Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study

Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms.

Safe treatment of head/neck AD with tacrolimus ointment

BACKGROUND

Atopic dermatitis(AD) with head and neck involvement is common and therapeutically challenging.

METHODS

Efficacy and safety data specific to treatment of head/neck regions with tacrolimus ointment (Protopic) from three double-blind, randomized, vehicle-controlled studies are reported. A total of 631 adult and 352 pediatric patients with moderate to severe atopic dermatitis applied the vehicle, 0.03% or 0.1% tacrolimus ointment twice daily to affected areas for up to 12 weeks.

RESULTS

Significant improvements from baseline to end of treatment for signs of atopic dermatitis (erythema, edema, excoriation, oozing, scaling, and lichenification) were noted for head/neck and non-head/neck areas treated with either 0.03% or 0.1% tacrolimus ointment (p<0.001). Within each treatment group, the overall 12-week adjusted incidence rate of application site adverse events was similar for both head/neck and non-head/neck areas. The incidence of common adverse events such as pruritus, "skin burning", erythema, infection, and skin tingling in head/neck areas was comparable to that observed in non-head/neck areas within each treatment group. The overall prevalence of application site adverse events decreased rapidly during the first few days of treatment.

CONCLUSION

Tacrolimus ointment is a safe and effective treatment for atopic dermatitis on the head and neck.

The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis

BACKGROUND

Atopic dermatitis can have detrimental effects on health-related quality of life (QOL).

OBJECTIVE

Our purpose was to examine the QOL impact of tacrolimus ointment in patients with atopic dermatitis.

METHODS

The Dermatology Life Quality Index (DLQI), Children's DLQI (CDLQI), and Toddler QOL Survey were used to assess QOL in adults (16 years or older), children (5-15 years), and toddlers (2-4 years) enrolled in 12-week, randomized, double-blind studies comparing two concentrations of tacrolimus ointment (0.03% and 0.1%) versus vehicle ointment for treatment of atopic dermatitis. QOL was assessed at baseline, week 3, and week 12/early discontinuation.

RESULTS

Of the 985 patients enrolled, 91.5% had evaluable QOL data. Among adults, both tacrolimus ointment groups experienced improved QOL relative to the vehicle control group for all QOL scales (P<.001). Among children and toddlers, both tacrolimus ointment groups demonstrated significant QOL improvements relative to the vehicle control group (P<.05) for all but the Personal Relationships scale in the 0.03% tacrolimus ointment group among children.

CONCLUSION

Tacrolimus ointment is associated with significant QOL benefits in adults, children, and toddlers with atopic dermatitis.

[Problems with topical therapies for extensive squamous cell carcinoma of the buttocks]

In patients in whom cancer originating from a bed-sore has advanced to a stage where radical treatment is impossible, topical treatment with ointment, or systemic anti-cancer chemotherapy, is usually applied. We recently attempted treatment of extensive squamous cell carcinoma of the buttocks, for which radical treatment was impossible, by chemotherapy using a reservoir for intraarterial injection. This therapy involved intraarterial injection of bleomycin and 5-FU, together with topical treatment with 5-FU ointment. We describe the problems encountered with this therapy, e.g., measures against fever after intraarterial injection, management of the affected area, evacuation, possibility and limits of radiation therapy, and assessment of its efficacy.

[Evaluation of reservoir inserted for the prevention of liver metastasis of colorectal cancer]

The subjects were 22 patients who had undergone intra-arterial chemotherapy using reservoirs for prevention of postoperative liver metastasis during the period from January 1986 to September 1989, 3 with non-resected liver metastasis, 1 with resected liver metastasis with intra-arterial chemotherapy, and patients with systemic chemotherapy. None of the 7 patients with macroscopic stage II disease, who had undergone intra-arterial therapy for the prevention of liver metastasis survived (maximum duration, 25 months), had liver metastasis. Two of 8 patients with stage III disease died, and liver metastasis was observed. Two of 7 patients with stage IV disease died, one of whom them had liver metastasis. Four of 12 patients with stage II disease treated by systemic chemotherapy died, and 2 of them had liver metastasis. Four of 18 patients with stage III disease treated by systemic chemotherapy died, and one of them had liver metastasis. One of 11 patients with stage IV disease systemic chemotherapy died, and liver metastasis was noted in another. None of the patients who had undergone intra-arterial chemotherapy for the prevention of liver metastasis had liver metastasis within a period of one year. At present there is no difference in survival period between the group given intra-arterial chemotherapy for the prevention of liver metastasis and the group given systemic chemotherapy.

[Effects of intra-arterial infusion chemotherapy in local recurrence of anal cancer]

At present, there is no effective local therapy for skin metastasis after radical operation for anorectal cancer. Most local recurrent lesions of this type are not indications for surgery. However, successful control of the local lesion can enhance the quality of life because the general condition is good. We performed intra-arterial infusion chemotherapy for skin metastasis after Miles operation for anorectal cancer and observed marked effects. A 62-year-old female with anal cancer underwent Miles operation in November, 1987. About July, 1988, an indurated mass appeared in the perineal region but was left untreated. However, urinary disturbance due to the mass developed, and she was admitted in September. A catheter for Intra-arterial infusion chemotherapy was inserted via the lateral deep femoral artery, and 5-FU, BLM, and MMC were administered. Local bleeding was stopped, and the mass began to be reduced about 16 days after the administration. After about 1 month, no secretion from the mass was observed, and the urinary disturbance improved due to a reduction in the mass.