Evaluation of opioid consumption trends for pain in Taiwan and comparison with neighboring Asian countries.

Opioids are effective analgesics for pain relief, however, inappropriate use may cause risks. The aims of the study were to evaluate trends of opioid consumption for pain management in Taiwan and compare them among neighboring Asian countries. Opioid consumption data, including fentanyl, morphine, oxycodone, hydromorphone, codeine, and pethidine, were collected from the Controlled Drugs Management Information System of Taiwan Food and Drug Administration from 2008 to 2018. Data of different continents and neighboring Asian countries were retrieved from the WHO website. The major findings include: (1) In Taiwan, the total annual opioid consumption has gradually increased from 2008 to 2018, with fentanyl being the most frequently consumed opioid analgesic, followed by morphine. Codeine and pethidine consumption dropped significantly over the years. (2) In neighboring Asian countries, the opioid consumption in order from highest to lowest consumption were South Korea, Japan, Taiwan, Singapore, Hong Kong (China), and China. We concluded that, from 2008 to 2018, the total opioid consumption trend for pain management in Taiwan has slowly increased, with fentanyl and morphine being the most commonly used opioids. When compared with neighboring Asian countries, level of opioid consumption in Taiwan was between Japan and Singapore. The research results may provide a reference for healthcare professionals worldwide.

Prevalence of opioid prescriptions in Taiwan (2008-2018).

BACKGROUND: Opioids are effective for severe pain; however, the safety issue is also a primary concern. To better understand the opioid use in Taiwan, we conducted this study. METHODS: Data on patients with opioid prescriptions, including morphine, fentanyl, pethidine, codeine, oxycodone, hydromorphone, and buprenorphine were collected using the Taiwan National Health Insurance Database (NHID). RESULTS: Our analysis of opioid prescriptions from 2008 to 2018 in Taiwan indicated that (1) A slow increase in prevalence of opioid prescription was found during the study period. Among the drugs studied, morphine accounted for the majority of the prescriptions written, with a gradual increase annually. Pethidine prescriptions showed a significant and rapid decline over the years; (2) medical centers prescribed the largest number of opioids, followed by regional hospitals, local hospitals, and clinics; (3) the number of prescriptions per year per capita in cancer group was much higher than that in noncancer group. In noncancer group, most of the prescriptions were used in acute pain service (98.7%); and (4) use of opioids increased with age in both cancer and noncancer patients. CONCLUSION: The total number of opioid prescriptions in Taiwan gradually increased annually, among which morphine was the most commonly used opioid. Cancer patients consumed more opioid prescriptions than noncancer patients and most of the prescriptions in noncancer patients were used in acute pain service. The number of prescriptions increased with the age of the patients in both cancer and noncancer patients. The low prescription rate of opioids in chronic pain in Taiwan is not similar as those in high opioid-consuming countries, such as United States.

Impact of Computer-Based and Pharmacist-Assisted Medication Review Initiated in the Emergency Department.

OBJECTIVES: Whether early medication reconciliation and integration can reduce polypharmacy and potentially inappropriate medication (PIM) in the emergency department (ED) remains unclear. Polypharmacy and PIM have been recognized as significant causes of adverse drug events in older adults. Therefore, this pilot study was conducted to delineate this issue. DESIGN: An interventional study. SETTING: A medical center in Taiwan. PARTICIPANTS: Older ED patients (aged ≥65 years) awaiting hospitalization between December 1, 2017, and October 31, 2018 were recruited in this study. A multidisciplinary team and a computer-based and pharmacist-assisted medication reconciliation and integration system were implemented. MEASUREMENTS: The reduced proportions of major polypharmacy (≥10 medications) and PIM at hospital discharge were compared with those on admission to the ED between pre- and post-intervention periods. RESULTS: A total of 911 patients (pre-intervention = 243 vs post-intervention = 668) were recruited. The proportions of major polypharmacy and PIM were lower in the post-intervention than in the pre-intervention period (-79.4% vs -65.3%; P < .001, and - 67.5% vs -49.1%; P < .001, respectively). The number of medications was reduced from 12.5 ± 2.7 to 6.9 ± 3.0 in the post-intervention period in patients with major polypharmacy (P < .001). CONCLUSION: Early initiation of computer-based and pharmacist-assisted intervention in the ED for reducing major polypharmacy and PIM is a promising method for improving geriatric care and reducing medical expenditures. J Am Geriatr Soc 67:2298-2304, 2019.

The Effects of a Diet and Exercise Program for Older Adults With Metabolic Syndrome.

BACKGROUND: The prevalence of metabolic syndrome is high among older adults in Taiwan. However, few studies have studied the effect of a combined diet and exercise program on managing metabolic syndrome (MetS) in individuals 65 years and older and living in Taiwan's rural areas. PURPOSE: This study tests the effectiveness of a diet and exercise program on the MetS biomarkers in older community residents with MetS. METHODS: This study used a quasiexperimental study design. All participants were 65 years and older and were diagnosed with MetS. The outcome variables included biomarkers (blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglycerides) and demographic characteristics. The participants were distributed into a diet-and-exercise group (n = 163) and a nondiet-and-nonexercise group (n = 138). The outcome variables were examined 3 months after the start of the intervention program. RESULTS: The participants in the diet-and-exercise group had lower values than the nondiet-and-nonexercise group for blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglyceride (all ps < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The diet and exercise program is an effective intervention for treating older individuals with MetS. Clear and concise information concerning the effects of diet and exercise in promoting the health of older residents with MetS is helpful to improve the health of the older adults inTaiwan.

The health promotion lifestyle of metabolic syndrome individuals with a diet and exercise programme.

The purpose of this study was to explore a health promotion lifestyle (HPL) with a diet and exercise programme (DEP) in metabolic syndrome adults. The study consisted of 207 individuals who followed a DEP and 185 who did not. The subjects were rural community adults. Their HPL was evaluated using the Chinese version of the Health Promotion Lifestyle Profile Short Form (HPLP-S). The average HPLP-S score was significantly higher in the DEP group (3.28 ± 0.36) than in the group without the DEP (2.05 ± 0.65). Stepwise regression analysis revealed that group, gender, smoking, alcohol use, marital status, religion and chronic disease were predictors of an HPL and accounted for 67.0% of the variance in the HPLP-S score. This study demonstrates that a DEP has positive effects on a health promotion lifestyle. The community-based DEP targeting health promotion behaviours should be presented as a strategy for metabolic syndrome in adults.

Human cancer cells retain modest levels of enzymatically active matriptase only in extracellular milieu following induction of zymogen activation.

The type 2 transmembrane serine protease matriptase is broadly expressed in human carcinomas and hematological cancers. The proteolytic activity of matriptase is a potential target of drugs and imaging probes. We assessed the fate of active matriptase following the induction of matriptase zymogen activation. Exposing eight human carcinoma cells to pH 6.0 buffer induced robust matriptase zymogen activation followed by rapid inhibition of the nascent active matriptase by hepatocyte growth factor activator inhibitor (HAI)-1. Consequently, no enzymatically active matriptase was detected in these cells. Some active matriptase is, however, rapidly shed to the extracellular milieu by these carcinoma cells. The lack of cell-associated active matriptase and the shedding of active matriptase were also observed in two hematological cancer lines. Matriptase shedding is correlated closely with the induction of matriptase activation, suggesting that matriptase activation and shedding are kinetically coupled. The coupling allows a proportion of active matriptase to survive HAI-1 inhibition by rapid shedding from cell surface. Our study suggests that cellular free, active matriptase is scarce and might not be an effective target for in vivo imaging and drug development.