medical process analysis and acquirement of knowledge from clinical information data
Book / Paper
Academic Paper (Judged Full Paper):
1.
Toyoshi Inoguchi, Tasuku Okui, Chinatsu Nojiri, Takanori Yamashita, Masaru Nakayama, Naoki Haruyama, Kunitaka Fukuizumi, Yoshifumi Wakata and Naoki Nakashima : A Novel Kidney Failure Prediction Model in Individuals With CKD: Impact of Serum Bilirubin Levels, The Journal of Clinical Endocrinology and Metabolism, 110, 5, 1375-1383, 2025.
(Summary)
Predicting the progression of chronic kidney disease (CKD) to end-stage kidney disease (ESKD) is crucial for improving patient outcomes. To reveal the highly predictive activity of serum bilirubin levels for the progression of CKD to ESKD, and to develop and validate a novel ESKD prediction model incorporating serum bilirubin levels. We assessed the relative importance of 20 candidate predictors for ESKD, including serum bilirubin levels, in a CKD cohort (15 ≤ estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), and subsequently developed a prediction model using the selected variables. The development cohort comprised 4103 individuals with CKD who underwent follow-up at Kyushu University Hospital, Japan, from 2008 to 2018. The primary outcome was incident ESKD, defined as an eGFR < 15 mL/min/1.73 m2, chronic dialysis, or renal transplantation. The mean follow-up time was 7.0 ± 4.2 years, during which 489 individuals (11.9%) progressed to ESKD. The Cox proportional hazard model selected eGFR, serum bilirubin, proteinuria, age, diabetes, gender, hypertension, serum albumin, and hemoglobin in order of their importance. The predictive performance of the model was optimized by incorporating these 9 variables in discrimination evaluated by time-dependent area under the curve (AUC). This model also demonstrated excellent calibration. Additionally, this model exhibited excellent predictive performance in both discrimination (2-year AUC: 0.943, 5-year AUC: 0.935) and calibration in a validation cohort (n = 2799). Serum bilirubin levels were strong predictors for the progression of CKD to ESKD. Our novel model that incorporates serum bilirubin levels could accurately predict ESKD in individuals with CKD.
Saori Tou, Koutarou Matsumoto, Asato Hashinokuchi, Fumihiko Kinoshita, Hideki Nakaguma, Yukio Kozuma, Rui Sugeta, Yasunobu Nohara, Takanori Yamashita, Yoshifumi Wakata, Tomoyoshi Takenaka, Kazunori Iwatani, Hidehisa Soejima, Tomoharu Yoshizumi, Naoki Nakashima and Masahiro Kamouchi : Data-driven prediction of prolonged air leak after video-assisted thoracoscopic surgery for lung cancer: Development and validation of machine-learning-based models using real-world data through the ePath system, Learning Health Systems, 9, 2, 2025.
(Keyword)
data-driven prediction / electronic clinical pathway / lung cancer / machine learning / prolonged air leak / real-world data / video-assisted thoracoscopic surgery
We recently reported on a late preterm infant born at 36 weeks' gestation with serious arrhythmia due to hyperkalemia associated with long-term maternal ritodrine administration. It is unknown whether ritodrine alone increases the risk of neonatal hyperkalemia in infants born at 34-36 weeks' gestation. This single-center, retrospective, cohort study enrolled late preterm infants (34-36 gestational weeks) born between 2004 and 2018. Cases with maternal magnesium sulfate use were not sufficient for statistical analysis and so were excluded from the study. Risk factors for the occurrence of hyperkalemia were determined based on clinical relevance and previous reports. In all, 212 late preterm infants with maternal ritodrine use and 400 infants without tocolysis were included in the study. Neonatal hyperkalemia occurred in 5.7% (12/212) in the ritodrine group and 1.8% (7/400) in the control group. The risk of neonatal hyperkalemia was significantly increased by maternal ritodrine administration with a crude odds ratio (OR) of 3.37 (95% confidence interval [CI]: 1.30-8.69; p < 0.01) and an adjusted OR of 3.71 (95% CI: 1.41-9.74; p < 0.01) on multivariable analysis. Long-term tocolysis (≥28 days) with ritodrine increased the risk of neonatal hyperkalemia with 9.3% (11/118) of infants developing hyperkalemia (adjusted OR 4.86; 95% CI: 1.59-14.83; p < 0.01). Neonatal hyperkalemia was not found within 2 weeks of ritodrine administration. This research suggests that late preterm infants born after long-term ritodrine administration are at risk of neonatal hyperkalemia and require special attention.
