The dilution or mixing of commercially available corticosteroid formulations is a common practice in our country. We therefore evaluated the pharmaceutical stability and clinical effects of such admixtures. The quantities of the aqueuos phase separated by centrifugation employed as an index of the destructution of an emulsion after mixing were measured, with a high value being obtained with the admixtures of corticosteroid ointments and o/w-type moisuturizing creams. In contrast, the admixtures utilizing w/o-type creams were found to be physically stable for a month. To evaluate the preservative efficacy, we attempted to investigate the microbial contamination of these admixtures with Antebete® ointment. For all aqueous phases separated by centrifugation stored and at room either temperature or in a refrigerator for one week, and each mixture was touched by a human finger twice a day. As a result, it was impossible to prevent microbial contamination in these admixtures. The permeability of corticosteroids using hairless mice skin in the admixture of Lidomex® ointment, Antebete® ointment, and Myser® ointment and moisturizing creams through the skin was 5-, 2-, 3-fold greater, respectively, than that from each corticosteroid ointment alone. The extent of the stability of the emulsion after mixing was related to the permeability. The vasoconstrictor activity of humans in the admixture of Lidomex® ointment and moisturizing creams, urea or heparinoid, was about 2 fold greater than that from the corticosteroid ointments alone, and this difference was significant. When the concentration of corticosteroid was reduced by half using an admixture of corticosteroid ointment with vaseline or moisturizing creams, no difference was observed in the systemic side effects between the corticosteroid ointment alone and the admixtures.
There has recently been an increase in medical accidents occurring in hospitals in which disinfectants have been mistaken for medications. One cause for this problem is considered to be the visibility of the medicine name on the bottle of disinfectants. We therefore examined whether or not the name displayed on the bottles of disinfectant were clearly displayed. We investigated the width of the medicine name currently displayed on bottles of commercial disinfectants and devised a new method to evaluate whether or not the name displayed on the bottle could be easily read from various angles. The evaluation of the width of the medicine name displayed on the bottles was performed by the central angle computed from the length of the arc of the medicine name displayed on the bottle. When 30 subjects viewed the medicine name from a horizontal direction, it became clear that the central angle with the most visible medicine name was from 68 degrees to 90 degrees. It was thus proven that the central angle, visual observation distance and the character font were clearly important factors regarding the visibility of the medicine name. From the results of the visibility examination of a medicine name displayed on the commercial disinfectants currently used in our hospital, it became clear that the visibility of half of disinfectants was high, while the visibility of the remaining half was low.
Although the standards for the quality of rubber closures on injectable glass vials were specified in USP 24 in the U.S. and BP 2001 in the U.K., no such guidelines for quality control exist in Japan. In the present study, we investigated the quality of rubber closures on glass vials of frequently-used anti-biotic and anti-viral injections in our hospital, according to the quality control method of rubber closures for aqueous infusion that was standardized in JP14. Sufficiently washed rubber closures were immersed in distilled water, and test solutions were prepared after gently shaking them for 5 min or heating them at 121°C under high-pressure steam for 60 min. The optic transmittance in the resultant solutions was measured at 430nm and 650nm, and the findings were compared with those for the standard values in JP14 for rubber closures on aqueous infusions. Of 23 different rubber closures tested, only one showed a lower transmittance at 430nm when the solution was prepared by gentle shaking. Under the condition of heating with high-pressure steam, 15 products did not reach the criteria at both wavelengths, 3 did not meet the standards set at either of the wavelengths, but 5 had no qualitative problems. We also checked the materials stuffed in 0. 45μm membranes after filtration with an injection by microscopic observations using scanning electron microscopy and by an element analysis with an X-ray energy dispersive microanalyzer. A number of micro-particles were observed and they were found to be composed of silicon, aluminium and titanium. These results indicate that the quality of rubber closures of injectable glass vials varies among products. Therefore, the standards and guidelines for the quality control of rubber closures of injectable glass vials should be established in JP.
