Clinical pharmacists play a central role in the implementation of antimicrobial stewardship programs (ASP). However, personnel shortages, the lack of a system for career development, and other challenges impede the active contribution of clinical pharmacists to ASPs in Japan.

To conduct a long-term evaluation of a pharmacist-led antimicrobial stewardship program.

The present, retrospective study used segmented time-series analysis to examine antimicrobial consumption, blood culture practices, and the rate of resistance in pathogens to the antimicrobials prescribed.

After the ASP was introduced, days of therapy (DOT) with anti-pseudomonal agents demonstrated a downward trend (-0.31; 95 % confidence interval [CI]: -0.43 to -0.19; p < 0.01). Moreover, the trend in the number of blood cultures after the intervention significantly increased (0.20; 95 % CI: 0.05 to 0.35; p = 0.01), and the rate of resistance of Pseudomonas aeruginosa to cefepime and piperacillin decreased. No significant change was observed in the DOT trend for total intravenous antimicrobial use before or after the intervention (-1.07; 95 % CI: -2.44 to 0.29; p = 0.12).

Although the role of pharmacists in an ASP should continue to be examined, the present, longitudinal study found that stepwise introduction of an ASP reduced broad-spectrum antimicrobial use and was associated with a decrease in the antimicrobial resistance rate of Pseudomonas aeruginosa but not of third-generation cephalosporin-resistant Escherichia coli or MRSA.

Fasudil hydrochloride is used as a therapeutic agent for cerebral vasospasm after aneurysmal subarachnoid hemorrhage surgery; however, its limited efficacy necessitates additional treatment options. Although the therapeutic potential of cilostazol for improved outcomes after aneurysmal subarachnoid hemorrhage has been reported, no clinical studies have examined the effects of administering both cilostazol and fasudil hydrochloride on mortality and physical disability in patients. Therefore, we investigated the impact of combined fasudil hydrochloride and cilostazol administration among patients with subarachnoid hemorrhage (SAH) in Japan. A cross-sectional study was conducted using the diagnosis procedure combination database among patients with SAH who received fasudil hydrocholoride alone (n = 8728) or in combination with cilostazol (n = 8052) between April 2016 and March 2020. The primary endpoint was in-hospital mortality, and the secondary endpoint was the proportion of patients with a modified Rankin Scale (mRS) score ≤2 at discharge. Statistical analysis was performed using multivariate-adjusted logistic regression analysis with a significance level of 5%. The mean age was 63.8 years (standard deviation [SD]: 14.4) in the fasudil hydrochloride monotherapy group (F group) and 62.8 years (SD: 14.3) in the fasudil hydrochloride and cilostazol combination group (FC group). Female patients accounted for 69.5% in the F group and 70.1% in the FC group. The in-hospital mortality rate was 7.4% in the F group and 4.0% in the FC group. Patients in the FC group had a lower in-hospital mortality rate than did those in the F group (odds ratio 0.28, 95% confidence interval [CI] 0.23-0.34, P < .001). The proportion of patients with an mRS score ≤2 at discharge was 49.4% in the F group and 55.7% in the FC group. Patients in the FC group had a higher mRS score ≤2 at discharge than those in the F group (odds ratio 1.43, 95% CI: 1.31-1.55, P < .001). We investigated the impact of combined fasudil hydrochloride and cilostazol administration on the prognosis of Japanese patients with SAH. The results suggest that combination therapy with fasudil hydrochloride and cilostazol may have a synergistic effectiveness on improving SAH prognosis compared with fasudil hydrochloride monotherapy. In future, research is needed to understand the mechanisms underlying the combined use of cilostazol.

Comparative evidence on the effectiveness of romosozumab and teriparatide in preventing osteoporotic fractures remains limited. This study evaluated their effectiveness in fracture prevention.

This observational new-user cohort study used the DeSC Healthcare database, a nationwide claims database in Japan. Patients aged ≥40 years with osteoporosis, defined by International Classification of Diseases, 10th Revision codes or prior fragility fractures, who newly initiated romosozumab or teriparatide between March 2019 and August 2021 were included. The primary outcome was the major osteoporotic fractures within 1 year. Secondary outcomes included 2-years fracture incidence and individual fracture types. Cox proportional hazards models, weighted by inverse probability-of-treatment derived from propensity scores, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs), accounting for patient- and facility-level confounders.

Among 35,547 observations (romosozumab: 9603; teriparatide: 25,944), the mean ages were 80.3 and 80.0 years, 85.2 % and 81.3 % were women, and 64.4 % and 71.9 % had a history of fragility fracture, respectively. The 1-year incidences of major osteoporotic fractures were 10.14 per 100 person-years (teriparatide) and 7.01 per 100 person-years (romosozumab) (HR: 0.80, 95 % CI: 0.71, 0.89). Romosozumab was also associated with lower rates of composite fractures over 2 years (HR: 0.81, 95 % CI: 0.72, 0.90); vertebral fractures over 1 and 2 years; and proximal humeral, distal forearm, and proximal femoral fractures over 1 year.

In this nationwide Japanese cohort, romosozumab use was associated with a lower incidence of major osteoporotic fractures compared to teriparatide over both 1- and 2-year follow-up periods among high-risk patients with osteoporosis.

The global cancer burden is rapidly increasing, with 20 million new cases estimated in 2022. The world population aged ≥65 years is also increasing, projected to reach 15.9% by 2050, making cancer control for older patients urgent. Surgical resection is important for cancer treatment; however, predicting postoperative disability and mortality in older patients is crucial for surgical decision-making, considering the quality of life and care burden. Currently, no model directly predicts postoperative functional disability in this population.

We aimed to develop and validate machine-learning models to predict postoperative functional disability (≥5-point decrease in the Barthel Index) or in-hospital death in patients with cancer aged ≥ 65 years.

This retrospective cohort study included patients aged ≥65 years who underwent surgery for major cancers (lung, stomach, colorectal, liver, pancreatic, breast, or prostate cancer) between April 2016 and March 2023 in 70 Japanese hospitals across 6 regional groups. One group was randomly selected for external validation, while the remaining 5 groups were randomly divided into training (70%) and internal validation (30%) sets. Predictor variables were selected from 37 routinely available preoperative factors through electronic medical records (age, sex, income, comorbidities, laboratory values, and vital signs) using crude odds ratios (P<.1) and the least absolute shrinkage and selection operator method. We developed 6 machine-learning models, including category boosting (CatBoost), extreme gradient boosting (XGBoost), logistic regression, neural networks, random forest, and support vector machine. Model predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) with 95% CI. We used the Shapley additive explanations (SHAP) method to evaluate contribution to the predictive performance for each predictor variable.

