Effect of Pharmacist Intervention in Outpatient Clinic—Pain Evaluation for Nerve Block Patients Using Pain Vision— / 社会薬学

Pain is a common problem all over the world. A previous report estimated that the prevalence of pain is 40% in Japan. One of the roles of pharmacist is to build evidence with more patient-centered care, but less in region of pain. Our objective was to identify pharmacists’ contributions to patient care through pain-management using PainVision (PV) in an outpatient pain clinic and interventions with polypharmacy. We investigated 28 patients who underwent nerve blocks. Pain were assessed relatively and subjectively using PV and numerical analogue scale (NRS), respectively. The pharmacist intervened pre- and post-nerve block. Interventions focused on evaluations of pain, drug efficacy, complications, blood pressure, pulse rate, and oxygen saturation. Wilcoxon signed-rank test, Spearman rank correlation coefficient and Friedman test were used to analyze the data. The mean age of the patients was 77 (interquartile range 69-84) years, and 12 patients were diagnosed with zoster-associated pain. The pharmacists consulted with patients 213 times and evaluated pain 426 times. We found that the analgesic effect of nerve block were evaluated PV (70; 23-162→20; 5.0-49) and NRS (4; 2-6→1; 0-2) by pharmacist, significantly. It was significant correlation between PV and NRS (r=0.799: P<0.001). Our study showed similar results to previous studies in which doctors and nurses used PV. It is clinically valuable for pharmacists to using PV in outpatient clinics to evaluate pain. Greater roles for pharmacists in hospital outpatient department should be considered, especially pharmacist-led clinical research.

Study on Drug Release from 25 Products of NSAIDs for External Use (4 Components) Using the Franz Diffusion Cell / 医薬品情報学

Objective: An evaluation index for drug release was measured in 25 currently used non‐steroidal anti‐inflammatory drugs (NSAIDs) for external use (4 components: indomethacin, diclofenac sodium, ketoprofen, and suprofen).Methods: All release tests were performed using the Franz diffusion cell with phosphate buffered saline (PBS) as the receptor phase and an artificial membrane to maintain uniform measurement conditions.　The receptor phase was collected over time and measured using high performance liquid chromatography (HPLC) to calculate the release rate.　The measurement time points were set over 0-4 h based on clinical use.　Furthermore, the additives were compared among the products.Results: The release profile of diclofenac sodium was similar among all 8 products.　On the other hand, the release rate of IN‐E (15.0% after 4 h) from indomethacin was higher than that from the other 6 products (6.2-9.1% after 4 h).　The release rate of KE‐D (39.2% after 4 h) from ketoprofen was higher than that from the cream, KE‐C (30.6 % after 4 h).　For suprofen, the release rate of SU‐E from the cream (18.1% after 4 h) was 1.6-1.7‐times higher than that of the other 2 products (10.9-11.3 %).　No release was detected from 3 suprofen ointments.Conclusion: Differences in the additives may have been a cause of the observed differences in release over 0-4 h.　This study may serve as a useful index for pharmacists to propose and select appropriate drugs.

Pharmaceutical Students’ Awareness of Drug Abuse and Assessment of the Effects of Education / 医薬品情報学

<b>Objective: </b>In this study, we evaluated to examine the short-term educational effects for drug abuse prevention, including lectures and students’ awareness of drug abuse.<br><b>Method: </b>A questionnaire consisting of eleven items and SD method-based image survey were conducted three times, prior to and following the lectures and after the summer vacation for first-year students of the Department of Pharmacy.<br><b>Results: </b>The numbers of responses to the questionnaire surveys conducted prior to and following the summer vacation were 323 (response rate: 95.8%) and 332 (response rate: 97.9%), respectively.  When asked: “Do you think that people should be allowed to use cannabis (illegal herbal drugs) as long as they do not cause any trouble to others”, 2.8 (3.4) and 6.9 (6.6)% of students answered “Yes” after the lectures prior to the summer vacation and following it, respectively; there were both increased.  Following the summer vacation, 28.6% of students answered “Yes” to the question: “Have you ever seen or heard of people using cannabis or illegal herbal drugs ?”  A total of 2.1% of students had been “solicited to use cannabis or illegal herbal drugs”, and all of them stated that it would be “easy to obtain illegal herbal drugs”.  As the reason for drug abuse by young people, 140 students (42.2%) cited “curiosity”, and 81.6%, or 271 students, stated that they would “refuse” to use any illegal drugs even if they were asked to do so.  The results of the SD method-based image survey suggested significant changes in students’ awareness of drug abuse during the summer vacation; they had the image of little risk on drug abuse prevention following the vacation.<br><b>Conclusion: </b>The effects of learning were not maintained in some first-year students because they faced a variety of temptations during the short summer vacation and their normative consciousness and images of drug abuse easily changed.  Therefore, it is necessary to provide lectures for new students to help them acquire accurate knowledge of drug abuse, enhance their normative consciousness, and increase their self-awareness as health care professionals, develop curriculums on a continuing basis, and deploy specialists so that students with psychological problems as identified by the survey, including stress, escapism, mental weakness, and anxiety, can consult them.

