Conectar
by Gen Tsujio, Masakazu Yashiro, Yuichiro Miki, Kohei Matsuoka, Koji Maruo, Mami Yoshii, Tatsuro Tamura, Katsunobu Sakurai, Takahiro Toyokawa, Naoshi Kubo, Shigeru Lee, Tomohisa Okuno, Kishu Kitayama, Go Masuda, Masaichi Ohira, Kiyoshi Maeda
BackgroundOur group revealed that the combination of intra-operative stamp cytology and peritoneal lavage cytology (CY) improved the identification of individuals with high risk of peritoneal metastasis. In this exploratory Phase II study, we aimed to evaluate the effect on relapse-free survival (RFS) of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer with positive peritoneal cytology (CY1) and/or stamp cytology positive (stamp+).
Materials and methodsThis study was a single arm, multi-institutional, exploratory phase 2 trial to assess the effects of EIPL after open gastrectomy for gastric cancer with CY1 and/ or stamp+. The primary endpoint was RFS. Secondary endpoints were overall survival (OS), postoperative recurrence site and incidence of postoperative adverse events.
ResultsBetween 2017 and 2021, 13 patients from 2 institutions were enrolled in this study. Because of the recent decline in open abdominal surgery, the number of cases did not increase and the trial was closed due to lack of applicants at 13 cases. Median 3-year RFS was 14.5 months (95% CI 5.4-NA), median 3-year OS was not reached (95% CI 14.5-NA) and median3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). Median 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6), and 0% in CY1 and stamp+/- cases (n=7). (Log-rank p=0.015).
ConclusionBecause of the slow accrual pace and early stop of the trial, we were not able to evaluate the prespecified endpoints thoroughly. However, EIPL might be effective to prevent perineal recurrence, especially in CY0 and stamp+ case.
Emergency general surgery (EGS) decisions often occur under time pressure and with reduced patient involvement in comparison to the elective setting. Variation in decision-making in the field of EGS is partly attributable to patient and contextual factors, but clinician factors also likely shape decisions.
This scoping review aims to clarify which clinician factors have been investigated in relation to decision-making in adult EGS, which have been identified as influential, and the methods used to measure them.
Any studies reporting on individual clinician factors and decision-making in EGS will be eligible. Studies must be only in adult populations (patients aged 18 and over). This review will consider quantitative, qualitative and mixed-methods study designs.
This scoping review will be conducted in accordance with the methodology developed by the Joanna Briggs Institute and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This protocol was prospectively registered with the Open Science Framework: https://osf.io/xcqp4. We will search MEDLINE, EMBASE, CINAHL, CDSR and CENTRAL. The search strategy will be adapted for each database, and no time or language restrictions will be applied.
Two independent reviewers will screen studies for eligibility and extract data using a purpose-designed data extraction form, with disagreements resolved by a third reviewer. Extracted data will be synthesised using a narrative approach to map key concepts, describe study characteristics and identify gaps in the literature.
Ethical approval is not required as this review will use publicly available data. Findings will be disseminated through peer-reviewed publication and conference presentations.
This study aimed to investigate the effects of long-term and habitual physical activity on mortality and long-term care insurance (LTCI) certification among cancer survivors using a population database.
5-year retrospective study.
13 Japanese municipalities participated in the Longevity Improvement & Fair Evidence study.
Among 471 511 participants who underwent health check-ups, 39 435 met the following eligible criteria: documented in the cancer claims database without a suspected diagnosis and participated in a health check-up at least once in a 12-month period, had no missing exercise data and had already been certified for LTCI.
Outcomes were new LTCI certification and all-cause mortality. LTCI certification was assigned by a trained local government official through a systematic process (involving various items—physical function, daily activity function, cognitive function, behavioural disorders, adjustment to social life and daily use of medical services—as well as overall consideration of computer-based and specialist team assessments), and the LTCI severity level correlates with the Barthel index. LTCI certification reflects some impairment in activities of daily living. All-cause mortality was defined based on claims data.
Three physical activity categories, ‘exercise and walking’, ‘exercise or walking’ and ‘no physical activity’, were used. Among survivors aged 65–74 years, the ‘no physical activity’ group had a higher risk of mortality and LTCI certification than the ‘exercise and walking’ group (adjusted model HR: 1.72, 95% CI 1.52 to 1.94). Among survivors aged ≥75 years, the low physical activity groups had a higher risk of mortality and LTCI certification than the ‘exercise and walking’ group (adjusted model: ‘exercise or walking’, HR: 1.51, 95% CI 1.29 to 1.85; ‘no physical activity’, HR: 1.66, 95% CI 1.43 to 1.92). The effects of physical activity differed according to cancer type.
