We verified the effect of a simplified washing procedure on the decontamination of antineoplastic drugs on vial surfaces.

The vials of Vitamedin^® were intentionally contaminated with 20 μL of 5-FU (1000 μg/20 μL)，cisplatin (10 μg/20 μL) or paclitaxel (120 μg/20 μL). The vials were soaked in tap water, sodium hypochlorite (NaClO) or ozone water and washed with running tap water or ozone water.

The decontamination rates were 5-FU (95.9-97.0％) > cisplatin (92.7-96.9％) > paclitaxel (68.9-71.3％) in all conditions. Washed by running tap water, it was found viscous 5-FU and cisplatin, which are water-soluble, were decontaminated largely with no significant difference. The decontamination rate of paclitaxel was lower than 5-FU or cisplatin. There were no differences in decontamination effects among the washing conditions. This may be due to the conditions that the amount of intentionally contaminated drugs was large and that the antineoplastic drugs penetrated the paper label. It was revealed the effect of the simplified washing procedure using tap water on decontamination was greater in 5-FU or cisplatin than paclitaxel. From the viewpoint of the amount of anticancer drug decontamination, it is suggested that low level contamination as detected from the vial surface of an anticancer drug can be removed by a simple washing method. Whereas, if the contamination removal rate by the simple washing method is constant, it is impossible to decontaminate by washing only once, and it should be necessary to perform multiple times and/or combined with physical removal to decontaminate completely.

Although the minimum effective dose of the once-a-day fentanyl citrate transdermal patch (tape) used for cancer pain is 1 mg, this may be excessive depending on the patient's condition. The dosage may be lowered using film dressing because the tape cannot be cut and patched; however, the feasibility of dose adjustment using this method is not confirmed. The tape was covered with OPSITE^＊ FLEXIFIX (OP), PERME-ROLL (PE), or Tegaderm™ Roll (TE) as film dressings, adopting 2 methods: (1) bonding the application surfaces of the tape and film dressing; or (2) pasting the tape on the surface of the film dressing. From the results of the drug release test and skin permeability test, OP was found to prevent drug release more markedly when adopting method (1).

During hospitalization at the Ashiya Municipal Hospital, the tapes were applied in the following dosages to each patient: A (1 mg and 0.5 mg), and B-D (0.5 mg). Administration of 0.5 mg was performed using PE with method (2). The residual rate for each patient was: A: 80.6％, B: 74.6 ± 8.39％, C: 75.6 ± 4.37％, and D: 79.4 ± 8.31％. When the tape at 1 mg was attached to patient A, the residual rate was 61.1 ± 9.50％.

These results support the feasibility of dose adjustment by covering the drug releasing surface of the tape with appropriate film dressing, such as OP or PE, adopting method (2).

The efficacy of pharmaceutical interventions for patients with cardiovascular disease has been reported in several countries. However, the interventions especially for patients with cardiovascular disease have not been evaluated for safety, efficacy and economy. To evaluate pharmaceutical interventions in the cardiovascular ward, we evaluated the economic benefit of pharmaceutical interventions retrospectively. We classified pharmaceutical interventions into 3 items, which included type of intervention, intervention that influences patients' outcome, and intervention according to guidelines. Moreover, we evaluated for economic benefit regarding the prevention of serious adverse drug reactions, and avoidance of drug interaction. We also collected interventions for initiating drugs, and the estimated cost savings by decreasing the risk of hospital readmission by initiating drugs.

One hundred and thirteen interventions were accepted and 27 interventions were rejected. It was considered that 48 interventions led to safety. The cost saving associated with pharmaceutical interventions that include the prevention of serious ADRs, avoidance of drug interaction and others was estimated to be about 13 million-yen of financial benefit.

In addition, 33 interventions were those for changing medications according to several guidelines. The interventions (drug initiation) cut the medical care cost by about one million yen per year by the decreased risk of hospital readmissions.

This is the first study to estimate the economic impact directly associated with various pharmaceutical interventions of pharmacists in cardiovascular disease in Japan. Evaluating the economic impact in relation to the pharmaceutical interventions is an important method for assessing the role of pharmacists.

The influenza virus causes seasonal influenza epidemics and, from time to time, worldwide pandemics. Seasonal influenza epidemics in winter cause increased morbidity because vaccination is aimed at preventing influenza. However, influenza treatment is limited because oseltamivir cannot be used in children. Recently, Kampo medicine containing maoto was reported to have anti-viral and antipyretic effects. In Japan, maoto is generally administered as concentrated extract-granules. However, children do not like to take the maoto extract-granules because of their distinctive smell and bitter taste. Therefore, masking the smell and bitter taste is necessary for administration to children who are unable to take oral medications. In this study, we developed and characterized a new chocolate formulation for masking the maoto extract, using human sensory tests.

