Endoscopic resection (ER) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). However, in patients aged ≥ 80 years, ER has limited long-term benefits owing to the higher mortality risk from other diseases. We assessed the therapeutic outcomes and prognostic predictors of ER in patients with ESCC aged ≥ 80 years at three institutions. Patient characteristics and overall survival (OS) were evaluated using Cox proportional hazards regression models. This study included 161 patients with 161 lesions. The median patient age was 82 years. Patient characteristics included a median Brinkman Index (BI) of 570, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) class 0–1 in 150 patients (93.2
Coronary artery disease (CAD) is a major risk factor for the development of heart failure (HF) with preserved ejection fraction (HFpEF) and is associated with increased mortality. However, an optimal strategy to screen for HFpEF among patients with CAD has not yet been established. The HFpEF-ABA score was introduced to estimate the pretest probability of HFpEF and was shown to predict adverse HF events. This retrospective multicenter cohort study included patients registered in the Clinical Deep Data Accumulation System database who underwent percutaneous coronary intervention from April 2013 to March 2019. Patients with a left ventricular (LV) ejection fraction ≥ 50
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Objectives To integrate and analyze domestic and international literature on interprofessional collaboration (hereafter, collaboration) in home-based palliative care for patients with terminal cancer, and to support the development of the evaluation of indicators of collaboration.Methods Medline, CINAHL, Cochrane Library, and Web of Science (via Igaku Chuo Zasshi) were searched using the terms "terminal cancer", "home", "palliative care", "interprofessional", and "indicators". The retrieved literature was thoroughly reviewed, emphasizing descriptions of the content, outcomes, and evaluation of "collaboration". The information obtained was organized according to the Donabedian framework for healthcare quality assessment: Structure (care-supporting resources and systems), Process (collaborative procedures and content), and Outcome (results or changes attributable to collaboration). All processes, from the formulation of the search strategy, to selection and classification of the literature, were conducted through discussion and agreement among the investigators.Results The initial search identified 159 articles (Medline, 16; CINAHL, 10; Cochrane Library, 0; Web of Science via Igaku Chuo Zasshi, 133), of which 150 were excluded because they did not meet the inclusion criteria. Nine eligible articles were supplemented with 10 articles, yielding 19 articles for analysis. These articles, published between 2001 and 2020, included 13 Japanese and six international studies. The topics included five scale development and validation studies on "collaboration", five qualitative studies identifying "collaboration" indicators, seven studies evaluating initiatives to strengthen "collaboration", and two studies evaluating the introduction of "collaboration" tools. Structure indicators included the care system, team relationships, information sharing, operations, community-based comprehensive collaboration systems, and 24-hour drug supply systems. Process indicators included visualization of the collaboration process, unification of team policies, formation of team trust, active collaborative behaviors by professionals, and educational support to enhance collaborative capacity. Outcome indicators included subjective evaluations from patients, families, and diverse professionals, and objective evaluations based on performance data.Conclusion The Structure, Process, and Outcome indicators identified in this study provide a foundation for developing measures to evaluate and promote collaboration. Future studies should standardize these indicators and assess their relationships with outcome measures to develop evaluation tools that enhance collaboration in clinical practice.
BACKGROUND/AIM:Chemotherapy-induced nausea and vomiting (CINV) remain major challenges during concurrent chemoradiotherapy (CCRT) for cervical cancer. Mannitol and furosemide are agents widely used to prevent cisplatin-induced nephrotoxicity; however, the differences in their effect on CINV have not been characterized. This study aimed to evaluate the impact of concomitant diuretic administration (mannitol versus furosemide) on the incidence and timing of vomiting in patients with cervical cancer undergoing CCRT. PATIENTS AND METHODS:This multicenter, retrospective study evaluated the impact of concomitant diuretic administration on CINV in 485 patients receiving weekly, cisplatin-based CCRT between 2016 and 2024, including 206 who received mannitol and 279 who received furosemide. RESULTS:Vomiting occurred more frequently in the mannitol group than in the furosemide group (18.4% vs. 10.4%). Time-to-event analysis found that vomiting occurred earlier with mannitol during the entire CCRT course. CONCLUSION:These findings may reflect mannitol's osmotic properties and the increased, intestinal permeability associated with CCRT-related mucosal injury. To the best of our knowledge, this study is the largest investigation to date comparing diuretic agents in this setting. The results suggested that furosemide may be a more appropriate option for patients with a high risk of CINV.
