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BACKGROUND: This study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients. METHODS: A total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups. RESULTS: SSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013). CONCLUSION: This study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery.
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BACKGROUND: Japan has the most rapidly ageing population in the world. The Japanese government has, therefore, promoted physician-led home health care for frail and disabled people. OBJECTIVES: To describe mortality among older people receiving physician-led health care at home or at a nursing home in Japan and to identify risk factors. METHODS: This was a multicentre prospective cohort study. Participants were aged ≥65 years and had started to receive regular physician-led health care at home or at nursing homes from 13 facilities between 1 February 2013 and 31 January 2016. The observation period ended on 31 January 2017. We used a biopsychosocial approach for exploratory analysis of 13 variables to identify mortality risk factors. RESULTS: The median (25th to 75th percentile) observation time was 417 (121-744) days. Of 825 participants, 380 died. The total cumulative survival for 180, 360, 720 and 1440 days was 73.4% (95% confidence interval: 70.2-76.3), 64.2% (60.8-67.5), 52.6% (48.8-56.3) and 34.6% (23.5-46.0). The Kaplan-Meier cumulative survival curve showed a steep drop during the first 6 months of observation. A multivariate Cox proportional hazard model showed that sex (male), high Charlson Comorbidity Index score, low serum albumin level, low Barthel Index score, receipt of oxygen therapy, high Cornell Scale for Depression in Dementia score and non-receipt of public assistance were associated with mortality. CONCLUSIONS: Overall mortality in physician-led home visits in Japan was described and mortality risk factors identified. Public assistance receipt was associated with lower mortality.
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Servicios de Atención de Salud a Domicilio , Médicos , Anciano , Visita Domiciliaria , Humanos , Japón/epidemiología , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: Osteoporotic vertebral compression fractures (VCFs) are commonly observed in elderly people and can be treated by conservatively with minimal risk of complications in most cases. However, utilization of direct oral anticoagulants (DOACs) increases the risks of secondary hematoma even after insignificant trauma. The use of DOACs increased over the past decade because of their approval and recommendation for both stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism. It is well known that DOACs are safer anticoagulants than warfarin in terms of major and nonmajor bleeding; however, we noted an increase in the number of bleeding events associated with DOACs that required medical intervention. This report describes the first case of delayed lumbar plexus palsy due to DOAC-associated psoas hematoma after VCF to draw attention to potential risk of severe complication associated with this type of common and stable trauma. CASE PRESENTATION: An 83-year-old man presented with his left inguinal pain and inability to ambulate after falling from standing position and was prescribed DOACs for chronic atrial fibrillation. Computed tomography angiography revealed a giant psoas hematoma arising from the ruptured segmental artery running around fractured L4 vertebra. Because of motor weakness of his lower limbs and expansion of psoas hematoma revealed by contrast computed tomography on day 8 of his hospital stay, angiography aimed for transcatheter arterial embolization was tried, but could not demonstrate any major active extravasation; therefore spontaneous hemostasis was expected with heparin replacement. On day 23 of his stay, hematoma turned to decrease, but dysarthria and motor weakness due to left side cerebral infarction occurred. His pain improved and bone healing was achieved about 2 months later from his admission, however the paralysis of the left lower limb and aftereffects of cerebral infarction remained after 1 year. CONCLUSION: In patients using DOACs with multiple risk factors, close attention must be taken in vertebral injury even if the fracture itself is a stable-type such as VCF, because segmental artery injury may cause massive psoas hematoma followed by lumbar plexus palsy and other complications.
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Fracturas por Compresión , Fracturas de la Columna Vertebral , Accidente Cerebrovascular , Administración Oral , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Fracturas por Compresión/tratamiento farmacológico , Hematoma/inducido químicamente , Hematoma/diagnóstico por imagen , Hematoma/tratamiento farmacológico , Humanos , Plexo Lumbosacro , Masculino , Parálisis , Fracturas de la Columna Vertebral/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológicoRESUMEN
INTRODUCTION: This multicenter, retrospective study aimed to clarify the changes in postoperative care provided by orthopaedic surgeons after hip fractures and clarify the incidence of secondary fractures requiring surgery. MATERIALS AND METHODS: Subjects were patients with hip fracture treated surgically in seven hospitals during the 10-year period from January 2008 to December 2017. Data on patient demographics, comorbidities, preoperative and postoperative osteoporosis treatments, and secondary fractures were collected from the medical records. RESULTS: In total, 4764 new hip fractures in 982 men and 3782 women (mean age: 81.3 ± 10.0 years) were identified. Approximately 10% of patients had a history of osteoporosis drug treatment and 35% of patients received postoperative drug treatment. The proportion of patients receiving postoperative drug therapy increased by approximately 10% between 2009 and 2010, 10% between 2010 and 2011, and 10% between 2011 and 2013. Although the rate of secondary fractures during the entire period and within 3 years decreased from 2011, the rate of secondary fracture within 1 year remained at around 2% every year. CONCLUSIONS: The approval of new osteoporosis drugs and the establishment of osteoporosis liaison services have had a positive effect on the use of postoperative drug therapy in the orthopedic field. Our finding that the rate of secondary fracture within 1 year of the initial fracture remained around 2% every year, despite improvements in postoperative drug therapy, suggests that both rehabilitation for preventing falls and early postoperative drug therapy are essential to prevent secondary fractures.
