In large earthquakes such as the Hanshin-Awaji Earthquake in 1995 and the Great East Japan Earthquake in 2011, some victims did not survive due to delays in transferring them to appropriate hospitals. These unfortunate results occurred mainly because rescue teams (ambulance drivers) did not receive correct information regarding to which hospitals the victims should be sent. Moreover, in pharmacies in the affected area, patients who had been taking medicines faced the problem of obtaining medicines that they could have received in another pharmacy in/near the affected area. If pharmacists had obtained information that certain medicines were available at other pharmacies/hospitals, pharmacists could have directed patients to such pharmacies/hospitals. Also, pharmacists could have purchased medicines they needed from other pharmacies/hospitals. Therefore, organizing a network to relay information on the available items in hospitals and pharmacies is important. In this article, we propose a system by which information is relayed from a hospital/pharmacy to disaster control (city halls, fire stations, etc) by ham radio operators near the hospital/pharmacy. Ham radio operators are amateur operators of licensed personal radio stations. The measures we propose here are relatively inexpensive and easy to perform. Furthermore, this system can increase the number of survivors following natural disasters. In addition, the system would help patients and hospitals/pharmacies in many ways. Appreciation and establishment of this system should be conducted as early as possible because a large earthquake is expected to occur in the not too distant future.
Epirubicin hydrochloride, which is used in adjuvant or neoadjuvant chemotherapy of breast cancer, causes vascularrelated adverse reactions such as phlebitis, pain at the injection site, and venous irritation. Although several methods for preventing epirubicin-induced phlebitis had been attempted, the incidence of all grade phlebitis was still high (as high as approximately 50%). In this study, we evaluated a new preventive regimen of epirubicin-induced phlebitis. The major changes are as follows: 1) switch of the diluted solution of epirubicin from 100 mL of 5% glucose solution to 50 mL of physiological saline, 2) reduction of infusion time of epirubicin, and 3) addition of 200 mL of infusion solution mixed with dexamethasone 6.6 mg after drip infusion of epirubicin. The incidence of phlebitis was 20.0% in the new regimen group, while it was 50.0% in the previous regimen group (P < 0.05). Severe phlebitis was significantly reduced in the new regimen group compared with that in the previous regimen group (1.8% vs 13.5%, P < 0.05). These results suggest that the reduction in infusion time of epirubicin and the addition of infusion solution mixed with dexamethasone after the administration of epirubicin are useful for the prevention of epirubicin-induced phlebitis.
The air extruded jelly formulation (AEJF), which is filled with clean air, is a newly developed jelly formulation. As a portion of the jelly is discharged smoothly by pushing air, AEJF is easily ingested by elderly patients. In this survey, we investigated the intention and ability of taking AEJF (without an active ingredient) in elderly patients when giving dosing instruction or not and when administering different portion sizes using a questionnaire. The subjects were elderly patients who had chronic diseases and routinely took some oral medicines from ages 50 to 79. In order to evaluate the receptivity of AEJF, the subjects (n = 108) took AEJF under various conditions, eg, they took 2 g-AEJF after being instructed not to chew, took it after being instructed not to chew but eventually being allowed to take AEJF with chewing at their own judgment, or took 1 g-AEJF and 3 g-AEJF in the presence of the investigators.The ratio of expressing the intention to take it with restraint from chewing was 76.9％ for 2 g-AEJF, 81.5% for 1 g-AEJF and 42.6% for 3 g-AEJF. The major reason for the negative impression with the 3 g-AEJF was that it was too large and too long. The investigators confirmed whether the applicants were able to swallow the jellies without chewing. The result showed that 98.1%, 88.0%, and 79.2% of the applicants swallowed 1 g-, 2 g-, and 3 g-AEJF without chewing, respectively. These results suggest that AEJF containing 1 to 2 g of jelly is the optimum size of AEJF to be administered to elderly patients with the restriction of chewing.
