The aim of the present study was to evaluate the safety precautions for occupational exposure to antineoplastic drugs in the hospital work environment following the investigation in December 2008. In order to evaluate the revised antineoplastic drug mixing manual of the Department of Pharmacy in April 2009, air samples, wipe samples of the equipment of the preparation room and the Department of Pharmacy, and urine samples of pharmacists were collected before and after improvement measures. Cyclophosphamide (CPA), fluorouracil (5FU), gemcitabine (GEM) and platinum-containing drugs (Pt) in the air and wipe samples were measured to evaluate the occupational contamination level of antineoplastic drugs. CPA and Pt in the urine samples were measured to evaluate the occupational exposure level. We used a checklist in order to score the safety measures. After the manual for antineoplastic drug mixing of our Pharmacy was revised, the compliancy for the check lists was highly improved, which lead to decreased contamination levels of CPA, GEM and Pt in the preparation room except for some parts. As CPA and Pt were not detected in the pharmacists' urine samples, we concluded that the safety precautions implemented here until then had been effective in improving the workplace environment contamination of antineoplastic drugs. In the meantime, most probably because we began mixing 5FU prescriptions on holidays from December 2010, we detected workplace environment contamination by 5FU in some spots. We aim to tackle this issue next.
We held classes and practice sessions on medicines for pupils and parents at elementary schools with the aim of promoting appropriate drug use. Pharmacy students participated in this project as volunteers where they taught pupils and learned and improved their communication skills at an early stage in their professional development. To evaluate whether pupils improved their medicine-related knowledge after attending these classes and practice sessions, we conducted medicine-related questionnaires (pre- and post-questionnaires) before and after the classes and practice sessions. Positive answers for the post-questionnaire were significantly higher than those for the pre-questionnaire, suggesting that the medicine-related knowledge of pupils was improved by attending the classes and practice sessions. The present results suggest that this activity benefits the education of pupils regarding appropriate drug use in Japan.
The aim of this study was to analyze retrospectively the multiple antiemetic combination on chemotherapy-induced nausea and vomiting (CINV) in patients receiving multiple-day and high-dose melphalan. Thirteen patients receiving 100 mg/m2 of melphalan for 2 days followed by autologous peripheral blood stem cell transplantation were surveyed. Patients were divided into the control (5 patients) and the combination (8 patients) groups. The control regimens included 5-HT3 receptor antagonists and aprepitant, and the multiple combination regimens included dexamethasone, prochlorperazine, lorazepam, and lansoprazole added to the control regimens. CINV was assessed on Days 1-2 (acute) and on Days 3-7 (delayed). No differences in the risk factors of CINV were observed between in the multiple combination and the control. The onset of CINV in the multiple combination, as well as the grade of CINV, was less than that in the control throughout the study period. Complete response (no emesis and rescue therapy) was observed in 50% of patients in the multiple combination. Regarding the safety of antiemetic regimens, somnolence, dizziness and dry mouth, which showed grade 1 toxicity, were observed in one patient each in the multiple combination group but not in the control group. There was no significant difference in the incidence of adverse effects between the two groups, suggesting good tolerability in the multiple combination group. In conclusion, the multiple combination regimen of antiemetic was suggested to improve the prevention of CINV in patients receiving multiple-day and high-dose melphalan.
This article discusses pharmacy practice training in the US and Japan for the purpose of improving pharmacy practice training in Japan. The authors compare the Advanced Pharmacy Practice Experience (APPE) in Nova Southeastern University (NSU) Doctor of Pharmacy program with the pharmacy practice training in Japan. The NSU APPE inhospital focuses on clinical practice training. It does not provide dispensing and drug distribution practice training, which are important as basic practice in Japan. On the other hand, there is no difference in the community pharmacy training between the NSU APPE and the pharmacy practice training in Japan. The article also examines students' limits in the NSU APPE and pharmacy practice training in Japan, classifying participation as (A) students performance without preceptors with post-performance approval by preceptors and (B) students performance under direct preceptor's supervision. There is no difference in hospital training between the NSU APPE and pharmacy practice training in Japan. However, there are significant limits on dispensing practice training in community pharmacies in Japan.
