当科における口腔癌に対する周術期口腔機能管理の取り組み：根拠に基づく口腔機能管理を目指して

Surgical site infections represent one of the most common and costly hospital-acquired infections. As a potential preventive measure for surgical site infections, the specific effectiveness of perioperative oral management remains unclear. We conducted systematic searches, study selection, data extraction, and meta-analysis. Subgroup analysis was performed based on patient disease type, surgical site, intervention type, and intervention frequency to assess the effects of perioperative oral management under different conditions. Additionally, the certainty of evidence for critical outcomes was evaluated through the GRADE framework. Sixteen studies were finally included, comprising 10 052 patients. Both experimental studies (RR = 0.64; 95% CI, 0.48-0.85; p = 0.002) and observational studies (OR = 0.49; 95% CI, 0.37-0.65; p < 0.001) indicate that perioperative oral management significantly reduced the risk of surgical site infections. Subgroup analyses revealed a more modest effect of perioperative oral management (POM) in patients with cardiovascular disease (OR = 0.72; 95% CI, 0.54-0.96; p = 0.027) and non-oncology patients (OR = 0.66; 95% CI, 0.48-0.92; p = 0.013). It is crucial to note that POM protocols excluding both oral chemical and mechanical cleaning components showed no significant effect (OR = 0.76; 95% CI, 0.44-1.31; p = 0.323). Additionally, perioperative oral management was associated with a reduction in hospital length of stay (MD = -1.88; 95% CI, -2.98 to -0.78; p = 0.001). Perioperative oral management significantly reduces surgical site infections and shortens hospital stays. In clinical practice, patient-specific oral management plans should be developed to enhance perioperative infection control. Future studies are needed to explore the best practices and scope of application of preoperative oral management.

ObjectiveThis study aims to evaluate the performance of ChatGPT-4o and DeepSeek-R1 in perioperative medication therapy management for gastric cancer, assessing their reliability and practicality as auxiliary tools in clinical pharmacy education.MethodsThis study utilized a retrospective design to collate issues pertaining to perioperative medication management in gastric cancer, from which a standardized question set was developed. The set was concurrently submitted to both ChatGPT-4o and DeepSeek-R1 to generate model responses. Two independent assessors, blinded to the model sources, evaluated the outputs according to a predefined framework covering three core domains: (1) Clinical applicability, assessed via a 7-point Likert scale; (2) Information quality, evaluated using the DISCERN instrument for evidence reliability and content completeness; and (3) Readability, measured through the Flesch Reading Ease Score (FRES) and the SMOG Index.ResultsIn the 24-item evaluation of perioperative drug therapy for gastric cancer, both models exhibited high inter-rater reliability, with Cronbach’s α values of 0.880 for DeepSeek-R1 and 0.852 for ChatGPT-4o. DeepSeek-R1 demonstrated superior performance in clinical applicability (Likert score: 5.63 ± 0.94 vs. 5.10 ± 0.78, p < 0.001) and information quality (DISCERN score: 54.50 ± 6.71 vs. 50.56 ± 6.08), although neither model reached the excellence threshold (≥65 points). Readability assessment revealed moderately complex text difficulty, with Flesch Reading Ease scores below 30 and SMOG indices indicating a reading level of ≥17 years, which remains appropriate for undergraduate clinical pharmacy education.ConclusionBoth ChatGPT-4o and DeepSeek-R1 have demonstrated potential in addressing issues related to perioperative medication management for gastric cancer, with their generated responses showing good practical Applicability and readability suitable for the clinical pharmacy professional community. However, it should be noted that the quality of information provided by both models does not currently meet professional standards for drug therapy management. Therefore, they can be utilized as auxiliary tools for training the analytical skills of undergraduate students in clinical pharmacy, but their use should be guided by mentors.

