Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study

BackgroundAdvances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions.MethodsWe used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk.ResultsThe median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor’s degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido.ConclusionAccess to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor’s degrees or above are at risk of death from stroke

Changing Trends in Birthday Preference:Long-Range Data Analysis of Several Specific Days Registered in Hospital Information Systems

The purpose of this study was to clarify the factors related to the deviation of the birth dates in Japan. The deviation of birth dates for several specific days was analyzed by some 580,000 patient\u27s birthday data registered in the hospital information system. We analyzed the deviation of the birth dates on the following specific days: (1) New Year\u27s day and the first day of a month; (2) lucky and unlucky days based on the lunar calendar; and (3) weekends and holidays. In the past, the number of births on New Year\u27s Day and the first day of a month were greater than the average day of the year. These deviations were disappeared at present. In recent years, there were few births on Saturdays and Sundays. The result of this study showed that the factitious reporting was caused to the deviation of the birth dates on the first half of the 20th century. Nowadays the obstetric interventions was affected the deviation of birth dates. It was concluded that the deviation of the number of births always reflected social factors

Analysis of Factors Inhibiting the Dissemination of Telemedicine in Japan : Using the Interpretive Structural Modeling

Background:Telemedicine is not significantly spreading globally and large variations in its availability and use exist internationally. Although many factors already inhibit the dissemination of telemedicine, its complexly intertwined factors make it more difficult to solve this problem. This study aimed to analyze and visualize relationships among factors inhibiting the dissemination of telemedicine. We applied the interpretive structural modeling method and cross-impact matrix multiplication applied to classification analysis. Materials and Methods:Factors inhibiting the dissemination of telemedicine in Japan were extracted by literature review and hearing from four medical informatics experts belonging to a university or hospital using the Kawakita Jiro method. Results:Eighteen factors were extracted as those inhibiting the dissemination of telemedicine service in Japan: initial and operation cost, research data, legal development, profitability, usability, human resources, image quality, network speed, information security, technical limitation, restriction for clinical practice, practice continuity, target use case, burden for physicians, respondence, risks for clinical safety, understanding of medical staff, and understanding of patients. The hierarchical structure chart showed a nine-level structure and the cross-impact matrix showed the relationship among factors and the classification of them inhibiting the dissemination of telemedicine. Discussion:We found that the underlying factors were high implementation and operation costs, low research data, and risks for clinical safety. Implementation and operation costs, research data, legal development, and profitability have high driving power; thus, it is expected that the elimination of these inhibiting factors would lead to the dissemination of telemedicine. Conclusions:There are many kinds of factors inhibiting the dissemination of telemedicine in Japan. The result of this showed the structure of these factors visually and could be useful to solve the problem inhibiting the dissemination of telemedicine effectively and efficiently

CONSTRUCT AND USE INFORMATION-INTENSIVE SYSTEM(RADIATION/PARTICLE THERAPY DATABASE) BY USING STANDARD TECHNIQUE

Purpose of this system simplifies to manage information on radiation therapy for a long term consistently, case report, and extraction of treatment results number. Electronic Medical Record system(EMR) was replaced from a past CPOE system in October, 2006. Patients\u27 case history and passage information are entered to EMR. This time, EMR and AMIDAS were made to cooperate and it achieved new function to store information of Patient, radiation/particle therapy treatment, and follow-up automatically from EMR to AMIDAS. Furthermore, report that we developed a new web-based aggregate analysis system to manage radiation/particle therapy data stored in AMIDAS. National Institute of Radiological Sciences (NIRS) is a hospital located in Chiba and a single radiation department which has 100 beds and 200 outpatients daily. The diagnosis specialized in the radiation/particle therapy. In 1961, radiation therapy by X rays was begun at NIRS. In addition, particle therapy(carbon ion) was begun in 1994, and about 5,600 examples were treated by March, 2010. NIRS is a research institute, so disease information on radiation therapy, content of treatment, and information on prognosis are important information for a clinical research. History of radiation/particle therapy database system (AMIDAS: Advanced Medical Information Database System) was constructed in 1999, and operation was begun in 2000.HL7 was used for communicate EMR and AMIDAS. The firefox web browser was used for AMIDAS user-interface. AMIDAS achieved following three functions. 1)Function to complement details for treatment information which is not inputted by EMR. 2) Function to support report writer of heavy particle therapy executed twice a year. 3) Function to display calculated survival rate image by doctors\u27 interested grouping method. Kaplan-Meier method is adopted for computational method of survival rate curve. Numerical result was displayed on a browser as an image, it enabled to use it for secondary use. In addition, the significant difference authorization function by grouping that user had freely specified was added. The user becomes unnecessary the dual input of data by making EMR and AMIDAS cooperate, and an efficiency improvement of work and the accuracy improvement of data were able to be achieved. Moreover, AMIDAS improved user\u27s convenience, flexibility and able to extract at high speed for the aggregate of treatment data, making patient list, and authorization between groups(analysis between classification of stages and TNM classification value) for user\u27s interested points and different disease sites.ESTRO2

