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Higashi T.,University of Tokyo | Nakamura F.,University of Tokyo | Shimada Y.,National Cancer Center Hospital | Shinkai T.,National Hospital Organization Shikoku Cancer Center | And 18 more authors.
International Journal for Quality in Health Care | Year: 2013

Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. Design. A retrospective medical record review. Settings. Eighteen designated cancer care hospitals throughout Japan. Participants. A total of 1685 patients diagnosed with gastric cancer in 2007. Main Outcome Measures. Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Results. Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Conclusions. Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan. © The Author 2013.. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.


Nishizawa T.,National Hospital Organization Tokyo Medical Center | Suzuki H.,Keio University | Maekawa T.,National Hospital Organization Tokyo Medical Center | Harada N.,National Kyushu Medical Center | And 16 more authors.
World Journal of Gastroenterology | Year: 2012

We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)-AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to follow-up. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P= 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT. © 2012 Baishideng. All rights reserved.


Haga Y.,National Hospital Organization Kumamoto Medical Center | Haga Y.,Kumamoto University | Wada Y.,National Hospital Organization Himeji Medical Center | Takeuchi H.,National Hospital Organization Iwakuni Clinical Center | And 3 more authors.
Gastric Cancer | Year: 2012

Background We recently modified our prediction scoring system "Estimation of Physiologic Ability and Surgical Stress" and have designated the current version mE-PASS. This scoring system has been designed to obtain predicted postoperative mortality rates before surgery and this study was performed to assess its usefulness in elective surgery for gastric carcinoma. Methods We investigated seven variables for mE-PASS and evaluated the postoperative course in 3,449 patients who underwent elective surgery for gastric carcinoma in Japan between August 20, 1987 and April 9, 2007, in order to quantify the predicted in-hospital mortality rates (R). The calibration and discrimination power of R were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC), respectively. The ratios of observed-to-estimated mortality rates (OE ratios) were quantified as a measure of quality. Results The overall postoperative morbidity and mortality rates were 19.0 and 2.0%, respectively. R demonstrated good power in calibration (χ 2 value, 12.5; df 8; P = 0.89) as well as discrimination (AUC, 95% confidence intervals: 0.80, 0.75-0.85). The OE ratios between hospitals ranged from 0.44 to 1.8. Overall, the OE ratios seemed to improve with time (OE ratio, 95% confidence intervals: 1.3, 0.73-2.4 for the early period between 1987 and 2000; 1.0, 0.59-1.7 for the middle period between 2001 and 2004; and 0.65, 0.36-1.2 for the late period between 2005 and 2007). Conclusion Based on these findings, mE-PASS might be useful for medical decision-making and for assessing the quality of care in elective surgery for gastric carcinoma. © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2011.


Yamamoto S.,Tottori University | Kaminou T.,Tottori University | Ono Y.,Tottori University | Hashimoto M.,Tottori Prefectural Kosei Hospital | And 3 more authors.
Skeletal Radiology | Year: 2014

Objective: To evaluate the heat effects of radiofrequency ablation (RFA) on normal bone by mechanical testing, MRI, and histology. Materials and methods: The institutional animal care and use committee approved the animal study. Thirty-two adult Japanese white rabbits were included in our study. Bone biopsy needles were inserted from the distal end of the right (RFA side) and the left (control side) femurs using a fluoroscopic guide. A 17-gauge internally cooled RFA electrode with a 2-cm active tip was inserted through the needle to the right femur, and RFA was performed for 12 min using a 200-W generator. Animals were divided into four groups and 8 animals from each group were euthanized on day 1, day 7, day 30, and day 60 after RFA. MRI was performed prior to euthanasia. Three-point bending test was performed to measure flexural strength. Student's t test was used to evaluate for significant differences between RFA and control side for each group. Femurs underwent histological examination by hematoxylin and eosin staining after the bending test. Results: MRI showed a high-intensity rim around the bone on T2WI. Three-point bending test showed no statistically significant differences (P < 0.05) between the RFA and the control side in any of the groups. Histologically, osteocytes of cortical bone showed cell death, but the lamellar structure was preserved in all groups and bone remodeling was observed. Conclusion: Heat by RFA did not change normal bone strength within 2 months, despite the heat effects in the cortical bone and cell death. © 2014 ISS.


