The purpose of this before-after study was to examine the psychometric properties of the Japanese version of the Decisional Conflict Scale (DCS) and to analyze the impact of pharmacist counseling on decisional conflict for patients infected with the human immunodeficiency virus (HIV). Internal consistency reliability was calculated. Multi-trait scaling and cluster analyses were performed to measure construct validity. In addition, decisional conflict in the patients infected with HIV was assessed before and after they received information from pharmacists. Data collected from 69 patients who were recommended a new anti-retroviral therapy were analyzed. A high degree of internal consistency was observed for the five subscales of the DCS (Cronbach's alpha = 0.78 - 0.90). Multi-trait scaling and cluster analyses indicated good construct validity. After the pharmacist counseling, the mean total DCS score decreased significantly (ie, from 46.3 to 26.5, P < 0.0001, paired t-test). Scores on all subscales of the DCS showed statistically significant improvement (Ps < 0.0001, paired t-test). This paper concludes that the Japanese version of the DCS is psychometrically sound for patients infected with HIV. Before initiating anti-retroviral therapy, these patients have high decisional conflict, which can be improved by pharmacist counseling.
We gradually introduced exposure control countermeasures for anticancer drugs from 2008 to 2013. Their utility was evaluated for cyclophosphamide (CP) and 5-fluorouracil (5-FU) detected by a wipe test. The countermeasures included use of a closed system (CS) from preparation to administration, vial-washing just after delivery, infuser pump preparation using CS, and preparation with priming using infusion. Continuous study of CP and 5-FU by wipe tests was performed in a preparation room in the pharmacy and chemotherapy center. In the preparation room, CP was detected in the range of ND-0.15, apart from 1.54 ng/cm2 in 11/2008. 5-FU was gradually reduced to ND-0.81 (1/2012), ND-1.54 (3/2012), and ND-0.06 (3/2013) ng/cm2. In the chemotherapy center, CP was detected in the range of ND-0.06 ng/cm2, apart from a high level (0.74 ng/cm2) in 3/2012. 5-FU was detected at a high level (26.53-61.22 ng/cm2) in 1-3/2012; however, it decreased to ND-2.65 ng/cm2 in 3/2012-12/2012. It was shown that CS and vial-washing are useful to reduce occupational exposure to anticancer drugs during pharmacy preparation. The results that 5-FU was detected when CP was not showed that use of only CP alone as an exposure marker is insufficient. It was considered that reduction of 5-FU exposure resulted from infuser pump preparation using CS. Furthermore, the preparation procedure with priming using infusion and CS use for administration reduced chemotherapy center exposure. The preparation of a secure work environment for healthcare workers is necessary to maintain high motivation for patient support.
Contamination of the external surfaces of drug vials with antineoplastic drugs has been reported in some countries. However, this has rarely been reported in Japan. The aim of this study was to investigate the external contamination level of doxorubicin vials in Japan. The external surfaces of 57 vials of six products containing doxorubicin were wiped with a non-woven fabric, and the contamination levels of doxorubicin were analysed by high-performance liquid chromatography combined with fluorescence detection; doxorubicin was confirmed by high performance liquid chromatography combined with quadrupole time-of-flight mass spectrometry. The surfaces of 28 of 57 vials were contaminated with doxorubicin. The maximum contamination level was 12.3 ng per vial. The external surfaces of some doxorubicin product vials produced by Japanese pharmaceutical companies were contaminated with doxorubicin.
We conducted a questionnaire survey in the 388 Cancer Medicine Cooperation Base Hospitals to evaluate the contribution of board certified oncology pharmacists or senior pharmacists and current state of pharmacists' involvement in cancer chemotherapy. The response rate of the questionnaire was 70.6% (274/388). From the results of the questionnaire, 85% (233/274) of hospitals had board certified oncology pharmacists, such as Board Certified Pharmacist in Oncology Pharmacy, JSPHCS-certified Oncology Pharmacist, or JSPHCS-certified Senior Oncology Pharmacist. There was no statistical significance in the chemotherapy regimen of intravenous injection check rates between hospitals that had the board certified oncology pharmacists and hospitals that did not have the certified pharmacists. However, the percentage of facilities in which pharmacists checked oral chemotherapy regimens was higher in hospitals that had board certified oncology pharmacists compared to hospitals that did not have certified pharmacists both in hospitals' prescriptions (60.1% vs 31.7%, P < 0.05) and out of hospitals' prescriptions (12.4% vs 2.4%, P = 0.058). The percentage of facilities that answered they currently had sufficient interventions was higher in hospitals that had board certified oncology pharmacists than in hospitals that did not have them (60.5% vs 36.6%, P < 0.05). The results revealed that those board certified pharmacists could enhance pharmacists' interventions to pursue safe cancer chemotherapy.