This study included 33,355 patients in the training, 14,294 in the internal validation, and 6711 in the external validation sets. In the training set, 1406/33,355 (4.2%) patients experienced worse discharge. A total of 24 predictor variables were selected for the final models. CatBoost and XGBoost achieved the largest AUCs among the 6 models: 0.81 (95% CI 0.80-0.82) and 0.81 (95% CI 0.80-0.82), respectively. In the top 15 influential factors based on the mean absolute SHAP value, both models shared the same 14 factors such as dementia, age ≥85 years, and gastrointestinal cancer. The CatBoost model showed the largest AUCs in both internal (0.77, 95% CI 0.75-0.79) and external validation (0.72, 95% CI 0.68-0.75).

The CatBoost model demonstrated good performance in predicting postoperative outcomes for older patients with cancer using routinely available preoperative factors. The robustness of these findings was supported by the identical top influential factors between the CatBoost and XGBoost models. This model could support surgical decision-making while considering postoperative quality of life and care burden, with potential for implementation through electronic health records.

Oral bacteria influence bloodstream infections in hematopoietic stem cell transplantation (HSCT). We investigated the effects of oral health management and its relationship with medical care delivery systems.

Patients aged >16 years who underwent HSCT, discharged from Japanese acute care hospitals between April 2018 and March 2022, were categorized into autologous and allogeneic HSCT groups. Multivariable analysis assessed the impact of peri-HSCT oral management on antibiotic use, narcotic injections, and mortality rates.

We included 12,248 patients, 5936 autologous and 6312 allogeneic HSCT patients, across 298 hospitals. The defined daily dose (DDD) of antibiotic use within 14 days post-transplantation in the oral and nonoral management groups for allogeneic HSCT patients was 34.10 (standard deviation [SD] 20.35) vs 36.37 (SD 21.33); broad-spectrum antibiotics use was 23.87 (SD 15.82) vs 24.45 (SD 15.76). Within 30 days post-transplantation, the DDD of antibiotic use was 69.13 (SD 40.18) vs 75.16 (SD 43.47) was 45.70 (SD 29.63) vs 47.95 (SD 30.48), respectively. In allogeneic HSCT patients, oral management resulted in lower DDD of antibiotic use by 2.66 within 14 days and 6.74 within 30 days post-transplantation, after adjustment for relevant factors. Broad-spectrum antibiotic use within 30 days post-transplantation showed a lower DDD by 2.79 (P < .01). Narcotic use led to a 0.34 lower DDD (P < .01) within 14 days and 0.70 lower DDD (P < .01) within 30 days. In autologous HSCT patients, oral management did not affect the outcomes. The certification standard for unrelated HSCT, categorized into four classes (no certification and certification levels 1-3), was associated with an 8.41 point increase in hospital oral management implementation per class.

Ensuring an appropriate oral environment for allogeneic HSCT patients helps preventing infection, extending life expectancy, and alleviating pain.

Coordinated care between dental and medical teams is essential to deliver safe, personalized, and high-quality patient outcomes during HSCT.

Endoscopic retrograde cholangiopancreatography (ERCP) is indispensable for the management of biliary and pancreatic diseases but carries a high risk of post-ERCP pancreatitis (PEP). This study aimed to clarify the current status and temporal trends of ERCP and PEP in Japan, including preventive measures.

We conducted a retrospective, population-based cohort study using the Diagnosis Procedure Combination database from April 1, 2016, to March 31, 2023. Trend analyses were performed for ERCP, PEP, nonsteroidal anti-inflammatory drugs (NSAIDs), and protease inhibitors. Additionally, factors associated with PEP and severe PEP were evaluated.

Among the 1,073,513 ERCP cases, PEP and severe PEP incidences were 85,212 (7.9%) and 4841 cases (0.5%), respectively. The mortality rate was 0.5% for severe PEP and 0.2% for non-severe cases. The number of ERCP procedures and the proportion of therapeutic ERCP increased over time. The incidence of PEP declined from 9.1% in the fiscal year 2016-2017 to 6.4% in the fiscal year 2022, while the incidence of severe PEP decreased from 0.5 to 0.33% over the same period. The usage rate of rectal NSAIDs increased from 16.4 to 27.6%, whereas that of protease inhibitors decreased from 70.5 to 53.5%. The administration of rectal NSAIDs at doses of 20-25 mg and 50 mg was associated with a reduced risk of severe PEP.

The number of ERCP procedures and the proportion of therapeutic ERCP have increased, whereas the incidences of PEP and severe PEP have decreased. Rectal NSAIDs may prevent the progression of PEP to severe disease.

Candidemia is an important coronavirus disease 2019 (COVID-19)-associated invasive fungal infection. Patients with COVID-19 may be susceptible to candidemia; however, evidence regarding its incidence, risk factors, and involvement in mortality is insufficient.

To explore the incidence of and potential risk factors for candidemia in patients with severe or critical COVID-19 and evaluate the relationship between candidemia and mortality in patients with severe or critical COVID-19.

The incidence of candidemia in patients with severe and critical COVID-19 was evaluated using administrative claims data from acute care hospitals in Japan. Multivariable regression models were used to explore potential risk factors for candidemia and their contribution to mortality in patients with severe and critical COVID-19.

Candidemia occurred in 0.3-1.1 % of patients with severe or critical COVID-19. Renal impairment, use of steroid, blood transfusion, and use of central venous catheter were potential risk factors for candidemia in patients with severe to critical COVID-19.

Candidemia in patients with COVID-19 was an independent risk factor for mortality. Candidemia in patients with severe to critical COVID-19 is a grave complication and may increase mortality.

In community-acquired pneumonia (CAP), short-course treatment is not inferior in effectiveness compared to conventional treatment durations, and clinical guidelines recommend 5-7-day-long treatments. However, it remains unclear how widely this practice is adopted in Japan. This study aimed to clarify the treatment duration of CAP in Japan using a large healthcare claims database.

We used health insurance claims data provided by JMDC Inc. (Tokyo, Japan) and included patients aged 18-64 years diagnosed with CAP who began antibiotic treatment between January 1, 2013, and December 31, 2022. Short-course treatment was defined as ≤ 7 d. Analyses were conducted separately for inpatient and outpatient cases, and the annual trends were also investigated.

Overall, 25,572 patients (3367 inpatients and 22,205 outpatients) were included in the analysis. Short-course treatment was administered to 1087 (32 %) inpatients and 15,614 (70 %) outpatients. The proportion of short-course treatments during the 10-year study period was 31-35 % for inpatient cases and 67-72 % for outpatient cases, with no marked changes over the years.

The proportion of inpatients receiving short-course treatments for CAP was low. In Japan, especially for inpatient cases, further efforts are required to optimize the duration of CAP treatment.

To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan's emerging hospital medicine program.

