INTRODUCTION: Health care educators are challenged with helping clinicians develop competencies beyond their foundational training. In health care systems where continuing professional development is not integral to practice, clinicians may have few opportunities. We describe the design, implementation, and evaluation of a professional development program in patient safety for Japanese clinical educators to acquire simulation instructional skills and become Patient Safety Champions at their organizations. METHODS: Mixed methods were used in a longitudinal pre/post study design. The Kirkpatrick evaluation model was used to evaluate outcomes of a workshop, overall program, on-site training experiences, and impact as Patient Safety Champions. Self-assessment data on skills and knowledge of patient safety, simulation instructional methods, interprofessional collaboration, and leadership were collected and analyzed. RESULTS: Eighty-nine percent of participants facilitated on-site patient safety training within 6 months of workshop completion. Skills and knowledge improvement were observed immediately postworkshop in four categories: patient safety, simulation instructional methods, interprofessional collaboration and communication, and leadership as a patient safety champion. Skills and knowledge increased at 6 months after facilitation of on-site safety training. Program mean satisfaction scores ranged from 84% to 92%. Mean Patient Safety Champion in-facility evaluations were 4.2 to 4.7 on a 5-point scale. DISCUSSION: High levels of knowledge, skill retention, and behavior change are attributed to goal setting, outcome-oriented pedagogy, and reflective sessions. The Patient Safety Champion model and experiential learning approach gave Japanese clinical educators in medicine, nursing, and pharmacy an opportunity to learn from each other in simulations reflecting the practice environment.

Although axitinib shows a good objective response rate and acceptable tolerability for advanced renal cell carcinoma, substantial differences in drug concentrations among individuals have hampered the reliable administration of the drug in a neoadjuvant setting. This study aimed to evaluate the relationship between axitinib pharmacokinetics and clinical efficacy in patients with advanced renal cell carcinoma treated in a neoadjuvant setting. We retrospectively reviewed 16 patients who underwent neoadjuvant axitinib treatment from prospective phase 2 study cohorts treated with axitinib and assessed whether the drug concentration was associated with clinical efficacy for primary tumors of advanced metastatic/oligometastatic clear cell renal cell carcinoma. Axitinib was administered orally at a starting dose of 5 mg twice daily for 2 months in principle before the operation, and the axitinib pharmacokinetics were examined. Best response, reduction rate, adverse events (AEs), and surgical complication were assessed. Four patients (25.0%) showed a partial response, and 12 (75.0%) had stable disease, with a mean reduction rate of 22.8%. No progressive disease was noted, and 9 of the 16 patinets (56.3%) showed downstaging. The trough level of axitinib significantly correlated with the objective response rate (P = .0052) and best tumor reduction (P = .0128). All AEs could be safely managed until termination of the dosing period. With respect to perioperative complications, grade 2 anemia was observed. Neoadjuvant axitinib treatment showed acceptable antitumor activity and safety profile for advanced renal cell carcinoma. The pharmacokinetics of neoadjuvant axitinib influenced the efficacy in patients with advanced renal cell carcinoma.

In order to examine the role of the pharmacist in medical care, we analyzed “arrangement of the previous discussions related to the revision of medical service fees for 2014, 2016 and 2018”. Co-occurrence network analysis suggested that “hospital”, “patient” and “reevaluation” formed strongly connected cluster. “Patient” was also connected with other two groups. One group included “pharmacy”, “drug” and “management” and the other included “home”, “visit” and “nursing”. Furthermore, correspondence analysis suggested that 2014 had relations to “hospital” and “home”, 2016 had relations to “hospital”, “care” and “outpatients” and 2018 had relations not only to “doctor” and “drugs” but also “area”, “visit” and “support”. Therefore, the government’s policy to shift the role of the pharmacist from hospitals to home medical care was clarified.

