with CT scan and antimicrobial information gave PPVs of 56.0% and an rSn of 97.0%, and ICD-10 codes with CT scan and antimicrobial information as well as three types of operation codes produced PPVs of 84.2% and an rSn of 24.2%. The same algorithms produced statistically significant differences in PPVs among the three institutions. Combining diagnostic and procedure codes improved the PPVs. The algorithm combining ICD-10 codes with CT scan and antimicrobial information and 80 different operation codes offered the optimal balance (PPV: 61.6%, rSn: 92.4%). Conclusion: This study developed valuable GIP identification algorithms for MID-NET®, revealing the trade-offs between accuracy and sensitivity. The algorithm with the most reasonable balance was determined. These findings enhance pharmacovigilance efforts and facilitate further research to optimize adverse event detection algorithms.

DOI： 10.1007/s43441-024-00619-4

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記述言語：英語  

DOI： 10.1210/clinem/dgae430

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PubMed

記述言語：英語   出版者・発行元：BMC Public Health  

Background: Although the coronavirus disease 2019 (COVID-19) pandemic affected trends of multiple health outcomes in Japan, there is a paucity of studies investigating the effect of the pandemic on adverse birth outcomes and fetal mortality. This study aimed to investigate the effect of the onset of the pandemic on the trends in adverse birth outcomes and fetal mortality using national data in Japan. Methods: We used the 2010–2022 birth and fetal mortality data from the Vital Statistics in Japan. We defined the starting time of the effect of the pandemic as April 2020, and the period from January 2010 to March 2020 and that from April 2020 to December 2022 were defined as the pre- and post- pandemic period, respectively. The rates of preterm birth, term low birth weight (TLBW), small-for-gestational-age (SGA), large-for-gestational-age (LGA), spontaneous fetal mortality, and artificial fetal mortality were used as outcomes. An interrupted time series analysis was conducted using monthly time series data of the outcomes to evaluate the effects of the pandemic. In addition, a modified Poisson regression model was used to evaluate the effects of the pandemic on these outcomes using individual-level data, and the adjusted risk ratio of the effect was calculated. Results: The adverse birth and fetal mortality outcomes showed a decreasing trend over the years, except for preterm birth and LGA birth rates, and SGA birth rates tended to reach their lowest values after the onset of the pandemic. The interrupted time series analysis revealed that the pandemic decreased preterm birth, TLBW, and SGA birth rates. In addition, the regression analysis revealed that the pandemic decreased the TLBW, SGA, and artificial fetal mortality rates. Conclusions: Analyses performed using national data suggested that the pandemic decreased the TLBW and SGA rates in Japan.

DOI： 10.1186/s12889-024-18905-z

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PubMed

記述言語：英語   出版者・発行元：Scientific Reports  

Understanding the association between compliance to the Chronic Kidney Disease (CKD) guidelines in real-world clinical settings and renal outcomes remains a critical gap in knowledge. A comprehensive analysis was conducted using data from a national, multicenter CKD registry. This study included 4,455 patients with an estimated glomerular filtration rate (eGFR) measurement on the index date and eight additional metrics recorded within six months. These metrics comprised serum electrolyte levels, low-density lipoprotein cholesterol, hemoglobin, and the use of renin-angiotensin system inhibitors. The primary outcome was a composite of renal events, defined by a decline in eGFR to < 15 mL/min/1.73 m2 or a reduction of ≥ 30% in eGFR, confirmed by follow-up tests. Over a median follow-up of 513 days, 838 renal events were observed. High serum potassium levels (> 5.4 mmol/L) were associated with increased event rates compared to lower levels. Similarly, low serum sodium-chloride levels (< 33) correlated with higher event rates. Usage of renin-angiotensin system inhibitors, low serum calcium (< 8.4 mg/dL), and high uric acid levels (> 7.0 mg/dL) were also linked to increased events. Conversely, higher hemoglobin levels (≥ 13 g/dL) were associated with lower event rates. Compliance to guidelines, categorized into quartiles based on the number of met metrics, revealed a significantly reduced risk of events in the highest compliance group (meeting 8 metrics) compared to the lowest (0–5 metrics). Compliance to CKD guidelines in clinical practice is significantly associated with improved renal outcomes, emphasizing the need for guideline-concordant care in the management of CKD.

DOI： 10.1038/s41598-024-62152-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Archives of Occupational and Environmental Health  

Objectives: Small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births are major adverse birth outcomes related to newborn health. In contrast, the association between ambient air pollution levels and SGA or LGA births has not been investigated in Japan; hence, the purpose of our study is to investigate this association. Methods: We used birth data from Vital Statistics in Japan from 2017 to 2021 and municipality-level data on air pollutants, including nitrogen dioxide (NO2), sulfur dioxide (SO2), photochemical oxidants, and particulate matter 2.5 (PM2.5). Ambient air pollution levels throughout the first, second, and third trimesters, as well as the whole pregnancy, were calculated for each birth. The association between SGA/LGA and ambient levels of the air pollutants was investigated using crude and adjusted log-binomial regression models. In addition, a regression model with spline functions was also used to detect the non-linear association. Results: We analyzed data from 2,434,217 births. Adjusted regression analyses revealed statistically significant and positive associations between SGA birth and SO2 level, regardless of the exposure period. Specifically, the risk ratio for average SO2 values throughout the whole pregnancy was 1.014 (95% confidence interval [CI] 1.009, 1.019) per 1 ppb increase. In addition, regression analysis with spline functions indicated that an increase in risk ratio for SGA birth depending on SO2 level was linear. Furthermore, statistically significant and negative associations were observed between LGA birth and SO2 except for the third trimester. Conclusions: It was suggested that ambient level of SO2 during the pregnancy term is a risk factor for SGA birth in Japan.

DOI： 10.1007/s00420-024-02063-1

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Rheumatology International  

This study aimed to clarify the efficacy and safety of treatment escalation by initiating therapeutic agents in serologically active clinically quiescent (SACQ) patients with systemic lupus erythematosus (SLE). We retrospectively evaluated SACQ patients with SLE for ≥ 180 days, with the introduction of a therapeutic agent for SLE defined as exposure. The efficacy endpoints included the time to flare and time to remission, whereas the safety endpoint was the incidence of adverse events. The efficacy endpoints were assessed via Cox proportional hazards model with time-dependent covariates, which included exposure, serological activity, and prednisolone dose. Among 109 SACQ patients, 24 were initiated on the following therapeutic agents for SLE: hydroxychloroquine (10 patients), belimumab (6 patients), and immunosuppressive agents (8 patients). A total of 37 patients experienced a flare (8 and 29 patients during exposure and nonexposure periods, respectively). The time to flare was comparable between the exposure and control groups. Among 68 patients who were not in remission at the start of observation, 27 patients achieved remission (5 and 22 patients during exposure and nonexposure periods, respectively). Although both groups had a similar time to remission, the exposure group treated with belimumab had a significantly higher rate of remission than the control group. The adverse events were more frequent during the exposure period than during the nonexposure period. Thus, this study did not reveal a clear influence of treatment escalation on flare prevention and remission achievement.

DOI： 10.1007/s00296-024-05593-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Annals of Occupational and Environmental Medicine  

Background: As few studies have explored the association between non-regular or precarious employment in parents and adverse birth outcomes, this study aimed to investigate this association using national data in Japan. Methods: This study utilized the census data from 2020 and birth data from the vital statistics in 2021 and 2022 in the analysis. Adverse birth outcomes, including preterm birth, term low birth weight (TLBW), and small-for-gestational-age, were examined. Data linkage was conducted between birth data and census data to link parental employment statuses and educational attainments with birth data. Rates of adverse birth outcomes were calculated for each parental employment status. Additionally, regression analysis was used to determine adjusted risk ratios (RRs) of parental employment statuses for each birth outcome. Results: After data linkage, 334,110 birth records were included in the statistical analysis. Rates for non-regular workers were consistently higher than those for regular workers across all adverse birth outcomes for maternal employment status. Results of regression analyses indicated that the risks of preterm birth for non-regular workers were statistically significantly higher than those for regular workers, both in mothers and fathers with a RR (95% confidence intervals [CIs]) of 1.053 (1.004-1.104) and 1.142 (1.032-1.264), respectively. Furthermore, the risk of TLBW birth for non-regular workers was statistically significantly higher than that for regular workers in fathers (RR [95% CI]: 1.092 [1.043-1.143]). Conclusions: Our findings demonstrate that non-regular workers have a higher risk of some adverse birth outcomes compared to regular workers.

