In Chugoku-Rosai General Hospital,doctors have notified the department of pharmacy of the use of anti-MRSA antibiotics beforehand since June 2005,and pharmacists have actively intervened in the determination of initial dosages of teicoplanin (TEIC).In the present study,we evaluated the effectiveness of pharmacist intervention by comparing the initial dosage,days of administration,plasma concentrations,and the clinical effect of TEIC treatment between before and after intervention by pharmacists began.The relationships between the initial dosage and plasma TEIC concentrations and between plasma TEIC concentrations and clinical efficacy were also evaluated.The following findings were obtained : 1)higher unbound plasma concentrations of TEIC did not always result in greater clinical efficacy ; 2)higher trough concentrations of TEIC resulted in greater clinical efficacy ; 3)trough TEIC concentrations of more than 20μg/mL caused hepatic damage,as evaluated by plasma AST and ALT activities and 4)higher initial TEIC dosages resulted in higher TEIC plasma concentrations in the early stage,shortening treatment periods as compared with before pharmacist intervention started,and severe renal dysfunction was avoided. In conclusion,active intervention by pharmacists in determining optimal dosages was considered effective in improving pharmacotherapy with TEIC.
We administered micafungin (MCFG) to 10 patients who were admitted to Sapporo City General Hospital with suspected deep invasive fungal infections,and evaluated (1)the relationship between peak and trough plasma concentrations of MCFG and the dose,(2)the effects of hepatic and renal dysfunction on plasma concentrations and (3)their efficacy and safety.Plasma MCFG levels were measured by high performance liquid chromatography.The efficacy of MCFG was evaluated on the basis of the results of a mycological serologic test and a culture test,and safety on the basis of liver function,kidney function,and presence or absence of blood disorders.The volume of distribution was 0.337±0.099 L/kg,the half-life was 12.21±3.16 hr,and clearance was 1.076±0.442 L/hr.There was a positive correlation between the dose per body weight and peak/trough plasma concentrations.Neither liver nor kidney dysfunction influenced the plasma concentration of MCFG.In 5 patients with candidiasis,1 patient with aspergillosis,and 2 patients with mycosis (diagnosis was unclear),the administration of MCFG relieved symptoms,and these patients were regarded as responders.In 4 (10 episodes) of 9 patients in whom the safety of MCFG could be evaluated,there were adverse events,for which it was unknown whether there was a relationship with MCFG or not,suggesting the necessity of careful clinical laboratory test monitoring during MCFG dosing.Our results suggest that MCFG was a useful antifungal agent since its plasma concentrations were not affected by liver or kidney dysfunction and demonstrated good efficacy.
The administration of acyclovir (ACV) sometimes causes neurotoxicity in patients with renal failure and recent research suggests that it is caused by 9-carboxymethoxymethylguanine (CMMG),the main metabolite of ACV,rather than ACV itself.In this study,therefore,we determined whether such neurotoxicity in dialysis patients was associated with serum levels of ACV or CMMG.Between December 2000 and August 2006,we obtained serum samples from dialysis patients who had been treated with ACV for herpes zoster infections,and who had adequate data for assessment.The patients were divided into two groups : with neurotoxicity (Group A) and without neurotoxicity (Group B).Serum concentrations of ACV and CMMG were measured by HPLC and compared between the 2 groups.CMMG/ACV ratios were also compared.There were 9 subjects in Group A and 18 in Group B and subject backgrounds were similar.ACV serum concentrations were not significantly different between the two groups-median (range) 6.6 (1.1-9.9)μg/mL and 3.6 (0.5-12.1)μg/mL respectively (P =0.26).However,serum CMMG concentrations were significantly higher in Group A than in Group B-median (range) 10.4 (6.6-17.2)μg/mL and 2.4 (0.0-11.8)μg/mL respectively (P <0.001).The serum CMMG/ACV ratio was also higher in Group A than in Group B-median (range) 2.17 (0.75-10.20)and 0.64 (0.00-3.citation=16)respectively (P <0.01).These results suggest that the development of neurotoxicity is associated with the accumulation of CMMG in the serum.The monitoring of serum CMMG concentrations could be therefore be useful for predicting neurotoxicity during ACV treatment in patients with renal failure.
