Investigation of Patients' Motivation for Cosmetic Surgery in a Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgeons in Japan have used social media to advertise their procedures. We analyzed the influence of social and other media on patients' motivation to visit our clinic using the aggregated results of a questionnaire distributed to our cosmetic surgery group. Methods: We obtained the data of 146,108 patients from our database between September 2018 and February 2023. To understand changes in patient motivation over time, patient motivation was compared between the opening (September 2018-February 2020), growth (March 2020-August 2021), and expansion (September 2021-February 2023) periods. Results: Most patients were motivated to visit clinics by the internet (53.7%) and Instagram (17.3%). Between the opening and growth periods, the internet [odds ratio (OR) 1.28; 95% confidence interval (CI), 1.14-1.43] and referrals (OR, 1.48; 95% CI, 1.08-2.01) significantly increased. Between the opening and expansion periods, there was a significant increase in TV (OR, 4.86; 95% CI, 3.09-7.65) and TikTok use (OR, 24.9; 95% CI, 3.50-177.0). There was more variability in the motivation to visit our clinic during the expansion period than during the other periods, and patients' motivation differed by procedure and region. In addition, TikTok was used primarily by patients in their late teens and early twenties, whereas TV was used by those in their twenties and forties. YouTube, referrals, and review websites were distributed bimodally. Conclusions: Patients choose information from various media sources. To attract more patients to our clinics, it is important to disseminate information on both the internet and social media.

Recent Status of Procedures in a Single Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgery demand has increased due to the spread of promotional social media in Japan. However, understanding the overall landscape remains difficult due to many clinics with varied procedure options. To understand the current trends and status of cosmetic surgery in Japan, we analyzed large-scale data from a group of clinics throughout the country. Methods: We analyzed data from 152,457 patients in our database. The periods from September 2018 to August 2021 and September 2021 to February 2023 were defined as the first and second periods, respectively, and the statuses of procedures were compared between the two. Results: Eye procedures were the most common (23.6%), followed by face-lifts (19.5%) and dark circles under the eyes (10.4%). Between the first and second periods, the number of procedures in the second period (128,898 cases) was overwhelmingly higher than that in the first period (23,559 cases). Orbital fat removal for dark circles under the eyes significantly increased (OR 2.97, 95%CI 2.78-3.17); procedures in provincial cities significantly increased (Kinki/Chugoku/Shikoku: OR 2.21, 95%CI 2.08-2.36); and procedures for patients with occupations where appearance is considered important, such as nightlife businesses or being a celebrity, decreased (celebrity: OR 0.44, 95%CI 0.38-0.51, nightlife business: OR 0.58, 95%CI 0.53-0.62). Conclusions: In Japan, cosmetic surgery has become increasingly common in recent years, and the trend has been changing over time. In the future, it will be important to organize and enhance our large-scale database to disseminate more accurate and useful information.

[The Strategic Plan of the Japan Pharmaceutical Association, The Aspect of a Super Aged Society].

The anticipation of Japan's decreased birthrate and a shift to an aged society has led to the field of medical care to review the country's social security system. The review calls for a reform of the medical insurance system under the universal health coverage system to fit the changing demographic. The target year of 2025 has the government advocating for an "integrated community care system", with the 'baby-boom generation' turning 75. This is a sustainable regional system that can cope with the aging society and the declining birthrate simultaneously. Within this new system, I would like to discuss The Strategic Plan of the Japan Pharmaceutical Association, released with the aim of realizing pharmacists and pharmacy services that can immediately respond to the expectations of society; from the perspective of the theme of this symposium, "Communicating the image of pharmacists in a community-based society".

Comparison of postoperative knee flexion and patient satisfaction between newly and conventionally designed medial pivot total knee arthroplasty: a 5-year follow-up matched cohort study.