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Fracturas de Cadera/epidemiología , Atención al Paciente , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Fracturas de Cadera/cirugía , Humanos , Incidencia , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Fracturas Osteoporóticas/tratamiento farmacológico , Fracturas Osteoporóticas/epidemiología , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
BACKGROUND: Japan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060. METHODS: Our estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count. RESULTS: Results were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030's, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040. CONCLUSION: The results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030's, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.
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Necesidades y Demandas de Servicios de Salud/tendencias , Servicios de Atención de Salud a Domicilio/organización & administración , Médicos/provisión & distribución , Anciano , Predicción , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , JapónRESUMEN
BACKGROUND: Little is known about psychological impact of disclosing lifestyle-related diseases. Previous studies discussed the long-term psychological impact of disease disclosure, and a significant psychological impact was not observed. This study clarified the psychological impact on anxiety state of patients when lifestyle-related diseases are disclosed at general checkups for local residents. In particular, this study evaluated the short-term impact on patients, and how the notification of abnormal values and the disclosure of disease at general checkups affect patients' subsequent behavioral changes. METHODS: The study design was a prospective cohort study. We compared the anxiety state of participants using a self-administered anxiety assessment scale, State-Trait Anxiety Inventory (STAI), before and after Physician's explanation of abnormal values in markers of lifestyle-related diseases. The participants were those between the age of 40 and 75 years who underwent general checkups at two primary care facilities. In addition, we assessed the effects on lifestyle habits and the psychological impact caused by general checkup using STAI and a survey on behavioral changes one month after the checkup. RESULTS: The valid response rate at the survey of the general checkup was 92% (534/578). Of those who showed abnormal levels in markers of lifestyle-related diseases, anxiety was augmented significantly among those who responded that the physician had told them of their diagnosis compared to those who responded that the physician had not told them of their diagnosis (Wilcoxon rank-sum test, P < 0.007). The percentage of patients whose state anxiety scale of STAI increased ≥5 points was 30% in the disease disclosed group (33/111) and 17% in the disease undisclosed group (27/159), respectively. The risk ratio was 1.5 (95% CI: 1.1-2.0). One month after the general checkup, overall anxiety diminished regardless of whether diagnosis of lifestyle-related diseases was disclosed to patients notified of abnormal values. In addition, improvements in daily life behaviors as a result of notification of abnormalities or disclosure of diagnosis at general checkup were not observed. CONCLUSION: Even in a general checkup for the general population, disclosing non-critical diseases such as lifestyle-related diseases exacerbated anxiety as a short-term psychological impact.
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Adaptación Psicológica/fisiología , Ansiedad , Estilo de Vida , Revelación de la Verdad , Anciano , Ansiedad/diagnóstico , Ansiedad/etiología , Actitud Frente a la Salud , Estudios de Cohortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/psicología , Dislipidemias/diagnóstico , Dislipidemias/psicología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/psicología , Japón , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Estudios Prospectivos , Técnicas PsicológicasRESUMEN
The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; â¢â¢: â¢â¢-â¢â¢.