Sota T.,Tottori University | Matsuo S.,Tottori University | Uchida Y.,National Hospital Organization Yonago Medical Center | Hagino H.,Tottori University | Kawai Y.,Tottori University
Physiological Research | Year: 2013

This study was undertaken to investigate the effects of lower body positive pressure (LBPP) on cardiovascular responses during a 15-min walking trial in young (22.1±0.4 years) and elderly women (67.8±1.1 years). The application of 20 mm Hg LBPP reduced ground reaction forces by 31.2±0.5 kgw in both groups. We hypothesized that cardiovascular responses to LBPP during walking were different between the young and elderly subjects. Applying 20 mm Hg of LBPP increased diastolic and mean blood pressure but not systolic blood pressure in both groups. LBPPinduced reduction in heart rate (HR) occurred more quickly in the young group compared to the elderly group (p<0.05). Applying LBPP also decreased double product (systolic blood pressure x HR) in both groups, suggesting that LBPP reduces myocardial oxygen consumption during exercise. These results suggest that heart rate responses to LBPP during exercise vary with increasing age. © 2013 Institute of Physiology v.v.i., Academy of Sciences of the Czech Republic, Prague, Czech Republic.


Takeda C.,Tottori University | Takagi Y.,Tottori University | Shiomi T.,Tottori University | Nosaka K.,Tottori University | And 7 more authors.
Diagnostic Pathology | Year: 2014

Background: Maspin is a 42 kDa protein known to act as a tumor suppressor. Although its function has not been fully elucidated, numerous reports have investigated the prognostic impact of maspin in patients with several types of cancer. However, there have been no reports on the association between maspin expression and the prognosis of patients with soft tissue sarcomas (STS). The aim of this study was thus to explore the association of maspin expression with the prognosis of patients with STS. Methods: One-hundred and eight paraffin-embedded STS tissue samples were immunohistochemically analyzed using antibodies for maspin and Ki-67 antigen. The patients were followed up for 1 to 300 months (median: 33 months) and the prognostic value was evaluated by log-rank test and Cox's regression hazard model. Results: Cytoplasmic maspin expression was observed in 48.1% of specimens, and was significantly correlated with a higher FNCLCC grade (P = 0.002) and the presence of distant metastases (P = 0.001), and those with cytoplasmic maspin expression had both shorter disease-free survival (DFS) and overall survival (OS) by log-rank test (P <0.001, P = 0.001, respectively). By Cox's multivariate analysis, the presence of distant metastases was the only prognostic factor for DFS and OS. Conclusions: This is the first report to reveal an association between maspin expression and the prognosis of patients with STS. Although further studies with a larger series of patients and a longer follow-up period will be needed, cytoplasmic maspin expression could be an indicator of unfavorable prognosis in patients with STS.


Kimura O.,National Hospital Organization Yonago Medical Center | Yamamoto O.,National Hospital Organization Yonago Medical Center | Hisamitsu K.,National Hospital Organization Yonago Medical Center | Yamane N.,National Hospital Organization Yonago Medical Center | Hamazoe R.,National Hospital Organization Yonago Medical Center
Japanese Journal of Cancer and Chemotherapy | Year: 2010

Imatinib is an effective drug for KIT positive GIST, and the usual dose is 400 mg/day. On the other hand, imatinib sometimes causes leucopeny and it is hard to maintain a dosage of 400 mg/day. We reported here the two cases with a remarkable response of unresectable GIST using a low-dose and long-term administration of imatinib. It seems that a low dose and long-term administration of imatinib will be an important therapy for unresectable GIST.


PubMed | National Hospital Organization Yonago Medical Center
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

Imatinib is an effective drug for KIT positive GIST, and the usual dose is 400 mg/day. On the other hand, imatinib sometimes causes leucopenia and it is hard to maintain a dosage of 400 mg/day. We reported here the two cases with a remarkable response of unresectable GIST using a low-dose and long-term administration of imatinib. It seems that a low dose and long-term administration of imatinib will be an important therapy for unresectable GIST.

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