Our pharmacists provide TPN preparations and injectable chemotherapy drugs for inpatients and outpatients.However,since the checking of injectable drug prescriptions is complicated and time consuming,we developed an aseptic preparation support system to raise efficiency in making admixtures of injectable drugs and improve risk management. We redesigned the clean bench and safety cabinet,and incorporated an embedded 15”LCD monitor.It is equipped with a weighing machine that allows us to record weights on a PC in real-time.A three-button footswitch is connected to the PC to allow us to have hands-free control of the system to maintain aseptic conditions.Liquid volumes and weights and number of vials are automatically calculated from the content per vial and the dosage of the drug in the injection order information.All of this information is displayed on the monitor and using it,we mix the injectable drugs.Differences between calculated and measured weights of vials are also recorded on the PC. The new system has raised the efficiency of mixing injections and improved monitoring accuracy.
It has been reported that fentanyl is released from transdermal fentanyl at a constant rate,the concentration reaches a steady state within 24 hours,and a constant serum concentration of the drug can be maintained through repeated patch application at 72-hour intervals.However,we have encountered a number of patients who experienced pain on the third day after application of the patch,and who were not able to gain satisfactory pain relief even when the dosage was increased.In the current study,serum concentrations of fentanyl were determined to elucidate the relationship between fentanyl concentration and transdermal fentanyl dosage,and intra-individual variability in fentanyl serum concentration after fetanyl patch application in patients with cancer pain.Blood samples were collected from 38 patients at 24,48,and 72 hours since the second or later application of the fentanyl patch.A good correlation was obtained between the dose of transdermal fentanyl and the fentanyl serum concentrations(r=0.9565,0.8785 and 0.9351 at 19-30,45-55 and 65-79 hours,respectively,after patch application).When the intra-individual variabilities in serum concentrations were examined,significant differences were noted between 45-52 and 19-25 hours,between 65-72 and 19-25 hours,and between 65-72 and 45-52 hours after application of patches in a paired analysis of variance(P =0.0038,P <0.0001,and P =0.0029,respectively),showing that fentanyl serum concentrations declined between 24 and 72 hours after application of the patch.These findings indicate that in the steady state,fentanyl serum concentrations may not be maintained at a constant level for 3 days following application of transdermal fentanyl,and that the analgesic effect of the drug may be attenuated by 72 hours after applying the patch.
We prepared a check list based on a standard care plan for constipated patients with the aim of achieving good defecation control and together with nurses and caregivers,used it in conducting medication management. Our subjects were 146 inpatients taking laxatives at the Kibikougen Lumiere Hospital.In consideration of objectivity,we excluded 64 patients,leaving 82 patients for the evaluation.The period of our study was December 2004 to May 2005 and medication management was conducted in the last 3 months.The frequency of constipation and drug costs were compared between before and after medication management was introduced. The average frequency of constipation(2.2±0.3 times vs.1.6±0.2 times ; p<0.05)and the average drug costs(1,692± 247.1 yen vs.1,320±212.2 yen ; p<0.05)decreased significantly after the introduction of medication management.We therefore consider that our joint intervention with nurses based on use of the check list was successful in improving defecation.
We examined the frequency of dangerous drug combinations in common antihypertensive medication regimens used for outpatients at Asahikawa Medical University Hospital and those under the State of Iowa Medicaid program.We also investigated the possibility of reducing the frequency through a computerized checking system for drug interactions at Asahikawa Medical University Hospital.We noted that 3,501 of the combinations were mentioned in the“Drug Interaction Facts”book as interacting combinations of antihypertensive drugs,and contraindicated and inappropriate combinations(importance level 1~2)accounted for 30.7%(1,074 combinations)of them.The majority of interactions for the contraindicated combinations were cardiovascular disorder-related.For the Medicaid patients,there was a strong correlation(r=0.741)between age over 30 years and frequency of importance level 1~2 in regimens and 21.4% of all combinations were importance level 1~2.At 0.4 times per prescription,the frequency was highest for potassium-sparing diuretics.On the other hand,at Asahikawa Medical University Hospital,the frequency of importance level 1~2 did not depend on age,but accounted for 30% of the all combinations whether the checking system was in operation or not.Further,at 0.5 times per prescription,the frequency for potassium-sparing diuretics was higher than that for the Medicaid patients.Thus the use of the checking system was not effective in reducing the frequency.We therefore considered that the criteria used for evaluating interacting drug pairs in Japan(refer to attached document)are different from those used in the United States.Our findings also suggest that the use of clear criteria for evaluating drug interactions is very important in preventing dangerous drug combinations for common medications.