Changes in economic conditions of development of economic subjects require application of new tools that improve functioning of entrepreneurial structures in the system of adaptation to global processes and challenges. These tools are especially important for implementation of innovative activities in large industrial structures that form the main part of the country’s GDP. One of such tools is project management, which is a targeted process of development and implementation of decisions aimed at successful execution of works within innovative activity. According to this, the purpose of the research is consideration of the models of project management of large industrial structures’ innovative activities that are used in the Russian and foreign practice. Within the research, it is necessary to solve the following tasks: consider the theoretical foundations of the essence of project management of innovative activities in large industrial structures; determine the peculiarities of the model of project management of innovative activities in large industrial structures of the Russian Federation; generalize foreign experience of project management of innovative activities of large industrial companies; form the proprietary model of project management of innovative activities of large industrial structures. The scientific novelty of the research consists in generalization of peculiarities of project management of innovative activities in the Russian and foreign realia of development with possible creation of the proprietary model of project management. The methodology of the research includes the following methods: theoretical analysis, used for generalization of existing theoretical and methodological studies in the sphere of project management of large industrial structures; generalization, used for determining peculiarities within the models of project management of innovative activities; comparison, used for comparing facts for the purpose of determining the common and different features within the Russian and foreign models of project management of innovative activities of large industrial structures; modeling, used for creating the proprietary model of project management of innovative activities within large industrial structures. The main conclusions and results could be used for studies in the sphere of project management of large industrial structures in the conditions of digital economy.

PurposeTo explore patients’, caregivers’, and health professionals’ perspectives on barriers and challenges to accessing, commencing and completing cancer therapy, with a focus on geriatric patients and the impacts of comorbidities and rurality.Patients and MethodsA qualitative sub-study using focus group discussions was conducted in a regional cancer center and one of its outreach clinics in rural New South Wales, Australia. Five discussions with three distinct cohorts were undertaken, including: 1) geriatric cancer patients (two discussions); 2) caregivers (two discussions); and 3) health professionals (one discussion). Each focus group comprised eight to ten participants. A question guide was used to elicit participants’ experiences of receiving/providing cancer care and support during cancer treatment in a rural setting. Iterative thematic analysis was undertaken, with transcripts coded using NVivo software.ResultsParticipants identified travel to larger regional centers and/or metropolitan areas and related arrangements as primary challenges to accessing diagnostic tests, surgeries, some treatments, and follow-up tests. Financial stress, and a lack of knowledge regarding available support services and mechanisms, was also a key issue for most patients and caregivers. Differences in availability of specific testing equipment, such as PET-CT, further complicated patients’ and caregivers’ experience of seeking diagnosis and management of cancer. While all interview cohorts identified positive rapport between clinicians and patients as a key characteristic of their experience of cancer management in rural and regional areas, difficulty in retaining clinical staff and related staffing levels at some health services were understood to negatively impact patients’ and caregivers’ experiences.ConclusionOverall, the study highlights the effects of geographical, social, and informational isolation on patients’ and caregivers’ experience of cancer diagnosis and management, and suggests several implications for further research and practice improvement.

ABSTRACTIntroduction: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research.Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed.Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

Surgical site infections (SSI) are associated with increased morbidity and mortality rates. This study aimed to investigate the ability of perioperative oral management (POM) to reduce the risk of SSI in abdominal surgery Real-world data collected from 16 university hospitals in Japan were reviewed. The medical records of consecutive 2782 patients (1750 men and 1032 women) who underwent abdominal surgery under general anesthesia at 16 university hospitals were retrospectively reviewed. Detailed information about SSI was assessed and compared between patients with and without POM in univariate and multivariate analyses. SSI were observed in 275 patients (incidence rate:9.9%), and POM was administered to 778 patients (28.0%). Univariate analyses revealed that diabetes mellitus, Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists classification, surgical site, preoperative Prognostic Nutritional Index score, POM, extent of surgery, operation time, and intraoperative blood loss were significantly associated with postoperative SSI (Chi-square or Mann–Whitney U test, P < .01). Multivariate analysis revealed that POM had significant preventive effects against postoperative SSI (estimate: −0.245, standard error: 0.080, P < .01). Surgical site, American Society of Anesthesiologists classification, and operation time were also significant and independent clinical predictors of SSI. The analysis of real-world data from 16 university hospitals revealed that, regardless of the content and degree of the problem, the addition of POM has significant beneficial effects in reducing the risk of SSI in patients who undergo abdominal surgery. Medical records from each hospital and data from the Health Care Payment Fund were collected and analyzed retrospectively.

