Journal of Pharmaceutical Health Care and Sciences最新文献

Background: Extravasation (EV) as an adverse effect of chemotherapy can induce tissue damage. Japanese guidelines on EV associated with cancer drug therapy were published in December 2022. However, few large-scale investigations on the frequency and patient clinical characteristics of EV have been conducted. In addition, although current guidelines newly recommend topical steroid use and consultation with dermatologists or plastic surgeons, it is necessary to clarify the actual status of EV management prior to the guideline revision in order to evaluate compliance with the current recommendations in the future. However, the real-world status has not been clarified to date. This study aimed to investigate the frequency of EV, the characteristics of patients who experienced EV, and the management of EV associated with docetaxel (DTX), a vesicant anticancer agent, using a large Japanese medical claims database.

Methods: Patients with cancer who received DTX monotherapy between 2008 and 2020 were evaluated. The patients were identified from the hospital-based medical claims database of Medical Data Vision Co., Ltd. The baseline characteristics of the study patients, the characteristics of patients who experienced EV, steroid prescriptions, and consultations with dermatologists or plastic surgeons were descriptively investigated.

Results: Among the 46,698 patients evaluated, 0.075% (35) patients developed DTX-related EV. In patients who experienced EV, 8.6% (3/35) had a history of EV. This proportion was higher than that of the overall study population. Only 34.3% (12/35) of the patients were prescribed injectable or topical steroids for EV, and 11.4% (4/35) received a consultation from the dermatology or plastic surgery department.

Conclusions: DTX monotherapy-related EV occurs in 0.075% of cancer patients. The proportion of patients with a history of EV was higher among those who experienced EV than among the overall study population. Only a small proportion of patients who develop EV are prescribed topical steroids or receive consultation from the dermatology or plastic surgery department. The incidence and management of EV may change following the publication of the 2023 edition of the Japanese EV guidelines, and thus, further investigation is warranted.

Background: Anemia is a frequent complication of heart failure (HF) that exacerbates cardiac dysfunction and worsens prognosis. However, its exact burden and treatment patterns in Sudan HF remain unknown. Thus, this study aimed to describe the prevalence, characteristics, and management of anemia among Sudanese HF patients.

Methods: We conducted a retrospective cross-sectional study of adult HF patients admitted to Wad Medani Heart Center, Sudan, over three years. Baseline hemoglobin (Hb) was defined as the first measurement within 24-48 h of index admission. Only patients with evaluable baseline Hb were included in the analytic cohort.

Results: Of 557 HF patients, 266 (47.8% of full cohort; 51% of analytic cohort) were anemic (mean Hb 10.68 ± 1.51 g/dL). The mean age was 60.4 ± 18 SD, 136 (51%) were females, 114 (43%) aged more than 65 years, and 77 (28%) had prior HF admissions. Hypertension 136 (51%), diabetes 91 (34%) and chronic kidney disease 75 (28%) were other comorbidities. Anemia was most prevalent in the HF with mid-range ejection fraction (HFmrEF) cohort 134 (50.4%), followed by HF with reduced ejection fraction (HFrEF) 71 (26.7%) and HF with a preserved ejection fraction (HFpEF) 61 (22.9%). Among anemic HF patients, only 77 (29%) received anemia management. Of those, 28(36.4%) received blood transfusions, and 34 (44.2%) received iron supplementation.

Conclusions: Nealy half of HF patients were anemic, particularly older and those with HFmrEF, and treatment was suboptimal. Incorporating routine anemia screening and standardized management into HF care protocols is essential to enhance clinical outcomes.

Background: This study aimed to investigate whether medication adherence was changed by the prescription of a single-pill combination (SPC) of antihypertensive drugs and whether it was associated with the incidence of major adverse cardiovascular events (MACE) at the 5-year follow-up.

Methods: The medical records of 707 patients whose medication adherence could be assessed at least one year before and after the date SPC was first prescribed were retrospectively reviewed. The patients' baseline characteristics included sex, age, medical and medication history within the past year (MACE, antidiabetic drugs, and antihyperlipidemic drugs), and polypharmacy (six or more drugs taken orally). Medication adherence was evaluated as the proportion of days covered, and the patients were divided into poor adherence (n = 28) and good adherence (n = 679) groups. Fisher's exact test and the Mann-Whitney U test were used to examine the differences in variables between the groups. Kaplan-Meier survival analysis was performed to assess time-to-event data, with group differences evaluated using the log-rank test and Cox proportional hazards models adjusted for baseline variables.

