Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice.Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.

INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.

Objective: To identify effective strategies to provide high-quality palliative care in settings where palliative care specialists are scarce, particularly in Japan. Methods: A scoping review of literature (in English) was conducted using Arksey and O’Malley’s methodological framework. Electronic databases (MEDLINE, CINAHL, and the Cochrane Library) were searched and supplemented with a manual search of relevant journal articles. Results: Nine studies met our inclusion criteria. Four key strategies have emerged: (1) developing a video consultation system to improve the timeliness of care; (2) providing online consultations by specialists to support general practitioners; (3) training nurses to manage the palliative care process; and (4) transferring knowledge and information from experts to non-specialists. Conclusion: Based on these strategies, creating a system tailored to the specific needs and readiness of palliative care in Japan is necessary. The effectiveness of these strategies should be evaluated in future research.

Introduction: We aimed to evaluate the impact of lifestyle modifications on the risk of eradication failure in patients undergoing first-line therapy for Helicobacter pylori infection.Methods: A survey was conducted in a community pharmacy to assess changes in alcohol consumption, smoking, and high-fat diet intake before, during, and after first-line therapy for H. pylori infection in enrolled patients.Results: A total of 100 patients (response rate: 3.4%) were included in the analysis. Before therapy, 20 patients (20%) smoked, 35 patients (35%) consumed alcohol, and 91 patients (91%) had a high-fat diet. During therapy, the proportion of patients who changed their habits was 15.0% (3/20) for smoking, 71.4% (25/35) for alcohol consumption, and 28.6% (26/91) for high-fat diet. However, the continuation of these changes post-therapy was minimal.Conclusion: Among patients undergoing first-line therapy for H. pylori infection, lifestyle habits that increase the risk of eradication failure were prevalent, with many patients maintaining their habits during therapy except for alcohol consumption. These findings provide fundamental data for lifestyle counselling during eradication therapy.

Background: This study surveyed pharmacists registered with the Yamaguchi Prefectural Pharmacists Association to determine the key elements of tablet printing design that enhance visibility and distinguishability during dispensing.Objectives: The purpose of this study is to identify suitable design components for tablets that enhance visibility and distinguishability by utilizing text data.Methods: Given the high risk of medication errors due to similar-looking tablets, the study employed KH Coder for text mining analysis of free-text responses.Results: Results indicated that design elements such as "horizontal writing," "straight lines, " and "emphasis on characters" significantly improve visibility and distinguishability, particularly for similar-looking tablets. The findings from this study provide specific guidelines for optimal tablet design, aiming to improve pharmacists' efficiency and enhance medication safety.Conclusions: KH Coder proved to be a valuable tool for analyzing qualitative data in the medical field. While the study focused on pharmacists in Yamaguchi Prefecture, expanding the survey to a national scale is recommended to validate and generalize the findings. This research supports the development of standardized tablet designs that can minimize dispensing errors and ensure patient safety, highlighting the importance of effective tablet printing design in pharmaceutical practice.