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      • Prognostic differences among patients with different etiologies of acute exacerbation of chronic fibrotic idiopathic interstitial pneumonia

        ( Motoyasu Kato ),( Yuta Arai ),( Hiroaki Motomura ),( Issei Sumiyoshi ),( Yusuke Ochi ),( Junko Watanabe ),( Hiroaki Ihara ),( Shinsaku Togo ),( Shinichi Sasaki ),( Kazuhisa Takahashi ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

        Background: Acute exacerbation of chronic fibrotic idiopathic interstitial pneumonia (AE-IIP) is associated with a high mortality rate. In 2016, the International Working Group classified the etiology of AE-IIP into idiopathic and triggered. Several factors can trigger AE-IIP; however, the triggers associated with the worst prognosis have not been identified. The aim of this study was to investigate the prognosis of patients with various types of AE-IIP, particularly infection-triggered, non-infection-triggered, and idiopathic AE-IIPs. Methods: We retrospectively collected data for 128 patients with chronic fibrotic IIP (CF-IIP) who were hospitalized because of respiratory failure during the period between April 2009 and March 2019 at Juntendo University Hospital. There were 79 patients who developed AE-IIP, and 21 patients who developed bacterial pneumonia combined with CF-IIP. AE-IIP was classified into idiopathic, infection-triggered, and non-infection-triggered. We analyzed differences in patient characteristics, examination findings, and prognosis among the types. Finally, we evaluated risk factors for early death due to AE-IIPs. Results: Idiopathic, infection-triggered, and non-infection-triggered AE-IIPs were diagnosed in 34, 25, and 20 patients, respectively. The survival time was significantly longer for bacterial pneumonia combined with IIP than for AE-IIP. Moreover, the survival time was significantly longer for infection-triggered AE-IIP than for idiopathic or non-infection-triggered AE-IIP. The mortality rate was significantly lower with infection-triggered AEIIP than with other types of AE-IIP. Finally, a multivariate analysis revealed that radiological findings at the time of onset of AE-IIPs and AE-IIP patterns were independent risk factors for early death. Conclusion: Our results suggest that patients with infection-triggered AE-IIP may have a better prognosis than those with other types of AE-IIP.

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        The National Clinical Database as an Initiative for Quality Improvement in Japan

        Arata Murakami,Yasutaka Hirata,Noboru Motomura,Hiroaki Miyata,Tadashi Iwanaka,Shinichi Takamoto 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.5

        The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons’ National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use ‘big data’ from these databases have been published. The national databases have contributed to evidence- based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.

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