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1.
J Pharm Health Care Sci ; 10(1): 34, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956739

RESUMO

BACKGROUND: Guideline-directed medical therapy (GDMT) is important in heart failure management; however, polypharmacy itself may impact heart failure. Although measures against polypharmacy are needed, current discussion on unilateral drug tapering (including the drugs that should be tapered) is insufficient. In this study, we investigated the relationship between the number of prescribed GDMT drugs and prognosis in patients with heart failure. METHODS: In this single-centre retrospective study, 3,146 eligible patients with heart failure were included and divided into four groups based on the median number of prescribed GDMT drugs and the median number of drugs not included in the GDMT (ni-GDMT) at the time of hospital discharge. The definition of GDMT was based on various Japanese guidelines. The primary outcome was all-cause mortality within 3 years of hospital discharge. RESULTS: A total of 252 deaths were observed during the 3-year follow-up period. Kaplan-Meier analysis revealed that groups with GDMT drug count ≥ 5 and ni-GDMT drug count < 4 had the lowest mortality, and those with GDMT drug count < 5 and ni-GDMT drug count ≥ 4 had the highest mortality (log-rank, P < 0.001). Cox regression analysis revealed a significant association between ni-GDMT drug count and all-cause mortality, even after adjustment for number of GDMT medications, age, male, left ventricular ejection function < 40%, hemoglobin, albumin levels, and estimated glomerular filtration rate [HR = 1.06 (95% CI: 1.01-1.11), P = 0.020]. Conversely, the GDMT drug count was not associated with increased mortality rates. CONCLUSIONS: The ni-GDMT drug count was significantly associated with 3-year mortality in patients with heart failure. Conversely, the GDMT drug count did not worsen the prognosis. Polypharmacy measures should consider ni-GDMT drug quantity to improve the prognosis and outcomes in patients with heart failure.

2.
J Pharm Health Care Sci ; 10(1): 24, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769584

RESUMO

BACKGROUND: Pimobendan reportedly improves the subjective symptoms of heart failure. However, evidence of improved prognosis is lacking. This study aimed to determine whether reinforcing guideline-directed medical therapy (GDMT) improved rehospitalization rates for worsening heart failure in patients administered pimobendan. METHODS: A total of 175 patients with heart failure who were urgently admitted to our hospital for worsening heart failure and who received pimobendan between January 2015 and February 2022 were included. Of the 175 patients, 44 were excluded because of in-hospital death at the time of pimobendan induction. The remaining 131 patients were divided into two groups, the reduced ejection fraction (rEF) (n = 93) and non-rEF (n = 38) groups, and further divided into the GDMT-reinforced and non-reinforced groups. RESULTS: In patients with rEF, the rate of rehospitalization for heart failure was significantly lower in the GDMT-reinforced group than in the non-reinforced group (log-rank test, P = .04). However, the same trend was not observed in the non-rEF group. CONCLUSIONS: Reinforcing GDMT may reduce the heart failure rehospitalization rate in patients with pimobendan administration and rEF. However, multicenter collaborative research is needed. TRIAL REGISTRATION: IRB Approval by the Nippon Medical School Hospital Ethics Committee B-2021-433 (April 10, 2023).

3.
J Pharm Health Care Sci ; 9(1): 3, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36721190

RESUMO

BACKGROUND: We aimed to evaluate the factors associated with baloxavir prescription in Japanese hospitals using a health insurance claim-based database (MDV analyzer), during the 2018/2019 and 2019/2020 influenza seasons. The MDV analyzer contains anonymized claims data from approximately 420 Diagnosis Procedure Combination hospitals, and does not contain data from clinics. METHODS: Data were collected for influenza patients treated with anti-influenza drugs during the 2018/2019 and 2019/2020 influenza seasons. Multivariate analysis was used to identify factors associated with baloxavir prescription. RESULTS: During the study period, 322,063 influenza patients were included for analyses. In multivariate analysis, children, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription. Compared to elderly patients, the adjusted odds ratio (OR) for baloxavir prescription was 0.612 (95% confidence interval (CI), 0.587-0.637) in children aged 6-11 years, and 0.119 (95% CI, 0.111-0.128) in children aged 0-5 years. Compared to small hospitals (bed capacity, 20-299), the adjusted OR for baloxavir prescription was 0.559 (95% CI, 0.540-0.578) in large hospitals (bed capacity, ≥ 500). CONCLUSION: Children, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription.

