Medication Distribution System Research Articles

Medical Report Management and Distribution System on Blockchain

The security and effective management of health records is a key issue for today's digitized healthcare environment. In terms of data security, integrity and accessibility, traditional centralized systems face challenges. We propose a novel system of medical report management and dissemination using the Block-chain technology, as well as SHA1 encryption for addressing these issues. In order to store hashed medical reports, our system uses a decentralized block-chain network to ensure tamper-proof and immutable records. SHA1 is used to hash every medical report, generating a unique identifier that's stored on the Block-chain. The integration of Flask, Python's lightweight web framework, facilitates the creation of an easy user interface to interact with a system easily. Secure storage, effective distribution and granular control of medical reports are among the key features of our system. In order to maintain the integrity and confidentiality of data, patients, physicians or authorized persons should be able to use secure means for accessing and updating their healthcare records. The use of SHA1 increases system security by providing a reliable cryptographic hash. Our system is aimed at simplifying the management and distribution of medical reports, thereby improving efficiency and patient outcomes in addition to enhanced data protection and integrity. By ensuring security, transparency and decentralized solutions, we are confident that the proposal for a medical records management system has the potential to revolutionize this area.

Automation of the medication process in Swiss hospitals: results of a survey

ObjectivesMedication management is a core process in hospital administration. The safety, timeliness and efficiency of medication distribution may be improved by automating logistical and administrative aspects of the process. Forming...

A Review on Pulsatile Drug Delivery System

In essence, pulsatile drug delivery systems (PDDS) are time-controlled drug delivery systems in which the system regulates the lag time independently of external parameters such as pH, enzymes, gastro-intestinal motility, etc. Traditionally, medications either release immediately or over time. Nevertheless, interest in pulsatile drug release devices has grown recently. These systems were created to work with the body's natural circadian cycle. In Latin literature, Circa and Dian are the words for day and night, respectively. For many medications or treatments, pulsatile drug release—in which the drug is released quickly after a clearly defined lag—could be useful. Asthma, peptic ulcer, cardiovascular disease, arthritis, attention deficit disorder in children, and hypercholesterolemia are among the illnesses where PDDS appears promising. This medication distribution system has been pre-programmed

Pharmacy practice in hospital settings in GCC countries: Dispensing and administration

PurposeTo outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries’ hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study. MethodsA modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. ResultsSixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps. ConclusionThe results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.

AN INSIGHT DATA ON MEDICATION SAFETY IN ACCORDANCE WITH DRUG COMPLICATIONS BASED ON THE AUTOMATED DISPENSING SYSTEM

Automated dispensing systems have been applied for maintaining medication safety, improving drug distribution, and reducing the risk of medication errors in different pharmacy practice. Automated dispensing machines maintain the balance of accessibility, stock control of medications, and protection which were the main features of a safe medication distribution system. It should be linked with medication review and regular patient counselling. Encourage the timely administration of drugs through expanding their access to patient care units and first-dose availability was improved in automated dispensing machines. Physicians allow treatment efficiently by providing convenient access to medications of critically ill patients for emergencies during and after pharmacy hours with automated dispensing machines. This investigation demonstrates that the nature of pharmacotherapy for patients with automated dose dispensing can be improved. This study highlights the impact of an automated dispensing system in primary healthcare, Automated Dispensing Cabinets, or, in an intensive care unit to reduce medication errors. Implementation of automated dispensing systems reduces dispensing errors and gives pharmacists more time to review patient profiles. It recommends that every patient with automatic dose dispensing ought to go through a careful medication review through prescribers and pharmacists. It concluded that the automatic drug dispensing focuses on the effect of a medication review in patients. The ideal recurrence for conducting medication reviews and follow-up will likely contrast between individual patients. Hence, it provides an insight data on medication safety based on the automated dispensing system in accordance with drug complications. KEYWORDS: Automated dose dispensing, Medication safety, Drug complication, Impact, Evaluation, Insight report on medication safety

Blockchain-driven authorized data access mechanism for digital healthcare

The existing traditional medical database system is a centralized system in which data manipulation is easy, privacy is critical, and there is a lack of easy information exchange and adequate data management. Although blockchain mechanisms have the potential to use and easily maintained on the distributed medical architecture around the globe to address the bottleneck situation. In this paper, we propose a blockchain-based authenticated access control framework. We use blockchain technology to defend patients’ rights to licensed medical material distribution systems. The proposed mechanism’s security has been demonstrated against adversary. The analysis of performance and comparative study is also performed, which shows that it is a reliable authenticated access control architecture for e-healthcare in terms of efficiency and security.