Masato Tagi, Mari Tajiri, Yasuhiro Hamada, Yoshifumi Wakata, Xiao Shan, Kazumi Ozaki, Masanori Kubota, Sosuke Amano, Hiroshi Sakaue, Yoshiko Suzuki and Jun Hirose : Accuracy of an Artificial Intelligence-Based Model for Estimating Leftover Liquid Food in Hospitals: Validation Study., JMIR Formative Research, 6, 5, e35991, 2022.
(Summary)
An accurate evaluation of the nutritional status of malnourished hospitalized patients at a higher risk of complications, such as frailty or disability, is crucial. Visual methods of estimating food intake are popular for evaluating the nutritional status in clinical environments. However, from the perspective of accurate measurement, such methods are unreliable. The accuracy of estimating leftover liquid food in hospitals using an artificial intelligence (AI)-based model was compared to that of visual estimation. The accuracy of the AI-based model (AI estimation) was compared to that of the visual estimation method for thin rice gruel as staple food and fermented milk and peach juice as side dishes. A total of 576 images of liquid food (432 images of thin rice gruel, 72 of fermented milk, and 72 of peach juice) were used. The mean absolute error, root mean squared error, and coefficient of determination (R) were used as metrics for determining the accuracy of the evaluation process. Welch t test and the confusion matrix were used to examine the difference of mean absolute error between AI and visual estimation. The mean absolute errors obtained through the AI estimation approach were 0.63 for fermented milk, 0.25 for peach juice, and 0.85 for the total. These were significantly smaller than those obtained using the visual estimation approach, which were 1.40 (P<.001) for fermented milk, 0.90 (P<.001) for peach juice, and 1.03 (P=.009) for the total. By contrast, the mean absolute error for thin rice gruel obtained using the AI estimation method (0.99) did not differ significantly from that obtained using visual estimation (0.99). The confusion matrix for thin rice gruel showed variation in the distribution of errors, indicating that the errors in the AI estimation were biased toward the case of many leftovers. The mean squared error for all liquid foods tended to be smaller for the AI estimation than for the visual estimation. Additionally, the coefficient of determination (R) for fermented milk and peach juice tended to be larger for the AI estimation than for the visual estimation, and the R value for the total was equal in terms of accuracy between the AI and visual estimations. The AI estimation approach achieved a smaller mean absolute error and root mean squared error and a larger coefficient of determination (R) than the visual estimation approach for the side dishes. Additionally, the AI estimation approach achieved a smaller mean absolute error and root mean squared error compared to the visual estimation method, and the coefficient of determination (R) was similar to that of the visual estimation method for the total. AI estimation measures liquid food intake in hospitals more precisely than visual estimation, but its accuracy in estimating staple food leftovers requires improvement.
Takanori Yamashita, Yoshifumi Wakata, Hideki Nakaguma, Yasunobu Nohara, Shinj Hato, Susumu Kawamura, Shuko Muraoka, Masatoshi Sugita, Mihoko Okada, Naoki Nakashima and Hidehisa Soejima : Machine learning for classification of postoperative patient status using standardized medical data, Computer Methods and Programs in Biomedicine, 214, 106583, 2021.
(Summary)
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. 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. 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. 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.
(Keyword)
Clinical pathway / Diagnosis procedure combination (DPC) / Learning health system / Machine learning / Real-world data (RWD)
Kotaro Matsumoto, Yasunobu Nohara, Yoshifumi Wakata, Takanori Yamashita and Yukio Kozuma : Impact of a learning health system on acute care and medical complications after intracerebral hemorrhage, Learning Health Systems, 2020.
(Keyword)
learning health system / oral care / pneumonia / stroke
Jun Hirose, Yoshifumi Wakata, Masato Tagi and Yuu Tamaki : The role of medical informatics in the management of medical information, The Journal of Medical Investigation : JMI, 67, 1,2, 27-29, 2020.
(Summary)
With progress in information and communication technology, medical information has been converted to digital formats and stored and managed using computer systems. The construction, management, and operation of medical information systems and regional medical liaison systems are the main components of the clinical tasks of medical informatics departments. Research using medical information accumulated in these systems is also a task for medical informatics department. Recently, medical real-world data (RWD) accumulated in medical information systems has become a focus not only for primary use but also for secondary uses of medical information. However, there are many problems, such as standardization, collection, cleaning, and analysis of them. The internet of things and artificial intelligence are also being applied in the collection and analysis of RWD and in resolving the above problems. Using these new technologies, progress in medical care and clinical research is about to enter a new era. J. Med. Invest. 67 : 27-29, February, 2020.
