Diagnosis Procedure Research Articles

Predictive Validity of Hospital-Associated Complications of Older People Identified Using Diagnosis Procedure Combination Data From an Acute Care Hospital in Japan: Observational Study

Background A composite outcome of hospital-associated complications of older people (HAC-OP; comprising functional decline, delirium, incontinence, falls, and pressure injuries) has been proposed as an outcome measure reflecting quality of acute hospital care. Estimating HAC-OP from routinely collected administrative data could facilitate the rapid and standardized evaluation of interventions in the clinical setting, thereby supporting the development, improvement, and wider implementation of effective interventions. Objective This study aimed to create a Diagnosis Procedure Combination (DPC) data version of the HAC-OP measure (HAC-OP-DPC) and demonstrate its predictive validity by assessing its associations with hospital length of stay (LOS) and discharge destination. Methods This retrospective cohort study acquired DPC data (routinely collected administrative data) from a general acute care hospital in Tokyo, Japan. We included data from index hospitalizations for patients aged ≥65 years hospitalized for ≥3 days and discharged between July 2016 and March 2021. HAC-OP-DPC were identified using diagnostic codes for functional decline, incontinence, delirium, pressure injury, and falls occurring during the index hospitalization. Generalized linear regression models were used to examine the associations between HAC-OP-DPC and LOS, and logistic regression models were used to examine the associations between HAC-OP-DPC and discharge to other hospitals and long-term care facilities (LTCFs). Results Among 15,278 patients, 3610 (23.6%) patients had coding evidence of one or more HAC-OP-DPC (1: 18.8% and ≥2: 4.8%). Using “no HAC-OP-DPC” as the reference category, the analysis showed a significant and graded association with longer LOS (adjusted risk ratio for patients with one HAC-OP-DPC 1.29, 95% CI 1.25-1.33; adjusted risk ratio for ≥2 HAC-OP-DPC 1.97, 95% CI 1.87-2.08), discharge to another hospital (adjusted odds ratio [AOR] for one HAC-OP-DPC 2.36, 95% CI 2.10-2.65; AOR for ≥2 HAC-OP-DPC 6.96, 95% CI 5.81-8.35), and discharge to LTCFs (AOR for one HAC-OP-DPC 1.35, 95% CI 1.09-1.67; AOR for ≥2 HAC-OP-DPC 1.68, 95% CI 1.18-2.39). Each individual HAC-OP was also significantly associated with longer LOS and discharge to another hospital, but only delirium was associated with discharge to LTCF. Conclusions This study demonstrated the predictive validity of the HAC-OP-DPC measure for longer LOS and discharge to other hospitals and LTCFs. To attain a more robust understanding of these relationships, additional studies are needed to verify our findings in other hospitals and regions. The clinical implementation of HAC-OP-DPC, which is identified using routinely collected administrative data, could support the evaluation of integrated interventions aimed at optimizing inpatient care for older adults.

Effectiveness of an Impella Versus Intra-Aortic Balloon Pump in Patients Who Received Extracorporeal MembraneOxygenation.

It is unclear whether an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups. Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14-day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, -8.2% [95% CI, -13.8 to -2.7]), whereas there was no significant difference in in-hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, -3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group. This nationwide inpatient database study showed no significant difference in in-hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.

Congratulations on the 60th anniversary of the Japanese Society of Nuclear Medicine.

The Japanese Society of Nuclear Medicine (JSNM) celebrates its 60th anniversary this year. JSNM has been contributing a lot to the development of nuclear medicine, leading a number of international activities. New procedures both in diagnosis and treatment have been continuously developed. JSNM will work hard for the better management of patients.

