Because it is essential to restrict phosphorus intake in dialysis patients, we investigated the phosphorus content per daily standard dose for eight different types of Chinese medicine and 12 different supplements, all of which are typically used by dialysis patients. Phosphorous contents in the range of 3-12 mg were detected in all of the Chinese medicines. Although 11 of the 12 kinds of supplements contained phosphorous, the levels were less than those in the Chinese medicines. The highest phosphorus content among those supplements was found in glucosamine, with a phosphorous content of 6 mg per dose. The phosphorous contents of glucosamine samples obtained from five different companies were all different. Taking these findings together, the intake of phosphorus by dialysis patients heeds to be restricted and the phosphorus contents of Chinese medicines and supplements need to be taken into consideration, by evaluating the total phosphorus intake per day for such patients. Pharmacists should pay attention to maintaining the serum phosphorus level within a reference value by effectively using a phosphate binder if necessary.
There is little evidence of chemotherapy for cancer patients undergoing hemodialysis. We report four hemodialysis patients with metastatic colorectal cancer who received bevacizumab plus capecitabine chemotherapy. Patients were administered bevacizumab 7.5 mg/kg every 3 weeks and capecitabine in a one-step dose reduction of 1,000 mg/m2 twice a day for 2 weeks of every 3 weeks from Monday to Friday. If adverse effects were well tolerated, capecitabine was increased up to 1,000 mg/m2. After chemotherapy started, chemotherapy decreased CEA and CA19-9 levels in all patients and chemotherapy was effective in 3 of 4 patients who underwent computed tomography examination. Chemotherapy was discontinued due to thrombocytopenia and infection but its adverse effects were reversible. These cases suggest bevacizumab plus capecitabine chemotherapy can be administered for hemodialysis patients.
The measurement of the uniformity of preparations is an important component of quality assessment. This study was conducted to evaluate the appropriate mixing time for external preparations using a planetary centrifugal mixer. Steroid ointment and white petrolatum (5 g each) were added to a 13-mL container and mixed using a planetary centrifugal mixer (NRE-120®, THINKY) at a rotation speed of 800 rpm and a revolution speed of 2000 rpm. We sampled 0.1 g of the mixture from three spots (the top, the middle, and the bottom portions) of the container, measured the steroid content, and evaluated the product uniformity of mixtures of ten different steroid ointments (Dermovate®, Antebate®, Myser®, Nerisona®, Methaderm®, Rinderon®-VG, Lidomex®, Almeta®, Kindavate®, and Locoid®) with white petrolatum (Propeto®). Our results showed that when the coefficient of variation (CV) is less than 15.2％, a mixing time of at least 60 seconds is required to achieve proper mixing to obtain the permissible limit of steroid ointment and white petrolatum, and the greater the difference of the yield point between steroid ointment and white petrolatum the easier mixing was. These results suggest that the spreadability of ointment affects the mixing efficiency of a planetary centrifugal mixer.
Many pregnant and lactating patients taking medicine feel anxious about its negative effects on their fetuses and infants. To help pharmacists implement safe drug therapy for them, Aichi Pharmaceutical Association holds communication skill training (CST) sessions as part of a “Program for pharmacists to support pregnant and lactating females.” In the present study, pharmacists' communication skills were analyzed prior to and following the CST to examine its usability. The subjects were 34 pharmacists who participated in the CST in 2013 and played the roles of lactating patients and pharmacists. Following this, videos of the role playing were analyzed: analyses of the “implementation of the process for confirmation of an explanatory model consisting of three items” and the structure of conversations using the RIAS. Furthermore, patients' satisfaction, its relation with the structures of conversations, and the implementation of the process for confirmation of the explanatory model were examined. There was an increase in the number of pharmacists who had conducted the three processes for confirmation of the explanatory model following the CST, and the level of patients' satisfaction was higher in the CST group than in the non-CST group. There was also an increase in the number of pharmacists who had asked psycho-social questions following the CST. Since the CST requires pharmacists to conduct the process of confirmation of the explanatory model and understand it before providing pregnant and lactating patients with explanations of drugs, it is an effective method of helping pharmacists to develop their communication skills to reduce patients' anxiety.
Compliance is improved and incorrect ingestion of medicine reduced when medicine is provided in one dose packages. However, hygroscopic medicines are not suitable for one-dose packages because they absorb moisture, which degrades their quality. Glucobay® tablets are highly hygroscopic. In this study, we examined appropriate preservation methods to maintain the quality of Glucobay® tablets after dispensing one-dose packages. Preservation methods were classified into four groups: naked medicine, one-dose package, one-doge package in a polyethylene bag, and one-doge package in a polyethylene bag with a desiccating agent. These four groups were analyzed for weight, hardness, and visual inspection after the packages were stored under room humidity or high-humidity conditions (75～80％RH) at room temperature. Preservation of the one-dose package in a polyethylene bag with a desiccating agent maintained the quality of Glucobay® tablets. Although the effect of preservation by the polyethylene bag was weak compared with that using a desiccating agent, the quality of medicine was better than that with the one-dose package alone. We further evaluated whether the moisture absorption during dispensation of the one-doge package affects the stability of the medicine. The moisture absorption during one-dose package dispensation decreased the hardness of the medicine even when stored in a polyethylene bag with a desiccating agent.
In conclusion, we revealed that patients need to use a polyethylene bag and/or a desiccating agent to maintain the quality of highly hygroscopic medicines in one-dose packages. In addition, pharmacists must carefully dispense medicines in one-dose packages to prevent moisture absorption.
Clostridium difficile (C. difficile) is a major causative bacterium of diarrhea that occurs concurrently after the administration of antibiotics (antibiotic associated diarrhea). Vancomycin (VCM) and metronidazole (MNZ) are used as therapeutic agents for C. difficile associated diarrhea (CDAD). In the C. difficile therapy guideline, the administration period of VCM and MNZ is defined as 10 to 14 days. However, because there were cases where medication treatment was discontinued within the administration period of less than 10 days, the symptoms improved early. Therefore, we investigated the relationship between the administration period of VCM or MNZ and the recurrence rate of CDAD. As a result, the recurrence rate of CDAD tended to be higher in the case where the treatment period was less than 10 days, and in the case where the number of doses per day was less than 4. This suggests the importance of intervention by pharmacists on the administration period and the number of administrations of VCM and MNZ in the treatment of CDAD.
We constructed a system for advising diabetic outpatients at cross-sectional departments in a small-scale hospital and investigated the feasibility and usefulness of the system. Our interdisciplinary diabetes care team developed a diabetes education program, and the team that formed around the primary physician advised the patients who were following the program. The team consisted of 5 different health professionals including the primary physician, and advised the outpatients on an on-call basis for approximately 6 months. The program was offered to 36 out of 38 diabetes outpatients who satisfied the entry criteria, and 14 of those patients (program group) completed the entire program. The average number of professionals who advised each patient was 3.6 ± 1.0. The HbA1c (NGSP ％) significantly decreased, especially body weight (kg) and BMI (kg/m2) remarkably decreased in obese patients. The HbA1c (NGSP ％) significantly decreased in the program group compared with the usual treatment group not participating the program. The feature of the program is that it is targeted at outpatients with a temporal restriction, and can implement cross-sectional care. The program that adopted an outpatient on-call system in order to optimize staffing suggests its feasibility and usefulness.