Usage and limitations of medical consultation with patients' families using online video calls: a prospective cohort study.

BACKGROUND: Few studies have been conducted on the usage of telehealth focusing on consultations between patients' families and physicians. This study aimed to identify the usage and limitations of online medical consultations with patients' families compared to the traditional in-person consultations. METHODS: We conducted a prospective cohort study from April 1, 2020, to September 30, 2021, at an educational acute-care hospital in Japan. The study included hospitalized patients aged 20 years or older and their family members for whom an online or in-person medical consultation between the family member and physician was conducted during the hospitalization period. The primary endpoints assessed were three topics pertaining to medical consultation: medical conditions and treatment plans, policies for life-threatening events, and post-discharge support. The secondary endpoint was the number of consultations required. RESULTS: Online consultations and traditional in-person consultations were provided to 58 and 53 patients' families, respectively. Of the patients in the online consultation group who underwent multiple consultations, 46 (79%) also underwent in-person consultations. Regarding the topics, all the patients' families in both consultation groups had consultations on medical conditions and treatment plans; regarding the policy for life-threatening events, 47% of patient families in the online consultation group were consulted compared to 53% of those in the in-person group. Regarding post-discharge support, 59% of patient families in the online group were consulted compared to 40% in the in-person group. In the online consultation group of 58 patients' families, 188 consultations were conducted, including 95 online and 93 in-person consultations. Consultations on policy for life-threatening events were significantly more frequent in in-person consultations than in online consultations (p < 0.05). Regarding post-discharge support, online consultations were significantly more frequent than in-person consultations (p < 0.05). The number of family members who attended online consultations was significantly higher than those who attended in-person consultations (p < 0.05). CONCLUSIONS: Online consultation between the physician and patient's family may be an alternative to in-person consultation for explaining medical conditions and treatment plans. However, in-person consultation still plays an important role in sensitive topics, such as policy consultation for life-threatening events.

Roles and Competencies of Doctors in Artificial Intelligence Implementation: Qualitative Analysis Through Physician Interviews.

BACKGROUND: Artificial intelligence (AI) is a term used to describe the use of computers and technology to emulate human intelligence mechanisms. Although AI is known to affect health services, the impact of information provided by AI on the patient-physician relationship in actual practice is unclear. OBJECTIVE: The purpose of this study is to investigate the effect of introducing AI functions into the medical field on the role of the physician or physician-patient relationship, as well as potential concerns in the AI era. METHODS: We conducted focus group interviews in Tokyo's suburbs with physicians recruited through snowball sampling. The interviews were conducted in accordance with the questions listed in the interview guide. A verbatim transcript recording of all interviews was qualitatively analyzed using content analysis by all authors. Similarly, extracted code was grouped into subcategories, categories, and then core categories. We continued interviewing, analyzing, and discussing until we reached data saturation. In addition, we shared the results with all interviewees and confirmed the content to ensure the credibility of the analysis results. RESULTS: A total of 9 participants who belonged to various clinical departments in the 3 groups were interviewed. The same interviewers conducted the interview as the moderator each time. The average group interview time for the 3 groups was 102 minutes. Content saturation and theme development were achieved with the 3 groups. We identified three core categories: (1) functions expected to be replaced by AI, (2) functions still expected of human physicians, and (3) concerns about the medical field in the AI era. We also summarized the roles of physicians and patients, as well as the changes in the clinical environment in the age of AI. Some of the current functions of the physician were primarily replaced by AI functions, while others were inherited as the functions of the physician. In addition, "functions extended by AI" obtained by processing massive amounts of data will emerge, and a new role for physicians will be created to deal with them. Accordingly, the importance of physician functions, such as responsibility and commitment based on values, will increase, which will simultaneously increase the expectations of the patients that physicians will perform these functions. CONCLUSIONS: We presented our findings on how the medical processes of physicians and patients will change as AI technology is fully implemented. Promoting interdisciplinary discussions on how to overcome the challenges is essential, referring to the discussions being conducted in other fields.

Short-Term Outcomes of Surgery and Rehabilitation on Activities of Daily Living after Displaced Femoral Neck Fractures: Structural Equation Modeling.

