国家のがん制御プラン: 世界規模での解析
title
National cancer control plans: a global analysis.
author
Romero Y, et al. Lancet Oncol. 2018.
Show full citation
Abstract
There is increasing global recognition that national cancer plans are crucial to effectively address the cancer burden and to prioritise and coordinate programmes. We did a global analysis of available national cancer-related health plans using a standardised assessment questionnaire to assess their inclusion of elements that characterise an effective cancer plan and, thereby, improve understanding of the strengths and limitations of existing plans. The results show progress in the development of cancer plans, as well as in the inclusion of stakeholders in plan development, but little evidence of their implementation. Areas of continued unmet need include setting of realistic priorities, specification of programmes for cancer management, allocation of appropriate budgets, monitoring and evaluation of plan implementation, promotion of research, and strengthening of information systems. We found that countries with a non-communicable disease (NCD) plan but no national cancer control plan (NCCP) were less likely than countries with an NCCP and NCP plan or an NCCP only to have comprehensive, coherent, or consistent plans. As countries move towards universal health coverage, greater emphasis is needed on developing NCCPs that are evidence based, financed, and implemented to ensure translation into action.
memo
◼︎知らない
crucial :重大な
programmes :計画、プログラム
prioritise :優先順位を付ける
inclusion :包括、含有物
implementation :履行、実施
comprehensive :包括的な
coherent :首尾一貫した
consistent :首尾一貫した
emphasis :強調、重要視
finance :資金調達する
implement :履行する、道具
◼︎使いたい
There is increasing global recognition that
We did a global analysis of
plans using a standardised assessment questionnaire to assess
We found that
慢性運動性完全脊髄損傷後の地上歩行の回復
title
Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury.
author
Angeli CA, et al. N Engl J Med. 2018.
Abstract
Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent walking. We tested intense locomotor treadmill training with weight support and simultaneous spinal cord epidural stimulation in four patients 2.5 to 3.3 years after traumatic spinal injury and after failure to improve with locomotor training alone. Two patients, one with damage to the mid-cervical region and one with damage to the high-thoracic region, achieved over-ground walking (not on a treadmill) after 278 sessions of epidural stimulation and gait training over a period of 85 weeks and 81 sessions over a period of 15 weeks, respectively, and all four achieved independent standing and trunk stability. One patient had a hip fracture during training. (Funded by the Leona M. and Harry B. Helmsley Charitable Trust and others; ClinicalTrials.gov number, NCT02339233 .).
memo
◼︎知らない
over-Ground Walking :地上歩行
Spinal Cord Injury :脊髄損傷
Complete :全部の、完全な
retention :保持、維持
epidural :硬膜外の
cervical :頚部の
gait :足ぶり、歩行
respectively :それぞれ、おのおの
fracture :骨折
◼︎使いたい
no voluntary movement or sphincter function below the level of injury
We tested intense locomotor treadmill training with weight support
one with damage to the mid-cervical region
2000-2015年のアフリカにおける小児の下痢性疾患の罹患率および死亡率の変動
title
Variation in Childhood Diarrheal Morbidity and Mortality in Africa, 2000-2015.
author
Reiner RC Jr, et al. N Engl J Med. 2018.
Abstract
BACKGROUND: Diarrheal diseases are the third leading cause of disease and death in children younger than 5 years of age in Africa and were responsible for an estimated 30 million cases of severe diarrhea (95% credible interval, 27 million to 33 million) and 330,000 deaths (95% credible interval, 270,000 to 380,000) in 2015. The development of targeted approaches to address this burden has been hampered by a paucity of comprehensive, fine-scale estimates of diarrhea-related disease and death among and within countries.
METHODS: We produced annual estimates of the prevalence and incidence of diarrhea and diarrhea-related mortality with high geographic detail (5 km2) across Africa from 2000 through 2015. Estimates were created with the use of Bayesian geostatistical techniques and were calibrated to the results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016.
RESULTS: The results revealed geographic inequality with regard to diarrhea risk in Africa. Of the estimated 330,000 childhood deaths that were attributable to diarrhea in 2015, more than 50% occurred in 55 of the 782 first-level administrative subdivisions (e.g., states). In 2015, mortality rates among first-level administrative subdivisions in Nigeria differed by up to a factor of 6. The case fatality rates were highly varied at the national level across Africa, with the highest values observed in Benin, Lesotho, Mali, Nigeria, and Sierra Leone.
CONCLUSIONS: Our findings showed concentrated areas of diarrheal disease and diarrhea-related death in countries that had a consistently high burden as well as in countries that had considerable national-level reductions in diarrhea burden. (Funded by the Bill and Melinda Gates Foundation.).
