Collaboration between medical institutions and community pharmacies is crucial for sharing patient’s treatment status and chemotherapy regimens in order to give safe and effective cancer chemotherapy for outpatient. In Kagoshima Medical Association Hospital, we established a framework for sharing this information with community pharmacies through a multidisciplinary approach. We conducted a questionnaire survey among community pharmacists to evaluate the usefulness of patient’s treatment status and chemotherapy regimens available on our hospital’s website. Most respondents found these resources “very useful.” Furthermore, respondents expressed a desire for additional information on chemotherapy regimen that was not currently available on our website but accessible from other institutions. This survey helped us understand the specific information required by community pharmacists regarding patient treatment status and chemotherapy regimens from medical institutions.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians. METHODS: A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism. RESULTS: Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism. CONCLUSIONS The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.
Humans ; COVID-19/epidemiology* ; Presenteeism ; Japan/epidemiology* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Physicians ; Surveys and Questionnaires

Objective: Antibiogram preparation is important for the proper selection of antimicrobial agent in empiric therapy. It is recommended to prepare the antibiogram separately for inpatients and outpatients. However, the antimicrobial agent susceptibility of bacteria detected from an inpatient is thought to be different when detected at an early date after admission and after a certain period after admission.Methods: In this study, we defined the bacteria detected from an inpatient within 3 days after admission as “brought bacteria” and those over 3 days after admission as “bacteria detected after admission.” Antimicrobial agent susceptibilities of brought bacteria and bacteria detected after admission in our hospital between April 2018 and March 2019 were compared for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.Results: The occurrence rate of Escherichia coli producing an extended β-lactamase of bacteria detected after admission was found to be significantly higher compared with that of brought bacteria. The sulbactam/ampicillin susceptibility rate of bacteria detected after admission was significantly lower than that of brought bacteria. The occurrence rate of the two drug-resistant Pseudomonas aeruginosa detected after admission tends to be higher compared with that of brought bacteria.Conclusion: Our findings showed that the susceptibility rate of some drugs differed substantially between brought bacteria and bacteria detected after admission. Therefore, the inpatient’s antibiogram is thought to be prepared by separating bacteria detected at an early date after admission and after a certain period after admission, leading to the proper selection of antimicrobial agent in empiric therapy tailored to a patient’s number of days in the hospital.

Objective: Drugs that are excreted by the kidneys may require dose adjustments, depending on the patient’s renal function. The pharmacist must ask the prescribing physician about the prescription if a dose is deemed inappropriate. In the current study, we investigated the economic effects of prescription questions associated with renal function and the antibiotics treatment completion rate.Methods: The current study included inpatient prescription inquiries by pharmacists at our institution between January and December 2018. For all cases that were inquired prescription, the economic effects were estimated as follows; the drug costs were calculated based on drug prices at April 2018 edition, and the reduced medical care costs associated with avoiding adverse reactions due to prescription questions were calculated based on the number of benefits and the total cost of benefits in the Relief System for Sufferers from Adverse Drug Reactions. The antibiotics treatment completion rates were calculated based on the number of cases in which drug and dose maintained after prescription questions.Results: The study included 279 cases, 266 of which involved inappropriate doses due to deteriorated renal function. Most prescriptions were for antibiotics. The drug costs were reduced due to the prescription question in 213 cases; the total reduced cost was 699,483 Japanese yen. The economic effects associated with avoiding adverse reactions due to prescription questions were worth approximately 11,481,056 Japanese yen. The completion rate of antibiotic treatment in cases where doses were reduced due to prescription questions was 63.0% (treatment of 75 cases completed/all cases were 119), compared with 63.6% (7 cases/11 cases) in cases in which doses were not changed. Thus, dose reduction due to questions regarding the prescription did not lead to reduced completion rates of antibiotics treatment (p=0.621).Conclusion: Dose adjustments due to prescription questions about drugs excreted by the kidneys led to reduced drug costs and adverse reactions, and did not result in negative effects during infectious disease therapy.

Background/Aims: Unsedated transnasal esophagogastroduodenoscopy (EGD) is affected by a poor scope lens-cleaning function. We have previously reported good, albeit limited, effects of an oolong tea washing solution; here, we evaluated the effectiveness of a 5% lens cleaning solution for cleaning an EGD lens. Methods: Five percent lens cleaning solution (C), 5% dimethicone solution (D), and distilled water (W) were prepared. Study I: Lenses were soiled with pork grease, washed with each washing solution, and their image quality was judged. Study II: Patients (n=996) scheduled for transnasal EGD were randomly assigned to the C- or W-group. Lens cleanliness level, washing solution volume used, and endoscopist stress due to lens contamination were determined. Results: Study I: The image quality of the lenses washed with (C) was significantly superior. (D) was clinically unsuitable because of spray nozzle clogging. Study II: Lens cleaning in the C-group was significantly superior (p<0.0001) and the solution volume required was significantly reduced (p<0.0001), while endoscopist stress was also lower (p<0.0001). Conclusions For transnasal small-caliber EGD, the present 5% lens cleaning solution provided good visibility. It features a high detergency level and is simple to formulate for therapeutic endoscopy applications, such as endoscopic submucosal dissection.

