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Analysis of Closed Claims in the Clinical Management of Rheumatoid Arthritis in Japan

Chinese Medical Journal 2017年第12期130卷 1454-1458页

作者： Yasuhiro Otaki Makiko DaSilva Ishida Yuichi Saito Yasuaki Oyama Giichiro Oiso mitsuru moriyama General Medical Education and Research Center Teikyo University Tokyo 1738605 Japan National Center of Neurology and Psychiatry Tokyo 1878551 Japan Specialty Claims Department Sompo Japan Nipponkoa Insurance Incorporated Tokyo 1648608 Japan Department of Integrated Human Sciences Hamamatsu University School of Medicine Shizuoka 4313192 Japan moriyama Management Law Office Tokyo 1010052 Japan

Background： Despite an increasing awareness of the risk of medical errors, few data sources are available to highlight the characteristics and patterns of medical errors in the clinical management of rheumatoid arthritis （RA）. The present study aimed to evaluate medical malpractice claims associated with the management of RA and other atltoimmune connective tissue diseases （ACTDs）. Methods： We analyzed 38 ACTD-associated closed claims extracted from a total of 8530 claims processed between July 2004 and June 2014 by the Tokyo headquarters office of Sompo Japan Nipponkoa Incorporated, a leading malpractice insurer in Japan. Results： RA was the most common ACTD assessed in this study, accounting for 20 cases. Although the male-to-female ratio among these cases was 5：15, in accordance with the general demographic distribution of RA, the proportion of patients older than 60 years （77.8%） was relatively high as the general range of RA susceptibility is 30-50 years. The analysis of allegation types among RA cases revealed statistically significant differences from non-RA cases （Fisher＇s exact test） as well as the following key findings： diagnosis-related allegations were absent （P 〈 0.01 ）, whereas medication-related allegations were distinctively common （P=0.02）. Clinical processes related to the assessment process were most vulnerable to breakdown and leading to negligence identified with subsequent medication-related allegations, particularly among RA cases. Conclusions： The characteristics of malpractice claims associated with RA management, including the high frequency of medication-related allegations, breakdowns in the assessment process, and high claim numbers among patients older than 60 years, suggest the importance of caution exercised by physicians when administering immunosuppressants for the clinical treatment of RA.

关键词： Autoinlmune Connective Tissue Disease Closed Claim Rheumatoid Arthritis

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Endoscopic resection for residual lesion of metastatic gastric cancer:A case report

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World Journal of Clinical Cases 2019年第4期7卷 482-488页

作者： Kaori Hayashi Sho Suzuki Hisatomo Ikehara Hiroaki Okuno Akira Irie mitsuru Esaki Chika Kusano Takuji Gotoda Mitsuhiko moriyama Division of Gastroenterology and Hepatology Department of Medicine Nihon University School of Medicine

BACKGROUND Chemotherapy is a standard strategy for stage IV gastric cancer ***, some cases cannot undergo conversion surgery because of their frailty,even if the patients had response to chemotherapy. For these patients, local tumor progression is a problem. We report here the case of a patient whose residual gastric cancer was resected through endoscopic submucosal dissection(ESD)after concomitant chemotherapy for metastatic gastric *** SUMMARY An 85-year-old male complained of difficulty swallowing, and examination revealed gastric cancer with multiple liver metastases. Although he received concomitant chemotherapy, a residual tumor was observed in the primary lesion while the metastatic lesions disappeared completely. Conversion surgery was considered optional treatment; however, he could not undergo that because of advanced age and comorbidities. Thus, we performed ESD to treat the residual tumor. As a result, we resected the residual lesion completely. The patient has been alive for 29 mo since ESD, without *** We achieved local control using ESD, and these findings may provide therapeutic improvements both in local control and patient survival outcomes.

关键词： Gastric cancer Liver metastases Conversion Endoscopic submucosal dissection Chemotherapy Case report

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Significance of timing of therapeutic line on effectiveness of nivolumab for metastatic renal cell carcinoma

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Current Urology 2023年第1期17卷 52-57页

作者： Jun Teishima Daiki Murata Kazuma Yukihiro Yohei Sekino Shogo Inoue Tetsutaro Hayashi Koji Mita Yasuhisa Hasegawa Masao Kato mitsuru Kajiwara Masanobu Shigeta Satoshi Maruyama Hiroyuki moriyama Seiji Fujiwara Akio Matsubara Department of Urology Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan Department of Urology Hiroshima-City Asa Citizens HospitalHiroshimaJapan Department of Urology Fukuyama Medical CenterFukuyamaJapan Department of Urology Hiroshima General HospitalHatsukaichiJapan Department of Urology Hiroshima Prefectural HospitalHiroshimaJapan Department of Urology Kure Medical Center and Chugoku Cancer CenterKureJapan Department of Urology Miyoshi Central HospitalMiyoshiJapan Department of Urology Onomichi General HospitalOnomichiJapan Department of Urology Higashi-Hiroshima Medical Center Higashi-HiroshimaJapan

Objectives:This study aimed to clarify the significance of therapeutic timing on the effectiveness of nivolumab for treating metastatic renal cell *** and methods:Fifty-eight patients with metastatic renal cell carcinoma treated with nivolumab monotherapy were retrospectively *** who were treated with nivolumab as second-line therapy were included in the second-line group,while the others were included in the later-line *** clinicopathological characteristics,effects of nivolumab,and prognoses of these groups were ***:Twenty and thirty-eight patients were included in the second-line and later-line groups,*** were no significant differences in the distribution of International Metastatic Renal Cell Carcinoma Database Consotium risk and other clinicopathological characteristics between the 2 *** proportion of patients whose objective best response was progressive disease in the second-line group was significantly lower than that in the later-line group(15%vs.50%,p=0.0090).The 50%progression-free survival with nivolumab in the second-line group was significantly better than that in the later-line group(not reached and 5 months,p=0.0018).Multivariate analysis showed that the second-line setting was an independent predictive factor for better progression-free survival(p=0.0028,hazard ratio=0.108).The 50%overall survival after starting nivolumab in the second-line and later-line groups was not reached and 27.8 months,respectively(p=0.2652).Conclusions:The therapeutic efficacy of nivolumab as second-line therapy is expected to be better than that of later therapy.

关键词： Immune checkpoint inhibitor Metastatic renal cell carcinoma Nivolumab Prognostic factor Second-line treatment

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