Yoshimasa Umesato

An Approach to Medical Knowledge Sharing in a Hospital Information System Using MCLink

Clinicians often need access to electronic information resources that answer questions that occur in daily clinical practice. This information generally comes from publicly available resources. However, clinicians also need knowledge on institution-specific information (e.g., institution-specific guidelines, choice of drug, choice of laboratory test, information on adverse events, and advice from professional colleagues). This information needs to be available in real time. This study characterizes these needs in order to build a prototype hospital information system (HIS) that can help clinicians get timely answers to questions. We previously designed medical knowledge units called Medical Cells (MCs). We developed a portal server of MCs that can create and store medical information such as institution-specific information. We then developed a prototype HIS that embeds MCs as links (MCLink); these links are based on specific terms (e.g., drug, laboratory test, and disease). This prototype HIS presents clinicians with institution-specific information. The HIS clients (e.g., clinicians, nurses, pharmacists, and laboratory technicians) can also create an MCLink in the HIS using the portal server in the hospital. The prototype HIS allowed efficient sharing and use of institution-specific information to clinicians at the point of care. This study included institution-specific information resources and advice from professional colleagues, both of which might have an important role in supporting good clinical decision making.

Disease staging as a measure of disease severity

Disease staging, first developed in 1970, has been used to assess the levels of biological severity, defined as the risk of organ failure or death, of specific medical diseases. Because few studies to date have evaluated disease staging in Japan, a small pilot study was designed to determine whether disease staging is available and useful in actual medical practice in Japan. The relationships between disease staging and length of stay, medical costs and age were retrospectively evaluated in patients admitted to Japan Association for Development of Community Medicine - Tokyo Bay Urayasu Ichikawa Medical Center for appendicitis, type 2 diabetes mellitus, and cerebrovascular diseases from April 2012 to March 2013. Patients were easily staged based on information at the time of hospital discharge. Disease stages were found to be affected significantly by length of hospital stay and medical costs. Age also affected disease stages in patients with appendicitis. These findings indicate that disease staging was available in Japan and was affected by hospital resources, including length of hospital stay and medical costs.

Abstract 5523: Adoptive cellular immunotherapy contributes to better survival for NSCLC patients: Case-control study of 395 Japanese patients with advanced NSCLC

Adoptive cellular immunotherapy (ITx) targeting various types of carcinoma including the lung is widely used, yet the clinical effectiveness has not been evaluated in large cases of lung carcinoma. So we carried out a case-control study to investigate the effect of ITx for the treatment of advanced non-small cell lung cancer (NSCLC) patients in Japanese population. Between 2001 and 2006, 163 patients were identified as having advanced NSCLC with ECOG performance status (PS) 0/1 who underwent ITx with or without standard chemotherapy (CTx). The controls were 232 advanced NSCLC patients with PS 0/1 who had standard CTx or BSC alone. Overall survival (OS) and 1- and 2-year survival were obtained with Kaplan-Meyer survival curves and compared using log-rank and generalized Wilcoxon analysis. Multivariate analysis with Cox proportional hazard models was also performed to analyze survival. The mean age of total population was 64.8 + 10.6 years. There were 251 males and 144 females and 295 adenocarcinoma (Ad) and 74 squamous cell carcinoma (Sq) patients. The mean period and frequency of ITx was 10.2 months and 8.7 times, respectively. Median OS for CTx and ITx + CTx was 15.7 and 20.8 months, respectively. Multivariate analysis with Cox proportional hazard model showed that sex (male vs female) (HR=0.33, p The present findings suggest that ITx may contribute to better survival for advanced or metastatic NSCLC patients under certain circumstances. These results should be confirmed in large prospective clinical trials. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5523. doi:10.1158/1538-7445.AM2011-5523