Pharmacists in the United States perform a wider range of occupational functions,and have greater authority than thosein Japan.Possible reasons for this are that they provide specific evidence of clinical benefits for patients and contribute toreducing medical costs through their involvement in clinical activities.The legal basis for their wider range of functions andgreater authority is defined in Collaborative Drug Therapy Management (CDTM) in the law that authorizes pharmacists totake part in the management of drug therapy and other tasks in accordance with a prior written agreement between physiciansand them.We recently investigated laws and regulations in the states that have introduced CDTM in order to examine the legal basisdefined in it for the wide range of occupational functions of pharmacists in the US,agreements on CDTM,and qualificationsof and requirements for pharmacists who take part in CDTM.We found that although different state laws have differentprovisions,there were no substantial differences among them regarding the basic structure of CDTM.In addition,publicly-available protocols actually used in the clinical setting were obtained from 3 institutions and examinedto determine how pharmacists and physicians reached agreement on the planning and implementation of CDTM,andthe drug therapies they provided according to different protocols,and the protocols were compared.All of them had thesame basic concept of CDTM and were prepared according to the joint statement of ACP and ASTM.
This study was conducted to develop a tool for evaluating the work environment for the preparation of antineoplasticdrugs and identify issues in safety assessment.We prepared a checklist for the safe handling of antineoplastic drugs,whichincluded the following items : A) safety equipment and its maintenance,B) training and training documentation,C) devicesfor ensuring safety,D) personal protective equipment and E) emergency care.Further,we examined relationships betweenattainment levels for checklist items and occupational contamination levels for cyclophosphamide (CPA),fluorouracil (5FU),gemcitabine (GEM) and platinum-containing drugs (Pt) based on wipe samples from equipment in the preparationroom (wipe test).Next,pharmacists in a particular hospital were asked to improve their work environment using the checklist.To evaluate their improvements,we collected wipe samples and one-day urine samples from them,before and afterthey took improvement measures.The results showed that an increase in safety attainment scores was reflected in a decrease in CPA,GEM and Pt contaminationlevels in the wipe test,as well as one in urinary levels of CPA.However,the 5FU level in the wipe test increased,probably due to a 6-fold increase in the amount of 5FU prepared,compared to before the improvement measures weretaken.From these findings,we concluded that the checklist would be useful for improving the hospital work environment.
We examined the effectiveness of cooling the injection site with refrigerants to alleviate pain during injection of the LHRH analogues goserelin and leuprorelin.Effectiveness was evaluated in 61 prostate cancer patients using the Face Scale and Visual Analogue Scale (VAS).Cooling achieved a significant reduction in pain at injection sites for both a group being treated with goserelin and one being treated with leuprorelin.However,there was no significant difference in the degree of pain between the 2 treatment groups regardless of whether cooling was used or not.On the other hand,the proportion of all patients who wished the injection site to be cooled in future was 42.6% while that for goserelin was significantly higher at 73.1%.This suggested that cooling was more effective for injection of goserelin.
As people age,their manual dexterity declines,and it may be difficult for elderly people to open medication packages well,especially those of powder medications.This becomes more of a problem for patients taking multiple drugs.To obtain data useful for solving this problem,we evaluated the ease of opening strip packages of powder medications by elderly people.The subjects were asked to evaluate the difficulty of separating individual packages from strips,and of opening them.Some subjects tended to accidentally open the packages when trying to separate them from the strip.In addition,the ease of opening packages depended more on the presence a notch in the package material than the strength required to open it.The findings of the present study should be applied not only to elderly patients hospitalized in medical institutions but also those living in their homes.Further investigation should be conducted in order to develop standards for medication packages that can be easily opened by a greater number of people.
