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Family pharmacy and medication adherence among older adults in Japan: A cross- sectional study of JAGES 2019
Get PDFObjectives: Poor medication adherence among older adults is a global concern as it causes adverse drug interactions and inappropriate dosing. This study aimed to assess the association between family pharmacy and medication adherence among older adults.
Methods: The Japan Gerontological Evaluation Study was a cross-sectional study of 18,792 people aged ≥65 years living in 61 municipalities in 25 prefectures who participated in a srvey conducted in 2019 and did not require long-term care. Self-reported questionnaires were administered to evaluate whether the participants “always received medicines from the same pharmacy” and whether they had unused medicines. Modified Poisson regression was used to examine the association after adjusting for confounders.
Results: Unused medicines were present in 89.9% of the “have group” (individuals who always received their medicines from the same pharmacy). This group had a lower prevalence of unused medicines (prevalence ratio=0.87, 95% confidence interval: 0.82–0.92) than the “none group” (individuals who did not always receive their medicines from the same pharmacy). In the stratified analysis by education level, the prevalence of unused medicines was lower among those with low levels of education (≤9 years: 0.82, 0.71–0.96; 10–12 years: 0.81, 0.74–0.88).
Discussion: Older adults who “always received medicines from the same pharmacy” had a lower prevalence of unused medicines, especially those with low levels of education. Thus, “always receiving medicines from the same pharmacy” may be effective in reducing the proportion of unused medicines and improving medication adherence
Response to a letter to the editor by Jia and Teng: remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery
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Inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein from bland thrombus using gadoxetic acid-enhanced magnetic resonance imaging
Get PDFPurpose: To assess inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein (TIV) from bland thrombus on gadoxetic acid-enhanced magnetic resonance imaging (Gx-MRI). Secondarily, to determine whether a multi-feature model improves accuracy compared to LI-RADS.
Methods: We retrospectively identified consecutive patients at risk for hepatocellular carcinoma with venous occlusion(s) reported on Gx-MRI. Five radiologists independently classified each occlusion as TIV or bland thrombus using the LI-RADS TIV criterion (enhancing soft tissue in vein). They also evaluated imaging features suggestive of TIV or bland thrombus. Intra-class correlation coefficient (ICC) was calculated for individual features. A multi-feature model was developed based on consensus scores of features with >5% consensus prevalence and >0.40 ICC. Sensitivity and specificity of the LI-RADS criterion and of the cross-validated multi-feature model were compared.
Results: Ninety-eight patients with 103 venous occlusions (58 TIV, 45 bland thrombus) were included. The LI-RADS criterion provided 0.63 ICC and, depending on the reader, 0.62–0.93 sensitivity and 0.87–1.00 specificity. Five other features had >5% consensus prevalence and >0.40 ICC, including three LI-RADS suggestive features and two non-LI-RADS features. The optimal multi-feature model incorporated the LI-RADS criterion and one LI-RADS suggestive feature (occluded or obscured vein contiguous with malignant parenchymal mass). After crossvalidation, the multi-feature model did not improve sensitivity or specificity compared to the LI-RADS criterion (P=0.23 and 0.25, respectively).
Conclusion: Using Gx-MRI, the LI-RADS criterion for TIV provides substantial inter-observer agreement, variable sensitivity, and high specificity for differentiating TIV from bland thrombus. A cross-validated multi-feature model did not improve diagnostic performance.journal articl
18-fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic aortic graft infection; difference between open and endovascular repair
Get PDF雑誌掲載タイトル：18-Fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic aortic graft infection: the difference between open and endovascular repair[Objective] 18F-FDG PET/CT has been reported useful for diagnosing aortic graft infection. However, 18F-FDG uptake may depend upon various factors including open vs endovascular repair and time from surgery. We aimed to elucidate the factors influencing its uptake and the diagnostic value of 18F-FDG PET/CT after open and endovascular repair.
[Methods] Hospital database of PET/CT (N=14490) and our departmental database were cross-checked to identify those who underwent 18F-FDG PET/CT after aortic repair. Patient’s data were retrieved from the chart. Images were reviewed by two nuclear medicine specialists in consensus, and the presence of increased 18F-FDG uptake was recorded. The maximum standardized uptake value (SUV max) was measured.
[Results] Among the 1112 patients who underwent aortic repair between 2011 and 2022, 71 patients were identified. Eighteen patients underwent 18F-FDG PET/CT for suspected graft infection and the remaining 53 patients for other purposes (malignancy etc.). Fourteen patients were treated as aortic graft infection. They had significantly higher SUV max than those without graft infection (mean 8.64 (SD2.78) vs 3.40 (SD0.84); p<0.01). In the non-infected grafts, SUV max was higher early after open surgical repair, while it remained low after endovascular repair.
[Conclusion] After endovascular aortic repair, a constant cut-off value of “SUV max=4.5” seems appropriate for diagnosing graft infection, since it remains low and stable from the early postoperative period. After open surgical repair, it seems acceptable to have “stepwise cut-off value” depending on the time from surgery.journal articl
Early enteral nutrition with arginine compensates for negative nitrogen balance in patients undergoing curative total gastrectomy
Get PDF浜松医科大学博士（医学）doctoral医学系研究科The effects of early enteral arginine-rich nutrition (EAN) were analyzed among patients undergoing curative-intent total gastrectomy for gastric cancer. There were 19 patients in this prospective study, all randomly assigned to either a parenteral nutrition (PN) group or an EAN group for the first seven days after surgery. The EAN group received 1.8-fold greater arginine (10.1g/day) compared with the PN group, which was administered through an enteral tube inserted into the jejunal loop. Both groups were provided almost identical amounts of total amino acids (54g/day), and the total energy was set at 65% of the total requirement (25kcal/kg/day). No significant differences were observed between the two groups in postoperative complications, length of hospital stay, oral intake, nutritional status, or body weight. The serum arginine profile was similar in the two groups, as it decreased significantly on postoperative day (POD) 1, and gradually returned to preoperative levels by POD 7. The nitrogen balance remained negative until POD 7 in the PN group, but turned neutral at POD 7 in the EAN group. While we could not confirm body weight loss improvement, these results suggested that early arginine-rich enteral nutrition could improve the nitrogen balance after total gastrectomy.doctoral thesi
Taurine depletion during fetal and postnatal development blunts firing responses of neocortical layer II/III pyramidal neurons
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Efficacy of HSV-TK/GCV system suicide gene therapy using SHED expressing modified HSV-TK against lung cancer brain metastases
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Effect of hypoxia on pulmonary endothelial cells from bleomycin-induced pulmonary fibrosis model mice
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