Results: No significant differences were observed in the patients' baseline characteristics between the good and poor adherence groups. During the first year after the initiation of prescribing the SPC of antihypertensive drugs, the percentage of patients who developed MACE was higher in the poor adherence group than in the good adherence group (21.4% and 11.8%, respectively), but the difference was not statistically significant (p = 0.137). No significant difference in the cumulative incidence of MACE during the 5-year observation period was observed between the poor and good adherence groups (p = 0.199). In the Cox proportional hazards analysis, 75 years of age or older, the occurrence of MACE within the past year, and polypharmacy were associated with increased risk of 5-year MACE compared to the references (adjusted hazard ratios 1.42 [95% Confidence Intervals: 1.10-1.83], p = 0.007; 0.72 [0.55-0.93], p = 0.011; and 1.36 [1.01-1.83], p = 0.044, respectively).

Conclusions: The present findings demonstrated that age 75 or older age, history of MACE, and polypharmacy were significant risk factors for MACE after the prescription of antihypertensive SPC.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) occupy a pivotal role in the management of Type 2 diabetes due to their unique glucose-lowering mechanism and multiple clinical benefits. Physicians, as decision-makers in treatment, and pharmacists, as disseminators of drug knowledge, play crucial roles in ensuring the effectiveness and safety of treatments involving SGLT2is. However, the extent of primary healthcare workers' understanding of SGLT2i characteristics prior to usage remains unclear.

Aim: This study aims to evaluate the level of knowledge pertaining to the use of SGLT2is among primary care physicians and hospital pharmacists.

Methods: A field survey on the cognition of SGLT2is was conducted among internal medicine, surgical, general practice, and pharmacy departments within healthcare institutions and community health service centers in Kaihua County, Zhejiang Province, China. An online questionnaire, including demographic information and knowledge about SGLT2is, was designed and administered.

Results: The survey included 105 physicians and 31 pharmacists, with 59.56% being male and 66.18% holding intermediate or senior professional titles. Scores were predominantly in the range of 9-11 out of a maximum of 16 points, encompassing 102 participants (75.00%), while 9 individuals (11.76%) scored 13 points or higher, and 13 participants (9.56%) scored 8 points or lower. Notably, 33.09% correctly identified that SGLT2is are not applicable for Type 1 diabetes patients, 15.44% correctly noted the need to discontinue SGLT2is before major surgery, 23.53% correctly answered that SGLT2is are not approved in China for treating Type 2 diabetes in children and adolescents, and 47.06% correctly recognized that SGLT2is can be combined with metformin to enhance glucose-lowering effects. Additionally, the average score of physicians in surgical departments was significantly lower than other departments (H = 19.733, P < 0.001), and female participants had significantly higher average scores than males (Z = -3.528, P < 0.001).

Conclusion: Primary care physicians and pharmacists in Kaihua County exhibit a robust understanding of the mechanisms of SGLT2is. However, there are notable deficiencies in the management of perioperative care in surgery, in discerning indications across internal and general medicine, in identifying contraindications in special populations, and in the pharmacists' roles in prescription review. These findings suggest a need for targeted educational initiatives to enhance understanding and safe use of SGLT2 inhibitors at the primary-care level.

Background: A team-based approach is essential to provide cancer patients with high-quality treatment. To ensure the best possible care while reducing the workload of physicians, Ehime University Hospital has introduced three protocol-based pharmacotherapy management (PBPM) strategies in the field of chemotherapy. First, we introduced PBPM to avoid reactivation of hepatitis B virus (HBV) in patients receiving immunosuppressive therapy or chemotherapy. In this PBPM strategy, pharmacists added laboratory test orders for patients who require regular HBV-DNA quantification (HBV-PBPM). Second, we devised PBPM for measurement of the urine protein/creatinine ratio (UPC) in patients receiving anti-vascular endothelial growth factor therapy. Finally, we introduced PBPM for measurement of serum magnesium in patients receiving anti-epidermal growth factor receptor antibody therapy (Mg-PBPM). In this study, we evaluated the usefulness of these three PBPM strategies in outpatients receiving chemotherapy.

Methods: The study included patients treated in the outpatient chemotherapy unit between July 2021 and February 2023. Rates of compliance with laboratory tests in the 6 months before and after introduction of PBPM were compared.