4.
J Pharm Health Care Sci ; 8(1): 13, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505446

RESUMO

BACKGROUND: Acetaminophen-induced hypotension has been reported in critically ill patients; however, it remains unclear whether mannitol, present as a stabilizing compound in acetaminophen formulations, affects hemodynamic changes. The objectives of this study were to clarify the direct effect of acetaminophen on blood pressure by comparing blood pressure changes after acetaminophen and intravenous immunoglobulin (IVIG) administration, both containing mannitol, in patients with sepsis and understand the risk factors for reduced blood pressure following acetaminophen administration. METHODS: This was a retrospective cohort study. Adult patients who were diagnosed with sepsis at Nippon Medical School Hospital, and who were undergoing continuous arterial blood pressure measurement and received intravenous acetaminophen or IVIG, were included. RESULTS: Overall, 185 patients were included, with 92 patients in the IVIG group and 93 in the acetaminophen group. The incidence of hypotension was 36.9% in the IVIG group (34 of 92 patients) and 58.0% in the acetaminophen group (54 of 93 patients) (OR = 8.26, p = 0.004). In a propensity score-matched cohort, 80 matched patients were selected. The incidence of hypotension was 37.5% in the IVIG group (15 of 40 patients) and 67.5% in the acetaminophen group (27 of 40 patients) (OR = 7.21, p = 0.007). CONCLUSIONS: Acetaminophen induced substantially greater hypotension than IVIG in patients with sepsis, with both containing mannitol. Further studies are needed to clarify the effects on hemodynamics of mannitol contained in acetaminophen formulations.

5.
Gan To Kagaku Ryoho ; 48(9): 1145-1151, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34521793

RESUMO

Although cytokine therapy has been a common drug therapy for renal cell carcinoma for long since the 1980s, the evidence for the rationale of this therapy has been limited. Currently, 7 molecular targeted drugs(ie, sorafenib, sunitinib, axitinib, pazopanib, cabozantinib, everolimus, and temsirolimus)are available in Japan. Among these molecular targeted drugs, we clinically evaluated 5 tyrosine kinase inhibitors(ie, sorafenib, sunitinib, axitinib, pazopanib, and cabozantinib)in terms of their effects on blood pressure and the response rate by Bayes-mixed treatment comparison meta-analysis(Bayes- MTC analysis)to develop the decision-making model for the optimal treatment selection. Cabozantinib and axitinib exerted the greatest effect on blood pressure, and their probability of affecting blood pressure was 1.7 to 2 times higher than the probability of sunitinib. Among the 5 tyrosine kinase inhibitors, the effects of sunitinib and sorafenib on blood pressure were small. According to the results of clinical trials in Japan, hypertension was observed in 27.5% of patients treated with sorafenib, 51.0% with sunitinib, and 75.7% with axitinib. Our analysis also showed similar results. This study demonstrated that Bayes-MTC analysis is a useful tool enabling not only direct evaluation but also indirect evaluation.