INTRODUCTION: The medial pivot total knee arthroplasty (TKA) has good patients' satisfaction; however, there is likely the restriction of postoperative knee flexion. The 2nd generation medial pivot TKA prosthesis was designed to improve postoperative knee flexion. This study aimed to compare the clinical outcomes and patient satisfaction between the 2nd generation and 1st generation medial pivot TKA prostheses. MATERIALS AND METHODS: We conducted a retrospective study of 472 consecutive TKAs, performed using either the 2nd generation (EVOLUTION™), having smaller posterior femoral condyle and asymmetrical tibial tray, or 1st generation (ADVANCE™) prosthesis. The use of each system was historically determined. Patient age, sex and body mass index were matched between the two groups, with 157 cases ultimately included in each group. Measured clinical outcomes included: knee range of motion, the Knee Society Score, the rate of re-operation, and radiological parameters. Patient satisfaction was evaluated using the 12-item Forgotten Joint Score (FJS-12). RESULTS: The average follow-up period was 5.0 (3.7-6.3) years for the 2nd generation group and 8.7 (6.1-12.8) years for the 1st generation group (p < 0.01). The postoperative knee flexion range was 127° (80°-140°) for the 2nd generation and 118° (90°-135°) for the 1st generation at final follow-up (p < 0.01). On multivariate regression analysis, use of the 2nd generation prosthesis predicted greater postoperative knee flexion. The average FJS-12 score was 64 (0-100) for the 2nd generation and mean 57 (0-100) for the 1st generation (p < 0.01). Other clinical outcomes were similar between the two groups. CONCLUSIONS: Compared to the 1st generation, the 2nd generation medial pivot prosthesis provides greater postoperative knee flexion and patient satisfaction.

Medial peg position of cementless porous tantalum tibial component affects bone mineral density around the prosthesis after total knee arthroplasty: 2-year follow-up study.

BACKGROUND: Use of a porous tantalum tibial component for total knee arthroplasty (TKA) was reported to have beneficial effects on periprosthetic bone mineral density (BMD). In some cases, hexagonal peg is placed close to or in contact with the tibial cortex, which may result in stress-shielding around the peg. However, no studies have analyzed the relationship between peg position and BMD. The aim of this study was to compare the peg position and BMD around the peg in a porous tantalum tibial component after TKA. METHODS: Twenty-seven patients (27 knees) who underwent primary TKA with a cementless porous tantalum tibial component were investigated. BMD was measured by dual-energy X-ray absorptiometry for 2 years after the operation. The distance between the peg and the tibial cortex (peg distance) was measured on the medial and lateral sides. RESULTS: BMD was decreased in the medial region after the operation (p < 0.01). Relative change in BMD was lower in the medial region than in the central and lateral regions (p < 0.01). Multiple regression analysis showed that medial peg distance was negatively correlated with relative change of BMD in the medial part of the tibia (p = 0.04, R = 0.402). CONCLUSIONS: The medial peg position affected the postoperative relative change of BMD in the medial part of the tibia, but did not affect the longevity of the implant. As the tibial medial peg became closer to the medial tibial cortex, the BMD loss became larger in the medial part of the tibia at 2 years postoperatively.

No Difference in Postoperative Knee Flexion and Patient Joint Awareness Between Cruciate-Substituting and Cruciate-Retaining Medial Pivot Total Knee Prostheses: A 10-Year Follow-Up Study.

BACKGROUND: This study aimed to clarify differences in clinical results, including in patients' joint awareness, between cruciate-substituting (CS) and cruciate-retaining (CR) medial pivot total knee arthroplasty (TKA) over a 10-year follow-up. METHODS: A total of 333 TKAs were included in this study. There were 257 cases of CS and 76 cases of CR TKAs. Knee range of motion, Knee Society Score, and radiological outcomes were assessed. The patients' joint awareness was evaluated using the Forgotten Joint Score-12 at the final follow-up. The survival rate with respect to reoperation or revision was analyzed. RESULTS: The mean follow-up period was 10 ± 1.7 years, and the loss to follow-up was 5.4%. All clinical outcomes improved significantly after surgery in both groups (P < .001). Postoperative knee flexion was 118° ± 13° in the CS group and 116° ± 10° in the CR group (P = .10). The mean Forgotten Joint Score-12 scores were 57 ± 27 points in the CS group and 56 ± 28 points in the CR group (P = .59). Ten years after the operation, the survival rates for reoperation were 96.3% in the CS group and 94.2% in the CR group (P = .61), and those for revision were 98.4% and 98.7% in the CS and CR groups, respectively (P = .87). Other postoperative clinical results did not differ between the 2 groups. CONCLUSION: In this 10-year follow-up study, medial pivot TKA, regardless of polyethylene insert type, showed a high survival rate and good patient awareness of the prosthetic joint.

Differences in the setting of acetabular component alignment guides between the supine and lateral positions for total hip arthroplasty.