P-677. Title: Estimation of Respiratory Syncytial Virus-attributable Hospitalizations among Older Adults in Japan between 2015 and 2018: an Administrative Health Claims Database Analysis

Abstract Background Respiratory Syncytial Virus (RSV) incidence in adults is often underestimated, mainly because of infrequent testing, nonspecific symptoms and lower diagnostic test sensitivity compared to infants. We estimated population-based incidence rates (IRs) of RSV-attributable hospitalizations in adults ≥60 years in Japan using a retrospective time-series model-based approach. Methods We obtained hospitalization data from the Medical Data Vision (MDV) database, which is restricted to Diagnosis Procedure Combination (DPC) hospitals; data were included for 01/01/2015-31/12/2018, with 2018 the last complete year available before COVID-19. We estimated the yearly and age-specific RSV-attributable IR of hospitalizations for five cardiorespiratory outcomes defined based on selected ICD-10 codes. We used a quasi-Poisson regression model accounting for periodic and aperiodic time trends, as well as viral activity proxies. An offset was included in the model to account for the increase of the source database size. We extrapolated our results to all DPC hospitals in Japan. Results In adults aged ≥60 years, the IRs of RSV-attributable cardiorespiratory hospitalizations were 100-124 per 100,000 person-years (up to 7% of selected cardiorespiratory hospitalizations) and 69-85 per 100,000 person-years for respiratory-specific hospitalizations (up to 8% of all respiratory hospitalizations). IRs for all outcomes were higher in adults aged ≥80 years compared to those aged 60-79 years (Table 1). Conclusion Modeled RSV-attributable IRs in Japan were lower than in most other developed countries, likely due to the MDV database only including advanced treatment hospitals. Taking this into account, our results indicate a high burden of RSV-attributable hospitalizations in older adults in Japan, highlighting the need to implement effective RSV prevention strategies. Future work will include a sensitivity analysis extrapolating IRs to all hospitals in Japan. Disclosures Yasuhiro Kobayashi, MS, Pfizer Japan Inc: employee of Pfizer Japan Inc.|Pfizer Japan Inc: Stocks/Bonds (Private Company) Aleksandra Polkowska-Kramek, n/a, Pfizer: employee of P95 which received funding from Pfizer to conduct this study Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Charles Nuttens, n/a, Pfizer: Stocks/Bonds (Private Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company)

Trends in dentomaxillofacial radiology.

Oral and maxillofacial diagnostic imaging is of paramount importance in dental clinical diagnosis, treatment planning, and follow-up procedures. Periapical radiographic examination and numerous panoramic systems are used in routine clinical dental practice. Cone beam CT is widely used and currently the method of choice in oral and maxillofacial implantology, endodontics, maxillofacial surgery, periodontics, degenerative temporomandibular joint disease, orthodontics, airway studies, sleep disorders, and forensic dentistry. Another innovative laboratory research tool that offers three-dimensional (3D) detailed high-resolution images of in vitro teeth and neighboring structures with submicrometric accuracy is microcomputed tomography. Ultra-high radiation doses, long scanning times, and high costs preclude its routine clinical use. In response to the high demand for a technique that could provide real-time images using a cost-effective, rapid, user-friendly, and portable technique without ionizing radiation, some authors proposed ultrasound imaging methods as an alternative to X-ray imaging techniques. Ultrasonography can be used in the dentomaxillofacial region for various diagnostic purposes such as salivary gland and superficial tissue examination. Recently, dedicated dental magnetic resonance imaging with appropriate software, hardware, sequences, and field of view tailored to fit dentomaxillofacial anatomy was introduced. Lately, 3D printing technologies and their application in dentistry has attracted attention. During 3D printing a given material is added in successive layers to create a 3D object. The application of this technology has the potential to decrease operation time and minimize operator bias and the possibility of procedural errors. Another hot topic regarding dentomaxillofacial radiology is artificial intelligence, which is a field related to computer science dedicated to developing systems or machines that can perform tasks traditionally associated with human intelligence. It is obvious that further investigation and research in the field of dentomaxillofacial radiology will make great contributions to diagnostic imaging for various dental specialties.

Effectiveness of Oral Prophylactic Antibiotics for Diagnostic Bronchoscopy: A Nationwide Database Study.