Assuntos
Antineoplásicos , Carcinoma de Células Renais , Neoplasias Renais , Antineoplásicos/uso terapêutico , Teorema de Bayes , Pressão Sanguínea , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Neoplasias Renais/tratamento farmacológico , Recidiva Local de Neoplasia , Inibidores de Proteínas Quinases/uso terapêutico
6.
J Arrhythm ; 36(6): 1032-1038, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33335621

RESUMO

BACKGROUND: Information on apixaban anticoagulant activity is required to prevent major bleeding or thrombosis during its use. METHODS: We enrolled 194 patients with nonvalvular atrial fibrillation (NVAF) in whom warfarin was replaced with apixaban: 105 (54.1%) received the standard dose of apixaban (5 mg twice daily [BID]; 5 mg group) and 89 (45.9%) received a reduced dose (2.5 mg BID; 2.5 mg group). Multiple regression analysis was performed to predict the prothrombin time of apixaban (PTa) based on factors including age, body weight (BW), serum creatinine, and CHA2DS2-VASc score. RESULTS: PTa and PT of warfarin (PTw) were significantly correlated in both groups (correlation coefficient R = 0.239 [P = .014] in the 5 mg group; R = 0.248 [P = .019] in the 2.5 mg group). PTa in the 5 mg group was predicted as follows: 16.952-0.036 × BW +0.299 × CHA2DS2-VASc score (P < .0004; R = 0.378). However, in the 2.5 mg group, PTa could not be predicted. The mean of the predicted and measured PTa values in the 5 mg group was 15.6 s, which was similar to the mean measured PTa of 15.5 s in the 2.5 mg group. CONCLUSIONS: PT can be predicted by a formula including simple clinical parameters in patients receiving the standard dose of apixaban. This simple predictive formula may help to stratify bleeding and thrombosis risks in patients treated with apixaban.

7.
J Nippon Med Sch ; 87(2): 66-72, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31611508

RESUMO

BACKGROUND: We investigated the incidence of acute kidney injury (AKI) and risk factors associated with vancomycin (VAN) and piperacillin-tazobactam (TZP) combination therapy in non-intensive care unit (ICU) and ICU settings. METHODS: In this single-center retrospective cohort study, adults who received VAN for ≥48 h during the period from 1 January 2016 through 31 December 2017 were included. The primary endpoint was incidence of AKI. RESULTS: Data from 593 adults were analyzed. The incidence of AKI was 10.6% overall, 8.0% in the non-TZP group, and 19.8% in the TZP group. In univariate analysis, the odds ratio (OR) for AKI was higher in the TZP group than in the non-TZP group (2.84, 95% CI = 1.64-4.90). In both the non-ICU and ICU settings, the OR for AKI was higher in the TZP group than in the non-TZP group (non-ICU: OR = 3.04, 95% CI = 1.52-6.09; ICU: OR = 2.51, 95% CI = 1.03-6.08). Furthermore, in propensity score analysis, the OR for AKI was higher in the TZP group than in the non-TZP group (OR = 2.81, 95% CI = 1.52-5.17). In both the non-ICU and ICU settings, the OR for AKI was higher in the TZP group than in the non-TZP group (non-ICU: OR = 2.57, 95% CI = 1.17-5.64; ICU: OR = 3.51, 95% CI = 1.05-11.6). CONCLUSIONS: Combined use of TZP in patients receiving VAN increased AKI incidence in non-ICU and ICU settings.


Assuntos
Injúria Renal Aguda/etiologia , Cuidados Críticos , Combinação Piperacilina e Tazobactam/efeitos adversos , Vancomicina/efeitos adversos , Estudos de Coortes , Humanos , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco
8.
J Palliat Med ; 23(3): 359-367, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31580790