A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions. Data were collected through direct observation and structured discussions focusing on care-team structures, workflows, multidisciplinary collaboration, educational approaches, and quality improvement activities. The authors subsequently developed a comparative analysis report of Japan-US differences. Guided discussions based on this report were conducted with experienced US hospitalists and a pioneer physician of General Medicine in Japan to obtain expert commentary on the analyses. No quantitative data analysis or specific analytical software was utilized for this narrative comparison.

The US hospitalist model demonstrated group practice approaches with shift-based schedules supporting work-life balance. Multidisciplinary teams actively incorporated residents and students in patient care, quality improvement, and teaching. Japan's traditional attending physician model emphasized continuity of care but showed high workloads and limited multidisciplinary integration. Japanese hospitalists faced challenges including extensive work hours, fewer specialized training opportunities in quality improvement and patient safety, and less robust team-based learning environments.

Incorporating elements from the US model-such as group practice with shift-based systems, enhanced multidisciplinary collaboration, and structured educational and quality improvement initiatives-could address workload issues and foster professional development in Japan's hospital medicine system while preserving valued aspects of continuity of care. These findings provide specific actionable guidance for healthcare administrators, medical education directors, and policymakers involved in developing Japan's hospitalist system, as well as to practicing Japanese hospitalists seeking to enhance their professional practice environments and educational frameworks.

In Japan, the current coverage rate of human papillomavirus (HPV) vaccination is only 30%, and the rate of biennial cervical screening is 40%. The Japanese Government has attempted to increase the coverage of HPV vaccination and cervical screening. We analyzed the cost-effectiveness of the 9-valent HPV vaccine and cervical screening in Japan.

A yearly cycle Markov model with 15 health states was created to evaluate the cost-effectiveness of the 9-valent HPV vaccination and cervical screening in women aged 12-75 years. We considered four scenarios: 30% coverage of vaccination with 40% coverage of biennial screening (Scenario 1 representing the current Japanese situation), 70% (the highest proportion in 2013 in Japan) and 90% coverage of vaccination with 40% coverage of biennial screening (Scenarios 2 and 3, respectively), and 90% coverage of vaccination with 70% coverage of biennial screening (Scenarios 4). The incremental cost-effectiveness ratio (ICER) was calculated as costs per quality-adjusted life year (QALY) based on the perspective of the healthcare payer and compared with the benchmark for willingness to pay in Japan (41 700 USD per QALY). The cumulative morbidity and mortality in each scenario were analyzed using the Markov model.

Compared with Scenario 1, the ICERs of Scenarios 2, 3, and 4 were 5382, 5321, and 8524 USD/QALY, respectively, which were lower than the benchmark for willingness to pay. As the coverage of HPV vaccination and cervical screening increased, the cumulative morbidity and mortality decreased.

Increasing the coverage of the 9-valent HPV vaccination and cervical screening is cost-effective in Japan.

The safety of intraoperative periarticular triamcinolone injection in total knee arthroplasty (TKA) remains unclear. This study aimed to assess the association between periarticular injection of triamcinolone during primary TKA and complications, including early postoperative infection.

A Japanese nationwide database was used to identify adults who underwent primary TKA between April 2016 and March 2022. Patients were divided into triamcinolone and control groups. The primary outcome was reoperation for infection within 90 days from primary TKA. Secondary outcomes included diagnosis of postoperative infection, wound complications, deep vein thrombosis (DVT), pulmonary embolism (PE), in-hospital death, and readmission within 90 days. Propensity score matching was performed to adjust baseline differences. During the study period, 242,571 cases underwent primary knee arthroplasty. Among 212,427 eligible TKA patients, 15,229 (7.2%) were in the triamcinolone group and 197,198 (92.8%) were in the control group.

Overall, there were 551 reoperations for infection within 90 days (0.26%), including 61 (0.40%) patients in the triamcinolone group and 490 (0.25%) in the control group. Propensity score matching yielded 14,683 pairs. The triamcinolone group had a higher incidence of reoperation for infection, with a risk ratio (RR) of 1.67 (95% confidence interval [CI]: 1.10 to 2.53) and risk difference of 0.16% (95% CI: 0.03 to 0.29). Diagnoses of infection (RR: 1.25 [95% CI: 1.09 to 1.44]) and wound complications (RR: 1.18 [95% CI: 0.99 to 1.39]) were more frequent in the triamcinolone group, while DVT incidence was significantly lower (RR: 0.69 [95% CI: 0.65 to 0.73]). No significant differences were observed in PE or in-hospital death, although 90-day readmission was more frequent in the triamcinolone group (RR: 1.22 [95% CI: 1.06 to 1.40]).

Although the difference was subtle, periarticular injection of triamcinolone during TKA was associated with an increased risk of early postoperative infection requiring reoperation.

The quality of healthcare at the regional level is of great interest. Regional differences in the quality of healthcare for cardiovascular diseases have been pointed out in previous research, but the regional factors that influence the quality remain unclear.

Using the national Diagnosis Procedure Combination (DPC) database, risk-adjusted mortality (RAM) in each secondary medical area (SMA) was derived as an indicator for the quality of the healthcare for patients with acute myocardial infarction (AMI). Factors associated with RAM were analysed using the partial least squares (PLS) regression model.

There is a wide variation in RAM in the SMAs; the maximum value was 0.593 and the minimum value was 1.445. The PLS regression identified two components positively correlated with RAM. The first component (Component 1) positively correlates with the proportion of the elderly within the population and negatively correlates with the number of medical facilities per area, the population density, and the intra-SMA access to centres with a high volume of emergency percutaneous coronary interventions (ePCI). The second component (Component 2) positively correlates with the number of medical facilities per area and negatively correlates with the number of doctors per person and the intra-SMA access to centres with a high volume of ePCI.

There was wide regional variation in the quality of in-hospital AMI treatments. Results suggested the degree of rurality, the sufficiency of medical resources, the access to high-volume ePCI centres, and coordination of healthcare delivery were associated with healthcare quality.

The introduction of novel drugs for metastatic castration-sensitive prostate cancer has expanded treatment options for patients. Associated changes in healthcare resource utilization may have occurred in tandem, but nationwide information is limited. This study aimed to describe initial treatment patterns and healthcare resource utilization (including costs) for patients with metastatic castration-sensitive prostate cancer in routine clinical practice in Japan.

This retrospective, longitudinal cohort study used a large-scale claims database covering acute care hospitals of various sizes. Included were men who received first medical treatment for metastatic castration-sensitive prostate cancer between January 2015 and July 2021 (identification period). The primary endpoint was the initial treatment pattern for metastatic castration-sensitive prostate cancer.

