External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. METHODS: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). RESULTS: We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. CONCLUSIONS: The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.

Development and Assessment of Usefulness about the Database System Based on Domestic and Overseas Drug Use Criteria for Pregnant and Lactating Women / 医薬品情報学

<b>Objective: </b>In drug treatment for pregnant and lactating women, pharmacists need to contribute to adequate drug treatment by collecting much information from various sources.  However, it takes much time to collect information using plural sources.  In this study, we tried to develop a database system which enables expeditiously collecting the domestic and foreign drug use criteria information in order to streamline collecting information for pregnant and lactating women.  In addition, we assessed the utility of the database by comparing the time to collect information using the database to that using each information source and the usability by questionnaires.<br><b>Methods: </b>We developed a database system that integrates drug information from the FDA Pregnancy Category, Australian categories for prescribing medicines in pregnancy, “Drugs in Pregnancy & Lactation,” and Japanese package inserts.  For assessment of the usability of the database, we assessed the time required to collect information and subjective evaluation using the five-method questionnaires.<br><b>Results: </b>The database significantly reduced the time needed for collecting criteria information and made it possible to compile the information simultaneously from various sources.  The questionnaire survey showed that over 80% of pharmacists and students were satisfied with the database.<br><b>Conclusion: </b>It is suggested that our database system is useful to efficiently collect drug use criteria information for pregnant and lactating women.

Usefulness of Electronic Mailing as an In-Hospital Drug Information Transmittal System: Assessment of Active Transmissions for Adverse Effect Information / 医薬品情報学

<b>Objective: </b>In the management of drug information, pharmacists are required to appropriately transmit information to the corresponding medical staff.  However, it is unclear whether the transmitted information is received and utilized effectively.  In this study, we assessed the effectiveness of drug safety information transmitted to doctors by pharmacists and investigated the requirements of doctors for the transmitted drug safety information in Okayama University Hospital.<br><b>Design and Methods: </b>We performed the assessment via questionnaire from doctors who had been sent drug safety information by electronic mail (e-mail) from January to October 2010.  The return rate and responses for the questionnaire were investigated.<br><b>Results: </b>For the study time period, 15 cases of e-mail drug safety information transmissions occurred.  The questionnaire was sent to 204 doctors, and the recovery rate of the questionnaire was 46.1%.  Seventy-six percent of doctors who responded to the questionnaire answered that the e-mail information was useful for the clinical practice.  Among the comments, it was noted that an improvement in the content of e-mail information would allow doctors to access the required information more conveniently.<br><b>Conclusion: </b>In this study, it was demonstrated that the majority of doctors were satisfied with the transmission of drug safety information using e-mail, although some improvement was needed.  Furthermore, it was considered that the feedback assessment and re-construction of information transmittal system were important to improve usability and availability of the drug information service.