Though many epidemiologic studies have found a progressive relative loss of pulmonary function with cumulative smoking, other studies did not find that smoking cessation benefited pulmonary function. We therefore performed a cross-sectional study to see whether there was a major difference in the rate of decline in FEV1/FVC (%) with aging between smokers and those who had ceased smoking. The subjects were 2, 326 men who came to our hospital for their annual medical checkup from April 2000 to September 2001, consisting of 796 men who had never smoked, 819 current smokers and 711 former smokers. Current smokers and former smokers showed significantly bigger declines in FEV1/FVC (%) than subjects who had never smoked. In the comparison of FEV1/FVC (%) between current smoker and former smokers, we divided the former smokers group into 2 groups according to whether they had stopped smoking less than 5 years ago or 5 or more years ago. However, in neither of these two groups was there a significantly difference in decline in FEV1/FVC (%) as compared to the smokers group, suggesting that smoking cessation did not slow the rate of decline in FEV1/FVC (%) with aging. Recently, more and more people have been giving up smoking after their medical checkup. The next step is to provide them with FEV1 and other useful data besides FEV1/FVC (%) to give them the incentive to stay off cigarettes.
At present, the number of drugs approved for use in children is much less than that approved for adults, and the lack of drug information for pediatric pharmacotherapy is a problem. In this regard, both the quantity and quality of information in drug package inserts concerning use in children are often inadequate. In the present study, we retrospectively surveyed the approval status of drugs for pediatric use and dosing information for children using the database of Shinshu University Hospital. We did searches by patients' hospital numbers, dates of birth, drugs administered, date and route of administration, dosage and number of doses, etc. Also, the actual doses administered to patients were compared with the appropriate doses calculated for each patient and the applicability of formulae for calculating pediatric dosages in off-label use was examined. Approximately 60 % of prescription drugs were administered under off-label use. The dosage deviation ranges by Young' s age rule were statistically significant (p<0.0001), while by Augsberger's age rule (II) and von Hamack's rule deviation ranges were not significant. From our survey, we concluded that many drugs are used under off-label use and for a great many of them pediatric dosage information is lacking. In off-label use, it is convenient to use von Harnack' s rule for working out prescription dosages and for prescription auditing under such use.
The purpose of this study was to evaluate the degree of bitterness of commercial dry syrups preparations of three kinds of macrolide antibiotic (erythromycin dry syrup (EMD), clarithromycin dry syrup (CAMD) and azithromycin dry syrup (AZMD) when suspended in various beverages (water, tea and acidic sports drinks) by human gustatory sensation testing and taste sensor measurements. In the human gustatory sensation test, we evaluated the bitterness at three time points. First, we evaluated the bitterness immediately after the dry syrup suspension had been kept in the mouth for 5 seconds, which we termed “immediate bitterness”. The second and third time points were directly after and 5 minutes after the suspension had been ejected from the mouth and the mouth rinsed with water, which we referred to as “residual bitterness” and “residual bitterness after 5 minutes”, respectively. By this test, the ranking of the immediate bitterness of the suspensions of the dry syrups in water was AZMD >EMD= CAMD. As compared with water and tea, the bitterness of the dry syrups was greater when suspended in sports drinks when the ranking by immediate bitterness and residual bitterness was CAMD >AZMD=EMD. The bitterness enhancement was probably due to the increased dissolution of the dry syrups under acidic conditions. In the taste sensor study, the predicted degrees of bitterness correlated well with the bitterness findings from the gustatory sensation test for both direct bitterness and residual-bitterness (r2 = 0.921, 0.794, respectively).
