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Background: Clinicians' research activities reportedly improve their healthcare performance. Presenting research at conferences may be related to improved patient care outcomes; however, few studies have investigated this relationship. Thus, we examined the association between presenting at conferences and the mortality of patients hospitalized for acute myocardial infarction. Methods: We analyzed an administrative database of acute care hospitals in Japan. The study compared patients admitted to hospitals in which physicians made at least one conference presentation during the patient's admission year (Presentation Group) with those admitted to hospitals with no conference presentations (Control group). We performed multivariable logistic regression analyses to estimate the risk of all-cause in-hospital mortality. Five models were fitted: a Crude model, unadjusted; Model 1, adjusted for personal factors, including sex, age, Killip classification, and so on; Model 2, adjusted for Model 1 plus hospital factors; Model 3 was a multilevel analysis clustered by hospital codes and adjusted for the same variables as Model 1; Model 4 was adjusted for Model 1 plus evidence-based practices through causal mediation analysis. Results: After excluding 3,544 patients with missing Killip classification or ambulance use, data for 56,923 patients in 384 acute care hospitals were analyzed. Drug prescription in accordance with the evidence was significantly greater in the Presentation group than in the Control group. Moreover, conference presentation was significantly associated with lower in-hospital mortality in all models (Odds ratios (OR) = 0.68, 95% Confidence intervals (CIs): 0.65 to 0.72 in the Crude model; OR = 0.73, 95% CIs: 0.68 to 0.79 in Model 1; OR = 0.76, 95% CIs: 0.70 to 0.82 in Model 2; OR = 0.84, 95% CIs: 0.76 to 0.92 in Model 3; OR = 1.00, 95% CIs: 0.92 to 1.09 in Model 4). Conclusion: The promotion of scholarly activities such as conference presentations might improve patient outcomes through increased evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: Biosimilars have the potential to save a significant amount of money in cancer treatment costs. However, barriers exist in the adoption of biosimilar products. Japan introduced a new health policy in 2022 to promote the use of biosimilars in oncology by offering financial incentives to eligible hospitals. This study aims to examine the association between these financial incentives and prescription patterns. Methods: The study analyzed Diagnosis Procedure Combination (DPC) data to assess the impact of the new health policy on the use of biosimilar products in oncology. The policy provided an additional fee for hospitals using biosimilar products. The study included patients with specific types of cancer and analyzed the proportion of monthly biosimilar prescriptions using the number of prescriptions of reference and biosimilar products. A generalized synthetic control method was used for analysis. Results: From April 2020 to March 2023, the study involved 27,737 patients in 114 hospitals, with 63 eligible hospitals receiving financial incentives. The average number of prescriptions of the drugs (rituximab, trastuzumab, and bevacizumab) increased gradually in both eligible and ineligible hospitals. The financial incentives were associated with a significant increase in the proportion of biosimilar product prescriptions, with a monthly increase of 0.092 per month (95% CI, 0.040–0.145) [9.2%, 95% CI, 4.0–14.5] compared to ineligible hospitals. Conclusion: Our study indicates that providing financial incentives to hospitals to utilize biosimilar products increased their prescriptions. Japan's recent health policy of moderate financial incentives is an effective approach to increasing prescriptions of biosimilar products. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-fold: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories. Methods: We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories. Results: The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group. Conclusion: The trajectory of the proportion of pPCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends. [ABSTRACT FROM AUTHOR]

Aim: Living‐donor liver transplantation (LDLT) is a highly effective life‐saving procedure; however, it requires substantial medical resources, and the cost‐effectiveness of LDLT versus conservative management (CM) for adult patients with end‐stage liver disease (ESLD) remains unclear in Japan. Methods: We performed a cost‐effectiveness analysis using the Diagnostic Procedure Combination (DPC) data from the nationwide database of the DPC research group. We selected adult patients (18 years or older) who were admitted or discharged between 2010 and 2021 with a diagnosis of ESLD with Child–Pugh class C or B. A decision tree and Markov model were constructed, and all event probabilities were computed in 3‐month cycles over a 10‐year period. The willingness‐to‐pay per quality‐adjusted life‐year (QALY) was set at 5 million Japanese yen (JPY) (49,801 US dollars [USD]) from the perspective of the public health‐care payer. Results: After propensity score matching, we identified 1297 and 111,849 patients in the LDLT and CM groups, respectively. The incremental cost‐effectiveness ratio for LDLT versus CM for Child–Pugh classes C and B was 2.08 million JPY/QALY (20,708 USD/QALY) and 5.24 million JPY/QALY (52,153 USD/QALY), respectively. The cost‐effectiveness acceptability curves showed the probabilities of being below the willingness‐to‐pay of 49,801 USD/QALY as 95.4% in class C and 48.5% in class B. Tornado diagrams revealed all variables in class C were below 49,801 USD/QALY while their ranges included or exceeded 49,801 USD/QALY in class B. Conclusions: Living‐donor liver transplantation for adult patients with Child–Pugh class C was cost‐effective compared with CM, whereas LDLT versus CM for class B patients was not cost‐effective in Japan. [ABSTRACT FROM AUTHOR]