The acetabular component orientation in total hip arthroplasty is of critical importance to clinical results. Although navigation systems and surgical robots have been introduced, most surgeons still use acetabular component alignment guides. This study aimed to compare the accuracy between modern acetabular component alignment guides for the lateral position and those for the supine position. Thirteen alignment guides for the lateral position and 10 for the supine position were investigated. All the lateral position alignment guides indicated cup alignment in operative definition, and the supine position alignment guides indicated cup alignment in radiographic definition. For lateral position alignment guides, the anteversion actually indicated by the alignment guide itself was smaller than that indicated by the manufacturer by a mean of 6° (maximum, 9°), and the inclination actually indicated by alignment guides themselves was larger than that by the manufacturer (p < 0.01) by a mean of 2° (maximum, 4°). For supine position alignment guides, the inclination and anteversion indicated by the alignment guide itself were identical with those indicated by the manufacturer. The current study showed that the angles actually indicated and those stated by manufacturers were not identical for lateral position alignment guides.

Primary Vascularized Bone Graft for the Extruded Scaphoid Proximal Pole: A Case Report.

CASE: A 52-year-old man sustained a radiocarpal dislocation with extrusion of the scaphoid proximal pole, which was completely detached from the soft tissue. To reduce the risk of avascular necrosis (AVN), treatment involved simultaneous anatomic reduction and internal fixation of the fracture and vascularized bone graft (VBG) for the scaphoid proximal pole. At 4 months, magnetic resonance imaging and 36 months of follow-up radiography showed a healed scaphoid and revealed no evidence of AVN in the scaphoid proximal pole. CONCLUSION: If the risk of AVN is high, we recommend considering the combination of internal fixation and VBG for the fresh scaphoid fracture.

Long-term clinical outcomes of medial pivot total knee arthroplasty for Asian patients: A mean 10-year follow-up study.

BACKGROUND: Many Asian populations have a unique floor-based lifestyle that might cause mechanical stress of the knees. It is important to clarify the longevity of a medial pivot total knee arthroplasty, as its prosthetic design could cause mechanical stress onto the insert. The purpose of this study was to clarify the clinical results of medial pivot total knee arthroplasty for Asian patients in a 10-year follow-up study. METHODS: Consecutive, primary total knee arthroplasties (n = 257) were analyzed in the study using the medial pivot knee system. The clinical outcomes were assessed preoperatively and at the final follow-up. The patient-reported Forgotten Joint Score-12 and radiological outcomes were measured at the final follow-up. The survival rate was assessed with reoperation or revision as the end-point. RESULTS: The mean follow-up period was 10.1 ± 1.7 years. The lost to follow-up was 4.5%. All clinical outcomes improved significantly after surgery (p < 0.001). The mean postoperative knee flexion was 118° ± 11° and the mean Forgotten Joint Score-12 was 59.7 ± 27 points. The radiolucent line was observed in 29 patients (11.3%), however there was no aseptic loosening noted. The survival rates with reoperation or revision were 96.3% or 98.4% at 10 years after the operation. CONCLUSIONS: Medial pivot total knee arthroplasty used for Asian patients showed good longevity and patient-reported outcome measurement in a mean 10-year follow-up study. Medial pivot total knee arthroplasty has long-term stability among patients who have a floor-based lifestyle. LEVEL OF EVIDENCE: III.

Community pharmacists provided telephone treatment support for patients who received long-term prescribed medication.

PURPOSE: This study was conducted to evaluate whether a community pharmacist's assistance during the treatment of a patient with a chronic illness would help to discover and improve issues regarding the treatment. METHOD: We employed a prospective intervention study with a control group. The patients ranging in age from 60 to 74, were using one of the six selected community pharmacies in the Tokyo metropolitan area. They had been prescribed six or fewer kinds of medications, one of which was amlodipine. The medication dosages covered 1 month or longer. Patients who agreed to participate in the study were randomly assigned to the groups at each pharmacy. For the patients in the intervention group, the pharmacists provided telephone counseling between physician visits, in addition to the time they visited the pharmacies to collect their medications. For the patients in the control group, the pharmacists provided counseling only at their pharmacies. RESULTS AND DISCUSSION: The average days of medication administration were 49.2 days for the 58 patients in the intervention group, and 49.8 days for the 53 patients in the control group, with the average number of medications being 3.4 items per person for both groups. Through the telephone counseling, we were able to collect more information, eg, changes in physical condition and occurrences of side effects, from the intervention group than from the control group. The rate of incident detection in the information from the intervention group was five times that of the control group, making subsequent incident resolutions faster. CONCLUSION: This study suggested that phone counseling between physician visits could enable the identification of more issues regarding patients' conditions.

