BACKGROUND:Recent advances in cancer treatment and improvements in prognosis have led to increasing recognition of the critical role of shared decision-making (SDM) between patients and healthcare providers in determining treatment strategies. SDM requires not only information on surgery-related outcomes and health-related quality of life, but also consideration of patient-specific factors such as the social background. However, determinants of surgical choice among Japanese patients remain unclear, and this study aimed to identify the influencing factors. METHODS:This multicenter, cross-sectional study evaluated patient-reported outcomes in 577 Japanese patients who underwent mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR). Participants completed questionnaires to assess the factors influencing surgical decision-making, including sociodemographic, psychosocial, and healthcare provider-related factors. Clinical data were obtained from the medical records, and multivariate analyses were conducted to identify the factors associated with the selection of surgical procedures. RESULTS:The most frequently cited factor was the surgeon's opinion (92.2%), followed by fear of recurrence (43.8%) and partner's opinion (35.5%). Partner's opinion was significantly more influential in BCS and IBR selection than in MT selection (P = 0.012), whereas concern about recurrence was the main factor influencing MT selection (P = 0.002). Multivariate analysis suggested the nurse's opinion was significantly associated with IBR, while concern about recurrence was inversely related. CONCLUSIONS:Considering that the factors influencing decision-making vary by surgical procedure, it is essential to tailor surgical choices to each patient's values and lifestyle. Strengthening decision-support systems by involving the entire healthcare team will be an important priority moving forward.
Background: Ascophyllan, a sulfated polysaccharide extracted from brown seaweed, has shown immunomodulatory and antioxidant effects in preclinical studies, yet human clinical evidence remains scarce. This randomized, double-blind, placebo-controlled pilot trial evaluated the safety and exploratory biological effects of daily ascophyllan supplementation in healthy adults. Methods: Twelve participants were randomized to receive either ascophyllan (n = 6) or placebo (n = 6) for 28 days. Safety was monitored through adverse event reporting and repeated laboratory assessments, including hematology, biochemistry, and inflammatory markers. Immune cell populations were analyzed via serial flow cytometry, serum total antioxidant capacity was measured at multiple time points, and gut microbiome composition was profiled using 16S rRNA gene sequencing. All analyses were exploratory in nature. Results: Ascophyllan supplementation proved well tolerated, with no adverse events observed and stable hematologic, renal, and biochemical parameters throughout the study. Exploratory longitudinal analyses suggested directional modulation of NK-cell-associated phenotypes during ascophyllan supplementation, including directional changes in CD57+, NKp46+, and NKG2D+ NK-cell phenotypes; however, group × time interaction analyses did not remain statistically significant after correction for multiple comparisons. Serum antioxidant capacity showed inter-individual variability with a directional but non-significant increase in the ascophyllan group at intermediate time points. Exploratory microbiome analyses suggested modest directional compositional differences involving members of the Bacteroidaceae and Bifidobacteriaceae families; however, no taxon remained statistically significant after correction for multiple comparisons. Conclusions: These preliminary findings indicate that ascophyllan is safe and well tolerated in healthy adults and may be associated with modulation of innate immune phenotypes, subtle microbiome compositional differences, and directional changes in antioxidant capacity. Larger, adequately powered clinical trials are warranted to confirm these observations and further investigate potential biological and clinical effects.
Accurate diagnosis of small bowel obstruction (SBO) is critical to patient outcomes, particularly in the emergency department (ED). To enhance diagnostic precision, we developed an artificial intelligence (AI) technology that automatically extracts dilated intestinal segments from contrast-enhanced computed tomography (CT) images. 158 contrast-enhanced CT examinations containing 5,200 annotated images were used for deep learning, and the potential utility of AI in improving SBO diagnosis was subsequently evaluated by residents and surgeons. CT images from 30 patients with suspected SBO in the ED were used as a test set. Seventeen residents and ten surgeons were divided into two groups, one interpreting images with AI support and the other without AI. Participants assessed the presence of SBO and identified the obstruction location, and diagnostic time was recorded. A hierarchical Bayesian model was applied for analysis. The median precision, recall, and Dice score of the AI model were 0.98, 0.63, and 0.77, respectively. For both residents and surgeons, the correct diagnosis rate of the obstruction location was significantly higher in the AI-assisted group compared with the non-AI group (74.1% vs. 56.7% and 88.2% vs. 66.2%, respectively; P < 0.0001 and P = 0.0001). Among residents, AI support significantly improved the diagnosis of obstruction location (odds ratio: 4.20; 95% credible interval: 2.14-8.26) and reduced reading time by 26.84 s per case (95% credible interval: -50.37 to - 2.83). These findings indicate that AI technology is clinically feasible and can improve diagnostic accuracy while reducing the time required for diagnosing bowel obstruction.
Importance The Academy of Nutrition and Dietetics Nutrition Care Process is a standardized, 4-step framework for nutrition assessment, diagnosis, intervention, and monitoring. Although the framework has been widely adopted globally, its association with improved clinical outcomes, including mortality and length of stay (LOS), remains unclear. Objective To evaluate the association of nutrition clinical framework implementation, delivered as an institutional clinical practice change, with clinical outcomes in older inpatients (aged ≥65 years), with a focus on effect modification by nutrition status. Design, Setting, and Participants This cohort study using a difference-in-differences design was conducted among older adult inpatients (aged ≥65 years) at a Japanese university hospital between January 1, 2022, and June 30, 2025, with a follow-up period of 1 year after admission. Exposures Institutional nutrition clinical framework implementation in 9 wards from July 1, 2024, to June 30, 2025, in which dedicated registered dietitians delivered the full 4-step process as part of a hospital-wide clinical practice change. Main Outcomes and Measures The main outcomes were in-hospital mortality, 6-month mortality, 1-year mortality, overall mortality, and LOS. All outcomes were stratified by Mini Nutritional Assessment–Short Form (MNA-SF) score (≤7, malnourished; 8-11, at risk of malnutrition; ≥12, normal nutrition status). Results Among 17 057 inpatients included in the study (mean [SD] age, 78.1 [7.5] years, 9070 male [53.2%]), in-hospital mortality in the malnourished stratum was lower during the implementation period (odds ratio [OR], 0.45; 95% CI, 0.22-0.91; P = .03). Nutrition clinical framework implementation was also associated with lower 6-month mortality (OR, 0.59; 95% CI, 0.35-0.98; P = .04) and shorter LOS (exponentiated coefficient, 0.87; 95% CI, 0.77-0.98; P = .03) among malnourished patients; after Benjamini-Hochberg adjustment, these findings were no longer significant. The bayesian posterior probability that the OR was less than 1 was at least 96% in all outcomes, and a dose-response association was observed for LOS ( P for trend = .01). Conclusions and Relevance This study found that ward-based implementation of the nutrition clinical framework was associated with lower in-hospital mortality and shorter LOS among patients with malnutrition at admission, whereas no such associations were observed in the overall cohort. These findings suggest that targeted clinical nutrition delivery may be a useful strategy for prioritizing limited dietitian resources for high-risk inpatients; however, confirmation in multicenter prospective studies is needed.
