We investigated the relation between the pH value of an infusion solution and the decrease of liquid level in a drip chamber in an infusion set. In the study, an infusion solution (not TPN solution) was admixed with sodium bicarbonate solution (Meylon^® Injection) and dripped into an infusion set. It was found that the liquid level in the drip chamber was decreased sharply when the pH value of the infusion solution became smaller than 7. Furthermore, with regard to infusion solutions that showed a large decrease of liquid level, the concentration of CO₂ in the drip chamber at the start of drip infusion was approximately 2 v/v% in the conventional procedure where no preventive measures were attempted for such decrease, while its concentration was as high as 15 v/v% when preventive measures were attempted for such decrease. As compared with the conventional procedure, there was no difference in the CO₂ concentration at 2 hours of drip infusion. These results indicate that the effect of prevention of decreasing the liquid level in the drip chamber was confirmed by changes in the CO₂ concentrations in a drip chamber. The concentration of H₂CO₃ involved in the decrease of liquid level in the drip chamber was approximately 10% of the total concentration of H₂CO₃, which was confirmed by measuring H₂CO₃ concentrations at the end of an infusion set when the infusion solution admixed with Meylon Injection, which showed the largest decrease of liquid level in the drip chamber, was dripped into an infusion set.

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In some cases, higher-level functional capacity (instrumental activities of daily living: instrumental ADL) is reduced prior to the decline in ADL functioning in elderly people. The rate of poor self-administration of medication is generally considered to be associated with a decline in ADL and cognitive impairment associated with aging in elderly patients. However, the relationships between patient satisfaction of self-applying transdermal delivery systems of anti inflammatory analgesic drugs (patches) and instrumental ADL in elderly patients are not clear.
In this study, we investigated the relationship between patient satisfaction regarding self-application of patches (satisfaction) and instrumental ADL in elderly patients aged 65 years and over, who independently live at their home (Barthel Index ≥ 60).
We analyzed data from 50 patients (14 males, 36 females; aged 65 - 95 years, with an average age of 77.7 ± 7.3 years) who used a self-administered patch. We conducted a survey on the satisfaction levels with a self-administered questionnaire that used a five-point Likert scale. We used the Barthel Index to measure their ADL, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence to measure instrumental ADL. Relationships between overall satisfaction levels and TMIG scores were determined using the Spearman rank correlation, performed using the SPSS Statistics 20.0, at a significance threshold of 5%.
The average Barthel Index score was 93.8 ± 1.0, and the average TMIG score was 11.1 ± 3.0. Additionally, the average overall satisfaction level was 4.3 ± 1.0. Finally, significant positive correlations were observed between overall satisfaction levels and TMIG scores (r = 0.473, P < 0.001).

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To provide safe outpatient chemotherapy, collaboration between community and hospital pharmacists is essential. However, through the lack of exchanging patient's information including regimen, insufficiency of the support provided to outpatient chemotherapy patients by community pharmacists was concern. Therefore, we developed a seminar with physicians, nurses, pharmacists working in our hospital and community pharmacists. Based on the results of the discussion of the seminar, we distributed chemotherapy labels and regimen worksheets to provide information for community pharmacists. We conducted a survey to clarify the efficacy of chemotherapy labels and regimen worksheets by collecting data from pharmaceutical management records of community pharmacies between January 2014 and August 2014. Fifty-five patients' pharmaceutical management records were assessed. Understanding about the presence or absence of chemotherapy administration before and after the distribution of chemotherapy labels was 58.2% and 100%, respectively. Before the distribution of chemotherapy labels, there was no understanding about the chemotherapy regimen and use of the regimen worksheet, but after the distribution of chemotherapy labels, they were 100% and 92.7%, respectively. Furthermore, the rates of patient instructions on the side effects of chemotherapy before and after the distribution of chemotherapy labels were 27.3% and 54.5%, respectively. All these differences were significant. After the distribution of chemotherapy labels, the number of patient instructions on the side effects of chemotherapy increased and the contents were more specific and effective. These results suggest that the use of chemotherapy labels and regimen worksheets are highly effective to provide information for community pharmacists and improve the support provided to outpatient chemotherapy patients by community pharmacies.

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The aim of this study was to evaluate the effects of stopping prophylactic oral antibiotic administration after cataract surgery. We retrospectively analyzed 205 eyes that underwent cataract surgery from May 2012 to November 2012 at the Tokyo Teishin Hospital. A clinical pathway involving phacoemulsification cataract surgery was followed in all cases. Until July 2012, this clinical pathway included administration of cefdinir capsules as a prophylactic oral antibiotic for 4 days after surgery; thereafter, administration of these antibiotics was stopped. One hundred and two patients received cefdinir capsules and 103 patients did not receive them. The backgrounds of patients in both these groups were almost the same and their clinical pathways remained unchanged except for the discontinuation of oral antibiotic administration. None of the cases showed any postoperative endophthalmitis. Even after the cessation of cefdinir administration, no increase in the incidence of the endophthalmitis was observed. Moreover, medical expenses and adverse events involving the digestive system were reduced. Therefore, our findings suggest that the administration of prophylactic oral antibiotics is not necessary in the clinical pathway for cataract surgery.