Among 7665 men with metastatic castration-sensitive prostate cancer, the median (Q1, Q3) duration of first-line therapy was 8.2 (3.4, 17.3) months. During the overall period between 2015 and 2021, the most common initial pharmacotherapy (88.1% of treatment regimens) was 'combined androgen blockade or androgen deprivation therapy only or first-generation anti-androgen only'. Use of androgen receptor signaling inhibitors increased following their introduction in 2018, reaching 26.6% of treatments started in 2021 (abiraterone + androgen deprivation therapy 9.4%, apalutamide + androgen deprivation therapy 9.2%, enzalutamide + androgen deprivation therapy 8.0%). Median total healthcare-related cost per person-year was JPY 244 479, with metastatic castration-sensitive prostate cancer drugs accounting for approximately one-third of the cost (JPY 396 620).

Since androgen receptor signaling inhibitors were introduced, treatment patterns in patients with metastatic castration-sensitive prostate cancer in Japan have shifted, with an increased trend toward prescription of these agents. However, the most frequently used regimen for first-line treatment continues to be 'combined androgen blockade or androgen deprivation therapy only or first-generation anti-androgen only'.

Respiratory syncytial virus (RSV) significantly impacts not only children but also adults. However, knowledge of the severity and outcomes among adult RSV inpatients is still limited.

To clarify the short- and long-term health threats associated with adult RSV infections.

This retrospective observational study included 56,980 adult inpatients aged 18 years and older due to RSV or influenza infection between April 2010 and March 2022. After inverse probability weighting adjustment, we used Poisson's regression to estimate the risk of outcomes.

The RSV group had a higher risk of requiring mechanical ventilation during hospitalization compared to the influenza group (9.7% vs. 7.0%; risk ratio (RR), 1.35; 95% confidence interval (CI), 1.08-1.67). In-hospital mortality was comparable between RSV and influenza groups (7.5% vs. 6.6%; RR, 1.05; 95% CI, 0.82-1.34). RSV group was associated with increased risk of readmission within 1 year after surviving discharge (34.0% vs. 28.9%; RR, 1.19; 95% CI, 1.07-1.32) and all-cause mortality within 1 year of admission (12.9% vs. 10.3%; RR, 1.17; 95% CI, 1.02-1.36). In the age-stratified analysis, the RSV group aged 60 years and older had a higher risk than the influenza group for in-hospital death, readmission and all-cause mortality within one year.

RSV infections demonstrated comparable or greater health threats than influenza infections not only during hospitalization but also in long-term outcomes. The findings underscore the threat of RSV in adults, the impact on healthcare systems and the need for continued development of public health counter measures against RSV.

Abdominal contrast-enhanced computed tomography (CT) is the gold standard for diagnosing acute focal bacterial nephritis (AFBN). However, contrast-enhanced CT is contraindicated for patients with contrast medium allergies, impaired renal function, pregnancy, metformin use, and thyroid disease. Diffusion-weighted whole body imaging with background body signal suppression (DWIBS) is a safe imaging modality for such patients. Although DWIBS can quickly evaluate inflammation, its role in diagnosing AFBN remains unclear. Therefore, we aimed to compare imaging modalities for diagnosing AFBN and evaluate the efficacy of DWIBS in patients receiving inpatient treatment.

In this retrospective cohort study, we included individuals aged ≥18 years hospitalized for AFBN under the Diagnosis Procedure Combination system from January 1, 2013, to December 31, 2022. Exclusion criteria included imaging findings not suggestive of AFBN. The primary outcome was the proportion of patients who underwent abdominal ultrasonography, contrast-enhanced CT, and DWIBS and their respective diagnostic rates for AFBN. The secondary outcome was the accuracy of AFBN detection using abdominal ultrasonography and DWIBS compared to that of the standard contrast-enhanced CT.

The study cohort included 123 patients, with an average age of 51±20.4 years; 107 (87.0%) were women. Abdominal ultrasonography was used in 74.0% (91/123) of the patients, yielding a diagnostic rate of 31.9% (29/91). Contrast-enhanced CT was used in 90.2% (111/123) of the patients, with a diagnostic rate of 100% (111/111). DWIBS was used in 11.4% (14/123) of the patients, with a diagnostic rate of 85.7% (12/14). The accuracy of AFBN detection (correct response rate) was 26.6% (21/79) for abdominal ultrasonography and 75.0% (6/8) for DWIBS, indicating that DWIBS had a significantly higher accuracy rate than that of abdominal ultrasonography [Chi-square test, χ2(1) =7.96, P=0.0048].

DWIBS demonstrated promising diagnostic accuracy for AFBN compared with abdominal ultrasonography, suggesting it could be a valuable diagnostic tool for this condition. Given its diagnostic accuracy, DWIBS may be considered over abdominal ultrasonography in patients who are unable to undergo contrast-enhanced CT due to allergies or pregnancy. However, further prospective studies with larger sample sizes are necessary to validate these findings.

Objective High-quality evidence proving the superiority of hospitalist services is lacking. We developed risk-adjusted performance indicators from a multilevel prediction model using a nationwide inpatient database to evaluate hospitalist medical care for patients with aspiration pneumonia. Methods We extracted cases diagnosed with aspiration pneumonia between 2014 and 2021 from the Diagnosis Procedure Combination (DPC) database. Hospital-level risk-adjusted performance indicators were the observed-to-expected ratio of the following outcomes using a multilevel prediction model containing both patient- and hospital-level variables: death or transfer in poor condition within 30 days (Poor outcome), in-hospital death within 30 days, and discharges within the 25th and 50th percentiles for length of stay defined by the DPC system. Using the predicted numbers of each outcome without random intercept as denominators of both indicators, the numerators of Indicator 1 were observed numbers of each outcome, while those in Indicator 2 were "smoothed" predicted numbers of outcomes estimated by the fitted model with random intercept. The ratio of the number of outcomes for each hospital to the mean number of outcomes among participating hospitals was used as a reference. We applied these indicators to Takatsuki General Hospital (TGH) as a working example. Results A total of 526,245 patients were analyzed. Compared with Indicator 1, Indicator 2 showed greater stability in the mean ratio and bootstrapping confidence interval (CI). Indicator 2 of Poor outcome and discharges within the 25th percentile in 2017 at TGH were 1.110 (95% CI 0.784-1.375) and 1.458 (95% CI 1.272-1.597), respectively. Conclusion Utilizing a nationwide inpatient database, we developed risk-adjusted performance indicators using a multilevel prediction model to evaluate hospitalist medical care for patients with aspiration pneumonia. Given the reliable results shown in the working example, these indicators have potential benefits for the accurate evaluation of the quality of medical care.

To evaluate the risks of colorectal endoscopic submucosal dissection (ESD) in older adult patients, given the increasing number of ESD in an aging population.

