基本情報
- 所属
- 自治医科大学 データサイエンスセンター 講師国立病院機構本部 総合研究センター診療情報分析部 非常勤研究員東京大学 臨床疫学・経済学 非常勤講師
- researchmap会員ID
- R000011081
研究キーワード
3論文
139-
Pediatric neurology 164 97-104 2025年3月BACKGROUND: The benefit of early corticosteroid use in pediatric bacterial meningitis is uncertain, except for its effect on hearing loss caused by Haemophilus influenzae type b (Hib) meningitis. We aimed to evaluate the association between early corticosteroid use and the short-term outcomes amid a background of decreased Hib infection incidence. METHODS: We conducted a retrospective cohort study using data from a nationwide inpatient database in Japan. We identified children younger than 15 years with bacterial meningitis who were discharged between April 2014 and March 2022. The primary outcome was a composite of in-hospital death and neurological sequelae, defined as tracheostomy during hospitalization or disturbed consciousness, mechanical ventilation, tube feeding, or antiepileptic drugs at discharge. The secondary outcome was a recorded diagnosis of hearing loss. Stabilized inverse probability of treatment weighting using propensity scores was performed to compare the outcomes between patients with and without intravenous corticosteroid use on the day of admission. RESULTS: Of the 1310 eligible patients, 454 (35%) received early corticosteroids. Overall, 170 patients (13%) had composite outcomes, including seven deaths (0.5%). Hearing loss was observed in seven patients. After propensity score weighting, no significant difference was observed between patients with and without early corticosteroid use in the composite outcome (14.2% vs 13.5%, respectively; risk difference: 0.7%; 95% confidence interval: -3.3% to 4.6%) or hearing loss (0.7% vs 0.5%, respectively; risk difference: 0.2%; 95% confidence interval: -0.7% to 1.2%). CONCLUSIONS: Early corticosteroid use in children with bacterial meningitis was not associated with reduced deaths or neurological sequelae.
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Vaccine 49 126812-126812 2025年1月31日Tetanus remains a major global health issue in both developing and developed countries. Although guidelines are established on tetanus prophylaxis protocol for trauma patients, adherence to tetanus vaccination is unknown. In this study, we aimed to investigate the administration of tetanus toxoid among trauma patients in Japan, where approximately 100 patients are hospitalized for tetanus annually. Using the JMDC claims database, a large administrative claims database, we identified outpatients with trauma between 2005 and 2020. We divided them into those born before 1968 and those born in 1968 or later, as the routine tetanus immunization program started in 1968 in Japan. We described the characteristics of the patients and whether they received the first dose of tetanus toxoid when they visited a medical institution for any injury. Finally, we followed up the patients who received the first tetanus toxoid dose and had a history of incomplete primary vaccination series to examine whether they completed the recommended three doses of tetanus immunization within 12 months. We identified 85,761 trauma patients from the database, of whom 19,541 (22.8 %) were born before 1968 and not covered by the routine vaccination program. Among the patients covered by the routine vaccination program, 2.1 % (1400/66,220) received tetanus toxoid vaccination at the initial clinic/hospital visit for their injuries, whereas the proportion was 5.8 % (1139/19,541) in the patients not covered by the routine vaccination program. Among the 1139 patients who received tetanus prophylaxis at the time of wound management and were born before the implementation of the routine vaccination program, 31.4 % received the second dose, and 7.0 % completed the third dose within 12 months. Taken together, most trauma patients without a history of primary tetanus immunization did not receive the recommended tetanus prophylaxis. Increased awareness of tetanus prophylaxis is needed among both patients and healthcare professionals.
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Journal of intensive care 12(1) 54-54 2024年12月23日
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Clinical kidney journal 17(12) sfae319 2024年12月BACKGROUND AND HYPOTHESIS: We aimed to evaluate the diagnostic validity of the International Classification of Diseases, 10th Revision (ICD-10) codes for hyponatremia and hypernatremia, using a database containing laboratory data. We also aimed to clarify whether corrections for blood glucose, triglyceride, and total protein may affect the prevalence and the diagnostic validity. METHODS: We retrospectively identified admissions with laboratory values using a Japanese hospital-based database. We calculated the sensitivity, specificity, and positive/negative predictive values of recorded ICD-10-based diagnoses of hyponatremia (E87.1) and hypernatremia (E87.2), using serum sodium measurements during hospitalization (<135 and >145 mmol/l, respectively) as the reference standard. We also performed analyses with corrections of sodium concentrations for blood glucose, triglyceride, and total protein. RESULTS: We identified 1 813 356 hospitalizations, including 419 470 hyponatremic and 132 563 hypernatremic cases based on laboratory measurements, and 18 378 hyponatremic and 2950 hypernatremic cases based on ICD-10 codes. The sensitivity, specificity, positive predictive value, and negative predictive value of the ICD-10 codes were 4.1%, 99.9%, 92.5%, and 77.6%, respectively, for hyponatremia and 2.2%, >99.9%, 96.5%, and 92.8%, respectively, for hypernatremia. Corrections for blood glucose, triglyceride, and total protein did not largely alter diagnostic values, although prevalence changed especially after corrections for blood glucose and total protein. CONCLUSIONS: The ICD-10 diagnostic codes showed low sensitivity, high specificity, and high positive predictive value for identifying hyponatremia and hypernatremia. Corrections for glucose or total protein did not affect diagnostic values but would be necessary for accurate prevalence calculation.
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Clinical Drug Investigation 2024年11月7日
MISC
15-
診療現場の実態に即した医療ビッグデータ(NDB等)の解析の精度向上及び高速化を可能にするための人材育成プログラムの実践と向上に関する研究 令和2年度 総括・分担研究報告書(Web) 2021年
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診療現場の実態に即した医療ビッグデータ(NDB等)の解析の精度向上及び高速化を可能にするための人材育成プログラムの実践と向上に関する研究 令和元年度 総括・分担研究報告書(Web) 2020年
書籍等出版物
3講演・口頭発表等
83-
34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management 2018年
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International Society for Biomedical Research on Alcoholism Worrld Congress 2018年
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American Public Health Association 2017 Annual Meeting & Expo 2017年
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World Congress of Epidemiology 2017 2017年
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第54回日本リハビリテーション医学会学術集会 2017年
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AcademyHealth 2017 Annual Research Meeting 2017年
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AcademyHealth 2016 Annual Research Meeting
担当経験のある科目(授業)
5-
2023年4月 - 現在医療リアルワールドデータ活用人材育成事業 (東京大学)
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2020年10月 - 2022年12月臨床疫学演習 (東京大学)
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2022年11月 - 2022年11月専門課程Ⅲ 地域保健臨床研修専攻科 (厚生労働省 国立保健医療科学院)
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2022年4月 - 2022年4月公共健康医学特論 (東京大学)
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2017年5月 - 2019年6月PDCA医療クオリティマネージャー養成プログラム (東京医科歯科大学)
所属学協会
4-
2017年2月 - 現在
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共同研究・競争的資金等の研究課題
2-
日本学術振興会 科学研究費助成事業 若手研究 2021年4月 - 2024年3月
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日本学術振興会 科学研究費助成事業 研究活動スタート支援 2019年4月 - 2020年3月