Objective: To compare effects of the fluoropyrimidines S-1 and capecitabine on prothrombin time international normalized ratios (PT-INR) of warfarin following coadministration and after discontinuation of each fluoropyrimidine treatment.
Methods: Medical records of patients receiving warfarin with either S-1 (6 patients) or capecitabine (7 patients) were obtained from four hospitals.
Results: Increased PT-INR was observed until peak levels of warfarin were achieved in all patients in S-1 and capecitabine treatment groups. Moreover, PT-INR significantly changed after coadministration within each group (p＜0.05). Specifically, ratios of peak PT-INR after coadministration of each fluoropyrimidine and those following administration of warfarin alone (PT-INR elevation ratio) were 3.31 and 3.29 in S-1 and capecitabine coadministration groups, respectively. Moreover, numbers of days to peak PT-INR were 38.3 and 31.3 days, respectively, and did not significantly differ between the treatment groups. Furthermore, PT-INR returned to pretreatment levels by 17.5 and 15.1 days after discontinuation of S-1 and capecitabine, respectively, and did not significantly differ between the treatment groups.
Conclusion: Coadministration of S-1 and capecitabine similarly prolongs PT-INR by approximately 3-fold compared with administration of warfarin alone; therefore, these drug-drug interactions were clinically suggested to be of high risk for episodes of bleeding and remarkable alterations in coagulation parameters. Therefore, blood coagulation ability should be more carefully monitored with regard to PT-INRs in patients receiving warfarin with S-1 or capecitabine not only during coadministration but also after discontinuation of fluoropyrimidine treatments.

We used the prothrombin time international normalized ratio(PT-INR)to investigate the change in degree and term of warfarin following co-administration and after discontinuation of capecitabine. In this study, approximately 3 years of medical records of 7 patients receiving co-administration therapy of warfarin and capecitabine were obtained from 4 hospitals. We observed daily increases in PT-INR values up to peak PT-INR levels following co-administration of warfarin and capecitabine. Interestingly, the peak PT-INR values of 4 of the patients remained remarkably high despite discontinuation of capecitabine. The peak PT-INR values for concomitant warfarin and capecitabine were attained after an average of 31.3 days of usage. When compared with the average PT-INR values attained before co-administration, the PT-INR values following co-administration significantly increased by 3 times (p<0.05). After discontinuation of capecitabine for an average of 15.1 days, i. e., for approximately 14 days, the PT-INR values returned to the PT-INR values attained prior to co-administration. These results suggest that capecitabine has influence on the anticoagulant effect of warfarin during not only the co-administered term but also the discontinuation term, and that this influence occasionally continues after discontinuation of capecitabine. These findings also suggest that a period of approximately 14 days after discontinuation is necessary for the interaction of capecitabine to dissipate and the PT-INR values to return the levels attained before receiving concomitant warfarin and capecitabine.

The creation of the National Health Insurance program has greatly contributed to giving Japan the world's highest level of life expectancy.  However, the cost of medical care in Japan has increased as a result of an aging society.  In response to this reality, the Japanese government initiated a campaign to promote the use of generic drugs (GEs).  In order to clarify some of the trends that contribute to different clinical medicine department usages of GEs, we carried out a survey of 400 pharmacies.  The survey data was analyzed using linear regression analysis.  Analysis of linear equations derived "utilization" that indicated ease of use of GEs, and a "saturation acceptable value (maximum allowed)" that indicated usage of GEs.  The breakdown for different clinical medicine department usages of GEs was determined as the following: psychosomatic medicine or psychiatry was 11±0.13%, internal medicine was 29±0.18%, orthopedics was 18±0.14%, ophthalmology or otolaryngology was 15±0.14%, other departments was 17±0.15%.  Furthermore, the highest utilization derived by linear regression analysis was orthopedics.  The highest acceptable saturation value was for psychosomatic medicine or psychiatry, while the lowest acceptable saturation value was orthopedics.  The results of the study confirm the importance of establishing evaluation methods for GE usage, and that linear regression analysis is a powerful tool for revealing trends in GE usage among different departments.  Additionally, the study suggests that determining GE spread measures is valuable, since they can serve as an aid to future pharmaceutical administration consideration.

