Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients having family, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement enhances shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.
Long-term outcomes after percutaneous coronary intervention (PCI) remain suboptimal, mainly due to progression of non-target lesion stenosis. Lifestyle modification can attenuate these outcomes, and digital health interventions may provide an alternative to standard care. We conducted a multicenter, open-label, randomized controlled trial in post-PCI patients (n = 152). Subjects were assigned to a 14-week app-based lifestyle modification program using IoT devices or to usual care. The primary endpoint was the proportion achieving ≥ 10
Introduction: Cervicobrachial symptoms are common causes of disability worldwide, yet the cost-effectiveness of combination therapy versus monotherapy remains unclear. In this nationwide multicenter study, we aimed to compare the economic value of multiple-drug therapy with that of monotherapy for cervicobrachial symptoms. Methods: This prospective observational study, conducted through the Japanese Society for Spine Surgery and Related Research, included 261 adults with cervicobrachial symptoms across 28 institutions (July 2020 to July 2022). Patients received monotherapy (n=112) or multiple-drug therapy (n=149) using five pre-specified agents: loxoprofen, celecoxib, acetaminophen, tramadol-acetaminophen, and pregabalin. The primary outcome was quality-adjusted life years (QALYs), calculated from monthly EuroQol 5-Dimension 5-Level assessments over six months. The secondary outcomes were drug costs and incremental cost-effectiveness ratios (ICERs), evaluated against Japan's reference threshold of 5,000,000 JPY per QALY. Results: Mean QALY gains were similar between the monotherapy (0.00267±0.00544) and multiple-drug therapy (0.00284±0.00774) groups, with no statistically significant difference (p>0.05). However, total drug costs were substantially higher with multiple-drug therapy (19,243 JPY vs. 8,275 JPY). ICERs were more favorable for monotherapy (3,093,957 JPY/QALY) than for multiple-drug therapy (6,781,101 JPY/QALY). Among agents used as monotherapy, loxoprofen (744,409 JPY/QALY) and acetaminophen (781,293 JPY/QALY) showed the most favorable cost-effectiveness profiles, whereas tramadol-acetaminophen (6,370,451 JPY/QALY) and pregabalin (10,995,651 JPY/QALY) had the least favorable cost-effectiveness. Most QALY gains occurred during the first three months in both groups. Conclusions: Multiple-drug therapy approximately doubled pharmaceutical costs without providing additional QALY gains over six months. Monotherapy, particularly with non-steroidal anti-inflammatory drugs or acetaminophen, offers superior cost-effectiveness and should be prioritized as first-line treatment. These findings underscore the need for restraint in polypharmacy and provide real-world evidence to guide clinical decision-making and national healthcare policy.
A basilar artery blood blister-like aneurysm (BBA) is a rare entity for which a standard treatment has not yet been established. We report a case of basilar artery BBA in the subacute stage of subarachnoid hemorrhage (SAH) that was treated using a single low-profile visualized intraluminal support (LVIS) stent. A 63-year-old woman presented with sudden-onset posterior neck pain. Head computed tomography (CT) revealed modified Fisher group 3 SAH, extending from the prepontine and basal cisterns to the quadrigeminal cistern. The patient was diagnosed with Hunt and Hess grade 2 SAH. Initial digital subtraction angiography (DSA) revealed an aneurysm in the right internal carotid artery (ICA), which was treated with coil embolization. Although a minute bulge on the basilar artery was identified on the initial three-dimensional DSA (3D DSA), it was too subtle for a definitive diagnosis on day 1. Repeat DSA was performed on day 11 because hemorrhage from the posterior circulation could not be excluded. DSA on day 11 revealed a 1.7-mm projection on the dorsal wall of the basilar artery by 3D DSA, confirming a basilar artery BBA. Dual antiplatelet therapy (DAPT) was initiated, and endovascular treatment was performed. The BBA was extremely small with a pinhole neck, making stent-assisted coil embolization difficult and high-risk for rupture; therefore, a single LVIS stent was placed in the basilar artery, forming a dense stent mesh around the aneurysm. The postoperative course was uneventful, and the patient was discharged without neurological deficit. Four months later, follow-up DSA showed complete resolution of the BBA. If coil placement is challenging in basilar artery BBA, treatment with a single LVIS stent may be an effective alternative option.
