Various systems for preventing dispensing errors have been developed.Although serious dispensing errors have been reduced by the introduction of these systems,they have not managed to eliminate all dispensing errors in pharmacies since prevention of human error is difficult.Few effective countermeasures have been established due to a lack of information on background factors in reports on dispensing errors and it takes a long time to analyze data if reports are handwritten.We therefore decided to develop a new risk management system to solve these problems.The development of the new system and its effectiveness when used in AIN PHARMACIEZ from October to December in 2008 are described in this report. The new system has 3 features : citation=1)direct reporting of dispensing errors by staff concerned,citation=2)clear distinction between errors and background factors in reports,and citation=3)simple input by means of multiple choice questions.Direct reporting of a dispensing error by the person responsible for it provides information that others can easily understand and it can be used to evaluate any staff problems.Moreover,the input of both numerical data and background factor information to the database enables organizational problems to be analyzed from various points of view.Such analysis should reveal the limitations of current systems for prevention of dispensing errors and lead to the establishment of effective countermeasures.The newly developed system is therefore expected to contribute greatly to the prevention of dispensing errors in pharmacies.
In many cases in the clinical setting,trace elements are mixed with TPN products.However,in such therapy the rapid oxidative decomposition of vitamin C is a problem.In view of this,we investigated the stability of vitamin C in a newly developed kit product for TPN (ELNEOPA No.1 and No.2 Injections) which contains trace elements in addition to glucose,electrolytes,amino acids,and vitamins. We evaluated the stability of vitamin C after mixing all the ingredients of ELNEOPA in comparison with the control solution (admixture of commercial TPN solution containing vitamins and a trace element preparation).Though vitamin C rapidly decomposed in the control solution,it was stable in ELNEOPA,with not less than 90% of the labeled amount remaining 7 days after mixing.The container (plastic bag) of ELNEOPA is made from a high gas barrier film and we consider the stability of vitamin C in it to be due to the film preventing an increase in oxygen in the solution.Also,as at least 90% of the labeled amount of vitamin B1 was still present 7 days after mixing,ELNEOPA is considered to be a very useful preparation for TPN therapy,including that in the home.
As part of the practical training curriculum for pharmacy undergraduates,we have introduced a role-playing simulation exercise in obtaining informed consent prior to clinical trials.The exercise has contributed to raising students’awareness of the importance of communication skills and understanding patient anxiety.We conducted the present study to evaluate the outcomes of this exercise. The study targeted 48 junior pharmacy students (21 males,27 females) who attended a one-day training session at the Clinical Research Center in Kitasato Institute Hospital between January and March 2008.Each student played all three roles,i.e.clinical research coordinator (CRC),prospective participant,and observer.We analyzed the role-play sessions of 15 students who had consented to video recording.In addition,the role-plays of professional CRCs for the same scenarios were recorded as a comparative control.The scenario for each session was chosen arbitrarily from the following 5 themes : hyperlipidemia,hay fever,dry eye,low back pain,and athlete’s foot. The average times for the students and the professional CRCs to obtain informed consent were approximately 16 and 36 minutes,respectively.The professional CRCs asked the prospective participants more questions,suggesting that they frequently ensured that the prospective participant had understood their explanation of the clinical trial. While the main objective of introducing the role-playing exercise was initially to verify the effectiveness of participatory training,through repeating it several times,interaction between the CRCs and the prospective participants has become more substantial.Additional qualitative analysis of role-plays should further clarify the significance of communication education.
We have been conducting practical training for fourth-year students at Gifu Pharmaceutical University.At the end of the training,they write reports on their practical training in the hospital pharmacy and practical training in the community pharmacy. We converted their sentence data into text format and performed Japanese-language morphologic analysis on it using language analysis software (KHCoder).We then worked out the frequency of keywords based on the word class information in the Japanese language morphologic analysis.We also classified the characteristics of keywords by assigning them to 5 categories which were“practice”,“patient”,“practical training”,“medical team”and“community healthcare”. The results showed that the students’awareness of“patient” tended to be higher in the clinical pharmacy report.Further,the results of correspondence analysis showed that the characteristics of reports on training in the hospital pharmacy and reports on training in the community pharmacy were independent.We therefore considered text-mining to be a useful approach in the evaluation of practical training.