Although the guidelines generally omit routine antibiotic prophylaxis for diagnostic bronchoscopy, this recommendation is primarily based on studies with relatively small sample sizes conducted at single institutions. Moreover, the applicability of recent technical and procedural advancements to these guidelines remains uncertain. To evaluate whether oral prophylactic antibiotic administration for diagnostic bronchoscopy reduces post-bronchoscopy infections among non-infectious diseases in the current setting. Using the Diagnosis Procedure Combination database, a national inpatient database in Japan, we identified patients who underwent diagnostic bronchoscopy with or without oral prophylactic antibiotics between April, 2020 and March, 2022. We employed the propensity score-stabilized inverse probability of treatment weighting and instrumental variable analyses to compare post-bronchoscopy infections between the groups. Stratified analyses were also conducted based on patient profiles and antibiotic types. A total of 68,660 eligible patients were divided into prophylaxis (N=10,426) and no prophylaxis (N=58,234) groups. Post-bronchoscopy infections were observed in 612 patients (0.89%). The stabilized inverse probability of treatment weighting analysis showed that the prophylactic group was significantly associated with a decrease in post-bronchoscopy infections (odds ratio, 0.60; 95% confidence interval, 0.45 to 0.80). The instrumental variable analysis showed similar results (odds ratio, 0.50; 95% confidence interval, 0.34-0.74). Oral antibiotic prophylaxis was associated with reduction in post-bronchoscopy infection in patients who were older than 70 years, underwent bronchoscopy for malignancy, underwent biopsy or bronchoalveolar lavage, or received aminopenicillin or fluoroquinolone for prophylaxis. Our findings suggest a potential role for prophylactic antibiotics in reducing post-bronchoscopy infections among non-infectious cases. While prophylactic antibiotics may help prevent these infections, their use should be carefully considered in relation to individual patient profiles and the specific antibiotics being administered.

Analysis of Factors Affecting Prolonged Air Leak and Expansion Failure in the Lung after Resection in Patients with Pulmonary Malignancy and Predictive Value of Preoperative Quantitative Chest Computed Tomography.

The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation area (LAA%) measured on preoperative quantitative chest computed tomography (Q-: CT) in predicting the development of postoperative PAL and the expansion time of the remaining lung (ET) in patients undergoing resection for lung malignancy was investigated. The data of 202 cases who underwent lung resection between July 2020 and December 2022 were analyzed. The factors affecting the development of PAL and ET were investigated using univariate and multivariate analyses. The cut-off value for LAA% was determined and its relationship with postoperative results was examined. In univariate analyses, for PAL, age (p = 0.022), presence of chronic obstructive pulmonary disease (COPD; p < 0.001), body mass index (BMI; p = 0.006), FEV1 (p = 0.020), FEV1/FVC (p < 0.001), LAA% (p = 0.008), diagnosis (p = 0.007), and surgical procedure (p < 0.001); for ET, diagnosis (p < 0.001) and surgical procedure (p = 0.001) were significant factors. A negative correlation between ET and BMI and FEV1/FVC (p < 0.01) and a positive correlation (p < 0.05) was detected with LAA%. The cut-off value for LAA% was calculated as 1.065. Multivariate analyses showed that the probability of developing PAL, increased 3.17-, 7.68-, and 3.08-fold in patients with COPD, lobectomy, and those above the cut-off value for LAA%, respectively (p = 0.045, p < 0.001, and p = 0.011). In addition, FEV1/FVC (p = 0.027), BMI (p = 0.016), and surgical procedure (p = 0.001) were shown to be independent factors affecting ET. Our study revealed the factors affecting PAL and expansion failure in the lung. Within this scope, it was concluded that preoperative Q-CT may have an important role in predicting the development of PAL and ET in the postoperative period and that LAA% measurement is an effective, objective, and practical method for taking precautions against possible complications.

