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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.
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<b>Objective: </b>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.<br><b>Methods: </b>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.<br><b>Results: </b>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.<br><b>Conclusion: </b>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.
ABSTRACT
PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care. Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards. However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management. To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center. Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them. The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward. In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work. These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.
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<p><b>OBJECTIVE</b>The cardiac action potential (AP) and the intracellular Ca(2+) transient (CaT) are closely associated under normal physiological conditions, but not during ventricular fibrillation (VF). The purpose of this study was to determine whether this dissociation is directly related to the higher activation rate during VF.</p><p><b>METHODS</b>We optically mapped AP and CaT simultaneously in nine isolated rabbit hearts. Pinacidil, a K(ATP) channel opener, was used to shorten the action potential duration (APD) in order to capture tissue at fast pacing rates or to induce ventricular tachycardia (VT) comparable to VF activation rates. Mutual information (MI) was used to calculate the degree of AP and CaT coupling.</p><p><b>RESULTS</b>Pinacidil (40 micromol/L) infusion significantly shortened APD. The averaged cycle length (CL) of VF without Pinacidil was (77 +/- 13) ms, whereas the shortest CL achieved during VT under Pinacidil infusion was 76 ms. MIs during fast pacing (1.13 +/- 0.15) bits and fast VT (0.88 +/- 0.18) bits were higher than those during baseline VF (0.39 +/- 0.11) bits, VF with Pinacidil infusion (0.21 +/- 0.07) bits and VF after Pinacidil washout (0.36 +/- 0.15) bits. MIs during fast pacing or fast VT were higher than those of VFs at comparable dominant frequencies.</p><p><b>CONCLUSIONS</b>CaT is closely associated with the AP during fast pacing and fast VT, but not during VF. The reduced MI during VF is not secondary to the fast rate of ventricular activation.</p>
Subject(s)
Animals , Rabbits , Action Potentials , Calcium , Metabolism , In Vitro Techniques , Myocardium , Metabolism , Ventricular Fibrillation , MetabolismABSTRACT
Objects : The purpose of this study is to evaluate objective measurements of skin moisture and its usefulness in the Kampo clinic.Methods : We measured the skin moisture of 6 male volunteers using a sensor twice, in a one to two week interval, and calculated the correlation of both data sets at 66 points. Secondly, we compared the skin moisture data at 10 regions in 81 patients without any skin disease, in a wide age range from 30 s to early 70 s. The ten regions measured were : face, chest, back, abdomen, leg and 4 forearm points, i.e. the inside and outside of the bilateral center forearm, and palm.Results : The correlation of two successively measured data sets showed excellent relation (r=0.716, p<0.0001). The sensor measurement of skin moisture was quite reliable. Measurements of the face, chest and back showed them to be significantly wetter than the abdomen, leg or any of the 4 forearm points. Palm measurements indicated a wetter tendency than for any forearm measurements. Back and abdomen measurements in males were significantly wetter than those in females. There were no significant differences among the data sets, with regards to age. Therefore, any forearm points are clinically useful for the standard measurement of skin moisture. We also demonstrated a case in which skin moisture measurements with a sensor were useful in prescribing and observing the effects of shigyakusan.Conclusion : Utilizing this method may be helpful in acquiring much more objective measurements for Kampo medicine.
Subject(s)
Integumentary System , Forearm , Medicine, KampoABSTRACT
Comparative trials were undertaken using 16 types of guide-tubes of different caliber and external diamter: small caliber (1.35mm) and large cliber (1.80mm) tubes of eight types of external diameter (i. e, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5 and 6.0mm). 540 tappings was performed with a hard needle (length: 58.0mm, diameter: 0.16mm, head diameter: 1.25mm).<br>The result can be summarized as follows:<br>1. Among the six small guide-tubes with 2.5-5.0mm external diameter, the larger external diameter was, the less sticking pain was experienced.<br>2. The four small caliber guide-tubes with 4.5-6.0mm external diameter caused significantly less sticking pain compared with the four small caliber guide-tubes of 2.5-4.0mm and the four large guide-tubes of 4.5-6.0mm.