We investigated the factors influencing non-adherence in patients using beclomethasone dipropionate(BDP)to evaluate the relationship between asthma control and adherence. Forty-seven adult asthmatic outpatients continuously using a BDP inhaler for 10-12 months in 1999 at Niigata University Hospital were recruited as subjects for this study.BDP adherence was defined as the ratio of“measured dose”/“expected dose”.Asthma control was estimated from peak expiratory flow(PEF). Median adherence was 0.73(interquartile range(25%-75%),0.49-0.90)(0.74±0.32 ; means±SD),and good adherence (1.25>adherence≥0.7)was 46.8%.Poor adherence(<0.7)was noted in 46.8% of the patients.We found that higher doses of BDP in the inhaler,lower age at time of onset age of asthma,and longer duration of asthma were associated with poor adherence.Data for individual patients were plotted as PEF vs.adherence relationship and divided into four zones as follows :(A)higher adherence with poor control,(B)lower adherence with poor control,(C)higher adherence with good control,and(D)lower adherence with good control.Medication for the A and D zones was assumed to be inappropriate,and in need of improvement.We considered that asthma control in the B zone could be improved by patient education and appropriate pharmaceutical care. In the present study,we assessed the adherence of outpatients using a steroid inhaler(BDP)for the first time in Japan and developed a method to evaluate the adequacy of asthma treatment based on adherence zone vs.%PEF relationship.
CDDP(Cisplatin) and CBDCA(Carboplatin) are likely to cause nausea and vomiting,which are considered to be factors lowering QOL for patients undergoing chemotherapy.In the present study,our Nutrition Support Team(NST) investigated the influence of cancer chemotherapy regimens using CDDP or CBDCA on ALB(serum albumin value) and TP(serum total protein).All measurements indicated that ALB and TP levels were significantly decreased after chemotherapy(ALB :CDDP p<0.001 CBDCA : p=0.002 TP : CDDP p<0.001 CBDCA p<0.001).Decreases were greater in the CDDP group than in the CBDCA group.ALB decreased by approximately 15% in the CDDP group compared to a decrease of about 6% in the CBDCA group.Decreases of TP were approximately 14% and 5%,respectively.Though we cannot conclude that decreases in ALB and TP levels are definitely due to platinum drugs,we considered that there is a strong relationship between them and the decreases and that CDDP is more likely to cause vomiting and nausea than CBDCA.These findings convince us that the NST needs to continuously monitor the nutritional needs of patients undergoing chemotherapy with platinum drugs even if their nutritional condition was good before chemotherapy.
Pharmacy education in Japan has been reorganized into a six-year curriculum to provide the clinical education required by pharmacists to actively participate in patient care as drug therapy specialists. Problem-based learning (PBL) is a highly suitable method to educate students regarding diverse clinical issues and in Japan, it has already been recognized as a universal education method in the fields of medicine and nursing. However, the extent to which PBL had been adopted in pharmacy education had not been clear. In order to clarify the present situation and gain information on how to achieve the optimal use of PBL in pharmacy education in the future, we conducted a questionnaire survey. The questionnaire was sent to deans of pharmacy faculties or presidents of universities of pharmacy (62 institutions) in June 2005 and the recovery rate was 72.6% (45 institutions). It was found that 34% (15 institutions) of them had already adopted PBL in their education programs. It was being used for a wide range of students and encompassed case histories and various other themes and subjects ranging from basic subjects to social medicine, and various tutors and facilitators were involved. As for institutions that had not adopted PBL, 28% (7 institutions) intended to do so soon. Further, 66% (29institutions) of all institutions indicated a desire to adopt PBL in the six-year education curriculum. This tendency was especially remarkable for private institutions. The results of our survey suggested that PBL is likely to become increasingly widespread in healthcare-oriented pharmacy education as well as in medical education in Japan.