RESUMO

Background: The number of hospital-based palliative care consultation teams (PCCTs) has increased in Japan, and quality improvement (QI) of PCCTs is an issue. The Japanese Society for Palliative Medicine is building a framework for continuous QI of PCCT activities. Objective: The objective of this study was to develop a program to support QI for PCCTs, and to describe the initial experience with the program. Design: The report details the development of a self-check program, followed by a one-year follow-up observational survey. Methods: We developed a self-check program using the concept of the Plan-Do-Check-Act (PDCA) cycle and a multidisciplinary expert panel. A total of 114 PCCTs entered the program in the first year. Results: We developed three forms for the CHECK, ACT-PLAN, and DO phases aligned with the PDCA cycle. The forms consisted of 34 items across 8 domains. A total of 83 PCCTs (729 members) returned the CHECK, ACT-PLAN forms, and 41 PCCTs returned the DO forms after one year. Overall, 213 high priority issues were identified in the ACT phase. The issues of many PCCTs were "Sharing goals of care is inadequate within the PCCT (33%)" and "Sharing goals of care is inadequate between patient/family or primary team and the PCCT (28%)." Improvements in identified issues were: "achieved" 23% and "almost achieved" 48% after one year. Conclusions: We developed a self-check program to support QI efforts for hospital-based PCCTs. The priority issues among PCCTs and improvement goals with examples were identified. These results will support ongoing efforts to develop a continuous improvement model for QI of PCCTs.


Assuntos
Medicina Paliativa , Melhoria de Qualidade , Hospitais , Humanos , Japão , Cuidados Paliativos , Equipe de Assistência ao Paciente , Encaminhamento e Consulta
9.
J Pharm Pharmacol ; 71(5): 746-752, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30515815

RESUMO

OBJECTIVES: As commercially available pregabalin preparations are limited to oral administration, it is impossible to use it as an adjuvant analgesic for neuropathic cancer-related pain in terminally ill cancer patients with oral feeding difficulties. The objective of this study was to develop a pregabalin suppository to be available at hospitals. METHODS: Pregabalin suppositories were prepared using bases comprising six different compositions of Witepsol H-15, Witepsol S-55, and Witepsol E-75. The suppository release test and stability test were performed in vitro. The pharmacokinetics and pharmacodynamics of the suppositories were assessed in rats. KEY FINDINGS: In the in vitro releasing test, the pregabalin suppositories with H-15, H-15 : S-55 = 1 : 1, H-15 : S-55 = 2 : 1, H-15 : S-55 = 1 : 2 released approximately 100% of the pregabalin within 180 min. Among these pregabalin suppositories, only the suppository with H-15 : S-55 = 2 : 1 demonstrated an equivalent AUC0-∞ with the oral administration group. Consistent with the results of the pharmacokinetic study, the pregabalin suppository with H-15 : S-55 = 2 : 1 exhibited antinociceptive effects. In addition, the pregabalin suppository with H-15 : S-55 = 2 : 1 was stable for 12 weeks when refrigerated with light shielding. CONCLUSIONS: The pregabalin suppositories prepared in this study may be applicable for pain control for terminally cancer ill patients with oral feeding difficulties.


Assuntos
Analgésicos/administração & dosagem , Analgésicos/farmacocinética , Pregabalina/administração & dosagem , Pregabalina/farmacocinética , Administração Oral , Administração Retal , Analgésicos/sangue , Animais , Sistemas de Liberação de Medicamentos/métodos , Liberação Controlada de Fármacos , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Masculino , Neuralgia/tratamento farmacológico , Pregabalina/sangue , Ratos , Ratos Wistar , Supositórios
10.
J Nippon Med Sch ; 84(6): 291-293, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29279560

RESUMO

We report a case of increased prothrombin time-international normalized ratio (PT-INR) when crizotinib and warfarin were co-administered. A 74-year-old Japanese woman presented to the hospital with dyspnea, and was diagnosed with anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC). Three years after surgical resection of the tumor, the patient started crizotinib because of the recurrence of NSCLC. She received 2 mg/day warfarin due to a medical history of cerebral infarction and chronic atrial fibrillation. Before crizotinib initiation, the patient's PT-INR was 2.60. After 7 days of daily doses of crizotinib, the patient's PT-INR increased to 3.65. This case report provides the first evidence of a drug interaction between crizotinib and warfarin.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Coeficiente Internacional Normatizado , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Tempo de Protrombina , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Idoso , Carcinoma Pulmonar de Células não Pequenas/sangue , Crizotinibe , Interações Medicamentosas , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/sangue
11.
Artigo em Inglês | MEDLINE | ID: mdl-27826454

