The conventional crushing method for administration of drugs to patients with feeding tubes has been commonly used at the Hyogo College of Medicine College Hospital. Compared with this conventional method, the simple suspension method can reduce drug degradation due to light and moisture absorption as well as avoid drug loss and contamination. We conducted a workshop to introduce this method to pharmacists. We asked the participants to fill a questionnaire-based survey both before and after the workshop to determine the effects of the workshop on the change in the degree of awareness among participants about these methods. The awareness of participants about the simple suspension method was approximately 80% before the workshop. Approximately 60% of participants answered that they had questions about simple suspension method from individuals from other occupations, suggesting a high awareness of this method. After the workshop, approximately 98% of participants answered that they were “satisfied” or “slightly satisfied,” suggesting that they were in favor of introducing the suspension method. The results of text mining indicated a requirement for participants to consider incompatibilities and to educate the nursing department. Participants who actively considered the proposal of simple suspension method had an altered perception toward the introduction and utilization of this method. Therefore, this survey suggested that workshops could alter the perception and behavior of pharmacists about the methods of drug administration via feeding tube.

OBJECTIVE: To compare the survival outcomes of patients with cervical squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) among patients with locally advanced cervical cancer that were treated with definitive radiotherapy. METHODS: The baseline characteristics and outcome data of patients with locally advanced cervical cancer who were treated with definitive radiotherapy between November 1993 and February 2014 were collected and retrospectively reviewed. A Cox proportional hazards regression model was used to investigate the prognostic significance of AC/ASC histology. RESULTS: The patients with AC/ASC of the cervix exhibited significantly shorter overall survival (OS) (p=0.004) and progression-free survival (PFS) (p=0.002) than the patients with SCC of the cervix. Multivariate analysis showed that AC/ASC histology was an independent negative prognostic factor for PFS. Among the patients who displayed AC/ASC histology, larger tumor size, older age, and incomplete response to radiotherapy were found to be independent prognostic factors. PFS was inversely associated with the number of poor prognostic factors the patients exhibited (the estimated 1-year PFS rates; 100.0%, 77.8%, 42.8%, 0.0% for 0, 1, 2, 3 factors, respectively). CONCLUSION: Locally advanced cervical cancer patients with AC/ASC histology experience significantly worse survival outcomes than those with SCC. Further clinical studies are warranted to develop a concurrent chemoradiotherapy (CCRT) protocol that is specifically tailored to locally advanced cervical AC/ASC.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Chemoradiotherapy ; Disease-Free Survival ; Epithelial Cells* ; Female ; Humans ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Uterine Cervical Neoplasms*

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care.  Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards.  However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management.  To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center.  Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them.  The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward.  In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work.  These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.

The human CCR4-NOT deadenylase complex consists of at least nine enzymatic and non-enzymatic subunits. Accumulating evidence suggests that the non-enzymatic subunits are involved in the regulation of mRNA deadenylation, although their precise roles remain to be established. In this study, we addressed the function of the CNOT1 subunit by depleting its expression in HeLa cells. Flow cytometric analysis revealed that the sub G(1) fraction was increased in CNOT1-depleted cells. Virtually, the same level of the sub G1 fraction was seen when cells were treated with a mixture of siRNAs targeted against all enzymatic subunits, suggesting that CNOT1 depletion induces apoptosis by destroying the CCR4-NOT-associated deadenylase activity. Further analysis revealed that CNOT1 depletion leads to a reduction in the amount of other CCR4-NOT subunits. Importantly, the specific activity of the CNOT6L immunoprecipitates-associated deadenylase from CNOT1-depleted cells was less than that from control cells. The formation of P-bodies, where mRNA decay is reported to take place, was largely suppressed in CNOT1-depleted cells. Therefore, CNOT1 has an important role in exhibiting enzymatic activity of the CCR4-NOT complex, and thus is critical in control of mRNA deadenylation and mRNA decay. We further showed that CNOT1 depletion enhanced CHOP mRNA levels and activated caspase-4, which is associated with endoplasmic reticulum ER stress-induced apoptosis. Taken together, CNOT1 depletion structurally and functionally deteriorates the CCR4-NOTcomplex and induces stabilization of mRNAs, which results in the increment of translation causing ER stress-mediated apoptosis. We conclude that CNOT1 contributes to cell viability by securing the activity of the CCR4-NOT deadenylase.
Apoptosis ; Caspases, Initiator ; genetics ; metabolism ; Cell Survival ; Endoplasmic Reticulum ; enzymology ; Enzyme Activation ; Flow Cytometry ; HEK293 Cells ; HeLa Cells ; Humans ; Protein Subunits ; genetics ; metabolism ; RNA Stability ; RNA, Messenger ; analysis ; RNA, Small Interfering ; genetics ; metabolism ; Ribonucleases ; metabolism ; Stress, Physiological ; Transcription Factor CHOP ; genetics ; metabolism ; Transcription Factors ; genetics ; metabolism ; Transfection

Opioids are potent analgesics mostly used for severe cancer and chronic noncancer pain. However, their efficacy and safety in acute noncancer pain are debatable. We describe the case of an 82-year-old male with severe back pain due to bacteremic Staphylococcus aureus spondylitis and paravertebral abscess. Pain in such cases is usually controlled by non-steroidal anti-inflammatory drugs (NSAIDs). However, this patient was administered morphine (oral, then intravenous; up to 23 mg/day) because acetaminophen and NSAIDs did not ameliorate pain. Considerable pain relief was achieved without toxicity, and the dose of morphine was tapered through 35 days. No symptoms of addiction or withdrawal were observed during or after this 35-day period. Thus, morphine appears to be safe and effective in the management of severe, acute noncancer pain in patients with bacterial spondylitis. Palliat Care Res 2010; 5(2): 327-331

It is well known that haloperidol is effective in the management of nausea and vomiting in cancer patients and that midazolam is used for inducing sedation in patients with delirium. Both the drugs are frequently used in a clinical setting, but there have been only few reports thus far on the concomitant administration of these 2 drugs. We report the case of a patient with massive ascites due to peritoneal carcinomatosis who had severe nausea and vomiting and went into a delirious state. This patient received a concomitant continuous infusion of haloperidol and midazolam for the management of these symptoms. Both haloperidol (up to 1.87mg/h) and midazolam (up to 1.87mg/h) were infused intravenously. For about 20 days, the nausea, vomiting and delirium were well under control without the development of any life threatening toxicities. Concomitant haloperidol and midazolam infusion was found to be a safe and effective therapy for the management of nausea and vomiting in the patient. Palliat Care Res 2009; 4(1): 312-316

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.
1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.
2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.
3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.
4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.
5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.
6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.