In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study

BackgroundIntermediate care units (IMCUs) provide care for patients who need more intensive treatment than general wards but less than intensive care units (ICUs). Although the concept of an IMCU requires co-location with an ICU, some hospitals have IMCUs but no ICUs, which potentially worsens patient outcomes. This study aimed to examine the annual trends and care processes, and compare the outcomes of patients admitted to IMCUs in hospitals with and without ICUs using a nationwide inpatient database in Japan.MethodsThis retrospective cohort study was conducted from 2016 to 2022 using the Diagnosis Procedure Combination Database and Hospital Bed Function Reports in Japan. The main exposure was admission to the IMCU in hospitals with and without ICUs. The primary outcome was in-hospital mortality rate in hospitals with and without ICUs that were compared using multilevel logistic regression models adjusted for confounders.ResultsThe number of IMCU beds in hospitals without ICUs increased by 59% from 3,388 in 2016 to 5,403 in 2022, and the IMCU beds in hospitals without ICUs represented 38% (n = 5,403/14,185) of all IMCU beds in Japan in 2022. Among the 3,061,960 eligible patients in the IMCUs, 2,296,939 (75%) and 765,021 (25%) were admitted to hospitals with and without ICUs, respectively. Transfer between IMCUs and ICUs occurred for 10.5% (n = 320,938/3,061,960) of patients, with a large variability between hospitals. After adjusting for potential confounders, patients admitted to IMCUs in hospitals without ICUs had significantly higher in-hospital mortality than those in hospitals with ICUs (adjusted odds ratio: 1.15; 95% confidence interval: 1.10–1.20; p < 0.001).ConclusionsAdmission in IMCUs in hospitals without ICUs increased, but was associated with higher in-hospital mortality. These findings suggest that IMCUs should be placed in hospitals with ICUs.

Research Progress in the Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness, and weakness in the hand due to a pinched median nerve in the wrist. A higher percentage of women than men have carpal tunnel syndrome, which affects about 3.8% of the population. The diagnosis procedure includes the patient's medical history, physical examination, and electrodiagnostic testing, all of which are essential for assessing the nervous system's function and severity. Based on these assessments, CTS is classified as mild, moderate, or severe. Conservative treatment, including corticosteroids, wrist splints, and a range of physical therapy, is usually recommended for mild to moderate cases, while surgical treatment is reserved for severe cases. Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) are surgical options. The purpose of this article is to explore risk factors, diagnostic approaches, and treatment approaches in order to provide better individualized care in clinical practice, and to make recommendations for future treatment improvements and research.

A retrospective comparative study of percutaneous transhepatic gallbladder drainage versus endoscopic gallbladder stenting on the clinical course of acute cholecystitis: A propensity score matching analysis using a nationwide inpatient database in Japan.

We performed a retrospective comparative study to clarify the optimal gallbladder drainage method prior to elective cholecystectomy. We collected data from the Diagnosis Procedure Combination database about cholecystitis patients who underwent gallbladder drainage prior to cholecystectomy in a subsequent hospitalization between April 2014 and March 2020. We divided the study population into two groups: an endoscopic gallbladder stenting (EGBS) group and a percutaneous transhepatic gallbladder drainage (PTGBD) group. We performed propensity score matching and compared surgical outcomes related to cholecystectomy. We collected 6306 cases (PTGBD: 6112 cases; EGBS: 194 cases). In propensity score matching, we obtained 193 matched pairs from the study population. Long-term postoperative antibiotics therapy (2 vs. 9; risk ratio 4.7 [95% CI: 1.1-30.9]) was more frequent in the EGBS group than the PTGBD group. There were no significant differences between the two groups for laparotomic cholecystectomy and postoperative bile duct drainage. For reoperation, postoperative abdominal drainage and postoperative blood transfusion, there were few outcome occurrences and effect measures were not obtained. Gallbladder drainage by EGBS may have more risk of surgical complications related to elective cholecystectomy than PTGBD. There are a few reports on this topic, so further research should be conducted.

Clinical evaluation and outcome in heart failure patients receiving chemotherapy with different anti-cancer agents.