In order to explore the factors affecting patients' level of activities of daily living (ADL) on discharge after undergoing bipolar hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures at an acute care hospital, patient data were analyzed with the following statistical tools: multiple regression analysis (MRA), structural equation modeling (SEM), and simultaneous analysis of several groups (SASG). The Barthel Index (BI) on discharge was set as the objective variable, while age, sex, degree of dementia, BI on admission, number of days from admission to surgery, surgical option, and number of rehabilitation units per day were set as explanatory variables. Factors such as age, sex, degree of dementia, BI on admission, and number of rehabilitation units per day were significant in MRA. While not significant in MRA, the number of days from admission to surgery was significant in SEM. According to the SASG, the number of rehabilitation units per day was significant for patients without dementia but not for patients with dementia. Analysis of real-world data suggests that early surgery and rehabilitation affect ADL on discharge to a greater degree than the surgical method. For patients without dementia, longer daily rehabilitation was significantly associated with better ADL on discharge.

Usefulness of maximum intensity projection images of non-enhanced CT for detection of hyperdense middle cerebral artery sign in acute thromboembolic ischemic stroke.

PURPOSE: To compare the sensitivity of the hyperdense middle cerebral artery (MCA) sign between maximum intensity projection (MIP) and conventional averaged images in patients with acute focal neurological deficits with acute thromboembolic MCA occlusion (MCA occlusion group) and patients with acute focal neurological deficits without MCA occlusion (control group). MATERIALS AND METHODS: Initial computed tomography (CT) scans on admission were reconstructed with 5 mm thickness at every 3 mm interval for averaged and MIP images from 1 mm thickness non-contrast axial source images. Images were obtained from 30 cases each in the MCA occlusion and control groups. The CT values in the region of interests (ROIs) on the affected and unaffected sides of the MCA were compared. To compare CT values among subjects, the CT values were normalized by obtaining a ratio on the affected and unaffected sides, and the normalized CT values were analyzed using the receiver operating characteristic (ROC) curve. RESULTS: The hyperdense MCA sign was visually detected on MIP images in 90% cases and on 5 mm averaged images in only 57% cases in the MCA occlusion group. Based on the ROC analysis of the normalized ratio on the affected and unaffected sides, area under the curve of MIP image and averaged image was 0.941 and 0.655, respectively. On MIP images, the optimal threshold of the ratio on the affected and unaffected sides was 1.152 (sensitivity: 90.0%, and specificity: 93.3%). CONCLUSION: The hyperdense MCA sign sensitivity on 5 mm MIP images was significantly higher than that on conventional 5 mm averaged CT images. This could be useful for the early initiation of proper therapy for patients with acute focal neurological deficits.

Public Attitudes Regarding Trade-offs Between the Functional Aspects of a Contact-Confirming App for COVID-19 Infection Control and the Benefits to Individuals and Public Health: Cross-sectional Survey.

BACKGROUND: It is expected that personal health information collected through mobile information terminals will be used to develop health strategies that benefit the public. Against this background, several countries have actively attempted to use mobile phones to control infectious diseases. These collected data, such as activity logs and contact history, are countermeasures against diseases such as COVID-19. In Japan, the Ministry of Health, Labor, and Welfare has developed and disseminated a contact-confirming app (COVID-19 Contact-Confirming Application [COCOA]) to the public, which detects and notifies individuals whether they have been near someone who had subsequently tested positive for COVID-19. However, there are concerns about leakage and misuse of the personal information collected by such information terminals. OBJECTIVE: This study aimed to investigate the possible trade-off between effectiveness in preventing infectious diseases and infringement of personal privacy in COCOA. In addition, we analyzed whether resistance to COCOA would reduce if the app contributed to public health or if a discount was provided on mobile phone charges. METHODS: A cross-sectional, quantitative survey of Japanese citizens was conducted using Survey Monkey, a general-purpose web-based survey platform. When developing the questions for the questionnaire, we included the installation status of COCOA and recorded the anxiety stemming from the potential leakage or misuse of personal information collected for COVID-19 infection control. The respondents were asked to rate various factors to determine their perceptions on a 5-point scale. RESULTS: In total, 1058 participants were included in the final analysis. In response to the question of whether the spread of the disease was being controlled by the infection control measures taken by the government, 25.71% (272/1058) of the respondents answered that they strongly agreed or agreed. One-quarter of the respondents indicated that they had already installed COCOA. This study found that the sense of resistance to government intervention was not alleviated by the benefits provided to individuals when using the app. The only factors that were positively associated with the response absolutely opposed to use of the app, even with a discount on mobile phone use charges, were those regarding leaks and misuse of personal information, which was true for all functions (function A: odds ratio [OR] 1.8, 95% CI 1.3-2.4; function B: OR 1.9, 95% CI 1.5-2.6; function C: OR 1.8, 95% CI 1.4-2.4). CONCLUSIONS: Public organizations need to emphasize the general benefits of allowing them to manage personal information and assure users that this information is being managed safely rather than offering incentives to individuals to provide such personal information. When collecting and using citizens' health information, it is essential that governments and other entities focus on contributing to the public good and ensuring safety rather than returning benefits to individual citizens.