DOI： 10.35371/aoem.2024.36.e6

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記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

出版者・発行元：Sustainability (Switzerland)  

In the pursuit of Universal Health Coverage (UHC), developing countries with limited resources face significant hurdles. Traditional top-down approaches, spearheaded by governments, often entail lengthy planning periods and substantial costs to reach underserved communities. This paper proposes a bottom-up, cost-effective, and preventive approach aimed at empowering local human resources and using advanced technology. We call it the Micro Healthcare Entrepreneurship (MHE) model. The MHE model comprises four primary components: (1) utilization of local human resources, (2) disruptive healthcare technology, (3) continuous training, and (4) available funds. Extensive testing of the digital health and social business elements across diverse contexts underscores their efficacy. Furthermore, the viability of social business funds has been established. To solicit feedback and refine the MHE concept, three workshops, conducted in phases, engaged 60 community healthcare service providers. This paper elucidates both the potential advantages and the challenges inherent in implementing the MHE model. By shifting the paradigm toward grassroots empowerment and leveraging existing community assets, this approach offers promise in advancing healthcare accessibility and sustainability in resource-constrained settings to achieve UHC.

DOI： 10.3390/su16062268

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記述言語：英語  

DOI： 10.2196/46840

PubMed

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：Studies in Health Technology and Informatics  

Portable medical sensors play an important role in healthcare services, especially in rural communities. Many telehealth systems use these devices for providing patients' vital information from a distance to remote doctors. Erroneous data will not only mislead the remote doctor for correct diagnosis but it will cause health threats to these unreached community people. Therefore, it is very important to identify good sensors with an acceptable level of accuracy but within the affordable price of the available sensors in the market. This study aims to identify quality portable cholesterol sensors with high accuracy with the reference of the Japanese clinical pathology laboratory as a gold standard. We have considered cholesterol sensors that measure total cholesterol for this study that are commonly used in the developing countries of Asia. We found that out of four, three of them were very much erroneous and cannot be recommended even for primary healthcare.

DOI： 10.3233/SHTI230977

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PubMed

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：Studies in Health Technology and Informatics  

Delirium is common in the emergency department, and once it develops, there is a risk of self-extubation of drains and tubes, so it is critical to predict delirium before it occurs. Machine learning was used to create two prediction models in this study: one for predicting the occurrence of delirium and one for predicting self-extubation after delirium. Each model showed high discriminative performance, indicating the possibility of selecting high-risk cases. Visualization of predictors using Shapley additive explanation (SHAP), a machine learning interpretability method, showed that the predictors of delirium were different from those of self-extubation after delirium. Data-driven decisions, rather than empirical decisions, on whether or not to use physical restraints or other actions that cause patient suffering will result in improved value in medical care.

DOI： 10.3233/SHTI231115

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出版者・発行元：Computer Methods and Programs in Biomedicine Update  

Background and Objective: One of the primary challenges faced by telehealth systems is the accurate transmission of patient information to remote doctors. In this context, portable medical sensors deployed at the remote patients' end play a crucial role in measuring vital information. There are many sensors available in the market. However, the accuracy of the sensors has been always a concern. The objective of this study is to verify different sensors and create awareness for using accurate sensors to avoid misdiagnosis for the patients’ safety. Methods: This study considered the test result of a Japanese clinical pathology laboratory as the reference gold standard. The clinical pathology laboratory uses 1) Hexokinase UV method for blood glucose, 2) Enzymatic Determination method for cholesterol, 3) Automatic Analyzer (EDTA-2 K) of Hemoglobin, and 4) Uricase POD method for uric acid. To assess the performance of a medical sensor, its test results were compared to the gold standard test results obtained from the laboratory using the same sample. A Normalized Root Mean Square Error (NRMSE) threshold of less than 0.2 was established as the criterion for determining whether the medical sensor's performance fell within an acceptable range. Results: Among the eight most commonly used blood glucose devices in the Asian market, only one device was deemed acceptable with NRMSE less than 0.2. However, all four devices found in the Japanese market showed their acceptability. In the case of cholesterol, hemoglobin, and uric acid devices, only a limited number of items were available in Asian markets. Some of the hemoglobin and uric acid devices were found to be somewhat acceptable, while all the cholesterol sensors were found erroneous. Conclusions: This study has clearly shown the issues with the portable medical sensors and recommends the device approval authority of each country to approve sales of the quality sensors only for patients’ safety.

DOI： 10.1016/j.cmpbup.2024.100147

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記述言語：日本語   出版者・発行元：一般社団法人 レギュラトリーサイエンス学会  

<p>日本における医療情報データベースネットワーク（MID-NET^®）は，医療ビッグデータを活用した医薬品等の高度な安全対策を推進するために，電子カルテなどの医療情報を大規模に収集・分析するデータベースである．独立行政法人医薬品医療機器総合機構により管理・運営されている．本研究では，MID-NET^®データをはじめとする医療情報の広範な活用に必要となる「データの標準化」と「データの品質管理」に関する取り組みを中心に，各医療機関が抱える課題とその解決策を検討した．MID-NET^®は本格稼働に向けた準備として，2013年度からデータ品質管理を導入した．複数の機関が医療データを統合的に分析するにはデータ品質管理が重要であり，標準化されたコードマッピングもその一つである．MID-NET^®の連携機関の医療マスターの品質向上を目的としたガバナンス手法を開発した．ガバナンス結果の提案は各施設にフィードバックされ，2020年8月よりガバナンスの本格運用を開始した．各施設の差異医療マスターを抽出するツールを開発・自動化した．ガバナンスセンターによる分類結果をもとに，医療従事者が最適な標準コードを提案し，毎月各施設にフィードバックした．標準コード提案後の登録率を高めるためにはさらなる検討が必要である．標準コードは各事業で管理するよりも各医療機関の部門システムなどの上流で管理することが効率的で正確になると思われる．</p>

DOI： 10.14982/rsmp.14.131

CiNii Research

記述言語：英語   出版者・発行元：Digital Health  

Objective: Research over the past decade has extensively covered the benefits of electronic health records in developing countries. Yet, the specific impact of their limited access on doctors’ workload and clinical decision-making, particularly in Bangladesh, remains underexplored. This study investigates current patients’ medical history storage mechanisms and associated challenges. It explores how doctors in Bangladesh obtain and review patients’ past medical histories, identifying the challenges they face. Additionally, it examines whether limited access to digital health records is an obstacle in clinical decision-making and explores factors influencing doctors’ willingness to adopt electronic health record systems in such contexts. Method: An online cross-sectional survey of 105 doctors with Bachelor of Medicine, Bachelor of Surgery/Bachelor of Dental Surgery (MBBS/BDS) degrees and at least 2 years of experience was conducted, covering (a) personal information, (b) workload, (c) patient history challenges, and (d) decision-making. Results: Out of 105 participants, 51.4% of them use paper-based methods with 56% facing challenges, versus 20% using digital methods. Most (94.3%) interview patients directly, and 80.9% are interested in a web-based, comprehensive medical history system. An ordinal regression model identified that the physicians’ disciplines, workload, and efficiency level of the current workplace in facilitating patient history-taking variables significantly affected willingness to adopt the described electronic health record in the survey. Conclusion: Doctors in Bangladesh encounter significant challenges related to workload and clinical decision-making, largely attributed to restricted access to patients’ past medical histories. Despite the prevalent use of paper-based records, there is a notable willingness among these medical professionals to embrace electronic health record systems, indicating a potential shift towards more efficient healthcare practices in the region.

