Analysis of Pharmacist-Patient Communication using the Roter Method of Interaction Process Analysis System

Background: Effective communication between pharmacists and patients is a crucial factor in ensuring thatmedications are used properly. However, few studies have examined the contents of actual on-sitecommunications between pharmacists and patients.Objective: To identify the characteristics of and problems with routine communications betweenpharmacists and patients using the Roter Method of Interaction Process Analysis System (RIAS).Methods: Conversations between pharmacists and simulated patients (SPs) were recorded and transcribed.Using the RIAS technique, their utterances were classified into 42 categories, and these were furtherdivided into 11 clusters, such as open- and closed-ended questions, and analyzed. Furthermore, theinfluence that the different scenarios performed by the pharmacists may have had on the structure of theircommunication was investigated. All of the transcripts were double-coded by two certified coders.Results: A total of 57 pharmacists took part in the study. The mean ratio of utterances made by SPs andpharmacists were 44% and 56%, respectively. The percentage of pharmacists’ questions was more thandouble that of SPs’ for both open- and closed-ended questions. In the influence that the different scenarios,the scenarios for patients with cancer was significantly higher ratio of utterances by the pharmacists.Conclusions: Pharmacists’ communications tended to focus more on information-gathering activities thatconcentrated on closed-ended questions and frequent counseling, or directing utterances about themedication than on considering the patient’s background. On the other hand, the pharmacists didcommunicate in ways that matched each patient’s disease. This study identified the structure ofpharmacists’ on-site communications, and revealed the associated characteristics and problems

Complete slaking collapse of dike sandstones by fresh water and prevention of the collapse by salt water

Slaking is a well-known process, in which the surface of rock masses consisting of rocks such as mudstone, shale, etc. show rapid and complete disintegration when they are subjected to drying and then wetting with fresh water. On the other hand, dried sandstones even if they contain clay minerals such as smectite, etc., usually do not exhibit complete disintegration when they are soaked in fresh water. Instead, they usually show a strength decrease. Their slaking durability is tested by rotating them in a drum which is partially immersed in fresh water and eventually measuring the decrease in weight. On the other hand, it was found that some of the Paleogene sandstones from Kushiro Coal Mine in Japan, were completely disintegrated when they were immersed in fresh water followed by drying, but they were not collapsed when saline water was used instead of the fresh water. It was also shown that sandstones containing calcite did not show the complete breakdown even in fresh water. To understand the complete collapse of sandstones in fresh water and prevention of the collapse by salt water, sandstones sampled from Neogene dikes and Cretaceous at the mine were immersed in pure and salt water with Shikotsu welded tuff for comparison. Only dike sandstones showed a complete collapse in pure water and 3% salt water. Dike sandstone further showed severe time-dependent damage in salt water whose salinity was less than 7%. The results were explained by the dissolution of halite, swelling pressure of montmorillonite, osmotic pressure, etc

Clinical and Epidemiological Characteristics of Persistent Bacteremia: A Decadal Observational Study

Background: Bloodstream infections (BSIs), including persistent bacteremia (PB), are a leading source of morbidity and mortality globally. PB has a higher mortality rate than non- PB, but the clinical aspects of PB in terms of the causative pathogens and the presence of clearance of PB are not well elucidated. Therefore, this study aimed to describe the clinical and epidemiological characteristics of PB in a real-world clinical setting. Methods: We performed a retrospective observational survey of patients who underwent blood culture between January 2012 and December 2021 at Tohoku University Hospital. Cases of PB were divided into three groups depending on the causative pathogen: gram-positive cocci (GPC), gram-negative rods (GNRs), and Candida spp. For each group, we examined the clinical and epidemiological characteristics of PB, including differences in clinical features depending on the clearance of PB. The main outcome variable was mortality, assessed as early (30-day), late (30–90 day), and 90-day mortality. Results: Overall, we identified 31,591 cases of single bacteremia; in 6709 (21.2%) cases, the first blood culture was positive, and in 3124 (46.6%) cases, a follow-up blood culture (FUBC) was performed. Of the cases with FUBCs, 414 (13.2%) were confirmed to be PB. The proportion of PB cases caused by Candida spp. was significantly higher (29.6%, 67/226 episodes) than that for GPC (11.1%, 220/1974 episodes, p < 0.001) and GNRs (12.1%, 100/824 episodes, p < 0.001). The Candida spp. group also had the highest late (30–90 day) and 90-day mortality rates. In all three pathogen groups, the subgroup without the clearance of PB tended to have a higher mortality rate than the subgroup with clearance. Conclusions: Patients with PB due to Candida spp. have a higher late (30–90 day) and 90-day mortality rate than patients with PB due to GPC or GNRs. In patients with PB, FUBCs and confirming the clearance of PB are useful to improve the survival rate

