Both allopurinol and febuxostat, xanthine oxidase inhibitors, are effective for the treatment of patients with hyperuricemia and gout. As febuxostat exerts an efficient anti-hyperuricemic effect even by taking only once a day, there are many cases of switching from allopurinol to febuxostat. Although a comparison of the anti-hyperuricemic effects between allopurinol and febuxostat has been reported previously, there are few studies exploring the factors affecting the uric acid (UA) levels in patients after switching from allopurinol to febuxostat. To address this problem, we carried out population pharmacodynamic analysis for patients with hyperuricemia or gout whose treatment was switched from allopurinol to febuxostat. Using the non-linear mixed effect model (NONMEM), we constructed an indirect model based on 1,263 serum UA levels of 56 patients. The model described the time course of serum UA levels before and after switching from allopurinol to febuxostat. Before the initiation of treatment, the basal UA levels were increased in correlation with serum creatinine (SCr) concentrations, but no significant factors were detected in the anti-hyperuricemic effect of allopurinol. After switching to febuxostat, its anti-hyperuricemic effect was attenuated in patients concomitantly treated with loop diuretics. Although these results suggest that febuxostat can decrease the serum UA levels even in patients who have allopurinol resistance, we should pay attention to possible interactions with concomitantly administered drugs.
We report a case of pharmacist intervention where a patient with uncontrolled pain after long-term use of high-dose opioid analgesics achieved complete opioid withdrawal post-radical cancer surgery. The patient was a woman in her sixties. At the time of being diagnosed with endometrial cancer in X, she refused aggressive treatment and was subsequently given sustained-release Oxycodone for pain control. In X + 6 years, she experienced uncontrollable pain and underwent radiation therapy for pain relief. Her sustained-release Oxycodone dose was reduced post-therapy. In X + 9 years, her pain again became uncontrollable. She underwent a total hysterectomy for pain relief, and her sustained-release Oxycodone dosage was tapered. She achieved complete withdrawal on postoperative day 316. At the following two points during the course of observation, pharmacists evaluated problems pharmaceutically and intervened in the dose reduction process.
1. When the sustained-release Oxycodone dosage was reduced from 80 mg/day to 60 mg/day, the number of rescue doses was increased, resulting in a non-reduction of total opioid dosage and uncontrolled withdrawal symptoms.
2. Upon further reduction of Oxycodone from 30 mg/day, there was no appropriate method for equally dividing the dosage taken three times daily. In this case, the main cause of pain was considered to be the cancer itself and complete pain relief by radical surgery may have led to total opioid withdrawal. The pharmacist intervention was considered useful in re-evaluating the drug reduction process and controlling withdrawal symptoms.
Blood culture collection is strongly recommended prior to the start of broad spectrum antibiotics. Once causative organisms are identified, the narrow spectrum antibiotics are introduced (de-escalation). In Fukuoka Red Cross Hospital, the infection control team (ICT) has been encouraging doctors to take 2 sets of blood culture, prior to the commencement of carbapenem. We compared the implementation of blood culture collection prior to the commencement of carbapenem from 2013 to 2016. During this period, the implementation rate was increased from 33.0％ to 71.1％ (P < 0.05), respectively. The de-escalation was also improved from 10.3％ to 33.0％ (P < 0.05), in the respective period. The cost in the use of carbapenem in 2016 was significantly decreased. This cost effectiveness showed a positive outcome when de-escalation took place, compared with a simulated case of continuous use of carbapenem. The total pharmaceutical cost reduction over this period was increased from 136,437 yen to 547,205 yen. The result showed the endorsement of mandatory blood culture collection prior to carbapenem use improved de-escalation as well as pharmaceutical cost.
