Introduction: This study aimed to survey patients on polypharmacy regarding their own intention and inclination to reduce medication use, and their subjective understanding of drug effectiveness and side effects. We aimed to contribute to the establishment of an information base to address polypharmacy.Methods: We enrolled 100 adult patients who had been admitted and administered ≥ 5 oral medications. A questionnaire was utilized to assess their willingness and inclination to reduce their medications, as well as their subjective understanding of drug effectiveness and side effects.Results: Sixty-two patients expressed an intention to reduce their medication use, citing reasons including medication management, drug combinations, and side effects. The proportion of patients with this intention increased as the number of prescribed medications increased. Of the 38 individuals who responded that they had no intention of reducing their medication, 21 (55.3%) cited the reason as being that they received the prescription from a physician. The level of understanding about the effectiveness of their own medications was significantly lower among those aged ≥ 75 years. However, the level of understanding of side effects did not vary based on age or number of prescriptions.Conclusion: To promote the optimization of prescriptions, it is necessary to ascertain patients' intentions, and the relationship between patients and prescribing physicians.

When treating finger, hand, and elbow trauma (hereinafter, surgically treated hand trauma) in self-employed farmers, it is also necessary to consider how the patient will be able to continue working in the family business. This study investigated return-to-work outcomes of self-employed farmers in the Tokachi area in Hokkaido, Japan after surgically treated hand trauma. A survey was conducted with 56 self-employed farmers (39 men and 17 women, median age 55 years). More than 80% of the farmers (n = 49) returned to their previous work, and most returned to work during the farming season while still experiencing functional impairment. Self-employed farmers with surgically treated hand trauma tend to return to work in time for the farming season regardless of the severity of functional impairment they are experiencing, and it is important for health care providers to recognize this fact and consider return-to-work support as part of the treatment plan in addition to treatment itself. Therefore, providers must understand the processes and details of tasks performed during each farming season and devise individualized measures to accommodate patients returning to work while still experiencing impairment. In cases where multiple treatments are required, such as two-stage functional reconstruction, it is also important that the treatment plan consider the farming season, for example, by having the patient temporarily return to work and then undergo surgery during the off season.

The balance between treatment and farming work must be considered when performing hand surgery in farmers, but no studies have previously examined the level of busyness in farmers in detail. We conducted a questionnaire survey on busyness by month and desirable time for hand surgery in 20 self-employed farmers in the Tokachi region of Hokkaido who had undergone hand surgery. Busyness in crop farming peaked approximately in May for fertilizer application, sowing, and raising and transplanting seedlings and in August-October for harvesting and transporting crops. On the other hand, livestock farmers were busy with rearing management throughout the year, with a peak of busyness in May-October for fertilizer application, sowing, and harvesting and transporting forage crop. Given the approximately 3-month period of work restriction following hand surgery, all respondents wished to have this period from November to January. If a farmer is injured during the peak farming period, a treatment plan is required that supports an early return to work and allows for two-stage reconstruction and treatment of degenerative disease in the quiet period for farming. Meanwhile, almost no respondents expected to receive support from official organizations and manufacturers, indicating that there is a need to provide the government with information from a medical perspective.

Objective: The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. Methods: A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. Results: A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. Conclusion Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. OVERVIEW OF LITERATURE: Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. METHODS: We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40–77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan–Meier method, and groups were compared using the log-rank method. RESULTS: The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71–39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. CONCLUSIONS: Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.
Clinical Decision-Making ; Follow-Up Studies ; Humans ; Kidney ; Liver ; Methods ; Neoplasm Metastasis ; Operative Time ; Recurrence ; Retrospective Studies ; Spine ; Survival Rate ; Thyroid Gland

Papua New Guinea (PNG) is one of the Pacific island countries facing a noncommunicable disease (NCD) crisis. Little has been reported about rehabilitation services for them. This study aimed to describe the characteristics of inpatients with the four major NCDs receiving rehabilitation services in PNG: cardiovascular disease (CVD) (divided into cerebrovascular disease and ischaemic heart disease), diabetes, cancer and respiratory disease. We conducted a subanalysis of our previous study. We reviewed the inpatient records of all inpatients (12,241 records, Total group) and those of inpatients receiving rehabilitation services by physical therapy (PT) (350 records, PT group). After extracting the records of patients with NCDs, we investigated the demographic data, diagnostic data and gait function. We calculated the percentages of inpatients’ characteristics and the ratio of the number of inpatients in the PT group to that in the Total group by diagnosis (PT ratio). The final analysis included 442 records in the Total group and 68 records in the PT group. Diagnoses and percentages in the PT group were cerebrovascular disease (65%), diabetes (22%), cancer (9%), respiratory disease (4%) and ischaemic heart disease (0%). The PT ratio was the highest in cerebrovascular disease (0.88), followed by diabetes (0.16) and other diagnosis (≤0.05). The inpatients with cerebrovascular disease and diabetes were more likely to have poor gait function than those with other NCDs. Our findings suggested that the provision of rehabilitation services for inpatients with the four NCDs was limited and biased for specific conditions. For development of rehabilitation services for patients with NCDs in PNG, scaling up the service provision and expanding its scope would be a possible way forward