Essential information for transition of care for frail elderly patients in Japan: A qualitative study.

BACKGROUND: Information exchange between hospitals and primary care physicians is suboptimal. Most physicians are dissatisfied with the current referral process, and poor communication leads to negative care transition outcomes. METHOD: To identify the key information needed for a successful transition of care, we conducted a qualitative study using consecutive, semistructured in-person interviews and focus group sessions. We recruited five participants engaged in clinical work for individual interviews and 16 participants for focus groups. We analyzed all data using qualitative thematic analysis. All results were returned to the participants and modified based on their feedback. RESULTS: The five individual interviews provided a general picture of the current referral process and an interview guide for the following focus group sessions. The focus group discussions were used to identify the essential information needed at admission and discharge from the hospital. Essential information on hospital admission was as follows: (1) basic medical and care information, (2) care resources available at home, (3) the purpose of admission and the goals of care during hospitalization, and (4) status of advance care planning (ACP) and patient's will in an emergency. Essential information on hospital discharge was as follows: (1) clinical course, (2) explanation of medical condition during hospitalization, (3) status of ACP and patient's will in an emergency, and (4) medical procedures to be continued at home. CONCLUSIONS: We identified the essential information needed for a successful transition of care in Japan. The clinical effectiveness of a template that contains the information identified in our study warrants further investigation.

Discussions on Present Japanese Psychocultural-Social Tendencies as Obstacles to Clinical Shared Decision-Making in Japan.

In Japan, where a prominent gap exists in what is considered a patient's best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies - "surmise (Sontaku)," "self-restraint (Jishuku)," "air (atmosphere or mood, Kuuki)," "peer pressure (or tuning pressure, Docho-Atsuryoku)," and "community (Seken)"-which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values.

Cross-sectional survey of surrogate decision-making in Japanese medical practice.

BACKGROUND: Instances of surrogate decision-making are expected to increase with the rise in hospitalised older adults in Japan. Few large-scale studies have comprehensively examined the entire surrogate decision-making process. This study aimed to gather information to assess the current state of surrogate decision-making in Japan. METHODS: A cross-sectional survey was conducted using online questionnaires. A total of 1000 surrogate decision-makers responded to the questionnaire. We examined the characteristics of surrogate decision-makers and patients, content of surrogate decision-making meeting regarding life-sustaining treatment between the doctors and surrogate decision-makers, extent of involvement of the various parties in the surrogate decision-making process, judgement grounds for surrogate decision-making, and frequency of involvement in the surrogate decision-making process. RESULTS: Of the participants, 70.5% were male and 48.3% were eldest sons. Only 7.6% of the patients had left a written record of their preferences and 48.8% of the surrogates reported no knowledge of the patient having expressed their prior intentions regarding medical care in any form. Respondents indicated that their family meetings with healthcare professionals mostly included the information recommended by guidelines in a surrogate decision-making meeting in Japan. Most participants reported a good understanding of the meeting content. Although many participants based their decisions on multiple grounds, surrogates' considerations may not adequately reflect respect for patient autonomy in Japan. Specifically, the eldest son considered his own preference more frequently than that of the other surrogate decision-makers. In 26.1% of the cases, either zero or one family meeting with healthcare professionals was held. In these cases, significantly fewer decisions involved the participation of healthcare professionals other than the doctor compared to cases with multiple meetings. CONCLUSIONS: Surrogate decisions in Japan are most commonly made by eldest sons and may not frequently consider the perspectives of other surrogates. The finding that patient preferences were rarely known suggests a role for increased advance care planning.

Should We Aim to Create a Perfect Healthy Utopia? Discussions of Ethical Issues Surrounding the World of Project Itoh's Harmony.