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The concept of "patient enablement" involves patients' perceptions of ability to understand and cope with illness. Improving enablement is an important goal of medical consultations for patients with chronic illness. To measure "enablement," a post-medical-consultation patient-reported questionnaire was developed and named "Patient Enablement Instrument (PEI)" in the United Kingdom. Unfortunately, there has been no tool to evaluate patient enablement in Japan. Therefore, this study aimed to develop PEI Japanese version, to examine its validity and reliability, and to clarify the constitution of concept about patient enablement among Japanese patients. The translation process included forward translation, expert panel back-translation, following the standard WHO process. Participants were 256 individuals (157 men and 99 women; mean age 62.9 ± 11.8 years) receiving a regular outpatient treatment due to chronic illness at the Department of Cardiology, Respiratory, or Endocrinology and Metabolism in a regional hospital. To assess validity, we compared PEI with Medical Interview Satisfaction Scale (MISS) by correlation coefficient, which was 0.55 (P < 0.01). Furthermore, factor analysis indicated that PEI had two principal factors labeled "coping with illness and health maintenance" and "confidence in oneself and independence". For an evaluation of reliability, internal consistency was calculated (Cronbach's alpha = 0.875). In conclusion, two principal factors comprise patient enablement measured by PEI with satisfactory validity and reliability. PEI Japanese version will be a useful tool to evaluate and improve medical consultations in Japan.
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Adaptación Psicológica , Satisfacción del Paciente , Pacientes/psicología , Anciano , Enfermedad Crónica , Estudios Transversales , Demografía , Análisis Factorial , Femenino , Humanos , Vida Independiente , Japón , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Relaciones Médico-Paciente , Encuestas y CuestionariosRESUMEN
BACKGROUND: The Japanese government is promoting physician-led home visits as well as end-of-life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years. OBJECTIVES: To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. METHODS: This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed-up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home. RESULTS: We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person-years (95% confidence interval 116.1-163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full-time caregiver increased the likelihood of deaths at home relative to deaths at other locations. CONCLUSIONS: Of deceased patients, only one-third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005-1012.
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Servicios de Atención de Salud a Domicilio , Médicos , Cuidado Terminal , Humanos , Anciano , Visita Domiciliaria , Estudios Prospectivos , Japón/epidemiologíaRESUMEN
CASE: We report 3 cases of thoracic myelopathy caused by vertebral osteophytes and coexisting intradural spinal arachnoid cyst (SAC), which was difficult to diagnose on preoperative magnetic resonance imaging. Intraoperative ultrasound sonography revealed spinal cord impingement because of osteophytes and a pulsating intradural SAC. Repeated pincer compression on the spinal cord seemed to be associated with their paraparetic symptoms. CONCLUSION: In treating patients presenting with unexplained progressive myelopathy with small ossified lesion in the thoracic spine, close attention should be paid to a coexisting SAC as a hidden aggravating factor for thoracic myelopathy.
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Quistes Aracnoideos , Enfermedades de la Médula Ósea , Osteofito , Enfermedades de la Médula Espinal , Espondilosis , Quistes Aracnoideos/complicaciones , Quistes Aracnoideos/diagnóstico por imagen , Quistes Aracnoideos/cirugía , Humanos , Osteofito/complicaciones , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: Although primary care (PC) is an indispensable part of the health system, measuring its quality is challenging. A recent measure of PC, Person-Centered Primary Care Measure (PCPCM), covers 11 important domains of PC and has been translated into 28 languages. This study aimed to develop a Japanese version of the PCPCM and assess its reliability and validity. METHODS: We employed a cross-sectional mail survey to examine the reliability and content, structure, criterion-related, and convergent validity of the Japanese version of the PCPCM. This study targeted 1000 potential participants aged 20-74 years, selected by simple random sampling in an urban area in Japan. We examined internal consistency, confirmatory factor analysis, correlation between the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF), and the association between the PCPCM score and influenza vaccine uptake. RESULTS: A total of 417 individuals responded to the survey (response rate = 41.7%), and we used the data of 244 participants who had the usual source of care to assess the reliability and validity of the PCPCM. Confirmatory factor analysis demonstrated sufficient structural validity of the original one-factor structure. The overall Cronbach's alpha was 0.94. The Spearman correlation coefficient between PCPCM and JPCAT-SF was 0.60. Influenza vaccine uptake was not significantly associated with total PCPCM score. CONCLUSIONS: The study showed that the Japanese version of the PCPCM has sufficient internal consistency reliability and structural- and criterion-related validity. The measure can be used to compare the quality of primary care in Japan and other countries.
