Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

A 60-year-old woman was treated with oxycodone extended-release tablets for the cancer pain due to cervical cancer, and oxycodone was continued for abdominal pain due to radiation enteritis, laparotomy, small bowel obstruction, and constipation even after the cancer had been cured with chemoradiotherapy. The patient experienced severe drowsiness, and the opioid analgesics dose was gradually reduced. The dose was reduced by switching from oxycodone extended-release tablets to morphine powder. The patient’s drowsiness, constipation, and abdominal pain improved with reduction in opioid dosage, but she developed malaise, sweating, and agitation. These symptoms improved with morphine powder; thus, she was diagnosed with opioid withdrawal syndrome. We attempted to further reduce the dose gradually over a period of four years, but withdrawal symptoms reappeared when morphine powder was discontinued. Therefore, at present, we are administering her small doses of morphine powder. Though inappropriate use of opioid analgesics should be strictly avoided, in some cases, long-term use under careful specialist supervision may be necessary before discontinuation of opioid analgesics.

We analyzed dispensing receipt data in the medical treatment in October 2019 using the Receipt Information/Specific Medical Examination Information National Database (NDB), extracted the cases of multiple combinations of Kampo prescriptions, and analyzed their frequencies. Of the 536,524 receipts, 44,731 (8.3%) included Kampo and non-Kampo crude drug preparations. Of the receipts that included Kampo and non-Kampo crude drug preparations, 38,032 receipts (7.1%) included single Kampo or non-Kampo crude drug preparation. There were 6,699 receipts (1.2%) that included multiple Kampo and non-Kampo crude drug preparations. There were 187 receipts for the decoctions containing multiple rude drugs without Kampo preparations, and the ratio was 0.035% of all receipts and 0.42% of the receipts containing Kampo and non-Kampo crude drug preparations. There was one receipt containing eight Kampo preparations, three receipts containing seven Kampo preparations, and a total of 84 receipts containing five or more Kampo preparations. Although it is unclear how many multiple Kampo preparations were prescribed at the same time, this investigation indicates the actual duplication of multiple Kampo preparations.

The Medical Safety Committee has conducted various activities for patient safety in Japanese traditional Kampo medicines. In this study, we conducted a questionnaire survey to promote the prevention of medical accidents and their recurrence. We received responses from 15 of 19 facilities specializing in Kampo medicine and collected a total of 247 incident and accident cases in the field of Kampo medicine. Cases of side effects included interstitial pneumonia caused by Kampo prescriptions containing Scutellariae Radix, aconite poisoning, and licorice-induced pseudoaldosteronism. Furthermore, we also collected decoction-specific cases, which are unique to facilities specializing in Kampo medicine, for the first time. From the results, we included the following seven points for risk management in the field of Kampo medicine : 1) insufficient recognition to the side effects of Kampo medicines, 2) misunderstanding of the dosages of Kampo products, 3) errors due to similarities in Kampo formulas and crude drug names, 4) preconception of frequently used Kampo prescriptions, 5) contamination in the decoctions, 6) errors related to crude drug items and their dosages that are frequently added or subtracted, 7) errors in hospital wards.

Depression requires continuous long-term treatment. However, many patients drop out from their treatment program. The purpose of this study is to investigate the current status of pharmacists’ support for depressed patients at higher risk of self-discontinuation of medication. This was a cross-sectional study of community pharmacists’ support for depressed patients using a web-based questionnaire. The survey items were 1) pharmacists’ basic attributes and 2) pharmacists’ support to prevent patients from dropping out of their treatment. Morphological analysis was performed using text mining to analyze the free responses, and the relationships between the extracted categories were examined using hierarchical cluster analysis. Free responses were obtained from 77 pharmacists. The morphological analysis extracted 26 categories from their responses, and the category with the highest frequency of occurrence was “explain” (44 times). The extracted categories were stratified into clusters 1 to 6 using hierarchical cluster analysis.

The left atrium and left atrial appendage have unique genetic anatomical and physiological features. Recently, advances in diagnostic imaging technology have provided much new knowledge. Clinically, the risk of developing atrial fibrillation increases with age. In order to reduce the public health burden such as cerebral infarction caused by atrial fibrillation, we need to find some predictive risk factors and preventive strategies for cerebral infarction and more effective treatments. The new concept of atrial myopathy has emerged, and animal models and human studies have revealed close interactions between atrial myopathy, atrial fibrillation, and stroke through various mechanisms. Structural and electrical remodeling such as fibrosis and deterioration of the balance of autonomic nerves and complicated interactions between these mechanisms lead to deterioration of atrial fibrillation and a continuous vicious cycle, and finally thrombosis in the left atrial appendage. Although anticoagulant therapy for patients with atrial fibrillation is strongly recommended, it is difficult for many patients to continue optimal treatment. In the nearly future, it will be important to understand the anatomy and physiology of the left atrial appendage and to understand the shape changes, size and the changes of autonomic function, and thrombus formation conditions associated with LAA remodeling during atrial fibrillation, and then we should provide early therapeutic intervention.

The Medical Safety Committee analyzed the case reports of minor incidents from the pharmacies last time as part of an activity to promote patient safety in Japanese traditional Kampo medicine. This time, we analyzed the case reports of medical accidents and minor incidents from the medical institutions. We extracted 626 reports related to Kampo products from the public database, which the Japan Council for Quality Health Care has established based on the collected information related to the medical accidents and minor incidents. The medical accident information includes case reports related to drug-induced liver injury. The minor incident reports include prescribing error due to misinterpretation related to the quantity of one sachet of Kampo extract product, dispensing error due to similarity of product appearance, number or name, and administration error due to judging the medicine only by Kanji characters or product company names without checking the Kampo formula name. Additionally, the minor incidents were often discovered by people belonging to different professions or patients themselves. In order to promote patient safety, knowledge about these incidents should be shared among the people involved in the same or different professions.

We collected and analyzed the case reports of minor incidents in the preparation of Kampo products in Japanese pharmacies in order to manage the medical safety control in Japanese traditional Kampo medicine. We extracted 2,166 reports that are related to Kampo products from the database of minor incidents in pharmacies supplied from The Japan Council for Quality Health Care from 2009 to 2019. Among the reports, we found the cases that pharmacists could find the mistakes about the name, dosage and administration of Kampo products or could prevent the appearance of adverse reaction when pharmacists check the prescription and ask prescription question for doctors. It is suggested that the system of separation of dispensing and prescribing functions would be well working in medical safety control. At the same time, we also found many cases that pharmacists have actually made mistakes by confusing the name of Kampo products and dosage. In this report, we summarized the cases of these minor incidents and frequently appearing confusions about the names of Kampo products.