To consider whether or not we should aim to create a perfect healthy utopia on Earth, we focus on the SF novel Harmony (2008), written by Japanese writer Project Ito, and analyze various issues in the world established in the novel from a bioethical standpoint. In the world depicted in Harmony, preserving health and life is a top priority. Super-medicine is realized through highly advanced medical technologies. Citizens in Harmony are required to strictly control themselves to achieve perfect health and must always disclose their health information to the public and continuously prove their health. From a bioethical standpoint, the world in Harmony is governed by a "healthy longevity supremacy" principle, with being healthy equated to being good and right. Privacy no longer exists, as it is perceived ethical for citizens to openly communicate health-related information to establish one's credibility. Moreover, there is no room for self-determination concerning healthcare because medical interventions and care are completely routinized, automated, centralized, and instantly provided. This is a situation where the community exhibits extremely powerful and effective paternalism. One can argue that healthy longevity is highly preferred. But is it right to aim for a perfectly healthy society at all costs? Should we sacrifice freedom, privacy, vivid feelings, and personal dignity to achieve such a world? In our view, the answer is no, as this would require the loss of many essential values. We conclude by proposing an alternative governing principle for future healthcare, and refer to it as the "do-everything-in-moderation" principle.

Characterizing patients issued DNR orders who are ultimately discharged alive: a retrospective observational study in Japan.

BACKGROUND: The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. METHODS: In total, 2997 DNR cases from all 61,037 patients aged ≥20 years admitted to a representative general hospital in Tokyo were extracted and divided into two groups by patient hospital release status (discharged alive/deceased). Study items included age, sex, disease type (non-cancer/cancer), hospital department (internal medicine/others), timing of DNR order issuance, implementation (or not) of life-sustaining treatment (LST) or the presence of any restrictions on LST and hospital length of stay. We conducted multiple logistic regression analysis, setting hospital release status as the dependent variable and each above study item as explanatory variables. RESULTS: DNR orders were issued at a rate of 4.9%. The analysis revealed that patients with a DNR who were ultimately discharged alive were statistically more likely to be those for whom DNR orders are issued early after admission (adjusted odds ratio: AOR, 13.7), non-cancer patients (AOR, 3.4), internal medicine department patients (AOR, 1.63), females (AOR, 1.34), and elderly (aged ≥85 years; AOR, 1.02); these patients were also less likely to be receiving LST (AOR, 0.36). CONCLUSIONS: By focusing on those with DNR orders who were ultimately discharged alive, we discovered that these patients were likely to have DNR orders issued early after admission, and that they were more likely to be elderly, female, non-cancer patients, or those in internal medicine departments. Further examination of these data may help to elucidate why these particular DNR-related characteristics (including socio-economic and cultural factors) are evident in patients who end up being discharged alive.

Association between delivery methods for enteral nutrition and physical status among older adults.

BACKGROUND: The physical status of patients who received enteral nutrition is still unclear. We aimed to compare the physical functional status among older adult patients who underwent percutaneous endoscopic gastrostomy (PEG) and those with nasogastric feeding. METHODS: We conducted a retrospective cohort study in an acute care hospital from August 1, 2009 to March 31, 2015. We included older adult patients (age ≥ 65 years) who were administered PEG or nasogastric feeding during hospitalization and received enteral nutrition for ≥14 days. We excluded patients who were completely bedridden at the administration of enteral nutrition. The primary outcome was death or becoming bedridden at discharge. The incidence of being bedridden among the patients who survived and received enteral nutrition at discharge was also compared according to the enteral nutrition method used. RESULTS: Among the 181 patients who were administered enteral nutrition during hospitalization, 40 patients (22%) died and 66 patients (36%) were bedridden at discharge. The proportions of patients who fully resumed oral intake were 30% in the nasogastric group and 2.3% in the PEG group. The adjusted odds ratios comparing PEG feeding to nasogastric feeding were 0.38 (95% CI, 0.16-0.93) for death or being bedridden and 0.09 (95% CI, 0.02-0.40) for being bedridden among the patients who were receiving enteral nutrition at discharge. CONCLUSIONS: Among older adult patients who were administered enteral nutrition, more than half of these patients died or became bedridden. PEG feeding could be associated with a lower risk of becoming bedridden or death in comparison with nasogastric feeding, although PEG feeding may be offered to the most mobile/ambulatory patients within clinical decision-making. Clinicians should carefully consider the administration and choice of enteral nutrition methods, when considering the prognosis of the patients.

