Continual long-term use of inhaled corticosteroids is crucial for asthma treatment, and poor medication adherence can lead to the exacerbation of asthma. However, medication adherence is difficult to secure in patients with chronic diseases such as asthma. To identify the factors influencing medication adherence in patients with asthma, we analyzed the relationship between the different factors evaluated during counseling and medication adherence. We found a significant positive correlation between medication adherence and inhalation technique, medication insight, and illness insight. No correlation was observed between medication adherence and the state of asthma control. These results suggest that patients who use an incorrect inhalation technique or have an insufficient understanding about the medication and pathology of asthma have poor medication adherence. Even though the patients' asthma was well-controlled, their adherence was poor, indicating that self-judgment by patients with asthma results in not only a decreased frequency, but also discontinuation of inhalation treatment. In conclusion, it is necessary to identify patients with poor adherence by regularly counseling patients with asthma, regardless of the state of asthma control; furthermore, the inhalation technique, medication insight, and illness insight should be reconfirmed in order to improve medication adherence in these patients.
Caffeine, a major component of coffee, exhibits pharmacological actions on the cardiovascular system. In the present study, we examined the acute effects of caffeine on blood pressure (BP) and heart rate (HR) and the influence of habitual coffee intake on cardiovascular responses to caffeine. In this double-blind, placebo-controlled study, 136 young normotensive Japanese subjects were randomized. The subjects were first divided into 84 non-habitual and 52 habitual coffee consumers and further subdivided into placebo and caffeine groups; in the placebo group they had a cup of decaffeinated coffee, whereas in the caffeine group they had a cup of caffeinated coffee. In non-habitual coffee consumers, the systolic and diastolic BP at 30, 60, and 90 min after coffee intake were significantly higher in the caffeine group than in the placebo group. However, the pressor effect of caffeine disappeared in habitual coffee consumers. The changes in HR after coffee intake were similar between the placebo and the caffeine groups in both consumers of coffee. These results suggest that a single cup of caffeinated coffee is capable of increasing BP, and that the acute pressor effect of caffeine is diminished by habitual coffee consumption.
To evaluate the usefulness of an injector designed for semi-solid enteral formula, in comparison with a catheter tip syringe. The subjects of this study were 20 health elderly adults and 20 medical professionals. The study was made in a crossover design for the time of the whole process for mock administration of semi-solid enteral formula and the associated survey. It contained ten questions about user-friendliness and hygiene afterwards. The time of the whole process for the injector designed for semi-solid enteral formula is significantly shorter than that of the catheter tip syringe (558.2 ± 54.4 vs 1231.5 ± 149.6 seconds among healthy elderly adults, and 406.6 ± 44.6 vs 854.8 ± 92.1 seconds among medical professionals). In the survey, the medical professionals group evaluated that the injector was better than the catheter tip syringe in response to all questions, except for one question, and the healthy elderly adults evaluated that the injector was better than the normal syringe in response to all questions. The results of the study show that the injector designed for semi-solid enteral formula is more useful than the catheter tip syringe.
In collaboration with orthopedic surgeons, we have developed and introduced a protocol for pharmacists with the aim of providing support for the prescription of analgesics used for pain associated with orthopedic areas. The prescription support mainly involves changes in the dose and administration of continually administered analgesics. This includes increasing, reducing, or discontinuing doses, as determined by the ward pharmacist in charge on the basis of the severity of the patient's pain. In the six-month period following the introduction of this protocol, 164 prescription entries (140 for oral drugs, 24 for external drugs) were made by pharmacists. For both oral and external drugs, the drugs prescribed were those having a high frequency of prescription at the hospital. Of the prescription entries for oral drugs, 94 were made for continued prescriptions. In addition, 18 were made for changes to prescriptions as needed and deletion, and 10 were for dose reduction. No adverse events were observed. All physicians who participated in the trial rated the protocol highly, and to justify their rating, many described the protocol as a procedure that “reduced the operational load for physicians.” Many physicians requested expansion of the scope of this protocol, and all physicians stated, “I wish this protocol was introduced for other drugs.” Although the protocol was found to be highly beneficial, it is important to discuss physicians' responsibilities in cases of adverse events.