Perioperative oral functional management (POFM) involves total oral management of a patient before surgery. Considerable benefits have been reported, but POFM remains scarce in medical settings. An interdisciplinary Medical Hospital Admission Center (MHAC) opened in our hospital in December 2014, and has since provided unified perioperative management for patients. This study reports on the clinical system and contributions of the systematized, standardized POFM applied through the MHAC. Patients awaiting surgery undergo oral screening before admission, with patients classified into three groups: red, needing surgical oral management (tooth extraction or other oral surgery) before surgery; yellow, needing non-surgical oral management before surgery, due to the planned surgery or the risk of tooth injury in connection with general anesthesia; or green, patients with good oral hygiene considered capable of suitable oral self-management. Patients categorized as red or yellow undergo POFM in the dental section of the MHAC before surgery. Almost all patients (88.8%) awaiting surgery now undergo preoperative oral screening, excluding emergent surgeries. In addition, oral screening is important for preventing tooth injury during endotracheal intubation for general anesthesia, and a need for preventive measures was identified in 6.1% of patients. No traumatic injuries of the teeth in connection with general anesthesia have occurred since the opening of the MHAC. Standardized POFM through an interdisciplinary MHAC thus seems extremely useful.

Health care system is the establishment of institutions, people and wealth that deliver health care services to meet the health needs of target residents. There is a broad variation of health systems on all sides of the world, with as numerous histories and organizational structures as there are nations. However common elements in almost all health systems are public health measures and primary healthcare. To assess the awareness of rural population in Dharmapuri district of Tamil Nadu in India about the medical facilities available for oral cancer treatment in their area. Questions on medical facilities available in the management of oral cancer and awareness of oral cancer were prepared to survey the residents of the Dharmapuri district, Tamilnadu, India. The survey instrument employed was a self-administered questionnaire comprising 15 questions and the responses were recorded. 83% are not aware of hospital in Dharmapuri district for oral cancer. 56% of people say oral cancer is caused by tobacco chewing, 24% of people says oral cancer is caused by smoking and 18 % of people say oral cancer is caused by using snuff and 6 % by other factors. The people in the rural parts are not aware of medical facilities available in management of oral cancer .They are moderately aware about the causative factors of oral cancer and people require the specialized units for a proper treatment.