RESUMO

BACKGROUND: Pregabalin is recommended as an adjuvant analgesic for neuropathic cancer-related pain, and may be taken at all steps of the World Health Organization analgesic ladder. However, unlike opioids, pregabalin treatments are limited to an oral administration route. If patients have oral feeding difficulties, it is not possible to administer any drug as an adjuvant analgesic for neuropathic cancer-related pain. Therefore, the aim of the present study was to clarify the problems of pain control after pregabalin discontinuation in terminally ill cancer patients. METHODS: Our subjects comprised cancer patients who died during their hospital stay and were referred between April 2013 and October 2015 to the palliative care team of the 899-bed Cancer Hospital at the Nippon Medical School Hospital in Japan. The medical records of each patient were retrospectively reviewed, and patient characteristics were recorded. RESULTS: We obtained data on 183 patients during the study period. Thirty-eight (20.8 %) patients were treated with pregabalin. Thirty-three (86.8 %) out of 38 patients were prescribed pregabalin for neuropathic cancer-related pain. The incidence of bony metastases was significantly higher in patients administered pregabalin than in those not taking the drug (non-pregabalin group 32.4 % vs pregabalin group 57.9 %). Pregabalin was ultimately discontinued in all patients, with the main reason being oral feeding difficulties (81.6 %). After the discontinuation of pregabalin, the amount of opioid drugs administered was increased in 56.5 % of patients with oral feeding difficulties. CONCLUSION: Our results demonstrated that the amount of opioid drugs administered was increased in more than 50 % of patients following the discontinuation of pregabalin, and was repeatedly increased for some patients. A new administration route is required for cancer patients unable to take oral medication. TRIAL REGISTRATION: UMIN000022507. May 28, 2016 retrospectively registered.

12.
Synapse ; 69(3): 166-71, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25559075

RESUMO

Previous studies have shown that sigma-1 receptor chaperone (Sig-1R) ligands can regulate pain-related behaviors, and Sig-1R itself can regulate µ-opioid receptor functions as well as signal transduction. Even though (±)-pentazocine has been used clinically for the treatment of pain through opioid receptors, (+)-pentazocine is known to be a selective Sig-1R agonist. To the best of our knowledge, there is no information available regarding the involvement of Sig-1R agonistic action in the antinociceptive effects of (±)-pentazocine. Therefore, the present study was designed to investigate the effects of (+)-pentazocine on the antinociceptive effects of (-)-pentazocine in mice. Both and (-)-pentazocine induced biphasic antinociceptive effects as measured by the warm-plate test. The early phase, but not the delayed phase, of the antinociceptive effects induced by (-)-pentazocine, which are mediated by the activation of µ-opioid receptors, were suppressed by pretreatment with (+)-pentazocine. These results suggest that the innate antinociceptive action of (±)-pentazocine could be marginally reduced by the effects of (+)-pentazocine, but (+)-pentazocine can suppress the antinociceptive effects of (-)-pentazocine at certain time points.


Assuntos
Analgésicos Opioides/farmacologia , Nociceptividade/efeitos dos fármacos , Pentazocina/farmacologia , Analgésicos Opioides/química , Animais , Células CHO , Cricetinae , Cricetulus , Isomerismo , Masculino , Camundongos , Pentazocina/química
13.
Addict Biol ; 20(4): 724-32, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25065832