The aim of the present study was to examine the pharmacoeconomical efficacy of critical pathways (CP) and medication management and instruction tasks (i.e. pharmaceutical care and counseling for inpatients) by employing gastrectomy patients. The pharmaceutical services of a uniform quality was provided for CP patients using a CP check sheet and medication management and instruction history of mainly prescribed medicine. As a result, in CP patients, which were offered pharmaceutical care, compared to non-CP patients, which were not offered such care, the average number of hospitalized days significantly decreased from 34.7 days to 24.7 days (p<0.01). Moreover, the average medication costs also significantly decreased from 85, 563 yen to 55, 114 yen (p<0.01). These data suggest the possibility that CP medication management and instruction tasks may play an important role in reducing both the length of hospitalization and medication costs of gastrectomy patients.
The responses of hematonosis patients, to explanations by pharmacists about the injection of antineoplastics were studied. Fifteen eligible patients were sampled for two years until November 2000. (1) All patients answered that they needed pharmacist consultations regarding the injections of antineoplastics. (2) Most patients answered that consultations were effective in helping them to understand the effect of drugs and, as a result, their level of anxiety decreased. (3) They also answered that explanations regarding the side effects prior to the treatments were good since they were prepared for the occurrence of any such side effects. This questionnaire indicated that pharmacist consultations regarding the injection of antineoplastics have a positive influence on the patients' mental preparedness to receive such medication.
The side effects were determined based on medical reports from 17 patients with chronic hepatitis type C who were admitted to a hospital in order to receive interferon (IFN) therapy. A pamphlet to explain the side effects was made by referring to the results of this investigation at the same time. All patients complained of fever. Two patients stopped the IFN therapy. In addition, the follow side effects have been reported in the literature; arthralgia, muscular pain, digestive system symptoms, eruptions, and sleeplessness. By investigating the period and length of time for such side effects caused by IFN therapy, we found a large number of side effects with the most frequent being fever due to IFN treatment. The occurrence of slight fever and general fatigue was immediately after IFN medication and tended to continue for a long period of time. The fever and the malaise reappeared after a fixed period during this investigation. Our findings helped us to accurately describe the side effects. In particular, patients undergoing long term IFN treatment tend to develop unique side effects. In conclusion, patients treated with IFN need to clearly understand what side effect, they can expect to experience during the course of therapy.
During our efforts to develop a training program for new pharmacists, we have come to the opinion that it is essential to understand the personality characteristics of each individual pharmacist. The present study was undertaken to examine the effects of various personality characteristics of new pharmacists regarding their work by psychological tests with existing education programs. The ultimate goal of obtaining basic data would be useful for devising effective training plans for new pharmacists. The subjects consisted of 16 new pharmacists who participated in the training program for new pharmacists conducted at the Q Pharmacy in April through June of 2001. A psychology test, the Tokyo University Egogram (TEG), was administered at the beginning and at the end of training, and the State-Trait Anxiety Inventory (STAI) was administered at the beginning and at the end of training and once a month for two months. An analysis of changes in egograms taken both before and after the training suggested that the effects of the training were manifested in their personality even after a short period of training. Some personality characteristics that seem desirable for pharmacists were derived from the data obtained for pharmacists with highly appraised performances. These include moderately high Critical Parent (CP) and Free Child (FC), high Nurturing Parent (NP) and Adult (A), and moderately low Adapted Child (AC). It is possible that more effective training can thus be provided if not only the trainee but also the trainer understands one's own personality haracteristics.
Cancer chemotherapy and radiation therapy-induced stomatitis often involves symptoms severe enough that the oral ingestion of food may become difficult. We therefore prepared a polaprezinc (zinc N- (3-aminopropionyl) -L-histidine) suspension dispersed in sodium alginate solution (P-AG) as a specific treatment and agent for the prophylaxis of severe stomatitis, and examined the chemical and physico-chemical stability of P-AG for clinical use. The chemical and physico-chemical stability of P-AG was established from its appearance, the percentage polaprezinc content and viscosity immediately after steam sterilization and uniformity after being left to stand for14 days at 25 and 5°C. Similarly, these parameters were examined in photostability testing (40°C, 2000lux) for14 days at the same time. As a result, a change in appearance was observed after steam sterilization according to photostability testing. However, the percentage of polaprezinc contents did not decline after either steam sterilization, photostability testing or after being left to stand for 14 days regardless of the storage temperature. On the other hand, the viscosity of P-AG declined after steam sterilization according to the findings of photostability testing.
