We conducted a survey on veterinarians regarding the use of anticancer drugs in veterinary medicine and instructions to owners. Two-hundred veterinary hospitals were randomly selected from 438 hospitals, in Yokohama and Kawasaki City, Kanagawa, using a questionnaire, by visit distribution, and by mail recovery. The recovery rate was 62.5% (n = 125). In total, 103 veterinarians (82.4%) had anticancer drug use experience, 99 (96.1%) had injectable drug administration experience, and 81 (78.6%) had oral administration experience. In total, 97.0% of veterinarians used cyclophosphamide and vincristine, 90.9% used doxorubicin. As a precaution for oral drug administration and excrement disposal of anticancer drugs after administration, approximately 50% of veterinarians instructed the owners to “wash your hands well” and “wear gloves.” With regard to injections (n = 99), 86.7% of veterinarians answered it was under an “open environment,” 8.1% used “Luer Lock” syringe, and 67.7% prepared the vial product with “negative pressure.” With regard to protective equipment used during preparations, “single latex gloves,” “mask” was more than 50% respectively. With regard to the first learning experience about anticancer drugs, 24.8% learned when they were in university and, 70.4% learned after graduation. With regard to experience after graduation, 53.4% answered that they “took a workshop” ; the “Veterinary System Society” was the main workshop organizer and the “veterinarian” was the main instructor. In total, 66.9% wished to attend a workshop on anticancer drugs. Considering the results of this study, human medicine and veterinary medicine need coordination, and it is important to provide training and education.
Effective use of a dry powder inhaler (DPI) requires an optimal inhalation flow pattern. However, practical devices for providing instructions on flow pattern are currently unavailable. We recorded inhalation flow patterns through DPI's in 9 asthmatics (6 concurrently using Diskus, and 3 using a pMDI, -pressurized metered dose inhaler) using a new flow pattern visualizer (Visual Trainer) that displays time related changes in inspiratory flow. Data acquisition and recording from a single DPI took 10 s, permitting ordinary clinical practice. Flows were classified into the following three patterns: an initial steep rise reaching a peak inhalation flow (PIFR) at < 0.6 s, followed by a gradual decrease with total inhalation time > 1.0 s / an initial steep rise with inhalation time < 1.0 s / an initial slow rise reaching PIFR at > 0.6 s with total inhalation time > 1.0 s. Inhalation patterns for Diskus and Turbuhaler use were evenly distributed among the three classifications. The PIFRs from Diskus tended to be higher than those from Turbuhaler in the same subjects. PIFRs using Diskus exceeded 60 L/min in all subjects, while 3 of 9 failed to reach this level using Turbuhaler. When inhaling from either DPI, PIFR appeared at > 0.6 s in 4 of 9 subjects. Inhaled volumes from Diskus were < 1 L in 3 of 9 subjects, and in 5 with Turbuhaler use. Both Diskus and pMDI users were included in the insufficient group. In conclusion, patients using DPIs regularly do not always inhale with adequate flow patterns. The Visual Trainer may be a useful adjunct in the outpatient setting.
The pH, osmolality, surface tension, and viscosity were measured in Timoptol® 0.25% and 0.5% w/v ophthalmic solutions containing timolol maleate, its 7 generic drugs, and Timoptol® XE and Rysmon® TG, which have the same composition and pharmacological effect but are administered by different methods, and their pharmaceutical properties were compared. The force required to deliver a single drop from various ophthalmic solution bottles (the squeeze force) was measured and usability was evaluated on a 6-point scale. The results obtained showed that the pH values of the medicines tested in this study ranged from pH 6.7 to pH 7.5. The osmotic pressure ratios of the various ophthalmic solutions were between 1.0 and 1.5. The surface tensions of the various ophthalmic solutions were between 41 and 71 dynes/cm at 25℃. The viscosities of Timoptol® XE and Rysmon® TG were higher than those of the other preparations. These results may have been due to different additives being contained at different proportions. The force required to deliver a single drop of Timoleate®PF was the highest. In addition, usability, which was evaluated using a 6-point scale in the present study, strongly correlated with the force required to deliver a single drop. Timoleate® PF may be less comfortable to use, but has the benefit of being “preservative-free.” These results suggest that generic drugs need to be selected that are not only cost-effective, but also match the individual requests of patients, for example, a good feeling without causing pain in the eyes when applied, the good usability of the bottle, or safety when applied for a long period.
Low-dose aspirin inhibits cyclooxygenase-1 (COX-1) on platelets irreversibly, suppressing platelet aggregation.Nonsteroidal anti-inflammatory drugs (NSAIDs) also inhibit COX-1 reversibly by forming a salt bridge. However, there is little information on the antiplatelet effects of the chronic use of NSAIDs (other than aspirin). We performed pharmacokinetics/pharmacodynamics (PK/PD) analysis using in vitro experimental data obtained when NSAIDs were added to human blank blood, and estimated the antiplatelet effects of continuous NSAID administration. Ibuprofen, diclofenac, indomethacin and loxoprofen were studied in a one-compartment model, and etodolac was studied in a two-compartment model. Platelet aggregation was measured after adding NSAIDs to platelet-rich plasma at a range of concentrations containing the maximum plasma concentrations of one clinical dose. We calculated the platelet-aggregation threshold index (PATI) as an index of aggregation activity, which was defined as the putative stimulus concentration giving 50% aggregation, and performed PD analysis according to the sigmoidal Emax model. Simulated time-PATI curves of NSAIDs were compared to that of low-dose aspirin. Simulated values of increase in PATI for the maximum plasma concentration of each NSAID were lower than 3.9 µg/mL, which is the same as that of low-dose aspirin. Increases in PATI around the trough concentration were nearly zero for all NSAIDs except ibuprofen, thus suggesting that the antiplatelet effects of continuous NSAID administration are weaker and less persistent than those of low-dose aspirin. The simulation results indicate that continuous NSAID administration is less effective at preventing thrombosis and embolism than low-dose aspirin, and postoperative NSAID treatment needs to be careful of the occurrence of bleeding.