We have disclosed 14 standardized laboratory data on out-of-hospital prescriptions since June 2015. In this study, we analyzed questions on out-of-hospital prescriptions related to laboratory data over 2 years. There were 229 prescription questions related to laboratory data (3.4％ of the total prescription questions), and 79.5％ of these were related to renal function. Among renal function-associated laboratory data, serum creatinine was used in most cases. The rate of prescription change after prescription questions was 66.5％ for laboratory data associated with renal function, which was significantly higher (P < 0.001) than the 25.5％ for other types of data. Furthermore, the clear description of dose reduction requirements on a package insert was confirmed to be one of the common factors for renal excretory drugs. Therefore, it is important to provide renal function laboratory data to facilitate the appropriate adjustment of out-of-hospital prescription doses. In addition, to enable appropriate dose adjustments using laboratory data, the description on the drug package insert should make it easy for pharmacists who are auditing prescriptions to make appropriate judgments.
Team-based learning (TBL) is an active learning method which has been designed to help students solve problems both by themselves and as a team. In this study, TBL was introduced in the journal club (gathering to read and discuss medical papers) for pharmacists, and its effectiveness was compared with that of a traditional lecture. The subjects, 29 pharmacists at Kobe University Hospital, were randomly allocated to the lecture group and TBL group. The pre-test was conducted two months before the journal club, and the post-tests were conducted immediately and one month after the journal club. There was no significant difference in the background data of the pharmacists between the lecture group and the TBL group. The score differences between the pre-test and the post-test immediately after the journal club were not significant (11.4 ± 2.3 points (mean ± SD) in the TBL group, 8.8 ± 4.2 points in the lecture group, P = 0.14). The post-test scores immediately after the journal club in the TBL group (19.6 ± 0.5 points) were significantly higher compared with those in the lecture group (17.8 ± 1.5 points) (P < 0.01), and the learning effect provided by TBL tended to be maintained one month after the TBL. In conclusion, TBL was an alternative method of the ordinal lecture and may be a useful learning method for pharmacists to read medical papers critically compared with the ordinal lecture.
Since 2007, Aozora Pharmacy has been holding a learning class twice a year for pharmacy users and community residents. A survey research was conducted on whether participation in the learning class had any effects on the awareness and behavior of the attendee at a series of learning classes on drugs and health information targeted at users of the pharmacy and community residents. Out of 187 subject attendees, responses were acquired from 91 (48.7％). The number of times of attendance was: once (24.4％), twice (23.1％), three times (6.6％), four times (2.2％), more than five times (13.2％), more than ten times (5.5％) and unknown (13.2％). For the changes in awareness and behavior, 51 people answered “Yes” (56.0％), 28 people answered “No” (30.8％) and 12 people answered “Neither” (12.1％). When the number of attendance became more than three times, the result of correlation significantly showed that those who said “Yes” to changes in awareness and behavior exceeded those that said “No”. Furthermore, a positive correlation（R2 = 0.986，P = 0.00135） was found between the number of times of attendance and the ratio of “Yes” for changes. It became clear that a continuous participation in such a learning class has influences on the health literacy of the attendee, and it was suggested that the more the number of attendance grows, the higher the effect is shown.
The purposes of our study are to carry out a trial focused on information sharing between universities and training facilities for pharmaceutical practical training with the Model Core Curriculum for Pharmacy Education −2013 version− and to clarify pharmacists’ awareness and opinion of the information sharing. We performed the trial in Gifu Municipal Hospital and Gifu Pharmaceutical University Community Pharmacy and performed a questionnaire survey for pharmacists in the facilities between December 1, 2017 and December 15, 2017. The contents of the survey were working place, experience, gender, awareness about a reflection report, etc. The response rates of “The reflection report was useful as a whole” were 52％ and 67％ in hospital and pharmacy pharmacists, respectively. The other results were as follows: “It was useful for sharing about the contents of training between facilities”, 60％ and 100％; “It was useful for sharing about evaluations of students between facilities”, 36％ and 68％; “It was useful for students to learn the representative diseases widely between facilities”, 48％ and 100％; “It was useful to complement the contents of training between facilities”, 44％ and 83％; “It was useful for pharmacists to confirm mature students after both trainings”, 32％ and 67％, respectively. In conclusion, both hospital and pharmacy pharmacists were aware of the usefulness of the reflection report, particularly for information sharing about the contents of training between facilities. Unlike pharmacy pharmacists, hospital pharmacists are not necessarily aware of its usefulness for evaluations of students, learning of the representative diseases, complementary training, and confirmation of mature students.