We conducted a retrospective cohort study using the Japanese nationwide database from 2012 to 2023. Patients aged 60 years or older who underwent colorectal ESD were included. The primary outcome was overall adverse events (AEs), including in-hospital mortality, procedure-related perforation, abdominal surgery, aspiration pneumonia, and significant postoperative bleeding and thromboembolic events. We first examined the association between age and AEs using multivariable regression adjusting for patient characteristics. Next, to explore the factors associated with overall AEs in those aged 85 years or older, we fit a multivariable logistic regression.

The study included 143,925 cases. Age distribution was as follows: 60-64 (13.5%), 65-74 (44.9%), 75-84 (35.8%), and ≥85 (5.8%) years. The prevalence of overall AEs increased with age: 5.3% for ages 60-64 years, 7.9% for ages 85-89 years, and 9.2% for ages 90 years or older. Patients aged 85 years or older had a higher prevalence of overall AEs compared with patients aged 60-64 years, with an adjusted odds ratio of 1.19 (95% confidence interval: 1.07-1.33, P < 0.01) for those aged 85-89 years and an adjusted odds ratio of 1.45 (95% confidence interval: 1.16-1.80, P < 0.01) for those aged 90 years or older. Most AEs in patients aged 85 years or older were due to significant postoperative bleeding, with anticoagulant use and body mass index ≥30 identified as key risk factors.

The risks of AEs during colorectal ESD increase with age, particularly in patients aged 85 years or older.

We conducted a multicenter retrospective cohort study across 38 hospitals in Chiba, Japan, between February 1, 2020 and November 31, 2021 to investigate the effect of coronavirus disease 2019 (COVID-19) on patients with diabetes mellitus receiving inpatient care. We collected inpatient medical data through Diagnosis procedure combination (DPC), the diagnoses and payment system of medical insurance, from each hospital. We excluded patients younger than 18 years, those who were pregnant, and those who had diabetes but were not treated with diabetic medication. A total of 10,776 patients were included: 7,679 in the non-diabetic (control) group and 3,097 in the diabetic group. Patients in the diabetic group were older and had a higher body mass index (BMI) than those in the control group. In the diabetes group, 88.4% of the patients were treated with insulin therapy and 44.2% were treated with oral hypoglycemic agents. The length of hospital days was significantly longer in the diabetes group. The in-hospital mortality rate was significantly higher especially between 50 and 59 years old. The rates of in-hospital mortality, mechanical ventilation, intensive care unit (ICU) admission, renal replacement therapies such as hemodialysis (HD), and continuous hemodiafiltration (CHDF) were all higher, even after adjusting for age, sex, BMI, and ambulance use. In conclusion, diabetes was a significant risk factor of the severe clinical outcomes especially for in-hospital mortality, mechanical ventilation usage, ICU admission, HD, and CHDF in Japan.

Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial.

This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays.

A retrospective observational study.

Acute care hospitals in Japan.

Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures.

Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays.

Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'.

Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.

Venous thromboembolism (VTE) is a major health problem worldwide. There are scarce data on the recent temporal trends of patients with VTE after the widespread use of direct oral anticoagulants (DOACs).

In a Japanese nationwide hospital administrative database, we identified 20,217 patients with VTE from 2017 to 2023, and evaluated their temporal trends in management strategies and clinical outcomes. The proportions of outpatient treatment among patients with out-of-hospital isolated deep vein thrombosis increased significantly (p trend <0.001, Pearson's R = 0.046) over time from 2017 to 2023. The proportions of warfarin use decreased significantly over time from 2017 to 2023 (p trend <0.001, Pearson's R = -0.053), whereas the use of most DOACs increased. The proportions of thrombolysis (p trend <0.001, Pearson's R = -0.046) and inferior vena cave filter (p trend <0.001, Pearson's R = -0.048) use decreased significantly over time from 2017 to 2023. The incidence of 6-month all-cause death, VTE recurrence, and bleeding was 9.1 %, 2.1 %, and 4.4 %, respectively. The incidence decreased in 6-month all-cause death (p trend = 0.018, Pearson's R = -0.017) and bleeding (p trend <0.001, Pearson's R = -0.029) over time from 2017 to 2023.

The current Japanese nationwide hospital administrative database provided the recent temporal trends in the real-world management strategies and clinical outcomes of VTE, which revealed several temporal changes in these aspects after the widespread use of DOACs.

Cardiovascular emergencies often require intensive care unit (ICU) management, but there is limited data comparing outcomes based on the admission ward.

We analyzed data from the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC) database (2016-2020) for 715,054 patients (mean age, 75.4±14.2 years, 58.4% male) admitted with acute myocardial infarction (N=175,974), unstable angina (N=45,308), acute heart failure (N=179,871), acute aortic dissection (N=58,597), pulmonary embolism (N=17,009), or post-cardiac arrest (N=184,701). Patients were categorized into 4 groups: intensive care add-ons 1/2, 3/4 (ICU 1/2, 3/4), high-care unit (HCU), and general wards. Comparisons included patient characteristics, hospitalization duration, mortality rates, and rates of defibrillation or cardiopulmonary resuscitation (CPR) defined by chest compression. General ward patients were the oldest and with shortest hospitalization durations. Additionally, mortality rates were the highest in general wards for acute heart failure, myocardial infarction, and aortic dissection. Defibrillation rates were 7.0%, 5.6%, 3.1%, and 4.3%, for ICU 1/2, 3/4, HCU, and general ward, respectively, with corresponding mortality rates of 40.4%, 44.1%, 44.6%, and 79.3%. CPR rates were 10.1%, 9.5%, 6.2%, and 3.1%, with mortality rates of 71.0%, 73.9%, 78.4%, and 97.7%, respectively.

High mortality rates in general wards highlight the importance of ICU management, particularly for acute myocardial infarction and aortic emergencies. These findings support prioritizing ICU admission for these critical conditions.

Remdesivir (RDV) was approved in Japan for the treatment of coronavirus disease 2019 (COVID-19) in May 2020. However, large-scale research describing the characterized use of RDV in the inpatient setting in Japan is limited. This study aimed to describe the treatment patterns and clinical outcomes of immunocompromised patients with COVID-19 treated with RDV.

We used a secondary nationwide administrative claims database of acute care hospitals in Japan. The study period was from October 19, 2020, to September 30, 2022. Patients with COVID-19 treated with RDV during hospitalization were included, and the proportion of patients with death and disease progression were calculated.

The analysis included a total of 2171 immunocompromised patients treated with RDV. The mean (standard deviation) age at index date was 75.1 (13.6) years. The median time to RDV initiation from hospitalization was 1.0 days (Q1-Q3: 1.0-2.0), and the median duration of RDV treatment was 5.0 days (Q1-Q3: 3.0-5.0). At RDV initiation, 53.02% (n=1151) of patients required non-invasive positive pressure ventilation, nasal high-flow or low-flow oxygen, and 2.26% (n=49) required mechanical ventilation, extracorporeal membrane oxygenation, or intensive care unit admission. Inpatient mortality rate by day 28 was 8.98% (95% confidence interval, 7.81-10.26). By day 28, the rate of disease progression was 9.86% (n=214), and 76.83% (n=1668) were discharged.