A model core-curriculum for practical training has been developed for the six-year educational system for pharmacy students.While educational objectives and strategies are explained in detail in the core-curriculum there are few details of methods for evaluating students.In order to evaluate the effectiveness of the practical training curriculum,it is essential to evaluate students’understanding,and evaluation methods should therefore be considered when establishing teaching programs in the pharmacy department.In this regard,portfolio assessment has been receiving attention in medical education since it enables progress in clinical performance to be measured and aids professional development by encouraging students to reflect on their experiences. The specific behavioral objectives (SBOs) in the core-curriculum associated with inpatient pharmaceutical care contain many affective objectives (10 of 24),whose achievement requires not only knowledge and technical ability but also communication and problem-solving skills.Since portfolios can be used to assess student capabilities that cannot be expressed numerically,we considered utilizing portfolios as an assessment tool for practical training for pharmacy students.Portfolio assessment was used in a SBO-based core-curriculum training program on inpatient pharmaceutical care for postgraduates that we had found to be effective in a previous study. Portfolio assessment showed instructors that students were definitely making progress and reflecting on their own portfolios enabled students to learn much from their practical experiences,which was effective in further improving their capabilities.
In view of reports of occasional leakage of insulin following injection by patients,we investigated the frequency of such insulin leakage and the amounts of leakage.To do this,we conducted a questionnaire survey and estimated the amount of insulin leakage based on the results of an insulin dropping test.We also investigated different needle tip angles to gauge the effect on insulin drops. In the results of the survey,71.0% of patients answered that insulin“always”or“sometimes”leaked from the needlepoint after injection and that an average of 2.1 drops of insulin per injection did not enter the body. The insulin dropping test indicated that greater needle internal diameters increased the weight of a drop of insulin dripping from the needlepoint.Drop weight also varied depending on whether there was a silicon coating or not.However,it was not affected by different needle tip angles.
The infection control team at Showa University Fujigaoka Hospital placed a formulary restriction on physicians’use of anti-methicillin resistant Staphylococcus aureus (MRSA) agents (vancomycin,arbekacin and teicoplanin) in January 2004.To evaluate the effect of this restriction,we investigated the changes in numbers of vials of anti-MRSA agents used between 1 year before and 1 year after the restriction was implemented,and in the numbers of new MRSA-positive inpatients (newly registered inpatients with MRSA infection or contamination). There was a significant decrease in monthly vial consumption for intravenous (iv) and oral vancomycins.This was accompanied by a 66% decrease in the cost of vancomycins used.However,there was no increase in the number of newly registered MRSA-positive inpatients over this period.There was also no significant change in monthly vial consumption for the newer anti-MRSA agents,arbekacin and teicoplanin,which was because the number of prescriptions of these drugs was much smaller than that for vancomycins. By hospital department,there was a remarkable decrease in iv and oral vancomycin usage in Gastroenterology and in the use of iv vancomycins in Chest Surgery.However,there was no significant decrease in newly registered MRSA-positive patients in these 2 departments. These findings suggest that such a formulary restriction contributes to ensuring the proper usage of anti-MRSA agents for inpatients with MRSA infections as well as to reducing medical costs.
White petrolatum is widely used as an ointment base.In this study,we examined the quality characteristics of pharmaceutical petrolatums and a cosmetic petrolatum.There are 6 brands of pharmaceutical white petrolatum which are Perfecta and White 1S made by Sonneborn Co.and Ultima,Snow,Snow V and Regent made by Penreco Co.<br>We measured the melting point and viscosity of the white petrolatums.Perfecta had the highest melting point and Ulitima had the lowest.Snow had the highest viscosity and Perfecta the lowest.These results show that the characteristics of white petolatums vary among brands.Spectrophotometry was used to evaluate potential allergenicity.For extracts of Ultima,Regent and a cosmetic petrolatum,absorption was not observed in the 260 to 270 nm range suggesting that Ultima,Regent and the cosmetic petrolatum have a low content of polycyclic aromatic hydrocarbons which cause skin irritation.Upon investigating the brands of white petrolatum used in the base of commercial ointments,we found that the brand of petrolatum varied among the ointments.In order to ensure the proper use of ointments,suitable ointments should therefore be selected in consideration of patient needs.
