The methods for the preparation of hospital drugs (i.e., powder dilution, opening the capsule shells and tablet crushing) are not validated and vary among medical facilities. In order to explore a quick and effective preparation method for dantrolene sodium diluted powder from capsule formulation without any weight loss and to maintain acceptability in pediatric patients, the uniformity test, particle size distribution analysis, pass efficiency test (the feeding tubes patency) and sensory evaluation of the mouth feel were examined.
The diluted powder prepared by the capsule opening method has uniformity, although the recovery rate was slightly low compared to the crushing method. The crushing of whole capsules using the mill provided non-uniformity of content and variable particle size distribution. The contamination of capsule shell debris is probably part of the explanation for the non-uniformity of the contents. The powder sieved through a 100-micron screen following capsule crushing provided uniformity of contents without any loss. The results of passing tests, and administration via a feeding tube including gastrostomy were acceptable in both capsule opening and capsule crushed powder formulation. In the sensory test, the products that were screened using a 100-micron screen filter after capsule crushing had a less gritty mouth feel. These results suggest that capsule crushing and screening are validated as an alternative preparation method for dantrolene sodium diluted powder.
In this study, we succeeded in developing effective methods for dantrolene sodium diluted powder. Most hospital preparations were not validated for pediatric patients and further tests in practical use are required.
To evaluate the usefulness of the screening test of the two-step bed side examination of swallowing function, we retrospectively analyzed 145 patients who were admitted to Nagoya Memorial Hospital with aspiration pneumonia between April 2015 and March 2016. The screening of swallowing function was performed by a multidisciplinary team in October, 2015. Then, the duration of hospital stay along with the patients' characteristics, such as age, sex, and underlying diseases, the severity of pneumonia defined by the A-DROP system, laboratory data (white blood cell count, C-reactive protein level, and albumin level), results of sputum bacterial cultures, and antibiotic therapy, were compared in patients between before (group A, n = 65) and after introducing the screening test of swallowing function (group B, n = 80). Aspiration risks were categorized into 4 grades using a standard sequential screening system; high, moderate, low, and none. Initiation of the screening test of swallowing function significantly reduced the number of inpatients whose duration of stay was more than 3 weeks (group A, 45/ 65 [69.2％] versus group B, 42/ 80 [52.5％]; P < 0.05, Fisher's exact test). This finding can mainly be attributed to the proper assessment of the aspiration risk, which enabled determination of the food form and the time to start oral ingestion without any incidents or accidents, and can facilitate the rapid intervention by a speech therapist and expert nurse.
In the medical scene of drug administration via tubes, catheter-type syringes should be changed whenever sliding of the syringe plunger deteriorates. We encountered a situation where the syringe plunger sliding worsened earlier than other preparations. However, there have been no reports investigating factors that impair plunger sliding. In this report, we evaluated the grime on the plunger gasket in relationship to the force for sliding resistance of the plunger.
Prescription drugs studied included “Gaster® Tablets 20 mg” and other four drugs. The number of pixels on the image corresponded to the amount of grime. The force applied on the plunger was measured using a digital force gauge.
We observed a correlation, albeit weak (R = 0.51), between the number of pixels and the force required to move the plunger. The force and particle number values were high for “Gaster® Tablets 20 mg”. We repeated the measurements with “Gaster® D Tablets 20 mg”. Lower values were obtained for “Gaster® D tablets 20 mg”. Talc, showed higher values so that the smaller the particle sizes, the higher the contents. Conversely, low substituted hydroxypropylcellulose and anhydrous dibasic calcium phosphate, of the type present in “Gaster® Tablets 20 mg” as an additive, gave lower values.
In conclusion, the grime on gaskets is a sign that the syringes need to be changed, and the content and particle size of the talc, which was an additive agent, is one of the factors that impair syringe plunger sliding.
