The subjective and qualitative survey reported that ward-based clinical pharmacy practices were reported to be rated highly by physicians and nurses. However, no reports have quantitatively evaluated the reduction of their workload from the viewpoint of task-shifting to pharmacists from other medical professionals. In this study, we conducted a questionnaire survey of physicians and nurses working in wards receiving the pharmacy practices service in Keio University Hospital. Survey items include the reduction in the workload of physicians and nurses and subjective ratings regarding the performance of pharmacy practices. The ward-based pharmacy practices (5.9 hours/day, average for a ward) were estimated to be equivalent to the workloads of 3.1 and 2.6 hours/day for a physician and nurse, respectively, adding up to 36.1 hours of their workload per ward. More than 80% of the responders positively rated the performance of pharmacy practices, except for sterile admixture. This is the first study to evaluate the quantitative contribution of ward-based pharmacy practices on task-shifting from physicians and nurses.
Ramucirumab (RAM) plus nanoparticle albumin-bound paclitaxel (nab-PTX) combination therapy is conditionally recommended as second-line therapy for advanced or recurrent gastric cancer in Japan. In a Japanese phase II clinical trial, neutropenia induced by RAM + nab-PTX combination therapy was observed in 90.7% of patients in all grades and 76.7% in grade 3 and higher, indicating that caution is required. Therefore, identification of risk factors for neutropenia is required to safely continue RAM + nab-PTX combination therapy for advanced or recurrent gastric cancer. Here, we retrospectively investigated the risk factors of severe neutropenia in advanced or recurrent gastric cancer patients who received the combination therapy of RAM + nab-PTX in seven hospitals participating in the Division of Oncology, Aichi Prefectural Society of Hospital Pharmacists.
Of the 40 patients, 22 patients (55%) had severe neutropenia of grade 3 or higher. Investigation of risk factors in these patients revealed that a history of grade 3 or higher neutropenia was a risk factor for developing severe neutropenia of grade 3 or higher (odds ratio 7.35, 95% confidence interval: 1.130 - 47.7, P < 0.05). In patients with neutropenia of Grade 3 or higher, those who have a history of two or more times of neutropenia tended to have a longer Time-to-Treatment-Failure (P < 0.05). The present findings may be useful in patients with the RAM + nab-PTX combination therapy to reduce severe neutropenia and prolong treatment duration.
Amrubicin (AMR) is recommended for the treatment of recurrent small cell lung cancer (SCLC) in Japan, but neutropenia is frequently observed as an adverse effect. However, the relationship between severe neutropenia caused by chemotherapy and treatment response remains controversial in AMR. We examined the association between severe neutropenia induced by AMR and progression-free survival (PFS) in recurrent SCLC.
The study included 115 patients who started AMR at Hiroshima Citizens Hospital between July 2011 and June 2021. We defined Grade ≥ 3 as severe neutropenia, retrospectively investigated patient background, the cumulative number of courses with severe neutropenia among all courses (incidence rate of severe neutropenia), and PFS. Cox proportional hazards regression analysis revealed that the performance status of the Eastern Cooperative Oncology Group (hazard ratio (HR) = 2.503, P < 0.001), previous therapy (topoisomerase inhibitors) (HR = 1.758, P = 0.041), stage at diagnosis (HR = 1.746, P = 0.024), and incidence rate of severe neutropenia (HR = 1.636, P = 0.025) were factors significantly related to PFS. The patients were classified into the high and low groups based on the incidence rate of severe neutropenia, and we also extracted 27 cases each from the high and low groups using propensity score matching. A comparison of PFS in both groups showed that the high group had a significantly shorter PFS (P = 0.019).
Therefore, our findings suggest that management of neutropenia during AMR treatment in recurrent SCLC may contribute to prolonged PFS.
This study explored how mask-wearing influences the assessment of emotions through facial expressions and whether it differs depending on daily communication. A model was asked to express “smile” and “pain” with different degrees of expressiveness, and these facial photos and photos with mask-wearing were prepared. We prepared pairs of expressions with two different degrees of expressiveness, and the participants (n = 16) were asked to assess “which expression is more expressive.” The analysis was performed using Scheffe’s method of paired comparison (modified Haga method). The strength of recognition of expressions was 24.6% for “smile” and 13.5% for “pain” due to wearing a mask. When a participant (n = 9) was not acquainted with the model, the degrees of “smile” and “pain” decreased by 28.3% and 14.6%, respectively. However, when the participant (n = 7) was acquainted with the model, they decreased less by 19.4% and 12.3%, respectively, indicating that the influence of wearing a mask was reduced. A two-way analysis of variance showed a significant difference in the main effects of “smile” and “pain” with or without communication, and “smile” with wearing a mask, but no significant difference in interaction. These results showed a trend in the paired comparison method regarding the relationship between mask wearing and communication, but no relationship was observed in the two-way analysis of variance.