Focusing on the Pharmaceutical Intervention Records (PIR) project, a collaboration between the Gifu Pharmaceutical Association and Gifu Pharmaceutical University, this study analyzed the characteristics and economic impact of prescription notes by using data from pharmaceutical audits of prescriptions. The pharmacists registered audit data for 1,105 prescriptions in the PIR database in 2017. For the analysis, we divided the 1,105 prescriptions into a subject group (those that used prescription notes) and a control group (comprising other prescriptions). The reduction in drug cost per prescription was 1,422 yen in the subject group, which was significantly greater than that in the control group (960 yen). In the subject group, pharmacists tended to find a reason to reduce prescription drugs, such as duplications and contraindications for combination. A high ratio of drug cancellation resulted from such inquiries. This was considered a significant factor in the reduction of drug costs in the group using prescription notes. The cancellation of drugs is a requirement for the prevention of duplications and the interactions of prescription drugs; therefore, pharmacists additionally tended to assess this addition in the subject group.
When press-through-package (PTP) sheets of similar appearance are divided into smaller sizes, their similarity increases. This in turn increases the probability of recognition errors. We created images of units of 10-, 6-, and 2-tablet PTP sheets of different colors and designs using a personal computer and then reduced their sizes in five steps. These images of different sizes were then arranged horizontally and presented to the study participants. Differences in recognizability were determined based on the percentages of correct recognition of the size differences. A logistic regression analysis showed that there were no interactions between the packaging units and the image reduction ratio to the original sizes of the PTP sheets. However, with respect to the main effect of the packaging units themselves, significant differences were observed based on the color or design of the PTP sheet, and recognizability deteriorated as the PTP sheets were further divided. As for the percentage of correct answers, right-left differences were observed in the identification of the presented images; this suggests the effect of ocular dominance.
We investigated the relationship between drug administration and the onset of acute pancreatitis using the Japanese Adverse Drug Event Report database (JADER) of the Pharmaceuticals and Medical Devices Agency. Upon analysis of the proportional reporting ratio, an indicator of signal detection in pharmacovigilance, signals were detected for 65 drugs such as L-asparaginase, mesalazine, and estrogen among 1,129,350 reports in JADER. Data suggest that the younger age groups have a higher risk of acute pancreatitis for 7 drugs including L-asparaginase and azathioprine, as do men compared to women for 4 drugs including telaprevir and sodium valproate. In analysis of the time-to-onset profile using Weibull distribution, 6 drugs including L-asparaginase and mesalazine were estimated to be the early failure type, and peginterferon alfa-2b and telaprevir were estimated to be the wear out failure type. Logistic regression analysis showed a significant association between the presence of concomitant drugs and the onset of acute pancreatitis for 4 drugs namely L-asparaginase, azathioprine, tacrolimus, and methylprednisolone sodium succinate. These results will be useful for monitoring acute pancreatitis induced by drugs.
Utilization of a clinical article requires consideration of the quality of the study. Greater numbers of cases make predicted values closer to true values. To conduct meta-analysis and to create guidelines, a sample size must be taken into account to identify the timing of analysis, as well as being aware of language bias. We investigated the quality and sample size of clinical articles over time to examine the timing of analysis and language bias.
Using PubMed and ICHUSHI Web, we searched for clinical articles on anti-influenza agents, followed by a study on the changes in quality and sample size in the selected articles, sorted by language. We assessed the quality as it related to the Jadad scale and the processing of the analysis sets.
Our assessment of the articles revealed that the quality of the English articles was higher than that of the Japanese articles. For the English articles, observation of the changes in quality and sample size confirmed a positive correlation in Phase I and a negative correlation in Phase II, whereas for the Japanese articles, a negative correlation was confirmed for both phases.
We found a linguistic bias between English and Japanese articles, with the temporal changes in the articles different for such languages. When analyzing clinical studies for treatment plans or meta-analysis, the internal validity should be assessed in light of the results described above. Should the bias not be completely eliminated, the reason should be clearly stated under the Limitations section before conducting the assessment.