Atsushi Kimura, Yoshihiro Matsumoto, Yoshifumi Wakata, Akiko Oyamada, Masanobu Ohishi, Toshifumi Fujiwara, Ko Ikuta, Kuniyoshi Tsuchiya, Naohisa Tayama, Shinji Tomari, Hisaaki Miyahara, Takao Mae, Toshihiko Hara, Taichi Saito, Takeshi Arizono, Kozo Kaji, Taro Mawatari, Masami Fujiwara, Riku Sakimura, Kunichika Shin, Kenichi Ninomiya, Kazutoshi Nakaie, Yasuaki Antoku, Shoji Tokunaga, Naoki Nakashima, Yukihide Iwamoto and Yasuharu Nakashima : Predictive factors of mortality of patients with fragility hip fractures at 1 year after discharge: A multicenter, retrospective study in the northern Kyushu district of Japan., Journal of Orthopaedic Surgery (Hong Kong), 27, 3, 2019.
(Summary)
, TCCI 5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.
Rieko Izukura, Tadashi Kandabashi, Yoshifumi Wakata, Chinatsu Nojiri, Yasunobu Nohara, Takanori Yamashita, Atsushi Takada, Jinsang Park, Yoshiaki Uyama and Naoki Nakashima : The Development of an Electronic Phenotyping Algorithm for Identifying Rhabdomyolysis Patients in the MID-NET Database., Studies in Health Technology and Informatics, 264, 1498-1499, 2019.
(Summary)
We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.
(Keyword)
Algorithms / Databases, Factual / Electronic Health Records / Humans / Machine Learning / Rhabdomyolysis
Akiko Oyamada, Yoshihiro Matsumoto, Yoshifumi Wakata, Atsushi Kimura, Ko Ikuta, Kuniyoshi Tsuchiya, Naohisa Tayama, Shinji Tomari, Hisaaki Miyahara, Takao Mae, Hirokazu Shiraishi, Taichi Saito, Takeshi Arizono, Kozo Kaji, Taro Mawatari, Masami Fujiwara, Riku Sakimura, Kunichika Shin, Kenichi Ninomiya, Kazutoshi Nakaie, Yasuaki Antoku, Shoji Tokunaga, Naoki Nakashima, Yukihide Iwamoto and Yasuharu Nakashima : Characteristics of patients with fragility hip fractures in the northern Kyushu district in Japan: a multicenter prospective registry based on an electronic data capture system, Journal of Bone and Mineral Metabolism, 36, 5, 596-604, 2017.
(Summary)
Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.
(Keyword)
Electronic data capture system / Fragility hip fracture / Multicenter prospective registry / Osteoporosis
Masayuki Ochiai, Hiroaki Kurata, Hirosuke Inoue, Koichi Tanaka, Yuki Matsushita, Junko Fujiyoshi, Yoshifumi Wakata, Kiyoko Kato, Tomoaki Taguchi and Hidetoshi Takada : An Elevation of Serum Ferritin Level Might Increase Clinical Risk for the Persistence of Patent Ductus Arteriosus, Sepsis and Bronchopulmonary Dysplasia in Erythropoietin-Treated Very-Low-Birth-Weight Infants, Neonatology, 111, 1, 68-75, 2016.
(Summary)
The substantial risk of iron overload is not routinely monitored in most of the neonatal intensive care units (NICUs) in Japan; however, blood transfusion is an essential strategy for successfully treating preterm low-birth-weight infants. The aim of this study was to investigate the iron status and clinical features of infants with a birth weight of <1,500 g, i.e. very-low-birth-weight infants (VLBWIs). This prospective observational study enrolled 176 (82.6%) patients from a total of 213 VLBWIs admitted to our NICU from 2009 to 2014. Clinical information was collected including maternal records and infant morbidity and treatment. Management strategies including enteral iron supplementation, erythropoietin administration and blood transfusion were allowed according to the consensus in Japan. The hematological status was surveyed from birth to 12 postnatal weeks of age. The iron status was determined according to serum iron, unbound iron-binding capacity and serum ferritin. The definition of hyperferritinemia was set as a value of ≥500 ng/ml. Twenty-four (13.6%) infants displayed hyperferritinemia. A multiple logistic analysis selected 3 associated factors of hyperferritinemia: surgical ligation for patent ductus arteriosus, sepsis and moderate or severe states of bronchopulmonary dysplasia. We also verified that the value of ferritin was significantly correlated with those of aspartate transaminase, creatine kinase and C-reactive protein according to a multilinear regression analysis. After excluding the ferritin data of these outliers, we did not observe any factors associated with hyperferritinemia. Hyperferritinemia might be associated with oxygen radical diseases and susceptibility to infection.