Patient factors affecting decision regret in the medical treatment process of gynecological diseases.

BACKGROUND: To ensure that patients continue treatment, it is essential that the patient is satisfied with the decision-making process of the treatment. One way to address this is to assess the healthcare quality using the concept of regret, which can measure "Being convinced in decision-making." This study aimed to elucidate patient factors affecting regret using the Japanese version of the Decision Regret Scale (DRS). METHODS: A questionnaire survey was conducted with 197 patients with uterine myoma, ovarian tumors, and endometriosis. We then examined the relationship between the Japanese DRS, the Japanese SF-8 as a health-related quality of life (QOL), and patient factors using latent class analysis and path analysis through a multi-group comparison. RESULTS: The final sample comprised 102 patients. Patients were classified into the following two groups based on the latent class analysis of patient characteristics: many patients who were married and had children and a few patients who were unmarried and had no children (class 1), and many patients who were unmarried and had no children and a few patients who were married and had children (class 2). The path analysis through the group comparison of the two classes revealed that subjective symptoms, preferences, and surgical procedure (laparotomy or laparoscopic surgery) had a direct impact on regret. The magnitude of the influence factors for Class 1 and Class 2 Regret was different. The indirect effect on regret was through mental component summary. CONCLUSION: Our results suggest that it is necessary to present treatment methods with consideration to patients' backgrounds and to obtain informed consent from patients.

Quality of primary care provided in community clinics in Japan.

BACKGROUND: Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. METHODS: Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic. RESULTS: A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%. CONCLUSIONS: The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.

Development and Pilot Testing of Quality Indicators for Primary Care in Japan.

INTRODUCTION: To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan. METHODS: Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, "Do you think it is preferable that the patients of this clinic be periodically surveyed?" and "Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?" RESULTS: Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body. CONCLUSIONS: We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.

Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.

BACKGROUND: Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan. OBJECTIVE: To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival. DESIGN: Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016. PATIENTS: We included elderly patients (age ≥ 65 years) who received CPR after 2 days of hospitalization. MAIN MEASURES: The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors. KEY RESULTS: Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22-0.55) for age ≥ 90 years compared to age 65-69 years, and 0.68 (95% CI, 0.48-0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51-0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40-0.83). CONCLUSIONS: Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile.

Comparative analysis of lactic acidosis induced by linezolid and vancomycin therapy using cohort and case-control studies of incidence and associated risk factors.

PURPOSE: Lactic acidosis is a rare complication of linezolid (LZD) therapy, and its incidence and risk factors remain unknown. This study aimed to compare the incidence of LZD-associated lactic acidosis (LALA) and vancomycin (VAN)-associated lactic acidosis (VALA) and investigate the risk factors for LALA. METHODS: We performed a retrospective cohort study using propensity score-matched analyses comparing the incidence of lactic acidosis between LZD and VAN therapy. We included adult patients administered LZD or VAN between April 2014 and March 2016 and extracted patient baseline data. In a case-control study, we identified the risk factors of lactic acidosis in patients treated with LZD. RESULTS: We identified 94 and 313 patients who were administered LZD and VAN, respectively. The incidence of lactic acidosis after LZD and VAN therapy was 10.6 and 0.3%, respectively. After propensity score-matched analyses, the incidence of lactic acidosis with LZD therapy was significantly higher than that with VAN therapy [10.0% (8/80) vs. 0% (0/80), respectively; risk difference, 0.1; 95% confidence interval (CI), 0.03-0.17; p = 0.004]. In a case-control study, 10 patients with LALA were matched to 20 non-lactic acidosis patients by age and sex. Patients with LALA were more likely to have renal insufficiency than non-lactic acidosis patients that were in the univariate analysis (odds ratio, 7.4; 95% CI, 1.0-84.4; p = 0.02). CONCLUSIONS: This study indicates that LALA occurs more frequently than VALA does and is associated with renal insufficiency. Therefore, close monitoring of kidney function and serum lactate is recommended during LZD therapy.

Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia.