To clarify consumer views and needs on Rx-to-OTC switches, our survey was conducted with 200 consumers at a gym in Tokyo, Japan. Among the respondents, the degree of recognition of Rx-to-OTC switches was 56.5%. A total of 74% of the respondents replied that they wanted to use Rx-to-OTC switches when they had been slightly ill and/or injured. The ratio of replies that “I want to use Rx-to-OTC switches” was significantly high in the group who were familiar with Rx-to-OTC switches than the group who were not. To familiarize the public with Rx-to-OTC switches, it has been suggested that education activities will be necessary to raise the public's recognition of Rx-to-OTC switches. A total of 32 and 25.3% percent of men hoped that the drugs that they took for hyperlipidemia and hyperpiesia would be switched from prescription drugs to OTC types. The price of the Rx-to-OTC switches the respondents were hoping for was approximately 65% of the fee they pay for a prescription drug to be filled at a pharmacy. The main reason prescription drugs are not switched to OTC types is safety. Therefore, to satisfy the needs of 74.0% of the respondents who replied that they wanted to use Rx-to-OTC switches, the establishment of a support system to secure the safety and improve the knowledge of pharmacists and registered salesclerks is required.
There is a lack of opportunities in Japan to engage in communication skills education about effective interactions between pharmacists and medical staff. This is despite the fact that current pharmacy education programs should be producing clinical experts in this area. Because of this, we delivered an educational program relating to building communication skills when working in a multidisciplinary team; 29 pharmacy students took part between May and November 2011. The program was based on two components: a lecture about communication skills by a facilitator (including “active listening”, “assertiveness” and “conflict management”), and a small group discussion (SGD) relating to decisions about opioid increases/rotation using a cancer pain case as an alternative opioid treatment. After the students finished the SGD, we distributed questionnaires to them and assessed outcomes using a five-grade Likert scale. As a result of the questionnaires, their mean understanding about opioid increasing and opioid rotation were 4.59 ± 0.68 and 4.48 ± 0.69, respectively. The mean implementation score of communication skills relating to “assertiveness” was 3.62 ± 0.94, which was significantly worse when compared with that of “active listening” (4.31 ± 0.60, P = 0.003). In addition, the mean satisfaction levels of the SGD group work and the overall educational program were 4.31 ± 0.81 and 4.38 ± 0.62, respectively. Care is required when interpreting the results given the study was limited to a single institution. However, these results suggest that this type of program may be useful for supporting pharmacy students to learn about communication skills. Improved skills should result in more effective communication, when pharmacists interact with medical staff.
In this study, a questionnaire survey was conducted among pharmacists to determine the actual dispensing conditions of anti-cancer drugs and problems associated with dispensing drugs, especially after the drugs are taken out of individual packaging. Responses were obtained from 163 pharmacists who had experience in handling oral anticancer drugs. Of these, 76 answered that they had filled oral anti-cancer drug prescriptions, which involved single dose packaging, pulverization of the drug, capsule opening, or preparation of a simple suspension. A total of 107 specific cases involving 26 oral anti-cancer drugs were collected. The drugs were dispensed in accordance with prescriptions in 85 cases (the percentage of prescription questions asked in these cases was 13%) and not in accordance with prescriptions in 16 cases (69%), a prescription was canceled in one case (100%), and details were unknown in 5 cases. Matters noted by the respondents included being careful not to cross-contaminate drugs with other drugs and not to expose dispensers to powdered anti-cancer drugs, which are characteristically easily scattered. The respondents also requested the development of new formulations that do not need special preparation, are easy to dispense and are easy to take for the patients. In conclusion, the following is needed for pharmacists to dispense oral anti-cancer drugs safely and properly: 1) an environment that allows pharmacists to ask physicians about their prescriptions and to cooperate with health professionals by sharing information about anti-cancer regimens; and 2) improvement of the procedures and environment for dispensing such drugs.