Effectiveness of weekly polymerase chain reaction-based open reading frame typing analysis of all newly isolated methicillin-resistant Staphylococcus aureus strains for controlling nosocomial infections.

Polymerase chain reaction (PCR)-based open reading frame typing (POT) helps differentiate between bacterial strains based on the open reading frames (ORFs) of the prophage-encoding genes; multiplex PCR screening is performed to identify strains based on keeping patterns. At our hospital, surveillance of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission is undertaken using POT to conduct molecular epidemiological analysis for all newly detected MRSA strains. In 2014, we performed POT only once a month; however, in 2015, we increased the frequency of POT to once a week, which helped us detect nosocomial transmission that would normally be difficult to detect, and thus achieve 40% reduction in nosocomial transmission, compared to that in 2014. This suggests that weekly POT screening for all MRSA strains is one of the effective methods available for minimizing nosocomial transmission of MRSA.

Linguistic analysis of large-scale medical incident reports for patient safety.

The analysis of medical incident reports is indispensable for patient safety. The cycles between analysis of incident reports and proposals to medical staffs are a key point for improving the patient safety in the hospital. Most incident reports are composed from freely written descriptions, but an analysis of such free descriptions is not sufficient in the medical field. In this study, we aim to accumulate and reinterpret findings using structured incident information, to clarify improvements that should be made to solve the root cause of the accident, and to ensure safe medical treatment through such improvements. We employ natural language processing (NLP) and network analysis to identify effective categories of medical incident reports. Network analysis can find various relationships that are not only direct but also indirect. In addition, we compare bottom-up results obtained by NLP with existing categories based on experts' judgment. By the bottom-up analysis, the class of patient managements regarding patients' fallings and medicines in top-down analysis is created clearly. Finally, we present new perspectives on ways of improving patient safety.

Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

Recent trend of increasing myopia can be traced to infancy.

In recent years, a trend has been noted for increasing numbers of myopia cases found globally, which could potentially be indicative of a bigger problem. However, the cause of this trend remains unknown and in addition, we have yet to be able to establish a reliable method for preventing the onset of myopia. Furthermore, previous myopia studies have not paid adequate attention to hyperopia. That is to say, it has been suggested that the development of refraction in infancy and the onset of myopia are distinct from emmetropization. However, myopia studies also need to focus on the development of refraction in infancy, which involves hyperopia. Based on this viewpoint, our new hypothesis is that the trend towards myopia is associated with changes during the infancy period. The supporting evidence for these changes can be found in four areas, epidemiology of hyperopia, relationship with body height, incidence of esotropia, and birth month research. If this hypothesis is true, we need to investigate why there has been a decrease in hyperopia patients rather than why there has been an increase in myopia patients.

The Use of Electronic Medical Record Data to Analyze the Association Between Atrial Fibrillation and Birth Month.

OBJECTIVES: Cardiovascular disease is a condition of enormous public health concern. Recently, a population study newly revealed associations between cardiovascular diseases and birth month. Here, we investigated the association between atrial fibrillation in cardiovascular disease and birth month. METHODS: We retrospectively extracted birth date data from 6,016 patients with atrial fibrillation (3,876 males; 2,140 females) from our electronic medical records. The number of live births in Japan fluctuates seasonally. Therefore, we corrected the number of patients for each birth month based on a Japanese population survey report. Then, a test of the significance of the association between atrial fibrillation and birth month was performed using a chi-square test. In addition, we compared the results of an analysis of patient data with that of simulated data that showed no association with birth month. RESULTS: The deviations of birth month were not significant (overall: p = 0.631, males: p = 0.842, females: p = 0.333). The number of female patients born in the first quarter of the year was slightly higher than those born in the other quarters of the year (p = 0.030). However, by comparing the magnitudes of dispersion in the simulated data, it seems that this finding was mere coincidence. CONCLUSION: An association between atrial fibrillation and birth month could not be confirmed in our Japanese study. However, this might be due to differences in ethnicity. Further epidemiologic studies on this topic may result in reduction of disease risk in the general population and contribute to public health.

Measuring Attitudes Toward Nursing Safety Violations.

This study measured implicit and explicit attitudes toward major nursing safety violations using the Implicit Association Test (IAT) and self-reported questionnaires, respectively. Experiment 1 sampled nursing students (n = 71), and Experiment 2 sampled patient safety nurses (n = 38). Although reaction time to IAT stimuli of major nursing safety violations was quicker than of general nursing behaviors, error trials did not reveal a significant difference between IAT stimuli of major nursing safety violations and of general nursing behaviors in Experiment 1. Explicit attitude was related with intention to violate safety protocols in Experiment 1. In Experiment 2, both reaction time and error trials showed significant differences between IAT stimuli of major nursing safety violations and of general nursing behaviors. This was interpreted in that patient safety nurses had formed a firm implicit attitude, unlike the nursing students; however, the findings suggested that attitudes were not related to violations in nursing.

Detection of various platelet-associated immunoglobulins by flow cytometry in idiopathic thrombocytopenic purpura.

BACKGROUND: In 1975, Dixson reported that anti-platelet IgG on platelets from patients with idiopathic thrombocytopenic purpura (ITP) is greater than in normal people, by determining anti-platelet antibodies directly on the platelet surface with a quantitative complement lysis-inhibition-assay. Since then, platelet-associated IgG (PAIgG) has been thought of as evidence of ITP. Although platelets from ITP patients show significantly higher PAIgG values than from normal control individuals, PAIgG is not specific for autoantibody because it increases in other than immune ITP patients. METHODS: We analyzed positive platelet percentage with various platelet-associated immunoglobulins: IgG, IgM, IgA, and total immunoglobulins, in the blood from 17 normal donors and 23 ITP patients. RESULTS: The specificity for ITP disease was better in flow cytometry than in ELISA, because, other than ITP, only aplastic anemia was positive in flow cytometry; however, various disorders (aplastic anemia, chronic lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome) showed positive in ELISA. Flow cytometry methods had the same sensitivity for ITP disease as ELISA. However, it is supposed that there was no nonimmune ITP in this study because the PAIgG negative patients (n = 1) showed positive results in flow cytometry. CONCLUSION: Flow cytometry method was effective for ITP screening, especially for specificity.