2 ． Overview of the DeSC Database and Utilization for Clinical Epidemiology and Pharmacoepidemiology Research / 薬剤疫学

Studies using real-world data are recently increasing worldwide. Various types of real-world data are available in Japan. Administrative claims databases include the National Database (NDB) and other types of databases including several commercially available databases. This article describes the DeSC database, newly constructed by DeSC Healthcare Co., Ltd. in 2020. One of the features of the DeSC database is that it includes data from the National Health Insurance, Health Insurance, and Advanced Elderly Medical Service System. In the present article, we referred to our previous study on population representativeness of the DeSC database and explained its overview. Estimated prevalence of some diseases were described for each type of insurance. Furthermore, we discussed the use of the DeSC database for clinical epidemiology and pharmacoepidemiology research.

Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula

Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.

Severe Bleeding and Perforation Are Rare Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Masses: An Analysis of 3,090 Patients from 212 Hospitals

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated. METHODS: We aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database. RESULTS: In total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045). CONCLUSIONS: Severe bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.

<b>7. Example of Healthcare Database Utilization: The Diagnosis Procedure Combination Database </b> / 薬剤疫学

The Diagnosis Procedure Combination(DPC) is a case-mix classification system for hospitalized patients, which is linked with lump-sum payment system called the Diagnosis Procedure Combination/Per-Diem Payment System(DPC/PDPS). The DPC Study Group works on the DPC data utilization project for research purpose, independently of Ministry of Health, Labour and Welfare, Japan. The database contains discharge data and administrative claim data, including diagnoses, comorbidities and complications coded with ICD-10(International Classification of Diseases and Related Health Problems, Tenth Revision) codes; procedures; duration of anesthesia; volume of blood transfusion; drugs and devices used; length of stay; discharge status; costs; and detailed clinical information(body height/weight; smoking index; Japan Coma Scale; cancer stage; modified Rankin Scale; Hugh-Johns classification; NYHA classification for heart failure, severity index for angina pectoris/myocardiac infarction, pneumonia, and acute pancreatitis; and Child-Pugh classification for liver cirrhosis). In this report, we introduced two studies using the DPC database: (i) the effect of fondaparinux on the prophylaxis of postoperative pulmonary embolism and (ii) the effect and cost of gabexate mesylate on the treatment of acute pancreatitis. In addition, we compared the DPC database with the US administrative databases(including the Nationwide Inpatient Sample database and the Medicare claim database) and discussed the tasks for the future set to the DPC database to further enhance clinical studies and health services research in Japan. (Jpn J Pharmacoepidemiol 2012; 17(2): 163-169)