An Attempt at Objective Evaluation of the Current Situation of Concomitant Drug Use for Dementia Outpatients at Community Pharmacies / 医薬品情報学

<b>Objectives: </b>The objectives of this study are to evaluate the current situation of concomitant drug use by community-dwelling elderly dementia patients, and to extract factors influencing the presence of potentially inappropriate medications (PIMs).<br><b>Method: </b>The research subjects were patients 65 years of age or older for whom concomitant drugs were prescribed on the same prescription form as donepezil hydrochloride.  One hundred and twenty community pharmacies randomly selected from 28 of the 47 prefectures throughout Japan.  Main research topics were sex, age, the clinical department to which the prescribing physician belonged, daily dosage of donepezil, and concomitant drugs.  Concomitant drugs were evaluated using the Beers Criteria: the Japanese Version. Furthermore, to search factors influencing the presence of PIMs, logistic regression analysis was used.<br><b>Results: </b>Data for 335 patients were extracted.  The average number of concomitant drug cases per patient were 4.2 (SD 2.6), and 109 patients (32.5%) were prescribed PIMs.  A logistic regression analysis confirmed that significant factors influencing the presence of PIMs were “the clinical department to which the prescribing physician belonged” (OR 4.80, 95%CI 1.01-22.72), “concomitant drug cases” (OR 1.26, 95%CI 1.13-1.41) and “the presence of concomitant use of central nervous system agents” (OR 5.82, 95%CI 3.35-10.11).<br><b>Conclusion: </b>This study revealed that more than a few cases of community-dwelling elderly patients of dementia were using concomitant drugs with potential risks.  It suggested that influencing factors were “the specialty of the prescribing physician” and “the presence of concomitant use of central nervous system agents.”

Commitment to safety in the department of anesthesiology and its integrated acupuncture care clinic at Mie University / 全日本鍼灸学会雑誌

[Objective]Mie University Hospital Department of Anesthesiology established an integrated acupuncture care clinic in April 2010. A total of 8 incidents and accidents occurred during a period of eight months from commencement in April through November of 2010.<BR>Re-examination of the issues from the incident and accident reports, led to the creation of a clinical manual for the acupuncture clinic as a means to improve the safety of the acupuncture clinic.<BR>[Methods]Based on the contents of the reported incidents, which were collected from electronic medical records up to November 1st 2010, a safety manual was created for the prevention of recurring incidents and accidents. Following a request for approval to the Safety Division of Mie University Hospital, the safety manual underwent screening and inspection and was eventually approved. <BR>After the introduction of the manual, the occurrence of incidents and accidents, was tracked using electronic medical records for a period of four months from December 2010 to March 2011.<BR>[Results]The incidents and accidents that occurred before the creation of the manual were all related to acupuncture (dropped acupuncture needles: 5, needles taken home: 1, and leaving needles inserted: 2). Incidents and accidents have not been reported since the introduction of the manual, that is, for a period of four months from December 2010 to March 2011.<BR>[Conclusion]Clinical practice based on the manual suggests the possibility of preventing incidents and accidents, as none have been reported since the introduction of the manual. The safety manual is still incomplete, as it emphasizes mainly the management of acupuncture and not its entire context. If any further negative incidents or accidents occur, a review and improvement of the present manual will be required. In order to deal with any new negative incidents or accidents, organizing a team will be indispensable.<BR>Since Mie University Hospital has an established Safety Division, soliciting the cooperation of the infectious disease control and medical safety experts to ensure safe clinical practices in the acupuncture core clinic should also be arranged. <BR>The results suggest that the creation of a safety manual can be a means of preventing the occurrence of incidents and accidents.

Questionnaire survey concerning acupuncture treatment to dialysis facilities in Mie Prefecture, Japan / 全日本鍼灸学会雑誌

[Objective]For the possibility of the spread of acupuncture treatment in the future, we did a questionnaire survey for the dialysis facilities in Mie Prefecture, and clarified dialyzed patient's complaints, the problems existing in the background, and the problem related to it.<BR>[Method]We sent questionnaire forms to representatives in the dialysis facilities (50 facilities as of February 2007) of Mie Prefecture. The survey contents were the situation of dialysis patients and acupuncture treatment for them.<BR>[Results]In 6.0%of the dialysis facilities in Mie Prefecture, acupuncture treatment had been introduced. No facility answered that acupuncture treatment is not recommended for patients, and some facilities were interested in acupuncture treatment (15.4%). Most patients were suffering from itching and pain, which would be a target of acupuncture treatment. The problem in the spread was treatment effect and safety.<BR>[Conclusion]Itching and pain, which are embarrassing symptoms, would be the target of acupuncture treatment. There are no facilities where acupuncture treatment had been introduced in Mie Prefecture. The possibility that acupuncture treatment introduction may not be low because there are no facilities where acupuncture treatment is not recommended and it had interest. For the spread of acupuncture in dialysis facilities, it is necessary to solve the problem of "Safety"and lack of the interface, and to construct an information network.