EXECUTIVE SUMMARY Oral cancer is the term described as cancers occurring in the mouthparts that include lips, cheeks, sinuses, tongue, hard and soft palate, or the base of the mouth extending up to the oropharynx. Globally, oral cancer ranks 17th among all types of cancer in terms of both incidence and mortality. India has the largest number of oral cancer cases in the world, and this constitutes more than one-third of the total global burden. In India, oral cancer ranks as the second most common cancer, and is the number one cancer among males. In India, around 130,000 new cases and &gt;75,000 deaths were reported only in the year 2020, with an expected doubling of incidence by 2040. This burden of oral cancer is further complicated by the late-stage diagnosis and low survival rates. In India, the majority of oral cancer cases are reported in the advanced stages, and hence, the chances of cure are very low. This report provides an insight into oral cancer as a public health problem in India, along with etiology and strategies to diagnose, treat, and prevent it while providing recommendations to improve upon the availability and delivery of treatment for oral cancer. The predominant risk factor for developing oral cancer is tobacco consumption. The continual use of tobacco in both smoking and smokeless forms is a major contributor to tumor development in the oral cavity. Other risk factors such as alcohol, diet and nutrition, oral thrush, dental problems, chronic irritation from sharp teeth or ill-fitting dentures, and human papillomavirus (HPV) infection also contribute to the burden. Further, social, cultural, and psychological factors too play an important role in developing oral cancer. Oral potentially malignant disorders (OPMDs) are a diverse group of conditions that are the precursors of oral cancer. It is important to recognize that a patient diagnosed with an OPMD has an increased risk of developing oral cancer compared to a person with a healthy mucosa. Lesions such as Erythroplakia, Erythroleukoplakia, Leukoplakia, Proliferative verrucous leukoplakia, Submucous fibrosis, Palatal lesions associated with reverse smoking, oral lichenoid lesions, oral lichen planus, smokeless tobacco keratosis, and more are the common OPMDs seen in the country. Oral cancer screenings, which are conducted to identify any clinical premalignant phase (accessible to visual inspection), are usually done on a mass scale and shows a decreased burden of advanced oral cancer incident cases and deaths as compared to no screening. Among the screening strategies, it is suggested that high-risk screening is cost-effective compared to mass screening at periodic intervals. Oral cancer screening methods vary across healthcare settings, each with its advantages and limitations. While visual inspection remains a fundamental tool, adjunctive technologies are sometimes used in dental clinics; community outreach programs and telemedicine extend accessibility to screening. The Ministry of Health and Family Welfare, Government of India, has prepared a universal and objective operational framework for cancer screening and management that aims to promote, coordinate, and conduct research to better understand, detect, diagnose, and treat cancer. The framework makes it mandatory to perform screening of oral, cervix, and breast cancer for males and females above the age of 30. Concerning oral cancer treatment, several modalities are available; however, the cure depends on the cancer stage when diagnosed and the delay in starting treatment. Primary surgery is the preferred modality of treatment for a vast majority of operable oral cancers. Radiotherapy is an alternate for early-stage oral cancers with comparable control rates to surgery. Typically, the primary treatment for oral cancer is surgery. The primary goal of surgical resection is to ensure complete removal of the tumor tissue. However, the potential negative impacts on appearance and functionality due to the extent of the disease and the necessary surgical removal stress the importance of using less invasive surgical methods. The National Cancer Grid Management Guidelines for early-stage cancer recommends surgical local excision with a minimum of 1 cm gross margin, accompanied by appropriate neck dissection and suitable reconstruction. For advanced stages, surgery is preferred, along with adjuvant radiotherapy or chemotherapy. Oral cancer in its entirety imposes a significant fiscal burden on a national, institutional, family, and individual level. Funding of cancer care in India is a complex mixture of state and government accountabilities, with the government shouldering most of the responsibility. Oral cancer as such, has not been given a separate budget in India, but it is covered under various facilities of the government, schemes, and programs for cancer. This report entails the Task Force Committee recommendation for screening, diagnosis, prevention, and management of oral cancer, along with research, policy, and advocacy recommendations to address this immense public health problem in the country.

The aim of this study was to develop a competency framework based on entrustable professional activities (EPAs) in oral cancer management by postgraduate trainees in oral and maxillofacial surgery through expert consensus. The study design was based on a modified Delphi technique and involved iterative online surveys with two rounds of data collection and analysis. Initial development of the questionnaire identified five EPAs based on 42 competencies along with supervision level and assessment strategies. The first Delphi round involved administration of the survey questionnaire online to maxillofacial surgeons meeting the inclusion criteria for experts. Consensus was achieved on five EPAs and 36 competencies (≥80% response rate). Six competencies were rephrased and sent again in the Round 2 questionnaire to achieve a consensus. A total of 45 experts participated in Round 1 followed by input from 27 experts in Round 2 of the Delphi panel. Following two iterative rounds of online surveys and feedback, expert consensus was achieved to develop an EPA framework in five EPA domains focused on the management of oral cancer by postgraduate trainees in maxillofacial surgery including 38 specific competencies, supervision level, and assessment strategies. High content validity of the study was established through a comprehensive literature search, and expert feedback was evidenced by an excellent response rate (93.34%, and 64.28%) and a stringent criteria of response agreement amongst experts (≥80%). In conclusion, this study employed expert consensus to identify five EPAs with 38 competencies along with the required supervision level of postgraduate maxillofacial trainees for the management of oral cancer. This EPA framework provides a roadmap for training supervisors to map the learning outcomes in oral oncology for postgraduate trainees in oral and maxillofacial surgery.