In clinical trials,patient name,date of birth,and sex are items of medical information used to refer to patients.Generally speaking,patient names are indicated by their initials.However,there are doubts as to whether patients may remain completely unidentified when initials are used. In this study,we investigated the identification levels of patients through the combination of the above three patient data items in post marketing surveillance data.We also investigated the necessity of items recorded in case registration forms for pharmaceutical companies and medical institutions. We investigated combinations of“K.K”and“Jan.2,1947”which were assumed to relate to the largest populations in the database of patient medical information at Kanazawa University Hospital.The total number of patients in the database with combinations of the above was 358,251.The number of patients with the initials“K.K.”was 7,892(1/45),that with the initials“K.K”and“1947”was 173(1/2000),and that with the initials“K.K”,“1947" and“Jan”was 23,while there were only 4 patients(1/8500)with the initials“K.K.”“1947”,“Jan”and ”2”. These results indicate that it would be possible to identify patients from the combination of their initials and their date of birth(DD/MM/YY).However,the size of the patient population in each medical institution’s database would be an important factor since it would determine the extent to which this could be done.From the point of view of protecting personal information,it is thus necessary to consider whether it is appropriate to use patients' initials and dates of birth based on the size of patient population.
Proton pump inhibitor(PPI)-based triple therapy with 2 antibiotics is a routine treatment for the eradication of Helicobacter pylori(H.pylori)infection in patients with gastric and duodenal ulcers.While this regimen achieves a high eradication rate for H.pylori infection,approximately 20% of patients fail to respond to it and several recent studies have shown that clarithromycin(CAM)resistance,PPI metabolic enzyme genetic polymorphism,smoking habit,and non-adherence to medication are associated with unsuccessful eradication of H.pylori infection.In view of this,we introduced a second-line H.pylori infection eradication therapy based on testing for CYP2C19 genetic polymorphism as a routine hospital procedure. A total of 51 patients in whom the initial PPI-based regimen failed underwent the second-line therapy based on their genotypes with respect to CYP2C19.Of the 48 patients evaluated,44 were extensive CYP2C19 metabolizers(EM : homoEM,23 ;heteroEM,21)and 4 were poor metabolizers(PM).The results of an antibiotic sensitivity test revealed CAM-resistant strains in 22 patients but AMPC-resistant strains were not evident.The EM group was retreated with 30 mg lansoprazole(LPZ)and 500 mg amoxicillin(AMPC)4 times a day for 2 weeks and the PM group was re-treated with 30 mg LPZ twice a day and 500 mg AMPC 4 times a day for 2 weeks.The second-line therapy succeeded in 94% of the patients(45 of 48 patients). We established CYP2C19 genetic polymorphism testing as a routine hospital procedure in H.pylori infection eradication therapy using PPI+AMPC.The second-line therapy based on this regimen was sufficiently effective despite the absence of CAM sensitivity.