(Keyword)
Anemia of prematurity / Blood transfusion / Erythropoietin / Iron supplementation
Koji Tanaka, Takeshi Yamada, Takako Torii, Shoji Matsumoto, Takeo Yoshimura, Ichiro Kei Takase, Yoshifumi Wakata, Naoki Nakashima, Ichi Jun Kira and Hiroyuki Murai : Predictive Factors for Excellent or Extremely Poor Functional Outcome in Initial Atrial Fibrillation-Related Cardioembolic Stroke, European Neurology, 76, 3-4, 105-111, 2016.
(Summary)
We aimed to determine the predictive factors for excellent or extremely poor functional outcome in patients with first-ever atrial fibrillation (AF)-related cardioembolic stroke. Retrospective observational study from a database. Patients with AF-related cardioembolic stroke with a premorbid modified Rankin Scale (mRS) score of 0 or 1 and without a previous history of stroke were included. Factors associated with excellent functional outcome (mRS scores of 0 or 1; n = 77; 30.4% of patients) included age >78 years (OR 0.31, 95% CI 0.15-0.61), male sex (OR 2.16, 95% CI 1.04-4.60), absence of hypertension (OR 0.46, 95% CI 0.22-0.94) and initial National Institutes of Health Stroke Scale (NIHSS) score of >9 (OR 0.08, 95% CI 0.03-0.16). Factors associated with extremely poor functional outcome (mRS scores of 5 or 6; n = 63; 24.9%) included age >78 years (OR 3.30, 95% CI 1.54-7.39), initial NIHSS score of >9 (OR 12.38, 95% CI 5.40-32.56), congestive heart failure (OR 4.82, 95% CI 2.00-12.19) and ischemic heart disease (OR 4.02, 95% CI 1.18-14.69). Predictive factors exist to delineate excellent and extremely poor functional outcomes after a first-time stroke associated with AF.
Koji Tanaka, Takeshi Yamada, Takako Torii, Shoji Matsumoto, Takeo Yoshimura, Ichiro Kei Takase, Yoshifumi Wakata, Naoki Nakashima, Ichi Jun Kira and Hiroyuki Murai : Clinical characteristics of atrial fibrillation-related cardioembolic stroke in patients aged 80 years or older, Geriatrics & Gerontology International, 17, 5, 708-713, 2016.
(Summary)
Atrial fibrillation (AF)-related cardioembolic stroke is a serious problem in the aging society. The present study examined the clinical characteristics and outcomes of AF-related cardioembolic stroke in patients aged ≥80 years. Between September 2011 and April 2014, consecutive patients with ischemic stroke and AF were retrospectively extracted from the multicenter database. Clinical characteristics were compared between patients aged ≥80 years and <80 years. Multivariate cox proportional hazard models were used to estimate hazard ratios and 95% confidential intervals on 90-day mortality for age of ≥80 years. A total of 253 patients aged ≥80 years (87 men, 86.4 ± 5.0 years) and 196 patients aged <80 years (134 men, 70.4 ± 7.1 years) were included. Patients aged ≥80 years were more frequently female, and more likely to have higher premorbid modified Rankin Scale score (mRS), lower body mass index, previous history of stroke, prior antiplatelet therapy, congestive heart failure, and persistent AF. Patients aged ≥80 years had higher initial National Institutes of Health Stroke Scale score and were more likely to have occlusion of the cervicocephalic arteries, but less likely to receive thrombolysis. Patients aged ≥80 years had a higher mRS and mortality after 3 months. Age of ≥80 years was a significant predictor of 90-day mortality after adjustment for sex (hazard ratio 2.20, 95% confidential interval 1.25-4.09), but was no longer significant after further adjustment for other clinical characteristics and stroke severity. In AF-related cardioembolic stroke, patients aged ≥80 years had different clinical characteristics and poorer outcome compared with patients aged <80 years. Geriatr Gerontol Int 2017; 17: 708-713.