Kalimate® is often administered to patients via a simple suspension method by feeding tube. However, this method has a low recovery ratio and tube obstruction can occur. In this study, we investigated whether adding dextrin to decrease the adhesiveness and dispersibility improves the low recovery ratio and reduce tube obstruction. The addition of 0.6% dextrin significantly increased the dispersibility and fluidity of kalimate® compared to the dispersibility and fluidity of kalimate in purified water, but the addition of 0.1% and 0.2% dextrin did not. On the other hand, the 0.1 - 0.6% dextrin improved the low recovery ratio of kalimate® in the simple suspension method by feeding tube. These results show that the addition of dextrin improves the low recovery ratio and prevents tube obstruction in the simple suspension method of kalimate®. In addition, it was suggested that the decrease in recovery ratio of kalimate® is related to the adhesiveness, and the increase of dispersibility suppressed the tube obstruction in the simple suspension method by feeding tube. These findings provide significant information that can be used in improving the low recovery ratio and tube obstruction in the simple suspension method by feeding tube.
It has been reported that 5-fluorouracil (5-FU) and saline were not mixed homogeneously in some portable infusion pumps when saline was loaded first and then 5-FU was added.We evaluated whether the homogeneity of the mixture can be improved by modifying the loading method. The ratio between a glucose solution instead of 5-FU and saline and the order of their loading were changed, and differences in the glucose concentration were evaluated by labeling with ethyl hydroxybenzoate. While characteristic unevenness of the concentration was noted when glucose solution was loaded after saline, as has been reported, the unevenness was reduced by mixing the contents by inverting the pump after loading regardless of the mixing ratio. Therefore, in loading drugs with high biological toxicity such as 5-FU, the homogeneity of the mixture is considered to be improved, and the safety of the procedure to be improved by reducing the risk of exposure if the drug is loaded after physiologic saline and mixed by inversion.
Renal failure induced by cyclosporin A(CyA) in hematopoietic stem cell transplantation recipients is frequently observed as a major side effect. However, it is difficult to compare the frequency or severity among the reports because of differences in the method of administering CyA. In addition, there is little analysis of risk factors influencing the development of renal failure. Therefore, in this study, we tried to analyze risk factors influencing the development of renal failure induced by CyA in hematopoietic stem cell transplantation recipients at Chiba University Hospital using patient records. Among 50 patients in our study, 26 (52%) developed renal failure (grade 2 <), and serum creatinine reached maximum 32.7 days after the initiation of CyA administration on average. The mean blood CyA concentration was not correlated with the variance of serum creatinine (r = 0.12). In univariate analysis, the frequency of renal failure was significantly higher in females than that in males (P = 0.02). In addition, female and myeloablative conditioning were shown to be significant risk factors by multivariate analysis. These findings suggest that it is necessary to observe changes in clinical examination data such as BUN, uric acid, and serum creatinine more carefully because the risk of renal failure increases in patients with such risk factors.
In the present study, an anonymous questionnaire and the TePSS-31 scale for measuring pharmacists' communication skills were conducted on 76 fifth-year students in the 2011 academic year after completing either term I, II or III of practical training at hospitals and pharmacies. Most students reported high levels of overall satisfaction with both hospital- and pharmacy-based practical training and also gave high evaluations regarding improvements in their medical communication skills, observing how pharmacist instructors dealt with patients, and direct patient interaction. These findings demonstrate that effective training was achieved. The high internal consistency of the TePSS-31 was also reconfirmed, and factor analysis of the 31 scale items identified the following four skill subscales: ‘information collection and acceptance,’ “encouraging others,” ‘dealing with patients positively,’ and ‘expressive behavior.’ No difference was observed in overall TePSS-31 scores between long-term practical training at hospitals and pharmacies or for training timing, clarifying that these factors did not affect student acquisition of communication skills. Conversely, overall TePSS-31 scores were affected by direct patient interaction during hospital-based practical training and by training satisfaction levels during pharmacy-based training.