薬学教育モデル・コアカリキュラムに沿った実習の実施状況を検証し、6年制長実務実習の問題点の検討と改善を目的に学生アンケートを実施した。アンケート結果は、薬学教育において改善項目の抽出などに使用されている顧客満足度(CS)分析より検討した。病院実務実習の実習内容は、「TDMについての演習あるいは実習を受けましたか?」が「要改善項目」として抽出され、薬局実務実習の実習内容は、「薬品管理に関する説明を受けましたか?」が「要改善項目」として抽出された。また、実務実習の指導にあたる指導薬剤師に関しては病院薬局共に、「指導薬剤師の言動に不快だと感じたことがありましたか?」が「改善検討項目」として抽出された。言動は実務実習を円滑に遂行する上で非常に重要かつ基本的な問題で、大学教員と実習指導薬剤師がワークショップなどで共にコミュニケーションとは何かを学び、スキルを検討する必要があった。

オーダリングシステムに入力された、がん化学療法の事前処方情報を利用した医薬品発注システムの有用性に関する報告。

In this study, we developed and evaluated an inventory management system based on prescriptions taken in advance via the ordering system with the objective of reducing the requirement for inventory management services, such as those for billing and replenishing medical products for automatic injection dispensers (hereafter, automatic dispensers). We first created a database for matching different medical product codes among systems to allow integration of the ordering system data for previously provided prescriptions and data in the existing medication management system. Next, we used a commercially available database program to develop an inventory management system for automatic dispensers to make it easy to determine which medical products were due for payment, their quantity, and the amount of inventory for them. After the system went into operation, we found that though the time required for billings and payments for automatic dispensers had been reduced by half, the automatic dispenser inventory turnover rate had risen by 17.6%. We also noted that there had been no changes in the number of interim billings during the period under study, indicating that our system was effective in controlling automatic dispenser inventory.

オーダリングシステムに入力された、がん化学療法の事前処方情報を利用した医薬品発注システムに関する報告。

OCRを利用したOSCE評価表集計システムに関する報告。

4年制の病院実務実習における実務実習モデル・コアカリキュラムの到達目標の実施状況について学生に調査を行い、平成19年度と20年度の結果を比較した。その結果、現在の4週間病院実習においてもモデル・コアカリキュラムの学習項目が導入、実施され、改善されていることがわかった。

自動注射薬調剤機の薬品払い出し情報をもとにした在庫管理システムに関する報告。

携帯電話医薬品情報システムの携帯電話機種別の検索時間に関する評価報告。

現在行われているマスメディア教育では、学生個々に対する講義内容の習熟度をリアルタイムに確認することは難しい。また教員も出席の確認や遅刻者の確認は重要と考えながら、手間がかかるため敬遠しがちである。これらマスメディア教育では実現できなかった、きめ細かな学生サポートを実現するために、新たなコンピューターシステムを構築することは、莫大な費用がかかってしまうなどの問題が生じる。そこで我々は、ここ数年で大学生や社会人がほぼ100%所有するといわれる携帯電話に注目した。近年の学生は、携帯電話による情報収集やゲーム・音楽ダウンロードなどあらゆることに携帯電話を利用し、携帯電話がなければ生きていけないという学生が出てきている。学生は、携帯電話の画面が小さいにもかかわらず、凝視し集中して見ることに違和感なく、体の一部と化している感がある。そこで、携帯電話を携帯情報端末として利用する学習支援・医薬品情報システム、

近畿大学における薬学部・医学部連携教育とPBL教材に関する報告。

携帯電話を利用した、バンコマイシン血中濃度解析システム、薬品情報検索システムに関する報告。

実務実習モデル・コアカリキュラムに示されている到達目標の実施状況について、保険薬局および学生に対して調査を行った。現在の短期実習においてもモデル・コアカリキュラムの学習項目が導入・実施されていることがわかった。さらに、学習項目の実施について、指導薬剤師と学生の認識の違いはなかった。

近畿大学薬学部・医学部合同学習会におけるPBL教育に関する報告。

携帯電話を利用した薬品情報検索システムに関する報告。

携帯電話を利用した出席管理、問題演習、小テストシステムに関する報告。

6年制教育における長期実務実習および事前実習をより充実させる目的で、学生に対して実務実習に関する意識調査を行った。実習内容については充実していたとの感想が80％以上を占めた。さらに深く学びたいと思った内容としては服薬指導が高く、次いで在宅医療(薬局実習)、チーム医療(病院実習)であった。指導については、約90％の学生がわかりやすかったと高い評価をしていた。

近畿大学医学部3病院で行った早期体験学習に対する学生の満足度調査に関する報告。

オーダリングシステムを利用したがん化学療法のレジメ管理の有用性に関する報告。

外来がん化学療法室の患者数の推移と問題点に関する報告。