The effect of one-dose package on medicationadherence for the elderly care in Japan / Efecto de los envases de dosis unitaria en la adherencia a la medicación de los ancianos en Japón

Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition. Objective: This study surveyed the effect of one dose package medication made up by a pharmaciston the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly. Methods: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefecture, Japan, the survey form of one-dose package was sent to 86 pharmacy directors located in Ueda-city. Results: The most frequent reasons of one dose packaging was 'Patient’s request' though, 'Largenumber of doses', 'Prevent the improper drug use'and 'Improved medication adherence' which is considered that the pharmacists are willing to utilize one dose package for patient’s care in order to improve the medication adherence were chosen aswell. The influences of one dose package for patient’s medication adherence were very positive, and most answers indicated that medication adherence was improved. Conclusion: It is noticed that the pharmacists were willing to dispense one dose packaging by own decision, not physician’s order, in order to improve the medication adherence, prevent improper drug use and optimize the medication therapy. It is also noticed that there are great improvement of patient’s compliance by one dose package, and patients felt advantage to reduce the improper drug use as well (AU)

Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition. Objective: This study surveyed the effect of one-dose package medication made up by a pharmacist on the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly. Methods: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefecture, Japan, the survey form of one-dose package was sent to 86 pharmacy directors located in Ueda-city. Results: The most frequent reasons of one dose packaging was 'Patient’s request' though, 'Large number of doses', 'Prevent the improper drug use' and 'Improved medication adherence' which is considered that the pharmacists are willing to utilize one dose package for patient’s care in order to improve the medication adherence were chosen as well. The influences of one dose package for patient’s medication adherence were very positive, and most answers indicated that medication adherence was improved. Conclusion: It is noticed that the pharmacists were willing to dispense one dose packaging by own decision, not physician’s order, in order to improve the medication adherence, prevent improper drug use and optimize the medication therapy. It is also noticed that there are great improvement of patient’s compliance by one dose package, and patients felt advantage to reduce the improper drug use as well (AU)

The effect of one-dose package on medication adherence for the elderly care in Japan.

UNLABELLED: Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition. OBJECTIVE: This study surveyed the effect of one-dose package medication made up by a pharmacist on the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly. METHODS: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefecture, Japan, the survey form of one-dose package was sent to 86 pharmacy directors located in Ueda-city. RESULTS: The most frequent reasons of one dose packaging was "Patient's request" though, "Large number of doses", "Prevent the improper drug use" and "Improved medication adherence" which is considered that the pharmacists are willing to utilize one dose package for patient's care in order to improve the medication adherence were chosen as well. The influences of one dose package for patient's medication adherence were very positive, and most answers indicated that medication adherence was improved. CONCLUSION: It is noticed that the pharmacists were willing to dispense one dose packaging by own decision, not physician's order, in order to improve the medication adherence, prevent improper drug use and optimize the medication therapy. It is also noticed that there are great improvement of patient's compliance by one dose package, and patients felt advantage to reduce the improper drug use as well.

Current state of community pharmacy in Japan: practice, research, and future opportunities or challenges.

OBJECTIVE: To describe the activities related to pharmaceutical care and research in community pharmacies in Japan. FINDINGS: Japan is an aging society; the proportion of elderly people aged at least 65 years was 19.9% in 2005 and is expected to rise to 26.0% by 2015. This increase will result in ballooning healthcare costs. To curb the huge and rapidly increasing expenditure on medical treatment, many structural reforms have been undertaken in Japan. The healthcare services in community pharmacies will also undergo reforms to meet social needs and patient/customer requirements. In 2006, the undergraduate pharmacy program offered by universities was changed to a 6 year program, including 6 months of clinical training in both hospitals and community pharmacies. This change should provide an opportunity for community pharmacists and academics to communicate with each other, and we anticipate that it will further the research in community pharmacies. Accreditation programs will also improve the level of health care. DISCUSSION: The healthcare system should undergo reforms to address the problems related to Japan's low birth rate and the needs of an aging population. Such reforms are also required to ensure a healthy aging society and should not have adverse effects on socially vulnerable children and the elderly. Pharmacists should contribute to the development of a healthcare system for an aging society by providing appropriate pharmaceutical care. Since a large number of prescriptions are dispensed through community pharmacies, pharmacists have a greater opportunity to improve health care. In addition, pharmacist associations are encouraging their members to actively participate in home medical care services. An effective community healthcare program should reduce the need for institutional care. CONCLUSIONS: Although Japanese pharmacists are not fully capable of providing pharmaceutical care at this stage, they will play a crucial role in ensuring a healthy aging society in the future, particularly in the community setting.

