Establishment of a new function for pharmacies : sharing of patient-monitored warfarin PT-INR information with clinics / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : 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.<br><b>Methods</b> : 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.<br><b>Results</b> : 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.<br><b>Discussion</b> : 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.

Frequency distribution function of red blood cell velocities in single capillaries of the rat cerebral cortex using intravital laser-scanning confocal microscopy with high-speed camera

Background: Brain metabolism depends largely on oxygen and therefore constant delivery of oxygen to the brain is more important than to any other organ. Previously we reported a newly developed method to automatically calculate red blood cell (RBC) flow and its temporal modulations at the layer 1 of the rat cerebral cortex. Objective: To examine a general tendency of frame-rate dependency of RBC velocities and heterogeneity of RBC movements in single capillaries identified by fluorescein isothiocyanate (FITC)-dextran staining. Methods: In urethane-anesthetized rats with a closed cranial window, intravenously administered FITC-labeled RBCs were traced at 125, 250 or 500 frames/s (fps) with a laser-scanning confocal fluorescence microscope and their velocities were automatically calculated with home-made software KEIO-IS2. Results: RBC velocities in single capillaries were not constant but variable, and were dependent on frame rate, with average values of 0.85 ± 0.43 mm/s at 125 fps, 1.34 ± 0.73 mm/s at 250 fps, and 2.05¬1.59 mm/s at 500 fps. When all capillary RBCs were plotted against their velocities (frequency distribution function of RBC velocities), RBC velocities were clustered at around 1.0 mm/s, smearing at higher velocities up to 9.4 mm/s. High RBC velocity was only detected from frame analysis with high frame rates since such high-flow RBCs were uncounted at low frame rates. RBC velocities higher than 6.5 mm/s were statistically significantly outlined from the main population (p \< 0.01). Such a group of capillaries was considered to belong to thoroughfare channels, although their diameter was almost the same as that of ordinary ones. Conclusion: Extra-high flow capillaries are confirmed in the cerebral cortex and these may be thoroughfare channels or non-nutritional capillaries carrying 42% of the blood in reserve.

Effect of Byakko-ka-ninjin-to on Interdialytic Body Weight Gain in Chronic Hemodialysis Patients / 日本東洋医学雑誌

To assess the effects of Byakko-ka-ninjin-to on thirst and body weight gain in chronic hemodialysis patients with excessive interdialytic body weight gain, 8 patients (4 men and 4 women, ranging in age from 47 to 75) were prescribed Byakko-ka-ninjin-to extract tablets, 6-12 tablets per day, for 10 weeks. In 4 of the patients, thirst symptoms improved, resulting in significant reduction of interdialytic weight gain. This effect continued to be significant even after cessation of the agent. In the cases of 4 patients whose thirst symptoms did not improve, interdialytic weight gain was not reduced either during or after treatment. For all 8 patients, there were no significant changes in cardiothoracic index, and no adverse effects or events were observed either during or after treatment. Significant reduction in interdialytic weight gain was observed only in the patients with reduced thirst, which suggests that Byakko-ka-ninjin-to allows patients to limit their weight gain by drinking less. These results suggest that Byakko-ka-ninjin-to could be a useful and safe agent to reduce excessive interdialytic body weight gain, at least in a significant cohort of chronic hemodialysis patients.