Early-exposure training involving vital sign assessment was conducted for first-year undergraduates of a 6-year pharmaceutical course. To evaluate the undergraduates’ motivation for obtaining pharmaceutical knowledge, the undergraduates were asked to complete a questionnaire before and after the early-exposure training program. To evaluate their satisfaction level with the vital signs training, the undergraduates were asked to complete a questionnaire after undergoing the training. Individual evaluations of subjects were obtained according to 4-point Likert scale items. We analyzed the results using customer satisfaction (CS) analysis to obtain information that would help increase the undergraduates’ internal motivation for learning and increase their satisfaction with the vital signs training. The results indicated that 41.3% and 47.4% (1-top ratio) of the undergraduates had a strong desire to study pharmacy before and after this early-exposure training, respectively. We found that 34.8 % (1-top ratio) of the undergraduates were very satisfied with the educational program for vital signs training. The CS analysis results indicated that the areas requiring most improvement with respect to motivation for learning were “having some idea regarding the kind of work performed by medical staff members” and “experiencing a sense of fulfillment with pharmacy work.” Improvement could not be achieved in these areas through this early-exposure training. The CS analysis results also indicated that the areas requiring most improvement with respect to satisfaction with the vital sign training were “preparation and review of lessons during after-school hours,” “a sense of purpose,” and “the time allotted for training.”
In October 2003, the Department of Pharmacy in Kyushu University Hospital obtained ISO9001 certification for the quality management system of the pharmacy practice in order to promote effective and safe pharmacotherapy for patients. We introduced this system in April 2005 to prevent dispensing errors for narcotic drugs. When the wrong medicines were given to patients, we analyzed the factors for the dispensing errors, took corrective and preventive actions to prevent such errors, and evaluated their effectiveness later. In this study, we analyzed the number, classification and environmental factors for the dispensing errors for narcotic drugs, and evaluated the usefulness of measures for preventing the errors based on the ISO9001 quality management system. As a result, since the introduction of the management system, the dispensing errors and incidents have remained below 0.1% and 0.025%, respectively, although the number of adopted narcotic drugs has been increased. These results suggest that the ISO9001 quality management system is useful for the prevention of dispensing errors for narcotic drugs.
Discontinuation of the treatment occurs in some cases for paclitaxel due to peripheral neuropathy. Although there have been several reports regarding the risk factors of peripheral neuropathy associated with this drug, there have been no such reports in Japan. Therefore, we conducted a retrospective survey to clarify risk factors of peripheral neuropathy among patients administered PTX. The subjects comprised all the patients in whom the administration of PTX was initiated at the Breast Center of Juntendo University Hospital between July 2004 and July 2008. PTX dosage, period of initial treatment, and severity of peripheral neuropathy were collected from the medical charts. Peripheral neuropathy developed in 82 out of 111 patients (73.9%), and 9 of them (8.1%) were assessed as Grade 3 or higher. A previous history of diabetes mellitus was identified as a risk factor of grade 3 or higher peripheral neuropathy (Hazard ratio 5.98, 95% confidence interval: 1.03-34.82; p=0.047). The rate of cases with peripheral neuropathy of Grade 3 or higher was lower than described in previous reports, and a history of diabetes mellitus was suggested as a risk factor. Because peripheral neuropathy is a problem for treatment, it is necessary to study treatment methods through a prospective controlled trial.
In this study, we switched from using dexamethasone sodium phosphate (DEX) injection (brand-name product), which is administered to reduce nausea/vomiting related to cancer chemotherapy, to a generic drug, considering its pharmaceutical features: the generic drug does not contain paraben as an additive, and it may be stored at room temperature, whereas the brand-name formulation must be stored in a cool place. We compared the clinical effects of the brand-name and generic formulations of DEX injection on nausea/vomiting related to therapy with cisplatin, which frequently causes nausea/vomiting, based on the nausea/vomiting inhibition rate. There was no significant difference in the inhibitory effects on acute or delayed nausea/vomiting. Furthermore, there was no significant difference in the frequency of treatment with first-aid agents, which were administered when the inhibitory effects were insufficient. These results suggest that the clinical effects are similar between brand-name and generic formulations of DEX injection. Generic formulations may be useful with respect to their cost and application.