Results: Compliance with HBV-DNA quantification improved significantly from 66.3% before PBPM to 86.7% after implementation of PBPM (p = 0.002). The median duration of noncompliance was significantly shorter after initiation of PBPM (p = 0.021). Compliance with measurement of UPC was already greater than 95% before PBPM and showed no change after implementation (98.7% pre-PBPM vs 99.3% post-PBPM). Compliance with measurement of serum magnesium improved from 95.8% pre-PBPM to 99.2% after starting PBPM, but the improvement was not statistically significant.

Conclusions: Introduction of PBPM improves compliance with the laboratory tests required in cancer patients during chemotherapy and enables safer delivery of treatment.

Background: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent life-threatening mucocutaneous reactions, predominantly triggered by medications. This case report presents a rare instance of SJS-TEN overlap in a young Indian female precipitated by the combined use of fluoroquinolone (ofloxacin), cephalosporin (cefixime), and paracetamol-an uncommon drug triad not widely reported in existing literature. The case highlights the importance of early diagnosis, thorough drug history evaluation, and the challenges of managing polypharmacy-induced severe cutaneous adverse reactions (SCARs).

Case presentation: A 29-year-old Indian female developed widespread dusky purpuric plaques, mucosal erosions (oral, genital, conjunctival, nasal), and bullae six days after local consultation with ofloxacin, cefixime, paracetamol, and other symptomatic agents. She presented to the emergency department with painful vesiculobullous eruptions involving > 10% body surface area, mucosal ulcerations, eye involvement with crusting, and systemic symptoms including fever, vomiting, and urinary discomfort. Laboratory investigations revealed anemia, elevated RDW, and positive ketones in urine. Diagnosis of SJS-TEN overlap was made clinically. The patient was managed with a multi-disciplinary approach involving systemic corticosteroids (IV dexamethasone), hydration, antibiotics (azithromycin), antihistamines, electrolyte balance, topical agents, ophthalmic care, and pain management. The extensive yet individualized treatment regimen reflected a robust pharmacovigilance response to avoid further drug-induced complications. Improvement was noted with complete re-epithelialization and symptomatic resolution over two weeks.

Conclusion: This case highlights the necessity for clinicians to maintain high suspicion for SCARs in patients presenting with mucocutaneous symptoms and recent drug exposure-even with commonly used medications not frequently associated with SJS-TEN. The unique presentation involving synchronous ocular, nasal, oral, and genital erosions alongside use of a rare drug combination strengthens the need for early recognition, comprehensive clinical assessment, and cautious prescription practices. Individualized treatment and close monitoring are crucial in preventing mortality and minimizing complications. This case underscores the importance of pharmacovigilance and personalized care in managing drug-induced hypersensitivity reactions, especially in resource-limited or polypharmacy scenarios.

Background: Falls are a serious concern for hospitalized patients, as they can lead to a decline in quality of life (QOL) and increased nursing care needs. Chemotherapy-induced peripheral neuropathy (CIPN) increases the risk of falls; however, only a few reports have investigated CIPN in conjunction with other factors. This study aimed to identify risk factors for falls in hospitalized patients undergoing chemotherapy.

Methods: We retrospectively analyzed 21,717 hospitalized patients, including 443 who received chemotherapy, at Matsuyama Shimin Hospital between April 2016 and March 2023. Multivariate logistic regression analysis was performed to assess the fall risk in hospitalized patients who received chemotherapy.

Results: Among 21,717 hospitalized patients, 930 (4.3%) experienced at least one fall. Multivariate logistic regression identified 13 factors, including age, sex, BMI, and mobility assistance. Notably, chemotherapy showed the highest odds ratio among these factors (OR 3.40, 95% CI 2.49-4.65). In the chemotherapy subgroup (n = 443), multivariate analysis identified five factors (body mass index (BMI); decline in judgment, comprehension, and memory; treatment with hypoglycemic drugs; treatment with high-risk CIPN drugs; and lung cancer). The fall rate was significantly higher in patients who received both hypoglycemic drugs and high-risk CIPN drugs (37.5%, 6/16) than in those who received either factor alone (14.1%, 27/192; p < 0.05).

Conclusions: Chemotherapy was identified as an independent risk factor for falls. Among patients receiving chemotherapy, both hypoglycemic drugs and high-risk CIPN drugs were associated with an increased risk of falls, and the fall rate was significantly higher in those treated with both drugs. Therefore, these patients should be carefully monitored for fall risk.