We developed a total management system of hospital preparations to manage the preparation of raw materials, hospital preparations and the use of patient information for hospital preparations generally in Aichi Medical University Hospital and built a safe means of preparing the hospital preparations and an appropriate use regime. We used an object-relational database management system. The main functions are the management of raw materials of hospital preparations and hospital preparation stock, checking preparations and management of information of hospital preparations. In administration of hospital preparation stock, when raw materials of hospital preparations are stocked, we record in the system the batch number of raw materials for hospital preparations to secure their traceability. When the system is started up, the information of hospital preparations is shown on the display before a deadline that makes possible the administration of all hospital preparations in terms of validity in the hospital. In preparing an evaluation, we made a preparation master of hospital preparations and then raw materials of hospital preparations were authenticated and the weight checked to make it possible to prepare hospital preparations by only a pharmacist. It was effective in reducing the working hours for preparation and recording information. Moreover, the information of patient's administration ensures that informed consent is obtained where necessary and reports on clinical use results are collected. The clinical use results report recorded in the system make it possible to administer hospital preparations validly, safely, and with awareness of the side effects.
This study analyzed factors affecting plasma lamotrigine (LTG) concentrations in patients with bipolar disorder. The mean concentration/dose (C/D) ratio of LTG was significantly higher in patients co-treated with LTG and valproic acid (VPA) [3.72 (μg/mL)/(mg/kg/day), n = 9] than in those receiving LTG monotherapy [1.76 (μg/mL)/(mg/kg/day), n = 9; P < 0.01]. LTG monotherapy patients were genotyped for UDP-glucuronosyltransferase 2B7 (UGT2B7) ＊1/＊1 (n = 5) and ＊1/＊2(n = 4), whereas VPA co-administration patients were genotyped for UGT2B7＊1/＊1 (n = 6), ＊1/＊2 (n = 2) and ＊2/＊2 (n = 1). ＊There were no significant differences in mean C/D ratios between patients carrying the UGT2B7＊1/＊1 genotype and the 1/＊2 or ＊2/＊2 genotype regardless of pharmacotherapy (P ≥ 0.150). In the LTG monotherapy group, the mean C/D ratio was similar in smoking patients [1.52 (μg/mL)/(mg/kg/day), n = 3] and non-smoking patients [1.88 (μg/mL)/(mg/kg/day), n = 6; P = 0.393]. In the VPA co-administration group, however, the mean C/D ratio in smoking patients [2.62 (μg/mL)/(mg/kg/day), n = 4] was significantly lower than that in non-smoking patients [4.61 (μg/mL)/(mg/kg/day), n = 5; P < 0.01]. In vitro studies with HepG2 cells indicated that benzo[a]pyrene, one of the polycyclic aromatic hydrocarbons contained in tobacco smoke, as well as 3-methylcholanthrene efficiently induced expression of UGT1A4 mRNA but not UGT2B7 mRNA and that VPA potently enhanced their induction. These results suggest that concomitant VPA administration and/or smoking may influence LTG concentrations in patients with bipolar disorder.
We surveyed the trends in the use of Kampo medicine (Japanese traditional medicine) and medication instructions of Kampo to patients using a questionnaire administered to pharmacies in Ishikawa Prefecture. Kampo medicine is dispensed in most of the pharmacies. Almost all the pharmacies used Kampo extract formulations for prescriptions, and few prescribed crude drugs. The diagnostic and treatment systems of Kampo are completely different from those of modern Western medicine. Many questionnaire respondents felt that Kampo medicine was more complicated than modern Western medicine in terms of determining the correct prescription. It may be that pharmacists do not understand the logic behind a medical doctor's prescription of Kampo medicine. Almost all respondents felt the need to enhance the pharmaceutical education of Kampo medicine at pharmaceutical colleges and lifelong learning support by the pharmaceutical association to increase the knowledge of Kampo medicine. Using cluster analysis, we showed that the respondents were divided into five groups by cluster analysis based on the awareness of Kampo medicine. We believe it is important to develop educational methods suitable for each cluster.
