Metformin hydrochloride is known to decrease blood sugar levels by reducing insulin resistance and controlling glyconeogenesis in the liver. However, its action on serum lipid metabolism and prognostic factors in responsive and non-responsive cases are unclear. In order to ensure that metformin hydrochloride is used properly, we attempted to elucidate the effects of metformin hydrochloride on blood sugar and serum lipid metabolism, which are known risk factors of arteriosclerosis, and the background factors of responsive patients. Metformin hydrochloride was prescribed to 36 patients with type 2 diabetes, who were monitored for 6 months. HemoglobinA1c (HbA1c) decreased by 1.1% (P<0.01). In addition, though there were no significant changes in body weight or serum lipids, serum triglycerides (TG) decreased by 20 mg/dL. Looking at the drop in HbA1c in relation to patient clinical backgrounds at the beginning of administration, a remarkable decrease in blood sugar level was observed in patients who had high HbA1c, TG, and serum low-density lipoprotein cholesterol (LDL-C) levels. The decrease in blood sugar was the same regardless of the duration of treatment with glibenclamide before administering metformin hydrochloride. Therefore, to ensure the proper use of metformin hydrochloride it is recommended that serum lipids be used as parameters.
In Chu-no Kosei hospital, the setting of the initial dosage of vancomycin (VCM) by pharmacists to optimize trough and peak VCM concentrations against methicillin-resistant Staphylococcus aureus (MRSA) significantly reduced the mean duration of VCM therapy, prevented renal dysfunction, and achieved high clinical efficacy and economy in treatment. In view of this, we developed a system for setting initial dosages called “TDM system for the setting of initial anti-MRSA drug dosages by pharmacists”. We also informed doctors and nurses about the basics of the system and TDM and created a TDM manual. As a result, in Chu-no Kosei hospital, the rates for attaining target VCM concentrations, and setting of initial VCM dosage by pharmacists rose significantly. In addition renal dysfunction could be prevented and high clinical efficacy achieved. Our system also enabled TDM to be conducted for all anti-MRSA drugs at Nishimino Kosei hospital, where TDM had previously not been practiced, and it produced the same clinical and economic benefits as at Chu-no Kosei Hospital. Our experience of introducing the system showed that it was very necessary to actively inform doctors and nurses concerning its use and TDM.
In August 2002, the Pharmaceutical Society of Japan proposed “Model Core Curriculum for Pharmaceutical Education” as a means of improving pharmaceutical education and raising it to a more advanced level to meet changing health care needs in Japan. It has yet to be evaluated in detail. All students in the 4th year at our university undergo 4 weeks of training in pharmacy practice (in hospital pharmacy and community pharmacy). Of these students, 121 were asked to make a self-evaluation regarding their understanding of the pharmacy practice and degree of difficulty of the lectures and pharmacy practice. Since the experience of pharmacy practice was given on a one-student-to-one pharmacist basis, the pharmacists (preceptors) were also asked to evaluate the students whom they had been responsible for. Overall, for hospital pharmacy practice, students gave themselves higher scores than their preceptors did. However, for community pharmacy practice, the preceptors gave higher scores than the students. We inferred from those results that the hospital pharmacists had higher expectations than the community pharmacists. Preceptors were stricter in the evaluation of attitude than students. By comparing the degree of understanding for each questionnaire item before and after the pharmacy practice, we found that students' understanding had increased as a result of the pharmacy practice. However, many students noted particular difficulty as regards items relating to communication and some students had not been able to receive training in communication in the pharmacy practice. Thus, in order for the new Japanese model curriculum to be as effective as possible, it is important that lecturers cooperate closely with preceptors regarding the content of lectures at university and items of pharmacy practice.
The aim of the present study was to investigate the effect of Clostridium butyricum, a probiotic drug, when combined with vancomycin in the treatment of Clostridium difficile-associated diarrhea (CDAD). Seventy-one patients suffering from CDAD were divided into 3 groups : vancomycin alone group, vancomycin with Streptococcus faecalis group and vancomycin with Clostridium butyricum group. The daily stool frequency for patients receiving vancomycin alone at 2 days was 3.9/day. For patients receiving vancomycin with C. butyricum, this parameter was significantly lower than in the vancomycin alone group (p<0.05) but this was not so for the vancomycin with S. faecalis group. In addition, the treatment period with vancomycin was reduced when it was co-administered with the C. butyricum probiotic drug. These results indicated that the combination of vancomycin and C. butyricum had a beneficial effect in the treatment of CDAD.
