Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences)
Online ISSN : 1882-1499
Print ISSN : 1346-342X
ISSN-L : 1346-342X
Volume 34, Issue 4
Displaying 1-12 of 12 articles from this issue
Regular Articles
  • Tetsuo Adachi, Masumi Suzui, Kuniko Naoi, Tetsuro Kamiya, Hirokazu Har ...
    2008 Volume 34 Issue 4 Pages 311-319
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    Fourth-year students in the conventional 4-year pharmaceutical education curriculum took part in a trial on advanced problem-based learning (PBL) in preparation for its introduction at higher levels of the 6-year curriculum of pharmaceutical education,which was started in April,2006.Students were divided into 15 groups and the products prepared by each one were evaluated using the same evaluation scale by the audience (instructors and students of other groups) as well as students of the group that made the presentation.Data obtained were subjected to Customer Satisfaction (CS) analysis,which is generally used for market surveys.A case of acute promyelocytic leukemia,typhoid fever,acute myocardial infarction,anaphylactic shock or sigmoid colon cancer was randomly assigned to each group.
    The results of a questionnaire survey concerning PBL classes indicated a high level of satisfaction level for many students,but it also revealed problems in conducting PBL,among them the number of students in each group,time of conducting it,and the number of cases.For the scheduling of advanced PBL next year,some of the matters that should therefore be studied are the use of a teaching assistant (TA) system,adjustment of timing of PBL and preparation of additional scenarios.
    As a result of the application of the CS analysis method for the assessment of group presentations,problems that would have been overlooked in conventional statistical analysis,such as the mean assessment value,were revealed,indicating the usefulness of the CS analysis method for the assessment of learning efficiency in PBL tutorials.
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  • Yutaka Negoro, Ryoichi Yano, Daisuke Tani, Kyohei Watanabe, Hitoshi Ts ...
    2008 Volume 34 Issue 4 Pages 320-327
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    During cancer chemotherapy,myelosuppression is a frequently observed toxicity manifestation which may sometimes cause severe infections.In this regard,though leukopenia-induced infections are more closely related to neutrophil counts than leukocyte counts,it is important to evaluate both leukocyte counts and neutrophil counts as markers of myelosuppression.Neutrophil counts,however,are sometimes estimated to be half leukocyte counts without conducting differential leukocyte counts.
    In the present study,the authors evaluated the necessity of differential leukocyte counts during cancer chemotherapy using pooled laboratory data at the University of Fukui Hospital.Variation in the percentage of neutrophils in leukocytes was observed in each leukocyte range,with the neutrophil count decreasing in pace with decreases in the leukocyte count.As an alternative index to the neutrophil count,the utility of the leukocyte count is thus considered to be low in cancer chemotherapy.There was also a divergence between adverse event grade between neutrophil and leukocyte numbers.In addition,neutrophil counts in 14.8% of the patients (26)were less than 1000/μL in spite of the fact that their leukocyte counts were higher than 3000/μL,and it was noted that 23 of them had undergone a paclitaxel-containing regimen.
    These results suggested that leukocyte differential counts should be measured during cancer chemotherapy,especially during the nadir period and when receiving chemotherapy containing paclitaxel.
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Notes
  • -Development of System for Use with Injection Labels-
    Masaki Hirabatake, Koji Hama, Kenji Yamamoto, Hirofumi Akase, Mieko Oh ...
    2008 Volume 34 Issue 4 Pages 328-332
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    When the aseptic mixture preparation service for ambulatory cancer chemotherapy was started,we felt that by providing information to aid persons making and checking preparations we could help prevent preparation errors.We studied the best way of providing information,monitored prescriptions we thought had high preparation risks and evaluated preparation errors after the introduction of our system.We considered that 3 types of information were necessary-“Precautions in Protocol”,“Important Notices to Patients”,and“Preparation Procedures”-and recorded each type in our injection label and audit information system.The information was also displayed on the label for every prescription.