Background/Aims: Unsedated transnasal esophagogastroduodenoscopy (EGD) is affected by a poor scope lens-cleaning function. We have previously reported good, albeit limited, effects of an oolong tea washing solution; here, we evaluated the effectiveness of a 5% lens cleaning solution for cleaning an EGD lens. Methods: Five percent lens cleaning solution (C), 5% dimethicone solution (D), and distilled water (W) were prepared. Study I: Lenses were soiled with pork grease, washed with each washing solution, and their image quality was judged. Study II: Patients (n=996) scheduled for transnasal EGD were randomly assigned to the C- or W-group. Lens cleanliness level, washing solution volume used, and endoscopist stress due to lens contamination were determined. Results: Study I: The image quality of the lenses washed with (C) was significantly superior. (D) was clinically unsuitable because of spray nozzle clogging. Study II: Lens cleaning in the C-group was significantly superior (p<0.0001) and the solution volume required was significantly reduced (p<0.0001), while endoscopist stress was also lower (p<0.0001). Conclusions For transnasal small-caliber EGD, the present 5% lens cleaning solution provided good visibility. It features a high detergency level and is simple to formulate for therapeutic endoscopy applications, such as endoscopic submucosal dissection.

Fecal microbiota transplantation (FMT) has been reported as a safe and effective therapy in patients with refractory and recurrent Clostridium difficile infection (CDI). FMT has also been reported as a promising therapy in patients with ulcerative colitis (UC). Both, CDI and UC, are believed to be caused by dysbiosis, such as altered compositions or decreased diversity of the intestinal microbiota. This report describes a patient with UC in remission with a second recurrent episode of CDI, who was treated with FMT. A single FMT performed via colonoscopy completely resolved the patient's diarrhea and eradicated C. difficile bacteriologically without any severe complications. Molecular biological analysis of the patient's fecal microbiota showed that FMT could dramatically change the altered composition of intestinal microbiota and restore its diversity. Despite the restoration of the intestinal microbiota, FMT could not prevent a relapse of UC in this patient. However, it improved the intestinal symptoms of CDI and could prevent further recurrences of CDI.
Clostridium difficile ; Clostridium ; Colitis, Ulcerative ; Colonoscopy ; Diarrhea ; Dysbiosis ; Fecal Microbiota Transplantation ; Gastrointestinal Microbiome ; Humans ; Microbiota ; Recurrence ; Ulcer

BACKGROUND/AIMS: Recent developments in analytical techniques including next-generation sequencing have clarified the correlation between intestinal microbiota and inflammatory bowel disease. Fecal microbiota transplantation (FMT) for patients with ulcerative colitis (UC) is proposed as a potential approach to resolving their dysbiosis; however, its safety and efficacy have not been confirmed. This single-arm, open-label, non-randomized study aimed to evaluate the safety and efficacy of FMT for Japanese patients with UC as the first registered clinical trial in Japan. METHODS: We enrolled 10 patients with active UC despite medical therapy. The donors were the patients' relatives and were carefully screened for infectious diseases. Fecal material was administered via colonoscopy, and the primary endpoint was the presence or absence of serious adverse events related to FMT. The secondary endpoint was a change in partial Mayo score at 12 weeks post-FMT. Scores ≤2 were considered a clinical response. Fecal samples were collected to follow changes in gut microbiota, while extracted complementary DNA were analyzed by a next-generation sequencer. We obtained written informed consent from all patients and donors. This study was approved by our Institutional Review Board and is registered in the University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN 000012814). RESULTS: Five patients with moderate disease and five with severe disease were enrolled. No severe adverse effects were observed. One patient achieved clinical response; however, none of the patients' microbiota diversity recovered to the donor levels. CONCLUSIONS: The use of single FMT for UC was safe; however, we failed to show its clinical efficacy and potential to change the intestinal microbiota.
Asian Continental Ancestry Group* ; Colitis, Ulcerative* ; Colonoscopy ; Communicable Diseases ; DNA, Complementary ; Dysbiosis ; Ethics Committees, Research ; Fecal Microbiota Transplantation* ; Gastrointestinal Microbiome* ; Humans ; Inflammatory Bowel Diseases ; Information Services ; Informed Consent ; Japan ; Microbiota ; Tissue Donors ; Treatment Outcome ; Ulcer*

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

Nasolacrimal duct stenosis, which causes epiphora and eye mucus, is generally treated with probing and irrigation of the nasolacrimal duct. A 57-year-old woman was treated with probing and irrigation of the nasolacrimal duct three times, however, her symptoms of refractory nasolacrimal duct stenosis did not improve. Following 3 days administration of saisoin, her epiphora ameliorated. Based on this experience, we treated 11 adult patients with nasolacrimal duct stenosis using saisoin, and 10 (90.9%) achieved remission within a week. All the adult patients had received treatment by probing and irrigation of the nasolacrimal duct at an ophthalmological clinic, and their symptoms had not improved. Two such cases in infants, moreover, were cured with saisoin in a week. This is the first report on the efficacy of saisoin for the treatment of nasolacrimal duct stenosis in Japan.