Objective: To evaluate outcomes of palliative surgery for malignant bowel obstruction (MBO) and identify factors associated with postoperative survival. Methods: We retrospectively reviewed 27 patients who underwent palliative surgery for MBO between April 2014 and March 2023. Clinical data including symptom relief, oral intake, discharge status, and overall survival (OS) were analyzed. Results: Median age was 70 years; 23 patients were Stage IV. Primary tumors included colon-rectum (15), stomach (6), pancreas (2), and others (4). Peritoneal dissemination was present in 18 cases. Median preoperative Palliative Prognostic Index (PPI) was 3.0. Postoperative symptom relief was achieved in 96.3%, oral intake in 81.5%, and discharge in 51.9%. Median OS was 118 days. Peritoneal dissemination and oral intake status were significantly associated with OS; sex, age, and PPI were not. Conclusion: Palliative surgery may improve outcomes such as symptom relief, oral intake, discharge to preferred care settings, and survival. These findings support its role in advance care planning and enhancing quality of life in patients with terminal cancer.

Methods: Consecutive patients diagnosed with OFs at Fujieda Heisei Memorial Hospital were divided into three groups: nonsurgical therapy, balloon kyphoplasty (BKP), and open surgery groups. The mOF score was calculated, and the levels of independence and posttreatment imaging data were compared between patients treated and not treated according to the mOF score-based treatment recommendation. Results: In total, 118 patients were included (nonsurgical therapy, n=57; BKP, n=48; open surgery, n=13), of whom 100 (85%) received treatment consistent with the mOF score-based treatment recommendation. In the BKP and open surgery groups, the mOF scorebased treatment recommendations were consistent with the actual treatment in 93% of the patients. However, in the nonsurgical group, the mOF score-based treatment recommendation was not consistent with the actual treatment in 25% of the patients. In this group, patients not treated according to the mOF score had significantly shorter vertebral body height, greater local kyphosis, and smaller sacral slope after treatment than patients treated according to the mOF score-based treatment recommendation. Conclusions In the BKP and open surgery groups, the mOF scores were consistent with actual clinical selection. In the nonsurgical therapy group, patients not treated according to the mOF score-based treatment recommendation exhibited severe vertebral body deformity and a less well-balanced spine shape after treatment. The mOF score may help in selecting suitable treatments for OFs.

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.

The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.

The expansion of home medical care and the growth in sales of OTC, coupled with Japan’s aging society and the need to reduce medical costs has broadened the role of the pharmacist to include physical assessment. In response, the Kindai University Faculty of Pharmacy, implemented the Physical Assessment Practical Training Course (PAPTC) to improve the physical assessment skills of pharmacy students and practicing pharmacists. In order to investigate pharmacy students’ and practicing pharmacists’ perceptions of PAPTC, a questionnaire using a five-part, forced- choice Lykert type scale was conducted. The results of the questionnaire were analyzed using factor analysis and cluster analysis. The total number of respondents was 456. Three hundred thirteen of the respondents were students, and 143 of the respondents were practicing pharmacists. Factor analysis revealed four factors which we titled, “Physical Assessment Skills”, “Physical Assessment Course”, “Pharmacist Jobs” and, “Knowledge Required by Pharmacist”. Subsequently, cluster analysis identified two distinct groups. Group A which constituted primarily of pharmacy students, and Group B which consisted primarily of practicing pharmacists. Each group displayed notable differences in perceptions related to PAPTC. These differences may be influenced by perceptions toward “skills” and/or “knowledge”. These findings suggest that in order to better address the motivational needs of the participants, PAPTC should be divided into two courses. One, for knowledge-based instruction, and other for skill-based practice.

The expansion of home medical care and the growth in sales of OTC, coupled with Japan’s aging society and the need to reduce medical costs has broadened the role of the pharmacist to include physical assessment. In response, the Kindai University Faculty of Pharmacy, implemented the Physical Assessment Practical Training Course (PAPTC) to improve the physical assessment skills of pharmacy students and practicing pharmacists. In order to investigate pharmacy students’ and practicing pharmacists’ perceptions of PAPTC, a questionnaire using a five-part, forced- choice Lykert type scale was conducted. The results of the questionnaire were analyzed using factor analysis and cluster analysis. The total number of respondents was 456. Three hundred thirteen of the respondents were students, and 143 of the respondents were practicing pharmacists. Factor analysis revealed four factors which we titled, “Physical Assessment Skills”, “Physical Assessment Course”, “Pharmacist Jobs” and, “Knowledge Required by Pharmacist”. Subsequently, cluster analysis identified two distinct groups. Group A which constituted primarily of pharmacy students, and Group B which consisted primarily of practicing pharmacists. Each group displayed notable differences in perceptions related to PAPTC. These differences may be influenced by perceptions toward “skills” and/or “knowledge”. These findings suggest that in order to better address the motivational needs of the participants, PAPTC should be divided into two courses. One, for knowledge-based instruction, and other for skill-based practice.