(Keyword)
aged 80 years and over / atrial fibrillation / outcomes / risk factors / stroke
Koji Tanaka, Takeshi Yamada, Takako Torii, Takeo Yoshimura, ichiro Kei Takase, Osamu Togao, Yoshifumi Wakata, Akio Hiwatashi, Naoki Nakashima, ichi Jun Kira and Hiroyuki Murai : Pure dysarthria and dysarthria-facial paresis syndrome due to internal capsule and/or corona radiata infarction, BMC Neurology, 15, 1, 184, 2015.
(Summary)
Pure dysarthria (PD) and dysarthria-facial paresis syndrome (DFP) mainly result from lenticulostriate artery territory infarction. PD and DFP are rare clinical entities, often grouped without distinction. The purpose of this study was to examine clinical and radiographic differences between PD and DFP due to unilateral internal capsule and/or corona radiata infarction. Using a database that included consecutive patients with ischemic stroke admitted to the neurological stroke units of three hospitals within 7 days from onset between September 2011 and April 2014, we retrospectively extracted first-ever stroke patient data, who presented with PD or DFP with a single ischemic lesion localized in the internal capsule and/or corona radiata. Patients with weakness, ataxia, sensory deficit, or cortical symptoms were excluded. Ischemic lesion volume was calculated by the ABC/2 method on diffusion-weighted imaging (DWI). DWI images were normalized and superimposed to the template for PD and DFP. We compared patients' characteristics between PD and DFP. A total of 2126 patients, including 65 patients (3.1%) with PD or DFP, were registered. Of these, 13 PD patients and 18 patients with DFP due to unilateral internal capsule and/or corona radiata infarction were included for analysis. Compared with DFP patients, PD patients had longer onset-to-door time (median 37.5 vs. 10.8 h, p = 0.031), shorter vertical length (C component) of ischemic lesions (median 12.0 vs. 18.8 mm, p = 0.007), and smaller ischemic lesion volume (median 285 vs. 828 mm(3), p = 0.023). Ischemic lesions causing PD were located more frequently in the left hemisphere than DFP (92% vs. 56%, p = 0.045). The superimposed lesion pattern indicated that DFP had lesions more medial and involving posterior portions of the putamen and the caudate body, as well as more of the genu and posterior limb of the internal capsule, than PD. Ninety days after onset, symptoms disappeared in 21 (72%) out of 29 patients. In cerebral infarction limited to the internal capsule and/or corona radiata, PD is derived from smaller and left-sided lesions with delay in diagnosis compared with DFP. The clinical course of those with PD and DFP might be benign.
(Keyword)
Cerebral small vessel diseases / Diffusion magnetic resonance imaging / Dysarthria / Facial paresis / Ischemic stroke
Koji Tanaka, Takeshi Yamada, Takako Torii, Konosuke Furuta, Shoji Matsumoto, Takeo Yoshimura, Ichiro Kei Takase, Yoshifumi Wakata, Naoki Nakashima, Ichi Jun Kira and Hiroyuki Murai : Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores on severity and functional outcome in acute ischemic stroke with atrial fibrillation, Journal of Stroke & Cerebrovascular Diseases, 24, 7, 1629-1635, 2015.
(Summary)
We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF). Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS ≥ 3 at 3 months from the onset) was assessed. A total of 344 patients (189 were men; age, 77.7 ± 10.0 years) were included in the analysis. The median pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS2 (ϱ = .116, P = .031), CHA2DS2-VASc (ϱ = .166, P = .020), and R2CHADS2 scores (ϱ = .106, P = .049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS2 score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC], .654), CHA2DS2-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC, .683), and R2CHADS2 score of 4 or more (sensitivity, 61%; specificity, 62%; AUC, .657) were associated with unfavorable outcome. The pre-admission CHA2DS2-VASc score was better than the pre-admission CHADS2 score in estimating unfavorable outcome (P = .017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with onset severity and functional outcome in acute ischemic stroke with AF.
Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Yoshifumi Wakata, Takashi Nagata and Yoshihiro Nabeshima : Prehospital Lactated Ringer's Solution Treatment and Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis, PLoS Medicine, 10, 2, e1001394, 2013.
