Tokyo Guidelines and Their Limits

Mishima, Kohei; Wakabayashi, Go

doi:10.1007/978-3-030-62102-5_5

Cited by 4 publications

(5 citation statements)

References 21 publications

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“…Therefore, early reduction or discontinuation (including switching) of BZD/non‐BZD may be beneficial. For these reasons, we attempted to reduce 25% of the prescribed dose of BZD/non‐BZD or switch to lemborexant in approximately 1 week, based on the guideline for appropriate use or discontinuation of sleeping medications 17 . This approach allowed the reduction or modification of the majority of BZD/non‐BZD prescriptions from previous physicians.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, we attempted to reduce 25% of the prescribed dose of BZD/non‐BZD or switch to lemborexant in approximately 1 week, based on the guideline for appropriate use or discontinuation of sleeping medications. 17 This approach allowed the reduction or modification of the majority of BZD/non‐BZD prescriptions from previous physicians. However, for eszopiclone, the dose should have been tapered more slowly than the guideline stated to avoid insomnia, which occurred in multiple patients with this method.…”

Section: Discussionmentioning

confidence: 99%

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Reducing the use of psychotropics in a convalescent rehabilitation ward

Uematsu,

Tomita,

Obara

et al. 2023

Neuropsychopharm Rep

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AimsMany patients who are transferred to the convalescent rehabilitation ward of Kawasaki Kokoro Hospital (hereinafter, our hospital) are on psychotropics prescribed for delirium by their physicians at acute care hospitals. In this study, psychiatrists and pharmacists collaborated with rehabilitation physicians to reduce the use of psychotropics.MethodsThe basic information and psychotropics prescription statuses of 88 patients discharged from the convalescent rehabilitation ward of our hospital between April 1, 2021 and March 31, 2022 were derived from their medical records.ResultsAt admission, psychotropics were prescribed to 55 patients and the number of prescribed drugs was 2 (median). At discharge, psychotropics were prescribed to 41 patients and the number of prescribed drugs was 1 (median), showing a significant decrease (p < 0.05). Compared with those at admission, prescribed psychotropic doses at discharge were significantly higher for lemborexant but significantly lower for antipsychotics, benzodiazepine/nonbenzodiazepine hypnotics, antidepressants, suvorexant, ramelteon, and sodium valproate (p < 0.05).ConclusionsThese results suggest that it may be possible to reduce the types and doses of psychotropics prescribed at acute care hospitals in convalescent rehabilitation wards. However, further investigation is needed because the number of patients in this study was limited, and selection bias due to different patient characteristics cannot be ruled out.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reducing the use of psychotropics in a convalescent rehabilitation ward

Uematsu,

Tomita,

Obara

et al. 2023

Neuropsychopharm Rep

View full text Add to dashboard Cite

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“…[15,36,37,43] Although there are models predicting difficulty, they are complex and not practical. [7][8][9][10]24,25,34,44,[44][45][46][47][48] . To predict the use of a bailout procedure in a more practical way, we estimated the area under the ROC curve of the time (minutes) spent trying to dissect the CD and found that it predicts the use of bailout techniques, as well as being a good predictor of conversion (see Graphs 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

2023

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Background: The Tokyo 2018 guidelines call for the study of quantitative predictors of surgical difficulty in laparoscopic cholecystectomy for complete cholecystectomy in a safe context. Objective: To evaluate the cystic duct (CD) dissection time as a predictor of surgical difficulty. Materials and methods: This prospective study included 193 patients who underwent laparoscopic cholecystectomy in 2022 and were grouped according to the indication for cholecystectomy: Urgent, Delayed, and Elective. Multiple linear regression and multinomial logistic regression analyses were used to identify the preoperative and operative predictive variables of surgical difficulty. The predictive value of the time spent dissecting the CD was estimated using a ROC curve. Results: The CD dissection time of 13 min had 100% sensitivity and 99% specificity, PPV 100%, NPV 1%, OR 3.3 to predict the use of bailout techniques. Conclusions: The time required to dissect the cystic duct, with or without success, is a practical predictor of the subsequent use of bailout procedures and, consequently, predicts the "Risk/Difficult Cholecystectomy". Keywords: Difficult laparoscopic cholecystectomy, predictors of difficult cholecystectomy, bailout procedures, cystic dissection time, risk of cholecystectomy.

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“…Benzodiazepine receptor agonist (BzRA) hypnotics are recommended as first-line short-term pharmacological treatments for chronic insomnia. [1][2][3][4][5] Although insomnia is often a persistent condition, 6 longterm use of BzRA hypnotics is not recommended owing to insufficient evidence for its long-term effects and risk of adverse effects, such as physical dependence, 7 cognitive dysfunction, 8 falls and fractures, 9,10 and traffic accidents. 11,12 The American Academy of Sleep Medicine states that long-term use of hypnotics should only be allowed for patients without access to cognitive behavioral therapy (CBT) or those who are irresponsive to CBT and may benefit from long-term pharmacotherapy.…”

mentioning

confidence: 99%

“…Benzodiazepine receptor agonist (BzRA) hypnotics are recommended as first‐line short‐term pharmacological treatments for chronic insomnia 1–5 . Although insomnia is often a persistent condition, 6 long‐term use of BzRA hypnotics is not recommended owing to insufficient evidence for its long‐term effects and risk of adverse effects, such as physical dependence, 7 cognitive dysfunction, 8 falls and fractures, 9,10 and traffic accidents 11,12 .…”

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confidence: 99%

Effects of Japanese policies and novel hypnotics on long‐term prescriptions of hypnotics

Takeshima

Yoshizawa

Enomoto

et al. 2023

Psychiatry Clin Neurosci

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Aim The current study aimed to examine the effect of Japanese policies for appropriate hypnotics use and novel hypnotics (e.g. melatonin receptor agonist and orexin receptor antagonist [ORA]) on long‐term prescriptions of hypnotics. Methods This retrospective study was conducted using a large‐scale health insurance claims database. Among subscribers prescribed hypnotics at least once between April 2005 and March 2021, those prescribed hypnotics for the first time after being included in the database in three periods (period 1: April 2012–March 2013; period 2: April 2016–March 2017; and period 3: April 2018–March 2019) were eligible. These were set considering the timing of the 2014 and 2018 medical fee revisions (2014 for polypharmacy of three or more hypnotics, 2018 for long‐term prescription of benzodiazepine receptor agonists for >12 months). The duration of consecutive prescriptions of hypnotics over 12 months was evaluated. Factors associated with short‐term prescriptions of hypnotics were also investigated. Results In total, 186 535 participants were newly prescribed hypnotics. The mean duration of prescriptions was 2.9 months, and 9.3% of participants were prescribed hypnotics for 12 months. Prescription periods were not associated with short‐term prescriptions of hypnotics. ORA use was associated with short‐term prescriptions of hypnotics (adjusted hazard ratio, 1.077 [95% confidence interval, 1.035–1.120]; P < 0.001), but melatonin receptor agonist use was not. Conclusion Japanese policies had no statistically significant effect on long‐term prescriptions of hypnotics. Although this study suggests initiating ORA for insomniacs as a candidate strategy to prevent long‐term prescriptions of hypnotics, further research is necessary to draw conclusions.

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Tokyo Guidelines and Their Limits

Cited by 4 publications

References 21 publications

Reducing the use of psychotropics in a convalescent rehabilitation ward

Reducing the use of psychotropics in a convalescent rehabilitation ward

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

Effects of Japanese policies and novel hypnotics on long‐term prescriptions of hypnotics

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