In recent years, multi-occupational collaboration aiming at patient-centered care is required to provide high-quality medical care. However, there are few studies on collaboration between hospitals or clinics and community pharmacies. In this study, we conducted a questionnaire survey to clarify the present conditions and awareness of hospitals or clinics in Gifu City regarding collaboration with community pharmacies. The following activities with community pharmacies were examined in the survey: “I. Participation in regional care meetings,” “II. Case discussion conferences,” “III. Workshops/study conferences,” “IV. Community service,” “V. Sharing information through medical cooperation network,” “VI. Accompanying community pharmacists at home medical care” and future plans for these items. The percentage of non-implementation was 80％ or more in Items I, IV and IV in the hospital and 80％ or more in items other than III in the clinics. The percentage of respondents who were not planning to implement Item VI was over 70％ in the hospital, and the percentage of respondents who were not planning to implement Items I, IV, VI was over 70％ in the clinic. In the comparison between the hospital and the clinic, the proportion of current collaboration is significantly higher for II and III in the hospital. For collaboration in the future, the proportion of respondents who were planning to implement these items other than VI was significantly higher in the hospital. Many hospitals and clinics currently do not collaborate with community pharmacies. And more hospitals are considering collaboration with community pharmacies than clinics.
Ganciclovir (GCV), an antiviral agent against cytomegalovirus infection, can cause hematological toxicity such as neutropenia. However, risk factors for neutropenia have not been well established. A decision tree (DT) model, which is a flowchart-like framework, is a data mining technique that is used to construct predictive models. In a previous study, we demonstrated its usefulness in defining prognostic factors in adverse drug reactions. Here, risk factors for GCV-induced neutropenia were analyzed using a DT model and a logistic regression model as a conventional method.
A single-center, retrospective study was conducted at Hokkaido University Hospital. A total of 369 patients administered GCV between April 2008 and March 2017 were enrolled. Neutropenia was defined as a decrease in absolute neutrophil count (ANC) of < 1,000 cells/mm3 and to a < 75％ decrease from the baseline. All data were retrospectively collected from the electronic medical records. In the DT analysis, a chi-squared automatic interaction detection algorithm was constructed. To evaluate the established algorithms, the accuracies of each model were calculated.
Forty (10.8％) patients developed neutropenia. Acquired immunodeficiency syndrome, hematopoietic stem cell transplantations, ANC < 6,679 cells/mm3, and duration of therapy ≥ 18 days were extracted to build the DT model, in which the patients were divided into five subgroups. Their incidence of neutropenia was 0.0 to 58.3％. The accuracies of each model were the same (89.7％), indicating that both were equally accurate.
The results show that a useful risk prediction model for GCV-induced neutropenia can be built using DT analysis.
Lenalidomide is used to treat multiple myeloma and is renally excreted. It is difficult to specify the appropriate dose of lenalidomide based on kidney function alone owing to the expected improvement of kidney function after treatment and the influence of pretreatment. Therefore, we investigated the relationship between proper usage of the initial dose of lenalidomide based on renal function and treatment duration. Between July 2012 and January 2017, we included 69 subjects using lenalidomide at Ogaki Municipal Hospital. The appropriate dosage for each renal function was evaluated using the package insert; the patient's renal function was evaluated using the Cockcroft-Gault formula. We analyzed the patient background and treatment duration and continuity.
The subjects were assessed and divided into the appropriate dose group (I; 43/69 (62％)), overdose group (II; 18/69 (26％)), and underdose group (III; 8/69 (12％)). On assessing the patient background, the number of patients who underwent pretreatment was significantly higher in Group III than that in other groups (I: II: III= 2: 2: 4 course, P = 0.02). No difference was observed for the duration of treatment and discontinuation due to side effects.
We conclude that patients were concerned about side effects when the pretreatment period was longer and thus the initial dose was reduced. However, there was no significant difference in the treatment duration and the incidence of side effects. Therefore, pharmacists must actively participate in specifying the lenalidomide dosage during treatment continuation from the initial dose.