The Department of Pharmacotherapy of Hiroshima University Hospital has been carrying out clinical training for pharmacy graduate students in primary care for outpatients in the Department of General Medicine. Recently, since pharmacists have frequently attended to outpatients for whom primary care is important, we developed software for students to learn the process of the examination and diagnosis of primary care outpatients and prescribing objectives. We also investigated the effectiveness of the software in pharmaceutical education for pharmacy students. In the development of the software, we improved a database of clinical cases used in training on primary care for outpatients. The software covered 50 cases and 52 pharmacy students in the junior year at Hiroshima University Faculty of Medicine's Institute of Pharmaceutical Sciences filled out a questionnaire on its usefulness in training. Eighty-three percent of the students considered the software to be useful and 58% said that software enhanced their desire to learn. The questionnaire responses also indicated that our concept of learning about the examination and diagnosis process and prescribing objectives using actual cases was well received by students. These results suggest that the software will be an effective new instruction tool and contribute much to pharmaceutical education.
To better estimate patient satisfaction, we developed a two-dimensional face scale to improve on the one-dimensional face scale. A major reason for doing this was to evaluate negative feelings which are often underestimated since Japanese patients are reluctant to express such feelings. Using more than 300 responders, we conducted a comparison of our original one-dimensional written scale (Scale A), a one-dimensional face scale (Scale B) and a two-dimensional face scale (Scale C). The results showed feelings of dissatisfaction with Scale C were significantly less than for Scale A and B and there was no significant difference between Scale A and B in this respect. In addition, over 80% of the responders favored Scale C from an accuracy point of view but for simplicity Scale B was preferable, and this was so for responders of all ages.
The FOLFOX regimen—oxaliplatin (L-OHP), fluorouracil (5-FU) and levofolinate calcium (l-LV)—has been approved as first-line chemotherapy for metastatic colorectal cancer. However, the package insert for L-OHP injection states that “it must not be mixed with a sodium chloride solution or other chloride-containing solutions” and “as an infusion solution, it must not be administered simultaneously with basic solutions through the same infusion line”. In our hospital, 5% glucose solution is normally used for diluting L-OHP as well as l-LV and pre-medicated injections. However, in the present study, we found that the time in contact with sodium chloride in the infusion line was less than 10 seconds, and the stability of L-OHP was not affected by it for at least 10 minutes. We therefore we changed 5% glucose solution to sodium chloride solution for diluting l-LV and other pre-medicated injections. This made it possible to standardize regimens and helped raise medical safety. It also shortened preparation time and outpatient waiting time because pre-medicated injections can be prepared in advance together with those for other regimens. We also consider that dilution with sodium chloride solution would be an option for diabetes patients who need strict glucose control. From the present study, we realized the importance of making efforts to improve our service to patients based on a good understanding of the information we have on medications and a consideration of their needs, as well as that of confirming all of this in practice in the clinical setting.
The purpose of this study was to evaluate the effect of gefitinib on quality of life (QOL) in patients with advanced non-small cell lung cancer in general practice. In order to do this, we retrospectively reviewed data of all patients who received a single course of treatment with gefitinib at Tosei General Hospital from July 2002 until May 2004, and evaluated their QOL based on The European Organization for Research and Treatment of Cancer's QLQ-C30 before and 4 weeks after initiation of treatment. Data for 45 patients were analyzed. Many QOL scores improved in patients who responded to treatment, though such improvement was not statistically significant. In addition many QOL scores improved in patients in whom the disease was stable, and many deteriorated in patients in whom it was progressing, though such changes were not statistically significant. In conclusion, a good response to gefitinib treatment can improve QOL in patients with advanced non-small cell lung cancer even if they have experienced a relapse or the disease has been refractory with 1 st or 2 nd line treatment. Pharmacists should take these findings into consideration when providing pharmaceutical advice to patients.
As many asthma patients suffer from asthma for long periods of time, we considered what pharmacists can do to help them lead a life free of asthma attacks in which they have a high QOL and autonomy. With this in mind, we established Japan's first “Asthma Pharmaceutical Care Clinic for Outpatients”. Our subjects for counseling at the clinic were new patients with bronchial asthma who were scheduled to begin treatment using a metered dose inhaler or dry powdered inhaler and patients who were undergoing treatment but in whom there had been no improvement in symptoms. At the clinic, the pharmacist identifies problems in the inhalation treatment by questioning the patient and based on the responses, provides instruction on the proper use inhalers so that such problems are avoided. More than 70% of the 116 patients who visited our pharmaceutical care clinic between July 2001 and March 2004 did not understand what asthma is, or why it is treated with an inhaler. In addition, they were not using inhalers correctly. Initial counseling significantly increased their level of understanding and it was further increased through repeated counseling. Our counseling maintained PEF scores at high levels for over two years. The counseling pharmacists provided at the bronchial asthma pharmaceutical care clinic for outpatients not only ensured that patients were following the proper inhalation technique, it also gave them useful information on the pathophysiology of asthma and the pharmacology and toxicity of the medicines they use. We are convinced of its effectiveness and necessity.