We studied the perioperative management (PM) of patients with both lung cancer (LC) and cardiac disease (CD) comorbidity (LCC) and their comparative clinical outcome between combined (CP) and staged (SP) surgical procedure. We searched international literature between 1990 up end of 2014, examining two different kinds of meta-analyses concerning a) the perioperative management (PM) and b) the clinical outcome (CO) of CP compared to SP inthe surgical management of these patients. For mortality rates and sequellae we used Freeman-Tukey transformation while for investigation of interpretation factors we used Stat meta-regression package, All studies agree that PM of patients with LCC includes sufficient myocardial perfusion prior to other surgery and the importance of pre/post-operative management. CO is affected is influenced by the surgical incision, the extracorporel circulation and the type of vascular grafts used. LC of stage I or II is an indication for CP. Advanced heart failure, hemorragic predisposition, proximity of tumor to esophagus, descending aorta and infiltration of parietal or diaphragmatic pleura by the tumor are strong contraindications for CP. It is concluded that patients submitted to CP (cardiopulmonary bye-pass + squamous carcinoma stage pT1 or pT2 and lobectomy) exhibit increased risk for postoperative complication not amenable to the cardiopulmonary bye-pass or the type of operation.

BackgroundManagers are considered to be main stakeholders in the return to work (RTW) of cancer survivors. However, the perspectives of cancer survivors and managers differ on what managerial actions should be taken during the RTW of cancer survivors. This difference might put effective collaboration and successful RTW at risk. Therefore, this study aims to reach consensus among managers and cancer survivors on the managerial actions to be taken during the four different RTW phases of cancer survivors (i.e., Disclosure, Treatment, RTW plan, Actual RTW).MethodsThe Technique for Research of Information by Animation of a Group of Experts (TRIAGE) was implemented with managers and cancer survivors (hereafter referred to as “experts”). An initial list of 24 actions was derived from a previous study. Firstly, for each action, fifteen experts were asked to indicate individually how important this action is per RTW phase (Likert scale from 1 – “Not important at all” to 6 – “Very important”). Consensus was reached when ≥ 80% (i.e., ≥ twelve experts) of the experts rated that action ≥5. Secondly, for each phase of the RTW process, the 15 actions with the highest percentage were discussed with eight experts during the collective consultation, except for the actions that already reached consensus. After discussion, the experts voted whether each action was important (“yes” / “no”) and consensus required ≥ 87.5% (i.e., ≥ seven experts) of the experts to consider an action as important.ResultsTwenty-five managerial actions were finally retained for at least one of the RTW phases, e.g., Disclosure: “respect privacy” and “radiate a positive attitude”, Treatment: “show appreciation” and “allow sufficient sick leave”, RTW Plan: “tailor” and “communicate”, and Actual RTW: “support practically” and “balance interest”.ConclusionCancer survivors and managers reached consensus on the importance of 25 managerial actions, distributed into each phase of the RTW process. These actions should be considered an interplay of managerial actions by different stakeholders on the part of the employer (e.g., direct supervisor, HR-manager), and should be a responsibility that is shared by these stakeholders. The collective implementation of these actions within the company will help cancer survivors feel fully supported.