Denosumab is frequently used to prevent skeletal-related events in advanced cancer patients with bone metastasis. However, serious hypocalcemia has been reported as an adverse effect after the administration of denosumab. Therefore, to prevent hypocalcemia, prophylactic administration of calcium and vitamin D is recommended concomitant with the administration of denosumab. Previously, we reported that co-administration of proton pomp inhibitors (PPIs) was significantly related to hypocalcemia induced by denosumab. That study, however, included patients who did not receive prophylactic administration of calcium and vitamin D. The purpose of the present study was to clarify whether PPIs also increase the incidence of hypocalcemia induced by denosumab only in patients receiving prophylactic administration of calcium and vitamin D. In this retrospective cohort study, we examined the incidence of hypocalcemia in 21 patients treated with PPIs (PPIs group) and 34 patients not treated with PPIs (non-PPIs group). The incidence of hypocalcemia for the PPIs group (57.1％, 12/21) was higher than that for the non-PPIs group (17.6％, 6/34). Comparison of the patient backgrounds in the two groups revealed significant differences in the serum albumin. In Cox proportional hazards regression analyses after adjusting for serum albumin and renal function, which is a known risk factor, co-administration of PPIs (hazard ratio, 4.25; 95％ confidence interval, 1.45-12.51; P = 0.025) was significantly related to hypocalcemia induced by denosumab. These results indicate that close monitoring of serum calcium levels is recommended for denosumab-treated patients with co-administration of PPIs, despite receiving prophylactic administration of calcium and vitamin D.
This study examined the effects of continuous outpatient intervention by pharmacists on medication adherence in patients with heart failure after discharge. Data in the intervention group (n = 25) and non-intervention group (n = 25) were compared on admission (baseline) and after 6 months. Medication adherence was evaluated using the Morisky Medication Adherence Scale (MMAS-4). The number of medications and the medication regimen complexity index (MRCI) were examined as factors influencing such adherence. For statistical processing, the paired t-test was used to clarify differences in the means of dependent variables between before and after intervention in both groups. The significance level was set at 0.05. MMAS-4 scores significantly decreased after intervention in the intervention group, while MRCI scores markedly increased after it in the non-intervention group. In conclusion, regular intervention by pharmacists for outpatients with heart failure may improve medication adherence.
As hepatitis B virus (HBV) can be reactivated in HBV carriers and infected patients during and after they take a course of immunosuppressant drugs and chemotherapy, it is necessary to follow-up the patients regularly. However, there are no reports on a system for following up patients during and after using immunosuppressant drugs and steroids.
We started a follow-up system of HBV reactivation for patients during and after using immunosuppressant drugs， chemotherapy and steroids from June 2015. We extracted target patients and their HBV inspection status from electronic medical records by using data warehouse CLISTA!SEARCH© every month and if a doctor did not inspect accurately we would send an e-mail requesting an HBV inspection. In June 2015， the number of sent e-mails was 177, but the number gradually decreased， and it was 27 in January 2016. We investigated the implementation rate of hepatitis B reactivation measures from February 2016 to August 2016, it was almost 98％, so we consider it is an effective system.
We investigated the contamination risk of 20％ serum eye drops after 1 week of their use. Fifteen bottles containing 20％ serum eye drops were prepared under aseptic conditions using serum eye drops obtained from three subjects without eye diseases and were stored at 5℃. The bottles were placed under running water in a washbasin eight times daily for 7 days. All bottles were placed under running water on the first day, 12 on the second day, nine on the third day, six on the fourth day, and three from the fifth to the seventh days. Residual sera from three bottles placed under running water on the first to the fourth day and on the seventh day were cultured for 14 days using thioglycollate broth. No bacterial growth was detected in the broth. From the results, we found that the 20％ serum eye drops remained aseptic after 1 week of use.