Tigecycline (TGC) is a glycylcycline antibiotic that arises from the cooperation of the t-butylglycylamido in position 9 of minocycline and is used to treat various bacterial infections. Side effects such as rash, itching, and other severe drug eruption have all been reported outside of Japan; however, symptomatic treatment of Japanese patients with TGC-related drug eruption is not well studied. Here, we present the first report on the symptomatic treatment of drug eruption in a TGC-treated Japanese patient. A man in his 70s with liver abscess, caused by metallo-β-lactamase producing Escherichia coli, was treated with TGC. On day 10 post-treatment, erythema accompanied by itching occurred on the back, precordium, cervix, and upper limb. As the irritation could be TGC-related, the treatment was discontinued and replaced with injectable hydrocortisone, oral fexofenadine, and topical corticosteroids. Following the symptomatic treatment, symptoms of erythema and itching showed improvement. This case report described the occurrence of drug eruption in a Japanese patient following TGC treatment was observed in Japanese patients as well, and discontinuing the TGC treatment and providing symptomatic treatment might be an effective therapy in such cases. In addition, the drug eruption caused by TGC improved at a much slower rate after discontinuing the respective treatments.
Treatment for chronic hepatitis C virus (HCV) infection has been developed worldwide with all-oral treatment gaining the attention of not only medical staff, but also patients recently. The therapy with daclatasvir and asunaprevir is a first interferon-free regimen for patients with HCV approved in Japan. This therapy demonstrates marked antiviral effects in patients without NS5A and NS3 resistance-associated variants. However, adverse events leading to the discontinuation of treatment are reported. Therefore, we researched the characteristics of patients retrospectively in order to predict the development of adverse event symptoms.
A retrospective analysis was performed on 39 patients who were prescribed daclatasvir and asunaprevir in the University of Miyazaki Hospital between September 2014 and August 2015. We focused on liver injury as adverse events.
Liver injury was assessed with ALT increase. The physical constitution of patients was not related to the development of liver injury. To analyze patient background at the onset of treatment, the serum albumin level of patients with ALT increase was significantly lower than that of patients without ALT increase. These results suggest that the serum albumin level at the onset of treatment is a predictive factor of liver injury in the therapy with daclatasvir and asunaprevir.
A Japanese guideline for the safe handling of anticancer drugs recommends a closed system drug transfer device (CSTD). We gradually introduced the PhaSealTM system from preparation to administration of all anticancer drugs to inpatients on holidays as well as weekdays. We evaluated whether the CSTD handling of 36 pharmacists was appropriate or not and also retrospectively compared outcomes before and after the introduction of CSTD. In nine pharmacists who had more than 4 items of an inappropriate handling of CSTD, the median noncompliance ratio after re-training was significantly improved from 4 to 1 items (P = 0.008). We subsequently administered a questionnaire for 36 pharmacists. The customer satisfaction analysis indicated two issues for improvement: anxiety over appropriate preparation on the double audit system of pharmacists and anxiety over miss priming after liquid sensor. On the other hand, the median introduction ratio per day of CSTD between February and April 2016 and between September and October 2016 was significantly increased on weekdays and holidays (P < 0.001 and P < 0.001, respectively). In addition, the median preparation time per day between February and April 2016 and between September and October 2016 was not significantly increased on weekdays and holidays (P = 0.514 and P = 0.423, respectively). These results suggest that our training for pharmacists contributed to an appropriate handling of CSTD, resulting in the safe handling of all anticancer drugs to inpatients on weekdays as well as holidays and the risk management of pharmacists without increase of the preparation time.
Recently, the use of complementary alternative medicine (CAM) has been increasing in Japan. There are few reports on the use of CAM such as health foods and supplements in cancer patients despite the high interest in it. In this study, we performed a retrospective research to elucidate factors influencing the use of health foods and supplements in cancer patients. The objectives were inpatients diagnosed with cancer at Gifu Municipal Hospital between October 1, 2014 and March 31, 2015. Survey items were age, gender, information on cancer, history of chemotherapy and operation, prescription drugs, and health foods and supplements at admission. A multiple logistic regression analysis was conducted to evaluate the influence of survey items on the use of health foods and supplements. Statistical significance was set at P < 0.05. Patients using health foods and supplements were 5.8％ (59/1,012). The use rate of health foods and supplements is significantly high in recurrent patients [odds ratio (OR), 4.83; 95％ confidence interval (CI), 2.55-9.15; P < 0.001] and is significantly low in patients receiving operation [OR, 0.363; 95％ CI, 0.197-0.667; P = 0.001]. In this study, it was clarified that recurrent cancer patients more frequently use health foods and supplements, and that cancer patients undergoing surgery use them less frequently.