Aim Potentially inappropriate medications (PIMs) are associated with a lower medication adherence and a higher incidence of adverse events and medical costs among elderly patients. The current study aimed to examine the prescription status of elderly patients transported to tertiary emergency medical institutions to compare the proportion of elderly patients using PIMs at admission and discharge and to investigate the characteristics of PIMs at discharge and their associated factors. Methods In total, 264 patients aged 75 years or older who were transferred to and discharged from the emergency room at Tokyo Medical University Hospital, a tertiary care hospital, from September 2018 to August 2019 were included in this study. We quantified the number of PIMs at admission and discharge based on the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) criteria version 2. The primary outcomes were the proportion of elderly patients taking at least one PIM at admission and discharge. Results The proportions of patients taking PIMs at admission and discharge were 55% ( n = 175) and 28% ( n = 74), respectively. Old age, greater number of PIMs at admission, and greater number of medications at discharge were directly associated with PIMs at discharge. Conclusions Admission to tertiary care hospitals resulted in a lower number of prescribed PIMs. Elderly patients with a higher number of PIMs at admission and higher number of medications at discharge might have been prescribed with PIMs.

We report three cases of using Impella that saved the life of patients with out‐of‐hospital cardiac arrest. For applying Impella in these patients, it is necessary to consider the age, initial rhythm, witness, bystander cardiopulmonary resuscitation, time from onset to hospital arrival, hemodynamics after intra‐aortic balloon pump introduction, and transthoracic echocardiography findings at arrival.

Objectives: Heparinized continuous-flush solutions are used to maintain arterial catheter patency. We sought to compare the patency and pressure wave integrity of radial artery catheters maintained with heparinized or nonheparinized infusions. Methods: Patients in the emergency room and intensive care unit were consecutively enrolled and randomly assigned to receive a heparinized solution (heparin group, n = 18) or normal saline (NS group, n = 16). The functional duration of radial artery catheters, the differences between arterial catheter and brachial cuff blood pressures, and the pressure wave curve quality were determined. Results: The mean duration of functional cannulas did not differ significantly between the heparin and NS groups (120 ± 129 and 105 ± 82 hours, respectively, P = 0.689). There was no difference in blood pressure between arterial catheter measurements and brachial cuff measurements between the two groups (P = 0.607). Kaplan-Meier analysis showed that the incidence of pressure wave dampening did not differ between the groups (log-rank test, P = 0.896). Conclusions: No significant differences were found between heparinized and nonheparinized flush solutions for maintaining radial artery catheter patency and function.

Aim Potentially inappropriate medications (PIMs) have been reported to be associated with lower adherence, higher rates of adverse events, and higher health‐care costs in elderly patients with high comorbidity. However, inappropriate prescribing has not been adequately reported in studies of patients transported to tertiary care hospitals. In this study, we investigated PIMs at the time of admission, on the basis of the prescription status of elderly patients admitted to a tertiary emergency room (ER). Methods We included 316 patients (168 men and 148 women, aged 75–97 years) who were admitted to our ER from September 2018 to August 2019, whose prescriptions were available on admission. Drugs that met the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2 were defined as PIMs. The primary outcome was the proportion of older adults taking at least one PIM at admission. Results The proportion of patients taking PIMs at admission was 57% ( n = 179). The most common PIMs were benzodiazepines, proton pump inhibitors, and nonsteroidal anti‐inflammatory drugs. The total number of medications prescribed at admission, prescriptions from multiple institutions, and prescriptions from clinics were the risk factors for PIMs at admission ( P < 0.01, P < 0.001, and P < 0.001, respectively). Conclusion We must be careful to avoid inappropriate prescribing for patients transported to tertiary care hospitals who have numerous prescriptions at the time of admission, patients who receive prescriptions from multiple medical institutions, and patients who receive prescriptions from clinics.