    From January 2004 to June 2006,the proportion of prescriptions for which discomfort to the patient was prevented by avoiding preparation errors through the use of the information provided was 8.7%.For medicines that require reconstitution at the time of use,there is a possibility of errors in choosing the solvent and diluent,and it was found that preparations requiring reconstitution accounted for 23.4% of the total.Also,the number of preparations thought to be at risk of calculation errors because of prescription quantities not being integral multiples of drug standards was 23.7%.In the period under investigation,there were 5 errors related to labels but there were none related to preparation quantities.The 5 errors did not seem to influence treatment.
    We consider that the information displayed on drug labels,including that for high-risk prescriptions such as those mentioned above,is an effective means of reducing the risk of errors in the preparation of anticancer agents.
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  • Sachiko Jingami, Mika Miyazaki, Yumiko Matsumoto, Akiko Sadanaga, Eiko ...
    2008 Volume 34 Issue 4 Pages 333-340
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    A simple method for making suspensions of tablets and capsules for administration via a feeding tube has been developed.It involves allowing tablets or capsules to disintegrate in hot water (55°C) without grinding.When this method was introduced for administration by feeding tube at the Japanese Red Cross Kumamoto Hospital in October,2006,we developed a dispensing support system for it.
    Our system enables us to verify whether medicines are appropriate for administration by feeding tube or not.It also raises efficiency in drug dispensing and facilitates the recording of drug information for the use of nurses at the time of administration.We feel that it is a useful and effective system for the administration of medicines by feeding tube.
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  • Takayuki Kohno, Daisuke Horinaka, Akira Nakamaru, Minoru Inase, Satosh ...
    2008 Volume 34 Issue 4 Pages 341-346
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    Methicillin-resistant Staphylococcus aureus (MRSA) infections have developed into a major social issue and while the media have become quieter in reporting on it,MRSA remains a significant nosocomial pathogen for the healthcare system.In the treatment of MRSA infections it is crucial to prevent the development of bacterial strains with increased drug resistance,such as VRE and VRSA.
    We report on a patient who had surgery for Fournier's gangrene due to MRSA infection.The affected area had been difficult to treat,blood flow was low as a result of necrosis,and bacteria had caused pustules to develop.The attending pharmacist selected antibiotics and drew up an administration plan in which they were administered based on substantiated evidence available from the Physicians' Desk Reference and up-to-date clinical information.The outcome of treatment was satisfactory,the patient experienced no adverse events and no increased drug resistance was observed.We therefore conclude that it is important for pharmacists to be involved in the treatment of MRSA infections in consideration of several factors including the pharmacological characteristics of various antibiotics,the patient's disease and general condition,transferability to tissues,and minimum inhibitory concentration (MIC).
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  • Kouichi Tanabe, Miyako Takeuchi, Tomoaki Ikezaki, Hidenori Kitazawa, T ...
    2008 Volume 34 Issue 4 Pages 347-354
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    Pravastatin sodium tablets are widely used for the treatment of hyperlipidemia,and 22 generic products of this compound have been approved in Japan.A few studies have compared the clinical efficacy of the original and generic forms,and 1 study has questioned the reliability of biological equivalency tests.We therefore retrospectively examined the effect of substituting a generic product (Mevan TM ; Nichi-iko Pharmaceutical Co.,Ltd.) for the original product (Mevalotin TM ; Daiichi Sankyo Co.,Ltd.) on clinical efficacy and safety.
    We targeted patients who were initially treated with the original product and then the generic product,and from electronic medical records,obtained their prescription data for 3 months before and after generic substitution.Next,we investigated clinical equivalence with regard to changes in total cholesterol (TC),HDL cholesterol (HDL),LDL cholesterol (LDL),and triglyceride (TG) levels as indices of clinical efficacy,as well as in ALT,AST,γ-GTP,and CPK levels as indices of safety.We examined the changes in each of these laboratory parameters between 3 months before substitution and 3 months after substitution.In 293 patients,no significant differences were observed in the indices of efficacy between before and after substitution.We also examined records for presence of diabetes mellitus and familial hypercholesterolemia and their influence on TC levels before and after substitution but no significant differences were observed in this regard.Accordingly,we concluded that the generic product investigated in this study was clinically as effective as the original product.
