Objective: The objective of this study was to examine information quality by quantitatively evaluating newspaper stories on drug therapy using the “Media Doctor” instrument.Methods: A database search was conducted to extract newspaper stories on drug therapy published between July 1, 2017 and December 31, 2017. Two evaluators independently evaluated each story using the “Media Doctor” instrument. Each of the 10 evaluation criteria were rated as “satisfactory” or “not satisfactory.” When the content of the story was not suitable for the evaluation criteria, it was regarded as “not applicable”.Results: Fifty-nine news stories (Asahi: 13, Mainichi: 8, Nikkei: 8, Sankei: 14, Yomiuri: 16) were included. The median number of evaluation criteria that the two evaluators judged as “satisfactory” was 5. The proportions of stories that the two evaluators judged as satisfactory were “1. availability,” 73%; “2. novelty,” 66%; “3. alternatives,” 39%; “4. disease mongering,” 58%; “5. evidence,” 32%; “6. quantification of benefits,” 31%; “7. harm,” 41%; “8. cost,” 22%; “9. sources of information/conflict of interest,” 12%; and “10. headline,” 66%. Conversely, the proportions of stories judged as “not satisfactory” were “1. availability,” 0%; “2. novelty,” 5%; “3. alternatives,” 12%; “4. disease mongering,” 8%; “5. evidence,” 24%; “6. quantification of benefits,” 29%; “7. harm,” 41%; “8. cost,”44%; “9. sources of information/conflict of interest,” 32%; and “10. headline,” 12%.Conclusion: These results suggest that the quality of newspaper stories are insufficient as drug information in terms of the validity of its scientific evidence.

Objective: To create an authorized translation of the “definition of palliative care” according to WHO using the Delphi method. Methods: Through a palliative care association council (hereafter referred to as the “council”) composed of 18 academic organizations, this research aimed to create an authorized translation draft and develop a consensus for it using the Delphi method according to 54 experts, three from each organization. The main clause and nine subordinate clauses of the document were evaluated from “not at all appropriate” (1 point) to “completely appropriate” (9 points). The standard for consensus was if the median was 7 points or above, or if there was a difference of 5 points or less between the maximum and minimum. The council created an authorized translation in light of the consensus status. Results: Three rounds of the Delphi method were performed; the response rates were 100%, 93%, and 91% respectively. As 30% of the clauses reached the predetermined standard for consensus, the council discussed and considered, established an authorized translation draft, and made a decision upon public comment from each academic organization. Conclusion: Academic organizations associated with palliative care jointly created an authorized translation for the “definition of palliative care” according to WHO.

A 76-year-old female was admitted with complaints of dyspnea on exertion and lower leg edema. She had undergone an aortic valve replacement thirty-nine years before and a redo aortic valve replacement and mitral valve replacement twenty-eight years before. She also had hemolytic anemia with jaundice. Echocardiography showed severe paravalvular leakage in the aortic and mitral valves, and a blood flow in the aortic annulus that flows from the aortic side into the left atrium. We diagnosed heart failure and hemolytic anemia due to paravalvular leakage and decided to perform a double-valve replacement for the third time. On operation, after removing the aortic valve through aortotomy, aorto- mitral fibrous continuity was extensively calcified and perforated, and its strength was not enough to sew the prosthetic valve to it. Therefore, we decided to perform the Commando procedure. Aortotomy was extended between the noncoronary aortic sinus and the left coronary aortic sinus until it reached the dome of the left atrium. After the prosthetic mitral valve was excised, annuloplasty of the posterior mitral annulus was performed using a bovine pericardial patch, and the new prosthesis mitral valve was implanted. The anterior part of the annulus corresponding to the aorto-mitral fibrous continuity was reconstructed by sewing the base of a two-tongued triangular bovine pericardial patch to the sewing cuff of the mitral prosthesis. After closing the left atrial ceiling with the posterior patch, the aortic prosthesis was secured to the aortic annulus and the pericardial patch. The anterior patch was used to close the right side of the aortotomy. The postoperative course was uneventful, and postoperative echocardiography revealed no paravalvular leakage.

We report a case of redo mitral valve replacement (MVR) for a Björk-Shiley Delrin valve implanted 47 years previously. A 71-year-old man initially underwent MVR for mitral regurgitation at our hospital at the age of 16 years. Following the operation, follow-up examinations were performed at the outpatient clinic and annual transthoracic echocardiogram findings showed only mild mitral regurgitation, with no adverse events noted. However, a transthoracic echocardiogram examination performed 45 years after the operation revealed mild to moderate mitral regurgitation, while dyspnea with exertion was also noted at that time. As part of a more detailed examination, transesophageal echocardiogram results showed moderate transvalvular leakage. Redo MVR was subsequently performed under the diagnosis of prosthetic valve dysfunction. Analysis of the explanted prosthetic valve revealed wear of the Delrin disk, and widening of the gap between the disk and strut, which were presumed to be the cause of transvalvular leakage. A half century has passed since introduction of the Björk-Shiley valve and the present is a rare case of valve malfunction. Presented here are related details, along with a review of existing literature and results of Björk-Shiley valve use at our hospital.