This study presents practical information on outcomes and treatment patterns of RDV in immunocompromised inpatients diagnosed with COVID-19.

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.

Current guidelines for community-acquired pneumonia (CAP) include ampicillin-sulbactam as an initial treatment option, though they do not mandate routine coverage of anaerobic organisms. This study aimed to compare the effectiveness of ampicillin-sulbactam with that of ceftriaxone as initial treatment for CAP in older adults.

This study was conducted using the target trial emulation framework, using a nationwide Japanese database (May 2010-June 2023). The study included patients aged ≥65 years, admitted to Diagnosis Procedure Combination hospitals for CAP, who received either ampicillin-sulbactam or ceftriaxone as the initial treatment. The exposure group received ampicillin-sulbactam, while the control group received ceftriaxone, both on the day of hospitalization. The primary outcome was in-hospital mortality; the secondary outcome was the development of Clostridioides difficile infection during hospitalization.

The study included 26 633 older patients hospitalized with CAP, with 14 906 receiving ampicillin-sulbactam and 11 727 receiving ceftriaxone as initial treatment. After inverse probability of treatment weighting, the ampicillin-sulbactam group was associated with a higher in-hospital mortality rate than the ceftriaxone group (10.5% vs 9.0%, respectively; adjusted risk difference, 1.5% [95% confidence interval, .7%-2.4%]; adjusted odds ratio, 1.19 [1.08-1.31]). The incidence of C difficile infection was numerically higher in the ampicillin-sulbactam group (0.6% vs 0.4%; adjusted risk difference, 0.2% [95% confidence interval, .0%-.4%]; adjusted odds ratio, 1.45 [.99-2.11]). These results were consistent among patients with risk factors for aspiration.

In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.

The duration of antimicrobial therapy required to treat community-acquired pneumonia is often longer than expected, likely because of the high number of such inpatients in developed countries with aging populations. In this study, we evaluated the effects of short-term treatments for both pneumonia and aspiration pneumonia in older Japanese adults using the nation's inpatient database. Inpatients aged ≥ 65 years who were admitted to the hospital for pneumonia or aspiration pneumonia between April 1, 2018, and October 31, 2018, were included. We compared patients treated via intravenous antibiotics for 3-7 days to control patients treated with a similar regimen for 8-28 days, using inverse probability of treatment-weighted Cox regression. The primary outcome was relapse or readmission for pneumonia and death within 30 days after completing antimicrobial therapy. The secondary outcomes were average treatment effect for Clostridioides difficile infection (CDI), chest drainage, and length of hospital stay. The total number of eligible patients was 72,294. The hazard ratio for the primary outcome was 1.04 (95% confidence interval: 0.99-1.10). The mean length of hospital stay was shortened to 9.74 days (range, 9.34-10.1) in the short-term treatment group. The prevalence rates of CDI and chest drainage did not differ significantly between the short- and long-term treatment groups. We observed no statistically significant difference in clinical outcomes between the older adults with pneumonia including aspiration pneumonia who received short- vs long-term antimicrobial therapy.

Hypertension and diabetes are prevalent among older people and may be associated with cancer. Although several network analyses have been conducted to visualize the associations between diseases and relevant factors, to the best of our knowledge, none have focused on visualizing the associations between cancer and other diseases. We conducted a network analysis to explore the associations between cancer, hypertension, and diabetes. This study used a large-scale clinical dataset of 1,026,305 hospitalized patients aged ≥ 65 years, collected between April 2008 and December 2020. Diseases were categorized using the International Classification of Diseases-10 (2019 version) codes. The analysis focused on diseases with a prevalence of ≥ 1%. A multimorbidity network was constructed for the entire patient cohort, and the same analysis was applied specifically to cancer patients. Hypertension (degree centrality: 58/61) and diabetes (degree centrality: 56/61) were connected to several diseases, indicating significant multimorbidity in the cohort. The associations (observed-to-expected ratio) between digestive system cancers and hypertension and diabetes were relatively stronger than those between the diseases and other cancers. Type 2 diabetes and essential hypertension may be risk factors of cancers at multiple digestive system sites. Early treatment of these conditions could prevent or delay the progression of digestive system cancers.

Exposure to heat may increase the risk of intussusception through various mechanisms, including alterations in dietary intake. However, no nationwide studies have examined the association between daily heat exposure and intussusception in children. This study aims to examine the association between higher daily ambient temperatures and intussusception in children.

The daily number of intussusception hospitalizations among children up to 5 years old from 2011 to 2022 was extracted from Japan's nationwide administrative claims database. Daily mean temperature data were obtained from the Japan Meteorological Agency. Since the focus is on heat exposure, the analysis examines hospitalizations that occurred during the five warmest months (May to September). A time-stratified case-crossover design with conditional quasi-Poisson regression analysis was applied to estimate the relative risk of heat exposure on intussusception with a lag of 0-4 days.

There were 13,083 cases of intussusception hospitalizations. Higher daily mean temperatures were associated with an elevated risk of intussusception hospitalizations. Specifically, exposure to extremely high daily mean temperatures at the 99th percentile was associated with a 39% increase in hospitalization risk (95% CI: 1.05, 1.83).

The study found the association between higher daily mean temperatures and an increased risk of hospitalization for intussusception. Future research should clarify the mechanisms of the association between higher daily mean temperatures and the increased risk of intussusception hospitalizations.

While exposure to heat may increase the risk of intussusception through mechanisms such as alterations in dietary intake and intestinal motility, no nationwide studies have investigated the association between daily heat exposure and intussusception in children. The study found the association between higher daily mean temperatures and an increased risk of hospitalization for intussusception. Both caregivers and healthcare providers should be aware of a potential increase in pediatric intussusception cases during warmer days, which may become even more critical as climate change results in more frequent and severe heat events.

Antimicrobial resistance is increased by antibiotic overuse, so it's crucial for stewardship programs to monitor and control their use. Pneumonia, particularly prevalent among older adults in Japan, is requiring higher rates of medical treatment. This study aimed to develop an improved method for benchmarking broad-spectrum antibiotic use in the empiric treatment of pneumonia in older adult inpatients by applying the "smoothed" observed-to-expected (O/E) ratio which adjusts for hospital-level variations and minimizes the effect of extreme values.

