Screening Tool for Older Persons' Appropriate Prescriptions for Japanese: Report of the Japan Geriatrics Society Working Group on "Guidelines for medical treatment and its safety in the elderly".

AIM: In 2005, the Japan Geriatrics Society published a list of potentially inappropriate medication that was an extract from the "Guidelines for medical treatment and its safety in the elderly 2005." The 2005 guidelines are due for a revision, and a new comprehensive list of potentially inappropriate medications is required. METHODS: A total of 15 diseases, conditions and special areas related to their clinical care were selected. We originated clinical questions and keywords for these 15 areas, carried out a systematic review using these search criteria, and formulated guidelines applying the Grading of Recommendations Assessment, Development and Evaluation system advocated by Minds2014. If we did not find good evidence despite the drug being clinically important, we looked for evidence of efficacy and for disease-specific guidelines, and incorporated them into our guidelines. RESULTS: We selected 2098 articles (140 articles per area), and extracted another 186 articles through a manual search. We further added guidelines based on disease entity and made two lists, one of "drugs to be prescribed with special caution" and the other of "drugs to consider starting," primarily considering individuals aged 75 years or older or those who are frail or in need of special care. CONCLUSIONS: New lists of potentially inappropriate medications and potential prescribing omissions called "Screening Tool for Older Person's Appropriate Prescriptions for Japanese" were constructed. We anticipate that future studies will highlight more evidence regarding the safety of high-quality drugs, further improving the provision of appropriate medical care for the elderly. Geriatr Gerontol Int 2016: 16: 983-1001.

[A case of isolated pulmonary valve infective endocarditis in a 78-year-old woman].

A 78-year-old woman was admitted to our hospital with lumbago. Her activities of daily living had previously been completely independent. However, she developed temporary chills in January 2009, that improved without treatment, but recurred on February 7, 2009 in association with left lumbago and loss of appetite. She was then referred to our hospital with a disturbance of consciousness and high fever on February 14. A blood test performed on admission revealed an elevated inflammatory response, coagulation disorder and low platelet count, and abdominal computed tomography demonstrated findings suggestive of pyogenic spondylitis. The patient was therefore admitted and treated with antibiotic therapy; however, she died on day 8 due to complications of disseminated intravascular coagulation. An autopsy showed isolated pulmonary valve endocarditis. The patient's history was later found to include regular dental treatment, and the same Streptococcus group G was detected in cultures of the sputum, blood and vegetation. It is important to interview patients regarding their history of dental treatment, particularly elderly individuals with fever of unknown origin.

Pulmonary focal fibrosis associated with microscopic arterio-venous fistula manifesting as focal ground-glass opacity on thin-section CT.

BACKGROUND: Focal ground-glass opacity (GGO) on thin-section computed tomography (CT) may be seen in atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ that has recently been renamed from bronchioloalveolar carcinoma (BAC) and various benign conditions. CASE PRESENTATION: We report a case of pulmonary focal fibrosis associated with microscopic arterio-venous fistula (AVF), which showed a focal area of GGO on thin-section CT. The patient was a 58-year-old woman with a GGO on thin-section CT which had increased in size over the period of 2 years. Slightly dilated vessels and thickened interlobular septa were also noted around the GGO. It was diagnosed preoperatively as adenocarcinoma in situ and a partial lung resection by video-assisted thoracic surgery (VATS) was performed. Pathological examination yielded a diagnosis of focal fibrosis associated with microscopic AVF. CONCLUSION: We speculate that the focal fibrosis was produced by a prolonged congestion due to the AVF and that the dilated vessels and thickening of interlobular septa on thin-section CT related to the AVF. Microscopic AVF may be one of the etiologies of focal fibrosis showing focal GGO on thins-section CT. Dilated vessels and thickened interlobular septa around the GGO might offer a clue to the diagnosis of this disease entity. In addition, it should be noted that focal fibrosis may increase in size.

[Educational effects of a single distribution of a leaflet on alcohol and pregnancy among female university students].

OBJECTIVE: To evaluate the educational effects of a single leaflet distributed once without explanation of its content. METHODS: All the 58 seniors on a dietitian course and all the 81 students who took "health and nutrition" as their elective in a women's university in F Prefecture were recruited. They were assigned to intervention or control groups. Both groups were asked the following choice questions in a baseline survey: "What do you think about alcohol drinking during pregnancy?" "What do you suppose you yourself will do in the future?" and "Do you know about the fetal alcohol syndrome (FAS)?" One month later, a leaflet was distributed to the intervention group only. One week after the distribution, a second questionnaire was administered to both groups. The leaflet and the two questionnaires were distributed and collected during class with the help of teaching staff. The leaflet was made by a NPO and it recommended stopping drinking when planning to become pregnant. RESULTS: The participation rate was 83%. There were no significant associations between groups and grades, current drinking habit, and learning experience on this topic. Almost 80% of the intervention group read the leaflet. Change in their thinking about drinking during pregnancy before and after the intervention did not significantly differ between the two groups. Compared to 57 controls, 66 students who received the leaflet showed significant improved changes in their attitudes toward drinking during pregnancy and the knowledge about FAS. CONCLUSIONS: No significant change in their thinking about drinking during pregnancy could be due to the fact that, even before the intervention, nearly 80% of the students thought pregnant women must abstain from alcohol entirely. This might be related to the sample characteristics, since 75% of them were majoring in nutrition. The improvement in attitudes was considered to reflect the content of the leaflet. In the intervention group, the percentage of the students who chose the alternative of "I plan to stop drinking when I wish to get pregnant" increased as the leaflet recommended and more than half of them said they learned about FAS by this leaflet. To sum up, even a single distribution of a leaflet in a school setting had educational effects which improved attitude and knowledge. Since the current sample seemed to have particular knowledge and interest in health, it is now necessary to examine effects of the same approach in the general population.

Adequacy of dietary intake information obtained from mailed food records differed by weight status and not education level of midlife women.

Mailed food records have been suggested as a means to acquire useful food intake data from a large number of participants with minimal effort. The purpose of this cross-sectional study was to explore whether education level and weight status of midlife women affected adequacy of information about dietary intake derived from a self-administered mailed 1-day food record. Adequacy was defined as the ability to describe and record intake with sufficient detail for entry into a computerized diet analysis program without missing data. From October 2007 through March 2008, 100 women (49+/-5 years), recruited by education level, were mailed a food record booklet and a 16-page actual-size two-dimensional food model booklet with instruction to describe foods, amounts consumed, and preparation methods/recipes. Women returned the completed food record booklet by mail. Between 3 and 13 days later, a registered dietitian called the participants to review missing details, clarify amounts, and probe for omissions. Six categories of missing data included: "omission of portion size," "inaccurate portion size," "insufficient description of portion size," "insufficient description of food," "omission of ingredients," and "insufficient or no preparation method." The percentage of foods with missing data did not differ by education level; however, higher percentages of missing data regarding "insufficient description of food," were observed in obese compared to overweight women. Adequacy of information from the mailed food record was dependent on weight status but not education level. Additional study is needed to determine how to revise instructions for mailed food records in future studies according to weight status of midlife women.