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  • Shinichi Harada, Ayaka Nawa, Wakako Hamabe, SungHi Kim, Yoko Akimoto, ...
    2008 Volume 34 Issue 4 Pages 355-360
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    It is well known that combination therapy with interferon (IFN) and ribavirin may not achieve the full therapeutic effect in patients with high-titers(≥100 KIU/mL) for hepatitis C virus genotype 1 b.Further,high low-density lipoprotein cholesterol (LDL-C) levels are reported to be a significant indicator of the potential therapeutic effect of IFN in hepatitis C patients,though this is still controversial.In this study,we examined the serum levels of various lipids - comprising LDL-C,total-cholesterol (T-Cho),triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C)-before and after combination therapy with pegylated interferon (PEG-IFN) and ribavirin in chronic hepatitis C patients.In an end of treatment response group (ETR) group,TG levels prior to the start of the therapy were significantly lower than those in a no response (NR) group,while there were no differences in LDL-C,T-Cho and HDL-C levels between the two groups.In a sustained virological response (SVR) group,TG levels were also significantly lower than those of the NR group.These findings suggest that serum TG levels may be a significant predictive factor for the outcome of combined therapy with PEG-IFN and ribavirin in chronic hepatitis C patients.
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  • Katsumi Tanizawa, Yoshiko Kiriyama, Toshikazu Shintani, Kunio Hayase, ...
    2008 Volume 34 Issue 4 Pages 361-365
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    A retrospective analysis was carried out to determine the neutropenia-associated factors that require the use of granulocytes-colony stimulating factor (G-CSF) in paclitaxel (PTX) plus carboplatin (CBDCA) combination chemotherapy for the treatment of advanced lung cancer.
    Forty-five patients (110 courses) with advanced lung cancer who received PTX plus CBDCA combination chemotherapy were the subjects of the present study.They had no previous treatment history.A logistic regression analysis was performed to determine patient backgrounds and therapeutic regimens that affect the incidence of neutropenia requiring G-CSF.The data showed that the risk factors involving the prolongation of G-CSF use were the monthly dosage regimen[odds ratio : 3.343(95% confidence interval : 1.292-8.648)],dose of PTX≥140 mg/m2 [7.529 (1.669-33.961)] and multiple(>2)courses of the chemotherapy[3.178 (1.228-8.222)].However,the duration of G-CSF use was not influenced by gender,age,performance status,serum albumin or radiation therapy.
    These findings suggest that pharmacists should carefully monitor the serological data on myeloid function in patients undergoing PTX plus CBDCA combination chemotherapy for advanced lung cancer,particularly in those with risk factors for prolongation of G-CSF use.
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  • -Characteristics of Benidipine Hydrochloride Tablets whose Dosage Form has been Changed and Comparison of Branded and Generic Products Regarding Drug Information Supplied-
    Emi Ichihara, Manabu Okumura, Fumi Yoshida, Yohei Kawano, Kayoko Ooura ...
    2008 Volume 34 Issue 4 Pages 366-373
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    In Japan,prescription costs account for more than 20% of the national health care budget.In order to curtail such expenditure as much as possible,the government recommends switching from branded products to generics.However,the information available regarding the equivalence of branded products and generics is often insufficient.With this in mind,we evaluated the equivalence of the branded benidipine hydrochloride tablets and generics of it,by comparing such aspects as their passage through a nasogastric tube,and the characteristics of divided tablets.Further,since drug information (DI) is a vital factor for evaluating generics,we conducted an objective evaluation of the adequacy of DI supplied for them.
    Among sixteen generic products,the passage through a nasogastric tube was significantly delayed for 2 products and for 1 of these products,there was a large variation in the weight of the halves of divided tablets.Further,the amount of information supplied by the manufacturers of the generics was less than that supplied by the manufacturer of the original product and for most of the former,it took longer to obtain.
    In the clinical setting,tablets are often divided or made into suspensions and our results suggest that the generics are not necessarily equivalent to the branded product when used in these ways.We therefore conclude that generics should be evaluated not just from the aspect of bioequivalence with no change in dosage form but from a wider overall perspective.