Relationship between the Psychological Stress Responses and Self-Efficacy in Pharmacy Students during Hospital Practical Training / 医薬品情報学

<b>Objective: </b>Pharmacy students are considered to experience various forms of stress during long-term practical training in the 6-year pharmacy education.  This study examined relationships between psychological stress responses and self-efficacy involving 77 subjects who consented to join this study in practical training conducted at Teikyo University Hospital (2010-2011FY).<br><b>Methods: </b>This study used the Profile of Mood States (POMS) for evaluating the psychological response, and an assessment form consisted of 20 items including interpersonal relationships, contents of practical training and health/life/stress coping for self-efficacy before, during, and after the training.<br><b>Results: </b>In the POMS, only the state of ‘vigor’ showed a significant difference in a comparison among before, during, and after the training; however, no significant change was observed in other mood states.  These results suggested that the students were under mild stress during the training.  Their self-efficacy was increased after the training in all 20 items except “contacting university instructors during the training”.  The results also showed that there was an association between self-efficacy and psychological stress responses.<br><b>Conclusions: </b>It is considered important that instructors and pharmacy technicians involved in pharmacy practice should understand the levels of individual stress responses or interpersonal communication skills to utilize them for coaching and maintaining students’ mental health.

Study of Efficacy and Safety in the Administration of 400 mg of Amikacin Sulfate Administered Once Daily to Elderly Patients / 医薬品情報学

<b>Objective: </b>In previously reported comparisons of aminoglycoside antimicrobials administered once daily versus multiple administration, toxicity was found to be equal or lower while efficiency remained high.  However, there are few reports on the clinical condition of targeted elderly persons.  The objective of this study was to evaluate the once-daily dosing regimen of 400 mg of AMK involving elderly pneumonia patients aged 75 years or older with regard to clinical evaluation including the efficacy and toxicity.<br><b>Methods: </b>A survey to clinically evaluate the efficacy and toxicity of 400 mg AMK administered once daily for 30 min at 24 h intervals was carried out.  One hundred twenty-seven patients with pneumonia and who were 75 years or older at Funabashi General Hospital were targeted, with the aim of an expected clinical effect of <i>C</i>_max/MIC≥ 8-10.  Serum concentration monitoring was carried out after administration began.<br><b>Results: </b>There were 121 patients (95.3%) of controlled AMK concentration with a trough serum concentration of <10 μg/mL, which is a safe concentration range.  There were 6 patients (4.7%) where trough serum concentration in the toxic range >10 μg/mL, with an average at 15.1±5.0 μg/mL, and the average administration days were 7.5 ± 3.3 days.  Moreover, before/after AMK administration, there were 3 patients (2.4%) where CRE values increased more than a 150% over the previous values, and were evaluated as renal dysfunction.  Average trough serum concentration at that time was 3.6 ± 1.1 μg/mL, and average number of days of administration were 13 ± 1.4 days.  Patients of trough serum concentration in the toxic range >10 μg/mL were not included.  The average peak serum concentration calculated by Winter’s pharmacokinetic parameter and the 1-compartment model was 35.3 ± 8.0 μg/mL, and the average <i>C</i>_max/MIC which correlates with the AMK effect was 9.9 ± 2.2.  The treatment was effective for 83 (65.4%) of the 127 patients.<br><b>Conclusion: </b>By once-daily administration of AMK 400 mg to aged persons 75 years or older, change in trough serum concentration into a safe range and <i>C</i>_max/MIC≥ 8-10, the level at which clinical effectivity can be expected, could be achieved.  This administration method is shown to be useful in maintaining AMK in the target serum concentration range for aged persons.

Attitude Survey of Pharmacy Students before and after Long-term Practical Training, and the Evaluation of Pre-clinical Training / 社会薬学

We conducted a questionnaire survey involving 270 interns in the year 2011 at the pharmaceutical department of Teikyo University, in order to clarify pre- to post-practical training changes in: 1) the degree of pre-clinical training’s usefulness, 2) desired workplace in the future, 3) degree of satisfaction, 4) confidence degree of practical training, etc. The degree of pre-clinical training’s usefulness exceeded 80% in all training periods. Regarding the desired workplace in the future, a large proportion of students answered that they want to become a pharmacist in a pharmacy or hospital, both before and after their practical training in all training periods. Also, it was estimated that students decide their career with reference to their practical training experience. In terms of the degree of satisfaction with practical training, the proportions of those who answered “Satisfied” or “Somewhat satisfied” were: 95.1% in the 1st, 95.6% in the 2nd, and 86.1% in the 3rd periods. The confidence degree significantly increased after practical training in all periods. Because the confidence degree showed a tendency to be higher before the 3rd period of training compared to the other two periods, it was considered that students’ experience of practical training led to increased confidence degree. Regarding communication abilities, the degrees of before-after confidence degree and pre-clinical training’s usefulness were low, and, hence, it was suggested that pre-clinical training needs to be further improved regarding these areas.

Clinical efficacy of the external preparation Metronidazole in the treatment of malodor associated with advanced and recurrent breast cancer

The external preparation Metronidazole (MTZ) is reported to be useful in controlling the malodor associated with advanced and recurrent breast cancer patients. We prepared two different MTZ external preparations, a 1% MTZ Hydrophilic Ointment and a 0.8% MTZ Carbopol Gel. These preparations were then used to control malodor associated with breast cancer and the results were clinically evaluated. Malodor disappeared within 1 week of administration of either preparation and no adverse reactions were observed. These MTZ external preparations were thus found to be useful in the elimination of malodor as part of the treatment of those patients with advanced and recurrent breast cancer.