ABSTRACT
Current evidence for the usefulness of prophylactic antiemetic drugs in opioid-induced nausea and vomiting (OINV) in cancer patients receiving opioid analgesics is limited. Further, antiemetic prophylaxis is not considered necessary in the Guideline for Cancer Pain Management by the Japanese Society of Palliative Medicine. However, prevention of side effects such as OINV is important when opioid analgesics are administered for adequate pain management and to maintain adherence. Cancer patients expect us to study factors affecting OINV and effective prophylactic measures for the condition. We retrospectively analyzed electronic records in our hospital. We found that female sex and the use of prophylactic antiemetics, chemotherapeutic agents, and steroids were statistically significant factors associated with opioid-induced nausea, and that female sex and radiation therapy were significant factors associated with opioid-induced vomiting. Especially in females, the frequency of nausea was significantly reduced in the group that received chemotherapy with antiemetics on the same day of receiving opioid analgesics, compared to the groups that did not receive chemotherapy, or that did not receive antiemetics but received chemotherapy. These results suggest that, especially in females, administering chemotherapy along with antiemetics on the same day may be one possible prophylactic measure for OINV.
ABSTRACT
BACKGROUND@#The health effects of biological aerosols on the respiratory system are unclear. The purpose of this study was to clarify the association of airborne particle, protein, and endotoxin with emergency department visits for asthma in Kyoto City, Japan.@*METHODS@#We collected data on emergency department visits at a hospital in Kyoto from September 2014 to May 2016. Fine (aerodynamic diameter ≤ 2.5 μm) and coarse (≥ 2.5 μm) particles were collected in Kyoto, and protein and endotoxin levels were analyzed. The association of the levels of particles, protein, endotoxin, and meteorological factors (temperature, relative humidity, wind speed, and air pressure) with emergency department visits for asthma was estimated.@*RESULTS@#There were 1 to 15 emergency department visits for asthma per week, and the numbers of visits increased in the autumn and spring, namely many weeks in September, October, and April. Weekly concentration of protein in fine particles was markedly higher than that in coarse particles, and protein concentration in fine particles was high in spring months. Weekly endotoxin concentrations in fine and coarse particles were high in autumn months, including September 2014 and 2015. Even after adjusting for meteorological factors, the concentrations of coarse particles and endotoxin in both particles were significant factors on emergency department visits for asthma.@*CONCLUSIONS@#Our results suggest that atmospheric coarse particles and endotoxin are significantly associated with an increased risk of asthma exacerbation.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Air Pollutants , Asthma , Epidemiology , Emergency Service, Hospital , Endotoxins , Japan , Epidemiology , Particle Size , Particulate Matter , Proteins , Seasons , WeatherABSTRACT
<b>Purpose:</b> This study aimed to evaluate the effect of continuous patient education on pain control in outpatients based on changes in pain intensity scores and occurrence of opioid-related adverse effects. <b>Methods:</b> The education intervention was conducted in the following phases; 1) interview at the first visit for opioid introduction, 2) telephone follow-up at home 3 to 7 days after introducing opioid analgesics, and 3) interview at the next visit. Pain intensity scores; frequency of rescue dose; and occurrence of adverse opioid-related effects such as constipation, nausea, and drowsiness were compared among the three intervention phases. <b>Results:</b> When comparing data at phase 2 and 3 with those at phase 1, daily maximum pain score decreased significantly, frequency of rescue dose and opioid dosage increased significantly, and occurrence rates of constipation decreased. <b>Conclusion:</b> Continuous patient education by pharmacist intervention based on not only patient visit interviews but also telephone communication on non-visiting days can improve the pain intensity scores and reduce the rate of opioid-related adverse effects for cancer outpatients.
ABSTRACT
<b>Objectives</b>: This study evaluates the relationship between the various words expressing pain and the efficacy of opioid analgesics, in order to provide information on the appropriate selection of analgesic drugs for cancer pain relief. A new and simplified evaluation list for the assessment of pain, including the common words used to express pain, was developed accordingly. <b>Methods</b>: The words expressing pain were classified into three categories based on the Guidelines for Drug Therapy in Cancer Pain. These words were grouped into clusters according to the efficacy of opioid drugs, as expressed by the patients. On the basis of these results, an evaluation list was developed, and its validity was assessed by clinical pharmacists and cancer patients experiencing pain. <b>Results</b>: On the basis of the classification of the words, their relationship with opioid efficacy was summarized, and the results of the cluster analysis were found to be helpful for the development of a new pain evaluation list. <b>Conclusion</b>: Patients use various words to express their pain. By classifying and clustering these words according to the guidelines and the efficacy of opioid drugs, we proposed a practical pain evaluation list for appropriate selection of analgesic drugs in patients with cancer.
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<b>Purpose</b>: Patients who receive chemotherapy for colorectal cancer with the prophylactic dexamethasone (DEX) for antiemesis may experience an abnormal elevation in their casual blood glucose levels. The purpose of this study was to determine the frequency of such a DEX-induced elevation in patients with metastatic colorectal cancer, and to emphasize the importance of pharmaceutical care in improving the quality of life of patients. <b>Methods</b>: We retrospectively analyzed data from 50 patients who had received chemotherapy with or without DEX. <b>Results</b>: Of the 30 patients who received DEX, 8 exhibited abnormally high blood glucose levels (>200 mg/dl on more than 2 occasions); 3 of these patients also had diabetes mellitus. None of the 20 patients who did not receive DEX exhibited a remarkable elevation in the blood glucose levels. <b>Conclusions</b>: We confirm that patients receiving concomitant administration of DEX with chemotherapy may exhibit elevated blood glucose levels. Because an increase in the blood glucose levels may produce symptoms indicative of diabetes such as fatigue, appropriate pharmaceutical care for early detection of the abnormal elevation in the blood glucose levels may be important in preventing complications in such patients.
ABSTRACT
In the medical interview portion of the objective structured clinical examination (OSCE), we usually use both detailed checklists and a global rating scale to evaluate a student's performance. In the present study we investigated a problem with the detailed checklists.<br>1) The quality of the assessment of information-gathering capability was investigated in a station for the medical interview in a pharmaceutical OSCE.<br>2)A video review revealed a 7% error in the detailed checklist assessment at the OSCE station.<br>3) Following the interview in this study, the students wrote down the information they had gathered. These results differed by 15.6% from those of the detailed checklist assessment at the OSCE station. <br>4) In the present style of OSCE, the detailed checklist assessment at the OSCE station is problematic. The style in which the students write down the gathered information after the interview might be re-considered.