Development and Evaluation of PACS -a Parallel Operation System with Improved Fault-tolerance-

We developed the dual PACS to enforce the robustness and the redundancy. These PACSs were made by two different vendors. We assumed that we had to continue the service with-out serious problems. By the different systems, users can se-lect the suitable interface, and the systems become inevitable for the hospital information system.MEDINFO200

Experience of Transfer Work of PACS Image Data in Multivendor Environment

The Heavy Particle Medical Science Center, affiliated to the National Institute of Radiological Sciences, began archiving digital medical images from 1995, and launched film-less operation from August 2005. Then, in fiscal 2006, PACS was changed into the duplex configuration to upgrade the server equipment and avoid problems. Before starting system operation, the image data managed by the old image system were transferred to the new image management system. The applicable data were approximately 12 million images obtained from approximately 130,000 cases of examination, and the categories of modality were CR, CT, DR, ES, MR, NM, PET, RF, SC, US, XA, and OT. The data transfer work was completed in approximately three months using the Q/R connection of DICOM. We repeated a procedure which extracts images UID from both the source and destination systems after the transfer has finished, compares them with each other, surveys causes if any differences are found, corrects the data appropriately, and stores the data again. The primary cause of such differences was that the management method of images including the multi-frame type (especially on a per-examination basis) was different depending on the system.The 5th KOREA-JAPAN Joint Meeting on Medical Physic

Penetration factors and introduction possibility for image diagnostic equipment

Background: This study investigated and analyzed the relationship between medical resources and economic conditions of OECD member countries and extracted factors for introducing imaging diagnostic equipment in each country. We also investigated the possibility of introducing diagnostic imaging equipment. Methods: A principal component analysis was conducted from medical environment indices and economic situation indices; the results were visualized on a graph with the extracted two principal components as axes, and the target nations were categorized according to the possibility of introducing diagnostic imaging equipment. Next, with the number of CTs and MRIs as response variables, we visualized the probability results on a graph by conducting a multiple regression analysis with the indices as explanatory variables and extracting the most influential factors on the number of diagnostic imaging equipment introduced. Results: We classified 29 countries into four groups according to medical environment and economic situation indices. By extracting from the four groups a group with a high possibility for introducing medical equipment then conducting a multiple regression analysis with CT and MRI unit counts as objective variables and other medical environment and economic situation indices as explanatory variables, it became clear that the factor with the greatest influence on CT and MRI unit counts is the number of hospital beds. Conclusion: As topics of future studies, we would like to clarify the factors behind as well as the probability for the introduction of medical equipment in each nation by researching high-growth medical equipment markets. (C) 2018 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved

Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke

Objectives: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombec-tomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endo-vascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. Materials and methods: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incre-mental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. Results: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,17316,802/QALY, significantly lower than the threshold that the Japanese guide-line suggested. Conclusions: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allo-cated as a policy

Relationship between accessibility and resources to treat acute ischemic stroke. Hokkaido, Japan : Analysis of inequality and coverage using geographic information systems

Objectives: This study aimed to clarify the relationship between the institution and resident with respect to accessibility to acute ischemic stroke (AIS) treatment in Hokkaido and to propose new methodology monitoring for accessibility to healthcare resources. Methods: This study involves the use of geographic information system (GIS) network analysis. We established hospital/clinic with one of the following conditions as resources for AIS treatment: (1) medical facility practicing AIS treatment, (2) having computed tomography (CT) equipment, (3) having angiography equipment, and (4) having AIS specialists (neurosurgeons). We evaluated the coverage of population resources using transport time between ambulance departure and arrival at the healthcare facility. Furthermore, we compared the population coverage rate using available resources and calculated a Gini coefficient to analyze its relation with inequality. Empirical analysis was performed, and public database for data collection was utilized. We calculated the rate of population coverage with a transport time within 10 min as an indicator of accessibility to medical resources by GIS. Results: The Gini coefficients of practicable facilities, CT, angiography, and neurosurgeons are 0.35, 0.16, 0.18, and 0.30, respectively. The inequality of accessibility differs depending on the resources, and Gini coefficients indicate that hospital/clinic and neurosurgeons were considered to have higher allocation inequalities than CT and angiography. Conclusions: Combining Gini coefficient and GIS network analysis in accessibility can be useful in quantifying and monitoring variation by region. We propose this combination as a new method for helping the government to make evidence-based healthcare planning. (C) 2019 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved