The role of medication history at pharmacies has increased as a means to realize improved pharmaceutical care. Furthermore, the education guidelines of clinical clerkship for pharmaceutical education were revised in 2013 to provide better clinical training. The principal aim of the new guidelines was to allow the students to experience medication management, such as medication counseling and the recording of medication histories, frequently. In these circumstances, pharmacy students should acquire, to some degree, the cardinal skills of medication management by the initiation of their clinical clerkship. In this study, we established methods to quantitively evaluate the ability of the medication management at pharmacies. Additionally, we conducted the same practice with pharmacists engaged in pharmacies for less than three years to compare their ability with that of the students. In the practice, the participants presumed the patient characteristics and disease state from a scenario and created the medication counseling phrases from a simulated prescription. Subsequently, they recorded a medication history electronically following the SOAP format. The results showed the scores of the pharmacists regarding medication counseling phrases and medication history descriptions were much higher than those of the students. In contrast, the scores of presumption skills in terms of patient characteristics and state were equivalent. To enhance clinical skills, education programs should include problem-oriented system exercises to integrate various factors of patients’ characteristics as well as to build up student knowledge. This study also suggests that the modification of an electronic medication history system might be efficacious for pharmaceutical education.
We have introduced the original milestone payment system in the cost management of clinical trials since September 2015. The milestone payment system is the installed payment in each study period, not the lump-sum payment at the start of the study. As there is no standard method for a milestone payment system, each institution set up an original payment system method. In our milestone payment system, the study periods are basically divided into three divisions: First period; beginning of dosage, 50％ payment, Second period; arriving at 1/3 dosage period, 25％ payment, and Third period; arriving at 2/3, 25％ payment.
The purpose of this study was to verify that the introduction of the milestone payment system optimizes clinical trial costs. The number of analysis cases was 136 in 42 pharmaceutical clinical trials, excluding those for medical devices and cellular and tissue-based products and dropout cases of the observational period. The number of cases that did not reach the final period was 27, costing 27.61 million yen by the milestone payment system, and 47.00 million yen by the lump-sum payment system. By the milestone payment system, the clinical trial cost was reduced by 41％. Therefore, the introduction of our original milestone payment system contributed to the optimization of clinical trial cost management.
The causes of motor vehicle accidents by elderly drivers include the ingestion of drugs that influence driving (precautionary/prohibited drugs). In this study, we investigated the status of driving and ingestion of precautionary/prohibited drugs by elderly persons living in a rural area, where the necessity of driving in daily life may be high because of limited public transportation.
The frequency of driving was “every day” for 82.3％. The number of years that the subjects wanted to continue driving was 10-14, accounting for 31.2％, and 17.0％ answered that they wanted to continue for ‘as long as possible’. Of the driver’s license holders taking drugs, 68.4％ had taken precautionary/prohibited drugs. The most frequently taken precautionary and prohibited drugs were amlodipine besylate and etizolam, respectively.
This survey suggests that many elderly driver’s license holders taking precautionary/prohibited drugs drive in the Sasayama-Tamba Area. To eliminate as many risk factors for motor vehicle accidents as possible, in addition to sufficient explanation, active intervention by pharmacists, such as proposing switching to drugs that do not influence driving, may be necessary.
In Japan, tosufloxacin has been used for the treatment of paediatric respiratory infectious diseases caused by respiratory pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae, since 2010. However, H. influenzae, a major respiratory pathogen, that shows low susceptibility to quinolones has already emerged. In this study, we encountered two lower respiratory infection cases that were suspected to have low-susceptible H. influenzae as a causative pathogen. Although these isolates were judged as “susceptible” by the in-hospital routine susceptibility test, these cases did not respond to tosufloxacin treatment and had to be treated with β-lactams. These findings strongly suggest that when using quinolones, low-susceptible strains among “susceptible strains” should be taken into account.
Aqueous and ethanolic solutions of 10-20％ aluminum (Ⅲ) chloride hexahydrate are external medicines known as hospital preparations to reduce sweat. For many years, according to some prescriptions, the aqueous solution has contained 0.4-0.8％ borax. Here, we investigated the need for ethanol or borax addition in the preparation of aluminum (Ⅲ) chloride hexahydrate solutions from the viewpoint of stability. An aqueous solution of 18.09 w/v％ AlCl3・6H2O was prepared according to the prescription of Nissan-Tamagawa Hospital, Tokyo, Japan. The solution immediately showed pH 1.9, and the pH slightly increased after the addition of 0.8 w/v％ borax. The aluminum (Ⅲ) chloride hexahydrate solution became more acidic when prepared as a rubbing alcohol solution than when prepared as an aqueous solution. The aqueous solutions that did not contain borax were stable, showing no significant fluctuation in pH nor bacterial growth for six months of storage at both 25℃ and 40℃. Based on these results, aluminum (Ⅲ) chloride hexahydrate solution can be kept for at least six months at room temperature without the addition of ethanol or borax.
This study clarifies the storage situation of drugs that require light-protection at patients’ homes, and reveals the proper storage conditions of these drugs.
We interviewed inpatients about the storage situation of drugs for light-protection. In addition, we measured light illuminance on the desktop (J), inside of a storage case (C) of the pill-shelf, inside medicine envelopes: white-color (YW), pink-color (YP) and black inside (YB), and lightproof plastic bags (S) at our prescription department.
Eighty-four percent of patients were not consciously protecting the drugs from light at home. As for the storage form of those patients, “storage in medicine envelopes / storage in non-lightproof plastic bags with a sealer or pill case / storage from medicine envelopes as is” were respectively 43, 41, and 17 percent. The illuminance of J was 696-811 lx. The illuminance of C, YW, YP, YB and S decreased to values corresponding to 6-13, 21-22, 15, 0.9, and 0.3-0.4 percent against J, respectively. We found that many patients have problems with drug storage situations.
As a result of the illuminance measurement, it was clear that storage in C and each medicine envelope have certain light protection effects. It was considered that YB might be useful as a storage condition for drugs that require light-protection, because a shielding effect of 99 percent was observed under 800 lx. These results were one indicator of the effects of exposure to light depending on the storage condition of the drug.
The number of patients hospitalized for heart failure (HF) and the mortality of HF are increasing year by year. Treatments for HF are complex, and include medical measures, rehabilitation, diet remedies, and catheter treatment. Therefore, multi-disciplinary cooperation in the form of Cardiac Rehabilitation Teams is widespread. Patients hospitalized for acute decompensated HF are at significant risk of developing acute kidney injury (AKI). As a component of the management of hospitalized patients with acute decompensated HF or congestive HF, we have started to use a check sheet that promotes the recognition of dehydration when we perform pharmaceutical interventions. There were 33 and 32 hospitalized patients with such HF in the 8 months before and after the introduction of this check sheet, respectively, and 11 and three of them, respectively, developed AKI. Thus, the frequency of AKI was reduced by using our check sheet. Therefore, we consider that such a check sheet is useful in the treatment of patients hospitalized for acute decompensated HF or congestive HF.