DOI： 10.1177/20552076241281626

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Alzheimer's Disease  

Background: An association between poor oral health and cognitive decline has been reported. Most of these studies have considered the number of teeth as a criterion, only a few studies have analyzed the relationship between occlusal status and Alzheimer’s disease (AD). Objective: To elucidate whether posterior occlusal contact is associated with AD, focusing on the Eichner classification, among an older population aged 65 years or older in Japan. Methods: This study used monthly claims data of National Health Insurance in Japan from April 2017 to March 2020. The outcome was newly diagnosed AD defined according to ICD-10 code G30. The number of teeth was estimated by dental code data, and occlusal contact was divided into three categories, namely A, B, and C, according to the Eichner classification. Multivariate Cox proportional hazards models were used to analyze the association between a new diagnosis of AD and the Eichner classification. Results: A total of 22,687 participants were included, 560 of whom had newly diagnosed AD during a mean follow-up period of 12.2 months. The AD participants had a lower proportion of Eichner A and a higher proportion of Eichner C. After adjusting for covariates, hazard ratios (95% confidence intervals) with Eichner B and C were 1.34 (1.01–1.77) and 1.54 (1.03–2.30), respectively. Conclusions: In older people aged ≥ 65 years old, reduced posterior occlusal contact as well as tooth loss have an impact on AD. This study emphasizes the importance of paying attention to occlusal contacts to reduce the risk of AD.

DOI： 10.3233/JAD-230449

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Hypertension  

DOI： 10.1161/HYPERTENSIONAHA.123.22084

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記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nephrology  

Aim: Among patients with Immunoglobulin A (IgA) nephropathy, we aimed to identify trajectory patterns stratified by the magnitude of haematuria and proteinuria using repeated urine dipstick tests, and assess whether the trajectories were associated with kidney events. Methods: Using a nationwide multicentre chronic kidney disease (CKD) registry, we analysed data from 889 patients with IgA nephropathy (mean age 49.3 years). The primary outcome was a sustained reduction in eGFR of 50% or more from the index date and thereafter. During follow-up (median 49.0 months), we identified four trajectories (low-stable, moderate-decreasing, moderate-stable, and high-stable) in both urine dipstick haematuria and proteinuria measurements, respectively. Results: In haematuria trajectory analyses, compared to the low-stable group, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) for kidney events were 2.59 (95% CI, 1.48–4.51) for the high-stable, 2.31 (95% CI, 1.19–4.50) for the moderate-stable, and 1.43 (95% CI, (0.72–2.82) for the moderate-decreasing groups, respectively. When each proteinuria trajectory group was subcategorized according to haematuria trajectories, the proteinuria group with high-stable and with modest-stable haematuria trajectories had approximately 2-times higher risk for eGFR reduction ≥50% compared to that with low-stable haematuria trajectory. Conclusion: Assessments of both haematuria and proteinuria trajectories using urine dipstick could identify high-risk IgA nephropathy patients.

DOI： 10.1111/nep.14250

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2196/50895.

Web of Science

記述言語：日本語   出版者・発行元：独立行政法人 労働者健康安全機構 労働安全衛生総合研究所  

<p>九州北部の5つの大学病院で働く対人業務のある医療専門職を対象に，2020年に労働災害や医療事故の発生状況を調査し，リスク要因を探索的に評価した．4職種（看護師1,305人，医師481人，放射線技師90人，薬剤師51人）を抽出し，過去1年間の労働災害および医療事故の発生とヒヤリ・ハット経験の回答に基づき職種別に高リスク群と低リスク群に分け，精神健康調査GHQ，主観的健康感，努力–報酬不均衡モデルで示される職業性ストレス，仕事や生活の時間的要因を比較し評価した．調査結果では，全職種で職業性ストレスと労災・医療事故リスクとの有意な関連が示された．薬剤師を除く高リスク群には精神健康の問題も見られた．看護師と医師の高リスク群は，低リスク群に比べ労働時間が長く，夜勤回数も多かった．睡眠不十分と家事時間はリスクとの関連を示さなかった．職業性ストレスは病院間の違いや性，年齢等の交絡因子を調整したマルチレベル混合効果ロジスティック回帰分析でも，全職種で労災・医療事故リスクと有意な関連を示した．この結果から，医療専門職の職場でのストレスを軽減することが，労災・医療事故リスクの低減につながる可能性があると示唆された．</p>

DOI： 10.2486/josh.josh-2023-0004-ge

CiNii Research

記述言語：英語   出版者・発行元：Scientific Reports  

There are great expectations for artificial intelligence (AI) in medicine. We aimed to develop an AI prognostic model for surgically resected non-small cell lung cancer (NSCLC). This study enrolled 1049 patients with pathological stage I–IIIA surgically resected NSCLC at Kyushu University. We set 17 clinicopathological factors and 30 preoperative and 22 postoperative blood test results as explanatory variables. Disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) were set as objective variables. The eXtreme Gradient Boosting (XGBoost) was used as the machine learning algorithm. The median age was 69 (23–89) years, and 605 patients (57.7%) were male. The numbers of patients with pathological stage IA, IB, IIA, IIB, and IIIA were 553 (52.7%), 223 (21.4%), 100 (9.5%), 55 (5.3%), and 118 (11.2%), respectively. The 5-year DFS, OS, and CSS rates were 71.0%, 82.8%, and 88.7%, respectively. Our AI prognostic model showed that the areas under the curve of the receiver operating characteristic curves of DFS, OS, and CSS at 5 years were 0.890, 0.926, and 0.960, respectively. The AI prognostic model using XGBoost showed good prediction accuracy and provided accurate predictive probability of postoperative prognosis of NSCLC.

DOI： 10.1038/s41598-023-42964-8

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：(独)労働者健康安全機構労働安全衛生総合研究所  

九州北部の5つの大学病院で働く対人業務のある医療専門職を対象に,2020年に労働災害や医療事故の発生状況を調査し,リスク要因を探索的に評価した.4職種(看護師1,305人,医師481人,放射線技師90人,薬剤師51人)を抽出し,過去1年間の労働災害および医療事故の発生とヒヤリ・ハット経験の回答に基づき職種別に高リスク群と低リスク群に分け,精神健康調査GHQ,主観的健康感,努力-報酬不均衡モデルで示される職業性ストレス,仕事や生活の時間的要因を比較し評価した.調査結果では,全職種で職業性ストレスと労災・医療事故リスクとの有意な関連が示された.薬剤師を除く高リスク群には精神健康の問題も見られた.看護師と医師の高リスク群は,低リスク群に比べ労働時間が長く,夜勤回数も多かった.睡眠不十分と家事時間はリスクとの関連を示さなかった.職業性ストレスは病院間の違いや性,年齢等の交絡因子を調整したマルチレベル混合効果ロジスティック回帰分析でも,全職種で労災・医療事故リスクと有意な関連を示した.この結果から,医療専門職の職場でのストレスを軽減することが,労災・医療事故リスクの低減につながる可能性があると示唆された.(著者抄録)

記述言語：日本語   出版者・発行元：一般社団法人 日本医療情報学会  

<p>【セッション抄録】</p><p>　新型コロナウイルス感染症（以下，コロナ）により医療や社会は大きく変わりつつある．日本医療情報学会（JAMI）は，COVID-19関連タスクフォース（TF）を設置し，「議論の継続」「情報共有」「社会貢献」の三本柱の対策を実施してきた．その中の「議論の継続」の一環として，2020年，日本医療情報学会春季学術大会で緊急企画として行った「postコロナの医療情報」に続いて，2020年，医療情報学連合大会では，本学会セッションを企画した．</p><p>　日本では2020年1月から始まったコロナ騒動であるが，4月には緊急事態宣言に至ったその後一旦落ちついたものの8月には第2波がみられた．その間の医療機関・医師会，行政，企業，教育機関など，それぞれ様々な苦難を味わい，それらの対策を立ててきた．これからも当面はこのような波の繰り返しを過ごすことであろう．そのような時代において，医療情報がどのようにwith/beyondコロナに貢献できるのか，逆にコロナによって医療情報がどう変革されるのか，多くの視点から現状を共有したい．</p><p>　また，コロナ以外にも日本には超少子高齢社会の到来，および自然災害の激化など多くの課題がある．また，すでに人工知能のみならずデジタルトランスフォーメーションと呼ばれる社会全体の情報改革が世界で進行しつつあり，医療もその例外ではない．コロナの影響と合わせて考えると，次世代への変革なしには今後の社会は成立しない．社会の変革に伴い，個々のステークホルダーがどう変革し，個人としての市民もどう変わるべきなのか，その中で保健医療情報システムはどうあるべきなのか，について，前半は現場中心の視点で情報を共有していただく．また後半は，社会構造や課題の視点で考察・議論をしていただく．</p>

DOI： 10.14948/jami.43.97

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Scientific Reports  

This study aimed to determine whether body weight is associated with functional outcome after acute ischemic stroke. We measured the body mass index (BMI) and assessed clinical outcomes in patients with acute ischemic stroke. The BMI was categorized into underweight (< 18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), and obesity (≥ 25.0 kg/m2). The association between BMI and a poor functional outcome (modified Rankin Scale [mRS] score: 3–6) was evaluated. We included 11,749 patients with acute ischemic stroke (70.3 ± 12.2 years, 36.1% women). The risk of a 3-month poor functional outcome was higher for underweight, lower for overweight, and did not change for obesity in reference to a normal weight even after adjusting for covariates by logistic regression analysis. Restricted cubic splines and SHapley Additive exPlanation values in eXtreme Gradient Boosting model also showed non-linear relationships. Associations between BMI and a poor functional outcome were maintained even after excluding death (mRS score: 3–5) or including mild disability (mRS score: 2–6) as the outcome. The associations were strong in older patients, non-diabetic patients, and patients with mild stroke. Body weight has a non-linear relationship with the risk of a poor functional outcome after acute ischemic stroke.

