才津 旭弘

BACKGROUND: The underlying general condition of older adults before proximal humerus fracture (PHF) and outcomes after PHF have not been described in detail. Furthermore, there is no consensus regarding the treatment of PHF in older adults requiring long-term care (LTC). This study assessed the LTC status and treatment in older adults with PHF and examined the changes in LTC status and death after PHF. METHODS: We conducted a retrospective cohort study using the medical and LTC insurance claims databases of a prefecture from 2014 to 2019. We included patients ≥ 65 years old with PHF and evaluated their LTC status and mortality, excluding those with an observation period of < 6 months before PHF. A survival time analysis was performed using the Kaplan-Meier method. RESULTS: We identified 887 eligible patients, including 452 (51%) in the surgical group and 435 (49%) in the non-surgical group. The proportions of patients requiring LTC were 42% and 52% in the surgical and non-surgical groups, respectively. In patients who did not require LTC, the proportion for surgery decreased with age, whereas in patients who required LTC, the proportion for surgery was highest in the 75- to 84-year-old group. The mortality rate was lower in the surgical group than in the non-surgical group among patients 75–84 years old who required LTC (log-rank p = 0.001; hazard ratio 0.16, 95% CI 0.04–0.56). In contrast, there was no significant association between treatment methods and mortality in the LTC status in the other age groups. The overall 1-year mortality after PHF was 7%, and an additional 20% of patients with PHF had worsening LTC 1 year after injury. CONCLUSIONS: Among the older adults with PHF, 47% required LTC before the injury, and 26% had a worsening LTC status or died 1 year after PHF. The prognoses after surgery for PHF differed according to age and LTC status. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-026-07269-1.

OBJECTIVE: To report on a volunteer-led program supporting local healthcare providers (L-HCPs) and disaster responders after the 2024 Noto Peninsula Earthquake, focusing on its implementation and immediate outcomes. METHODS: A volunteer-led initiative established by university alumni deployed medical teams to a local hospital on weekends following the earthquake, providing onsite support to relieve L-HCPs from prolonged strain. The program integrated information and communication technology (ICT) platforms to enable remote support, communication, and structured debriefing sessions for volunteers, facilitating assistance from a wider network. RESULTS: The project effectively sustained the local health care institution's capacity by managing diverse patient needs, including a surge in internal medical conditions. It provided essential respite, allowing local physicians crucial personal time, for which they expressed profound gratitude. Volunteer doctors reported effective stress management through the onsite and ICT-based support structure, and the initiative concluded safely without injury. CONCLUSIONS: The project demonstrated that combining onsite medical assistance with strategically implemented ICT effectively mitigates burnout among L-HCPs, providing essential psychological support for deployed volunteers. The findings highlight the significance of sustained recovery-phase support, professional networks, and ICT in disaster response. These experiences highlight the need for comprehensive, system-wide support strategies for all frontline personnel in future disasters.

BackgroundOrthopaedic infections are difficult to eradicate because biofilm and poor local vascularity limit antibiotic exposure. Continuous local antibiotic perfusion (CLAP) delivers sustained, titratable antibiotics directly into infected compartments. We used harmonised individual participant data (IPD) to quantify early effectiveness, longer-term control, safety, and patient-level modifiers.MethodsWe performed an IPD review of observational reports using CLAP as primary or adjunctive therapy (January-May 2025). The primary outcome was 30-days early response (C-reactive protein ≤3 mg/L or earliest sustained clinical/wound improvement). Secondary outcomes were durable infection control at ≥6 and ≥12 months using evaluable denominators with best-worst bounds, infection-free days) and safety. One-stage analyses used mixed-effects logistic regression; Restricted Mean Survival Time (RMST) was preferred when proportional hazards were violated. Multiple imputation supported inferences.ResultsEighty-one studies (n = 256) were included; 164 patients had observed time-to-response. Fifty-nine percent achieved a 30-days response; median time-to-response was 26 days. Implant involvement was associated with lower odds of 30-days response; trajectories were slower with implants and higher organism burden (polymicrobial ≥3), while osteomyelitis responded faster than fracture-related infection. RMST (30) showed delays with implants (+4.43 days) and polymicrobial infection (+6.74 days), and faster response for osteomyelitis versus fracture-related infection (-9.06 days). Durable control among evaluable patients was 88.4% at ≥6 months and 90.2% at ≥12 months, with best-worst bounds of 89.2-82.2% and 90.9-83.5%, respectively. Infection-free-day RMST supported substantial time free of recurrent infection within the first year. Adverse events were uncommon; renal events were generally reversible.ConclusionsCLAP achieved encouraging early response and high durability among evaluable patients, with slower trajectories when implants were retained or pathogen burden was high and faster responses in osteomyelitis. Safety appeared acceptable with monitoring. Prospective comparative studies using standardised endpoints, with RMST for non-proportional hazards, are warranted.