XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

International Consensus Statement on an Update of the Classification Criteria for Definite Antiphospholipid Syndrome(APS)

Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

There are more than half a million incident cases of squamous-cell carcinoma of the head and neck worldwide each year, primarily affecting the oropharynx, oral cavity, hypopharynx, and larynx. This review considers the biologic features of these tumors, including the role of human papillomavirus as a risk factor for cancer of the oropharynx. New therapies are considered, along with management approaches.

/pdf/recent-advances-in-head-and-neck-cancer-2bc7t5c0vx.pdf

Recent Advances in Head and Neck Cancer

We have identified a new role for the matrix enzyme lysyl oxidase-like-2 (LOXL2) in the creation and maintenance of the pathologic microenvironment of cancer and fibrotic disease. Our analysis of biopsies from human tumors and fibrotic lung and liver tissues revealed an increase in LOXL2 in disease-associated stroma and limited expression in healthy tissues. Targeting LOXL2 with an inhibitory monoclonal antibody (AB0023) was efficacious in both primary and metastatic xenograft models of cancer, as well as in liver and lung fibrosis models. Inhibition of LOXL2 resulted in a marked reduction in activated fibroblasts, desmoplasia and endothelial cells, decreased production of growth factors and cytokines and decreased transforming growth factor-beta (TGF-beta) pathway signaling. AB0023 outperformed the small-molecule lysyl oxidase inhibitor beta-aminoproprionitrile. The efficacy and safety of LOXL2-specific AB0023 represents a new therapeutic approach with broad applicability in oncologic and fibrotic diseases.

http://basicmed.med.ncku.edu.tw/admin/up_img/0325-1.pdf

Allosteric inhibition of lysyl oxidase-like-2 impedes the development of a pathologic microenvironment.

Epidemiology and Risk Factors of Vascular Access-Associated Infections in Japanese Patients on Hemodialysis

Association between the duration of antibiotic prophylaxis and surgical site infection after orthognathic surgery in Japan.

Among the reports on needlestick and sharps injuries (NSIs), many are orthopedic-related due to the frequent use of sharp devices such as pins and wires. This study aimed to identify high-risk instruments, the most common injury sites for each instrument, and the circumstances of NSIs of the hand during orthopedic surgeries in Japan. Incidents of exposure to blood or bodily fluids among physicians during orthopedic surgeries reported to the Japan-EPINet between 2000 and 2015 were included in this study. The four most common devices were identified and the associations among years of experience, equipment users, and injured sites were analyzed. We identified 666 cases of NSIs affecting orthopedic surgeons in the operating room. The instrument most frequently responsible for NSIs was suture needles, which were involved in 265 cases (39.7%). The second most common instrument was pins/wires, which was involved in 111 cases (16.6%). NSIs of the hands of orthopedic surgeons were frequently caused by suture needles used in all surgeries, but relatively often caused by orthopedic devices. Orthopedic surgeons must be aware that they are at risk of NSIs and must take appropriate measures and always be cautious when performing surgery, regardless of their years of experience.

/pdf/characteristics-of-needlestick-and-sharps-injuries-of-the-241513g4.pdf

Characteristics of needlestick and sharps injuries of the hands in the operating room among orthopedic surgeons in Japan

Biliary tract infection (BTI) including acalculous cholecystitis is a rare but life-threatening complication after cardiovascular surgery. The objective of our study was to describe epidemiology, clinical characteristics, and risk factors of BTI after cardiovascular surgery. From January 2007 to December 2011, 586 consecutive patients(age68±11;397 men,189 women)were enrolled in this study. BTI was diagnosed according to Centers for Disease Control and Prevention (CDC) surveillance criteria for healthcare associated infection. Data collection included preoperative, intraoperative, and post-operative variables. The overall incidence of BTI was 3.9%. The mortality in BTI group was significantly higher than that in non-BTI group (17.1% vs 5.5%, p<0.05). Multi-logistic analysis revealed that operation of the thoracic aorta( p<0.05) and massive transfusion(p<0.01) were independent risk factors for BTI after cardiovascular surgery.

Clinical characteristics of biliary tract infection and acalculous cholecystitis after cardiovascular surgery

は じめ に 病院感染サーベイランスを行なうことは,病 院感染の 減少につながる,ア ウ トブレイクの早期発見に役立つ, 等の様々な効果をもたらす.ま た最近,日 本医療機能評 価機構による病院機能評価において,対 象限定のサーベ イランスを行なっていることが受審の条件 となってい る.し かし,ア メリカ合衆国をはじめとした諸外国に比 べて 日本の病院感染サーベ イランスは歴史が浅 く, 1990年 代に入 り先進的施設でようや くその端緒につい たにすぎない.全 国的なデータベース構築についても, 1999年 に日本環境感染学会の事業 としてJNISシ ステ ムが確立され1,2),主にSSIを 中心 としたサーベイラン スデータが集積されてきている.2000年 からは国の事 業 としての病院感染サーベイランスのデータ収集が開始 された. JNISは 発足後6年 を経過 し,5回 のフィー ドバ ック を各施設に対して行なってきた.し かしそれを各施設が 有効に活用しているか否かなどの検証が行なわれていな い.そ もそも,院 内感染サーベイラソスはデータの収集 および分析が最終目標ではなく,有 効なフィー ドバック を経て各施設が感染制御にデータを役立て,究 極的に感 染発生を減少させることが目標である.そ の意味で,各 施設において現場に向けてどのようなフィー ドバックが 行なわれているのか,JNISに よる全国的データベース のフィー ドバックに関して有効に活用されているかどう か,な どの点が評価される必要がある. そ こで 今 回,JNISに 参 加 して い る 施設 に対 し て,主 にSSIサ ー ベ イラン ス に 関 す るア ン ケ ー ト調 査 を実 施 した.

Keita Morikane

Papers

Epidemiology and Risk Factors of Vascular Access-Associated Infections in Japanese Patients on Hemodialysis

Association between the duration of antibiotic prophylaxis and surgical site infection after orthognathic surgery in Japan.

Characteristics of needlestick and sharps injuries of the hands in the operating room among orthopedic surgeons in Japan

Clinical characteristics of biliary tract infection and acalculous cholecystitis after cardiovascular surgery

A Report on Surgical Site Infections Surveillance in Japanese Healthcare Settings