末田 敬志朗

<jats:sec><jats:title>Aim</jats:title><jats:p>This study aimed to assess the impact of a physician‐led intervention on advance care planning (ACP) introduction among older outpatients using a model discussion video.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This prospective interventional study included Japanese general practice outpatients aged ≥65 years. All participants received an ACP leaflet. Co‐researchers were trained using a model discussion video based on the “Serious Illness Conversation Guide,” and provided ACP introduction explanations to the intervention group to ensure intervention content consistency. The control group received the ACP leaflet only, with no standardized explanations. The primary outcome was ACP discussion occurrence. Secondary outcomes included ACP engagement (assessed through the 4‐item ACP Engagement Survey), engagement score for advance directives acquisition and score for surrogate decision‐maker identification, and anxiety incidence (assessed through Generalized Anxiety Disorder‐7).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>This study included 48 participants: 25 (52.1%) in the intervention group and 23 (47.9%) in the control group. Regarding primary outcome, the intervention group had significantly more ACP discussions compared with the control group (92.0% <jats:italic>vs</jats:italic> 26.1%, adjusted odds ratio 50.2, <jats:italic>P</jats:italic> = 0.0012). Regarding secondary outcomes, the intervention group showed greater readiness (mean scores for the 4‐item Engagement Survey [<jats:italic>P</jats:italic> = 0.0001], engagement score for advance directives acquisition [<jats:italic>P</jats:italic> = 0.01] and score for surrogate decision‐maker determination [<jats:italic>P</jats:italic> = 0.03]) than the control group, without increasing anxiety.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This physician‐led ACP introduction for older patients in a Japanese general practice setting enhanced ACP readiness and stimulated discussions, without increasing anxiety. The model discussion video for ACP introduction might effectively train physicians in general practice settings. <jats:bold>Geriatr Gerontol Int 2024; ••: ••–••</jats:bold>.</jats:p></jats:sec>

The optimal timing of antibiotic administration relative to liver abscess aspiration is debatable. This retrospective cohort study investigated whether the timing affects the abscess culture positivity rate and clinical outcomes. Twenty-nine patients with 30 percutaneously drained liver abscess cases were analyzed. Antibiotics were administered before aspiration (pre-aspiration antibiotics) in 22 cases and following aspiration (post-aspiration antibiotics) in 8 cases (i.e., 1 patient underwent aspiration twice, both before and following antibiotics). Both groups demonstrated similar patient characteristics, short time to aspiration, and high antibiotic appropriateness. Most patients were immunocompetent and non-septic. Pre-aspiration antibiotics did not reduce the culture yield (95% with pre-aspiration antibiotics vs. 100% with post-aspiration antibiotics; p = 1). Post-aspiration antibiotics were not associated with higher mortality, longer length of hospitalization, or an increased rate of clinical deterioration following aspiration. With appropriate antibiotic and aspiration, antibiotics timing can be either before or after aspiration without compromising the culture positivity rate and clinical outcomes.