Objectives: Anti-asparaginyl tRNA synthetase (anti-KS) antibody is present in patients with interstitial lung disease (ILD) accompanied by polymyositis/dermatomyositis. We examined clinical/immunological features of these patients. Methods: Polymyositis/dermatomyositis or ILD patients were screened for autoantibodies, and clinical/immunological data were collected retrospectively. ILD was diagnosed by computed tomography, and clinical/immunological features of anti-KS-positive patients were compared with those of anti-Jo-1-positive patients. Results: Sixteen anti-KS-positive patients [female = 11; male = 5; average age 63.6 years (range, 40–81) years] were diagnosed: seven had ILD, four had clinically amyopathic DM (CADM) and ILD, three had Sjögren's syndrome (SS) and ILD one each had rheumatoid arthritis and ILD, or CADM/SS overlap and ILD. All patients had ILD with chronic onset and clinical course; 11/16 (69%) had nonspecific interstitial pneumonia, and five (31%) had usual interstitial pneumonia pattern. Regarding skin manifestations, 4 (27%) had typical DM rash and 11 (69%) had mechanic's hands. All anti-KS-positive patients had no clinical muscle weakness or serum creatine kinase elevation; 8/16 patients (50%) had sicca symptoms at a significantly high frequency compared with anti-Jo-1-positive patients (50% vs 11%, P = 0.01). Conclusions: Anti-KS-positive patients might form a distinguishable subset closely associated with sicca symptoms, CADM and chronic-type ILD with a relatively favourable prognosis. [ABSTRACT FROM AUTHOR]

Background: Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia. Methods: Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient's place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created. Results: The derivation cohort included 19,746 cases admitted from home and 14,359 cases admitted from a nursing home. Of the former, 10,760 (54.5%) cases were discharged home; from the latter, 7,071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6,262 cases admitted from home and 6,352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively. Conclusions: We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning. [ABSTRACT FROM AUTHOR]

While the preS1 region of the large hepatitis B surface protein plays an essential role in hepatitis B virus (HBV) infection, the effect of preS1 on liver fibrosis and hepatocarcinogenesis in chronic hepatitis B (CHB) patients is not well known. In this study, we measured serum preS1 levels by chemiluminescent immunoassay technology in 690 CHB patients and evaluated the correlation between serum preS1 levels and HBV, liver function markers and liver inflammation, fibrosis assessed by histological findings. Predictive factors for hepatocellular carcinoma (HCC) development in patients who had no previous history of HCC at the time of preS1 level measurement were also analysed. Median hepatitis B surface antigen (HBsAg) and preS1 levels were 3.08 log IU/mL and 98 ng/mL, respectively. PreS1 values were significantly correlated with serum HBsAg (p <0.001), hepatitis B core‐related antigen (HBcrAg) (p <0.001) and HBV DNA levels (p <0.01). PreS1 values were also significantly correlated with serum alanine aminotransferase levels (p <0.001) and were significantly higher in patients who had higher grading of liver inflammatory activity (p <0.05). HBsAg level was correlated, but preS1/HBsAg ratio reflected liver fibrosis staging more directly than HBsAg alone. Multivariate analysis identified age ≥53 years (hazard ratio [HR], 18.360 for <53 years; p = 0.021) and preS1/HBsAg ratio ≥0.12 (HR, 6.205 for <0.12; p = 0.040) as significant and independent factors for HCC development in CHB patients. The preS1/HBsAg ratio directly reflects liver fibrosis, and the ratio might be a predictive marker for HCC development in CHB patients. [ABSTRACT FROM AUTHOR]

