Cisplatin is classified as a drug with high emetic risk; thus, the use of aprepitant or fosaprepitant in addition to a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist and dexamethasone is ...recommended for antiemetic therapy. Further, hydration is required to prevent renal dysfunction, and the use of magnesium has been proposed as a part of the hydration procedure. When fosaprepitant is chosen for antiemetic therapy because the patient has dysphagia, and magnesium is added to the hydration procedure, there may be an incompatibility between the two drugs that reduces the antiemetic effect. In our hospital, in a former regimen, these two drugs were administered concurrently as premedication for regimens containing cisplatin. We varied the conditions so that in a revised regimen the two drugs did not come into contact due to pharmaceutical support, and we conducted a retrospective study to determine the difference in the antiemetic effect. The observation period was 2 years (from October 2015 to September 2017) for the former regimen group (n = 89) and 2 years (from October 2017 to September 2019) for the revised regimen group (n = 177). Comparison of the former and revised regimen groups revealed sex (p = 0.012); anticancer drug dosage (p = 0.006); and variation of premedication condition (p = 0.043) as factors affected by the revised regimen. Optimization of the premedication regimen was a form of necessary pharmaceutical support to maintain the patient’s QOL.
In this study, we investigated four clinical cases of microbial contamination of in-use intravenous infusion fluid, detected by measuring “Adenosine triphosphate (ATP) + adenosine monophosphate ...(AMP)” (“ATP+AMP”) levels. High “ATP+AMP” values correlate with microbial contamination, and by utilizing these values as indicator for microbial contamination possibility, we were able to rapidly detect the contamination and recommend replacement of catheters and administration sets. In three out of four cases, changing the infusion fluid led to improvement in the condition of the patients. “ATP+AMP” levels can be used to confirm microbial contamination of in-use intravenous infusion fluids, as it is fast (several minites) and convenient to measure them.
The efficacy of biologics in psoriasis treatment is clinically proven; however, biologics are expensive. In this study, we assessed the real‐world cost‐effectiveness of biologics for psoriasis ...treatment by evaluating the relationship between biologic drug survival (DS) and total medical‐treatment costs from a pharmacoeconomic viewpoint. Furthermore, the effects of patient factors on cost‐effectiveness were investigated. We retrospectively reviewed the medical records of 135 cases who received either a tumor necrosis factor‐alpha (TNF‐α) monoclonal antibody (TNF‐mab), interleukin (IL)‐17 mab, or IL23p19‐mab for psoriasis from January 2010 to June 2020 at Yamaguchi University Hospital. We compared the monthly medical‐treatment costs according to biologic classification and found that costs of medical services, tests, and external preparations required for the treatment process were significantly higher in the TNF‐mab group than in the other groups, and the total medical costs associated with TNF‐mab treatment were significantly higher than those of IL17‐mab treatment. The total monthly cost of medical care was lower in the long‐term DS group than in the short‐term group. The number of prescriptions for external preparations, comprising Vitamin D3 and corticosteroid, was significantly higher in the long‐term DS group than in the short‐term group; in the TNF‐mab group, the proportion of patients without smoking habits was significantly higher in the long‐term group as well. Our study indicated that when costly biologics are used for psoriasis treatment, the maintenance of long‐term DS and appropriate patient guidance might improve the quality of medical care, thus allowing cost‐effective medical care.
Abstract Fosaprepitant dimeglumine relieves nausea and vomiting caused by highly emetogenic chemotherapy agents such as high-dose cisplatin. Magnesium has renoprotective effects against ...cisplatin-induced damage. Thus, both drugs are sometimes used concomitantly, but administering them together intravenously may cause occlusion of the in-line filter. We aimed to clarify the extent to which the delivery of intravenous fosaprepitant dimeglumine is reduced by magnesium sulfate. Fosaprepitant dimeglumine was combined with magnesium sulfate and then filtered. Two ratios and concentrations of magnesium sulfate were tested (1:1 and 7:3 corresponding to 1.5 mg/mL fosaprepitant dimeglumine solution to 3.85% and 0.99% magnesium sulfate solution (v/v), respectively). The concentration of fosaprepitant dimeglumine in the filtrates was measured via high-performance liquid chromatography to determine the rate of decline in fosaprepitant dimeglumine. These experiments were performed in triplicate. When the ratio of fosaprepitant dimeglumine to magnesium sulfate was 1:1, the maximum rate of decline for fosaprepitant dimeglumine was 38.67%. At a ratio of 7:3, the maximum rate of decline was 7.62%. Fosaprepitant dimeglumine likely reacted with magnesium sulfate, which might inhibit the efficacy of fosaprepitant. To prevent this, we recommend flushing the in-line filter with 50 mL of normal saline before and after the administration of fosaprepitant dimeglumine.