The purpose of this survey was to investigate the current situation of the content of clinical practice education and the system for implementing it for university pharmacy faculties and hospital pharmacies in the Kyushu-Yamaguchi area.The mean questionnaire recovery rate for hospital pharmacies was 59.5%,and a decrease in recovery rate with hospital size.There was no difference in the training fees being considered by the hospitals or universities and it was clear that the only form of compensation provided to hospitals by universities was training fees.The proportion of hospitals that would be able to run the long-term clinical practice training,which will start in 2010,was 62%.We found that universities varied con- cerning vaccination and insurance coverage.The results of this study should prove useful in bringing clinical practice edu- cation and training into line with each other.
Six-year pharmacy education curriculums started in Japan in April 2006 and universities have been conducting early exposure to hospital work programs.We conducted such a program at Okayama University hospital for 45 first-year undergraduate pharmacy students at Okayama University.In the hospital the students visited a pharmacy,clinical trial center,hospital ward,rehabilitation division and an integrated support center for patients,led by hospital pharmacists and teachers of the faculty of pharmacy.In the pharmacy,they experienced the dispensing of a simulated prescription.In the present program,we obtained the help of not only pharmacists but also other medical staff including physicians,nurses,clinical research coordinators,physical therapists,social workers,and arranged it so that students could feel the importance of the medical care team. A questionnaire survey conducted before and after the early exposure to hospital work program indicated that all of students were satisfied with it,and many students were more aware of the roles of hospital pharmacists and their skills.In addition,comments made by students showed that they had greater motivation for learning,were more aware of the importance of the medical care team and communication skills.These results suggest that it would be useful to introduce such early exposure to hospital work programs into primary education for pharmacy students.
We introduced an early exposure pharmacy-training program on prescribing for first year students who entered the Faculty of Pharmaceutical Sciences,Doshisha Women’s College of Liberal Arts in 2005,and then evaluated its results.The purpose of the program is to motivate students to increase their knowledge of pharmacy to higher levels in the early part of their university study.It includes exposure to all basic techniques required by pharmacists to dispense prescriptions in hospital and community pharmacies. We evaluated the effectiveness of the program using the visual analog scale (VAS) method and a questionnaire.In the VAS evaluation,scores for students’self-evaluation of their degree of understanding and proficiency for several subjects were higher after introducing the program than they were before.The results of the questionnaire showed that almost of all of the students had gained much basic knowledge of pharmacy as well as an awareness that pharmacy practice is intimately connected with the life of human beings.Major changes have recently been made to the educational curriculum at faculties of pharmaceutical science at Japanese universities and with our program we were able to show that exposing students to the basic techniques of the pharmacist soon after entering university is a useful way of increasing their desire to learn about pharmacy.We feel that it will become a fundamental part of pharmaceutical education for first year students as it will enable them to be more aware of the functions of the pharmacist in the hospital pharmacies,community pharmacies and other clinical settings.
Doxorubicin and vincristine were added to various infusion solutions used for vincristine,doxorubicin and dexamethazone (VAD) chemotherapy.The infusion solutions were kept at room temperature,and stability was evaluated after 3,16,24,40,48,64,72,88 and 96 hours using high performance liquid chromatography.Doxorubicin and vincristine were stable in all infusion solutions up to 24 hours as residual contents were still over 90% at this time.Afterwards,a drop in vincristine content was observed for the infusion solution of physiological saline and this was considered to be due to adsorption of vincristine onto ethylene vinyl acetate copolymer,the material from which the infusion solution container was made.