Using nationwide data from the Diagnosis Procedure Combination research group, pneumonia patients between April 1st 2018 and March 31st 2020 were analyzed. The primary outcome was the smoothed O/E ratio of the broad-spectrum antibiotic use for hospitals. It was calculated from the predicted values of broad-spectrum antibiotic use that were obtained through multilevel logistic regression using patient characteristics as predictors from data clustered by hospitals. The analysis investigated the risk-adjusted use of broad-spectrum antibiotics among hospitals.

A total of 244,747 patients from 958 hospitals were included, with a mean age of 81 (±8.30) years. The proportion of broad-spectrum antibiotic use was 35.3% (n = 86,316). The prediction model showed a C-statistic of 0.722. There was a noticeable variation in the O/E ratio among hospitals with values ranging from 0.13 (95% CI: 0.09-0.20) to 2.81 (95% CI: 2.64-2.97).

Using a risk-adjusted smoothed O/E ratio, we assessed the use of broad-spectrum antibiotics across hospitals, identifying those with high O/E ratios that may indicate a need for improvement.

In Japan, the publication of the Fracture Liaison Service Clinical Standard (FLS-CS) had no apparent effect on the implementation of secondary fracture prevention, but the introduction of a new management fee for secondary fracture prevention significantly promoted the implementation of secondary fracture prevention for the target disease.

Secondary fracture prevention is important for managing fragility fractures. In Japan, the FLS-CS was published in 2019, alongside the introduction of a new management fee for secondary fracture prevention, launched in 2022 for patients who underwent surgery for hip fracture. FLS programs were hospital-based. This study evaluated the impact of these interventions on the implementation of secondary fracture prevention during hospitalization for fragility fractures.

Using claims data from the Quality Indicator/Improvement Project database, patients aged 50 years or older with hip fracture who underwent surgery or with vertebral fractures were included. The publication of FLS-CS was the first intervention, followed by the introduction of the management fee as the second intervention. To evaluate the impact of these interventions, we performed an interrupted time series analysis separately for hip and vertebral fractures.

For hip fractures, there was no immediate change after the first intervention, and the monthly rate of change decreased (incidence rate ratio [IRR]: 0.985, 95% confidence interval [CI]: 0.979-0.991). After the second intervention, there was an immediate increase (IRR: 1.890, 1.761-2.029), and the monthly rate of change also increased (IRR: 1.050, 1.044-1.056). For vertebral fractures, the proportion of change increased only immediately after the second intervention (IRR: 1.148, 1.038-1.270).

The publication of FLS-CS had no apparent effect on the implementation of secondary fracture prevention in patients with either hip or vertebral fractures. Conversely, the introduction of the management fee had the effect of increasing that for the target disease.

This study examined the impact of the COVID-19 pandemic on the number of colorectal cancer surgeries performed in Japan.

We selected patients who underwent colorectal cancer surgeries between January, 2017 and December, 2020 from the Diagnosis Procedure Combination database. The COVID-19 pandemic was divided into three waves. We evaluated the changes in the number of surgeries performed for colorectal cancer during each wave, stratified by cancer stage using Poisson regression.

During the first wave, the rate ratio (RR) for stage III colon cancer decreased significantly (RR, 0.94), whereas those for stages 0 to II (RR, 1.01) and stage IV (RR, 1.04) were not different. During the second and third waves, the RR for stage 0 to II colon cancer decreased significantly (RR, 0.96), that for stage IV increased (RR, 1.09), and that for stage III was not different (RR, 0.97). During the first wave, the RR for stage 0 to II rectal cancer increased significantly (RR, 1.09), that for stage IV decreased (RR, 0.84), and that for stage III was not different (RR, 0.97).

The number of colorectal cancer surgeries changed during the pandemic and varied according to the stage of disease.

The variation in survival rates among patients with cancer based on residential areas has become a significant concern globally. Japan's Basic Plan to Promote Cancer Control Programs (BPPCCP), implemented in 2007, aimed to reduce this variation by designating cancer care hospitals in each cancer medical area (CMA) where patients resided. From the Osaka Cancer Registry data, we extracted 407,489 patients aged 15-74 years with cancer who received treatment in Osaka Prefecture between 1997 and 2015 and analyzed regional variations in survival rates for each patient's residential CMA before and after the implementation of the BPPCCP. By standardizing the distribution of the patients' background factors (sex, age, stage, and socioeconomic status) to the distribution of the whole prefecture, 5-year relative survival rates for each CMA were calculated, and regional variations were assessed. Before BPPCCP, survival variation reached 2.00 percentage points (p-values < 0.05); post-BPPCCP, it decreased to 0.98 percentage points and was no longer significant. In conclusion, the introduction of the BPPCCP in 2007 may have reduced regional variation in the survival rate of patients with cancer in Osaka Prefecture. Measures such as the BPPCCP could potentially equalize the cancer care delivery system.

Several studies reported an association between the number of teeth and the incidence of hip fractures in observational studies, mainly in middle-aged adults. This retrospective cohort study aimed to clarify the association between the number of teeth and the incidence of hip fractures.

In this retrospective cohort study, a total of 256,772 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated. Exposure in this study was the number of teeth, with a maximum number of 28, excluding third molars. Outcome measures were the incidence of hip fractures needing surgery, using the Japanese procedure codes in medical claims.

A total of 190,998 participants met the inclusion criteria and were available for analysis. Adjusted Fine and Gray models identified a significant association between the number of teeth, including sound, filled, and decayed teeth, and the incidence of hip fractures among women but not for men. The continuous net reclassification improvement (NRI) of the sound and filled teeth count model increased by 0.078 compared with that of the sound, filled, and decayed teeth count model among women.

The number of sound and filled teeth predicted the risk of hip fractures in women, whereas no association was observed between the number of teeth and hip fractures in men.

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.

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.

Numerous studies have described positive relationships between hospital volume (HV) and clinical outcomes in highly complex procedures, including esophagectomies. Although the centralization of surgery has been considered a possible solution for improving clinical outcomes, the HV impact on perioperative healthcare costs is unknown. This study aimed to determine the relationship between HV and perioperative healthcare costs for patients undergoing esophagectomy for esophageal cancer.

This retrospective, nationwide cohort study used Japanese Administrative Claims Database data. Data on esophagectomies performed nationwide in 2015 were extracted. The outcome measure was perioperative healthcare costs per person from the perspective of the insurer. The healthcare costs in outpatient or inpatient settings of any hospital and clinic where patients received treatment were summed up from the month the surgery was performed to 3 months after. Linear regression analyses were conducted to assess the risk-adjusted effects of the HV category (1-4/5-9/10-14/15-) on perioperative costs.

A total of 5232 patients underwent an esophagectomy at 584 hospitals. The overall perioperative cost was 20.834 billion Japanese yen (JPY). The median perioperative costs per person for each HV category (1-4/5-9/10-14/15-) were 3.728 (709 patients), 3.740 (658 patients), 3.760 (512 patients), and 3.760 (3253 patients) million JPY, respectively (P = 0.676). Multivariate analyses revealed that each HV category had no significant impact on perioperative costs.

