Protocol to acquire time series data on adverse reactions following vaccination using a smartphone or web-based platform

Summary: Data collection on adverse reactions in recipients after vaccination is vital to evaluate potential health issues, but health observation diaries are onerous for participants. Here, we present a protocol to collect time series information using a smartphone or web-based platform, thus eliminating the need for paperwork and data submission. We describe steps for setting up the platform using the Model-View-Controller web framework, uploading lists of recipients, sending notifications, and managing respondent data.For complete details on the use and execution of this protocol, please refer to Ikeda et al. (2022).1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics

Epidemiology of sepsis in a Japanese administrative database

Abstract Sepsis is the leading cause of death worldwide. Considering regional variations in the characteristics of patients with sepsis, a better understanding of the epidemiology in Japan will lead to further development of strategies for the prevention and treatment of sepsis. To investigate the epidemiology of sepsis, we conducted a systematic literature review of PubMed between 2003 and January 2023. Among the 78 studies using a Japanese administrative database, we included 20 that defined patients with sepsis as those with an infection and organ dysfunction. The mortality rate in patients with sepsis has decreased since 2010, reaching 18% in 2017. However, the proportion of inpatients with sepsis is increasing. A study comparing short‐course (≤7 days) and long‐course (≥8 days) antibiotic administration showed lower 28‐day mortality in the short‐course group. Six studies on the treatment of patients with septic shock reported that low‐dose corticosteroids or polymyxin B hemoperfusion reduced mortality, whereas intravenous immunoglobulins had no such effect. Four studies investigating the effects of treatment in patients with sepsis‐associated disseminated intravascular coagulation demonstrated that antithrombin may reduce mortality, whereas recombinant human soluble thrombomodulin does not. A descriptive study of medical costs for patients with sepsis showed that the effective cost per survivor decreased over an 8‐year period from 2010 to 2017. Sepsis has a significant impact on public health, and is attracting attention as an ongoing issue. Further research to determine more appropriate prevention methods and treatment for sepsis should be a matter of priority

The Effects of Fasting and Massive Diarrhea on Absorption of Enteral Vancomycin in Critically Ill Patients: A Retrospective Observational Study

PurposeAlthough vancomycin (VCM) is not absorbed from healthy intestinal mucosa, elevations in the serum VCM concentrations have been reported in some cases. The aims of this study are to evaluate the necessity of therapeutic drug monitoring (TDM) during enteral VCM administration in critically ill patients.Materials and methodsIn this retrospective study, we enrolled 19 patients admitted to our intensive care unit who were treated with enteral VCM from December 2006 to January 2014. Clinical factors were compared between two groups: Group E whose serum concentrations were detectable, and Group N whose concentrations were below the detection limit of the VCM assay.ResultsGroup E comprises 7 patients, and Group N comprises 12 patients. The fasting duration in Group E was significantly longer compared with that in Group N (17 vs. 8 days, p = 0.023). Furthermore, there was a significant correlation between the serum VCM concentrations and the fasting duration (r = 0.79, p < 0.0001), and the amount of diarrhea (r = 0.46, p = 0.046). No difference was observed in the amount of diarrhea at the time of TDM (Group E; 1,850 mL vs. Group N; 210 mL, p = 0.055) and in the Sequential Organ Failure Assessment subscore for the renal system at the time of TDM (Group E; 4.0 vs. Group N; 1.5, p = 0.068).ConclusionLong durations of fasting and massive diarrhea were associated with elevations in the serum VCM concentrations, which suggested that TDM might be necessary during enteral VCM administration in critically ill patients.Trial registrationUMIN Clinical Trials Registry identifier UMIN000016955

Additional file 4: of l-carnitine in critically ill patients—a case series study

Figure S4. Correlation of BMI and SOFA score with the change in f-Carnitine from day 0 to day 14. (a) Each plot depicts a relationship between the BMI on the x-axis, and the change of f-Carnitine from day 0 to day 14 (Δ f-Carnitine) on the y-axis. There was a significant negative correlation between the BMI and the Δf-Carnitine (r = − 0.47, p = 0.01), which suggests an association between lower BMI and larger decrease of f-Carnitine. (b) Each plot depicts a relationship between the SOFA score at the time of ICU admission on the x-axis, and the change of f-Carnitine from day 0 to day 14 (Δ f-Carnitine) on the y-axis. There was a significant correlation between the SOFA score on ICU admission and the Δf-Carnitine (r = 0.46, p = 0.01), which suggests an association between high SOFA score and larger decrease of f-Carnitine. (ZIP 188 kb

Additional file 3: of l-carnitine in critically ill patients—a case series study

Figure S3. Comparison of f-Carnitine transition among the patients with f-Carnitine increased and decreased. The transition of f-Carnitine area for 14 days plotted at each sampling point. The round and square signs within the figure indicate the medians for f-Carnitine, and the error bars indicate 25th and 75th percentile range. The dotted lines indicate the upper and lower reference values for f-Carnitine. The patients whose data are lacking at day 7 or day 14 were excluded from this analysis. (TIFF 123 kb

Additional file 2: of l-carnitine in critically ill patients—a case series study

Figure S2. Distribution of carnitine concentrations on ICU admission. (a) The distribution of t-Carnitine on ICU admission is shown in the histogram. The mean t-Carnitine was 94.9 ± 79.6 nmol/mL, and the median t-Carnitine was 64.2 (50.5–102.3) nmol/mL. (b) The distribution of f-Carnitine on ICU admission is shown in the histogram. The mean f-Carnitine was 68.6 ± 51.2 nmol/mL, and the median f-Carnitine was 50.5 (36.8–80.3) nmol/mL. (ZIP 160 kb

Additional file 1: of l-carnitine in critically ill patients—a case series study

Figure S1. Flowchart of study enrollment. (TIFF 117 kb

Machine learning algorithms for predicting days of high incidence for out-of-hospital cardiac arrest

Abstract Predicting out-of-hospital cardiac arrest (OHCA) events might improve outcomes of OHCA patients. We hypothesized that machine learning algorithms using meteorological information would predict OHCA incidences. We used the Japanese population-based repository database of OHCA and weather information. The Tokyo data (2005–2012) was used as the training cohort and datasets of the top six populated prefectures (2013–2015) as the test. Eight various algorithms were evaluated to predict the high-incidence OHCA days, defined as the daily events exceeding 75% tile of our dataset, using meteorological and chronological values: temperature, humidity, air pressure, months, days, national holidays, the day before the holidays, the day after the holidays, and New Year’s holidays. Additionally, we evaluated the contribution of each feature by Shapley Additive exPlanations (SHAP) values. The training cohort included 96,597 OHCA patients. The eXtreme Gradient Boosting (XGBoost) had the highest area under the receiver operating curve (AUROC) of 0.906 (95% confidence interval; 0.868–0.944). In the test cohorts, the XGBoost algorithms also had high AUROC (0.862–0.923). The SHAP values indicated that the “mean temperature on the previous day” impacted the most on the model. Algorithms using machine learning with meteorological and chronological information could predict OHCA events accurately

Additional file 5: of l-carnitine in critically ill patients—a case series study

Table S1. Clinical outcomes according to f-carnitine levels at ICU admissiona. (DOCX 21 kb