DOI： 10.1038/s41598-023-35894-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer Medicine  

Background: Immunotherapy has become a standard-of-care for patients with non-small-cell lung cancer (NSCLC). Although several biomarkers, such as programmed cell death-1, have been shown to be useful in selecting patients likely to benefit from immune checkpoint inhibitors (ICIs), more useful and reliable ones should be investigated. The prognostic nutritional index (PNI) is a marker of the immune and nutritional status of the host, and is derived from serum albumin level and peripheral lymphocyte count. Although several groups reported its prognostic role in patients with NSCLC receiving a single ICI, there exist no reports which have demonstrated its role in the first-line ICI combined with or without chemotherapy. Materials and Methods: Two-hundred and eighteen patients with NSCLC were included in the current study and received pembrolizumab alone or chemoimmunotherapy as the first-line therapy. Cutoff value of the pretreatment PNI was set as 42.17. Results: Among 218 patients, 123 (56.4%) had a high PNI (≥42.17), while 95 (43.6%) had a low PNI (<42.17). A significant association was observed between the PNI and both the progression-free survival (PFS; hazard ratio [HR] = 0.67, 95% confidence interval [CI]: 0.51–0.88, p = 0.0021) and overall survival (OS; HR = 0.46, 95% CI: 0.32–0.67, p < 0.0001) in the entire population, respectively. The multivariate analysis identified the pretreatment PNI as an independent prognosticator for the PFS (p = 0.0011) and OS (p < 0.0001), and in patients receiving either pembrolizumab alone or chemoimmunotherapy, the pretreatment PNI remained an independent prognostic factor for the OS (p = 0.0270 and 0.0006, respectively). Conclusion: The PNI might help clinicians appropriately identifying patients with better treatment outcomes when receiving first-line ICI therapy.

DOI： 10.1002/cam4.6110

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Thrombosis and Haemostasis  

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) requires lifelong anticoagulation. Long-term outcomes of CTEPH under current anticoagulants are unclear. Objectives: The CTEPH AC registry is a prospective, nationwide cohort study comparing the safety and effectiveness of direct oral anticoagulants (DOACs) and warfarin for CTEPH. Patients/Methods: Patients with CTEPH, both tre atment-naïve and on treatment, were eligible for the registry. Inclusion criteria were patients aged ≥20 years and those who were diagnosed with CTEPH according to standard guidelines. Exclusion criteria were not specified. The primary efficacy outcome was a composite morbidity, and mortality outcome comprised all-cause death, rescue reperfusion therapy, initiation of parenteral pulmonary vasodilators, and worsened 6-minute walk distance and WHO functional class. The safety outcome was clinically relevant bleeding, including major bleeding. Results: Nine hundred twenty-seven patients on oral anticoagulants at baseline were analyzed: 481 (52%) used DOACs and 446 (48%) used warfarin. The 1-, 2-, and 3-year rates of composite morbidity and mortality outcome were comparable between the DOAC and warfarin groups (2.6%, 3.1%, and 4.2% vs 3.0%, 4.8%, and 5.9%, respectively; P = .52). The 1-, 2-, and 3-year rates of clinically relevant bleeding were significantly lower in DOACs than in the warfarin group (0.8%, 2.4%, and 2.4% vs 2.5%, 4.8%, and 6.4%, respectively; P = 0.036). Multivariable Cox proportional-hazards regression models revealed lower risk of clinically relevant bleeding in the DOAC group than the warfarin group (hazard ratio: 0.35; 95% CI: 0.13-0.91; P = .032). Conclusion: This registry demonstrated that under current standard of care, morbidity and mortality events were effectively prevented regardless of anticoagulants, while the clinically relevant bleeding rate was lower when using DOACs compared with warfarin.

DOI： 10.1016/j.jtha.2023.03.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40748-023-00149-1

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Circulation: Arrhythmia and Electrophysiology  

DOI： 10.1161/CIRCEP.122.011579

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：Applied Sciences (Switzerland)  

Delirium in hospitalized patients is a worldwide problem, causing a burden on healthcare professionals and impacting patient prognosis. A machine learning interpretation method (ML interpretation method) presents the results of machine learning predictions and promotes guided decisions. This study focuses on visualizing the predictors of delirium using a ML interpretation method and implementing the analysis results in clinical practice. Retrospective data of 55,389 patients hospitalized in a single acute care center in Japan between December 2017 and February 2022 were collected. Patients were categorized into three analysis populations, according to inclusion and exclusion criteria, to develop delirium prediction models. The predictors were then visualized using Shapley additive explanation (SHAP) and fed back to clinical practice. The machine learning-based prediction of delirium in each population exhibited excellent predictive performance. SHAP was used to visualize the body mass index and albumin levels as critical contributors to delirium prediction. In addition, the cutoff value for age, which was previously unknown, was visualized, and the risk threshold for age was raised. By using the SHAP method, we demonstrated that data-driven decision support is possible using electronic medical record data.

DOI： 10.3390/app13031564

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記述言語：英語  

DOI： 10.1007/s43999-022-00018-y

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.1007/s43999-022-00018-y

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Applied Sciences (Switzerland)  

The COVID-19 pandemic has limited routine community health services, including screening for non-communicable diseases (NCDs). An adaptive and innovative digital approach is needed in the health technology ecosystem. A portable health clinic (PHC) is a community-based mobile health service equipped with telemonitoring and teleconsultation using portable medical devices and an Android application. The aim of this study was to assess the challenges and potential improvement in PHC implementation in Indonesia. This study was conducted in February–April 2021 in three primary health centers, Mlati II in Sleman District, Samigaluh II in Kulon Progo, and Kalikotes in Klaten. In-depth interviews were conducted with 11 health workers and community health workers. At the baseline, 268 patients were examined, and 214 patients were successfully followed-up until the third month. A proportion of 32% of the patients required teleconsultations based on automatic triage. Implementation challenges included technical constraints such as complexity of applications; unstable networks; and non-technical constraints, such as the effectivity of training, the availability of doctors, and the workload at the primary health center. PHCs were perceived as an added value in addition to existing community-based health services. The successful implementation of PHCs should not only be considered with respect to technology but also in terms of human impact, organization, and legality.

