Gifu Pharmaceutical Association conducted a survey on the actual situation of family pharmacists in collaboration with Gifu Pharmaceutical University in 2016. Data of 3,340 people were obtained from 342 pharmacies. A total of 2,666 patients received prescriptions in May 2017 and family pharmacists were assigned to 221 patients (8.3％). The patients group who selected family pharmacists had a greater tendency to bring all the prescriptions to the same pharmacy, to bring the medicine notebook with the prescriptions, and to buy over the counter drugs (OTC) from the family pharmacy than the group not covered by the family pharmacists. The patients ask family pharmacists for reliability, health consultation, and advice in selecting OTC. They are satisfied with family pharmacists on consultations being responded to at any time and feeling that they could ask questions that they could not ask the doctor.
FOLFIRINOX is a novel chemotherapy that has been approved for the treatment of advanced pancreatic adenocarcinoma. In comparison with the conventional gemcitabine single agent therapy, FOLFIRINOX is advanced for objective responses, progression-free survival, and median overall survival. Cholinergic syndromes are frequently observed in patients receiving FOLFIRINOX and have been suggested to occur due to the inhibition of acetylcholinesterase by irinotecan (CPT-11). However, no research has been performed on the incidence and risk factors of cholinergic syndromes under FOLFIRINOX. This study aimed to evaluate the incidence and risk factors of cholinergic syndromes induced by FOLFIRINOX in retrospective investigation. Forty-eight patients who were treated with the first cycle of FOLFIRINOX were analyzed and 33 (68.8％) of those experienced cholinergic syndromes including diaphoresis (50.0％), acute diarrhea (33.3％), abdominal pain (29.2％), dysarthria (8.3％), and one for each case of bradycardia, nasal flow, miosis and numbness in the hands. Diaphoresis was experienced more frequently in younger patients (P = 0.029). Other characteristics of patients had no significant relationship with the induction of cholinergic syndrome; sex, stage of cancer, performance status, prior chemotherapy, dose of CPT-11, use of opioid, use of NSAIDs and/or acetaminophen and UGT1A1 genotype. This study indicated for the first time that cholinergic syndromes are observed in almost 70％ of patients treated with FOLFIRINOX, and it might be due to the combination of CPT-11 and oxaliplatin. Since cholinergic syndromes can deteriorate the quality of life, patients should be monitored carefully regardless of their characteristics under FOLFIRINOX.
In this study, we classified the efficacy and safety of pharmaceutical interventions using a check list for pharmaceutical care and evaluated the improved quality of medical care and the contribution to medical safety. We retrospectively reviewed the pharmaceutical intervention records from January 2014 to December 2015. We also investigated the effect of pharmaceutical interventions by pharmacists on the reduction in drug costs.
In the item of check list for pharmaceutical care, 468 cases were the most with untreated clinical conditions, followed by over-doses (235 cases), inappropriate drug management (169 cases), and multiple treatment (151 cases). In addition, we estimated that there would be a reduction in the cost of drugs of around 1,833,788 yen per two years (7,500 yen per drug treatment suggestion) as a result of discontinuation of administration and dose reduction, and medication change through pharmaceutical interventions.
By classifying based on the check list for pharmaceutical care, it is possible to evaluate the drug treatment suggestions made by pharmacists as effective and safe.
Although it was reported that carboplatin, a second-generation platinum agent, exhibits an anti-cancer effect after the structure is changed from carboplatin to cisplatin, how this change takes place remains unclear. In this study, the stability of carboplatin to pH and Cl- concentration was examined by HPLC using πNAP column. In the absence of sodium chloride, carboplatin did not change to cisplatin. However, in the presence of sodium chloride at pH 3.0 and 6.0, carboplatin changed to cisplatin after 8 hr and carboplatin changed to 0.33 mmol cisplatin at 24 hr in the presence of sodium chloride at pH 3.0. The result of this study shows that when carboplatin was mixed with an infusion solution of inorganic salts including chloride, the solution should be infused within 8 hr.
The Japanese Ministry of Health, Labour and Welfare declared the National Action Plan on Antimicrobial Resistance in 2016 and emphasized the necessity of antimicrobial stewardship. The amount of oral third-generation cephalosporins administered is greater in Japan than in other countries. Therefore, we promoted the proper administration of oral third-generation cephalosporins.
We investigated the changes in prescriptions before and after the approaches of our hospital toward correct administration of antibacterial drugs after day dental surgeries, and their adverse effects, such as the incidence of surgical site infection and changes in costs.
The percentage of prescribed oral third-generation cephalosporins decreased with an increase in penicillin administration; there was a significant difference before and after implementing the approaches (P < 0.01). Due to an increase in penicillin administration, prevention of the development and spread of resistant bacteria was possible.
Furthermore, the incidence of surgical site infection was supposedly not affected and the cost-effectiveness ratio had improved. Efforts toward the appropriate administration of oral third-generation cephalosporins in outpatients have contributed greatly to improving the quality of medical care.
In November 2014, Hitachi, Ltd. Hitachinaka General Hospital started protocols that partly allowed community pharmacists to dispense medicines, without obtaining permission from physicians who made prescriptions, in order to alleviate the burden on community pharmacists, and to maintain high-quality pharmacotherapy management. However, the utilization frequency of one protocol, the protocol on adjusting the amount of medications in accordance with unused medications, called the“unused medications protocol,” which contained regulations on adjustment days, was relatively low. Based on this result, we removed regulations on adjustment days, and also revised the protocol, which enabled physicians and community pharmacists to share information on unused medications. During one year, the term before and after the revision, the utilization rate of unused medications protocol, in which it had been necessary to consult physicians, increased from 4.5％ to 92.4％. Also, the number of the utilization of unused medications protocol that included asking permission per month increased 1.5 times. The medication cost, which was reduced by the revision of unused medications protocol, was about 12 million yen / year, by the calculation of the reduced amount of medications and the price of each medicine. It is concluded that the renewed unused medications protocol established a cooperative system between physicians and community pharmacists, and it has led to the realization of new medical support in a team to approach unused medications in the community.