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Hayashino Y.,Kyoto University | Utsugi-Ozaki M.,Horikawa Hospital | Feldman M.D.,University of California at San Francisco | Fukuhara S.,Kyoto University
PLoS ONE | Year: 2012

The presence of hope has been found to influence an individual's ability to cope with stressful situations. The objective of this study is to evaluate the relationship between medical errors, hope and burnout among practicing physicians using validated metrics. Prospective cohort study was conducted among hospital based physicians practicing in Japan (N = 836). Measures included the validated Burnout Scale, self-assessment of medical errors and Herth Hope Index (HHI). The main outcome measure was the frequency of self-perceived medical errors, and Poisson regression analysis was used to evaluate the association between hope and medical error. A total of 361 errors were reported in 836 physician-years. We observed a significant association between hope and self-report of medical errors. Compared with the lowest tertile category of HHI, incidence rate ratios (IRRs) of self-perceived medical errors of physicians in the highest category were 0.44 (95%CI, 0.34 to 0.58) and 0.54 (95%CI, 0.42 to 0.70) respectively, for the 2nd and 3rd tertile. In stratified analysis by hope score, among physicians with a low hope score, those who experienced higher burnout reported higher incidence of errors; physicians with high hope scores did not report high incidences of errors, even if they experienced high burnout. Self-perceived medical errors showed a strong association with physicians' hope, and hope modified the association between physicians' burnout and self-perceived medical errors. © 2012 Hayashino et al.

Miyagawa K.,Horikawa Hospital | Yata Y.,Horikawa Hospital | Yamaoka N.,Horikawa Hospital | Sagara Y.,Horikawa Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2010

Pancreatic cancer is among the most lethal of all digestive cancers, and it is very difficult to obtain long-term survival of unresectable cases. This case report reveals that combination chemotherapy with S-1/gemcitabine (GEM) was very effective for a patient with unresectable pancreatic body cancer. The patient was a 72-year-old female (Stage IVb). They were administered S-1 80 mg/day for 2 weeks and GEM 1, 000 mg/m2 on day 8 and 15 followed by a 2-week recovery period. After finishing the 2 courses, there was a notable reduction in tumor size. After finishing 9 courses, the tumor could not be observed and it was judged it to be CR. Currently, at 1 year and 4 months from the initial diagnosis, there is no recurrence of tumor, and the general condition of the patient is very good. Combination chemotherapy with S-1/GEM may be useful to improve the prognosis for unresectable pancreatic cancer.

Konishi H.,Horikawa Hospital | Okamura H.,Horikawa Hospital | Kawai K.,Horikawa Hospital | Sagara Y.,Horikawa Hospital
Japanese Journal of Gastroenterological Surgery | Year: 2014

The patient was a 74-year-old woman who developed thoracolumbar vertebral metastases after surgery for bilateral breast cancer and underwent palliative therapy by oral administration of oxycodone. She urgently came to our hospital due to increased back pain and malaise. Abdominal CT showed the presence of free air in the abdominal cavity and an emphysematous lesion. Peritoneal irritation signs were not apparently detected by the initial physical examination. However, the lack of symptoms was thought to be caused by oxycodone. As the possibility of gastrointestinal perforation could not be denied, exploratory laparotomy was performed. Surgery revealed an emphysematous lesion about 10 cm in length at the ileum site of the mesentery but no perforation. Assuming the possibility of metastasis of breast cancer to the small intestine, partial ileal resection was performed. Postoperative histopathology indicated pneumatosis cystoides intestinalis. Recently, pneumatosis cystoides intestinalis has been increasingly reported and there is a certain level of consensus on the diagnosis and treatment. Herein, we report the present case, demonstrating the difficulty in the diagnosis and treatment of pneumatosis cystoides intestinalis associated with free air in the abdomen during palliative therapy, with a review of the literature. © 2014 The Japanese Society of Gastroenterological Surgery.

PubMed | Horikawa Hospital
Type: Journal Article | Journal: Journal of neurosurgery. Spine | Year: 2016

In the conventional posterior approach to the lumbar spine, the lamina is exposed by stripping the paravertebral muscles from the spinous process, and the resulting paravertebral muscle damage can produce muscle atrophy and decreased muscle strength. The author developed a novel surgical approach to the lumbar spine in which the attachment of the paravertebral muscles to the spinous process is preserved. In the novel approach, the spinous process is split on the midline without stripping the attached muscles, and a hemilateral half of the spinous process is then resected at the base, exposing only the ipsilateral lamina. Before closing, the resected half is sutured and reattached to the remaining half of the spinous process. Thirty-eight patients with lumbar spinal canal stenosis (LSCS) undergoing unilateral partial laminectomy and bilateral decompression using this novel approach were analyzed. Postoperative changes in the multifidus muscle were evaluated by T2 signal intensity on MR images. MRI performed 1 year after the operation revealed no significant difference in the T2 signal intensity of the multifidus muscle between the approach and nonapproach sides. This result indicated that postoperative changes of the multifidus muscle on the approach side were slight. The clinical outcomes of unilateral partial laminectomy and bilateral decompression using this approach for LSCS were satisfactory. The novel approach can be a useful alternative to the conventional posterior lumbar approach.

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