There is concern about the possibility of degradation of the active substance as a result of pH changes when making suspensions of several drugs together by the simple suspension method.However,this has been investigated by few researchers.In the present study,we focused our attention on aspirin since it is known to be hydrolyzed at high temperatures or with elevation in pH.In this study,a Bufferin® 81 mg Tablet was suspended alone or together with alkaline drugs by the simple suspension method,and its stability evaluated. When in the suspension alone,the Bufferin® 81 mg Tablet was stable for 5 hours and the amount of salicylic acid (hydrolyte of aspirin) produced was negligible.On the other hand,when it was suspended together with alkaline agents (magnesium oxide tablet/powder,or lithium carbonate tablet),the residual content of aspirin decreased to 77-84% in ten minutes.The pH of the suspensions containing both the Bufferin® 81 mg Tablet and alkaline agents ranged from about 9 to 10 showing that alkalinity had been enhanced as compared with the suspension of Bufferin alone whose pH was 4. It has been reported that in low-dose aspirin therapy,platelet aggregation inhibition is unstable if the daily aspirin dosage is reduced to less than 75 mg.However for Bufferin® 81 mg Tablet,the results of the present study suggested that the beneficial effect of low-dose aspirin therapy might not be fully achieved it were suspended together with alkaline agents by the simple suspension method.
This study investigated the effects of pharmaceutical care during cancer chemotherapy on the mental condition of patients with hematological malignant diseases.A questionnaire survey was conducted of 33 patients who received cancer chemotherapy between December 2005 and November 2006 for which the questionnaire recovery rate was 100%. The results showed that about 90% of the patients (29/33)felt“relieved”and“encouraged”after receiving pharmaceutical care and the majority of them noted that their“anxiety was eased”.This suggested that team medical care including pharmaceutical care would relieve the unease of patients. The combined response rate for“slight adverse effects”and“prevention of adverse effects”was 45.5%,indicating that the positive effect of team medical care including pharmaceutical care on patients’psychological attitude could improve symptoms and prevent adverse effects.In addition,many patients expressed a desire to receive pharmaceutical care during subsequent treatments,suggesting that a psychological dependence on pharmacists had developed. In conclusion,our findings showed that team medical care including pharmaceutical care reduces the psychological burden on patients,and active pharmaceutical intervention during cancer therapy is necessary and useful from the perspective of psycho-oncology.
One approach to limiting the progression of liver fibrosis in chronic hepatitis C (CHC) is to decrease the amount of iron stored in the liver and guidance regarding dietary iron consumption is therefore important.Many people with CHC consume turmeric (ukon) believing it to be good for the liver,though it is considered to have a high iron content.In this study,we investigated turmeric consumption by patients with CHC and measured the iron content of the turmeric they consumed.We also investigated changes in liver function based on blood samples taken before and after ceasing to take turmeric and compared them to a control group. From the results,we could not conclude that turmeric had a higher iron content than other foods,though patients consuming turmeric had high concentrations of serum iron,ferritin,AST,and ALT overall.However,AST and ALT concentrations dropped to levels close to those in the control group when they ceased consuming it.We considered that even a small quantity of iron could affect liver function because the patients consumed turmeric on a daily basis as self-medication.Around half of the turmeric investigated was home-grown and varied widely in iron content.There was also the problem that patients have not received precise dietary advice but simply believed that turmeric was good for the liver.
In order to provide useful information on insulin self-injection to patients with diabetes mellitus,the physicopharmaceutical properties of insulin injectors and needles were investigated. Humalog® Luxur/Humalog® Cart (HLL),Novopen® 300/Novorapid® 300 (NPR),Rantas Opticlic® /Rantas® (OPC),Humalog® Kit (HLK),Novo Rapid Frex Pen® (NRF) and Rantas Solostar® (SOL) were investigated as insulin injectors. The amount of insulin actually infused,when various injectors were set to inject 10units was evaluated.For each injector,variability in the amount infused showed a tendency to decrease gradually,evaluation of the time-course of changes in infusion resistance was important for the comparison of injectors.Despite equal viscosity,levels infusion resistance of SOL was 20% of that for OPC and the infusion resistance of HLL became 75% of that for HLK.The infusion resistance with a 30G needle decreased compared those of 31G and 32G needles.The penetration stress of a 30G needle was approximately twice that of a 32G needle.The penetration stress of the needle was proportional to the strength. When selecting an insulin injector,it is necessary to choose the device most suitable to the patient’s needs.
Gemcitabine hydrochloride (GEM) is a standard anticancer agent for pancreatic cancer.However,gemcitabine chemotherapy is often prolonged or ceased due to hematological toxicity or other adverse events.In the package insert of GEM,gender differences in clearance and half-life are mentioned but there is little information on the clinical effects of these differences.In this study,we carried out a retrospective analysis of the relationship between gender differences and adverse events in GEM treatment in 60 patients (30 males and 30 females).Severe neutropenia (grade 3 or grade citation=4)was observed in 28 patients and statistical analysis revealed that its occurrence was significantly higher in females (19 of 30 patients) than in males (9 of 30 patients) (p=0.010 byχ2 test).Gender differences were not observed for other hematological toxicities.These results suggested that gender difference is a potentially useful factor for predicting neutropenia due to GEM treatment.