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Vacunas contra la Influenza , Estudios Transversales , Humanos , Japón , Atención Primaria de Salud , Reproducibilidad de los ResultadosRESUMEN
Water movement between cells in a plant body is the basic phenomenon of plant solute transport; however, it has not been well documented due to limitations in observational techniques. This paper reports a visualization technique to observe water movement among plant cells in different tissues using a time of flight-secondary ion mass spectrometry (Tof-SIMS) cryo-system. The specific purpose of this study is to examine the route of water supply from xylem to stem tissues. The maximum resolution of Tof-SIMS imaging was 1.8 µm (defined as the three pixel step length), which allowed detection of water movement at the cellular level. Deuterium-labelled water was found in xylem vessels in the stem 2.5 min after the uptake of labelled water by soybean plants. The water moved from the xylem to the phloem, cambium, and cortex tissues within 30-60 min after water absorption. Deuterium ion counts in the phloem complex were slightly higher than those in the cortex and cambium tissue seen in enlarged images of stem cell tissue during high transpiration. However, deuterium ion counts in the phloem were lower than those in the cambium at night with no evaporative demand. These results indicate that the stem tissues do not receive water directly from the xylem, but rather from the phloem, during high evaporative demand. In contrast, xylem water would be directly supplied to the growing sink during the night without evaporative demand.
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Glycine max/metabolismo , Agua/metabolismo , Xilema/metabolismo , Criopreservación , Espectrometría de Masa de Ion SecundarioRESUMEN
OBJECTIVE: To identify the morphologic changes in the vertebral artery (VA) subsequent to cervical spine degeneration and aging and to investigate the risk factors for iatrogenic VA injury or occlusion. METHODS: Eighty-eight consecutive patients (176 bilateral VAs) were retrospectively analyzed using radiographs, computed tomography, and computed tomography angiography images. The Kellgren and Lawrence (KL) score and its modified subscores were used to grade the severity of degenerative changes in the cervical spine. VA tortuosity widths and diameters were measured between the C2 and C6 transverse foramens. The outcome measures were statistically analyzed for difference, correlation, and explanatory variable. The level with a high prevalence of VA stenosis was also evaluated. RESULTS: There were significant positive correlations between the KL score and VA tortuosity width, and between age and VA tortuosity width. Osteophyte formation in the facet joint was the predominant explanatory variable for medial deviation of the VA. Significant positive correlations were evident between the dominant VA diameter and KL score or age. VA stenosis occurred at C3/C4 (24.5%) with the highest prevalence and it was caused by uncovertebral joint osteophytes (52.0%) with the highest incidence. CONCLUSIONS: The present study provides important evidence for decisions of surgical strategy and for avoiding catastrophic VA injury or occlusion in cervical spine surgeries.
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Envejecimiento/patología , Degeneración del Disco Intervertebral/patología , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales , Angiografía por Tomografía Computarizada/métodos , Estudios Transversales , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Degeneración del Disco Intervertebral/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
A 7 9-year-old man with advanced gallbladder cancer (stage IVa) underwent chemotherapy with single-agent gemcitabine (1,400mg/body: day 1, 8, 15, every 4 weeks) as first-line chemotherapy. As soon as the chemotherapy started, the carbohydrate antigen 19-9 (CA19-9) level was notably reduced, and after 4 courses, CT scan revealed that the tumor was markedly reduced in size. We thought he could undergo curative operation, and performed and extended cholecystectomy and lymph node dissection. Intraoperative findings revealed that the gallbladder atrophied and, with no obvious invasion to adjacent organs, a small hard mass like only fibrosis was confirmed. Then, 18 days after the operation, he was discharged without any complication. In the histological findings, cancer tissue was replaced by fibrosis, and malignant cells could not be detected. Now the patient has remained well without recurrence after 6-month follow-up. Many clinical trials show that gemcitabine, which is used as a single agent or combined with other agents (for example, cisplatin), demonstrated high efficacy with manageable toxicity in patients with advanced or metastatic biliary tract cancer. For this disease, including gallbladder cancer, gemcitabine is the mainstay of chemotherapy, and it is thought that this agent could have high efficacy in many cases.