RESUMO

Most opioid receptor agonists have abuse potential, and the rewarding effects of opioids can be reduced in the presence of pain. While each of the enantiomers of pentazocine has a differential pharmacologic profile, (±)-pentazocine has been used clinically for the treatment of pain. However, little information is available regarding which components of pentazocine are associated with its rewarding effects, and whether the (±)-pentazocine-induced rewarding effects can be suppressed under pain. Therefore, the present study was performed to investigate the effects of pain on the acquisition of the rewarding effects of (±)-pentazocine, and to examine the mechanism of the rewarding effects of (±)-pentazocine using the conditioned place preference paradigm. (±)-Pentazocine and (-)-pentazocine, but not (+)-pentazocine, produced significant rewarding effects. Even though the rewarding effects induced by (±)-pentazocine were significantly suppressed under pain induced by formalin, accompanied by increase of preprodynorphin mRNA levels in the nucleus accumbens, a high dose of (±)-pentazocine produced significant rewarding effects under pain. In the normal condition, (±)-pentazocine-induced rewarding effects were blocked by a low dose of naloxone, whereas the rewarding effects induced by high doses of pentazocine under pain were suppressed by naltrindole (a δ-opioid receptor antagonist). Interestingly, (±)-pentazocine did not significantly affect dopamine levels in the nucleus accumbens. These findings suggest that the rewarding effects of (-)-pentazocine may contribute to the abuse potential of (±)-pentazocine through µ- as well as δ-opioid receptors, without robust activation of the mesolimbic dopaminergic system. We also found that neural adaptations can reduce the abuse potential of (±)-pentazocine under pain.


Assuntos
Analgésicos Opioides/farmacologia , Dor/fisiopatologia , Pentazocina/farmacologia , Receptores Opioides delta/fisiologia , Receptores Opioides mu/fisiologia , Recompensa , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/química , Análise de Variância , Animais , Condicionamento Psicológico/efeitos dos fármacos , Relação Dose-Resposta a Droga , Isomerismo , Masculino , Naloxona/farmacologia , Naltrexona/análogos & derivados , Naltrexona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Núcleo Accumbens/efeitos dos fármacos , Pentazocina/administração & dosagem , Pentazocina/química , Ratos , Receptores Opioides delta/efeitos dos fármacos , Receptores Opioides mu/efeitos dos fármacos
14.
J Nippon Med Sch ; 81(1): 53-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24614397

RESUMO

This study was designed to determine whether genetic differences influence the rewarding effects of nicotine in 4 inbred strains of mice (DBA/2, BALB/c, C3H, and C57BL/6). Nicotine (subcutaneous) induced a place preference in DBA/2 and BALB/c mice but a place aversion in C57BL/6 mice. A low dose of nicotine produced a significant place preference, whereas a high dose of nicotine produced place aversion in C3H mice. These effects were completely reversed by the nicotinic receptor antagonist mecamylamine. These results strongly suggest that a conditioned state, such as rewarding effects or aversive effects, can be influenced by genetic background.


Assuntos
Camundongos Endogâmicos/genética , Nicotina/farmacologia , Animais , Comportamento Animal/efeitos dos fármacos , Condicionamento Psicológico/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Tabagismo/genética
15.
J Pain Symptom Manage ; 47(3): 588-93, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24018207

RESUMO

CONTEXT: The role of pharmacists in palliative care has become more important now that they are able to provide medication review, patient education, and advice to physicians about a patient's pharmacotherapy. However, there is little known about pharmacists' activity on palliative care teams. OBJECTIVES: The present study aimed to examine the clinical, educational, and research activities of pharmacists on palliative care teams and pharmacist-perceived contributions to a palliative care team or why they could not contribute. METHODS: We sent 397 questionnaires to designated cancer hospitals, and 304 responses were analyzed (response rate 77%). RESULTS: Of the pharmacists surveyed, 79% and 94% reported attending ward rounds and conferences, respectively. Half of the pharmacists provided information/suggestions to the team about pharmacology, pharmaceutical production, managing adverse effects, drug interactions, and/or rotation of drugs. In addition, 80% of the pharmacists organized a multidisciplinary conference on palliative care education. Furthermore, 60% of the pharmacists reported on palliative care research to a scientific society. Seventy percent of the pharmacists reported some level of contribution to a palliative care team, whereas 16% reported that they did not contribute, with the main perceived reasons for no contribution listed as insufficient time (90%) and/or staff (68%). CONCLUSION: In Japan, pharmacists exercise a moderate level of clinical activity on palliative care teams. Many pharmacists believe that they contribute to such a team and generally place more emphasis on their educational and research roles compared with clinical work.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Farmacêuticos/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , Congressos como Assunto/estatística & dados numéricos , Educação Profissionalizante/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Cuidados Paliativos/métodos , Papel Profissional , Inquéritos e Questionários
16.
J Nippon Med Sch ; 80(1): 34-41, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23470804

