Few studies have examined the effect of immediate breast reconstruction (IBR) on the overall progression of breast cancer therapy. This study examins the effect of IBR on the breast cancer therapy. 142 patients underwent mastectomy in our department (With IBR group, n = 17; Without IBR group, n = 125). We examined the number of days from diagnosis to surgery, operation time, length of postoperative stay, number of days from surgery to postoperative therapy, and complications in patients with or without breast reconstruction and by type of reconstruction. In the IBR group, the operation time was longer (P < 0.001), postoperative hospital stay was longer when adjusted for multivariate analysis (P = 0.008), and complications were significantly more common (P < 0.001), but there was no significant difference when limited to grade ≥3 complications. There was no difference until the start of postoperative treatment. The results reveal that IBR requires coordination between the surgical and operating room staff, and does not affect the transition to postoperative treatment but does affect an increased incidence of minor complications and length of postoperative stay.
The relationship between the Hospital Frailty Risk Score (HFRS)-based frailty risk and outcomes after coronary artery bypass grafting (CABG) is yet unclear. The objective of this study was to investigate the relationship between preoperative frailty risk as assessed by the HFRS and postoperative outcomes in patients undergoing CABG. This observational study used the diagnosis procedure combination (DPC) system in Japan (2014–2017). In total, 35,015 adults aged ≥ 65 years and diagnosed with angina pectoris and acute myocardial infarction who had undergone CABG were enrolled. We investigated the association between the HFRS-based frailty risk and the home discharge rate, as well as the prevalence of complications. Multilevel logistic regression analysis revealed that having an HFRS ≥ 5 was a determinant of lower home discharge rate (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.49–0.74, P <0.01), aspiration pneumonia (OR 2.25, 95%CI 1.27–3.96, P <0.01) and disuse syndrome (OR 1.90, 95%CI 1.23–2.94, P <0.01). Preoperative stratification of frailty risk using HFRS may help in predicting postoperative progress and in planning postoperative rehabilitation.
In this technical note, we primarily demonstrate the computation of confidence limits for a novel measure of average lifespan shortened (ALSS). We identified women who had died from cervical and ovarian cancer between 2000 and 2020 from the Alberta cancer registry. Years of life lost (YLL) was calculated using the national life tables of Canada. We estimated the ALSS as a ratio of YLL in relation to the expected lifespan. We computed the confidence limits of the measure using various approaches, including the normal distribution, gamma distribution, and bootstrap method. The new ALSS measure shows a modest gain in lifespan of women, particularly women with ovarian cancer, over the study period.
The purpose of this study is to clarify factors related to the quality evaluation of dementia nursing care in acute hospitals. We conducted a survey that consisted of individual attributes, organizational attributes, knowledge about dementia, ethical behavior scales, and quality evaluation of dementia nursing. The number of valid responses was 835. The dependent variable was the quality assessment of dementia nursing, and the independent variable was the variables in which there were significant differences in the quality evaluation of dementia nursing care and the univariate analysis of each variable. Multiple regression analysis results showed that the factors related to the quality assessment of dementia nursing were “risk aversion” and “good care” of ethical behavior. The ethical behavior of “risk aversion” meant to sense the distress felt by dementia patients and to avoid pain and danger in the hospitalization environment. It was suggested that enhancing the ethical behavior of “good care”, which means always thinking and acting for the best while searching for the will of dementia patients, may lead to quality evaluation of dementia nursing.
Hemifacial spasm is commonly caused by compression of the facial nerve due to overlying vessels, and also due to various types of tumor or aneurysm, and other factors. It occurs, although rarely, as a secondary effect of cerebellar or brainstem shift resulting from a tumor. In such a case, the presence of a large tumor often leads to additional neurological deficits. We present a case of hemifacial spasm caused by a peritorcular type of large tentorial meningioma in the posterior fossa. A 68-year-old woman presented with right facial numbness 4 months ago and right hemifacial spasm 2 weeks ago. Upon visiting our hospital, she displayed no neurological deficits other than the right hemifacial spasm. MRI revealed a peritorcular type of large tentorial meningioma in the posterior fossa with perifocal edema. The right cerebellopontine cistern was narrowed, and the cerebellar tonsil was herniated. The right facial nerve ran adjacent to the anterior inferior cerebellar artery (AICA). Angiography showed that only the left posterior meningeal artery (PMA) flowed to the tumor. The loop of the right AICA extended into the right cerebellopontine cistern. After embolization of the PMA, the tumor was surgically removed, leading to an improvement in the patient’s hemifacial spasm. Postoperative MRI confirmed complete removal of the tentorial meningioma without any contact with the right facial nerve. The hemifacial spasm was caused secondarily by the cerebellar or brainstem shift due to the large tentorial meningioma in the posterior fossa. This large tumor had not produced any other neurological deficits before the hemifacial spasm appeared. We report this case because it is extremely rare.
The purpose of this study was to summarize the typical and specific causes and risk reduction measures of serious accidents in Japan caused by chemical substances in terms of the 10 types of human health hazards in the UN GHS (Globally Harmonized System of Classification and Labelling of Chemicals) classification. The list of “Cases of Major Accidents Caused by Chemical Substances” published on the “Safety in the Workplace Website” of the Ministry of Health, Labor and Welfare (MHLW) was linked to the “Results of GHS Classification by the Government” of the National Institute of Technology and Evaluation (NITE). Analysis was conducted by health hazards in order to obtain reference examples of measures taken against health hazards in response to the revision of the law on autonomous chemical substance management in 2022. Using the text mining tool KH Coder ver. Three using cluster analysis, we grouped causes and measures among serious disasters by health hazard, illustrated co-occurrence networks, and extracted typical examples of each in a co-occurrence network. Representative causes of and measures against occupational accidents caused by health hazardous properties were summarized from the extracted typical cases. Although few occupational accidents were caused by the health hazards of chemicals, when all health hazards were classified into acute toxicity, acute health hazard, and chronic health hazard, contact was a clear cause for many of the acute toxicity and acute health hazards, such as corrosiveness and sensitization. However, many occupational accidents were caused by the physical hazardous aspects of the chemical substances or by the safety aspects of the workplace. Causes of occupational accidents due to health hazards included unsafe behavior and unsafe conditions, or lack of understanding of the physicochemical properties of a substance and specific reactions such as mixing or hydrolysis of the substance. Typical risk reduction measures for health hazards included equipment to prevent human contact with health hazardous substances, systems to control unsafe behavior, promoting understanding of chemical reactions, and providing information about chemicals to all persons involved in testing, research, and subcontract work. The data of occupational accident cases of “death or more than 4 days lost from work” were used. Most of the cases were related to acute health hazards, but relatively few to chronic health hazards, and few occupational accidents were caused by health hazards. Most of the occupational accidents were caused by health hazards due to the physical hazards of chemical substances and inadequate workplace safety. In light of the above, it is necessary in autonomous chemical substance management to first take risk reduction measures for workplace safety and chemical physical hazards, then to prevent contact with acute toxicity and acute health hazards such as corrosiveness and sensitization, and, lastly, to take risk reduction measures for chronic health hazards, using allowable concentrations and controlled concentrations as indices.