Basic Verification of β-D Glucan in Leukocyte-Rich Plasma for the Diagnosis of Deep Mycosis

Background@#Currently, supplementary serological testing for β-D glucan (BDG) is often selected to diagnose deep mycosis in care covered by the health insurance in Japan. The Wako method used by our center has low sensitivity, and different studies have used different cut-off values due to factors that cause false positives and false negatives. One possible cause of false negatives is the use of platelet-rich plasma (PRP) as the sample material. Because phagocytic white blood cells (WBC) are precipitated by centrifugation and only plasma is measured, it seems unlikely that the actual amount of BDG is being measured when using PRP. Further, a frequent cause of false positives is contamination from blood products and gauze containing BDG. To resolve these issues, the blood cell separator, hydroxyethyl starch, is used to precipitate only the red blood cells to obtain leukocyte-rich plasma (LRP).We hypothesized that it might be possible to improve the diagnostic rate of deep mycosis by measuring the BDG content of plasma containing WBC and fungal components and by comparing the BDG content of PRP and LRP measured simultaneously. @*Materials and Methods@#Healthy human blood, albumin-added blood, wrung-out gauze fluid-added blood, and fungal solution-added blood were prepared, and PRP and LRP were prepared using hydroxyethyl starch. The BDG content of each sample was measured using the Wako method and compared. In addition, PRP and LRP of fungal-added blood were Gramstained and examined under a microscope, and the number of WBCs and phagocytosed fungi was counted visually and compared. @*Results@#Measuring the BDG content of LRP confirmed that there were no false positives with LRP, and in vitro experiments comparing albumin-added false-positive blood to fungal-added blood showed significant differences between PRP and LRP only in the fungal-added blood. @*Conclusion@#Calculating the BDG-ratio (LRP/PRP) by measuring both LRP and PRP may eliminate false positives and false negatives of true deep mycosis and improve the diagnostic rate.

Basic Verification of β-D Glucan in Leukocyte-Rich Plasma for the Diagnosis of Deep Mycosis

Background@#Currently, supplementary serological testing for β-D glucan (BDG) is often selected to diagnose deep mycosis in care covered by the health insurance in Japan. The Wako method used by our center has low sensitivity, and different studies have used different cut-off values due to factors that cause false positives and false negatives. One possible cause of false negatives is the use of platelet-rich plasma (PRP) as the sample material. Because phagocytic white blood cells (WBC) are precipitated by centrifugation and only plasma is measured, it seems unlikely that the actual amount of BDG is being measured when using PRP. Further, a frequent cause of false positives is contamination from blood products and gauze containing BDG. To resolve these issues, the blood cell separator, hydroxyethyl starch, is used to precipitate only the red blood cells to obtain leukocyte-rich plasma (LRP).We hypothesized that it might be possible to improve the diagnostic rate of deep mycosis by measuring the BDG content of plasma containing WBC and fungal components and by comparing the BDG content of PRP and LRP measured simultaneously. @*Materials and Methods@#Healthy human blood, albumin-added blood, wrung-out gauze fluid-added blood, and fungal solution-added blood were prepared, and PRP and LRP were prepared using hydroxyethyl starch. The BDG content of each sample was measured using the Wako method and compared. In addition, PRP and LRP of fungal-added blood were Gramstained and examined under a microscope, and the number of WBCs and phagocytosed fungi was counted visually and compared. @*Results@#Measuring the BDG content of LRP confirmed that there were no false positives with LRP, and in vitro experiments comparing albumin-added false-positive blood to fungal-added blood showed significant differences between PRP and LRP only in the fungal-added blood. @*Conclusion@#Calculating the BDG-ratio (LRP/PRP) by measuring both LRP and PRP may eliminate false positives and false negatives of true deep mycosis and improve the diagnostic rate.

The Actual Status of the Provision of Drug Information in Clinical Clerkships and Development of an Online Self-Learning Tool / 医薬品情報学

<b>Objective: </b>The purpose of this study was to identify existing problems related to the provision of drug information in clinical clerkships.  In addition, we aimed to develop a self-learning tool based on our findings.<br><b>Methods: </b>We conducted a questionnaire survey on students who had completed a clinical clerkship between December 2012 and February 2013 concerning the actual status of the provision of drug information.  Based on responses received from 86 students, we then developed an online self-learning tool.  This online tool was subsequently evaluated by the same 86 students.<br><b>Results: </b>More than 20% of students surveyed reported never having made inquiries at their clerkship site; therefore, we developed an online self-learning tool for inquiry services in which students were able to learn step-by-step how to analyze, search, evaluate and provide inquiries.  A total of 89% of the students who tried this tool reported being satisfied with its use.<br><b>Conclusion: </b>Our results suggest that students in clinical clerkships lack sufficient experience regarding drug information-related inquiries.  Therefore, our online self-learning tool should be helpful in promoting understanding of how to manage such inquiries for students in clinical clerkships.