A hybrid BIM and BN-based model to improve the resiliency of hospitals' utility systems in disasters

The growing number of disasters in recent years has become a significant threat to hospital buildings' resilience and preparedness. Besides, the stochastic nature of these disasters and the complexity of the hospital building systems exacerbate the difficulty of making appropriate decisions during and after disasters. To address the issue, this research proposes a novel model that utilizes the capabilities of Bayesian Networks (BNs) and Building Information Modeling (BIM). This model helps decision-makers in hospitals and medical centers measure various effects of disasters on utility systems and analyze the consequences of their decisions. The capabilities of the proposed model are tested in the case of a medical gas distribution system in a hospital building. The findings indicate that using this model brings new insights for decision-makers into the effects of an earthquake on the medical gas system of the hospital case. Applying the hybrid BIM and BN model improves the spatial understanding of the utility systems and expedites the hospital team members' response to critical situations.

Analysis of the material distribution system of wise information technology of 120 under deep learning

In order to explore the feasibility of using deep learning in the Wise Information Technology of 120 (WIT120) material distribution system under deep learning, in the study, first, the Hopfield neural network and simulated annealing (SA) algorithm are used to study the path optimization in the WIT120 material distribution system. Aiming at the poor optimization and robustness of the traditional Hopfield neural network and the low optimization efficiency of SA algorithm, in this study, a memory device is added to the SA algorithm, the distribution starting points of the two algorithms are fixed, and an improved hybrid algorithm is designed by combining Hopfield neural network and SA algorithm. Then, the improved hybrid algorithm of the traditional Hopfield neural network and SA algorithm is used in the actual medical material distribution system, and comparative analysis of the distribution route, cost, and scheduling time before and after using the proposed algorithm is performed. Besides, the difference between the proposed algorithm and other algorithms in path optimization and path planning efficiency is compared and analyzed. The results show that the improved hybrid algorithm proposed in this research reduces the total mileage of distribution by 46.9%, costs by 33.9%, and the time required for scheduling by 99% after applied in the medical material distribution system. It is also better than traditional analog algorithms and neural networks in distribution path optimization. The path optimization results show that the shortest path produced by the improved hybrid algorithm in this study is 27.85, which is superior to the traditional SA algorithm, Hopfield neural network, and genetic algorithm (the shortest paths obtained are 41.21, 44.63 and 36.48, respectively). Compared with other optimization algorithms, the path planning efficiency of the hybrid algorithm is the highest (the amount of distribution tasks completed in unit time is 22). In conclusion, the improved hybrid algorithm proposed in this study can effectively reduce distribution costs, shorten transportation routes, and improve optimization efficiency, indicating that the hybrid algorithm proposed in this study is effective and practical when applied in the medical material distribution system, which can provide reference value for medical material distribution and provide data support for the management of medical material distribution.

A Description of Mothers’ Knowledge and Practice about Antibiotic Use in Children in Northwest of Iran

Background Inadequate antibiotic usage in children might have severe side effects and lead to antibiotic-resistant pathogens. Iran is the second country in terms of the rate of antibioticuse globally, and approximately one-fourth of the population of this country is under 14- year- old. Therefore, the existing problems in this regard could be identified by evaluating the knowledge and practices of mothers concerning antibiotics. The present study aimed to investigate the knowledge and practice of mothers about antibiotics use among children. Materials and Methods This descriptive cross-sectional study was carried out in the pediatric hospital of Tabriz, Iran. A total of 450 mothers of children under 12 years old participated in this convenience sampling. They completed questionnaires (13 questions) of knowledge and practices (8 questions) designed by researchers. The data were analyzed using the SPSS software version 20.0. Results The mean scores of mothers’ knowledge (ranged 0-13), and practices (from 0-8) were 6.83±2.89 and 5.83±1.63, respectively. Moreover, the education level and occupation of mothers had a significant relationship with their knowledge and practices (p <0.05). Conclusion Considering the low level of knowledge and practices of mothers and the elevated antibiotic resistance during recent decades, major policies are required for medication distribution and counseling systems for parents. Furthermore, some plans are needed for public health education.