DOI： 10.3390/app13031623

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.3390/app13031564

記述言語：英語   出版者・発行元：JMIR Perioperative Medicine  

Background: Although machine learning models demonstrate significant potential in predicting postoperative delirium, the advantages of their implementation in real-world settings remain unclear and require a comparison with conventional models in practical applications. Objective: The objective of this study was to validate the temporal generalizability of decision tree ensemble and sparse linear regression models for predicting delirium after surgery compared with that of the traditional logistic regression model. Methods: The health record data of patients hospitalized at an advanced emergency and critical care medical center in Kumamoto, Japan, were collected electronically. We developed a decision tree ensemble model using extreme gradient boosting (XGBoost) and a sparse linear regression model using least absolute shrinkage and selection operator (LASSO) regression. To evaluate the predictive performance of the model, we used the area under the receiver operating characteristic curve (AUROC) and the Matthews correlation coefficient (MCC) to measure discrimination and the slope and intercept of the regression between predicted and observed probabilities to measure calibration. The Brier score was evaluated as an overall performance metric. We included 11,863 consecutive patients who underwent surgery with general anesthesia between December 2017 and February 2022. The patients were divided into a derivation cohort before the COVID-19 pandemic and a validation cohort during the COVID-19 pandemic. Postoperative delirium was diagnosed according to the confusion assessment method. Results: A total of 6497 patients (68.5, SD 14.4 years, women n=2627, 40.4%) were included in the derivation cohort, and 5366 patients (67.8, SD 14.6 years, women n=2105, 39.2%) were included in the validation cohort. Regarding discrimination, the XGBoost model (AUROC 0.87-0.90 and MCC 0.34-0.44) did not significantly outperform the LASSO model (AUROC 0.86-0.89 and MCC 0.34-0.41). The logistic regression model (AUROC 0.84-0.88, MCC 0.33-0.40, slope 1.01-1.19, intercept –0.16 to 0.06, and Brier score 0.06-0.07), with 8 predictors (age, intensive care unit, neurosurgery, emergency admission, anesthesia time, BMI, blood loss during surgery, and use of an ambulance) achieved good predictive performance. Conclusions: The XGBoost model did not significantly outperform the LASSO model in predicting postoperative delirium. Furthermore, a parsimonious logistic model with a few important predictors achieved comparable performance to machine learning models in predicting postoperative delirium.

DOI： 10.2196/50895

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PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本臨床薬理学会  

<p>【目的】原資料の直接閲覧(SDV:Source Data Verification)は、治験データの信頼性確保のためにGCP上定められている。近年、多施設共同試験の増加や実施医療機関ごとの被験者数減少により、SDVに多大な労力やコストを費やしていることが問題となっている。効率化のために「臨床研究・治験活性化5か年計画2012」でリモートSDVの推進が提言され、医療機関側で様々な取り組みが行われている。今回、九州大学病院においてセキュアな環境を用いた新たなリモートSDVシステムを開発し、導入したので紹介する。【方法】医師向けの病院敷地外からも電子カルテの画面を操作・閲覧することを可能とするシステムが別目的で存在していた。厚生労働省の「医療情報システムの安全管理に関するガイドライン」に準拠し、VPN（Virtual Private Network）の暗号化通信回線を用いて仮想デスクトップ（VDI:Virtual Desktop Infrastructure）上で電子カルテを閲覧することとした。閲覧者の本人確認は通常の電子カルテと同じで生体認証（手のひら静脈認証）とした。また、運用開始前に協力の得られた3試験において、リモートSDVを試行し、問題点の抽出と対応について検討した。【結果・考察】専用モバイルPCをSDV用に権限、周辺システムなどの閲覧可能な範囲をカスタマイズしたリモートSDV用端末として、治験依頼者に貸し出し、リモートSDV用端末～VDI端末にVPNを構築し、通信内容を秘匿した状態でセキュアに電子カルテを閲覧できるようにした。リモートSDV用端末にはCLOMOの位置情報監視機能を利用し、SDV用の隔離した個室等、事前に登録した場所以外では閲覧できない設定とした。また、リモートSDV用端末の貸与は治験依頼者と契約を締結し、閲覧できる患者は該当する試験の被験者のみとした。試行の結果、遠隔地からVPN機能を用いて安全にリモートSDVの実施が可能であることを確認したため、2023年4月より本格運用を開始している。【結論】VDI機能とVPN技術を組み合わせたセキュアな環境により、安全なリモートSDVの実施が可能となった。リモートSDVの導入により、モニタリングの効率化による品質向上やコスト削減等のメリットが見込まれる。</p>

DOI： 10.50993/jsptsuppl.44.0_2-c-p-e5

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本薬剤疫学会  

DOI： 10.3820/jjpe.28.s154

CiNii Research

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JMIR Publications  

Background: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Objective: Our study will examine the telehealth care system’s effectiveness in improving women’s and infants’ care uptake and detecting their health problems. Methods: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants’ health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants’ health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention’s effectiveness. Results: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Conclusions: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women’s and infants’ health status. Trial Registration: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621 International Registered Report Identifier (IRRID): DERR1-10.2196/41586.

DOI： 10.2196/41586

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記述言語：英語   出版者・発行元：(一社)日本血液学会  

レニン-アルドステロン-アンジオテンシン系阻害剤(RAASi)を含む特定の降圧薬の偶発的使用が、TKI治療中の慢性骨髄性白血病(CML)の推算糸球体濾過量(eGFR)の変化に及ぼす影響を評価した。対象は当院のCML患者142名で、混合効果モデルを用いてeGFR変化率を推定し、TKI治療中の全てのeGFR測定値を遡及的に分析した。全体的に、使用した降圧薬の種類とeGFRの年間変化との間に有意な相互作用を認め、RAASi使用者が最も急速なeGFR減少(-5.5%/年)を示した。TKI別の分析では、イマチニブ(IMA)とボスチニブ(BOS)の間でのみ相互作用が有意であった。eGFRの年間減少率はRAASi使用者で最も顕著で、IMAとBOSでは-5.7と-10.1であった。以上より、上記TKIを服用している患者はeGFRを監視する必要があると考えられた。

記述言語：英語   出版者・発行元：Hypertension Research  

Renin-angiotensin system inhibitors have been shown to prevent cancer metastasis in experimental models, but there are limited data in clinical studies. We aimed to explore whether renin-angiotensin system inhibitors administered during the period of cancer resection can influence the subsequent development of metastasis by analyzing multiple individual types of primary cancers. A total of 4927 patients who had undergone resection of primary cancers at Kyushu University Hospital from 2009 to 2014 were enrolled and categorized into 3 groups based on the use of antihypertensive drugs: renin-angiotensin system inhibitors, other drugs, and none. Cumulative incidence functions of metastasis, treating death as a competing risk, were calculated, and the difference was examined among groups by Gray’s test. Fine and Gray’s model was employed to evaluate multivariate-adjusted hazards of incidental metastasis. In the multivariate-adjusted analysis, patients with skin and renal cancers showed statistically higher risks of metastasis with the use of renin-angiotensin system inhibitors (hazard ratio [95% confidence interval], 5.81 [1.07–31.57] and 4.24 [1.71–10.53], respectively). Regarding pancreatic cancer, patients treated with antihypertensive drugs other than renin-angiotensin system inhibitors had a significantly increased risk of metastasis (hazard ratio [95% confidence interval], 3.31 [1.43–7.69]). Future larger studies are needed to ascertain whether renin-angiotensin system inhibitors can increase the risk of metastasis in skin and renal cancers, focusing on specific tissue types and potential factors associated with renin-angiotensin system inhibitor use.

DOI： 10.1038/s41440-022-01038-4

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記述言語：英語   出版者・発行元：International Journal of Hematology  

Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML). However, TKI-related chronic renal toxicity has been reported, particularly in patients with hypertension. We assessed whether incidental use of specific types of antihypertensive drugs, including renin–aldosterone–angiotensin system inhibitors (RAASis), affects the change in estimated glomerular filtration rate (eGFR) during TKI treatment. We retrospectively analyzed all eGFR measurements during TKI treatment for 142 CML patients at Kyushu University Hospital, estimating the rate of eGFR change using a mixed-effects model. Overall, a significant interaction was found between the type of antihypertensive medication used and the yearly change in eGFR (P < 0.01), with RAASi users exhibiting the most rapid decrease in eGFR (− 5.5%/year). The analysis by TKI used showed that the interaction was significant only in imatinib and bosutinib users (P < 0.01 and P = 0.04, respectively). The yearly rate of eGFR decrease was the most notable in RAASi users, at − 5.7 (− 6.6, − 4.9) and − 10.1 (− 12.3, − 7.9) for imatinib and bosutinib users, respectively. Our findings indicate that eGFR should be carefully monitored in patients taking these TKIs.