The optimal strategy for modern chemotherapy should be based on a comprehensive approach for cancer patients with cardiovascular diseases. Therefore, cardio-oncology has received increasing attention owing to the cardiotoxic effects of anti-cancer therapies. We aimed to evaluate the clinical characteristics and outcomes of patients with heart failure (HF) who received chemotherapy compared with those of a matched cohort with HF who did not receive chemotherapy, using real-world HF data. This study was based on the Diagnosis Procedure Combination (DPC) database of the Japanese Registry of All Cardiac and Vascular Diseases (JROAD). We identified 1328113 patients who were hospitalized for HF between April 2012 and March 2021. The propensity score (PS) was estimated using a logistic regression model, with chemotherapy as the dependent variable, and a clinically score-matched analysis of 11532 patients with HF with or without chemotherapy. The primary endpoint was readmission. Colon, lung, breast and prostate cancers accounted for >60% of all cancer types. After PS matching, readmission was significantly more frequently observed in patients with chemotherapy than those without [odds ratio (OR), 1.26; 95% confidence interval (CI) 1.17-1.36, P<0.01]. In particular, treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) (OR, 1.69; 95% CI 1.39-2.07), taxane (OR, 2.95; 95% CI 2.11-4.12), anthracyclines (OR, 1.86; 95% CI 1.19-2.90) and fluorouracil agents (OR, 1.65; 95% CI 1.18-2.30) caused a higher risk of readmission. Medical providers need to monitor and follow-up patients with HF, depending on the characteristics of the anti-cancer agents and types of cancer.

Impact of Nurse Staffing Levels on Patient Fall Rates: A Retrospective Cross-Sectional Study in General Wards in Japan.

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the general wards (excluding pediatrics and obstetrics/gynecology) of 11 National Hospital Organization institutions between April 2019 and March 2020. The data were obtained from the Diagnosis Procedure Combination Work Record and institutional fall reports. The variables used in the analyses included patient conditions, number of hospitalization cases, emergency hospitalizations, surgeries/examinations, disease composition ratio, patient attributes, hospital stay duration, hospital bed size, and nursing time per patient (day and night) on a ward-day basis. Multivariate analysis was performed to determine the effects of these factors on fall events. Results: A total of 36,209 ward days were analyzed, with falls reported on 2866 days (fall event rate of 9.0%). The mean nursing times per patient were 1.99 h (day) and 1.47 h (night). The nursing time per patient in the fall group compared to the non-fall group showed an odds ratio of 1.19 (p < 0.01) during day shifts and 0.17 (p < 0.02) during night shifts. An increase in nursing time per patient during the night was associated with fewer fall events, whereas during the day, increased nursing time appeared to contribute to more falls. Common background factors that increased nurse staffing and patient falls simultaneously could be suggested to exist during the day. Conclusions: Increased nursing time was correlated with reduced fall incidence, indicating the need for policy improvements in nurse staffing practices in Japan to enhance patient safety and outcomes. Further research is needed to accumulate evidence reflecting policies regarding nurse staffing.

Influence of Nursing Time and Staffing on Medication Errors: A Cross-Sectional Analysis of Administrative Data.

Background: Medication errors cause adverse events; however, studies have yet to examine medication errors related to nursing hours while considering ward characteristics in Japan. Purpose: This study investigated medication errors caused by nurses to quantitatively assess ward activity as busyness in nursing duties. Methods: This study considered patients hospitalized in the general wards of 10 National Hospital Organization institutions between April 2019 and March 2020. The study data were obtained from the Diagnosis Procedure Combination system, incident report system, and reports on nurse staffing and work hours. Data for 27,629 ward days with 88,475 patients were analyzed. Multivariate analysis was performed to determine the impact of factors on medication errors. Results: The mean patient age was 71.43 years (SD = 15.08). The medication error rate in nursing wards was 13.71%. The mean nursing time per patient during day shift was 1.95 h (SD = 0.58) in the non-medication error group and 2.06 h (SD = 0.58) in the medication error group (p < 0.01). The nursing time per patient in the medication error group compared to that in the non-medication error group had an odds ratio of 1.31 (p < 0.01) during day shifts. Conclusions/Implications for practice: Contrary to evidence, the results showed that medication errors caused by nurses related to increased nurse time with patients during day shifts. Further investigation is needed on the relationship of busyness with nursing duties to ensure an adequate nurse-patient ratio, nursing time, and improved patient safety.