After 60 MeOH and water extracts of natural crude drugs were screened for their ability to stimulate osteoblast proliferation, four MeOH extracts (Cynomorium songaricum, Drynaria fortunei, Lycium ...chinense, Rehmannia glutinosa) and seven water extracts (Cornus officinalis, Dendrobium nobile, Dioscorea spongiosa, Drynaria fortunei, Eucommia ulmoides, Lycium chinensis, Viscum coloratum) showed that potent activities were evaluated for inhibition of osteoclast formation. The results indicated that the water extract of D. spongiosa not only showed the strongest stimulation of osteoblast proliferation but also possessed potent inhibitory activity aganist osteoclast formation, whereas it showed lower cytotoxicity in osteoblast and bone marrow cells. A further in vivo experiment determined the antiosteoporotic activity of this extract, in which it inhibited the decrease in cancellous bone mineral content, cancellous bone mineral density, and cortical bone mineral content of the proximal tibia in ovariectomized rats.
The utility of big data in spontaneous adverse drug reactions (ADRs) reporting systems has improved the pharmacovigilance process. However, identifying culprit drugs in ADRs remains challenging, ...although it is one of the foremost steps to managing ADRs. Aiming to estimate the likelihood of prescribed drugs being culprit drugs for given ADRs, we devised a Bayesian estimation model based on the Japanese Adverse Drug Events Reports database. After developing the model, a validation study was conducted with 67 ADR reports with a gross of 1,387 drugs (67 culprit drugs and 1,320 concomitant drugs) prescribed and recorded at Yamaguchi University Hospital. As a result, the model estimated a culprit drug of ADRs with acceptable accuracy (area under the receiver operating characteristic curve 0.93 (95% confidence interval 0.88–0.97)). The estimation results provided by the model to healthcare practitioners can be used as one clue to determine the culprit drugs for various ADRs, which will improve the management of ADRs by shortening the treatment turnaround time and increasing the precision of diagnosis, leading to minimizing the adverse effects on patients.
This study aimed to identify risk factors for remote infection (RI) within 30 days after colorectal surgery.
This retrospective study included 660 patients who underwent colorectal surgery at ...Yamaguchi University Hospital or Ube Kosan Central Hospital between April 2015 and March 2019. Using electronic medical records, we identified the incidence of surgical site infection and RI within 30 days after surgery and obtained information on associated factors. Univariate and multivariable analyses were performed to identify significant risk factors in 607 (median age, 71 years) patients.
Seventy-eight (13%) and 38 (6.3%) patients had surgical site infection and RI, respectively. Of the 38 patients diagnosed with RI, 14 (36.8%) had a bloodstream infection, 13 (34.2%) had a urinary tract infection, 8 (21.1%) had a Clostridioides difficile infection, and 7 (18.4%) had respiratory tract infections. Multivariable analysis showed that a preoperative prognostic nutritional index of ≤40 (OR, 2.30; 95% CI, 1.07-4.92; P = .032), intraoperative blood transfusion (OR (odds ratio), 3.06; 95% CI, 1.25-7.47; P = .014), and concomitant stoma creation (OR, 4.13; 95% CI, 1.93-8.83; P = .0002) were significant RI predictors.
Nutritional interventions prompted by low preoperative prognostic nutritional index in colorectal surgery may lead to decreases in postoperative RI.
In Japan, China, and Singapore, several studies have reported increased incidences of peripheral venous catheter-related bloodstream infection by
during the summer. Therefore, we hypothesized that ...bed bathing with a
-contaminated "clean" towels increases
contact with the catheter and increases the odds of contaminating the peripheral parenteral nutrition (PPN). We found that 1) professionally laundered "clean" towels used in hospitals have
(3.3×10
colony forming units (CFUs) / 25cm
), 2)
is transferable onto the forearms of volunteers by wiping with the towels (n=9), and 3)
remain detectable (80∼660 CFUs /50cm
) on the forearms of volunteers even with subsequent efforts of disinfection using alcohol wipes. We further confirmed that
grow robustly (10
CFUs /mL to more than 10
CFUs /mL) within 24hours at 30°C in PPN. Altogether we find that bed bathing with a towel contaminated with
leads to spore attachments to the skin, and that
can proliferate at an accelerated rate at 30°C compared to 20°C in PPN. We therefore highly recommend ensuring the use of sterile bed bath towels prior to PPN administration with catheter in patients requiring bed bathing.
We describe herein 4 clinical cases of microbial contamination of in-use intravenous infusion, in which we detected microbial contamination in the infusion fluid by measuring “Adenosine triphosphate ...(ATP) + adenosine monophosphate (AMP)” values. High “ATP+AMP” values correlate with microbial contamination, and by utilizing these values as indicator for microbial contamination possibility, we were able to rapidly detect the contamination and recommend replacement of catheters and administration sets. In three cases, changing out the infusion fluid led to improvement in patient outcome. The assay used to measure “ATP+AMP” values is fast (several minutes) and convenient, and therefore we recommend measuring the values as one method to ascertain microbial contamination of in-use intravenous infusion fluids.
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