On the medication distribution system for home health care through convenience stores, lockers, and home delivery

Medication distribution service can be delivered based on a combination of home delivery and customer pickup. That is, medications are delivered either to customers' homes directly or to the pickup facilities (e.g. lockers) close to customers' homes. In Taiwan, there are more than 11,000 convenience stores that provide a 24-h service for customers to pick up the ordered items from e-commerce, which is unique to the world. In the medication distribution system, convenience stores can provide a unique opportunity for customers to more conveniently collect medications at stores, and also can reduce the operating cost for a logistics company providing the medication delivery service. Therefore, this work proposes a medication distribution system through convenience stores, lockers, and home delivery. Under this system, this work investigates how to simultaneously determine employment of convenience store chains, the convenience store locations to be visited, locations of lockers, vehicle routes for convenience stores and lockers, and vehicle routes for customers' homes, so that the total operating cost is minimized. This work further proposes a genetic algorithm to solve the medication distribution problem. Through simulation, the experimental results show that the proposed algorithm is able to solve the problem efficiently.

Solid Lipid Nanoparticles (SLN) as a Novel Drug Delivery System: A Theoretical Review

The introduction of solid Lipid Nanoparticles (SLN) for the first time in late 1991 to be a substitute transporter system to what known old colloidal carriers, like emulsions, liposomes, and polymeric micro- and nanoparticles. SLN has merits and potentialities of Classical structures except avoiding some of their common and known disadvantages. This paper reviews SLN production techniques, The integration of drugs, the capacity to load and the release of drugs, with particular emphasis on drug discharge techniques. Issues relating to the introduction of the SLN into the pharmaceutical industry, like the excipients position. From the very beginning a special and wide interest paid to Lipid nanoparticles (LNPs) during the last decade. Nanostructured lipid transporters strong lipid nanoparticles (SLNs) become the most two essential forms of nanoparticles formed from lipids. SLNs were designed to be able to overcome certain restrictions types of colloidal vectors, like liposomes, emulsions, and polymeric nanoparticles as they possess bright sides like strong discharge profile and guided distribution of drugs with the most perfect physical health. NLCs will amend the SLNs in the next generation of lipid nanoparticles in a way that enhances stability, safety and capacity loading. This paper focuses on methods to reduce toxic effects using advanced production techniques such as homogenization and solvent evaporation. As it facilitates way for the solid lipid nanoparticles approval as novel or targeted medication distribution system by using several recent analytical techniques like electron microscopy and dynamic light scattering (DLS), differential scanning calorimetry (DSC), nuclear magnetic resonance, atomic force microscopy and their evaluation parameters concurrent with the application. Conclusion • Solid lipid nanoparticles (SLNs) represent a transport system alternative to conventional colloidal carriers. • SLNs combine the advantages of traditional and modern systems if some of their major difficult proceedings are eliminated. • SLN production techniques include drug incorporation, drug loading and release capacity, with a special focus on drug release methods. • SLNs as novel system and targeted drugs delivery method through using recent techniques.

Nurses\xb4 perceptions of automated dispensing cabinets \u2013 an observational study and an online survey

BackgroundThirty-two automated dispensing cabinets (ADCs) were introduced in May 2015 in Kuopio University Hospital, Finland. These medication distribution systems represent relatively new technology in Europe and are aimed at rationalising the medication process and improving patient safety. Nurses are the end-users of ADCs, and it is therefore important to survey their perceptions of ADCs. Our aim was to investigate nurses’ perceptions of ADCs and the impacts of ADCs on nurses’ work.MethodsThe study was conducted in the Anaesthesia and Surgical Unit (OR) and Intensive Care Unit (ICU), of a tertiary care hospital, in Finland. We used two different research methods: observation and a survey. The observational study consisted of two 5-day observation periods in both units, one before (2014) and the other after (2016) the introduction of ADCs. An online questionnaire was distributed to 346 nurses in April 2017. The data were analysed using descriptive statistics including frequencies and percentages and the Chi-Square test.ResultsThe majority (n = 68) of the 81 respondents were satisfied with ADCs. Attitudes to ADCs were more positive in the ICU than in the OR. Nearly 80% of the nurses in the ICU and 42% in the OR found that ADCs make their work easier. The observational study revealed that in the OR, time spent on dispensing and preparing medications decreased on average by 32 min per 8-h shift and more time was spent on direct patient care activities. The need to collect medicines from outside the operating theatre during an operation was less after the introduction of ADCs than before that. Some resistance to change was observed in the OR in the form of non-compliance with some instructions; nurses took medicines from ADCs when someone else was logged in and the barcode was not always used. The results of the survey support these findings.ConclusionsOverall, nurses were satisfied with ADCs and stated that they make their work easier. In the ICU, nurses were more satisfied with ADCs and complied with the instructions better than the nurses in the OR. One reason for that can be the more extensive pilot period in the ICU.

