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Effects of transcatheter aortic valve implantation (TAVI) on cost-effectiveness in older patients with aortic stenosis (AS) compared with medical therapy (MT) were not well scrutinized in the real-world settings. Patients with AS were extracted from an administrative claims database of late elderly patients aged ≥ 75 years in Japan from 2018 to 2021. The patients were divided into TAVI and MT groups, and all-cause death and medical costs were compared between the two groups. The effect of TAVI on mortality compared with MT and the incremental cost-effectiveness ratio (ICER) of the TAVI compared with MT were calculated in JPY/quality-adjusted life year (QALY). Of the 45,664 patients analyzed, 2,217 (4.9
The ONCO DVT study demonstrated the benefit of extended anticoagulation therapy with edoxaban in patients with cancer-associated isolated distal deep vein thrombosis (DVT). However, it remains unclear whether these results can be applied regardless of the number of thrombosed venous segments. In this post-hoc subgroup analysis of the ONCO DVT study, 601 patients were stratified into the single-site (N=268) and multiple-sites (N=333) DVT subgroups based on the number of thrombosed venous segments at diagnosis. We compared 12-month and 3-month edoxaban treatment groups in each subgroup for the primary endpoint of symptomatic recurrent venous thromboembolism (VTE) or VTE-related death and the major secondary endpoint of major bleeding at 12 months. The cumulative 12-month incidence of the primary endpoint was significantly lower in the 12-month edoxaban group than in the 3-month edoxaban group both in the single-site (0.8
Summary:. Unplanned excision of soft tissue sarcoma presents a significant clinical challenge, frequently necessitating wide re-excision that results in complex soft tissue defects. Reconstructing these defects, particularly in the extremities, often requires invasive procedures such as free flaps. This report describes the case of a 40-year-old woman with a myxoid liposarcoma of the thigh. After an initial unplanned transverse excision, a wide re-excision was performed, creating a cross-shaped defect that posed a reconstructive challenge. To reconstruct this defect, we used a pinwheel flap, a 4-flap rotation technique traditionally applied for scalp reconstruction. The selection of this method was based on the geometric coincidence between the iatrogenic defect and the flap design. The reconstruction was performed successfully, with all flaps remaining viable and leading to an uneventful postoperative recovery. At the 2-year follow-up, the patient demonstrated full ambulation, no evidence of tumor recurrence, and a satisfactory aesthetic result. To our knowledge, this is the first reported application of the pinwheel flap in the lower extremity. This case suggests that the pinwheel flap is a simple and viable reconstructive option for the specific cross-shaped defects arising from the re-excision of soft tissue sarcoma.
BACKGROUND:The worldwide acceleration of digital transformation in healthcare underscores the need for professionals to continuously adapt and sustain robust digital health competence, shaped not only by individual characteristics and institutional environments but also by broader social, cultural, and geopolitical factors. OBJECTIVE:This study aimed to identify distinct clusters of digital health competence among healthcare professionals across 19 diverse countries and regions, and to examine the factors influencing the development and distribution of these competence clusters. METHODS:A cross-sectional international survey study was conducted between 2023 and 2024, using a validated survey instrument measuring digital health competence and its influencing factors. Data were collected from healthcare professionals in 19 countries and regions (n = 6440; n = 5945 used for this study), following a harmonised protocol with shared demographic templates and instruments. K-means cluster analysis was employed to derive digital competence profiles, with comparative analyses conducted to investigate associations between the identified clusters and individual characteristics (e.g., age, education, professional experience). RESULTS:Five distinct clusters of digital health competence were identified: (1) Beginners, (2) Developing Professionals, (3) Emerging Users, (4) Proficient Practitioners, and (5) Pioneers. Higher competence clusters (4 and 5) were associated with younger age, higher education, hospital-based work, and stronger perceived support from management, organisational structures, and colleagues. In contrast, lower-performing clusters reported limited digital engagement and minimal support. Perceived leadership influence, particularly managerial commitment to digital change, was a key differentiator across clusters. CONCLUSIONS:The findings demonstrate substantial variation in digital health competence across healthcare professionals internationally. Cluster-specific strategies, such as targeted upskilling, peer mentoring, and leadership engagement, are needed to address competence gaps. The results provide a foundation for policy development and workforce training frameworks aimed at strengthening digital readiness in global healthcare systems. Future research should explore longitudinal competence development and evaluate targeted interventions.
PURPOSE:Ten years after the first Global Consensus on Keratoconus and Ectatic Diseases, this updated edition revisits key issues, incorporates advances in new technologies, and integrates the expertise of corneal and refractive surgeons from 12 international societies. This initiative aimed to establish a consensus among global ophthalmology experts, including corneal and refractive specialists from 6 continents, on the definition, diagnosis, staging, clinical management, and surgical treatment of keratoconus and ectatic corneal diseases. METHODS:The Delphi method consisted of 4 rounds of questionnaires, supplemented by a face-to-face meeting. A total of 128 ophthalmologists participated, with 3 main coordinators and 125 keratoconus experts distributed across 7 panels: definition/diagnosis/staging, clinical treatment and noninvasive visual rehabilitation, cross-linking for progression, and invasive visual rehabilitation (including therapeutic approaches, improved corrected distance visual acuity, keratoplasty techniques, and cataract surgery in keratoconus). The consensus threshold was defined as at least two-thirds agreement. RESULTS:A significant consensus was reached on topics such as definitions, diagnostic and progression criteria, and management strategies for keratoconus and other ectatic corneal disorders. A comprehensive approach was outlined, encompassing both nonsurgical and surgical treatments, organized in a group-based approach. In addition, major agreements and disagreements across the 7 subcommittees are outlined in individual tables. CONCLUSIONS:This updated Global Consensus provides revised definitions, expert statements, and recommendations for diagnosing and managing keratoconus and other ectatic corneal diseases. It benefits from broader participation, with more refractive surgeons and greater representation from major ophthalmic societies across 6 continents, capturing a wider range of global clinical perspectives than the prior report.