DOI： 10.1007/s12185-022-03433-6

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記述言語：英語   出版者・発行元：Nature Publishing Group  

がん切除時のレニン-アンジオテンシン系(RAS)阻害薬の投与が、その後の転移出現に影響を及ぼすか検討した。2009年1月1日～2014年12月31日に日本の単一施設で原発がんの切除を行い、90日以上の観察を行ったがん患者4927名(男性2654例、女性2273例、中央値66歳)の医療記録を解析した。RAS阻害薬投与群(1064例)、他の降圧薬投与群(975例)、降圧薬非投与群(2888例)に分類し、原発がんの種類別に転移リスクを評価した。多変量調整解析において、皮膚癌および腎癌の患者ではRAS阻害薬投与群で転移リスクが有意に増大し(ハザード比はそれぞれ5.81[95%CI 1.07～31.57]、4.24[95%CI 1.71～10.53])、膵癌患者では他の降圧薬投与群で転移リスクが有意に増大した(ハザード比3.31[95%CI 1.43～7.69])。皮膚癌と腎癌におけるRAS阻害薬による転移リスク増大については、特定の組織型およびRAS阻害薬使用の関連因子に注目して、さらに研究する必要があることが示された。

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語  

DOI： 10.1186/s40748-022-00143-z

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.1038/s41440-022-01038-4

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.1007/s12185-022-03433-6

記述言語：英語   出版者・発行元：Scientific Reports  

This study aimed to develop a simplified model for predicting end-stage kidney disease (ESKD) in patients with diabetes. The cohort included 2549 individuals who were followed up at Kyushu University Hospital (Japan) between January 1, 2008 and December 31, 2018. The outcome was a composite of ESKD, defined as an eGFR < 15 mL min−1 [1.73 m]−2, dialysis, or renal transplantation. The mean follow-up was 5.6 ± 3.7 years, and ESKD occurred in 176 (6.2%) individuals. Both a machine learning random forest model and a Cox proportional hazard model selected eGFR, proteinuria, hemoglobin A1c, serum albumin levels, and serum bilirubin levels in a descending order as the most important predictors among 20 baseline variables. A model using eGFR, proteinuria and hemoglobin A1c showed a relatively good performance in discrimination (C-statistic: 0.842) and calibration (Nam and D’Agostino χ2 statistic: 22.4). Adding serum albumin and bilirubin levels to the model further improved it, and a model using 5 variables showed the best performance in the predictive ability (C-statistic: 0.895, χ2 statistic: 7.7). The accuracy of this model was validated in an external cohort (n = 5153). This novel simplified prediction model may be clinically useful for predicting ESKD in patients with diabetes.

DOI： 10.1038/s41598-022-16451-5

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記述言語：英語   出版者・発行元：Epidemiology and Health  

OBJECTIVES: Geographical variation in the standardized mortality ratio (SMR) for ischemic heart disease (IHD) among municipalities has not been assessed in Japan. Additionally, associations between area-level socioeconomic deprivation indices and IHD mortality have not been identified in Japan. The present study investigated this association. METHODS: Information on IHD mortality was extracted from Vital Statistics data from 2018 to 2020 for each municipality in Japan. The socioeconomic deprivation level was derived from multiple socioeconomic characteristics. We classified municipalities into quintiles based on the deprivation level and investigated the association between the deprivation level and the SMR of IHD. Additionally, a Bayesian spatial regression model was used to investigate this association, adjusting for other municipal characteristics. RESULTS: Geographical variation in the SMR of IHD was revealed, and municipalities with high SMRs were spatially clustered. There was a weak negative correlation between the socioeconomic deprivation level and the SMRs (correlation coefficient, -0.057 for men and -0.091 for women). In contrast, the regression analysis showed a statistically significant positive association between deprived areas and the IHD mortality rate, and the relative risks for the most deprived municipalities compared with the least deprived municipalities were 1.184 (95% credible interval [CrI], 1.110 to 1.277) and 1.138 (95% CrI, 1.048 to 1.249) for men and women, respectively. CONCLUSIONS: A weak negative correlation between the socioeconomic deprivation level and the SMR was observed in the descriptive analysis, while the regression analysis showed that living in deprived areas was statistically positively associated with the IHD mortality rate.

DOI： 10.4178/epih.e2022059

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記述言語：英語   出版者・発行元：PLoS ONE  

Objective Previous reports have demonstrated the association of serum bilirubin levels with the progression of diabetic nephropathy. The objective of this study is to assess the association of basal bilirubin levels with progressive renal decline (PRD) and end-stage kidney disease (ESKD). Methods A total of 298 patients with diabetes who visited Kyushu University Hospital (Japan) were recruited and followed up for 10 years. PRD was defined as a negative change in estimated glomerular filtration ratio (eGFR) >3.7%/year, 2.5th percentile. Logistic regression analysis was performed to evaluate the association of total bilirubin levels with PRD and its cut-off point was determined by receiver operating characteristic (ROC) analysis. Kaplan-Meier method and Cox hazard regression analysis were used to evaluate the predictive ability of its cut-off point for ESKD. Results Logistic regression model showed that total bilirubin levels were significantly associated with PRD, and ROC analysis showed that its cut-off point was 0.5 mg/dL. Kaplan-Meier method showed that the percent of patients who reached two endpoints, composite endpoint (ESKD or doubling of creatinine level) or 30% eGFR decline, was significantly higher in the low bilirubin group than in the high bilirubin group (18.5% vs 11.0%, P = 0.045; 49.1% vs 42.1%, P = 0.045, respectively, log-rank test). Cox hazard regression models confirmed the independence of the predictive ability of its cut-off point. Conclusions Serum total bilirubin levels were negatively associated with PRD in diabetic nephropathy and its cut-off point was 0.5 mg/dL. It may be clinically useful for identifying patients at high risk of ESKD.

DOI： 10.1371/journal.pone.0271179

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記述言語：英語   出版者・発行元：(一社)日本腎臓学会  

レセプト情報・特定健診等情報データベース(NDB)を用いて、透析患者数の季節的な推移について検討した。2011年4月から2015年3月までにNDBに登録された医療費請求データを分析した。1300億件の記録から、1ヵ月に1回以上血液透析(HD)を受けた患者の記録を対象とした。調査期間の最終月には、患者274100例が慢性HDを受けていることが確認され、それまでの手動調査で確認された患者数の95%以上と推定された。新規にHDを開始した患者数は約5000～7000例であり、冬から春にかけて増加し、夏から秋にかけて減少するというわずかな季節性が観察された。HD開始後3ヵ月以内の患者の死亡率は、推定される腎転帰を考慮するとほぼ25%であり、冬に増加し夏に減少するという再現性のある季節変動が認められた。一時的HDの発生は、冬季、特に12月から2月にかけて、他の月と比較して有意に高かった。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/978-3-030-91237-6_44

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.4178/epih.e2022059

記述言語：英語   出版者・発行元：Journal of Preventive Medicine and Public Health  

Objectives: No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data. Methods: Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births. Results: Unemployed households had the highest preterm birth rate, and households with an occupation classification of “full-time worker 2” (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan. Conclusions: Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.

DOI： 10.3961/jpmph.22.178

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Studies in Health Technology and Informatics  

In Japan, the polypharmacy reduction policy for psychotropic drugs is intended to reduce the reimbursement of medical costs when 'three or more types of psychotropic drugs' are prescribed. However, non-polypharmacy patients who need multiple drugs are also comprehensively evaluated. This study demonstrated that the polypharmacy reduction policy for psychotropic drugs is associated with reductions of the amounts of in-hospital prescriptions for patients using antidepressants, antipsychotics, anxiolytics, and benzodiazepines.

DOI： 10.3233/SHTI220303

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記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Computer Methods and Programs in Biomedicine Update  

Background: A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. Methods: The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients’ treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. Results: This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1–2 weeks. Conclusions: This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.

DOI： 10.1016/j.cmpbup.2022.100061

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ Open  

Introduction Immunotherapy is the fourth leading therapy for lung cancer following surgery, chemotherapy and radiotherapy. Recently, several studies have reported about the potential association between the gut microbiome and therapeutic response to immunotherapy. Nevertheless, the specific composition of the gut microbiome or combination of gut microbes that truly predict the efficacy of immunotherapy is not definitive. Methods and analysis The present multicentre, prospective, observational study aims to discover the specific composition of the gut microbiome or combination of gut microbes predicting the therapeutic response to immunotherapy in lung cancer using artificial intelligence. The main inclusion criteria are as follows: (1) pathologically or cytologically confirmed metastatic or postoperative recurrent lung cancer including non-small cell lung cancer and small cell lung cancer; (2) age≥20 years at the time of informed consent; (3) planned treatment with immunotherapy including combination therapy and monotherapy, as the first-line immunotherapy; and (4) ability to provide faecal samples. In total, 400 patients will be enrolled prospectively. Enrolment will begin in 2021, and the final analyses will be completed by 2024. Ethics and dissemination The study protocol was approved by the institutional review board of each participating centre in 2021 (Kyushu Cancer Center, IRB approved No. 2021-13, 8 June 2021 and Kyushu Medical Center, IRB approved No. 21-076, 31 August 2021). Study results will be disseminated through peer-reviewed journals and national and international conferences. Trial registration number UMIN000046428.