Bereaved families may experience psychological and physical problems increasing their reliance on medical, pharmaceutical, and financial/legal services. Our Japan-wide survey (n = 1078) researched bereaved who showed increased reliance on medical, pharmaceutical, and financial/legal services. Increased use was most evident in the '50's age bracket, and for unemployed widows; it corresponded less with low annual income than with high income declining significantly after bereavement. Increased users showed higher psychological and physical symptoms of grief, and reported their decline in physical health seriously influencing their work and lives, suggesting "presenteeism"—reduced productivity for those continuing to work. Increased users spent 2.7 times more for medical and pharmaceutical services than those reporting continual use, portending 4 to 10 times more Japanese government expense for this group, half of whom considered their own out-of-pocket expenses a financial burden. These findings warrant further research on cost-effectiveness of interventions to reduce declining health of the bereaved. [ABSTRACT FROM AUTHOR]

Dermatomyositis (DM) is a categorised as one of idiopathic inflammatory myopathy (IIM) indicated by symmetrical proximal muscle weakness as well as characteristic cutaneous manifestations typical of DM. Clinically amyopathic dermatomyositis (CADM), a subtype of DM, shows only the skin involvement without any clinical signs of myositis. This condition is often associated with fatal anti-MDA5 antibody-positive rapidly progressive interstitial lung disease (RP-ILD), especially in Eastern Asian populations. Here, we report a CADM patient with anti-MDA5 antibody-positive RP-ILD whom we successfully treated by early initiation of plasma exchange (PE) together with multiple immunosuppressive therapies. In this patient, initial treatment with high-dose prednisolone (PSL), tacrolimus and intermittent intravenous cyclophosphamide had resulted in no obvious improvement in the respiratory condition. Therefore, soon after the first evaluation, we initiated PE therapy in addition to these multiple immunosuppressive therapies. Although the patient had pneumomediastinum, cytomegalovirus and fungal infections over the clinical course, RP-ILD did gradually improved and the anti-MDA5 titre decreased down to within the normal range paralleled by improvement in the patient's respiratory condition. [ABSTRACT FROM AUTHOR]

Diazoxide is a benzothiadiazine that can be effective in managing hypoglycemia in frail patients with surgical risk. We report here a case of insulinoma effectively treated with diazoxide, as our report will be helpful for similar cases. [ABSTRACT FROM AUTHOR]

We report a case of eosinophilic cholecystitis associated with eosinophilic granulomatosis with polyangiitis (EGPA) complicated by cerebral hemorrhage. A 60-year-old man presented to a local hospital with a diagnosis of acute cholecystitis, with persistent fever and epigastric pain for 2 weeks. His symptoms persisted despite 3-week hospitalization; therefore, he was transferred to our hospital for further evaluation. Laboratory investigations upon admission showed white blood cells 26,300/µL and significant eosinophilia (eosinophils 61%). Abdominal computed tomography revealed no gallbladder enlargement but a circumferentially edematous gallbladder wall. Additional blood test results were negative for antineutrophil cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies; however, immunoglobulin (Ig)G and IgE levels were high at 1,953 mg/dL and 3,040/IU/mL, respectively. He improved following endoscopic transnasal gallbladder drainage for cholecystitis and was diagnosed with EGPA and received corticosteroid and immunosuppressant combination therapy. The eosinophil count decreased immediately after treatment, and abdominal pain and numbness resolved. He returned with left-sided suboccipital hemorrhage likely attributed to EGPA 6 months after discharge. EGPA is characterized by inflammation of small blood vessels and clinically manifests with an allergic presentation of bronchial asthma, as well as renal dysfunction, interstitial pneumonia, enteritis, and cerebral hemorrhage. Few reports have described cholecystitis as a presenting symptom of EGPA. We report a rare case of such a presentation with added considerations. [ABSTRACT FROM AUTHOR]

Object: The appropriate use of antiemetics is important for the prevention of chemotherapy‐induced nausea and vomiting (CINV); however, little is known about the rate of concordance with antiemetic guidelines for CINV in the field of pediatric, adolescent, and young adult. Methods: Using the Diagnosis Procedure Combination system in Japan, we identified patients <30 years of age who were diagnosed with cancer between July 2010 and March 2016. We have assessed concordance with the ASCO antiemetic guidelines for each emetic risk category of chemotherapeutic drugs. Furthermore, we have assessed the risk factors of discordance with the antiemetic guidelines using a logistic regression. Results: In total, 21 106 patients who underwent chemotherapy were included. The rates of concordance with the guidelines in each emetic risk category of chemotherapeutic drugs were 51.1% in high risk, ≥18 years of age; 21.5% in high risk, <18 years of age; 32.1% in moderate risk; 52.0% in low risk; and 51.6% in minimal risk. The main reason for the discordance was underuse of antiemetics, especially steroids. The factors for discordance were younger age, use of moderate and high emetic risk chemotherapeutic drugs, hematological malignancy, and brain tumor. Conclusion: There is substantial scope to improve the antiemetic practice and reduce the risk of discordance with the antiemetic guidelines in pediatric, adolescent, and young adult patients. The risk factors are different from those in adults. Further investigations to evaluate the causes of discordance are warranted. [ABSTRACT FROM AUTHOR]