Clinical guidance on the choice of anesthetic modality vis-à-vis the risk of perioperative venous thromboembolism (VTE) is largely lacking because of a paucity of recent evidence. A comparative effect of general anesthesia and neuraxial blockade on the perioperative incidence of VTE has not been well-investigated.We compared the effects of different types of anesthetic modalities on the risk of VTE after total hip arthroplasty (THA) and total knee arthroplasty (TKA).This is a secondary analysis of the Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT). Data pertaining to a total of 2162 patients who underwent THA and TKA at 34 hospitals were included in this analysis. We compared the different anesthetic modalities with respect to the incidence of VTE. The composite end-point was asymptomatic/symptomatic deep vein thrombosis detected using scheduled bilateral ultrasonography up to postoperative day (POD) 10 and fatal/non-fatal pulmonary embolism up to POD 10.The study groups were as follows: general anesthesia (n = 646), combined epidural/general anesthesia (n = 1004), epidural anesthesia (n = 87), and spinal anesthesia (n = 425). On multivariate analysis, only spinal anesthesia was associated with a significant increase in the risk of VTE as compared with that associated with general anesthesia. Propensity score-matched analysis for "combined epidural/general anesthesia group" versus "spinal anesthesia group" demonstrated a 48% higher incidence of VTE (relative risk = 1.48, 95% confidence interval [CI] 1.18-1.85) in the latter.Spinal anesthesia was associated with a higher risk of postoperative VTE, as compared with that associated with combined epidural/general anesthesia, in patients undergoing total arthroplasty.

Having a Mentor or a Doctoral Degree Is Helpful for Mid-Career Physicians to Publish Papers in Peer-Reviewed Journals.

The evidence suggests that mentoring is one of useful teaching methods in academic medicine but it is not clear for which outcome mentoring is effective. In this study, the authors investigated the number of original research articles that the participants had published in peer-reviewed English-language journals (as a first or a corresponding author) within one year prior to investigation and what characteristics of the participants who published at least one paper would be like compared to those who did not. In March 2015, the authors recruit early- and mid-career Japanese physicians (238 men and 240 women; mean age 40.6 years old) in a web survey. In total, 23.9% of physicians had published at least one original research article as a first author, 10.0% had published as a corresponding author, and 23.4% had a research mentor. A multivariate logistic regression model adjusting for variables selected at p < 0.15 in univariable models showed that even after adjusting for their motivation levels for clinical research, physicians with a research mentor [odds ratio (OR) 6.68; 95% confidence interval (CI), 3.74-11.93], physicians who obtained DMSc, roughly equivalent to PhD in the West (OR, 2.17; 95% CI, 1.26-3.72), and physicians who worked at teaching hospitals (OR 6.39; 95% CI, 2.54-16.04) were more likely to publish an original paper in a peer-reviewed journal. Having a research mentor or DMSc is associated with an experience of successfully publishing original papers in peer-reviewed journals for young and mid-career physician-researchers.

Prospective study of patient satisfaction and postoperative quality of life after laparoscopic colectomy in Japan.

INTRODUCTION: This prospective cohort study was designed to compare the short-term and intermediate health-related quality of life of Japanese patients after laparoscopic colectomy (LC) or open colectomy (OC) for colonic cancer. METHODS: Seventeen hospitals participated, and 240 colonic cancer patients with T3 or T4 invasion that were estimated as curatively resected were enrolled. Three patients were excluded as ineligible, one patient died suddenly before operation, and one patient was not registered based on the doctor's decision. Therefore, analysis was done on 235 patients who underwent either LC (n = 165) or OC (n = 70) in accordance with their stated preference. The major outcome scale end-point was health-related quality of life as assessed by the 36-item Short Form Health Survey (Japanese version 2.0). Accessory end-points were feeling of satisfaction 1 month after operation and recovery time needed to perform normal activities after operation. Observations were performed on enrollment, postoperative day 3, postoperative day 7, discharge day or postoperative month 1, and postoperative month 6. RESULTS: Defecation condition, wound pain score, and abdominal pain score were better in the LC group than in the OC group on postoperative day 7 and in postoperative month 1. Recovery time to normal daily activity took 30 days in the LC group, whereas the OC group needed 44 days. CONCLUSION: Patients' subjective responses indicated that LC was more beneficial than OC for patients with stage II or III colonic cancer. LC's superiority was seen particularly in the following indicators: (i) health-related quality of life during early postoperative days; (ii) recovery to normal daily activities; and (iii) defecation after surgery.