DOI： 10.1136/bmjopen-2022-061674

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1200/JCO.2022.40.16_suppl.e21125

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Studies in Health Technology and Informatics  

A personal health record (PHR) is not only a collection of personal health data but also a personal healthcare and disease management tool for individual patients. Recently, PHRs have been considered indispensable tools for patient engagement in the area of noncommunicable diseases (NCDs) and have gained a special importance. Unfortunately, similar to several other developing countries, Bangladesh remains far behind in establishing a standard PHR system for the country despite the fact that the growth of NCDs is extremely high and accounts for approximately 70% of the total diseases experienced in the country. The Portable Health Clinic system, which has a PHR feature, was established in Bangladesh in 2010. This PHR system requires standardization for each country. The objective of this research is to standardize this PHR system with reference to the PHR system proposed by the Japanese Clinical Societies, which is a pioneer of work in this field in Asia.

DOI： 10.3233/SHTI220053

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：南江堂  

DOI： 10.15106/j_naika129_1195

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PLoS ONE  

The coronavirus disease (COVID-19) pandemic has widely spread worldwide since 2020. Several countries have imposed lockdown or stay-at-home policies to prevent the infection. Bangladesh experienced a lockdown from March 2020 to May 2020, and internal travel was restricted. Such long and strict confinement may impact women’s health. Herein, we aimed to assess the impact of the COVID-19 pandemic on women’s health by comparing their health status before and during the pandemic. We conducted a prospective longitudinal study in two zones in the Chhaygaon union, rural district Shariatpur, Bangladesh. The study population comprised non-pregnant women aged 15–49 years. We visited the household of all eligible women and invited them for health checkups. The survey staff examined their health status at the checkup camps and conducted questionnaire interviews. In total, 121 non-pregnant women received health checkups both from June 2019 to July 2019 and in October 2020, before and during the COVID-19 pandemic, respectively. Compared with those during the 2019 health checkup, the medians of body mass index, systolic blood pressure, and diastolic blood pressure were significantly higher (22.7 kg/m2 to 23.6 kg/m2; 110.0 mmHg to 111.0 mmHg; and 73.0 mmHg to 75.0 mmHg, respectively, p<0.05) during the 2020 health checkup. In contrast, urine glucose levels were significantly lower (10.1% to 3.4%, p = 0.021). The lack of physical activity and other inconvenience accumulation caused by the prolonged confinement might have affected their health status. This necessitates local health workers to promote physical activity to prevent health deterioration during the pandemic.

DOI： 10.1371/journal.pone.0266141

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本気管食道科学会  

DOI： 10.2468/jbes.73.174

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Environmental Research and Public Health  

This study aimed to show geographical differences in esophageal cancer mortality in Japan and reveal an association of esophageal cancer mortality with municipal socioeconomic deprivation level. Esophageal cancer mortality data in the Vital Statistics from 2013 to 2017 for each municipality and corresponding population data were analyzed. The deprivation level was derived from the municipal socioeconomic variables by principal component analysis. Municipalities were classified into five quintiles based on the deprivation level, and an association between the level and esophageal cancer mortality was evaluated using a Bayesian spatial model. As a result of regression analysis, the relative risk of esophageal cancer mortality tended to become larger as the deprivation level increased irrespective of sex, and the relative risk of esophageal cancer mortality was significantly higher in quintile 5 (most deprived) than quintile 1 (least deprived) among men and women. These results suggest that the deprivation level increases the risk of esophageal cancer mortality in Japan.

DOI： 10.3390/ijerph19095483

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Public Health  

Background: We investigated the association between municipal socioeconomic deprivation levels and the positivity of hepatitis B surface antigen (HBsAg) and the prevalence of hepatitis C virus (HCV) among individuals who have never participated in hepatitis screening using Japanese national screening data. Methods: The hepatitis virus screening data analyzed included the 5-year age group-specific number of participants aged 40 years or older, number of HBsAg-positive persons, and number of HCV carriers for each municipality from 2013 to 2017. Principal component analysis was used to derive a socioeconomic deprivation level using the socioeconomic characteristics of municipalities. Bayesian spatial Poisson regression analysis was conducted to investigate the association between the socioeconomic deprivation level and the results of screening. Data on 1,660 municipalities were used in the analysis. Results: The data of 4,233,819 participants in the HBV screening and 4,216,720 in the HCV screening were used in the analysis. A principal component interpreted as level of rurality (principal component 1) and another principal component interpreted as level of low socioeconomic status among individuals (principal component 2) were extracted as the major principal components. Their principal component scores were used as the deprivation levels of municipalities. Spatial regression analysis showed that the deprivation level derived from the sum of the scores of principal components 1 and 2 was significantly and positively associated with HBsAg positivity and HCV prevalence. In addition, the deprivation level derived only from the score of principal component 2 was also significantly and positively associated with the outcomes. Conversely, the deprivation level derived only from the score of principal component 1 was not associated with the outcomes. Moreover, population density was significantly and positively associated with HBsAg positivity and HCV prevalence. Conclusions: This study suggested that participation in hepatitis virus screening is important and meaningful, particularly for areas with a higher lower socioeconomic level in Japan.

DOI： 10.1186/s12889-022-13089-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.1016/j.annonc.2022.02.071

DOI： 10.1016/j.annonc.2022.02.071

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.21203/rs.3.rs-1440453/v1

記述言語：英語   出版者・発行元：Journal of Gastroenterology and Hepatology (Australia)  

Background and Aim: The prevalence of ulcerative colitis (UC) is increasing in Japan. Validated claims-based definitions are required to investigate the epidemiology of UC and its treatment and disease course in clinical practice. This study aimed to develop a claims-based algorithm for UC in Japan. Methods: A committee of epidemiologists, gastroenterologists, and internal medicine physicians developed a claims-based definition for UC, based on diagnostic codes and claims for UC treatments, procedures (cytapheresis), or surgery (postoperative claims). Claims data and medical records for a random sample of 200 cases per site at two large tertiary care academic centers in Japan were used to calculate the positive predictive value (PPV) of the algorithm for three gold standards of diagnosis, defined as physician diagnosis in the medical records, adjudicated cases, or registration in the Japanese Intractable Disease Registry (IDR). Results: Overall, 1139 claims-defined UC cases were identified. Among 393 randomly sampled cases (mean age 44; 48% female), 94% had received ≥ 1 systemic treatment (immunosuppressants, tumor necrosis factor inhibitors, corticosteroids, or antidiarrheals), 7% had cytapheresis, and 7% had postoperative claims. When physician diagnosis was used as a gold standard, PPV was 90.6% (95% confidence interval [CI]: 87.7–93.5). PPV with expert adjudication was also 90.6% (95% CI: 87.7–93.5). PPVs with enrollment in the IDR as gold standard were lower at 41.5% (95% CI: 36.6–46.3) due to incomplete case registration. Conclusions: The claims-based algorithm developed for use in Japan is likely to identify UC cases with high PPV for clinical studies using administrative claims databases.

DOI： 10.1111/jgh.15732

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PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Children  

The differences in the rates and trends of the overall low birth weight and term low birth weight in recent years are unknown for the Japanese prefectures. In this ecological study, we revealed the rates for each prefecture and investigated the factors affecting the regional differences in these outcomes. Aggregated vital statistics data from 2007 to 2019 were obtained from the Ministry of Health, Labour, and Welfare in Japan. The association between the outcomes and the variables, including the infants’ birth characteristics, medical characteristics, and socioeconomic characteristics of the prefectures, were analyzed. An analysis of repeated-measures data was conducted using the data from 2013 and 2018 for each prefecture. The trend for the rates of overall low birth weight and term low birth weight over the years differed among the prefectures. Moreover, the proportions of multiple births and lean (body mass index <18.5 kg/m2) and obese (body mass index ≥25.0 kg/m2) women had a statistically significant positive association with both the overall low birth weight rate and the term low birth weight rate among the prefectures. It was suggested that to resolve the difference in these outcomes among the prefectures, being obese or underweight needs to be addressed in mothers.