(Summary)
No studies have evaluated whether administering intravenous lactated Ringer's (LR) solution to patients with out-of-hospital cardiac arrest (OHCA) improves their outcomes, to our knowledge. Therefore, we examined the association between prehospital use of LR solution and patients' return of spontaneous circulation (ROSC), 1-month survival, and neurological or physical outcomes at 1 month after the event. We conducted a prospective, non-randomized, observational study using national data of all patients with OHCA from 2005 through 2009 in Japan. We performed a propensity analysis and examined the association between prehospital use of LR solution and short- and long-term survival. The study patients were ≥18 years of age, had an OHCA before arrival of EMS personnel, were treated by EMS personnel, and were then transported to hospitals. A total of 531,854 patients with OHCA met the inclusion criteria. Among propensity-matched patients, compared with those who did not receive pre-hospital intravenous fluids, prehospital use of LR solution was associated with an increased likelihood of ROSC before hospital arrival (odds ratio [OR] adjusted for all covariates [95% CI] = 1.239 [1.146-1.339] [p<0.001], but with a reduced likelihood of 1-month survival with minimal neurological or physical impairment (cerebral performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.764 [0.589-0.992] [p = 0.04]; and overall performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.746 [0.573-0.971] [p = 0.03]). There was no association between prehospital use of LR solution and 1-month survival (OR adjusted for all covariates [95% CI] = 0.960 [0.854-1.078]). In Japanese patients experiencing OHCA, the prehospital use of LR solution was independently associated with a decreased likelihood of a good functional outcome 1 month after the event, but with an increased likelihood of ROSC before hospital arrival. Prehospital use of LR solution was not associated with 1-month survival. Further study is necessary to verify these findings. Please see later in the article for the Editors' Summary.
(Keyword)
Aged / Aged, 80 and over / Case-Control Studies / Chi-Square Distribution / Emergency Medical Services / Female / Fluid Therapy / Humans / Infusions, Intravenous / Isotonic Solutions / Japan / Logistic Models / Male / Middle Aged / Multivariate Analysis / Odds Ratio / Out-of-Hospital Cardiac Arrest / Propensity Score / Prospective Studies / Registries / Ringer's Lactate / Risk Assessment / Risk Factors / Survival Analysis / Time Factors / Treatment Outcome
Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Takashi Nagata, Yoshifumi Wakata and Shogo Miyazaki : Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest, JAMA, 307, 11, 1161-1168, 2012.
(Summary)
Epinephrine is widely used in cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA). However, the effectiveness of epinephrine use before hospital arrival has not been established. To evaluate the association between epinephrine use before hospital arrival and short- and long-term mortality in patients with cardiac arrest. Prospective, nonrandomized, observational propensity analysis of data from 417 188 OHCAs occurring in 2005-2008 in Japan in which patients aged 18 years or older had an OHCA before arrival of emergency medical service (EMS) personnel, were treated by EMS personnel, and were transported to the hospital. Return of spontaneous circulation before hospital arrival, survival at 1 month after cardiac arrest, survival with good or moderate cerebral performance (Cerebral Performance Category [CPC] 1 or 2), and survival with no, mild, or moderate neurological disability (Overall Performance Category [OPC] 1 or 2). Return of spontaneous circulation before hospital arrival was observed in 2786 of 15,030 patients (18.5%) in the epinephrine group and 23,042 of 402,158 patients (5.7%) in the no-epinephrine group (P < .001); it was observed in 2446 (18.3%) and 1400 (10.5%) of 13,401 propensity-matched patients, respectively (P < .001). In the total sample, the numbers of patients with 1-month survival and survival with CPC 1 or 2 and OPC 1 or 2, respectively, were 805 (5.4%), 205 (1.4%), and 211 (1.4%) with epinephrine and 18,906 (4.7%), 8903 (2.2%), and 8831 (2.2%) without epinephrine (all P <.001). Corresponding numbers in propensity-matched patients were 687 (5.1%), 173 (1.3%), and 178 (1.3%) with epinephrine and 944 (7.0%), 413 (3.1%), and 410 (3.1%) without epinephrine (all P <.001). In all patients, a positive association was observed between prehospital epinephrine and return of spontaneous circulation before hospital arrival (adjusted odds ratio [OR], 2.36; 95% CI, 2.22-2.50; P < .001). In propensity-matched patients, a positive association was also observed (adjusted OR, 2.51; 95% CI, 2.24-2.80; P < .001). In contrast, among all patients, negative associations were observed between prehospital epinephrine and long-term outcome measures (adjusted ORs: 1-month survival, 0.46 [95% CI, 0.42-0.51]; CPC 1-2, 0.31 [95% CI, 0.26-0.36]; and OPC 1-2, 0.32 [95% CI, 0.27-0.38]; all P < .001). Similar negative associations were observed among propensity-matched patients (adjusted ORs: 1-month survival, 0.54 [95% CI, 0.43-0.68]; CPC 1-2, 0.21 [95% CI, 0.10-0.44]; and OPC 1-2, 0.23 [95% CI, 0.11-0.45]; all P < .001). Among patients with OHCA in Japan, use of prehospital epinephrine was significantly associated with increased chance of return of spontaneous circulation before hospital arrival but decreased chance of survival and good functional outcomes 1 month after the event.