Objective: Papua New Guinea (PNG) is the largest of the Pacific Island countries that is facing challenges related to the burden of cerebrovascular disease. There are few reports on rehabilitation services for inpatients with cerebrovascular disease, including stroke. This study aimed to examine the provision of rehabilitation services, physical therapy (PT) and service outcomes in PNG. Methods: A sub analysis of our previous retrospective observational study at a single provincial hospital in PNG was conducted in which patient records of all inpatients (Total group, n = 12,241) and those of inpatients receiving rehabilitation services (PT group, n = 350) were reviewed, and the records of inpatients with cerebrovascular disease were extracted for analysis. For descriptive purposes, demographic data, service provision statistics (length of hospital stay and duration and frequency of PT services provided) and gait function were summarized. Results: The final analysis comprised 50 of 12,241 records in the Total group and 34 of 350 records in the PT group. All of these studied patients suffered a stroke. The dominant age in both groups was ≥40 years. The median length of stay in hospital was 9 days in the Total group. The median frequency and duration of PT services were 4 times and 8.5 days, respectively. Of the 34 inpatients in the PT group, 32 (94%) were discharged with poor gait function defined as ‘dependent or no walking function’. Conclusions: The results implied that stroke patients who were discharged with poor gait function and restarted their life in the community would confront significant barriers and challenges in PNG. This first report, to our knowledge, on rehabilitation services for stroke in PNG may provide a reference point for further clinical research.

OBJECTIVE: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
Cohort Studies ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Uterine Cervical Neoplasms

Multiple system atrophy (MSA) is an adult-onset, progressive neurodegenerative disorder. Patients with MSA show various phenotypes during the course of their illness, including parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal signs. Patients with MSA sometimes present with isolated autonomic failure or motor symptoms/signs. The median duration from onset to the concomitant appearance of motor and autonomic symptoms is approximately 2 years but can range up to 14 years. As the presence of both motor and autonomic symptoms is essential for the current diagnostic criteria, early diagnosis is difficult when patients present with isolated autonomic failure or motor symptoms/signs. In contrast, patients with MSA may show severe autonomic failure and die before the presentation of motor symptoms/signs, which are currently required for the diagnosis of MSA. Recent studies have also revealed that patients with MSA may show nonsupporting features of MSA such as dementia, hallucinations, and vertical gaze palsy. To establish early diagnostic criteria and clinically definitive categorization for the successful development of disease-modifying therapy or symptomatic interventions for MSA, research should focus on the isolated phase and atypical symptoms to develop specific clinical, imaging, and fluid biomarkers that satisfy the requirements for objectivity, for semi- or quantitative measurements, and for uncomplicated, worldwide availability. Several novel techniques, such as automated compartmentalization of the brain into multiple parcels for the quantification of gray and white matter volumes on an individual basis and the visualization of α-synuclein and other candidate serum and cerebrospinal fluid biomarkers, may be promising for the early and clinically definitive diagnosis of MSA.
Biomarkers ; Brain ; Cerebellar Ataxia ; Cerebrospinal Fluid ; Dementia ; Diagnosis ; Early Diagnosis ; Hallucinations ; Humans ; Multiple System Atrophy ; Neurodegenerative Diseases ; Paralysis ; Parkinsonian Disorders ; Phenotype ; White Matter

We report a case of 76 year-old woman who had previously undergone coronary artery bypass grafting (CABG) with the right internal thoracic artery (RITA) bypassed to the left anterior descending artery. Six years after CABG, she developed acute type A aortic dissection, and she was medically treated because the false lumen was thrombosed and it was considered that surgical intervention would be high risk for the patent RITA graft crossing between the sternum and the ascending aorta. During follow-up, her aortic aneurysm enlarged to 57 mm in diameter, and finally she was referred to our hospital for surgical intervention. In this case, preservation of the patent RITA graft was thought to be critical because the RITA graft was the only blood source for the left anterior descending artery. Prior to re-median sternotomy, we performed a right anterior minithoracotomy to make sufficient space between the sternum and the RITA graft, and then instituted peripheral cardiopulmonary bypass to decompress the heart. After re-sternotomy, we ensured minimum dissection of the RITA graft, and we successfully accomplished graft replacement of the ascending aorta to the aortic arch without injuring the patent RITA graft. In cases with a patent RITA graft and an ascending aortic aneurysm close to the sternum, our strategy is considered to be efficient for re-median sternotomy.