There were no significant differences in the perioperative costs between high- and low-volume centers. Esophageal cancer surgery centralization may be achievable without increasing healthcare costs.

Acquired haemophilia A (AHA) is characterized by the development of autoantibodies against factor VIII, reducing its activity and potentially resulting in bleeding.

To assess the characteristics of people with AHA undergoing rehabilitation and/or with low activities of daily living (ADL) scores, thereby characterizing unmet needs in the management of AHA and informing treatment optimization.

ORIHIME II, the largest epidemiological and treatment survey of AHA in Japan, is a descriptive, retrospective, observational study conducted using health claims data from April 2008 to October 2021. The primary outcome measures were rehabilitation practice and ADL scores on hospital admission and discharge; use of haemostatic agents and immunosuppressive therapy were also assessed.

Overall, 427 patients in Japan were eligible for the study. Median (Q1-Q3) age was 78.0 (70.0-84.0) years; 264 patients (61.8%) were male. Median (Q1-Q3) time to start rehabilitation was 9 (4-21) and 14 (6-31) days for those with an admission ADL score of <85 and ≥85, respectively. Of the 427 patients, 249 underwent rehabilitation. The most common rehabilitation type was for disuse syndrome; haemostatic agents were more commonly used in patients undergoing earlier rehabilitation.

The physical condition of the patient at hospitalization was associated with rehabilitation practice and the ability of the patient to perform day-to-day activities independently. Treatment strategies should be optimized to allow initiation of rehabilitation as early as possible in the course of AHA.

Human cytomegalovirus (HCMV) infection occurs in immunosuppressed individuals and is known to increase mortality. Patients with coronavirus disease 2019 (COVID-19) are often treated with steroids, require intensive care unit (ICU) treatment, and may therefore be at risk for HCMV infection. However, which factors predispose severely ill patients with COVID-19 to HCMV infection and the prognostic value of such infections remain largely unexplored. This study aimed to examine the incidence and potential risk factors of HCMV infection in patients with severe or critical COVID-19 and evaluate the relationship between HCMV infection and mortality.

We used administrative claims data from advanced treatment hospitals in Japan to identify and analyze patients with severe or critical COVID-19. We explored potential risk factors for HCMV infection using multivariable regression models and its contribution to mortality in patients with COVID-19. Overall, 33,151 patients who progressed to severe or critical COVID-19 illness were identified. The incidence of HCMV infection was 0.3-1.7 % depending on the definition of HCMV infection. Steroids, immunosuppressants, ICU admission, and blood transfusion were strongly associated with HCMV infection. Furthermore, HCMV infection was associated with patient mortality independent of the observed risk factors for death.

HCMV infection is a notable complication in patients with severe or critical COVID-19 who are admitted to the ICU or receive steroids, immunosuppressants, and blood transfusion and can significantly increase mortality risk.

Low blood pressure (BP) is suggested to be associated with all-cause mortality in older adults. The aim of this study is to validate the relationship in older adults and to examine the possible involvement of clinical characteristics, namely functional disability, comorbidities, antihypertensive treatment, and reverse causation, in the relationship using insurance claims data including annual health checkup data. The study participants were 337,975 individuals aged ≥65 years. The earliest day of participation in the annual health checkup from 2012 to 2020 was determined at baseline. Data on comorbidities, functional disability levels, prescribed antihypertensive medications, and incidence of stroke, myocardial infarction and all-cause mortality were obtained from the insurance claims. During a mean follow-up period of 5.3 years, there were 27,495 cases of all-cause mortality, 9000 cases of stroke and 1640 cases of myocardial infarction. A U-shaped association was observed between systolic BP and all-cause mortality in participants aged ≥75 years and the hazard ratio calculated systolic BP 120-129 mmHg as reference was 1.14 for <110 mmHg and 1.16 for ≥150 mmHg (all P < 0.001). The U-shaped association remained significant in the sub-analyses of individuals without severe comorbidities, antihypertensive treatment, or functional disability. Similar results were observed in the analysis excluding early-mortality cases. In contrast, the risk of stroke and myocardial infarction increased linearly with increasing BP. Low BP was associated with all-cause mortality in older adults. The U-shaped association may not be solely attributed to the previously suggested factors, including antihypertensive treatment, potential comorbidities, and functional disability.

Although conservative treatment is commonly used for osteoporotic vertebral fracture (OVF), some patients experience functional disability following OVF. This study aimed to develop prediction models for new-onset functional impairment following admission for OVF using machine learning approaches and compare their performance. Our study consisted of patients aged 65 years or older admitted for OVF using a large hospital-based database between April 2014 and December 2021. As the primary outcome, we defined new-onset functional impairment as a Barthel Index ≤ 60 at discharge. In the training dataset, we developed three machine learning models (random forest [RF], gradient-boosting decision tree [GBDT], and deep neural network [DNN]) and one conventional model (logistic regression [LR]). In the test dataset, we compared the predictive performance of these models. A total of 31,306 patients were identified as the study cohort. In the test dataset, all models showed good discriminatory ability, with an area under the curve (AUC) greater than 0.7. GBDT (AUC = 0.761) outperformed LR (0.756), followed by DNN (0.755), and RF (0.753). We successfully developed prediction models for new-onset functional impairment following admission for OVF. Our findings will contribute to effective treatment planning in this era of increasing prevalence of OVF.

Lockdowns and outing restrictions during the COVID-19 pandemic may have altered attitudes towards hospital visits. This study aimed to investigate changes in long-distance visits outside of secondary healthcare service areas (SHSA) among cancer patients in Japan.

Retrospective observational study.

Inpatient data from the Japanese Diagnosis Procedure Combination database.

We retrospectively analysed inpatient data from January 2018 to December 2021, extracted from the Japanese Diagnosis Procedure Combination database. The study examined whether the patient's hospital was within their residence's SHSA and compared the admission rates before and after the pandemic.

The data of a total of 2 394 760 patients were analysed. Admission rates outside the SHSA significantly decreased after the pandemic compared with prepandemic years (26.67% and 27.58%, respectively, p<0.001). Significant reductions were observed in nearly all age groups over 30 years old, but not in younger ones. Characteristics of patients' residences, including COVID-19 infection rates, population density and the number of regional cancer hospitals, were also influential factors. The cancer site was a significant factor, with the respiratory system showing a 3.77% decrease, particularly a 5.29% decrease in those who needed surgeries that are not highly specialised (p<0.001).

Admission to distant hospitals among cancer patients decreased following the COVID-19 pandemic, indicating a restraint in their behaviour of visiting distant hospitals. The appropriate allocation of specialised hospitals will serve as a measure for the next pandemic.