[Randomized controlled study on the effectiveness of community pharmacists' advice for smoking cessation by Nicorette--evaluation at three months after initiation].

We conducted a randomized, controlled study to evaluate whether pharmacists' advice on smoking cessation would result in a higher smoking cessation rate using Nicorette (nicotine gum preparation). Fourteen pharmacies in Tokyo, Kanagawa, and Nagano participated. Smokers who visited pharmacies to buy Nicorette from March 1, 2002, through August 31, 2002, were recruited and randomly assigned to two groups. For the intervention group (A), pharmacists provided both regular instructions on Nicorette use and smoking cessation advice at the first sale and then gave follow-up advice just before starting a cessation and 1, 3, and 8 weeks and 3 months thereafter. For the control group (B), pharmacists provided regular instructions alone. The primary outcome measure was the self-reported smoking cessation rate and the secondary outcome measure was the relationship between the smoker's egogram and effectiveness of intervention. Twenty-eight smokers were enrolled and randomized into group A (n=11) or group B (n=17). The absolute abstinence rate in groups A and B at 3 months was 45.5% and 31.2%, respectively. The odds ratio was 1.83, which was not statistically significant. There was no difference in egogram score between absolute abstinence subjects and nonabstinence subjects in group A. The egogram scores in Adapted Child of absolute abstinence subjects in group B were significantly higher than in nonabstinence subjects. In conclusion, instructions and advice given by pharmacists may improve the smoking cessation rate in smokers receiving nicotine replacement therapy.

Porous properties of activated carbons from waste newspaper prepared by chemical and physical activation.

Activated carbons were prepared from old newspaper and paper prepared from simulated paper sludge by chemical activation using various alkali carbonates and hydroxides as activating reagents and also by physical activation using steam. In the chemical activation, the influence of oxidation, carbonization, and activation on the porous properties of the resulting activated carbons was investigated. The specific surface areas (S(BET)) of the activated carbons prepared by single-step activation (direct activation without oxidation and carbonization) were higher than those resulting from two-step activation (oxidation-activation and carbonization-activation) and three-step activation (oxidation-carbonization-activation) methods. The S(BET) values were strongly dependent on the activating reagents and the activating conditions, being >1000 m(2)/g using K(2)CO(3), Rb(2)CO(3), Cs(2)CO(3), and KOH as activating reagents but <1000 m(2)/g using Li(2)CO(3), Na(2)CO(3), and NaOH. These differences in S(BET) values are suggested to be related to the ionic radii of the alkalis used as activating reagents. The microstructures of the higher S(BET) samples show a complete loss of fiber shape but those of the lower S(BET) samples maintain the shape. In the physical activation, the porous properties of the activated carbons prepared by the single-step method were examined as a function of the production conditions such as activation temperature, activation time, steam concentration, and flow rate of the carrier gas. The maximum S(BET) and total pore volume (V(P)) were 1086 m(2)/g and 1.01 ml/g, obtained by activation at 850 degrees C for 2 h, flowing 20 mol% of steam in nitrogen gas at 0.5 l/min. A correlation was found between S(BET) and the yield of the product, the maximum S(BET) value corresponding to a product yield of about 10%. This result is suggested to result from competition between pore formation and surface erosion. Compared with chemically activated carbons using K(2)CO(3), the porous properties of the physically activated carbons have lower S(BET) and V(P) values because of the smaller size and lower volume of their micropores. On the other hand, they retain the original fiber shape and the paper sheet morphology after activation.

Adsorption properties of activated carbon from waste newspaper prepared by chemical and physical activation.

Adsorption properties of activated carbons prepared from waste newspaper by chemical and physical activation were investigated using water vapor, ammonia, methane, and methylene blue (MB) as adsorbents. The water vapor adsorption isotherms show type V behavior and the maximum vapor adsorption of the chemically and physically activated products is about 1050 and 450 ml/g, respectively. The higher water vapor adsorption of the chemically activated products is attributed to the higher specific surface area (S(BET)) and greater hydrophilic activity (arising from the surface oxygen-containing functional groups) than in the physically activated products. The adsorption of ammonia and methane was measured by temperature-programmed desorption (TPD). NH(3) adsorption is found to be higher in the chemically activated product than in the physically activated product while methane adsorption is slightly higher in the physically activated products even though these have lower S(BET) values. In the MB adsorption, the chemically activated products show higher adsorption (390 mg/g) than the physically activated product. These results are suggested to be related to the surface characteristics.