We investigated the relationships between the renal excretion ratio (RR) and changes in drug exposure in patients with renal dysfunction (RD), to examine the usefulness of RR in determining the optimal dosage for patients with renal dysfunction. The area under the plasma concentration time curve ratios (AUC ratios: AUCRs = AUCRD/AUCNormal) of 52 out of 70 drugs was observed within 67-150% of the theoretical values calculated by the Giusti-Hayton method using the RR value. It was confirmed that the RR is useful for determining the optimal dosage of extensively renally excreted drugs for patients with RD. However, it should be noted that the AUCRs were more than 150 % of the theoretical value for some orally administrated drugs that are excreted renally but less extensively. Especially, for substrates of OATP1B1 or OATP1B3, the AUCRs of four out of five drugs were more than 150%. Substrates of metabolizing enzymes and other transporters showed less relevance in this regard.
We developed a dispensing support system for community pharmacists that uses an iPhone in conjunction with a prescription database. This system integrates three functions: verification of drug tablet dispensing, recording photographs of dispensed medicines, and displaying patients' medication records. During tablet dispensation, the system displays the number of prescribed tablets, collates the dispensed tablets with prescribed tablets through a barcode reader, and issues warnings when dispensing is incomplete. When patients call about their medicine, a pharmacist can check their medication records and view photographs of the dispensed medicines with their iPhone. We evaluated this system in terms of risk management and operation time. First, we compared the rate of incidents per types of prescription medicine between system-operated and non-system-operated dispensing; the error rates were 1.12% and 2.00%, respectively, and this difference was significant. System-operated dispensing completely prevented medication incidents related to drug names. The average waiting time for patients of system-operated and non-systemoperated dispensing were 606 seconds and 612 seconds, respectively, and this difference was not significant. Therefore, this dispensing support system for community pharmacists appears to be particularly useful for preventing dispensing errors.
To examine to what degree pharmacy students understand the essential parts of palliative care and opioids through clinical practice, we conducted a study on the level of acquisition of knowledge about palliative care and opioids in pharmacy students who had completed practical training in community pharmacies and hospitals. We conducted a questionnaire survey of 121 fifth-year pharmacy students, who completed practical training, before and after the training in community pharmacies and hospitals. The content of the questionnaire included the significance of palliative care and the appropriate use of opioids. The level of understanding showed a tendency to be higher after training for all question items regarding knowledge. This tendency was marked in the students after in-hospital training compared to those before in-hospital training. Furthermore, a student group who experienced direct contact with patients receiving palliative care showed a higher level of understanding compared to students without direct contact with those patients. The present investigation revealed that practical training in healthcare settings has beneficial effects on pharmacy students learning palliative care. In addition, it was suggested that the experience of direct contact with patients receiving palliative care further improves the level of understanding, and is markedly effective for educating students.
The basic pathology of asthma is chronic inflammation of the airway, and inhibition of this inflammation is fundamental to control the symptoms. Since inhalants cause less systemic adverse effects compared to other dosage forms, these are basically used in the long-term management of asthma. However, it is essential to learn an inhalation technique to improve adherence to inhaled steroids, requiring sufficient instruction. In this study, we investigated the influences of checking patients' inhalation techniques by both pharmacists and patients using an inhalation instruction check list employing several indices of continuous treatment using 2 types of device, Diskus and Turbuhaler. In the Diskus-using group, the frequency of gargling was significantly increased by instruction from 2.6 ± 0.3 to 3.2 ± 0.4, and the Asthma Control Test (ACT) score was also significantly increased from 22.4 ± 3.2 to 23.4 ± 1.7. In the Turbuhaler-using group, the frequency of gargling was significantly increased from 2.0 ± 0.3 to 3.9 ± 0.4. Periodic instruction by pharmacists using the inhalation instruction check list improved items concerning proper use in the Diskus-using group, and the frequency of gargling after inhalation, ACT score, and self-evaluation score of inhalation control also significantly increased. The items concerning proper use were also improved in the Turbuhaler-using group, and the frequency of gargling after inhalation significantly increased.