DOI： 10.3390/children9030305

Web of Science

Scopus

PubMed

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Computer Methods and Programs in Biomedicine  

Background and objective: Real-world evidence is defined as clinical evidence regarding the use and potential benefits or risks of a medical product derived from real-world data analyses. Standardization and structuring of data are necessary to analyze medical real-world data collected from different medical institutions. An electronic message and repository have been developed to link electronic medical records in this research project, which has simplified the data integration. Therefore, this paper proposes an analysis method and learning health systems to determine the priority of clinical intervention by clustering and visualizing time-series and prioritizing patient outcomes and status during hospitalization. Methods: Common data items for reimbursement (Diagnosis Procedure Combination [DPC]) and clinical pathway data were examined in this project at each participating institution that runs the verification test. Long-term hospitalization data were analyzed using the data stored in the cloud platform of the institutions’ repositories using multiple machine learning methods for classification, visualization, and interpretation. Results: The ePath platform contributed to integrate the standardized data from multiple institutions. The distribution of DPC items or variances could be confirmed by clustering, temporal tendency through the directed graph, and extracting variables that contributed to the prediction and evaluation of SHapley Additive Explanation effects. Constipation was determined to be the risk factor most strongly related to long-term hospitalization. Drainage management was identified as a factor that can improve long-term hospitalization. These analyses effectively extracted patient status to provide feedback to the learning health system. Conclusions: We successfully generated evidence of medical processes by gathering patient status, medical purposes, and patient outcomes with high data quality from multiple institutions, which were difficult with conventional electronic medical records. Regarding the significant analysis results, the learning health system will be used on this project to provide feedback to each institution, operate it for a certain period, and analyze and re-evaluate it.

DOI： 10.1016/j.cmpb.2021.106583

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical and Experimental Nephrology  

Background: The numbers of patients treated with hemodialysis (HD) in Japan are currently quantified by manual survey. As this method requires much effort from medical institutions and cannot achieve 100% response, a more practical method is required. We aimed to establish a novel method for determining the static and dynamic numbers of patients treated with HD. Methods: This observational study used the national medical billing database (termed NDB) of Japan, based on the records of the universal healthcare insurance system. Medical billing data registered in the NDB between April 2011 and March 2015 were analyzed. From 130 billion records, we extracted and analyzed records of patients who had undergone HD at least once per month. Patients’ monthly condition was classified as newly initiated HD, chronic HD, or presumed death, using conditional expressions. We also investigated renal outcome and presumed survival in newly initiated HD patients. Results: In the last month of the study period, 274,100 patients were identified as receiving chronic HD, which is estimated as > 95% of the number of these patients identified in the manual survey so far. The monthly data showed clear seasonality in the incidence of transient HD, which increased in winter and decreased in summer. Conclusion: Analysis of a large national database revealed a significant increase in transient HD in winter and decrease in summer. Applied to additional epidemiological exploratory studies or clinical research, this analytical technique would enable collection of the dynamics of almost all HD patients nationwide.

DOI： 10.1007/s10157-022-02202-3

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Computer Methods and Programs in Biomedicine  

Background and Objective: When using machine learning techniques in decision-making processes, the interpretability of the models is important. In the present paper, we adopted the Shapley additive explanation (SHAP), which is based on fair profit allocation among many stakeholders depending on their contribution, for interpreting a gradient-boosting decision tree model using hospital data. Methods: For better interpretability, we propose two novel techniques as follows: (1) a new metric of feature importance using SHAP and (2) a technique termed feature packing, which packs multiple similar features into one grouped feature to allow an easier understanding of the model without reconstruction of the model. We then compared the explanation results between the SHAP framework and existing methods using cerebral infarction data from our hospital. Results: The interpretation by SHAP was mostly consistent with that by the existing methods. We showed how the A/G ratio works as an important prognostic factor for cerebral infarction using proposed techniques. Conclusion: Our techniques are useful for interpreting machine learning models and can uncover the underlying relationships between features and outcome.

DOI： 10.1016/j.cmpb.2021.106584

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般財団法人 医薬品医療機器レギュラトリーサイエンス財団  

DOI： 10.51018/pmdrs.53.6_460

CiNii Research

記述言語：英語   出版者・発行元：Studies in Health Technology and Informatics  

Rural women in developing countries do not have any option but to visit the distant city to see the obstetricians and gynecologists in case of any maternal and child health issues. However, it becomes more difficult to travel during the COVID-19 pandemic situation. Thus, the telehealth service using the Portable Health Clinic can be very effective for maternal and child health care services. Since the PHC system provides home delivery services through the local health workers, the rural women can avail regular continuum of care services. This study found a 300% increase in participation in the continuum of care. This is not because they receive the service at home but also because they can receive consultancy from urban specialist doctors without travel during the pandemic situation.

DOI： 10.3233/SHTI220700

Scopus

PubMed

CiNii Research

出版者・発行元：LifeTech 2022 - 2022 IEEE 4th Global Conference on Life Sciences and Technologies  

It is essential for a doctor to know a patient's medical history to make an accurate clinical decision, preferably in a short period of time. Most of the patients' medical histories are in analog forms and it is difficult for a doctor to search and find the appropriate information quickly. A doctor-friendly healthcare data visualization tool can assist a doctor in better understanding the patient's status in an accurate and quick manner. Collection, integration, and visualization of personal health data in a standard manner became technically easier due to the rapid advancement of information technologies. The objective of this research is to investigate the state-of-the-art medical history visualization tools that can support doctors. We have reviewed 25 academic papers and found 8 tools are relevant to our objective. We summarised their key features, visualization items, and mechanisms, and listed their limitations. This paper also proposes a unique visualization tool where an individual patient's medical history will be visualized in a single health Gantt chart window and the doctor can get relevant information to ensure efficient decision-making.

DOI： 10.1109/LifeTech53646.2022.9754925

Scopus

記述言語：日本語   出版者・発行元：一般財団法人 医薬品医療機器レギュラトリーサイエンス財団  

DOI： 10.51018/pmdrs.53.6_452

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/healthcare9121724

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi:10.1111/jgh.15732

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： https://doi.org/10.1371/journal.pone.0256894

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400025

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400016

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400020

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400022

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400023

記述言語：英語   掲載種別：研究論文（学術雑誌）  

リポジトリ公開URL： http://hdl.handle.net/2324/4400024

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi10.1145/3194480.3194499

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3233/978-1-61499-830-3-1280

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3233/978-1-61499-830-3-649

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 978-1-61499-830-3-403

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 1-8

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00774-017-0869-9.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2197

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000447629

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DOI： 10.1371/journal.pone.0161439

記述言語：英語  

DOI： 10.1111/ggi.12773

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記述言語：英語  

DOI： 10.4172/2157-7420.1000216

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DOI： 10.1111

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DOI： 10.1186/s12883-015-0439-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1145/2750858.2807533

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記述言語：英語  

DOI： 10.1145/2783258.2788587

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語  

DOI： 10.1111

記述言語：日本語  

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DOI： 10.1016/j.jstrokecerebrovasdis.2015.03.036

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DOI： 10.2196/jmir.3705

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記述言語：日本語  

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記述言語：英語  

DOI： 10.1109/IWCA.2014.6845748

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DOI： 10.1089/tmj.2014.0018

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DOI： 10.1109/AINA.2014.108

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記述言語：英語  

DOI： 10.1111

記述言語：英語  

DOI： 10.1587/transcom.E97.13.540

記述言語：日本語  

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記述言語：英語  

DOI： 10.3233/978-1-61499-289-9-1001

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記述言語：日本語  

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記述言語：日本語  

記述言語：日本語  

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記述言語：日本語  

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DOI： 10.3348/kjr.2012.13.S1.S21

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DOI： 10.1002/lt.22427

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DOI： 10.1007/s00534-010-0351-8

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DOI： 10.1016/j.surg.2009.11.001

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DOI： 10.2337/db08-1494

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DOI： 10.1089/tmj.2008.0067

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