To clarify the issues involved in the promotion of pharmacists’ participation in home medical care, we performed a questionnaire survey on the implementation situation of home medical care and pharmacists’ attitudes and opinions in community pharmacies. We mailed a questionnaire to 715 community pharmacies in July 2010. The pharmacists’ attitudes and opinions were validated through text mining. 78.3% of community pharmacies were requested to visit a patient’s home and provide a pharmaceutical service, but only 53.0% of these visits were made. In many pharmacies, an average of 2.3 pharmacists provided care to within 5 patients and visited the patient’s homes twice a month. Meanwhile, 27.7% of the pharmacies delivered prescription medicines to nursing facilities, and of these, only 19.8% of the pharmacies provided instructions regarding pharmaceutical care. Only 9.1% of the pharmacists participated in training workshops related to home medical care. 48.4% of the pharmacists recognized that they had to provide pharmaceutical care visits for patients coming to their pharmacies. Only 3.7% of the pharmacists participated in joint directions at the time of hospital discharge. Results of text mining showed the need for pharmaceutical care visits for patients with poor compliance, those who found it difficult to go to the pharmacy or had dementia, and the elderly living alone. Also, the patients and other homecare staff felt the necessity for pharmacists to provide pharmaceutical care in the patient’s home. In conclusion, in order to promote home medical care, inhibitory factors such as lack of pharmacists’ manpower and cooperation with home care staff, and insufficient provision of training workshops for home medical care need to be tackled.
Hazardous drugs such as anticancer drugs have been detected in the hospital environment and urine of health professionals. These contaminations by such drugs result from the leakage of the drug from the vial at least in part when injections are prepared. However, the leakage of hazardous drugs from vials has not been studied in detail owing to the lack of appropriate assay systems for each vial. We established a new evaluation method, which enabled determination of the leaked volume from vials. Firstly leaked solution was trapped on a filter paper. Afterwards, a standard specimen was extracted and the concentration was determined by capillary electrophoresis which allows quick analysis with high resolution, linearity and reproducibility. Since the evaluation method developed gave suitable validation data, we estimated the levels of leakage from the vial when various types of injection needles were used. The result showed that the leakage level of the standard solution with 22 gage needles was significantly decreased compared with 18 gauge needles. The leakage level with short bevel needles was slightly decreased or similar compared with regular bevel. This is the first report on the evaluation of needles in terms of leakage to the best of our knowledge, and the established method should be applicable to evaluations of other injection containers and injection mixing skills of health professionals.
Semi-solid enteral nutrient administration has recently been performed at many institutions. Drugs are mixed with semi-solidified pure water and administered, but the drug dissolution pattern may alter depending on the type of semisolidifying material. We investigated differences in viscosity changes due to the characteristics of semi-solidifying materials and dissolution behavior of a drug mixed with semi-solidified pure water. Pure water preparations semi-solidified by 4 semi-solidifiers were adjusted to about 8,000 mPa･s, and viscosity changes at 25℃ and 37℃ were measured using a cone-plate rotational viscometer. In addition, gliclazide tablets used as a model drug were ground or mixed with the semi-solidified pure water preparations and subjected to dissolution tests employing the paddle method under the conditions of: dissolution time, 90 minutes; and test solution pH 1.2 and 6.8. The pure water preparations semi-solidified by the 4 semi-solidifiers (Kanten Cook Ⓡ(agar), Gelatin Leaf, Toromeiku ⓇSP, Tsururinko) showed non-Newtonian flow (except Gelatin Leaf at 37℃), and viscosity changes varied among the semi-solidifiers. In the dissolution tests, the dissolution rates of gliclazide mixed with pure water semi-solidified by Kanten Cook Ⓡand Gelatin Leaf showed elution patterns similar to that of ground tablets, but those mixed with pure water semi-solidified by Toromeiku ⓇSP and Tsururinko were about half of these rates. The viscosity change and delay in drug dissolution were observed depending on the type of semi-solidifier.
We developed an integrated curriculum involving focused study on four subjects in one month and conducted comprehensive study of advanced problem-based learning (PBL) using case studies in ‘Clinical and Pharmacy Practice Pharmaceutical Science’ class for sixth-year students at Gifu Pharmaceutical University. A questionnaire survey was conducted on the 66 students taking the course (collection and valid response rates, 95.5%). Most students evaluated their understanding of the seven target learning points as ≧4. The results indicated appropriate case study difficulty and that an appropriate amount of time had been spent on group discussion and presentations. With regard to PBL classes overall, the one-month focused curriculum, study motivation enhancement, and PBL class utility were also highly evaluated. The three factors of ‘knowledge’, ‘communication’ and ‘issue identification and intervention’ were extracted from factor analysis of the seven items relating to levels of attainment. Covariance structure analysis of these three factors and ‘utility of PBL classes’ clarified that ‘knowledge’ and ‘communication’ were linked to ‘issue identification and intervention’ and that the PBL classes were beneficial for learning.