(Keyword)
Adrenergic beta-Agonists / Aged / Aged, 80 and over / Blood Circulation / Cardiopulmonary Resuscitation / Emergency Medical Services / Epinephrine / Female / Humans / Infusions, Intravenous / Japan / Male / Middle Aged / Out-of-Hospital Cardiac Arrest / Prospective Studies / Registries / Survival Analysis
Yoshifumi Wakata, Naoki Nakashima, Akinobu Taketomi, Ken Shirabe, Yoshihiko Maehara and Akihito Hagihara : Factors associated with the postoperative status of donor patients for living donor liver transplantation, Liver Transplantation, 17, 12, 1412-1419, 2011.
(Summary)
Deceased donor liver transplantation has been an established surgical procedure since the 1960s. More recently, the technique of living donor liver transplantation (LDLT) was introduced, and it is being performed with increasing frequency. However, there is a paucity of information on the clinical outcomes of donor patients. In this study, which was conducted at a single university hospital, the relationship between potentially relevant factors (eg, patient characteristics, preoperative status, and operation characteristics) and postoperative developments in donor patients was examined. We used electronic critical pathways, which are charts of medical process that include favorable states (defined as outcomes) to be achieved during the hospital stay of a patient; predefined outcomes that are not achieved are recorded as variances. With the electronic critical pathway system, objective data about the conditions of patients and relevant clinical processes could be collected readily. Using data from the electronic critical pathways for LDLT donor patients and applying multiple logistic regression analysis, we examined factors that were related to the variance of each outcome measure for postoperative developments. Among the various donor characteristics, the duration of the operation was related to variance in 5 types of health outcomes, age and blood loss volume were related to variance in 2 types of health outcomes, and other characteristics (ie, sex, body surface area, operation urgency, and volume ratio of the remnant liver) were related to variance in 1 type of health outcome. In conclusion, the findings in this study may facilitate improvements in the postoperative status of LDLT donor patients. Further studies that incorporate analogous data from other medical facilities are necessary to verify these findings.
(Keyword)
Adult / Critical Pathways / Electronic Health Records / Female / Hepatectomy / Hospitals, University / Humans / Japan / Liver Transplantation / Living Donors / Logistic Models / Male / Postoperative Complications / Risk Assessment / Risk Factors / Treatment Outcome / Young Adult
Fumihiro Shoji, Tokujiro Yano, Akira Haro, Tsukihisa Yoshida, Kensaku Ito, Yosuke Morodomi, Yoshifumi Wakata and Yoshihiko Maehara : Assessing a clinical pathway to improve the quality of care in pulmonary resections, Surgery Today, 41, 6, 787-790, 2011.
(Summary)
To evaluate the efficacy of the current clinical pathway for pulmonary resections. This study examined variances from expected clinical pathway outcomes for pulmonary resections performed between 2005 and 2009. Data on a total of 383 patients were retrospectively analyzed. The median length of hospital stay (LOS) using the clinical pathway was 12 days (range: 1-188 days); the mean LOS was 15.5 days. The cost per day with use of the clinical pathway was 102 726 yen. Poor control of pain from intercostal neuralgia was the most frequently observed variance from expected outcomes. It affected 119 of 168 electronic clinical pathway patients (70.8%). The clinical pathway was terminated in 3.9% of patients (15/383) due to serious or life-threatening complications. This study showed the single institutional experience of the clinical pathway for pulmonary resections. These findings indicate a need to revise certain aspects of the pathway, based on data from our analysis of variances.
Takeshi Ogose, Wataru Tamaki, Kumi Shinahara, Masaya Kaneko, Yoshifumi Wakata and Keishi Naruse : A case of recurrent myositis as the main manifestation of Behçet disease, Pediatrics International, 52, 2, e101-e104, 2010.
Takeshi Ogose, Yoshifumi Wakata, Masaya Kaneko, Kumi Shinahara, Tomoki Takechi and Haruko Kotani : A case of recurrent paroxysmal cold hemoglobinuria with the different temperature thresholds of Donath-Landsteiner antibodies, Journal of Pediatric Hematology/Oncology, 29, 10, 716-719, 2007.