Although pharmacists explain the use of inhalation therapy to patients with chronic obstructive pulmonary disease (COPD), few reports have examined the effectiveness of treatment and adherence levels. The present study investigated the impact of confirmed inhalant use, and explanation of medication use by the pharmacist, on the effectiveness of drugs and the level of understanding of drug usage in patients with COPD. For the five patients included, pre-intervention was defined as the time of signing the informed consent form, and post-intervention was defined as the time of the next consultation at approximately 35 days. The following items were compared pre- and post-intervention: lung function and symptomatic evaluation, and a questionnaire to determine the patient's level of understanding of the disease and medication. Furthermore, each patient demonstrated use of the inhalant to confirm that drugs were administered correctly. Because COPD is an inflammatory disorder, which is characterized by high levels of C-reactive protein (CRP), the effect of inhalation therapy on blood levels of high sensitivity CRP (hsCRP) and the inflammatory cytokine interleukin-6 (IL-6) was measured. After pharmacist intervention, use of COPD therapy was enhanced, and patients had a better understanding of drug usage. Vital capacity and forced vital capacity were significantly increased, while HsCRP and IL-6 levels were significantly decreased. Pharmacist intervention to optimize drug usage was associated with better lung function in patients with COPD. The involvement of the pharmacist/pharmacist intervention is considered to be highly important for optimal treatment use, and, consequently, the quality of life of patients.
For pharmacists, the environment has changed greatly. In “A study to investigate and evaluate the effectiveness of team medical care and community healthcare, in which pharmacists play a key role,” a new standard for promoting home-care was formulated and published on the Japanese Society of Pharmaceutical Health Care and Sciences homepage in January 2014. This document provides community pharmacies with a set of guidelines that define the recommended functions and structure that community pharmacies should aim to achieve. In the present study, we surveyed the chief pharmacists of community pharmacies to find out how well they were able to meet the new standards and what changes would be necessary to achieve these standards and evaluate the results. The survey response rate was 60.0% (300/500). While many pharmacies have established the necessary basic systems, only 23.7% have installed aseptic preparation equipment. Procedures for medication and pharmacology management in community pharmacies varied widely; the levels of readiness for dispensing a single prescription in multiple portions (because of, for example, too long an administration period), homecare medicine, and the promotion of generic medicines was low, with only 50% or fewer of the pharmacies meeting the required standard. It is important that all community pharmacies take a positive approach to achieving the new standard of work.
The role of pharmacists in the US that have advanced functions compared to the traditional pharmacists is based on the collaborative drug therapy management (CDTM). Recently in Japan, the importance of enhancing the team approach whose concept is to make the best use of the each health providers' expertise has been discussed in the health care society. As regards pharmacists, pharmacists' pivotal role in medication therapy management is in great demand in the discussion. On the other hand, pharmacists are more exposed to a litigation risk as pharmacists sometimes are sued for their medical negligence these days. In this manuscript, we conducted a literature and case review for pharmacist responsibility conducting the CDTM in the US. However, we could not find reports and cases, though a litigation risk for pharmacists has been enhanced with the pharmacist role expanding in the CDTM. Furthermore, we conducted a literature and case review for nurse practitioner (NP) as well. As a result, in some cases, NP's negligence was judged independently by the action of NP was whether appropriate or not with no consideration for physician's supervise, and the supervising or collaborating physician's negligence was judged according to the physician's action in the consultation is appropriate or not. As the number of litigation for NP increased, nurse societies raised so many opinions on how to judge appropriately such as which the standard of care (SOC) for physicians or for NPs was applicable and as whether a physician might have an expert witness qualification.
A quantitative evaluation method has not yet been established for pharmacy students in relation to learning achievements and their hospital-based practical training. We therefore developed an outpatient chemotherapy educational program to address this issue. To assess the learning achievements quantitatively, we carried out four examinations - twice at the halfway point (first) and at the program's term-end (second); a perfect score was 100. This study was conducted between May and November 2013 and 24 pharmacy students participated. The results showed that the first and second mean scores relating to their cytotoxic agent handling knowledge were 91.5 ± 5.2 and 99.1 ± 1.8, respectively. The first and second mean scores relating to preparation skills for vials (how to handle anticancer drugs) were 68.5 ± 13.1 and 78.9 ± 18.5, respectively. For their preparation skills (using closed systems to handle anticancer drugs) the mean scores were 85.2 ± 13.1 (first) and 97.0 ± 3.7 (second). The first and second mean scores about the processes involved in solving chemotherapy-related patient problems were 52.1 ± 23.7 and 77.8 ± 21.9, respectively. All of the scores were significantly increased at the end of the program compared with scores halfway through. These results suggest that our program may be useful for supporting pharmacy students to learn more effectively during their hospital-based practical training in Japan.