Warfarin is the most widely used oral anticoagulant for the prevention of thrombotic events and for the treatment of a confirmed episode of venous thrombosis. However, it has a narrow therapeutic range and there is large inter-individual variation in dose requirements. In particular, the anticipated side effects of warfarin could lead to serious problems. Therefore, warfarin is expected to be prescribed in response to the individual before drug administration. Recently, this variability has been accounted for by several single nucleotide polymorphisms (SNPs), including CYP2C9*3 and vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A. We established a new direct TaqMan PCR genotyping assay of the most common allelic variants of CYP2C9 and VKORC1 using saliva samples that are put on water-soluble paper without DNA extraction. A total of 186 healthy Japanese subjects participated in each genotype determination of the allele frequencies of CYP2C9 and VKORC1 by the TaqMan PCR and the duplex PCR-RFLP methods. Both methods yielded identical results. Therefore, our newly developed direct TaqMan PCR method has been shown to have sufficient accuracy. Furthermore, this method could reduce both the time and effort involved, as well as considerably reduce the risk of contamination, since the DNA extraction step is eliminated. We expect that this simple genotyping method will be useful in achieving personalized medication in the near future.
While mogamulizumab is a promising treatment for adult T-cell leukemia-lymphoma (ATLL), premedication must be administered to combat the infusion reactions (IR) that frequently develop. However, the actual standard premedication is insufficient to prevent IR. We therefore performed a retrospective case series to evaluate the modified premedication regimen suggested by our medical team for the prevention of IR with mogamulizumab therapy. Despite standard premedication with hydrocortisone succinate, d-chlorpheniramine maleate, and acetaminophen, our first patient who had acute-type ATLL and received the first administration of mogamulizumab as fourth-line chemotherapy developed severe IR. We stopped the infusion and immediately administered methylprednisolone (125 mg, intravenous injection [iv]), oxygen inhalation, nitroglycerin (5 mg/h, intravenous drip infusion [div]), and loxoprofen (60 mg, per os [po]), which ameliorated IR after an hour. We administered a second dose of mogamulizumab to the patient after formulating a modified premedication regimen of dexamethasone (9.9 mg, iv), d-chlorpheniramine maleate (5 mg, iv), loxoprofen (60 mg, po), and a 12-h infusion of mogamulizumab. As a result, no IR occurred, and the patient received a total of seven infusions of mogamulizumab without any subsequent IR. We then administered this modified regimen to another seven patients from the initial cycle respectively, one of whom developed IR. This frequency of one in seven was lower than that noted in previous reports, suggesting that this modified premedication regimen was useful in preventing mogamulizumab-associated IR.
Several guidelines recommend that antimicrobial prophylaxis in surgery should be administered for a duration of less than 48 hours. However, in our facility oral antimicrobial prophylaxes were used after intravenous agents for orthopedic surgery and the duration of the administration was over 48 hours. Consequently, an orthopedic ward pharmacist recommended discontinuing oral antimicrobial agents. To support this intervention, we conducted a retrospective cohort study on patients who received total hip arthroplasty, total knee arthroplasty or micro fenestration to evaluate changes in the rate of surgical site infection (SSI) and the effects on medical expenses. A total of 344 patients were enrolled as group one (before the intervention) and 343 patients as group two (after the intervention). Of these, 98 and 114 patients from each group respectively were analyzed. One patient (1.02%) was diagnosed with SSI in group one, and one patient (0.88%) was diagnosed with SSI in group two. The incidence of infection in the latter group was not inferior to that of the former group (difference －0.14%; 95% confidence interval-2.33 to 2.05%; P < 0.05). The rate of the administration of oral antimicrobial agents changed from 65.3% (64/98) to 2.6% (3/114) and was significantly lower in the latter group (P < 0.001). Furthermore, medical expenses were reduced from 134,401 yen to 12,046 yen. In conclusion, it is not recommended to administer prophylaxes for long periods, and the ward pharmacist contributed to appropriate administration of antimicrobial prophylaxis. This study reconfirmed the importance of having pharmacists in wards.