Keisuke Nagase

Electronic Clinical Path System Based on Semistructured Data Model Using Personal Digital Assistant for Onsite Access

Clinical Paths (Paths) have been introduced by different hospitals for patient care management. An Electronic Clinical Path (ECP) with onsite access provision seems to improve the efficiency of medical staffs because they can share vast medical information about patients at a time and also can reuse accumulated data easily, which is impossible with paper-based Path. Data model is the basis for implementing ECP. However, there is no established model for ECP. The purpose of this study is to introduce a model for ECP and implement an ECP with onsite access system. We introduced a Semistructured Data Model (SSDM) for ECP, and implemented a Web application system based on this model using Personal Digital Assistant (PDA) as inputting device. Our system functioned as expected with wireless LAN, and users handled the data on bedside using PDA. By introducing SSDM, we showed the correspondence between schema of Paths and implementation of ECP.

Prescription rate of medications potentially contributing to lower urinary tract symptoms and detection of adverse reactions by prescription sequence symmetry analysis

BackgroundThe lower urinary tract symptoms (LUTS) increases with age and can have a significant effect on the quality of life of the patients. Elderly patients, who are often characterized by a decline in physiological functional and polypharmacy, are susceptible to adverse drug reactions to pharmacotherapy. LUTS can also be a side effect of medication. The purpose of this study was to investigate the possible association between the initiation of LUTS-causing drug therapy and the onset of LUTS.MethodsDrug dispensing data at the individual level were retrieved from the CISA (Platform for Clinical Information Statistical Analysis: http://www.cisa.jp) database. A retrospective study was conducted by reviewing patients with LUTS who were dispensed drugs that increased the risk of LUTS between April 2011 and March 2012. Prescription sequence symmetry analysis (PSSA) was employed to investigate the associations between the dispensing of medicines of LUTS and that of LUTS-causing drugs.ResultsLUTS-causing drugs were frequently dispensed to patients with LUTS. The use of medications potentially contributing to LUTS was associated with polypharmacy [number of prescription drugs:12.13 ± 6.78 (user) vs. 5.67 ± 5.24 (nonuser)] but not patient age [ age: (71.38 ± 13.28 (user) vs. 70.45 ± 14.80 (nonuser)]. Significant adverse drug events were observed the use of donepezil, cyclophosphamide, antiparkinson drugs, antidepressant, diazepam, antipsychotic drugs for peptic ulcer, tiotropium bromide, and opioids.ConclusionsThe use of prescription LUTS-causing drugs was correlated with polypharmacy. The adverse drug events associated with LUTS-causing drugs were highly prevalent in elderly patients. To prevent of adverse drug events in patients with LUTS, pharmacists and physicians should regularly review medication lists and reduce the prescribed medicines.

Microproteomics with microfluidic-based cell sorting: Application to 1000 and 100 immune cells

Ultimately, cell biology seeks to define molecular mechanisms underlying cellular functions. However, heterogeneity within cell populations must be considered for optimal assay design and data interpretation. Although single‐cell analyses are desirable for addressing this issue, practical considerations, including assay sensitivity, limit their broad application. Therefore, omics studies on small numbers of cells in defined subpopulations represent a viable alternative for elucidating cell functions at the molecular level. MS‐based proteomics allows in‐depth proteome exploration, although analyses of small numbers of cells have not been pursued due to loss during the multistep procedure involved. Thus, optimization of the proteomics workflow to facilitate the analysis of rare cells would be useful. Here, we report a microproteomics workflow for limited numbers of immune cells using non‐damaging, microfluidic chip‐based cell sorting and MS‐based proteomics. Samples of 1000 or 100 THP‐1 cells were sorted, and after enzymatic digestion, peptide mixtures were subjected to nano‐LC‐MS analysis. We achieved reasonable proteome coverage from as few as 100‐sorted cells, and the data obtained from 1000‐sorted cells were as comprehensive as those obtained using 1 μg of whole cell lysate. With further refinement, our approach could be useful for studying cell subpopulations or limited samples, such as clinical specimens.

A framework for conceptualizing patient loyalty to healthcare organizations

This paper develops a framework with which to conceptualize loyalty to healthcare organizations in terms of relationship marketing, patient satisfaction, provider switching, and retention programs. This conceptual framework can be viewed from the perspective of hospitals and clinics using structural equation modeling with a partial least squares approach (Smart PLS 2.0). Respondents received healthcare services, funded by the government and a university health insurance plan, from both types of organizations. The concept of loyalty differed slightly depended on whether data from the hospital and the clinic were analyzed together or separately. Indeed, hospitals and clinics differ with regard to several factors that can affect loyalty.

Patient loyalty to health care organizations: Strengthening and weakening (satisfaction and provider switching)

This study tested a model of patient loyalty, patient satisfaction, and providers switching. The data were analyzed in two separate stages but linked sequentially with structural equation modeling ...

Development of a methodology for the detection of hospital financial outliers using information systems.

Comparison of financial indices helps to illustrate differences in operations and efficiency among similar hospitals. Outlier data tend to influence statistical indices, and so detection of outliers is desirable. Development of a methodology for financial outlier detection using information systems will help to reduce the time and effort required, eliminate the subjective elements in detection of outlier data, and improve the efficiency and quality of analysis. The purpose of this research was to develop such a methodology. Financial outliers were defined based on a case model. An outlier-detection method using the distances between cases in multi-dimensional space is proposed. Experiments using three diagnosis groups indicated successful detection of cases for which the profitability and income structure differed from other cases. Therefore, the method proposed here can be used to detect outliers.

Constructing new coordinate system suitable for sign animation

This paper proposes new coordinate system suitable for denoting sign language motion. As the proposed coordinate system consists of polar coordinate systems whose origins are certain points of human body, postures shown on the system can be proportional for avatars with any possible shape and fit with existing subjective sign notation systems. This paper extracted coordinate origins from Japanese-Japanese Sign Language Dictionary via morphological analysis. Selected 85 points are successfully mapped on H-ANIM standard humanoid avatar.

Speculative FEM Simulation System for Invasive Surgical Operation with Haptic Interaction

Conventional virtual reality surgical simulators are provided for non-invasive operation because of the calculation resource limitation of personal computer. For development of advanced simulator, simulation of invasive operation such as incision and ablation is required. Besides, for interactive haptic simulation, the rupture model should be adopted based on physics. Therefore, achievement of huge scale rupture simulation system with interactivity is desired. This study aims to provide real-time rupture simulator with physics-based haptic interaction. The proposed system adopts speculative calculation of stiffness matrix for concealing of calculation delay on FEM rupture model. The system assumes implementation on PC cluster adopting simulation cache for hiding calculation delay. This paper provides a report of hit ratio performance of speculation.