We introduced a medication management module (MMM) for the education of psychiatric inpatients that uses a video (FMV) produced by Fukushima Medical University. We then asked 32 staff members to evaluate the usefulness of FMV by filling out a questionnaire. Nine of the staff (28 %) responded that it greatly improved the patients' comprehension level, 19 (59 %) felt that it had improved, and 4 (13 %) thought that there had been no change. We estimated that the workload of staff had decreased from 10 to 3.7 points. Further, by testing the 37 participants in MMM on their comprehension level before and after it with the same questions, the mean score was significantly higher after MMM (21.4 ± 0.9 points) than before (18.3 ± 3.5 points) (p< 0.001). To assess the effect of MMM on post-hospital self-medication behavior, we mailed another questionnaire to patients who had participated in MMM and those who had not. The sixty-three respondents (34 men and 29 women, aged from 15 to 78 years) consisted of 43 schizophrenia patients and 20 manic-depressive psychosis patients, of whom 33 had participated in MMM and 30 had not. The percentage of MMM-participants who were taking medication regularly was not significantly different from that of non-participants. However, the percentages of MMM participants who understood the necessity of medication and knew how to cope with side effects were significantly higher (p< 0.05 and p< 0.001, respectively). These results indicate that MMM is useful in raising patients' level of comprehension of medication and helping them acquire the proper post-hospital self- medication behavior.
Hormonal therapy (androgen deprivation therapy) is the standard treatment for controlling prostate cancer, but adverse effects on bone health have been reported frequently. The aim of the present study was to evaluate the severity of progressive bone loss due to androgen deprivation therapy for prostate cancer through a meta-analysis. Relevant articles on this topic were selected using the Medline database and manual searches, and randomized controlled trials and open-labeled uncontrolled trials were performed. The overall mean loss in bone mineral density was estimated as the weighted mean of the percentage change from the initial bone density. The results of our systematic review showed that bone mineral density had decreased by 2.8 % at the femoral neck, by 2.7 % at the lumbar spine, and by 1.5% at the hip after 12 months of androgen deprivation therapy. The degree of the effect of androgen deprivation therapy versus the control was estimated to be 0.62 (95 % confidence interval, 0.24 to 0.99 ; P=0.002) at the femoral neck ; 0.58 (0.20 to 0.97 ; P = 0.003) at the lumbar spine ; and 0.89 (0.47 to 1.32 ; P< 0.001) at the hip. These results provide evidence that androgen deprivation therapy for prostate cancer results in a rapid loss of bone mineral density, and increases the risk of osteoporosis and related fractures. In order to prevent this, it may be necessary to monitor the bone mineral density before and during therapy and administer agents that stimulate bone metabolism.
Contamination of total parenteral nutrition (TPN) fluids is a problem occurring when preparing admixtures of them. In the present study, we carried out an investigation into the cause of contamination with a view to its prevention. For the TPN admixtures prepared in our pharmacy, we investigated the number prepared, their contents, the number that had contaminants and the nature of the contaminating substances. Contaminants were found in about 10% of the TPN admixtures and micro-infrared spectrophotometer analysis indicated that most of the contaminants were pieces of the rubber produced by coring. Further, an investigation of a correlation between TPN prescription contents and the incidence of contamination showed that the highest incidence of contamination occurred in preparations made by a particular pharmaceutical company. In order to prevent rubber particles from being produced, we need to be very careful when sticking the needle into the rubber stopper during the mixing of TPN admixtures. However as it is difficult to prevent contamination completely, we suggest checking TPN admixtures for contamination after mixing them and using in-line filters when they are administered to patients.
In the present study, we examined the clinical significance and utility of measuring salivary valproic acid (VPA) levels in saliva samples taken at patients' homes for therapeutic drug monitoring (TDM). The subjects were 74 patients (33 males and 41 females ; mean age 30.8 ± 1.9 years) under treatment at Outpatient Clinic, Department of Neuropsychiatry, Fukushima Medical University Hospital. For the VPA measurements, saliva samples and blood samples were taken at the Outpatient clinic simultaneously. Salivary VPA levels showed significant correlations with total and free VPA serum concentrations (r=0.71 and r=0.77, respectively) but were not significantly correlated with serum albumin concentration or salivary pH. From a preliminary experiment that we conducted, salivary VPA levels were found to remain stable when saliva samples were kept in home freezers at 4 and -20°C. Based upon the above results, we concluded that TDM based on measurements on saliva samples taken by patients receiving VPA has significant clinical utility because 1) saliva sampling is less invasive than blood sampling and easy to carry out for patients who do not wish their blood to be taken, 2) saliva sampling at home is convenient because either patients or their family members can take the samples and 3) samples taken at home can accurately show VPA levels as they are in everyday life.