memo
◼︎知らない
diarrheal :下痢性の
address :(問題を)処理する
hamper :妨げる
paucity :不足、少量
comprehensive :包括的な
calibrate :目盛を定める、キャリブレーションする
with regard to :に関して
◼︎使いたい
Diarrheal diseases are the third leading cause of disease and death in children
children younger than 5 years of age in Africa
Estimates were created with the use of Bayesian geostatistical techniques
more than 50% occurred in 55 of the 782 first-level administrative subdivisions
ちょっと大事なお金の話。
医学以外の道を進んでいる友人との飲み会の場で、結構リアルなお金の話が出てきました。話を聞いてみると興味深い。というより、
「医師としてしっかりとキャリアを積んでいくためにも、経済的な障害を取り除きながら働くことはとっても重要なのでは？」
と思い始め、ここ数日、お金のお勉強をちょこちょこと。
学んだことをまとめると、以下のような感じ。
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■前提
① 世界経済は人間の際限ない欲望によってドライブされているのでおおよそ右肩上がりで成長している
② 過去のデータによると、世界経済全体に投資をするのが基本的には最も「負け」の少ない投資法
(プロの機関投資家であっても5~6割は世界経済の利率に負ける)
③ 日本に生まれたならばかなりの割合で総資産1億を目指せるが、世の中のお金の動きを知らなければ貧困に陥りうる
■個人として出来ること
① 収入と支出のバランスを認識する(貯蓄が最高効率の投資である)
② 剰余資産で世界経済への投資、すなわちインデックス投資を実施する
③ 上記2つを辛抱強く継続する
■投資の具体的な方法
① サラリーマンはドルコスト法で長期のインデックス投資をする
② ポートフォリオは有リスク資産：無リスク資産 ＝ 5:5 くらいがオススメ
③ 有リスク資産は基本的に「世界市場ポートフォリオ」になるように組む(先進国株式：日本株式 ＝ 8:2くらい)
④ 無リスク資産で動かす予定のあるものは、1000万までは銀行預金でOK、それを超えてきたらMRFなどにする
⑤ 無リスク資産で動かす予定のないものは「変動10」で日本国債に投資
⑥ 1~3年に一回、ポートフォリオのリバランスを実施する
■インデックス投資を始めるにあたって
① SBI証券か楽天証券に口座を開設する
② まずは「つみたてNISA」と「iDeCo」の口座から少額の投資を試してみる
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ネットをうろうろしていた時に参考になったエントリ↓
参考図書↓
・世界一ラクなお金の増やし方
・全面改訂 ほったらかし投資術
興味があれば読んでみてください。
インドにおける複合的腫瘍手術の経済的インパクト:膵癌における研究の一例
[title]
Financial Impact of Complex Cancer Surgery in India: A Study of Pancreatic Cancer.
[author]
Basavaiah G, et al. J Glob Oncol. 2018.
Show full citation
[Abstract]
PURPOSE: The rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India.
METHODS: Prospective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income.
RESULTS: The mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards.
CONCLUSION: The cost of PD is high and is often unaffordable for a majority of India's population. A review of insurance coverage policies for better coverage must be considered.
[memo]
■知らない
expenditure :支出
impoverishment :疲弊、貧困
Complex cancer surgery :複合的な腫瘍手術
undergo :受ける
pancreatico-duodenectomy(PD) :膵頭十二指腸切除術
tertiary :第3の
ward :病棟
complications :合併症
incur :負う、受ける
semiprivate :準個室の
unaffordable :負担しきれない
■使いたい
create a vicious cycle
, leading to
were collected and analyzed
The time frame for consideration of expenses was from the first hospital visit to the day of discharge
be admitted to (the) hospital
急性骨髄性白血病: 良い亜型、悪い亜型、最悪な亜型
[title]
Acute Myeloid Leukemia: The Good, the Bad, and the Ugly.
[author]
Kuykendall A, et al. Am Soc Clin Oncol Educ Book. 2018.
[Abstract]
Acute myeloid leukemia (AML) was initially subdivided according to morphology (the French-American-British system), which proved helpful in pathologic categorization. Subsequently, clinical and genomic factors were found to correlate with response to chemotherapy and with overall survival. These included a history of antecedent hematologic disease, a history of chemotherapy or radiation therapy, the presence of various recurrent cytogenetic abnormalities, and, more recently, the presence of specific point mutations. This article reviews the biology and responses of one AML subgroup with consistent response and good outcomes following chemotherapy (core-binding factor leukemia), and two subgroups with persistently bad, and even ugly, outcomes (secondary AML and TP53-mutated AML).
[memo]
◼︎知らない
subdivide :細分化する
morphology :形態学
Subsequently :その後に
antecedent :先行する、先立つ
hematologic :血液学的な
◼︎使いたい
which proved helpful in pathologic categorization
were found to correlate with response to chemotherapy
筋弛緩薬の使用後の麻酔後肺合併症 : 多施設前向き観察研究
[title]
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study.
[author]
Kirmeier E, et al. Lancet Respir Med. 2018.
[Abstract]
BACKGROUND: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.
METHODS: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.
FINDINGS: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53-2·26; ARRadj -4·4%, 95% CI -5·5 to -3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15-1·49; ARRadj -2·6%, 95% CI -3·9 to -1·4) and the administration of reversal agents (1·23, 1·07-1·41; -1·9%, -3·2 to -0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85-1·25; ARRadj -0·3%, 95% CI -2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82-1·31; -0·4%, -3·5 to 2·2) was associated with better pulmonary outcomes.
INTERPRETATION: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications.
[memo]
◼︎知らない
anaesthesia :麻酔
Post-anaesthesia pulmonary complications :麻酔後肺合併症
multicentre :多施設
prospective :前向きな
muscle relaxant :筋弛緩薬
general anaesthesia :a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents
agents :薬品
except :除いて
chart review at discharge :退院時カルテ審査
adverse :不利な、逆に作用する、副作用の
Logistic regression analyses :ロジスティック回帰分析
sugammadex :an agent for reversal of neuromuscular blockade by the agent rocuronium in general anaesthesia. It is the first selective relaxant binding agent
reversal agents :拮抗薬
extubation :抜管
train-of-four :筋弛緩のモニターに使われる刺激パターン？
◼︎使いたい
might be linked to postoperative pulmonary complications
We did a multicentre, prospective observational cohort study.
Patients were recruited from 211 hospitals in 28 European countries
chart review at discharge were prospectively collected over 2 weeks
Additionally,
The study outcome was the incidence of postoperative pulmonary complications
was associated with an increased incidence of postoperative pulmonary complications in patients who
