Tacrolimus (TL) is used topically for atopic dermatitis (AD) treatment. In AD, the skin shows various physiological alterations across individuals, body sites, and time-courses. Our previous study using rats showed that alterations in the skin barrier function and skin blood flow affected systemic absorption of topically applied TL. In this study, we performed an in vivo skin absorption study using NC/Nga mice repeatedly administered Dermatophagoides farinae extract as an AD animal model to assess skin barrier function and skin blood flow. We used three types of TL ointment: or iginal TL ointment (Protopic® 0.1％ ointment) and liquid paraffin-diluted TL ointment with or without adrenaline (0.5w /w％) to suppress systemic absorption of TL. Skin barrier function correlated positively with the systemic absorption of TL in AD skin as well as in tape-stripped rat skin, and dilution of TL ointment suppressed TL absorption and showed high skin TL retention. Although skin blood flow affected TL absorption as the skin barrier was disrupted, the distinct relationship among skin blood flow, TL absorption, and the effect of combined-use of adrenaline was unclear. The relationship between blood and skin disposition of TL was biphasic—the ratio of blood to skin disposition increased rapidly at an inflection point. These results demonstrate that the dilution of TL ointment is useful for increasing treatment safety while retaining efficacy. The observed relationship between TL behavior and skin barrier function in AD model mice may also occur in AD patients and needs to be confirmed in further studies.
Decapsulating clindamycin (CLDM) formulations could lead to poor medicine adherence as they have a strong bitter taste. To mask the bitterness and to facilitate administration, medicines are generally mixed with food. This study identified candidate foods to conceal the bitterness of CLDM, as no such foods have been reported thus far. Twenty-one candidate foods, which were selected based on previous reports, were screened using an electronic gustatory system. Five foods of interest were selected and used as samples for organoleptic examination, in which 30 volunteers aged between 22 and 26 years were enrolled. Vanilla ice cream, condensed milk, and brown sugar syrup significantly reduced the bitterness of CLDM compared to mineral water as a control. A positive correlation tendency between the gustatory system evaluation and the organoleptic examination was observed (R = 0.829, P = 0.058). In this study, we identified, for the first time, potential candidates for masking the bitterness of CLDM. Furthermore, these findings constitute the basis for identifying foods that are more efficient in masking the bitterness of medicines in the future.
In February 2015, we introduced a drug verification and quantity management system using personal digital assistants and medicine barcodes to prevent dispensing errors. We evaluated the effect of this system by comparing the number of dispensing errors and incident cases for one year before and after the introduction. The time required for dispensing was prolonged from about 28.4 seconds to 37.3 seconds per drug, about 1.3 times. The number of dispensing errors for one year before and after system introduction significantly decreased from 33.8 ± 4.7 per month to 5.8 ± 0.8 per month (P < 0.01). In addition, the number of incidents significantly decreased from 6.0 ± 0.9 per month to 3.2 ± 0.5 per month (P = 0.02). The system seems to be useful as a tool of medical safety measures because it significantly lowers the number of dispensing errors and incidents.
The inclusion of role-playing or improvisational tasks as part of the curriculum to enhance communication skills helps students develop their patient-care skills and information collection abilities. An early-exposure program that included role-playing and active learning in visually impaired patient-care scenarios was conducted for first-year students of a 6-year pharmaceutical course at Toho University. To evaluate the impact of the program on role-playing and active learning, the students were asked to complete a questionnaire after completing the program. The questionnaire asked students about the development of their communication skills through the program. The students' scores on questions related to their consideration of visually impaired patients during dispensing and medication counselling significantly increased after the program. In particular, the mean font size that the students used for drugs written on envelopes clearly increased. These results suggest that our program may be useful for guiding pharmacy students to learn how to think and convey information from the perspective of their patients.
Postoperative pain and postoperative nausea and vomiting (PONV) are distressing for patients, and can inhibit postoperative recovery. This study examined the differences in postoperative pain intensity and PONV intensity between patients who received intravenous (IV) patient-controlled analgesia (PCA) or patient-controlled epidural analgesia (PCEA) for the control of pain after laparoscopic myomectomy. A retrospective chart review was performed of 62 consecutive patients who underwent laparoscopic myomectomy at Kitasato Institute Hospital, Tokyo, Japan. Patients who received IV-PCA (n = 30) as their primary postoperative analgesic modality were compared with patients who received PCEA (n = 32). Demographic profiles for the two groups were similar regarding characteristics at the time of surgery. Dose per hour of fentanyl in IV-PCA was significantly less than that in PCEA (P < 0.001). For the first postoperative days, pain intensity was significantly lower in patients who received PCEA than in those who received IV-PCA (P < 0.001). There were no significant between-group differences in the incidence of PONV and adverse events of PCA. However, clinically significant severe PONV (PONV grade = 3) was more frequent in IV-PCA than in PCEA.
Our study shows that use of PCEA significantly reduces postoperative pain in the early postoperative period in patients who undergo laparoscopic myomectomy compared with the use of IV-PCA. PONV is more severe in IV-PCA than in PCEA.
To improve pharmacy practices, a pharmacists' journal club program to advance reading of clinical literature was examined. Pharmacists with careers longer than 5 years were recruited to be preceptors-in-training. The preceptor-intraining education program consisted of 16 hour-long blocks, once per week. The 1st to 7th blocks emphasized medical terminology. The 8th and 9th blocks focused on interpreting clinical literature using the ACCOMPLISH trial and a journal club guide (translated into Japanese by the first author). The 10th to 15th blocks were oral presentations by trainees who presented handouts and led discussions about an article of clinical literature that had been published in the previous 6 months. The 16th block, small group discussion, used the Kawakita Jiro method and the topic, “What is important for preceptors?”
Verification of outcomes of the journal club advancement program was performed with a pre- and post- medical terminology test (50 questions) and pre-and post-questionnaire (7-point Likert scale). Each trainee preceptor then taught 2 pharmacists in turn, and verified outcomes with the same test and questionnaire noted above. There were no significant differences in the medical terminology test scores between the pre- and post-program and it was clear that the preceptor education program was equivalent to the program in which educated preceptors taught pharmacists. Regarding the question of “AT THIS TIME, do you habitually read clinical literature?,” there is a significant increase in points between the pre- and post-program, suggesting that the program improves skills and contributes to improved pharmacotherapy.