It has been reported that hypertensive renal damage occurs not only in the glomerulus but also in the renal tubule.However,the excretion of urinary proteins other than albumin has not been sufficiently evaluated in hypertensive patients.Theaim of this study was to study the effect of antihypertensive therapy with candesartan cilexetil on urinary protein excretion.Twenty-nine hypertensive patients were enrolled in it.The target of the antihypertensive therapy was less than 140/90mmHg or a reduction of more than 20/10 mmHg.In 20 patients,the therapy decreased blood pressure significantly (from161.1±14.3/95.3±11.6 mmHg to 132.7±7.6/82.8±7.0 mmHg) (p<0.001/p<0.001).Total urinary protein excretion wasalso significantly decreased (from 97.7±49.1 to 66.8±30.9 mg/gCr) (p=0.009).When urinary proteins were electrophoresed using SDS-PAGE,the content of 6 fractions (100 kD,82 kD,64 kD,23 kD,22 kD and 11 kD) was significantly decreased after treatment (p=0.024,0.044,0.009,0.048,0.044,and 0.017,respectively).In 9 patients in whom blood pressure was not lowered sufficiently,total urinary protein excretion and all of theabove urinary protein fractions were decreased,though not significantly.These results suggest that if antihypertensive therapy with candesartan cilexetil lowers blood pressure sufficiently,the excretionof total urinary protein and some glomerular and tubular urinary proteins would also be adequately decreased.Also,the influence of the treatment in this study on urinary protein excretion might differ depending on the urinary protein factions.
Pharmacists are expected to play an important role in the safety management of cancer chemotherapy by checking prescriptions.Prescriptions must be checked not only with regard to the content of the regimen and patient's height,bodyweight,and body surface area,but also the status of the disease and history of treatment.In this regard,referring to electroniccharts is useful because they provide a large volume of information concerning these matters but time is required tofind the relevant items,so it may not necessarily be efficient.Therefore,we prepared aseptic preparation records with pharmaceuticalmanagement information (PMI) using the comment function of Microsoft Office Excel to facilitate quick referencingconcerning items needed for prescription checking for patients undergoing cancer chemotherapy.The active use ofthe PMI with these records allowed inquiries to be made earlier and more precisely,facilitating important changes in prescriptionssuch as dose reductions and regimen changes,and helping prevent any discomfort or inconvenience to patients.
To ensure the proper use of drugs,pharmacists must pay attention to drug incompatibility information.However,drug incompatibilityinformation relating to tablets or capsules in one-dose packages (DII) is not well understood.Therefore,weactively collected DII and shared it with Tottori West District pharmacists and investigated how they currently dispensedone-dose packages as well as their degree of understanding of DII.For sharing,we selected 3 combinations of one-dosepackage including the olmesartan medoxomil(OM)-metformin hydrochloride (MET) combination for which incompatibilityhad actually been reported in our area.Before sharing DII,hardly any of the pharmacists knew about such information inthe package inserts,suggesting that it was not widely available to them.Our sharing of DII enhanced understanding of itfor all combinations.Also,the dispensing of one-dose packages was improved in many hospitals and community pharmacies.This suggestedthat the active collection of DII and its sharing by pharmacists helped ensure proper drug use.However,we should shareDII continuously to achieve a thorough understanding of it and additional methods may be required (for example,makingpresentations at meetings) for this purpose.We should also actively collect DII because the DII in package inserts is insufficientto ensure proper drug use.
We examined the lecture“Feelings management in Communication”using the KiSS-18 standard,a social skills measurementstandard introduced by Akio Kikuchi.We also examined a link between social skills and feelings management incommunication by pharmacists.To do this,we carried out questionnaire survey of pharmacists (n=25citation=4)who attended thelecture on November 29,2009.The collection rate was 92.1%,and the response rate 79.9%.Using the KiSS-18 standard,we compared the total scores by sex,age and job.Averages of total KiSS-18 scores did notsignificantly differ between the sexes,between age groups or jobs.Three factor (s“Trouble management skill”,“Conversationskill”,and“Problem solving skill”) were identified for factor analysis for the 18 questions of the KiSS-18 standard.Themean for“Problem solving skill”factor was significantly higher than for“Trouble management skill" and“Conversationskill”).Conducting covariance structure analysis as proposed in the casual model showed that“Conversation skill”affects allother factors,making it possible to cope with trouble management,and the succeeding steps in the model.