A 0.625% povidone-iodine solution (PVP-I) for eye washing, a pharmaceutical product prepared in our hospital, is used to disinfect the conjunctival sac in eye surgery. Since iodine is unstable, its bactericidal activity is reduced when PVP-I is diluted. Therefore, the stability of a 0.625% PVP-I solution under various preservation conditions was studied. Its stability was evaluated by pH variation, visual inspection and the residual rate of available iodine. The 0.625% PVP-I solution was stored for 5 weeks at room temperature (25°C) and at 4°C under diffused light or in a dark place. The amount of available iodine was determined by the oxidationreduction titration method according to the fourteenth revised edition of the Japanese Pharmacopoeia (JPXIV). No apparent changes were found by pH variation or visual inspection after storage for 5 weeks either at 4°C or 25°C. The residual rates of available iodine after 5 weeks of storage were 91 % at 25°C and 98% at 4°C, thus suggesting that a reduction in available iodine is smaller at 4°C than at 25°C. This finding also suggests that a reduction in available iodine is dependent on temperature. The results of this study indicate that a 0.625% PVP-I solution for eye washing remains stable for 5 weeks if stored at a temperature of less than 4°C.
Various types of protocols with several kinds of anti-tumor injections and various dosing regimens have been applied in cancer chemotherapy. The protocol is usually decided depending on the patient backgrounds including gender, age, weight and height, and type and stage of cancer. Consequently, it is well-accepted that cancer chemotherapy is one of the most risky types of pharmacotherapy. It is important but usually difficult to manage patients undergoing cancer chemotherapy. As a result, we decided to develop a cancer chemotherapy management system using computer programs. Database sets and operating programs have been developed for 10 protocols using Microsoft Access, which have enabled us to check the trade names, dose, and dosing schedule automatically. Moreover, this system indicates the recommended doses and date of administration. This system is therefore considered to be useful for the management of cancer chemotherapy patients.
We investigated the usefulness of a prescription checking system in risk management. At Gifu University Hospital, doctors prescribe medications using an order entry system or by writing out a prescription by hand. The ordering of prescriptions is checked by an order entry system when doctors make a prescription, and is checked by a dispensing support system at the time the drugs are dispensed. Regarding prescriptions ordered by this system and handwritten prescriptions prescribed from October, 2000 to April, 2001, the frequency that a prescription was correct was investigated. The total number of prescription during the investigation period was 92, 624 sheets, and 973 prescriptions had to be corrected. The frequency that system ordered and handwritten prescriptions had to be corrected 0.9% and 6.5%, respectively. The frequency of correcting prescriptions ordered through the order entry system was significantly low. Drug duplication, drug interaction, and so on were corrected when ordering with this system, and some of them were checked by the prescription checking system. A mistake in the prescription, the prescription of non-registered medicines at our hospital, all had to be corrected for handwritten prescriptions, and 81% of such mistakes would have been avoided if they had been prescribed by the order entry system. Based on our findings, we consider our order entry system and prescription support system to effectively decrease the number of corrections needed when doctors make prescriptions.
For the development of a practical training system to effectively teach sterilization techniques, we conducted on unregistered questionnaire survey of the undergraduate student's view about the training practice for glass ample cutting, and then evaluated and discussed the introduction to practical training of pharmaceutical health care and sciences for the third-grade undergraduate students. Among 96 third-grade undergraduate students, 54 students (56%) had some experience in cutting glass amples while the remaining students did not. Twenty-six of the 54 students with some experience (48%) had some anxiety regarding glass ample cutting, while only 13 of the 42 inexperienced students (31 %) had such anxiety. Twelve of the 13 inexperienced students overcame some anxiety against glass ample cutting. Moreover, 87 of 96 students (91%) considered that receiving practice in glass ample cutting was necessary for them. Consequently, the training programs on glass ample cutting were found to be appropriate and useful for students to develop sufficient practical skills and accurate ability in sterilization techniques. As a result, we are now preparing to introduce a training program for glass ample cutting in addition to the regular practical training of pharmaceutical health care and sciences at Kyoto Pharmaceutical University.
