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Otake S, Shoji T, Yamada K, Kimura M, Myojin S, Kamiyoshi N, Ochi F, Nezu M, Ishida A, Miyairi I, Kasai M. Trend in antibiotic prescription at pediatric primary emergency medical centers in Japan: A multi-center, cross-sectional study. J Infect Chemother 2024; 30:616-620. [PMID: 38237860 DOI: 10.1016/j.jiac.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Antimicrobial resistance is a global issue, and implementation of antimicrobial stewardship programs in outpatient settings is crucial. Japan has also focused on outpatient oral antimicrobial stewardship programs and difficulties in standardizing prescriptions have led to overprescription in primary emergency medical centers. There is a lack of research investigating the antibiotic prescription status of pediatric primary emergency medical centers and the benchmark prescription rates in pediatric outpatient settings. METHODS We conducted a multi-center, cross-sectional study of seven pediatric primary emergency medical centers located in five prefectures of Japan. We retrospectively extracted data from health claims or directly obtained them from charts at each institution and evaluated trends in the antibiotic prescription rate based on the AWaRe classification between April 2016 and December 2019. RESULTS Our study included 383,525 encounters, with the most common infectious disease diagnosis being acute upper respiratory tract infection in 93,449 cases (24.4 %). The antibiotic prescription rate during the study period was 7.4 %, representing a decrease of 46 %, from 10.2 % in 2016 to 5.5 % in 2019. The percentage of prescriptions in the Access group increased at all institutions; however, it exceeded 60 % in only three facilities in 2019. The percentage of third-generation cephalosporins varied among facilities, ranging from 1.7 % to 59.4 %, as of 2019. CONCLUSIONS For pediatric primary emergency medical centers where antimicrobial stewardship programs are implemented, we suggest 5 % as a reasonable benchmark level for the antibiotic prescription rate. Prescribing the antibiotics in the Access groups less frequently remains a domestic challenge in Japan.
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Affiliation(s)
- Shogo Otake
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan; Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan.
| | - Takayo Shoji
- Department of Infectious Diseases, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kenta Yamada
- Department of Pediatrics, University of Fukui Hospital, Fukui, Japan
| | - Makoto Kimura
- Kobe Children's Primary Emergency Medical Center, Hyogo, Japan
| | - Shota Myojin
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Naohiro Kamiyoshi
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Fumihiro Ochi
- Department of Pediatrics, Ehime Prefectural Niihama Hospital, Ehime, Japan
| | - Mari Nezu
- Department of Clinical Epidemiology, Hyogo Medical University, Hyogo, Japan
| | - Akihito Ishida
- Kobe Children's Primary Emergency Medical Center, Hyogo, Japan
| | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA
| | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan
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Iwata S, Ashida K, Demiya M, Nagayama A, Hasuzawa N, Yoshinobu S, Sonezaki A, Yasuda J, Motomura S, Katsuki Y, Sugi K, Nomura M. Preserved seasonal variation in glycemic control in patients with type 2 diabetes mellitus during COVID-19: a 3-year-long retrospective cohort study in older adults in Japan. BMC Endocr Disord 2024; 24:70. [PMID: 38755559 PMCID: PMC11100128 DOI: 10.1186/s12902-024-01602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has changed our lifestyle by imposing restrictions, such as physical distancing. The effect of COVID-19 prevalence on seasonal variations in glycemic control in patients with diabetes mellitus (DM) remains unknown. METHODS This single-center retrospective cohort study evaluated glycemic control in patients with type 2 DM who visited Sugi Cardiovascular Hospital in December 2021. We evaluated the clinical findings of all patients treated regularly between March 1, 2019, and December 31, 2021, including the periods both before and after the COVID-19 pandemic. All the standard treatments were approved. Furthermore, seasonal changes in hemoglobin A1c (HbA1c) levels were evaluated using stratified analyses based on age. RESULTS This study analyzed 86 patients (mean age, 69.6 ± 9.2 years; men, 57). Median HbA1c (National Glycohemoglobin Standardization Program [Union of Clinical Chemistry]) levels in spring (March) were 7.70% (interquartile range (IQR):7.23%-8.30%) [60.6 mmol/mol (IQR:55.4-67.2 mmol/mol)], 7.35% (IQR:6.90%-7.90%) [56.8 mmol/mol (IQR:51.9-62.8 mmol/mol)], and 7.50% (IQR:7.10%-8.00%) [58.5 mmol/mol (IQR:54.1-63.9 mmol/mol)] in 2019, 2020, and 2021, respectively. During these periods, HbA1c levels and body mass index (BMI) revealed significant seasonal variations "high in spring" and "low in autumn." Median HbA1c levels in spring (March) and autumn (September) were 7.86% [61.2 mmol/mol] and 7.48% [57.4 mmol/mol] in 2019 (P < 0.001), 7.50% [57.7 mmol/mol] and 7.17% [54.2 mmol/mol] in 2020 (P < 0.001), and 7.61% [58.3 mmol/mol] and 7.19% [53.8 mmol/mol] in 2021 (P < 0.001). Seasonal variations in HbA1c levels and BMI were maintained over the past 3 years, including the pandemic period. None of the patients in this study developed COVID-19 during the study period. CONCLUSIONS Seasonal variations in glycemic control in patients with DM were not influenced by lifestyle modifications associated with COVID-19. Maintenance of physical activity is necessary to prevent the development of sarcopenia. Moreover, seasonal variations in glycemic metabolism should be considered an independent factor for DM management. Additional extensive multifacility investigations are necessary to corroborate our findings.