RESUMO

This study investigated whether ethanol combined with low doses of morphine produces rewarding effects in rats. Ethanol (0.075-1.2 g/kg, intraperitoneal [i.p.]) alone did not induce place preference. A moderate dose (1 mg/kg, s.c.), but not a low dose (0.1 mg/kg), of morphine induced a significant place preference. The combination of ethanol (0.075-0.6 g/kg, i.p.) and 0.1 mg/kg of morphine, as well as low doses of morphine (0.03-0.1 mg/kg, subcutaneous [s.c.]) combined with ethanol (0.3 g/kg, i.p.), induced a significant place preference. The combined effect of ethanol and morphine was significantly attenuated by naloxone (0.3 mg/kg, s.c.), naltrindole (1.0 mg/kg, s.c.), or long-term administration of the dopamine D1 receptor antagonist SCH23390 (1.0 mg/kg/day, s.c.). These results suggest that the rewarding effect induced by ethanol and a low dose of morphine is mediated by activation of the central opioidergic and dopaminergic systems through dopamine D1 receptors.


Assuntos
Etanol/farmacologia , Morfina/farmacologia , Receptores de Dopamina D1/fisiologia , Recompensa , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacologia , Animais , Benzazepinas/administração & dosagem , Benzazepinas/farmacologia , Depressores do Sistema Nervoso Central/administração & dosagem , Depressores do Sistema Nervoso Central/farmacologia , Condicionamento Psicológico/efeitos dos fármacos , Condicionamento Psicológico/fisiologia , Relação Dose-Resposta a Droga , Etanol/administração & dosagem , Injeções Intraperitoneais , Injeções Subcutâneas , Masculino , Morfina/administração & dosagem , Naloxona/administração & dosagem , Naloxona/farmacologia , Naltrexona/administração & dosagem , Naltrexona/análogos & derivados , Naltrexona/farmacologia , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/farmacologia , Ratos , Ratos Sprague-Dawley , Receptores de Dopamina D1/antagonistas & inibidores
17.
J Nippon Med Sch ; 80(6): 481-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24419723

RESUMO

Preventing infectious diseases in patients with cancer receiving palliative care is extremely important. However, little is known about the factors causing infection in these patients. The aim of this study was to clarify the factors contributing to infection in patients with cancer receiving palliative care. The medical records of each patient were reviewed, and patient characteristics were recorded. Factors that correlated significantly with infection, as revealed by univariate analysis, were performance status, the fall risk assessment score, and venous catheters. Our present study provides further evidence that the fall risk assessment score is a risk factor for infection. Critical infections might be prevented in patients with cancer receiving palliative care by monitoring the above 3 factors.


Assuntos
Infecções/complicações , Infecções/epidemiologia , Neoplasias/complicações , Neoplasias/epidemiologia , Cuidados Paliativos , Idoso , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco
18.
Gan To Kagaku Ryoho ; 37(11): 2093-100, 2010 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-21084806