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It is difficult to lower blood pressure to target levels recommended in the guidelines using antihypertensive monotherapy. Therefore combination therapy of several antihypertensive drugs is used at present for increased efficacy. Combination therapy may offset the adverse effects of drugs in some instances. However, the exact outcome of combination therapy is not clear. In this study, using the Japanese Adverse Drug Event Report database (JADER), we calculated the proportional reporting ratio (PRR), one of the safety signals of hypokalemia, hyperkalemia, hyponatremia and hypernatremia, to determine the effects of thiazide diuretic (TD) on blood potassium and blood sodium levels when used in combination therapy with an angiotensin receptor blocker (ARB).
The results suggested that the onset of hypokalemia by TD was not often offset by an increase in blood potassium levels induced by ARB. Although combination therapy with TD and ARB may decrease the risk of hypokalemia compared to use of ARB alone, it results in hyperkalemia. In addition, an increased risk of hyponatremia was suggested. While using a fixed-dose combination therapy, it is necessary to note that both drugs could increase the risk of the adverse events mentioned in this study.

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Opioid analgesics such as morphine and fentanyl have been widely used for the treatment of cancer pain. The PK/PD for these opioids was mainly estimated in intraoperative plasma concentration and putative effect-site concentration by multi-compartment models including effect-site compartment. However, the PK/PD for the widely used opioid oxycodone has rarely been estimated. Leow et al measured both the plasma concentration of oxycodone and VAS after intravenous administration in cancer patient. Here, based on their report, we simulated the PK/PD for oxycodone and compared it with those for morphine and fentanyl.
After 5 min intravenous injection of opioid, the t_max of oxycodone was 14 min. With regard to the t_max of those opioids, morphine was 112 min, morphine-6-gluclonized metabolite was 352 min, and fentanyl was 2 min. Under the same conditions, time above 50% maximum concentration of the putative effect site concentration was 60 min in oxycodone. Regarding those of other opioids, morphine was 441 min, morphine-6-gluclonized metabolite was 997 min, and fentanyl was 22 min. As a result, after intravenous administration of a single dose of opioids, the rank order of pain relief duration time length was the following: morphine > oxycodone > fentanyl and that of pain relief onset time rapidity was the following: fentanyl > oxycodone > morphine. These simulations were thought to be useful information for planning how much opioid analgesic should be intravenously administered.

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There has been an increase in the necessity of home healthcare, and it has become increasingly important to provide home healthcare for patients living in the community. We have been exerting efforts to improve practice implemented by pharmacists to provide higher-quality home healthcare. The present paper introduces two clinical cases in which the quality of life (QOL) of terminal cancer patients was improved in order to discuss systems for comprehensive home healthcare. Case 1 was a woman in her 70s diagnosed with adenocarcinoma of the uterine cervix. Her symptoms of pain and restlessness worsened in stages. Multidisciplinary care was provided, including prompt opioid switching and drug administration, and the symptoms improved. The family of the patient also evaluated the treatment positively at the completion of home healthcare. Case 2 was a woman in her 50s diagnosed with stomach cancer. The patient had continuing intractable nausea. A pharmacist advised her to take drugs and monitored the adverse effects, and the symptoms improved. On Day 179 of home care, the patient died at home, the place chosen by both the patient and her family, after receiving appropriate and continuing care for sedation provided by a multidisciplinary team. A system established in accordance with the “functions required for pharmacies and their desired form” will be able to respond to a variety of home healthcare needs, and provide care services that will be positively evaluated by patients, their families, and other healthcare professionals.

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The merit of outpatient chemotherapy is that patients can continue their daily life in their house and at their job, while the demerit is that patients sometimes experience severe adverse effect because they cannot prevent and treat adverse effects in their house. Therefore, investigated the impact of outpatient chemotherapy-related adverse effects on patient's daily life and work productivity. Subjects were 48 breast cancer patients receiving first outpatient chemotherapy in Gifu Municipal Hospital between December 2012 and November 2013. We performed a questionnaire survey on quality of life (EQ-5D and QOL-ACD), adverse effects and time loss before the 1st and the 2nd course. No significant decrease in EQ-5D utility was observed, but a significant decrease in QOL-ACD score was observed. The average hour when an adverse effect influenced patient's daily life was 3.63 hours/day, and the average work productivity was 2,359 yen/day. The work productivity in the patients who answered “I suppose that I could have prevented this adverse effect if I had taken the drugs as the doctor directed.” were 1,545 yen/day in malaise and tiredness and 534 yen/day in nausea and vomiting. Regarding “I suppose that I could have prevented this adverse effect if I had been more careful in my daily life.”, the work productivity were 1,883 yen/day and 1,827 yen/day, respectively. The results suggest that the loss of work productivity caused by adverse effects would decrease if pharmacists instruct patients and improve their adherence, then prevent the adverse effects.

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