Purpose. The purpose of the study was to analyze the mechanisms of anti-crisis management of the activities of enterprises in the conditions of international economic activity. The formation of mechanisms for anti-crisis management of enterprise activities was studied, in particular, the development of event development scenarios and action plans in case of their implementation, early warning systems, cost optimization, production efficiency improvement, personnel training for work in crisis situations. Design/methodology/approach. The definition of the concept of "anti-crisis management" is considered, as well as the goals and main tasks of anti-crisis management are highlighted. Classification of the factors of activation of anti-crisis management at the macro, meso and micro levels has been carried out. The international experience of anti-crisis management of enterprises is considered. The following research methods are used: analysis, synthesis, generalization, analogy, comparison, systematization. Findings.The international economic features of the formation and development of anti-crisis management of enterprise activities are analyzed. The use of artificial intelligence for proactive risk management with the aim of improving anti-crisis management, in particular in forecasting large databases, forecasting trends, identifying risks, creating scenarios and automating routine tasks, is considered. It was concluded that the formation and development of effective anti-crisis management mechanisms is one of the most important tasks for any enterprise, and, taking into account international economic features, enterprises must constantly adapt their strategies and tools to ensure sustainable development in conditions of uncertainty. Practical implications. In anti-crisis management, the use of AI allows to achieve the following results: improved forecasting – AI allows more accurate forecasting of risks and opportunities, which helps companies respond to market changes in a timely manner; optimization of resources – AI helps to optimize the use of resources, such as finances, personnel and materials, which allows to reduce costs and increase efficiency; increasing the speed of decision-making – AI allows you to quickly process large volumes of data and make informed decisions; improving the quality of customer service – AI allows personalizing interaction with customers, which increases their loyalty; increased competitiveness – companies that use AI can adapt more quickly to market changes and remain competitive. Originality/value. Modern trends in the field of anti-crisis management of enterprises include: proactive risk management (instead of reacting to crises that have already occurred, enterprises switch to proactive risk management, predicting them and taking measures to minimize them); use of technologies (artificial intelligence, machine learning and other technologies allow analyzing large volumes of data, identifying potential threats and making more informed decisions); cooperation with external experts (engagement of consultants and other specialists helps enterprises gain additional knowledge and experience in the field of anti-crisis management).

This editorial explores the important role that nurses play in bridging the gap in the prevention and management of oral cancer. Despite advances in medical science, oral cancer remains a significant global public health challenge, with high mortality rates due to late diagnosis and inadequate treatment. Nurses, with their multifaceted contributions, are indispensable in addressing this challenge. The editorial emphasizes the key role of nurses in patient education and awareness, early detection and screening, comprehensive patient care, supportive services, and advocacy. Nurses are frontline educators, advocates, caregivers, and collaborators in the fight against oral cancer. Through their expertise, compassion, and dedication, nurses have a significant impact on patient outcomes, reducing mortality rates, and promoting a healthier future for those affected by oral cancer. Recognizing and supporting the crucial role of nurses in the management of oral cancer is essential for advancing prevention, detection, and treatment efforts.

Este estudo teve como objetivo analisar o perfil e as experiências dos clinical managers que atuam em hospitais brasileiros, qualificando sua atuação como profissionais híbridos e comparando suas vivências nos contextos público e privado. A intenção foi compreender suas atividades clínicas e gerenciais, bem como avaliar sua preparação e desenvolvimento para essa função. Trata-se de um estudo transversal, de caráter exploratório e abordagem qualitativa, realizado entre março de 2019 e julho de 2020, com profissionais da saúde que ocupavam cargos de gestão. Os resultados apontam que os clinical managers possuem formação acadêmica predominantemente em Enfermagem e Medicina. Nos hospitais públicos, destaca-se a formação em Enfermagem (61,7%), enquanto a Medicina predomina nos hospitais privados (55,6%). A pós-graduação lato sensu na área de Gestão de Saúde/MBA é a mais recorrente entre esses profissionais (52,5%). Observou-se que há conciliação entre as atividades clínicas e gerenciais na rotina dos clinical managers, sendo que, nos hospitais privados, a dedicação às funções gerenciais é mais intensa em comparação aos públicos, nos quais os gestores precisam atuar de forma mais presente na assistência. Conclui-se que aspectos relacionados à identidade profissional e à análise dos projetos pedagógicos dos cursos de graduação em Medicina e Enfermagem podem ser explorados para auxiliar na transição do profissional clínico para o perfil híbrido de clinical manager. Tal transição deve ocorrer com planejamento, clareza e preparação, permitindo a conciliação eficiente entre atividades clínicas e gerenciais, o que é fundamental para a execução adequada dos artefatos de Contabilidade Gerencial.