In Kobe University Hospital, we have been conducting case conferences once a week to investigate the adequacy of administration of broad-spectrum antibiotics to ensure their appropriate use. However, immediate interventions were not implemented except for cases with positive blood culture results. Therefore, as a part of the newly-launched Antimicrobial Stewardship Team, a full-time pharmacist started monitoring the use of broad-spectrum antimicrobials early and conducted lectures on the appropriate use of antibiotics for hospital staff. The purpose of this study was to assess the impact of full-time pharmacist interventions on antimicrobial stewardship, in addition to the existing support activities. During the intervention period from May 2018 to February 2019, the full-time pharmacist provided advice on early monitoring for 149 cases and the change rate based on the advice was 81.2％. Lectures for hospital staff were conducted six times during the intervention period. Additionally, as compared to the period from May 2017 to February 2018, that is, before the intervention, the days of therapy (DOTs) for antipseudomonal agents significantly decreased from 56.0 to 47.7 during the intervention period (P = 0.004). Furthermore, the cost of all injectable antibiotics decreased by an estimated 8.24 million yen, reflecting a decrease in the use of antipseudomonal agents. These findings suggest that, in addition to the existing support activities, the implementation of aggressive interventions by full-time pharmacists is useful not only for promoting the appropriate use of antibiotics but is also important from the perspective of medical economics.
In Japan, pharmacists are required to instruct patients about the proper use of drugs (since the Pharmacists Act was amended in December 2013). For outpatients who were prescribed medications whose documentation indicated that driving was prohibited, we started performing medication consultations using medication consultation sheets. However, it takes a long time to prepare medication consultation sheets, and they do not contain information about the patient's medication history. In the current study, we tried to develop a sheet preparation system based on Microsoft® Excel that would enable pharmacists to identify any changes in a patient's medication, in order to promote the proper use of drugs. In addition, we assessed the utility of the system by examining the time required to prepare medication sheets using the system, and the usability of the system was evaluated using four questionnaires. The use of the system resulted in the time required to prepare medication counseling sheets reducing from 107 ± 55 seconds to 38 ± 23 seconds, and the resultant sheets categorized the prescribed drugs into “new drugs”, “stopped drugs”, “continuing drugs”, and “restarted drugs”. The questionnaire results were analyzed using customer satisfaction (CS) analysis to determine if there had been any improvement in the pharmacists' views of the system. CS analysis revealed that the readability of the sheets needed to improve, and that easy-to-understand explanations of the sheets' contents were required. In conclusion, we suggest that the abovementioned system is useful for efficiently preparing medication counseling sheets.
The Pharmaceutical Education Council recommends that students of a 6-year-pharmacy degree program should be tested for their antibody titers to measles, rubella, varicella and mumps before clinical training, and if antibody titers aren't sufficient, they should get vaccinated. However, there are no regulations on testing methods, the level of antibody titers considered not positive, or the frequency of vaccinations. In addition, the requirement of antibody titer measurements and HB vaccines are not regulated, and whether Pharmacists graduated from a 6-year-pharmacy degree program have acquired immunity as healthcare workers aren't clear.
Therefore, we investigated the antibody-positive-rates of Pharmacists who started working at our hospital after graduation from a six-year-pharmacy degree program to evaluate whether they have acquired immunity, and compared with them with the antibody-positive-rates of doctors and nurses.
When antibody titers of the Pharmacists were evaluated based on a general standard, antibody-positive-rates for measles, rubella, varicella and mumps were 100％, 95％, 100％, and 37.5％. On the other hand, when evaluation was conducted by a standard for healthcare workers, antibody-positive-rates were 50％, 60％, 100％, and 37.5％, respectively. The antibody-positive-rate for HBs was 15％. The antibody-positive-rate for mumps of the Pharmacists was significantly lower than that of the nurses. In addition, the antibody-positive-rate for HBs of the Pharmacists was significantly lower than that of the doctors and the nurses.
Further rise in the antibody-positive-rates of Pharmacists graduated from a 6-year-pharmacy degree program can be expected by defining the testing methods and criteria for antibody titers, and the frequency of vaccinations.
Maintaining Average Relative Dose Intensity (ARDI) in neo adjuvant chemotherapy and adjuvant chemotherapy in breast cancer leads to an improved therapeutic effect, but few patients have clear indicators.
In the study we report the effect of ARDI on the treatment effect in EC followed by weekly nab-PTX therapy. Our subjects were 48 patients with breast cancer who received EC followed by weekly nab-PTX therapy in neo adjuvant chemotherapy and adjuvant chemotherapy at Nihon University Itabashi Hospital between 2012 and 2017.
In the study we compared Disease-free survival (DFS) and adverse effect rates between the two groups of the ARDI ≥ 90％ group and ARDI < 90％ group.
The patients in the ARDI ≥ 90％ group exhibited significant difference in 2 years DFS and 3 years DFS (2 years DFS: P = 0.0095, 3 years DFS: P = 0.0019) as compared to the ARDI < 90％ group. In terms of the adverse effect incidence rate, pathological subtype by type DFS, there was no difference between the two groups. Maintaining ARDI at 90％ or higher in this study leads to improvement of the therapeutic effect.