At Okayama University, a pharmacy educational curriculum requiring a period of six-years was started in April, 2006 and in its novel core curriculum, long-term practical training in a hospital is specified. Preliminary practical training based on the core curriculum was conducted to uncover problems in the long-term hospital training. The preliminary training, which was given to fourth-year undergraduate students and focused on dispensing practice, was preceded by lectures. Arrangements for the training included the preparation of a new textbook, drawing up evaluation criteria, the appointment of pharmacists to conduct the training and preparing a schedule for it. Students were evaluated using oral examinations, practical examinations to assess skills and written tests. By the end of the preliminary training, approximately 69% of the training schedule created beforehand had been reorganized showing that it was difficult to base the syllabus for the practical training on the core curriculum. In addition, from having conducted the training, we felt that it was important to have coordination among academic staff and hospital pharmacists as well as in the preparation of the standard text and tutorial manual.
Over the past several years, patients' safety has become a key issue for all health care institutions. In this regard, medication errors are a particularly serious matter because of their high frequency. We thought that Failure Modes and Effect Analysis (FMEA) would be an effective method of preventing them, since it can be used to evaluate each process systematically, and applied it to the risk management of a cancer chemotherapy medication system because patients suffer greatly in the case of medication errors in cancer chemotherapy. We collected inquiries concerning protocols and prescriptions from January to June 2005, and from them determined failure modes for the cancer chemotherapy medication system. The Risk Priority Number (RPN) for each failure mode was calculated by multiplying the severity of the effects of the failure by frequency and detectability, each given a rating of 1-3 (minimum 1 ; maximum 27). Among 187 protocols and 788 prescriptions, the frequencies of inquiry were 23.5% and 11.7%, respectively. Twenty-nine failure modes were isolated from the inquiries and the one with the highest RPN (15.9) was dosage errors in patients' chemotherapy protocols. Other high-ranking failure modes were errors in accumulated dosage, contraindications, administration schedules and laboratory data. Using the RPNs obtained, we created a hazard map for the cancer chemotherapy system. FMEA enabled us to numerically express the potential risks of the system and our findings suggest that it is essential to visualize and locate failures from every point of view of risk management in cancer chemotherapy.
Though there have been several reports on the usage of epithems and their adverse effects by doctors or pharmacists, very few researchers have conducted surveys on outpatients' awareness concerning these products. In this study, we gave outpatients a questionnaire on their experience of using epithems in order to gauge their awareness regarding them. The survey consisted of two parts, “usage of epithems and their forms”, and “side effects of epithems”. The survey found that the subjects were using epithems once a day and that they desired a small and thin form that did not have a smell. Most of them had experienced side effects due to epithems. However, eighty-five percent of the respondents did not realize that hypersensitivity to light was a severe side effect. The findings of the present study will prove useful in preventing side effects as well as in the development of improved forms of epithems.
Through the use of a questionnaire, we compared the usability of FlexPen®, a new portable prefilled insulin injector, with that of various conventional pens. The 175 diabetic patients who participated in this study were divided into four age groups. The insulin injectors were evaluated based on various usability factors including ease of gripping, weight, dosage scale legibility, ease of setting dosage, ease of pressing the injection button, stability during injection, simplicity of operation, portability and overall ease of use. The results of the questionnaire indicated that FlexPen® had improved usability in terms of weight, dosage scale legibility, ease of setting dosage and simplicity of operation, though there was no improvement as regards ease of pressing injection button. This aspect of usability was given low marks by subjects in the older age groups. There was no significant difference between it and the conventional pens as regards ease of gripping, stability during injection and portability. Overall, there was no big variation in evaluation scores for FlexPen® among the four age groups. The results of the present study indicate that FlexPen® has many technical improvements that give it superior usability to conventional insulin pens and it may be useful for patients with disability in their fingers. However, we would like to further discuss the choice of the optimal insulin pen with doctors based on the results of this study.