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Desoxicitidina/análogos & derivados , Neoplasias de la Vesícula Biliar/tratamiento farmacológico , Anciano , Terapia Combinada , Desoxicitidina/uso terapéutico , Neoplasias de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Masculino , Estadificación de Neoplasias , Inducción de Remisión , Tomografía Computarizada por Rayos X , GemcitabinaRESUMEN
OBJECTIVES: The primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the validity and reliability in the primary care setting. DESIGN: Cross-sectional study. SETTING: Three family physician teaching clinics located in urban residential areas in Tokyo, Japan. PARTICIPANTS: Patients who were aged 20 years or older, and who had an appointment with physicians at the three participating clinics. MAIN OUTCOME MEASURES: Patient complexity measured by PCAM and complexity/burden level measured by a Visual Analogue Scale (VAS). RESULTS: Although confirmatory factor analysis using a model described in a previous study revealed that the indices did not meet the criteria for good fit, exploratory factor analysis revealed a new three-factor structure of 'Personal well-being,' 'Social interaction' and 'Needs for care/service.' Cronbach's alpha of PCAM was 0.86. Spearman's rank correlation coefficients between PCAM scores and VAS scores were 0.51 for complexity (p<0.001) and 0.41 for burden (p<0.001). There were 42 patients (14.3% of total patients) with PCAM scores greater than its mean of 16.5 but with complexity VAS scores less than its mean of 20.8. CONCLUSIONS: The Japanese version of PCAM and its user guide were developed through Japanese translation and cultural adaptation by cognitive debriefing. PCAM is a valid and reliable tool to assess patient complexity in the primary care settings in Japan. Additionally, although the correlation between total PCAM scores and complexity/burden as assessed by VAS was moderate, PCAM can more precisely identify patient complexity than skilled physician's intuition.
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Traducciones , Adulto , Estudios Transversales , Femenino , Humanos , Japón , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Tokio , Adulto JovenRESUMEN
FOLFOX therapy is a commonly used chemotherapeutic regimen against recurrent and unresectable colon cancer. However, its acute neurotoxicity is rare and not well recognized. We herein report a case of mFOLFOX6-induced hyperammonemic encephalopathy in a patient having recurrent colon cancer. A 74-year-old female with a history of sigmoid colon cancer was diagnosed as liver, lung, and peritoneal recurrences by surveillance CT and PET/CT. She was initially treated with modified FOLFOX6 therapy. After completing treatment, she presented with sudden onset of confusion, cognitive disturbances, and repeated seizures. None of the other radiographic examinations and laboratory tests provided an explanation for her symptoms except hyperammonemia. She was treated with branched-chain amino acid solutions and high-volume drip infusion, 6 hours after which the encephalopathy resolved. Clinicians should be aware of the adverse hyperammonemia induced by mFOLFOX6 when patients treated with mFOLFOX6 present with neurological disorders.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Encefalopatías Metabólicas/sangre , Encefalopatías Metabólicas/inducido químicamente , Neoplasias del Colon/tratamiento farmacológico , Hiperamonemia/sangre , Hiperamonemia/inducido químicamente , Anciano , Encefalopatías Metabólicas/patología , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/patología , Femenino , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Compuestos Organoplatinos/uso terapéutico , Tomografía de Emisión de Positrones , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
1,2-Alkanediol exhibits antibacterial activity against several bacteria and yeast. However, few studies have reported antimicrobial tests on skin microbiome. Bacterial microbiome on the skin surface include Staphylococcus aureus (S. aureus), which causes rough skin and inflammation in atopic dermatitis and Staphylococcus epidermidis (S. epidermidis), which enhances innate immunity. In this study, the minimal inhibitory concentration (MIC) was evaluated for 1,2-alkanediol comprising 4-12 carbon atoms against S. aureus and S. epidermidis. 1,2-Alkanediol comprising 6-12 carbon atoms exhibited antimicrobial activity against both species of Staphylococcus. The antibacterial activity depended on the alkyl chain length. In addition, the minimum bactericidal concentration (MBC) on agar was evaluated for 1,2-alkanediol comprising 6-12 carbon atoms. 1,2-Octanediol and 1,2-decanediol exhibited significant bactericidal activity.
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Antibacterianos/farmacología , Glicoles/farmacología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Antibacterianos/química , Glicoles/química , Interacciones Hidrofóbicas e Hidrofílicas , Pruebas de Sensibilidad Microbiana , Estructura MolecularRESUMEN
Bacterial flora on the skin surface contains Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) which causes rough skin and atopic dermatitis and enhances innate immunity, respectively. In this study, minimum inhibitory concentration (MIC) was evaluated for six saturated fatty acids and two unsaturated fatty acids against S. aureus and S. epidermidis. The antimicrobial behavior in the liquid medium was categorized into three groups. The first was the selective antibacterial activity group comprising myristic acid (C14:0 fatty acid), palmitoleic acid (C16:1 fatty acid), and oleic acid (C18:1 fatty acid) and preferentially displayed antimicrobial activity for S. aureus (group 1). C16:1 fatty acid displayed high antimicrobial activity only for S. aureus. The second was the non-selective antibacterial activity group which displayed antibacterial activity for both Staphylococci (group 2). Caprylic acid (C8:0 fatty acid), capric acid (C10:0 fatty acid), and lauric acid (C12:0 fatty acid) comprised group 2. The third was the nonantibacterial activity group which did not show significant antimicrobial activity (group 3). Bactericidal activities were confirmed for C12:0 fatty acid and C16:1 fatty acid by evaluating the minimum bactericidal concentration (MBC) on the agar medium. C12:0 fatty acid displayed non-selective bactericidal behavior against S. aureus and S. epidermidis when the fatty acid concentration was above 250 µg mL-1. These findings suggest that C16:1 fatty acid has the potential to be used as a detergent in skin care and medical products because it can selectively kill only S. aureus.
