Objective : To provide efficient medical care to patients taking warfarin by developing a system for sharing prothrombin time-international normalized ratio (PT-INR) monitoring data between clinic and pharmacy ; and to verify the functionality of this system.
Methods : Before a clinic appointment, patients visited a pharmacy to self-monitor PT-INR levels with the rapid measuring device Coagucheck. Pharmacists noted the following on a form shared between the clinic and the pharmacy : 1) compliance, 2) side effects, 3) diet, and 4) PT-INR. On the basis of this information, they noted their opinions on the appropriate warfarin dose. Each patient submitted the form to the clinic doctor, who then prescribed warfarin on the basis of the information recorded. After the consultation, the patient took this prescription to the pharmacy to obtain the required medication, and received from the pharmacist the dosage information based on the doctor's instructions. Thus, the sequence of the patient's visits was pharmacy-clinic-pharmacy.
Results : From one pharmacist's report, it was apparent that one patient whose PT-INR level was outside the target range was occasionally skipping a warfarin dose because of a misunderstanding about the treatment. The pharmacist recorded the patient's information on the form to inform the doctor. After consultation with the doctor, the pharmacist gave a detailed explanation on the purpose of taking warfarin. As a result, patient compliance improved and the PT-INR reached the target level after one month.
Discussion : Development of this system revealed that patients can receive appropriate warfarin treatment when information on PT-INR becomes available during clinical consultation and compliance is achieved. The system for sharing the patient's self-monitored PT-INR data between clinic and pharmacy is considered beneficial for the patient.

Purpose: From shortly after the fentanyl patch became commercially available, we have been using it as part of our armamentarium for cancer therapy to produce a reliable analgesic effect from the active treatment period to the terminal stage in patients who are expected to develop resistance to oral analgesics. To confirm the usefulness of fentanyl patch, a retrospective study was conducted to determine its efficacy and safety. Method: A survey was conducted of 28 cancer patients who were undergoing pharmacological pain control. The following parameters were recorded: opioids administered prior to fentanyl patch use, reasons for switching to fentanyl patch, duration of administration and dosage of fentanyl patch, pain score before switching to fentanyl patch, adverse effects (nausea, vomiting, constipation and drowsiness), and the results of clinical tests. Results: The major reasons for switching to fentanyl patch were: "pain control with oral agents was expected to become difficult in future" and "adverse effects of chemotherapy were noted or were likely to develop". The mean duration of fentanyl patch use was 133 days, during which time the pain score and the constipation symptom were significantly reduced. No significant difference was found with nausea, vomiting, drowsiness or the results of clinical tests. Conclusion: It is concluded that fentanyl patch is a highly useful opioid for analgesia when administered during chemotherapy for cancer and continued to the terminal stage.

Objectives: A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.

Methods: Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.

Results: The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.

Conclusion: It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.

A correction of a coauthor's name from Chigusa Nakamura to Chigusa Nakagawa on the author list and the abstract.