No abstract available.
Humans ; Hypertriglyceridemia* ; Pancreatitis* ; Xanthomatosis*

Since its outbreak in 2019, COVID-19 has significantly impacted human lives worldwide. It has caused millions of deaths globally, as well as profound confusion and turmoil among medical professionals. During the COVID-19 pandemic, medical professionals have realized the challenges of controlling infectious diseases and the need to update their knowledge and skills to manage them better. This study examines physicians’ experiences of COVID-19 through an alumni survey conducted at Asahikawa Medical University faculty of medicine in Japan (final sample: 3,105 alumni since the university’s establishment in 1973). It draws important implications to enhance continuing education to prepare for future pandemics. An online questionnaire was developed and administered to investigate the alumni’s experiences with COVID-19, as well as their medical specialty and opinions on medical education. The response rate was 21.9%, with 680 responses collected out of the 3,105 questionnaires sent. Results show that the top three important items from participants’ experiences are infectious disease control and prevention (90.7%), acquisition of accurate knowledge on infectious diseases (85.1%), and providing accurate information on infectious diseases (83.6%). Furthermore, multiple coders conducted content analysis of free text data regarding other important elements. They identified the following major themes: information literacy, difficulty in risk management, medical treatment and healthcare system, and prejudice against medical workers and their families. Continuing education can be improved by incorporating alumni’s experiences with COVID-19 to better prepare for future pandemics.

Introduction: Voriconazole (VRCZ) is a triazole antifungal agent for which therapeutic drug monitoring (TDM) is recommended. At Juntendo University Hospital, the VRCZ TDM implementation rate was 42% between January 2011 and October 2017. Here, we report that modifications to the hospital’s drug ordering system improved the implementation rate of VRCZ TDM.Method: In August 2018, the drug ordering system was modified so that a message appeared on the screen to notify clinicians of the need to monitor VRCZ blood concentrations and to recommend a date for sample collection. In addition, the laboratory orders for VRCZ levels were digitized. We compared two one-year periods before and after implementation of the modifications (August 2017 to July 2018 and August 2018 to July 2019) to verify the effect of the changes.Result: Results showed an increase in the TDM implementation rate: 12 patients (42.8%) received TDM before modification of the system, and 26 patients (92.9%) received TDM after modification of the system. Further, the rate of blood sampling at the recommended time point for estimating blood concentration (day 5-7 after the start of administration) improved after system modification, i.e., blood samples were collected from 18 patients (64.3%) at the steady state point. In contrast, blood samples were collected from only 6 patients (21.4%) before system modification. When blood concentrations deviated from the target range in patients who received TDM, clinicians took appropriate actions, such as reducing drug doses, prescribing drug holidays, or discontinuing medications.Conclusion: A system that provides information related to VRCZ blood concentration measurements can help clinicians provide patients with optimal pharmacotherapy.

Purpose: Integrated care pathway (ICP) is structured multidisciplinary care plan that aim to improve the quality of care. ICP could be effective in providing quality End-of-Life (EOL) care in long-term care facilities (LTCFs). However, the outcomes and components of ICP for EOL care in LTCFs are not clear. Methods: We conducted a scoping review to identify the outcomes and components. We searched electronic databases (PubMed, CINAHL, Cochrane Library, PsycINFO, Ichushi) and conducted an additional hand search for relevant journal articles related to EOL care. We searched intervention and implementation studies for ICP in EOL care in LTCFs. Results: Thirteen papers met the inclusion criteria. We identified the following components of ICP: documents, education regarding EOL care and ICP, support by experts, and regular conferences among care providers. The effects of ICP were reported as reductions in transfers to hospitals and improvement in staff confidence regarding EOL care. Conclusion: With reference to the components of ICP identified in this study, ICP should be developed based on the characteristics of LTCFs, and the effects of intervention or implementation studies using a more robust design should be examined.