RESUMO

Carboplatin plus weekly paclitaxel (CBDCA/wPTX) and cisplatin plus docetaxel (CDDP/DTX) are the standard regimens used in the first-line treatment of advanced non-small cell lung carcinoma (NSCLC), with no significant difference in efficacy between the two. However, because there has been no study of the cost-effectiveness of CBDCA/wPTX versus CDDP/DTX to data, we compared these two regimens in the present study. Expected costs were calculated based on data from patients with Stage III b/IV NSCLC who were treated with either CBDCA/wPTX or CDDP/DTX in the Nippon Medical School Hospital. Efficacy (1-year survival rate) was determined by pooled analysis of studies extracted from the database. The cost-effectiveness ratio was calculated from expected costs and 1-year survival rates for both the CBDCA/wPTX and CDDP/DTX regimens. The expected costs per patient of the CBDCA/wPTX and CDDP/DTX regimens were ¥2, 847, 514 and ¥3, 513, 195, respectively, with 1-year survival rates of 38.6% and 42.5%, respectively. Thus, the cost-effectiveness ratio for the CBDCA/wPTX and CDDP/DTX regimens is ¥6, 750, 863 and ¥8, 329, 054, respectively. These findings clearly suggest that, CBDCA/wPTX is a more cost-effective regimen than CDDP/DTX.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Antineoplásicos/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Carboplatina/administração & dosagem , Cisplatino/administração & dosagem , Análise Custo-Benefício , Docetaxel , Humanos , Paclitaxel/administração & dosagem , Taxoides/administração & dosagem
19.
J Palliat Med ; 13(6): 733-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20597706

RESUMO

PURPOSE: The role of the community pharmacy in palliative care may become increasingly important in Japan. There has been however no investigation to date of community pharmacies in Japan that takes into account their role in enabling palliative care in the home. The aims of the present study were thus to evaluate (1) the availability of narcotics through community pharmacies and the experience of pharmacists in prescribing narcotics; (2) availability of patient counseling provided by pharmacists; (3) pharmacist-perceived difficulties in treating cancer patients with narcotics; and (4) useful strategies to make narcotics more easily available to patients. METHODS: We sent 3000 questionnaires to community pharmacies as a representative national sample, and 1036 responses were analyzed (response rate: 34.5%). RESULTS: We found that 77% of community pharmacies had a narcotics retailer license, and that approximately 50% received prescriptions for and prepared narcotics each month. Approximately 70% of community pharmacies received however only 3 narcotics prescriptions each month. Half of the pharmacists reported that they did not counsel patients, primarily because they lacked information about the patient. The most common area reported by pharmacists as being extremely difficult was communicating with terminally ill cancer patients. To make narcotics more easily available to patients, 76% of community pharmacists felt it was important to be able to return narcotics to wholesalers. CONCLUSION: The present study suggests that there are many problems in community pharmacy that need to be addressed to improve access to palliative care in the home, including (1) increased sharing of patient information; (2) increasing community pharmacists' communication skills; and (3) changing current regulations regarding the distribution of narcotics. If these issues are addressed, palliative care in the home could become more widely accepted.


Assuntos
Serviços Comunitários de Farmácia , Pesquisas sobre Atenção à Saúde , Cuidados Paliativos , Papel Profissional , Feminino , Humanos , Japão , Masculino , Antagonistas de Entorpecentes/uso terapêutico , Neoplasias/tratamento farmacológico
20.
Gan To Kagaku Ryoho ; 36(13): 2599-603, 2009 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-20009462

RESUMO

The present study was undertaken to determine the pharmacoeconomics of switching from sustained-release morphine tablet to matrix type (MT) of transdermal fontanel or sustained-release Oxycodone tablet. Cost-effective analysis was performed using a simulation model along with decision analysis. The analysis was done from the payer's perspective. The cost-effective ratio/patient of transdermal MT fontanel (22, 539 yen)was lower than that of sustained -release Oxycodone tablet (23, 630 yen), although a sensitivity analysis could not indicate that this result was reliable. These results suggest the possibility that transdermal MT fontanel was much less expensive than a sustained-release Oxycodone tablet.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/economia , Fentanila/administração & dosagem , Fentanila/economia , Morfina/administração & dosagem , Morfina/economia , Oxicodona/administração & dosagem , Oxicodona/economia , Administração Cutânea , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Árvores de Decisões , Preparações de Ação Retardada , Humanos , Japão , Comprimidos
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