The chocolate bases A to J (10 forms) were selected from commercial products. The total evaluation score for the maoto extract-containing chocolate formulation-D (Mao/nC) was the highest of the 10 forms according to the human sensory test results. The maoto extract-containing adjusted chocolate formulation (Mao/OrC) was based on an adjusted version of the Mao/nC formulation. The Mao/OrC exhibited improved smell and sweetness and overall evaluation scores compared with the Mao/nC, according to the human sensory test results. The results of a dissolution test, drug release test, and viscosity and osmotic pressure of the Mao/OrC were improved compared with those of the Mao/nC, and those of bioequivalence were similar. These results suggest that the Mao/OrC could be used as a new masking chocolate formulation for preparation in hospitals.

There are few reports on post-exposure prophylaxis (PEP) of oseltamivir for preventive efficacy of secondary infection of influenza. Especially, there is no report on medical institutions with many elderly people. Our aim was to verify the preventive efficacy of secondary infection of influenza by post-exposure prophylaxis of oseltamivir in medical institutions with many elderly people. We retrospectively investigated the secondary infection rate of roommates administered oseltamivir prophylactically for 5 days (PEP group) and that of roommates who were not administered oseltamivir (non-PEP group). The observation period was set as up to 10 days from influenza diagnosis.

There were 121 index cases of influenza, 550 roommates. We compared 441 cases of the PEP group with 95 cases of the non-PEP group. The median age was 72[57-84] in the PEP group and 73[53-83] in the non-PEP group. The secondary infection to the roommates was 0.7％ (3/441) in the PEP group and 9.5％ (9/95) in the non-PEP group (Protective efficacy 92％; 95％ confidence interval, 72.1-97.9; P < 0.001), and the secondary infection to the roommates who could be observed for 10 days was 1.2％ (3/242) in the PEP group and 14.5％ (9/62) in the non-PEP group (Protective efficacy 92％; 95％ confidence interval, 69.4-97.6; P < 0.001).

This study suggests that in medical institutions with many elderly people, oseltamivir 5-day prophylactic administration to roommates of influenza patients might be useful for preventing secondary infection.

Infantile hemangiomas (IH) are the most common tumor of infancy. Recently, a topical β-blocker formulation has been reported as a potentially effective treatment for IH, and in Japan, oral therapeutic drugs are also approved for adaptation. The topical administration of β-blockers may reduce systemic side effects and increase effectiveness. In our hospital, we began preparing a timolol gel with hydroxypropyl methylcellulose (HPMC) as a hospital grade preparation. In order to investigate an appropriate substrate concentration, we evaluated the pharmaceutical properties when changing the HPMC concentration (2.0％: L-gel, 4.5％: M-gel, 7.0％: H-gel). The comparison of mean dissolution time (MDT) by moment analysis showed no significant difference between M-gel and L-gel, or H-gel. When examining the spreadability, L-gel was judged to be too soft, and we decided to use M-gel in our hospital, based on the results of a releasability test. Further, skin permeability of M-gel was confirmed by a skin permeability test. The release profile of M-gel was almost the same, when comparing that prepared immediately with that stored for 6 weeks at 4℃ after preparation. Our data suggest that M-gel was the best formulation from a pharmaceutical viewpoint.

Equashield^® is a closed-system drug-transfer device (CSTD); it comprises a closed plunger and a barrel and is effective for decreasing the exposure of a syringe plunger to anti-cancer drugs. The protection of the syringe plunger has been surmised to decrease the exposure of preparation gloves and the surrounding environment to drugs. However, the effectiveness of Equashield^® in decreasing the exposure of preparation gloves to anti-cancer drugs has not been validated. We conducted a study to examine the exposure of preparation gloves and the surrounding environment to a cyclophosphamide (CPA) preparation in comparison with different types of CSTDs. Using ChemoCLAVE^®, which does not comprise a closed syringe plunger, CPA was detected in two of six preparation gloves (0.60 ng and 31.1 ng), nursing gloves (1.84 ng), and a drug container (759 ng). Using Equashield^®, CPA was not detected in any preparation glove, nursing glove, or drug container. Therefore, Equashield^® may be effective for decreasing the risk of exposure of preparation gloves and the surrounding environment to CPA.