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Affiliation(s)
- Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
- Sugi Cardiovascular Hospital, 950-1 Taguma, Ohmuta, Fukuoka, 837-0916, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Mutsuyuki Demiya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nao Hasuzawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoko Yoshinobu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Aya Sonezaki
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Junichi Yasuda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Seiichi Motomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshio Katsuki
- Sugi Cardiovascular Hospital, 950-1 Taguma, Ohmuta, Fukuoka, 837-0916, Japan
| | - Kenzo Sugi
- Sugi Cardiovascular Hospital, 950-1 Taguma, Ohmuta, Fukuoka, 837-0916, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
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Fukuyama K, Mori Y, Ueshima H, Ito S, Tanabe M, Kuroda T. Medical resource usage for COVID-19 evaluated using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. PLoS One 2024; 19:e0303493. [PMID: 38739628 PMCID: PMC11090316 DOI: 10.1371/journal.pone.0303493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic exhibited several different waves threatening global health care. During this pandemic, medical resources were depleted. However, the kind of medical resources provided to each wave was not clarified. This study aimed to examine the characteristics of medical care provision at COVID-19 peaks in preparation for the next pandemic. METHODS Using medical insurance claim records in Japan, we examined the presence or absence of COVID-19 infection and the use of medical resources for all patients monthly by age group. RESULTS The wave around August 2021 with the Delta strain had the strongest impact on the working population in terms of hospital admission and respiratory support. For healthcare providers, this peak had the highest frequency of severely ill patients. In the subsequent wave, although the number of patients with COVID-19 remained high, they were predominantly older adults, with relatively fewer patients receiving intensive care. CONCLUSIONS In future pandemics, we should refer to the wave around August 2021 as a situation of medical resource shortage resulting from the COVID-19 pandemic.
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Affiliation(s)
- Keita Fukuyama
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Hiroaki Ueshima
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Shiho Ito
- Department of Clinical Laboratory, Mie University Hospital, Edobashi, Tsu city, Mie, Japan
| | - Masaki Tanabe
- Department of Clinical Laboratory, Mie University Hospital, Edobashi, Tsu city, Mie, Japan
- Department of Infection Control and Prevention, Mie University Hospital, Edobashi, Tsu city, Mie, Japan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Sakyo-ku, Kyoto city, Kyoto, Japan
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Komagamine J. Prevalence of urgent hospitalizations caused by adverse drug reactions: a cross-sectional study. Sci Rep 2024; 14:6058. [PMID: 38480855 PMCID: PMC10937656 DOI: 10.1038/s41598-024-56855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024] Open
Abstract
Adverse drug reactions account for a substantial portion of emergency hospital admissions. However, in the last decade, few studies have been conducted to determine the prevalence of hospitalization due to adverse drug reactions. Therefore, this cross-sectional study was conducted to determine the proportion of adverse drug reactions leading to emergency hospital admission and to evaluate the risk factors for these reactions. A total of 5707 consecutive patients aged > 18 years who were emergently hospitalized due to acute medical illnesses between June 2018 and May 2021 were included. Causality assessment for adverse drug reactions was performed by using the World Health Organization-Uppsala Monitoring Centre criteria. The median patient age was 78 years (IQR 63-87), and the proportion of women was 47.9%. Among all the hospitalizations, 287 (5.0%; 95% confidence interval (CI) 4.5-5.6%) were caused by 368 adverse drug reactions. The risk factors independently associated with hospitalization due to adverse drug reactions were polypharmacy (OR 2.66), age ≥ 65 years (OR 2.00), and ambulance use (OR 1.41). Given that the population is rapidly aging worldwide, further efforts are needed to minimize hospitalizations caused by adverse drug reactions.
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Affiliation(s)
- Junpei Komagamine
- Department of Emergency and Critical Care Medicine, NHO Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo, Japan.
- Department of Clinical Research, NHO Tochigi Medical Center, Utsunomiya, Japan.
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