Background: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. Methods: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. Findings: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. Interpretation: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Differences in the way that health systems are structured likely explains some of this variation, which suggests the potential of cross-system learning opportunities. Our findings highlight the need for further studies including comparable performance metrics and institutional analysis. [ABSTRACT FROM AUTHOR]

Objective: We aimed to quantify the personal economic burden of dementia care in Japan according to residence type.Methods: A cross-sectional online survey was conducted on 3841 caregivers of people with dementia. An opportunity cost approach was used to calculate informal care costs. All costs and the observed/expected (OE) ratio of costs were adjusted using patient sex, age, and care-needs levels, and compared among the residence types.Results: The mean daily informal care time was 8.2 hours, and the mean monthly informal care costs for community-dwelling people with dementia were US$1559. The OE ratio for informal care costs in community-dwelling patients was higher than in institutionalized patients.Conclusion: The inclusion of informal care costs reduced the differences in total personal costs among the residence types. The economic burden of informal care should be considered when quantifying dementia care costs. [ABSTRACT FROM AUTHOR]

Background: Patients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients. Methods and results: Using a large nationwide administrative database, we analyzed 103,908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03–1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions. Conclusions: In-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend daytime admissions may be a potential target for improvement in the Japanese healthcare system. [ABSTRACT FROM AUTHOR]

Chronic intestinal pseudoobstruction (CIPO) is a serious complication in patients with connective tissue disease (CTD) and is sometimes life-threatening or fatal despite intensive medical treatment. Here, we report a patient with dermatomyositis (DM) and anti-EJ autoantibody who developed CIPO that was improved by octreotide. Because her abdominal pain and bloatedness were so severe and persistent, we introduced octreotide to relieve symptoms. In this case, continuous intravenous administration as well as long-acting subcutaneous injection of octreotide was effective for treating CIPO. [ABSTRACT FROM AUTHOR]

Objective: A cross-sectional study was conducted to examine the factors associated with long-term care (LTC) expenditure among LTC service users in Kyoto Prefecture, Japan. Method: Using descriptive statistics and multiple linear regression analysis, we investigated the associations of gender, dementia, service type, and other factors with LTC expenditure. Result: Our regression analysis showed that older age, women, and higher care needs levels were significantly associated with higher LTC expenditure. Furthermore, women who used home care and community-based/other care services had higher expenditures than men who used the same services. In contrast, men who used facility care services had higher expenditures than women. Service users with dementia were also found to be significantly associated with higher LTC expenditure. Conclusion: There is a need for policy interventions that focus on gender differences and dementia when developing care service plans to ensure the sustainability of the LTC system. [ABSTRACT FROM AUTHOR]

Background: The microbiota associated with healthy peri-implant tissues has been studied in many cases. However, gram-negative anaerobic rods may also be found in small numbers and in low proportions around the endosseous dental implants. Objective: The purpose of this study was to investigate colonization of the peri-implant sulcus around two different types of implants by periopathogenic microbiota in a healthy patient. Materials and Methods: A patient with a healthy periodontium was selected. One hydroxy-apatite coated one-stage (AQB) implant was implanted at the site of the missing upper Right maxillary 1st molar; the two units two-stage (PLATON) were implanted at the sites of the missing 1st and 2nd molars in the Left maxillary region. Saliva samples were collected from the peri-implant sulcus using paper points every 3 months for 9 months after implantation and fixation of porcelain crowns. Real-Time Polymerase Reaction (RT-PCR-Invader method) was used to detect periodontal pathogens. Results: Salivary periodontal pathogens were checked prior to implantation and Tannerella forsythia (0.06%) was detected. No periodontal pathogens were observed at 3 months. T. forsythia (0.06%) was detected at 6 months around the AQB implant; it was not detected in the PLATON implant. At 9 months, periopathogens increased in number around both types of implants; there was a major difference in numbers of Fusobacterium nucleatum (10.81%), and T. forsythia (0.057%) around the submerged and non-submerged implant systems. Conclusions: Submerged implants with screw-retained superstructures are more vulnerable to pathogenic microflora colonization than non-submerged implants. [ABSTRACT FROM AUTHOR]