電子カルテシステムの進化的設計

付記する学位プログラム名: デザイン学大学院連携プログラム京都大学0048新制・課程博士博士(情報学)甲第22097号情博第707号新制||情||121(附属図書館)京都大学大学院情報学研究科社会情報学専攻(主査)教授 黒田 知宏, 教授 吉川 正俊, 教授 矢守 克也学位規則第4条第1項該当Doctor of InformaticsKyoto UniversityDFA

Virtual reality for healthcare: A scoping review of commercially available applications for head-mounted displays

Objective: This scoping review aimed to describe the scope of commercially available virtual reality (VR) healthcare applications for mainstream head-mounted displays (HMD)s. Methods: A search was conducted during late April and early May 2022 over five major VR app stores using “health,” “healthcare,” “medicine,” and “medical” as keywords. Apps were screened based on their title and description sections. Metadata collected included: title, description, release date, price (free or paid), multilingual support, VR app store availability, and HMD support. Results: The search yielded 1995 apps, out of which 60 met the inclusion criteria. The analysis showed that the number of healthcare VR apps has been steadily increasing since 2016, but no developer has released more than two apps so far. Most of the reviewed apps can run on HTC Vive, Oculus Quest, and Valve Index. Thirty-four (56.7%) apps had a free version, and 12 (20%) apps were multilingual, i.e., supported languages other than English. The reviewed apps fell into eight major themes: life science education (3D anatomy, physiology and pathology, biochemistry, and genetics); rehabilitation (physical, mental, and phobia therapy); public health training (safety, life-saving skills, and management); medical training (surgical and patient simulators); role-playing as a patient; 3D medical imagery viewing; children’s health; and online health communities. Conclusions: Although commercial healthcare VR is still in its early phases, end-users can already access a broad range of healthcare VR apps on mainstream HMDs. Further research is needed to assess the usefulness and usability of existing apps

Cost of bladder cancer in Lebanon before and after the economic collapse: a probabilistic modeling study

Abstract Background and objectives Lebanon has one of the highest incidence rates of bladder cancer (BC) in the world. In 2019, Lebanon’s economy collapsed which majorly impacted healthcare costs and coverage. This study assesses the overall direct costs of urothelial BC in Lebanon, from the perspective of public and private third-party payers (TPP) and households, and evaluates the impact of the economic collapse on these costs. Methods This was a quantitative, incidence-based cost-of-illness study, conducted using a macro-costing approach. Costs of medical procedures were obtained from the records of various TPPs and the Ministry of Public Health. We modeled the clinical management processes for each stage of BC, and conducted probabilistic sensitivity analyses to estimate and compare the cost of each stage, pre-and post-collapse, and for each payer category. Results Before the collapse, the total annual cost of BC in Lebanon was estimated at LBP 19,676,494,000 (USD 13,117,662). Post-collapse, the total annual cost of BC in Lebanon increased by 768% and was estimated at LBP 170,727,187,000 (USD 7,422,921). TPP payments increased by 61% whereas out-of-pocket (OOP) payments increased by 2,745% resulting in a decrease in TPP coverage to only 17% of total costs. Conclusion Our study shows that BC in Lebanon constitutes a significant economic burden costing 0.32% of total health expenditures. The economic collapse induced an increase of 768% in the total annual cost, and a catastrophic increase in OOP payments

Assessment of Lead Pollution in Urban Roadside Environments of Gaza City

This research investigated Roadside lead concentration at four different locations at Gaza city. Road dust continues to be a major potential reservoir of lead (Pb) in the urban environment, and an important potential component of child Pb exposure. This study presents analyses of lead concentration for 20 samples, collected along selected streets of different traffic volume (PCU) of Gaza city over different intervals of time. Lead concentrations determined for particulates, which were collected from the soil and the lead accumulated by the leaves of Ficusbengalensis were also measured. The maximum lead concentrations accumulated by the leaves was 122.77 at EL-Wehda street equals to 122.77 mg/kg. Meanwhile a lead concentration of 12 mg/kg was the highest concentration in soil a sample which is also found at EL-Wehda street. A statistically significant correlation was found between the number of traffic volume and lead concentrations accumulated by the leaves which ranges between (0.87<P <0.99 ) at the designated streets . Also significant correlation was found between the lead concentration in soil and lead accumulated by the leaves which ranges between (0.4<P <0.6). From our study it was obviously noticed that a high traffic volume increases with the concentration of lead on deposits and soil. Beside traffic volume, road characterization had its effect on the distribution of lead emission

Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual—A Rare Complication of Varicella-Zoster Virus Reactivation

Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult&#8212;a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies

Statins decrease mortality in Lebanese patients with sepsis: a multicenter study

Background: Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients. Objective: The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis. Methods: A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS. Results: Three hundred fifty one Lebanese patients were included (age: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). Conclusion: At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis.Antecedentes: La sepsis es un significativo problema de salud pública. La respuesta clínica a las estatinas es variable entre los pacientes con sepsis. Objetivo: El objetivo del estudio fue determinar el efecto del tratamiento con estatinas en la mortalidad de pacientes libaneses con sepsis. Métodos: Se realizó un estudio multicentrico retrospectivo en pacientes libaneses con sepsis entre enero 2008 y marzo 2012. Se incluyeron los pacientes con un diagnóstico primario de sepsis ingresados en la unidad de cuidados intensivos de dos hospitales de Beirut. Se incluyó en el grupo de tratamiento a los pacientes que continuaron recibiendo estatinas para dislipidemia durante la estancia hospitalaria. El grupo control consistió en pacientes que no tomaron estatinas. Utilizando análisis univariado, se compararon entre estos dos grupos las características demográficas, signos clínicos, resultados de laboratorio y tratamiento recibido. Se realizó una regresión logística y un análisis de supervivencia con un SPSS. Resultados: Se incluyó a 351 pacientes libaneses (edad 71,33 DE=14,97 años; 56% hombres). Entre ellos, el 30% tomaba estatinas a dosis recomendadas para dislipemia. La comparación de los dos grupos mostró que en el grupo de tratamiento con estatinas: el nivel sérico medio de proteína C-reactiva estaba significativamente disminuido (p=0,050), la estancia en UCI significativamente aumentada (p=0,047) y la mortalidad significativamente reducida (p<0,001). Los resultados se confirmaron con una regresión logística, particularmente para la mortalidad. En el análisis de regresión de Cox, la hipotermia y el shock estaban significativamente asociados a alta mortalidad, mientras que el tratamiento con estatinas disminuyó la mortalidad (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). Conclusión: A dosis habituales para dislipemia, el tratamiento con estatinas disminuyó la mortalidad relacionada con la sepsis y mejoró la supervivencia en una población séptica libanesa. Deben realizarse ensayos controlados aleatorizados grandes para proporcionar resultados conclusivos sobre el potencial efecto benéfico de las estatinas en la sepsis