Iliac artery-enteric fistula developed during bevacizumab-containing chemotherapy for recurrent cervical cancer: A case report and literature review.

An arterioenteric fistula is a devastating and life-threatening condition. As patients often present in extremis from hemorrhage shock, an early diagnosis and prompt life-saving interventions have to be performed. In this report, we describe a case of a 38-year-old Japanese woman who presented with hematochezia that rapidly progressed to hemorrhagic shock secondary to an iliac artery-enteric fistula that developed during bevacizumab-containing chemotherapy for recurrent cervical cancer. The patient underwent successful endovascular treatment with a covered stent-graft as a bridge to definitive open surgery.

Association of Patients' Past Misdiagnosis Experiences with Trust in Their Current Physician Among Japanese Adults.

BACKGROUND: Previous qualitative research has described that previous misdiagnoses may reduce patient and their families' trust in healthcare. OBJECTIVE: To quantify the associations between patients or family members' misdiagnosis experiences and trust in their physician. DESIGN: Cross-sectional study. PARTICIPANTS: Adult Japanese people with non-communicable diseases (cancer, diabetes, depression, heart disease, and connective tissue disease), recruited using a web-based panel survey. MAIN MEASURES: Surveys assessed the patient and the patient's family's experience with misdiagnosis. Trust in the respondent's current physician was measured using the Japanese version of the 11-item Trust in Physician Scale. KEY RESULTS: Among 661 patients (response rate 30.1%), 23.2% had a personal history of misdiagnosis and 20.4% had a family history of misdiagnosis. In a multivariable-adjusted general linear model, patients or a family members' misdiagnosis experiences were associated with lower confidence in their current physician (mean difference -4.3, 95%CI -8.1 to -0.49 and -3.2, 95%CI -6.3 to -0.05, respectively). The impact of having a personal and a family member's experience of misdiagnosis on trust was additive, with no evidence of interaction (P for interaction = 0.494). CONCLUSIONS: The patient's or family members' misdiagnosis experiences reduced trust in the patient's current physicians. Interventions specifically targeting misdiagnosed patients are needed to restore trust.

The impact that family members' health care experiences have on patients' trust in physicians.

BACKGROUND: A family member's negative experiences with medical care have long-term effects on a patient's attitudes and emotions. However, the impact of family members' experiences on patients' trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations. METHODS: A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients' (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit. RESULTS: The results showed a lower rating for trust in physicians generally as compared to trust in the respondent's personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member's medical care was associated with lower trust in physicians generally (mean difference - 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member's care was also associated with lower trust in the respondent's personal physician (mean difference - 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally. CONCLUSIONS: We suggest that physicians enquire about past patients' negative experiences, including dissatisfaction with family members' medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

[Performance Utility of High Sensitivity Quantitative Assay for HBs Antigen].

A high sensitivity quantitative assay for hepatitis B virus (HBV) surface antigen (HBsAg-HQ assay) was recently developed and is useful for earlier detection of HBV reactivation. We created HBsAg-HQ assay operational proce- dures by the sample transport system and laboratory information system. In this study, we evaluated the perfor- mance and utility of the HBsAg-HQ assay based on our operational procedures using internal quality control (IQC) data and 13,762 samples routinely measured for 8 months. The IQC data of the HBsAg-HQ assay demonstrated good accuracy (CV: 1.6-2.7%). The difference in IQC data between two of the same analyzers or several reagent lots had no clinical significance. Of 13,762 samples, HBsAg titer was negative in 12,592(91.5%) and positive in 1,169(8.5%), and HBsAg negative samples were remarkably lower(<0.001 IU/mL) than the cut-off value(0.005 IU/mL). Among 114 HBsAg weakly positive samples ranging from 0.005 to 1.000 IU/mL, false positive results occurred in 12 samples, which were converted into negative results after re-measurement. We could effectively perform carry-over prevention and dilution of high titer samples using our operational procedures. Furthermore, we performed inhibition test in 52 HBsAg weakly positive samples, and 20 samples, most of which were taken from patients with connective tissue disease or malignancy, were judged as non-specific reactivity. Taken together, our operational HBsAg-HQ assay procedures may contribute to efficient workflow for routine testing. Moreover, the HBsAg-HQ assay may be clinically useful for not only highly sensitive assays, but also for reducing false positives.

Automatic detection of immature platelets for decision making regarding platelet transfusion indications for pediatric patients.

Immature or reticulated platelets are known as a clinical marker of thrombopoiesis. Recently, an automatic method was established to detect reticulated platelets as immature platelet fraction (IPF) by means of hematology analyzer XE-2100. We assessed the effects of IPF detection after chemotherapy for various pediatric malignant disorders of 16 patients. Our results indicate that IPF should be considered a useful marker of imminent platelet recovery so that unnecessary platelet transfusion can be avoided.