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Antibacterianos/farmacología , Ácidos Grasos/farmacología , Staphylococcus aureus/efectos de los fármacos , Detergentes/farmacología , Pruebas de Sensibilidad Microbiana , Staphylococcus epidermidis/efectos de los fármacosRESUMEN
OBJECTIVE: The number of spine surgeries performed in elderly patients is consistently increasing. However, to date the prevalence of and risk factors for perioperative complications remain unclear, especially in patients 80 years of age or older. This study had two goals: 1) determine the perioperative complications of spine surgery associated with patients 80 years of age or older; and 2) investigate the risk factors for perioperative systemic complications. METHODS: In this paper, the authors describe a multicenter prospective cohort study. Seven spine centers with board-certified spine surgeons participated in this all-case investigation. A total of 270 consecutively enrolled patients (109 males and 161 females), 80 years of age or older, underwent spine surgery between January and December 2017. Patients with trauma, infection, or tumor were excluded in this cohort. Perioperative complications were defined as adverse events that occurred intraoperatively or within 30 days postoperatively. The patients' preoperative health status was determined using the following means of assessment: 1) the Charlson Comorbidity Index, 2) the American Society of Anesthesiologists Physical Status Classification System, 3) the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), 4) the presence of sarcopenia, and 5) the Geriatric Nutritional Risk Index. Associations among patient age, preoperative health status, surgical factors (instrumentation surgery, operation time, number of spinal levels treated, and estimated blood loss), and perioperative systemic complications were analyzed. RESULTS: Overall perioperative, surgical site, and minor systemic complications were observed in 20.0%, 8.1%, and 14.8% of patients, respectively. Major systemic complications, on the other hand, were not observed. The reoperation rate was low-only 4.1%. Multivariate analysis revealed that the ECOG-PS (p = 0.013), instrumentation surgery (p = 0.024), and an operation time longer than 180 minutes (p = 0.016) were associated with minor systemic complications. CONCLUSIONS: To the best of the authors' knowledge, this is the first multicenter prospective all-case investigation of perioperative complications of spine surgery in elderly patients. Although decreased daily activity (ECOG-PS), instrumentation surgery, and longer operation time were associated with minor systemic complications, no major systemic complications were observed in these elderly patients. Thus, spine surgery can be safely performed in elderly patients 80 years of age or older.
RESUMEN
OBJECTIVES: An ageing society includes high patient complexity. Various biopsychosocial problems result in a high burden for health-related professionals. The direct relationship between the burden and patient complexity, however, has not been reported. We aimed to examine correlations between the burden for the attending physicians and nurses, and Patient Centred Assessment Method (PCAM) scores of patient complexity. DESIGN: Prospective cohort study. SETTING: A regional secondary care hospital in Japan. PARTICIPANTS: We included all inpatients admitted to our acute care unit between 1 July 2014 and 30 September 2014. Exclusion criteria were age <20 years, refusal to participate in the study and length of stay fixed at the time of admission. MAIN PREDICTOR: PCAM total score in the initial phase of hospital admission. MAIN OUTCOME: The burden for each profession (measured on a Visual Analogue Scale). RESULTS: In total, 201 inpatients participated [female/male=98/103, mean (SD) age of 77.4±11.9 years]. Spearman's rank correlation coefficients between the burden and the PCAM score ranged from 0.23 to 0.32. All p values were <0.05. Multivariate analysis was conducted using multilevel mixed-effects linear regression to determine the association between the burden and the PCAM score in two models. Model 1 used the total PCAM score as the predictive variable. Model 2 used the PCAM factors, patient-oriented complexity and medicine-oriented complexity, as predictive variables. In Model 2, with the burden of physicians, medicine-oriented complexity was statistically significant, whereas with the burden of nurses, both age and patient-oriented complexity were statistically significant. CONCLUSIONS: PCAM scores correlated with the burden for physicians and nurses. Individual PCAM factors affected the burden for each profession differently.