Pharmacy Students’ Ability to Identify the Steps of the Pharmacists’ Patient Care Process During IPPE

Objective. To determine the ability of first-year Doctor of Pharmacy (PharmD) students to describe patient care activities performed by pharmacists and accurately associate those activities with the five core steps of the Pharmacists' Patient Care Process (PPCP). Methods. First-year student pharmacists completed introductory practice experiences at ambulatory and institutional pharmacies. Students' ability to describe activities that occurred in these settings and align them with the five core steps (collect, assess, plan, implement, and follow-up) of the PPCP were assessed. Results. The students were more adept in describing patient care activities and aligning them to the appropriate PPCP steps in an ambulatory pharmacy setting than in an institutional pharmacy setting. Students achieved higher scores when describing and aligning patient care activities associated with the collect and implement steps in an ambulatory pharmacy setting and for the assess step in an institutional pharmacy setting. Conclusion. As institutions strive to adopt the PPCP in all areas of the curriculum, this application serves as an example of successful PPCP integration early in the introductory experiential curriculum. Our results challenge faculty to provide early opportunities for students to apply the PPCP in a variety of practice settings, including settings focused on the medication distribution system.

Japanese clinical practice guidelines for vascular anomalies 2017

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

Japanese Clinical Practice Guidelines for Vascular Anomalies 2017.

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence‐based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.

Japanese clinical practice guidelines for vascular anomalies 2017.

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence‐based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.

Reducing adverse medication events in mental health: Australian National Survey.

To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review.

Background and Aims:Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings.Methods:The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types.Results:A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group.Conclusion:The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses.Lay summary Activities to reduce medication errors in adult medical and surgical hospital areas Introduction:Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world.Objective:To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital.Methods:Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities.Results:A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity.Conclusion:A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.

Análise físico-química e microbiológica de sistemas de produção e distribuição de ar respirável de uso hospitalar com proposta de melhoria

A qualidade do ar respirável (AR) utilizado no manejo de paciente tem sido objeto de interesse em medicina, uma vez que, se não adequada, pode oferecer o risco de doenças de várias etiologias, incluindo as de caráter infeccioso. Os sistemas de produção, armazenamento e distribuição do AR medicinal devem garantir condições seguras de funcionamento para uma efetiva manutenção da saúde. Há normas que regem e definem valores de segurança para o ar respirável medicinal utilizado em centros de atendimento a saúde. O objetivo deste trabalho foi detectar o ar respirável em centro cirúrgico oftalmológico com envolvimento do seu preparo, distribuição e entrega no ponto de uso.

Japanese clinical practice guidelines for sacrococcygeal teratoma, 2017.

Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates and infants. Although most cases of infantile SCT are benign tumors by nature, some develop into extremely large lesions, leading to massive bleeding, high-output heart failure, disseminated intravascular coagulation, and even fatal outcomes during the neonatal period. In addition, some patients may present with tumor recurrence, malignant transformation, long-term sequelae (including bladder and bowel dysfunction) and lower leg palsy during the long-term follow up. SCT, however, is very rare, and there are few opportunities to encounter this disease, therefore general physicians without expert credentials currently lack information relevant to clinical practice. For this reason, the research project committee has compiled guidelines concerning SCT. The purpose of these guidelines was to share information concerning the treatment and follow up of infantile SCT. The guidelines were developed using the methodologies in the Medical Information Network Distribution System. A comprehensive search of the English- and Japanese-language articles in PubMed and Ichu-Shi Web identified only case reports or case series, and the recommendations were developed through a process of informal consensus. The clinical questions addressed the risk factors, the efficacy of cesarean section, the initial devascularization of tumor feeding vessels, interventional radiology, recommended clinical studies for follow up and possible long-term complications. These are the first guidelines for SCT to be established in Japan, and they may have huge clinical value and significance in terms of developing therapeutic strategies and follow up, potentially contributing to the improvement of the prognosis and quality of life of SCT patients.