Indirect CRISPR screening with photoconversion revealed key factors of drug resistance with cell–cell interactions

Abstract Comprehensive screenings to clarify indirect cell–cell interactions, such as those in the tumor microenvironment, especially comprehensive assessments of supporting cells’ effects, are challenging. Therefore, in this study, indirect CRISPR screening for drug resistance with cell–cell interactions was invented. The photoconvertible fluorescent protein Dendra2 was inducted to supporting cells and explored the drug resistance responsible factors of supporting cells with CRISPR screenings. Random mutated supporting cells co-cultured with leukemic cells induced drug resistance with cell–cell interactions. Supporting cells responsible for drug resistance were isolated with green-to-red photoconversion, and 39 candidate genes were identified. Knocking out C9orf89, MAGI2, MLPH, or RHBDD2 in supporting cells reduced the ratio of apoptosis of cancer cells. In addition, the low expression of RHBDD2 in supporting cells, specifically fibroblasts, of clinical pancreatic cancer showed a shortened prognosis, and a negative correlation with CXCL12 was observed. Indirect CRISPR screening was established to isolate the responsible elements of cell–cell interactions. This screening method could reveal unknown mechanisms in all kinds of cell–cell interactions by revealing live phenotype-inducible cells, and it could be a platform for discovering new targets of drugs for conventional chemotherapies

Association between Unhealthy Dietary Habits and Proteinuria Onset in a Japanese General Population: A Retrospective Cohort Study

The relationship between dietary habits and development of chronic kidney disease (CKD) is unclear. This retrospective cohort study was conducted to examine the association between unhealthy dietary habits and proteinuria onset, a key prognostic factor of CKD, among a Japanese general population aged ≥40 years. The risks of proteinuria onset were estimated based on the status of baseline unhealthy dietary habits (quick eating, late dinner, late evening snack, and skipping breakfast) compared with the status without these habits. A total of 26,764 subjects were included, with a mean follow-up period of 3.4 years. The most frequent unhealthy dietary habit was quick eating (29%), followed by late dinner (19%), late evening snack (16%), and skipping breakfast (9%). During the follow-up period, 10.6% of participants developed proteinuria. Late dinner and skipping breakfast showed an increased adjusted risk of proteinuria onset (hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.02 to 1.22, and HR 1.15, 95% CI 1.01 to 1.31, respectively). Unhealthy dietary habits were not associated with changes in body mass index or waist-to-height ratio during the follow-up period. Our results suggest that late dinner and skipping breakfast are associated with higher risks for proteinuria onset

Clinical features of anthracycline‐induced cardiotoxicity in patients with malignant lymphoma who received a CHOP regimen with or without rituximab: A single‐center, retrospective observational study

Abstract We investigated the incidence of cardiotoxicity, its risk factors, and the clinical course of cardiac function in patients with malignant lymphoma (ML) who received a cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen. Among all ML patients who received a CHOP regimen with or without rituximab from January 2008 to December 2017 in Nagoya City University hospital, 229 patients who underwent both baseline and follow‐up echocardiography and had baseline left ventricular ejection fraction (LVEF) ≥50% were analyzed, retrospectively. Cardiotoxicity was defined as a ≥10% decline in LVEF and LVEF < 50%; recovery from cardiotoxicity was defined as a ≥5% increase in LVEF and LVEF ≥50%. Re‐cardiotoxicity was defined as meeting the criteria of cardiotoxicity again. With a median follow‐up of 1132 days, cardiotoxicity, symptomatic heart failure, and cardiovascular death were observed in 48 (21%), 30 (13%), and 5 (2%) patients, respectively. Multivariate analysis demonstrated that history of ischemic heart disease (hazard ratio (HR), 3.15; 95% CI, 1.17‐8.47, P = .023) and decreased baseline LVEF (HR per 10% increase, 2.55; 95% CI, 1.49‐4.06; P < .001) were independent risk factors for cardiotoxicity. Recovery from cardiotoxicity and re‐cardiotoxicity were observed in 21 of 48, and six of 21, respectively. Cardiac condition before chemotherapy seemed to be most relevant for developing cardiotoxicity. Furthermore, Continuous management must be required in patients with cardiotoxicity, even after LVEF recovery