Habitual physical activity had positive effects on cancer survivors. These effects differed according to age and cancer type.
To clarify how public health nurses allocate their time across various tasks and compare time-use patterns between prefectural and municipal public health nurses in Japan, where distinct administrative mandates define their roles.
A self-reported, prospective time study.
Public health nurses from two municipalities and one prefecture recorded their daily practices and time allocations using Kintone. Time allocation differences by administrative level and job position were analysed using linear mixed-effects models.
Overall, 121 participants contributed 9502 person-days of data. Participants spent an average of 463.6 min/workday on work-related activities. Municipal public health nurses dedicated more time to application paperwork (64.0 min), health examinations (57.6 min), and individual coordination (48.3 min). Prefectural public health nurses allocated more time to business management and organisational operations (69.0 min) and traveliing, particularly in rural contexts. Managers spent less time on direct care and more on administrative tasks.
This study provides the first quantitative, self-reported evidence of task distribution among public health nurses across administrative levels and positions. The findings reflect structural differences in role expectations and underscore the need to reallocate workloads to better align with each level's mandate.
Task prioritisation, information and communication technology tool integration, and administrative support are essential in optimising public health nurses' contributions to community health. These strategies can reduce non-clinical workload and enable public health nurses to focus on high-impact, value-added public health services that promote health equity.
This study closes a longstanding gap by quantifying PHNs' time allocation, revealing the hidden burden of administrative work, and providing critical insights for workforce planning and sustainable public health service delivery.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guideline.
No Patient or Public Involvement.
UMIN Clinical Trials Registry; UMIN000051509 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000058761; August 1, 2023)
To assess the reliability and validity of a negative emotion scale for public health nurses conducting child abuse prevention activities.
A four-phase mixed method design.
Participants were public health nurses with experience in child abuse prevention across Japan. The initial scale was developed and refined based on previous studies, expert panel reviews, interviews with public health nurses, and a questionnaire-based pilot study. In 2024, 549 public health nurses completed a questionnaire on scale items. Item analysis, exploratory factor analysis, confirmatory factor analysis, comparisons with a preexisting scale, the number of times negative attitudes and the types of behaviours exhibited by parents were used to narrow the scale and assess its psychometric properties.
Item analysis and exploratory factor analysis reduced the scale to 15 items on two factors: ‘negative emotions toward aggressive and emotional attitudes’ and ‘negative emotions toward rejecting and uncooperative attitudes.’ Confirmatory factor analysis indicated a good model fit. The Cronbach's alpha was high, and the negative emotions scale score positively correlated with the pre-existing scale, negative attitudes and parental behaviours.
The Cronbach's alpha coefficient and other factors confirmed the scale's reliability, and correlations with other scales confirmed its validity.
Evaluating negative emotions provides critical insights into the quality of support and its influence on psychological well-being.
By assessing negative emotions that public health nurses find difficult using this scale, the support system for them can be examined.
STROBE checklist for cross-sectional studies was followed.
Public health nurses were involved in the generation of items for the scale. Their perspective was sought in determining the items for the scale.
Registered in the UMIIN Clinical Trial Registry (UMIN-CTR ID UMIN000054650).
Hypertension is a major health challenge imposing substantial economic and health burdens worldwide. This study compared treatment outcomes and costs between cost-intensive and non-cost-intensive pharmacotherapies, defined by prescribing intervals and the type of drugs, using electronic health record (EHR) data from multiple healthcare facilities, focusing on the type of antihypertensive drug and prescribing patterns.
A retrospective cohort study. A mixed-effects Cox proportional hazards model was used to investigate the association between cardiovascular events and healthcare resource use.
EHRs from 34 primary care facilities in Japan.
Patients prescribed either angiotensin receptor blockers (ARBs) alone or calcium channel blockers (CCBs) alone were included.
During 6629 person-years of follow-up, 71 events were observed. Model diagnostics confirmed the proportional hazards assumption and substantial inter-clinic heterogeneity. The type of drug (ARBs or CCBs) had no statistically significant impact on the incidence of cardiovascular events (HR 0.999, 95% CI 0.603 to 1.655). Similarly, shorter prescribing intervals (less than 36 days) were not significantly associated with the outcome (HR 1.724, 95% CI 0.906 to 3.279). The mean annual medical cost per patient for the cost-intensive (ARB with short prescribing intervals) and non-cost-intensive (CCB with long prescribing intervals) groups was Japanese yen (JPY) 137 023 and JPY 85 911, respectively. Sensitivity analysis using different time windows yielded similar results, confirming the robustness of the findings.
No apparent reduction in cardiovascular events associated with the use of ARBs or shorter prescribing intervals was observed despite the elevated cost caused by intensive pharmacotherapy and frequent clinic visits.
FreshRSS 