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Objective: Tocilizumab and infliximab are biologic drugs that are widely used for the treatment of rheumatoid arthritis (RA). The dosage of these injectable RA drugs is calculated based on body weight. However, injectable RA drugs are used only once due to stability and sterility concerns. For expensive biologic drugs, drug disposal wastage needs to be reduced. Tocilizumab is approved in three vial sizes: 80, 200, and 400 mg. In this study, we evaluated the validity of these tocilizumab vial sizes to help resolve the issue of excess residual drug.Methods: A log-normal distribution was assumed for body weight, and 10,000 hypothetical cases were created using the programming language R. We analyzed the average wasted dose rate per vial (%) by gender after considering different vial size combinations.Results: The average wasted dose rate per vial of tocilizumab was estimated to be 3.7% for males and 4.7% for females.Conclusion: The three vial sizes of 80, 200, and 400 mg are reasonable for tocilizumab. The average wasted dose rate per vial of infliximab was estimated to be 17.7% for males and 22.6% for females. The average wasted dose rate per vial was lower for tocilizumab than infliximab. Tocilizumab is administered in a dose range of 200 to 1,100 mg with three different vial sizes in multiples of 40 mg. However, infliximab is administered in a dose range of 50 to 400 mg with a single vial size of 100 mg. Multiple vial sizes should be prepared to ensure the efficient use of limited medical resources. It is also expected that the method employed for this hypothetical case model will be applied to other drugs for which disposal wastage is a problem and used to set appropriate vial size combinations.
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Background: Bone marrow aspiration is an essential but hazardous procedure. We have developed a mannequin simulator with posterior iliac crests to teach needle puncture.<br>Method: After watching a video demonstration of bone marrow aspiration, undergraduate medical students were asked to complete a questionnaire concerning their calmness （C） and self-confidence （S） in performing the procedure using 5-point rating scales （1–5: worst–best） and its estimated ease （E） （1-5: difficult–easy）. The students were given hands-on, small-group instruction using the simulator and allowed to practice, after which they were asked to answer the questionnaire again. The outcome was a change in scores between before and after practice. The paired Student’s t-test （two-tailed） was used for statistical analysis. We also evaluated correlations between pairs among 3 factors.<br>Results: The participants were 200 fifth-year student volunteers from Kawasaki Medical School. The scores after instruction and practice were higher than those before （C: 1.57±0.85 vs. 2.61±1.27; S: 1.61±0.85 vs. 2.86±1.01; and E: 2.36±1.13 vs. 3.65±1.11）. Estimated ease was moderately correlated with self-confidence in performing the procedure after instruction and practice, and the rank-correlation coefficients of before and after were 0.481 and 0.557, respectively. The coefficients of C and E before and after the instruction and practice were 0.346 and 0.526, respectively, whereas the coefficients S and C were 0.487 and 0.414, respectively.<br>Discussion: Simulator-based training may reduce medical students’ anxiety about bone marrow aspiration and its estimated difficulty.
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<b>Objectives</b>: This study evaluates the relationship between the various words expressing pain and the efficacy of opioid analgesics, in order to provide information on the appropriate selection of analgesic drugs for cancer pain relief. A new and simplified evaluation list for the assessment of pain, including the common words used to express pain, was developed accordingly. <b>Methods</b>: The words expressing pain were classified into three categories based on the Guidelines for Drug Therapy in Cancer Pain. These words were grouped into clusters according to the efficacy of opioid drugs, as expressed by the patients. On the basis of these results, an evaluation list was developed, and its validity was assessed by clinical pharmacists and cancer patients experiencing pain. <b>Results</b>: On the basis of the classification of the words, their relationship with opioid efficacy was summarized, and the results of the cluster analysis were found to be helpful for the development of a new pain evaluation list. <b>Conclusion</b>: Patients use various words to express their pain. By classifying and clustering these words according to the guidelines and the efficacy of opioid drugs, we proposed a practical pain evaluation list for appropriate selection of analgesic drugs in patients with cancer.
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<b>Purpose</b>: Patients who receive chemotherapy for colorectal cancer with the prophylactic dexamethasone (DEX) for antiemesis may experience an abnormal elevation in their casual blood glucose levels. The purpose of this study was to determine the frequency of such a DEX-induced elevation in patients with metastatic colorectal cancer, and to emphasize the importance of pharmaceutical care in improving the quality of life of patients. <b>Methods</b>: We retrospectively analyzed data from 50 patients who had received chemotherapy with or without DEX. <b>Results</b>: Of the 30 patients who received DEX, 8 exhibited abnormally high blood glucose levels (>200 mg/dl on more than 2 occasions); 3 of these patients also had diabetes mellitus. None of the 20 patients who did not receive DEX exhibited a remarkable elevation in the blood glucose levels. <b>Conclusions</b>: We confirm that patients receiving concomitant administration of DEX with chemotherapy may exhibit elevated blood glucose levels. Because an increase in the blood glucose levels may produce symptoms indicative of diabetes such as fatigue, appropriate pharmaceutical care for early detection of the abnormal elevation in the blood glucose levels may be important in preventing complications in such patients.