Integrated multiple interventional radiologic procedures for diagnosis and treatment of unresectable breast cancer: a case description.

Integrated multiple interventional radiologic procedures for diagnosis and treatment of unresectable breast cancer: a case description.

Association of In-Hospital Cardiac Rehabilitation on Hospital-Associated Disability for Octogenarian Patients With Acute Myocardial Infarction ― An Insight From the JROAD-DPC Database ―

This study aimed to determine the status of in-hospital cardiac rehabilitation (CR) and hospital-associated disability (HAD) for patients with acute myocardial infarction (AMI) aged >80 years. This study involved the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination databases, and included patients who were hospitalized with AMI from April 2014 to March 2021. Patients were categorized by the daily amount of CR: NA, not applicable; Low, 20-30 min; Moderate, 30-40 min; and High, >40 min. Activities of daily living were assessed using the Barthel index (BI) score, and evaluated at both admission and discharge. This study defined HAD as a ≥5-point decrease in BI score at discharge compared with admission. A total of 12,061 eligible patients were selected (age 83.0 years; 36.4% female), of which 2.7% had HAD (NA, 2.0%; Low, 4.7%; Moderate, 2.6%; High, 2.6%). The Low group was more likely to develop HAD. Chronological trends in hospital stay and incidence rate of HAD gradually decreased with the increased in-hospital CR participation rate. The multivariable logistic regression analysis revealed that the daily amount of CR was selected as an independent associated factor for preventing HAD (odds ratio 0.737; 95% confidence interval 0.567-0.960; P=0.023). Our results revealed that higher amounts of in-hospital CR for patients with AMI should be performed, especially in octogenarians.

Association of the Glasgow Coma Scale with the Length of Hospital Stay in Patients with Thyroid Storm

Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. Thyroid storm was diagnosed based on the latest diagnostic criteria in Japan. Since 30 days is the upper limit of LOS in the Diagnosis Procedure Combination [DPC]-based reimbursement system, the study population was divided into patients with permissible LOS (<30 days) and those with undesirable LOS (≥30 days). As a supplementary analysis, we examined the correlation of the GCS score and other clinical parameters with LOS using a Spearman's rank correlation analysis. Results The GCS score was significantly higher (14.1±2.7 vs. 9.9±4.9 points; p <0.001), and the Sequential Organ Failure Assessment (SOFA) score significantly lower (1.68±2.16 vs. 7.50±7.91 points; p =0.009) in patients with permissible LOS than in those with undesirable LOS, while other clinical parameters were not significantly different between the groups. The area under the receiver operating characteristic curve of the GCS for the permissible vs. undesirable LOS was 0.866. The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.

Impact of COVID-19 pandemic on pneumonia trends in Japan: Insights from diagnosis procedure combination data.

This study analyzed changes in pneumonia hospitalizations in Japan before and after the COVID-19 pandemic using Diagnosis Procedure Combination data. The proportion of inpatients with non-aspiration pneumonia (non-AP) decreased by 48.8%, whereas that of inpatients with aspiration pneumonia (AP) decreased by only 8.8%. The proportion of AP among all pneumonia cases increased from approximately 33%-47% post-pandemic. The significant reduction in non-AP incidence likely reflects its sensitivity to external factors such as public health measures. Conversely, the limited decrease in AP demonstrates its stronger association with internal factors that are less affected by lifestyle changes. This study provides insights into the differential impact of the pandemic on pneumonia subtypes, revealing how external interventions may have varying effects on different forms of pneumonia. These findings highlight the complex interplay between public health measures and the epidemiology of respiratory infections in the context of a global pandemic.