In the present case of recurring localized maxillary cancer(T3N0M0)no surgical procedure was thought to be suitable in consideration of a possible decrease in quality of life(QOL)as enucleation of the right eye would be necessary.We performed one course of radiotherapy consisting of cisplatin(CDDP)and fluorouracil(5-FU)administered at the same time. As vasculitis was detected,presumably an adverse effect of 5-FU,the dentists and oral surgeons we were working with wished to switch to intra-arterial infusion chemotherapy with docetaxel(DOC)and asked us to provide information for use in dosage determination.Intra-arterial infusion chemotherapy was thought appropriate as regards QOL since it can be expected to enhance the localized effects of concurrent radiotherapy and retain the shape of the face.As no DOC dosing regimen had been established,in consultation with the dentists and oral surgeons,we determined the dosage,dosing rate and interval on the basis of data in our possession.In consideration of the possibility of this regimen causing blood vessel invasion,the primary focus of attention was on determining a dosage that would not cause vasculitis.The resulting regimen was weekly DOC,with the intra-arterial infusion of DOC set at 12 mg/m2/day,and concurrent radiotherapy.With the exception of some insignificant epilation,vasculitis could be completely prevented and a complete response(CR)was achieved.The close cooperation among dentists,oral surgeons and pharmacists in this case achieved better pharmacotherapy.
To evaluate the effects of switching from NPH insulin(twice daily)to insulin glargine on blood glucose control(HbA1C),insulin dosage and frequency of hypoglycemia in Japanese patients with type 1 diabetes,we monitored these parameters in 37 type 1 diabetics for 12 months after switching.The patients were assigned to 3 groups according to HbA1C at switching :good(<7.0%),fair(7.0-7.9%)and poor(≥8.0%).Though there was no improvement in HbA1C in the good and fair groups over the 12 months,there was a significant decrease in HbA1C in the poor group(10.2±1.2%→9.2±1.2%,p<0.01).Over this period,total dosage and basal dosage significantly decreased as compared to the time of switching.In the good and poor control groups,there was a significant decrease in the frequency of hypoglycemia.In conclusion,insuling largine improves glycemic control in patients with type 1 diabetes mellitus,especially in patients with poor blood glucose control.
In patients with lifestyle-related diseases such as hyperlipidemia,medication adherence tends to be low due to lack of subjective symptoms.The purpose of this study was to evaluate the usefulness of a visual aid in medication guidance given to patients on statins at a community pharmacy.As the visual aid,we used the J-LIT(Japan Lipid Intervention Trial)chart,a diagram based on the results of J-LIT which helps patients visualize the risk of developing a coronary heart disease.We first developed software(J-LIT chart plotter)to enable the J-LIT chart to be displayed on a computer and then added details of the importance of treatment with statins to the chart.The effectiveness of this new way of providing information to patients was investigated using a questionnaire whose responses indicated that most patients had a better understanding of treatment with statins.This should improve adherence in statin therapy.The patients seemed satisfied with the new way of providing guidance and most of them wanted it to be continued. In conclusion,in a community pharmacy,guidance on drug administration in which patients can understand the significance of clinical laboratory values and risk of developing coronary heart diseases visually seems to be an effective way of improving medication adherence in the case of those who have chronic diseases that require long-term treatment but show few subjective symptoms.
The large amount of information printed in the limited space of PTP sheets is a cause of confusion.This includes drug names,manufacturers’names and warnings.However,an appropriate color scheme and design for the PTP as a whole can help people distinguish the individual information and differentiate the product from its competitors.This would also be effective in preventing misidentification of drugs in medical facilities. In the present study,we investigated the effect of color and printing on human sensibility.To do this,we used 3 types of photo of a well-known branded drug(BR group)and a little-know generic drug(GE group)-photo of original PTP with printing,photo of original PTP without printing,and“gray scale”photo of PTP(no color/printing)-by the SD(Semantic Differential)method and factor analysis.For the GE group,the profile of the original PTP with printing and that without printing looked more similar than those for the BR group,and this tended to be influenced by color. The factors of familiarity and sensibility could be identified in a factor pattern matrix.A cluster analysis of subject scores indicated clusters giving a strong impression of familiarity and sensibility for the original photo with printing in the BR group while in the case of the photo of the original PTP with no printing,cluster layouts were similar for both the BR and GE groups.We therefore consider that factors determining sensibility comprise recognition of printing and design as well as coloring.