(Summary)
In this article, we first report a case of recurrent paroxysmal cold hemoglobinuria with serologic confirmation. On 2 occasions, the Donath-Landsteiner (DL) antibodies belonged to an IgM subclass and showed neither anti-P nor anti-I specificity. Furthermore, it is very interesting that the temperature thresholds of DL antibodies were different on each occasion. Although acute paroxysmal cold hemoglobinuria is considered to be self-limited and transient, we should be careful of its possible recurrence. DL tests must be repeated after the complete recovery from the first episode, with careful attention to several possible causes of false-negative DL tests.
(Keyword)
Childhood / Donath-Landsteiner test / Paroxysmal cold hemoglobinuria / Recurrence / Temperature threshold
H. Watanabe, T. Watanabe, H. Suzuya, Yoshifumi Wakata, M. Kaneko, T. Onishi, Y. Okamoto, T. Abe, Y. Kawano, S. Kagami and Y. Takaue : Peripheral blood stem cell mobilization by granulocyte colony-stimulating factor alone and engraftment kinetics following autologous transplantation in children and adolescents with solid tumor, Bone Marrow Transplantation, 37, 7, 661-668, 2006.
(Summary)
In 56 pediatric and adolescent patients (median age 7 years, range 1-21) with various solid tumors, peripheral blood stem cells (PBSC) were mobilized with granulocyte colony-stimulating factor (G-CSF) alone, and the yields of PBSC and engraftment kinetics following autologous peripheral blood stem cell transplantation (PBSCT) were evaluated retrospectively. Granulocyte colony-stimulating factor (10 microg/kg) was injected subcutaneously for mobilization when patients showed no influence of previous chemotherapy, and administration was continued for 5 days. The peaks of CD34+ cells and colony-forming units-granulocyte/macrophage in the blood were observed on days 4 through 6 of G-CSF administration in all patients. Peripheral blood stem cell harvest was commenced on day 5 of G-CSF treatment. Compared to the results in patients mobilized by chemotherapy plus G-CSF (N=18), the progenitor cell yields were lower in patients mobilized with G-CSF alone. However, there were no significant differences in WBC and ANC engraftment compared to the chemotherapy plus G-CSF mobilization group. Platelet recovery following autologous PBSCT was delayed in patients mobilized with G-CSF alone. The median time taken for ANC and platelet counts to reach 0.5 x 10(9) and 20 x 10(9)/l was 12 days (range: 9-28) and 15 days (8-55), respectively, in all patients who received PBSC mobilized by G-CSF alone. In summary, mobilization with G-CSF alone can mobilize sufficient CD34+ cells for successful autografting and sustained hematological reconstitution in pediatric and adolescent patients with solid tumors, and even in heavily pre-treated patients.
Takanori Yamashita, Yoshifumi Wakata, Hideki Nakaguma, Yasunobu Nohara and Shinji Hato : Machine Learning for Classification of Postoperative Patient Status Using Standardized Medical Data, APAMI 2020, Nov. 2020.
Yasunobu Nohara, Yoshifumi Wakata and Naoki Nakashima : Interpreting Medical Information Using Machine Learning and Individual Conditional Expectation, Studies in Health Technology and Informatics, 216, 1073, 2015.
(Summary)
Recently, machine-learning techniques have spread many fields. However, machine-learning is still not popular in medical research field due to difficulty of interpreting. In this paper, we introduce a method of interpreting medical information using machine learning technique. The method gave new explanation of partial dependence plot and individual conditional expectation plot from medical research field.
Takanori Yamashita, Yoshifumi Wakata, Satoshi Hamai, Yasuharu Nakashima, Yukihide Iwamoto, Brendan Franagan, Naoki Nakashima and Sachio Hirokawa : Temporal Relation Extraction in Outcome Variances of Clinical Pathways, Studies in Health Technology and Informatics, 216, 1077, 2015.
(Summary)
Recently the clinical pathway has progressed with digitalization and the analysis of activity. There are many previous studies on the clinical pathway but not many feed directly into medical practice. We constructed a mind map system that applies the spanning tree. This system can visualize temporal relations in outcome variances, and indicate outcomes that affect long-term hospitalization.
(Keyword)
Clinical pathway / Hip replacement arthroplasty / Mind map / Spanning Tree
Masato Tagi, Jun Hirose, Yoshifumi Wakata and Xiao Shan : Visualization of the hospital network flow and the security alert function by automatic analysis of NetFlow data : Evaluation of the usefulness of security system, 月刊新医療, 47, 11, 38-41, Nov. 2020.