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  • Hitomi Teramachi, Mitsuhiro Nakamura, Eiji Takashima, Masafumi Kubota, ...
    2008 Volume 34 Issue 4 Pages 374-380
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    In this study,we conducted a questionnaire survey of fourth year students at Gifu Pharmaceutical University to investigate satisfaction levels after practical training in a hospital pharmacy.The response rate was 97.5% (119/122).Levels of satisfaction with the training overall were higher among students whose training had lasted for four weeks and involved numerous sickbeds than among those who did not receive such extensive training.A significant negative correlation was noted between satisfaction levels and not being able to receive training in certain items.Students who had undergone training in “dispensing”were significantly more satisfied with this item than those who had not.As for individual training items,the level of satisfaction with“dispensing”was very high because it had been available at all hospitals.In an analysis of the results according to 10 areas of training,one that stood out was“Clinical Trials”because 40% of the respondents had not experienced training in this category and among the 60% who had received training,satisfaction levels were significantly lower than for others.In a customer satisfaction analysis of the results,the area that needed the most improvement was “Clinical Trials”.
    Based on these results and students’opinions,we consider there is a need for hospitals to establish their own curriculums and based on this,provide an environment that will create the desire to learn in students.We also feel that the actual experience of training will have a great effect in improving satisfaction levels.
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  • Masato Ishii, Yasuhiro Kawakami, Hiroshi Date, Kazutaka Higaki, Toshia ...
    2008 Volume 34 Issue 4 Pages 381-385
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    Lung transplantation has proved to be an effective treatment worldwide for a variety of end-stage lung diseases.In Japan,living-donor lung transplantation is the predominant procedure used.In this and other types of transplantation,the calcineurin inhibitor cyclosporine (CYA) is frequently used as an immunosuppressive drug.However,this drug requires strict control of dosing to minimize the risk of rejection and over-immunosuppression,and for the orally administered drug,interand intra-individual bioavailability vary widely.Intensive drug monitoring is therefore necessary.
    In this study,25 patients who received lung allografts from living donors between October 1998 and January 2006 at Okayama University Hospital were investigated to see if there was any correlation between the CYA concentration-dose ratio and biochemical parameters.The most significant correlation was between the CYA concentration-dose ratio and total cholesterol,with a correlation coefficient of 0.46.As for individual results in this respect,14 of 25 patients had a correlation coefficient of 0.5 or greater,and the highest was 0.92.There was thus a definite correlation between the CYA concentration-dose ratio and total cholesterol in patients who had undergone living-donor lung transplantation.
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  • Mikiko Ueda, Etsuko Uejima, Hiroko Kadowaki, Manabu Takegami, Tomoya Y ...
    2008 Volume 34 Issue 4 Pages 386-393
    Published: 2008
    Released on J-STAGE: September 04, 2009
    JOURNAL FREE ACCESS
    In recent years,the role of the pharmacist in ensuring the safety of medical treatment,cancer chemotherapy in particular,has become much clearer.Pharmacists now contribute to safety management in cancer chemotherapy by checking for medication errors systematically.However,in this regard,few studies have been conducted on hospital computer systems for ordering and checking cancer chemotherapy agents for inpatients and outpatients or electronic chemotherapy protocol management systems that that are directly connected to the order entry system.
    At Osaka University Hospital,the management of chemotherapy protocols by pharmacists has been steadily expanding since June 2003,and they are now helping greatly to reduce the risks of treating cancer by chemotherapy.In order to further improve the efficiency and safety of chemotherapy,we have been conducting various studies at our hospital since July 2005.In one of them,an electronic chemotherapy protocol management system for both hospital inpatients and outpatients was developed and it started operating in July 2007.The introduction of the new system has enabled us to solve problems concerning dates of administering chemotherapy agents,dosage restrictions,and optimum distribution of treatment agents when several chemotherapy agents are to be administered.It has greatly improved the safety of chemotherapy in our hospital.
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