The sequelae of stroke include eating disorders and dysphagia. In order to ascertain whether differences in drugs used for the treatment of stroke affect the mode of nutrient intake and the level of consciousness, we investigated patients with cerebral infarction who were admitted to Osaka-Minami Medical Center in 2013. The patients were divided into two groups, ie, one treated with recombinant tissue plasminogen activator (rt-PA) and the other not treated with rt-PA, and their treatment results were compared.
The Japan Coma Scale (JCS) scores showed a correlation with the mode of nutrient intake, and better JCS scores were obtained at the time of admission and one week afterwards in the rt-PA-treated group compared to the other group. The modes of nutrient intake at one week after admission and at discharge were the same in many patients. It was suggested that the use of rt-PA, which improved the level of consciousness from an early stage, would be effective in reducing the occurrence of eating disorders and dysphagia in stroke patients.
Febrile neutropenia (FN) is an oncologic emergency requiring immediate treatment. Outpatients who develop a fever are often instructed to take previously prescribed oral antibiotics without any initial assessment. Oral moxiﬂoxacin hydrochloride (MFLX) is efﬁcacious and safe in low-risk febrile neutropenic patients, but the use of MFLX according to the patients' discretion has not yet been established. In this study, we investigated the effectiveness and safety of the treatment technique during adjuvant or neoadjuvant chemotherapy for breast cancer. The 229 patients received 839 administrations of chemotherapy during the study period and 82 patients (35.8％) had a total of 128 febrile episodes (15.3％). The rate of visits due to heat generation in the pre-prescription group was significantly lower than that in the non pre-prescription group (33/99 [33.3％] vs 24/29 [82.8％], P < 0.001, by the episode). Our results suggest that the strategy might be an effective option for the management of FN of outpatients by reducing the number of hospital visits required.
The disaster manual of our hospital stipulates that the damage situation for each department should be confirmed in a disaster and reported to the disaster headquarters. Since about half of the staff in our hospital's departments of pharmacy services work outside, it is difficult to confirm the damage situation at the time of a disaster. Therefore, to grasp the damage situation efficiently and control the incident responses in a disaster, we developed action cards for each department that summarize the actions that pharmacists should perform when confronted with disaster situations. The action cards were used for tabletop disaster training. The usefulness of the action cards was verified by analysis of participants' behavior according to four parameters before and after the training: safety, damage related to medicine, communication tools, and information transmission to the departments of pharmacy services.
Before the training, safety checks were conducted by 68.6％ of participants, checks of damage related to medicine and information transmission to the departments of pharmacy services by 25.7％ of participants, and communication tools' checks by 2.9％ of participants. The use of the action cards improved all parameters for the training participants by nearly 100％. Furthermore, it was possible to correct the safety actions of all the training participants. These results suggest that the action cards are useful for controlling incident responses in a disaster and can serve as disaster response guidelines for pharmacists.
To provide appropriate information concerning ethical or Rx-OTC-switch drugs containing the same ingredients by pharmacists, it is necessary to understand the properties of both. In this study, pharmaceutical properties and economics were compared between ethical and Rx-OTC-switch anti-allergy ophthalmic solutions containing tranilast, pemirolast, or acitazanolast.
Regarding 14 ethical and 3 Rx-OTC-switch products, the squeeze force, drop weight, pH, specific gravity, and total number of drops were measured. The usable period per bottle and daily cost were calculated from the total number of drops.
The squeeze forces of the three drugs differed about 1.5-2 times among their products. Single-drop volumes calculated from the drop weights and specific gravities ranged from 30 to 46 μL for 0.5％ tranilast ophthalmic solution, larger for the original drugs than for the Rx-OTC-switch and generic ones. The pH values of the ophthalmic solutions differed among the drugs, but not among their products. The usable periods of each bottle of the three drugs were longer for the Rx-OTC-switch drugs. However, the daily drug costs of 0.1％ pemirolast ophthalmic solution were higher for the Rx-OTC-switch drug than for the original one, although those of 0.5％ tranilast ophthalmic solution were lower.
The present study demonstrated that the squeeze forces and drop volumes differed between the Rx-OTC-switch and ethical drugs and that the usable periods of each bottle and daily costs differed among the drugs. It is important for pharmacists to obtain information on the pharmaceutical properties and economics for in order to select products for individual patients.