Drug information is essential for the proper use of pharmaceuticals. However, drug information could be even more effective and safety further enhanced if it could be more tailored to the individual patient. We therefore conducted a survey on the utilization of patient information by pharmacies with the idea of using the results to make drug information more useful. The survey was sent by fax to Chiba Pharmaceutical Association pharmacies and was returned by fax when completed. The survey focused on the status of patient information in pharmacies. The results were presented as percentages of pharmacies responding in the affirmative to individual survey items, and significance was evaluated by McNemar's test. Patient information was obtained directly from patients by 94.0% of pharmacies, through patient medication journals by 75.6% of pharmacies, and from drug histories by 73.3% of pharmacies. Patient information considered useful included concomitant medications, selected by 92.2% of respondents and allergy history, by 73.5%. Most pharmacies were found to be IT ready, with 92.8 % equipped with a dispensing fee invoicing computer system. Other electronic methods of handling patient information were not widely used. Currently only a small percentage of pharmacies receive patient information from medical institutions. In order to remedy this situation, closer cooperation with medical institutions and widespread introduction of IT systems that facilitate the sharing of patient information are necessary. In addition, more detailed package inserts would be of great benefit to pharmacies aiming to provide drug information that includes patient-specific information.
We examined the clinical efficacy of shitei-decoction in 108 patients with hiccups with respect to various factors influencing them : sex, age, other drugs for hiccups, use of benzodiazepines, malignant tumors, use of antitumor agents, metastasis, complications and stress. Hiccups completely disappeared in 63 of the 108 patients following the administration of shitei-decoction, a rate of 58.3%. However, if we judge efficacy by the sum of patients whose hiccups disappeared and those who experienced remission, the efficacy rate for shitei-decoction was 82.4%. The chi-square test showed that there was no significant correlation between the above hiccup influencing factors and the efficacy of shitei-decoction. Despite previous reports to the contrary, there was no correlation between the efficacy of shitei-decoction and co-administration of benzodiazepines. However, the efficacy of shitei-decoction tended to be higher in patients with brain metastasis, suggesting that efficacy may be greater for central hiccups than peripheral hiccups.
At the Division of Pharmacy in Ehime University Hospital, we conduct drug counseling training for undergraduate students and graduate students aimed at helping them acquire communication skills as well as clinical knowledge. The program relies largely on case-based learning (CBL) procedures and role-play practice using video tape recordings. In the following, we describe the drug counseling training program and report the results of a student evaluation of the program. The training program consists of the following : 1. Explanation of the procedure of the practical training ; 2. Presentation of a mock case file-including a patient profile, diagnosis, clinical history, laboratory data and prescription ; 3. Explanation of how to collect drug information ; 4. Study of individual cases by students, 5. Role-play in providing drug counseling and recording this on video (with a student in the counseling role and a pharmacist in the patient role) and 6. Discussion and review by students and clinical pharmacists (including the person who played the patient role) after watching the video recording. After the training, we conducted a survey of the participating students by questionnaire regarding their opinions of the training program. Almost all of the students considered the practical training to be useful because it enabled them to evaluate their performance in drug counseling and communication skills objectively.They also felt that the guidance they had received from clinical pharmacists had been useful. Our training program on drug counseling using CBL procedures and video recordings is thus a simple method of training students which enables them to improve both their communication skills and clinical knowledge.