Lessons learned in the development of process quality indicators for cancer care in Japan

In Japan, attention has increasingly focused on ensuring the quality of care, particularly in the area of cancer care. The 2006 Basic Cancer Control Act reinforced efforts to ensure the quality of cancer care in a number of sectors, including the role of government in ensuring quality. We initiated a government-funded research project to develop quality indicators to measure the quality of care for five major cancers (breast, lung, stomach, colorectal, and liver cancer) in Japan, and palliative care for cancers in general. While we successfully developed a total of 206 quality indicators, a number of issues have been raised regarding the concepts and methodologies used to measure quality. Examples include the choice between measuring the process of care versus the outcome of care; the degree to which the process-outcome link should be confirmed in real-world measurement; handling of exceptional cases; interpretation of measurement results between quality of care versus quality of documentation; creation of summary scores; and the optimal number of quality indicators for measurement considering the trade-off between the measurement validity versus resource limitations. These and other issues must be carefully considered when attempting to measure quality of care, and although many appear to have no correct answer, continuation of the project requires that a decision nevertheless be made. Future activities in this project, which is still ongoing, should focus on the further exploration of these problems

弾塑性有限要素法による地盤の応力・変形・支持力解析

第1章 序論 第2章 弾塑性FEMによる圧密変形解析手法を用いた地盤の支持力評価手法の一提案と非排水支持力解析への適用 第3章 弾塑性FEMによる異方正規圧密地盤の支持力解析 第4章 動水勾配の評価法の違いが圧密解析結果へ及ぼす影響-赤井･田村の圧密解析法についての一検討- 第5章 有限変形弾塑性FEMによる地盤の圧密変形解析 第6章 有限変形弾塑性FEMによる地盤の支持力解析 第7章 有限変形弾塑性FEMによる盛土基礎地盤の圧密変形解析-有明干拓新白石排水樋門右岸側取付堤防の場合- 第8章 結論Made available in DSpace on 2012-09-06T04:10:26Z (GMT). No. of bitstreams: 2 higashi1.pdf: 9024866 bytes, checksum: 6f458afdeb9623e735a6c2f91385de6c (MD5) higashi2.pdf: 10619267 bytes, checksum: 1d1f1b7da74524b2e2e374f316822275 (MD5) Previous issue date: 1999-03-25主1-参

Impact of loss-to-follow-up on cancer survival estimates for small populations: a simulation study using Hospital-Based Cancer Registries in Japan

Objectives: The accuracy of the ascertainment of vital status impacts the validity of cancer survival. This study assesses the potential impact of loss-to-follow-up on survival in Japan, both nationally and in the samples seen at individual hospitals. Design: Simulation study Setting and participants: Data of patients diagnosed in 2007, provided by the Hospital-Based Cancer Registries of 177 hospitals throughout Japan. Primary and secondary outcome measures: We performed simulations for each cancer site, for sample sizes of 100, 1000 and 8000 patients, and for loss-to-follow-up ranging from 1% to 5%. We estimated the average bias and the variation in bias in survival due to loss-to-follow-up. Results: The expected bias was not associated with the sample size (with 5% loss-to-follow-up, about 2.1% for the cohort including all cancers), but a smaller sample size led to more variable bias. Sample sizes of around 100 patients, as may be seen at individual hospitals, had very variable bias: with 5% loss-to-follow-up for all cancers, 25% of samples had a bias of 3.06%. Conclusion: Survival should be interpreted with caution when loss-to-follow-up is a concern, especially for poor-prognosis cancers and for small-area estimates

Synthesis and Luminescence Properties of Near-Infrared N-Heterocyclic Luciferin Analogues for In Vivo Optical Imaging

As a means of achieving highly sensitive bioluminescence imaging of deep tissues utilizing the firefly luciferin-luciferase (L-L) reaction, we previously reported a luciferin analogue, AkaLumine, which exhibits high cell-permeability and emits near-infrared (NIR) light with high tissue-penetration by the L-L reaction. However, while AkaLumine enables us to observe targets in deep tissues, its poor solubility in aqueous media limits its utility for in vivo imaging. Herein, to address this issue, we have synthesized three AkaLumine derivatives with N-heterocyclic aromatic rings as new red luciferin analogues that have substantially higher solubility than that of AkaLumine in phosphate buffered saline solution. One of the derivatives (herein termed seMpai) exhibits an emission maximum at 675 nm upon L-L reaction with Photinus pyralis luciferase and presents an activity in mouse-tissue imaging similar to that of AkaLumine. It is hoped that seMpai will extend the application of high-sensitivity NIR bioluminescence imaging in a wide range of biomedical research fields

Dispersion of single-walled carbon nanotubes modified with poly-l-tyrosine in water

In this study, complexes composed of poly-l-tyrosine (pLT) and single-walled carbon nanotubes (SWCNTs) were produced and the dispersibility of the pLT/SWCNT complexes in water by measuring the ζ potential of the complexes and the turbidity of the solution were investigated. It is found that the absolute value of the ζ potential of the pLT/SWCNT complexes is as high as that of SWCNTs modified with double-stranded DNA (dsDNA) and that the complexes remain stably dispersed in the water at least for two weeks. Thermogravimetry analysis (TGA) and visualization of the surface structures of pLT/SWCNT complexes using an atomic force microscope (AFM) were also carried out

再発性甲状腺癌のリンパ節転移におけるTc-99m MDPの集積(Tc-99m MDP Accumulation in Lymph Node Metastases of Recurrent Thyroid Cancer)(英語)

金沢医科大学 放射線科原著論文/症例報

Effects of insulin and glucagon on serum amino acid concentrations in liver disease.

The effects of insulin and glucagon administration on serum amino acid levels were investigated in patients with severe liver disease, since simultaneous injection of pancreatic hormones has been recently introduced as a therapeutic approach. The changes in serum amino acid concentrations, as observed 3 h after ceasing a 3 h infusion of insulin and glucagon in 500 ml glucose solution, were an elevation of serum branched chain amino acid (BACA) levels and of the molar ratio of BCAA/aromatic amino acid (AAA) levels in patients with liver cirrhosis. Similar increases of serum BCAA levels during the infusion were also observed in patients with fulminant hepatitis. The results suggest that insulin-glucagon therapy for severe liver disease has no harmful side effects at least with respect to alterations in the serum aminogram.</p

Hyperbilirubinemia and enhanced mitosis of hepatocytes in phalloidin-treated female rats.

Cholestasis with htperbilirubinemia was induced in female, but not male, Sprague-Dawley rats by daily treatment with phalloidin for 7 days. Increases in serum direct bilirubin level and alkaline phosphatase (Al-Pase) activity were observed concomitantpy with diminished bile flow and a decreased output of bile acid and cholesterol. Kidht microscope findings of the liver revealed proliferated bile ductules and enhanced mitosis of hepatocytes.</p