BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of...BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.展开更多
Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives...Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%;p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG;p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.展开更多
基金the Foundation for Cancer Research supported by Kyoto Preventive Medical Center and the Japan Society for the Promotion of Science(JSPS)Grants-in-Aid KAKENHI,No.JP 22K21080.
文摘BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.
文摘Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%;p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG;p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.
