Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation

AbstractLittle information is available on the clinical characteristics of infectious complications that occur in the early period after reduced-intensity stem cell transplantation (RIST). We retrospectively investigated the clinical features of neutropenic fever and infectious episodes within 30 days after RIST in 76 patients who had received fluoroquinolones as part of their antibacterial prophylaxis. Preparative regimens included cladribine 0.66 mg/kg or fludarabine 180 mg/m2 plus busulfan 8 mg/kg. All but 1 patient survived 30 days after transplantation, and 75 patients (99%) became neutropenic within a median duration of 9 days. Neutropenic fever was observed in 29 patients (38%), and bacterial infection was confirmed in 15 (20%) of these, including bacteremia (n = 13), bacteremia plus pneumonia (n = 1), and urinary tract infection (n = 1). The causative organisms were gram-positive (n = 9) and gram-negative organisms (n = 7), with a mortality rate of 6%. Neither viral nor fungal infection was documented. Multivariate analysis showed that the presence of neutropenia at the initiation of preparative regimens was an independent risk factor for subsequent documented bacterial infections (P = .026; 95% confidence interval, 1.25–35.1). We conclude that neutropenic fever and bacteremia remain common complications in RIST

Forecasting Japan's Physician Shortage in 2035 as the First Full-Fledged Aged Society

<div><h3>Introduction</h3><p>Japan is rapidly becoming a full-fledged aged society, and physician shortage is a significant concern. The Japanese government has increased the number of medical school enrollments since 2008, but some researchers warn that this increase could lead to physician surplus in the future. It is unknown how many physicians will be required to accommodate future healthcare needs.</p> <h3>Materials and Methods</h3><p>We simulated changes in age/sex composition of the population, fatalities (the number of fatalities for the consecutive five years), and number of physicians from 2010 to 2035. Two indicators were defined: fatalities per physician and fatalities by physician working hour, based on the data of the working hours of physicians for each tuple of sex and age groups. We estimated the necessary number of physicians in 2035 and the number of new physicians to maintain the indicator levels in 2010.</p> <h3>Results</h3><p>The number of physicians per 1,000 population is predicted to rise from 2·00 in 2010 to 3·14 in 2035. The number of physicians aged 60 years or older is expected to increase from 55,375 (20% of physicians) to 141,711 (36%). In 2010 and 2035, fatalities per physician were 23·1 and 24·0 for the total population, and 13·9 and 19·2 for 75 years or older, respectively. Fatalities per physician working hour are predicted to rise from 0·128 to 0·138. If working hours are limited to 48 hours per week in 2035, the number of fatalities per physician working hour is expected to be 0·196, and the number of new physicians must be increased by 53% over the current pace.</p> <h3>Discussion</h3><p>The number of physicians per population continues to rise, but the estimated supply will not fulfill the demand for healthcare in the aging society. Strategies to increase the number of physicians and improve working conditions are urgently needed.</p> </div

Changes in simulated paramaters, 2010 and 2035.

<p>Changes in simulated paramaters, 2010 and 2035.</p

Correlation between prefectural populations and the differential increase in rates in the number of fatalities per physician for the entire population.

<p>When fatalities per practicing physician were compared between 2010 and 2035, the differential increase in rates was correlated with prefectural populations.</p

Physicians' population pyramids.

<p>Physicians' population pyramids for 2010 (panel A) and 2035 (panel B).</p

Number of fatalities per practicing physician for the entire population by prefecture.

<p>Values for 2010 are calculated and mapped (panel A). The indicator for all of Japan is 24·0. The best five prefectures are Tokyo (15·8), Okinawa (16·5), Kyoto (17·7), Fukuoka (18·2), and Osaka (19·1). The worst five prefectures are Aomori (35·2), Iwate (34·8), Akita (34·3), Niigata (34·2), and Ibaraki (32·7). Values for 2035 are calculated and mapped (panel B). The indicator for all of Japan is 23·1. The best five prefectures are Tokyo (15·7), Kyoto (17·3), Okinawa (17·3), Fukuoka (17·9) and Saga (20·0). The worst five prefectures are Saitama (38·2), Aomori (36·9), Ibraraki (36·1), Niigata (34·1), and Iwate (32·6).</p