Comparison between the Outcomes of Pentamidine and Trimethoprim-Sulfamethoxazole for Pneumocystis Pneumonia in Non-HIV Patients: A Nationwide Japanese Retrospective Cohort Study

Background Data on the first-line treatment options for patients with Pneumocystis pneumonia (PCP) without human immunodeficiency virus (HIV) infection are limited. Therefore, we evaluated the outcome of pentamidine compared to trimethoprim-sulfamethoxazole (TMP-SMX) in non-HIV patients with PCP. Methods We used data from the Japanese Diagnosis Procedure Combination Inpatient Database. We included non-HIV PCP patients who initially received TMP-SMX or pentamidine between July 2010 and March 2022. We categorized eligible patients into TMP-SMX and pentamidine groups and performed a propensity score overlap weighting analysis to compare in-hospital mortality between the groups. Results Among 5,870 eligible patients, 5,456 and 414 received TMP-SMX and pentamidine, respectively. Pentamidine treatment was associated with a higher in-hospital mortality than TMP-SMX treatment in the propensity score overlap weighting analysis (23.6% vs. 40.1%; risk difference, 16.5%; 95% confidence interval, 10.8-22.2%; p<0.001). Conclusions Based on these findings, pentamidine may not be as effective as TMP-SMX for treating PCP in non-HIV patients.

Impact of COVID-19 on resuscitation after hospital arrival for patients with out-of-hospital cardiac arrest: An interrupted time series analysis.

In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA). Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: -0.54 to 1.4; p = 0.39), but the intubation rate was significantly lower (-5.9%; 95% CI: -8.4 to 3.4; p < 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081-0.74; p = 0.016). The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.

Assessment of peripheral nerve affection of the lower limbs in type 2 diabetic patients using neuromuscular ultrasound and electrodiagnostic studies

BackgroundDiabetic peripheral neuropathy is regarded as one of the most common microvascular sequalae of type 2 diabetes mellitus which leads to lower limb complications. Lately, the focus has shifted to early detection of diabetic neuropathy in the subclinical stage. While nerve conduction studies are considered non-invasive, sensitive and objective procedures for diagnosis of neuropathies, the missed diagnosis rate is high in early neuropathy. Recently, ultrasonography use has been regarded as an alternative method for detecting neuropathies, being an inexpensive and a more comfortable tool. The aim of this study was to define the pattern of affection of lower limb peripheral nerves in type 2 diabetic patients using neuromuscular ultrasound and to assess its utility in evaluation of diabetic peripheral neuropathy in asymptomatic diabetic patients.MethodsThis cross-sectional study included 40 type 2 diabetic patients and 20 healthy age- and sex-matched controls. All patients were subjected to full history taking, clinical examination, electrodiagnostic studies and neuromuscular ultrasound. Neuromuscular ultrasound was performed for tibial, fibular and sural nerves bilaterally for all patients and controls. Nerve cross-sectional area was measured at multiple sites for each nerve.ResultsDiabetic patients had statistically significant higher mean cross-sectional area values than controls in nearly all examined sites of all nerves. Furthermore, patients with electrophysiological diabetic peripheral neuropathy (EDPN) had higher statistically significant mean sural cross-sectional area values than patients without EDPN. There were no statistically significant differences in mean cross-sectional area values between symptomatic and asymptomatic patients with EDPN in all measured nerves. ROC analysis showed that sural nerve cross-sectional area cut off value of > 5 mm2 was predictive for diagnosis of EDPN.ConclusionsDiabetic cases, even asymptomatic ones, had statistically significant higher mean cross-sectional area values than controls on neuromuscular ultrasound. In addition, patients with EDPN showed higher cross-sectional area values of lower limbs peripheral nerves. Thus, neuromuscular ultrasound could be used as a screening tool for diabetic peripheral neuropathy using sural nerve cross-sectional area measurement at the ankle even in asymptomatic diabetic patients.