The purpose of the report is to assess the effectiveness of drug consultations by pharmacists in accordance with a prospective controlled study for asthma patents during a four month period. This prospective study was based on a questionnaire and interview for asthma patients to investigate the disease recognition. The subjects consisted of 43 male and female asthma patients who were treated with theophylline and other drugs between September 1997 and December 1997. In particular, the subjects receiving drug consultations consisted of 17 patients, who were all outpatients with asthma disease. The severity and incidence of asthma symptoms and the knowledge of prescribed drugs for patients were obtained by the questionnaires. In addition, we directly interviewed 32 male and female patients, who replied to the questionnaire, to evaluate his/her understanding of drug therapy with asthma. We then determined the values. The values were expressed as the means ± S.D. of nobservations for each score. In this study, the average age of the subjects was 56.5 years. The drugs used for the asthma patients were inhaled steroids, theophylline, expectants, inhaled bronchodilators and anti-allergic agents (such as thromboxane A2 synthesis inhibitors, leukotriene receptor antagonists). The number of correct answers for inhaled anti-inflammatory agents and inhaled bronchodilator agents were significantly better than those of the non-consultation patients during our observation period. In addition, in the stepwise approach for asthma patients treatment, the peak flow monitoring usage and recognition both improved by pharmacist's drug consultations with asthma patient. In this study, we indicated that the drug consultations by pharmacists exercises have a favorable effect on the management of asthma patients.
A novel neutral gummi base was newly formulated and several gummi containing model drugs (carboxylic acid drug : ibuprofen and mefenamic acid, sodium carboxylate drug : loxoprofen sodium and sodium valproate) were prepared in order to compare the base and a conventional acidic gummi base using citric acid. By acidic formulation, both loxoprofen sodium and sodium valproate were found to not be able to jell into a gummi form. Furthermore, an acidic gummi base containing mefenamic acid lost its uniformity of drug contents during the jelling process. On the other hand, a neutral formulation made it possible for gummi containing loxoprofen sodium or sodium valproate to jell into gummi form, and thereby maintained the distribution of mefenamic acid in the neutral gummi base.
As Japan becomes an increasingly aged society, we believe that a survey and analysis of prescription medication use by elderly patients will provide valuable information for selecting appropriate drug therapies. We surveyed changes in the number of outpatients examined and the number of concomitant drugs prescribed to elderly patients in our hospital, and the risk of adverse drug interactions in elderly patients undergoing polypharmacy. The ratio of elderly patients was relatively high in every department at our hospital except for pediatric patients. The total number of departments in which patients were examined tended to increase with age. The number of drugs taken in the elderly group was significantly larger than for the other groups, and the incidence of concomitant drug interaction increased with the number of drugs prescribed. As a result, a higher risk of adverse reactions to polypharmacy was observed in elderly patients. We therefore recommend devising a way to prescribe fewer drugs regarding both drug-interaction and the risk of adverse reaction. Elderly patients are examined in several departments and medical facilities, and so it is important to create a network system to centrally manage information on which drugs are actually prescribed, in order to avoid or decrease this risk.
Clinical pharmacy is now widely performed at Japanese hospitals. Clinical pharmacists are a member of the patient care team and play a new role in pharmacy practice. Drug consultants for doctors as well as counselors for patients also play an important role in clinical pharmacy. To improve such clinical pharmacy practice, we chiefly report to doctors following consultations. As a result of pharmaceutical consultations with doctors, 78.2% of the prescriptions were changed. This result indicates that such drug consultations by clinical pharmacists are useful for improving curative drug therapy. A case report regarding such a drug change after consultations is herein reported. In conclusion, consultations with doctors and clinical pharmacists and therefore considered to be necessary to improve the effectiveness of clinical pharmacy practice.