ABSTRACT
OBJECTIVE: The Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system. METHODS: Data of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model. RESULTS: In total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003). CONCLUSION: It was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome.
Subject(s)
Female , Humans , Chemotherapy, Adjuvant , Drug Therapy , Endometrial Neoplasms , Gynecology , Japan , Lymph Node Excision , Obstetrics , PrognosisABSTRACT
Since 2003, Clinical training center of Fujita Health University hospital has been cooperated with the Office for medical education of Fujita Health University, school of medicine, in reorganizing the previous training system based mainly on individual departments. After 9 years since then, we established Yanegawara style training system and the trainee–centered curriculums. Outcomes from new system are as follows:<br>1. Self–establishment by problem based learning became common understandings between trainers and trainees.<br>2. Teaching by trainers to trainees and between trainees （R2 to R1） became common in the hospital.<br>3. Trainees can learn the standardized approach in diagnosis and treatment of the patients in ER.<br>4. Unified understanding of the training system was established in the hospital.Although new system brought several good aspects, we found a large heterogeneity in fulfillment of our curriculums not only by the capability of individual residents but also by the effort induced by each department.
ABSTRACT
<b>Purpose :</b> Recently, it has been reported that insulin resistance was revealed among non-PCOS women with ovulation disorder. There have been many relevant reports so far that glucose metabolism and lipid metabolism were improved by acupuncture therapy. In this research, therefore, it was examined if acupuncture therapy is effective for glucose metabolism or menstrual cycle disorder of women with ovulation disorder.<br><b>Method :</b> We had thirty three adult female measured their basal body temperature (BBT) for three months. Six of them whose BBT showed a normal menstrual cycle were put into a control group, and seven who didn’t show the high temperature phase were put into an abnormal group. Each group was given 75g of glucose tolerance test (OGTT) and their blood glucose level and insulin level were compared. Also, the abnormal group had acupuncture therapies for about a year, and their menstrual cycle, blood glucose level and serum insulin level were compared between before and after the series of therapies.<br><b>Results :</b> The comparison of the blood glucose level at 30 minutes, 60 minutes, 120 minutes and serum insulin level at 120 minutes between the control group and the abnormal group showed that they were significantly higher in the abnormal group. (The blood glucose level at 30 minutes : 113±16.0 mg/<I>dl</I> vs. 142.4±22.0 mg/<I>dl</I>, p<0.01, the blood glucose level at 60 minutes : 91.6±21.2 mg/<I>dl</I> vs. 128.2±47.9 mg/<I>dl</I>, p<0.01, the blood glucose level at 120 minutes : 84.1±9.1 mg/<I>dl</I> vs. 123.2±32.6mg/<I>dl</I>, p<0.01, serum insulin level at 120 minutes : 35.3±14.5 μU/<I>ml</I> vs. 55.0±17.5μU/<I>ml</I>, p<0.01) The comparison between before and after the therapies of the abnormal group showed that they were significantly lower at the blood glucose level at 30 minutes, 120 minutes and serum insulin level at 30 minutes, 120 minutes. (The blood glucose level at 30 minutes : 142.4±22.0 mg/<I>dl</I> vs. 119.8±26.6mg/<I>dl</I>, p<0.01, the blood glucose level at 120 minutes : 123.2±32.6 mg/<I>dl</I> vs. 94.2±18.7 mg/<I>dl</I>, p<0.01, serum insulin level at 30 minutes : 74.2±50.0μU/<I>ml</I> vs. 54.5±29.1μU/<I>ml</I>, p<0.01, serum insulin level at 120 minutes : 55.0±17.5μU/<I>ml</I> vs. 37.3±13.3μU/<I>ml</I>, p<0.05) The number of days of menstmal cycle became significantly shorter and the high temperature phase became significantly longer after the series of therapies. (Cycle : 110.8±124.7 days vs. 37.7±13.0 days, p<0.03, number of days of high temperature : 0 days vs. 7.5±4.5 days, p<0.03)<br><b>Conclusion :</b> It was suggested that acupuncture has a possibility to work effectively for improving glucose metabolism disorder and menstrual cycle for women with ovulation disorder.