Development and Evaluation of a Self-Learning Tool for Drug Information / 医薬品情報学

<b>Objective: </b>In pharmacy school, most faculty members use generic names when discussing medicine; however, in clinical clerkships, most staff members use brand names. This sometimes leads to poor communication and understanding between the students and medical staff.  The purpose of this study was to clarify the need for a tool to improve communication and understanding in relation to drug information.  Based on the findings of this survey, our secondary aim was to develop and subsequently evaluate such a tool.<br><b>Methods: </b>To clarify the need for a self-learning tool, we conducted a questionnaire survey on 58 faculty members who teach courses on drug informatics.  Based on their responses, we then developed a self-learning tool that was subsequently evaluated by a total of 78 undergraduate students.<br><b>Results: </b>Most of the faculty agreed concerning the necessity of a self-learning tool for drug information, particularly in regard to the establishment of a more user-friendly system and reduced user fees for students.  The faculty also believed that students should be able to associate the generic drug name with various kinds of information, including its safety, efficacy, and brand name.  All students agreed that the tool was helpful, very easy to use, and could be learned during their commute to school.<br><b>Conclusion: </b>Our results suggest that most faculty members support the idea of having a tool capable of promoting a better understanding and grasp of drug information.  Therefore, our self-learning tool should be helpful in promoting increased knowledge concerning drug information for students in clinical clerkships.

The construction of the method for providing drug information to the patients received magnetic resonance cholangiopancreatography in the laboratory / 医薬品情報学

  Recently, the number of outpatients who visit the hospital only for the examination is increased in Ofuna Chuo hospital.  It is important that the pharmacists manage the contrast media used to these outpatients for the rational drug therapy.  However, there are a few hospitals where the pharmacists work in the laboratory.  Therefore, we investigated the effect of the providing drug information by pharmacists to the patients received magnetic resonance cholangiopancreatography (MRCP) in the laboratory.  The subjects were consisted of 38 patients who were taken with Bothdel®Oral Solution 10 during receiving MRCP.  The pharmacist instructed the patients about Bothdel®Oral Solution 10 before MRCP.  The percentage of patients who were already treated with the other drugs was 92.0%.  The 4 patients were taken the drugs interacted with Bothdel®Oral Solution 10 and then were able to prevent the drug interaction by the pharmacist.  Also, the patients were taken the questionnaire form about the adverse events of this drug and sent it to the pharmacy by mail after more than 5 days.  As the results, the gastrointestinal symptoms such as a loose stool and a diarrhea were reported 28.5% of the patients.  In addition, as the adverse events other than listed in the package insert, epigastric distress, heaviness of the head and hot flash, were shown in each of a patient, respectively.  In conclusion, it was very important that the pharmacists provide the information of rational use of contrast media to the patients who received examination.

Evaluation of training in a prepractical pharmacy by students at the school of pharmacy after clinical training at hospitals or community pharmacies / 医学教育

1) The aim of this study was to develop a training method for pre-educational clinical pharmacy in a 6-year curriculum. In the evaluation of training in a prepractical pharmacy by pharmacy students after completing clinical training in a 4-year curriculum, the average scores for the necessity and usefulness of training in a prepractical pharmacy were 4.5 and 3.9, respectively (maximum score, 5; minimum score, 1).<br>2) The average scores for usefulness in the subcategories of knowledge, technique, and attitude were 3.5, 4.2 and 3.8, respectively. The percentages of scores of 4 or 5 in these subcategories were 60.1%, 83.2%, and 64.1%, respectively. <br>3) The students recognized the necessity and usefulness of training in a prepractical pharmacy, but dissociation was seen in both scores. Therefore, the amount of attitude education in training in a prepractical pharmacy was thought to be insufficient. The strong desire for education by clinical pharmacists and the development of educational programs are future challenges for the Faculty of Pharmaceutical Sciences.

The ideal focus of the study in the drug information sciences / 医薬品情報学

  In 2008, Japanese Society of Drug Informatics (JASDI) organized the Future Vision Committee (the Committee) to propose the essential focus of drug informatics.  To explore a future vision about the drug information sciences, it was necessary to collect a variety of opinions widely from researchers.  Therefore, at the 11^th annual meeting of JASDI in July 5-6, 2008, the Committee convened a workshop to extract problems in the researches of drug informatics by using KJ method and evaluated the contents.  The major problems raised were “the field of drug informatics is too broad” and “there is no definition and/or no system of the drug informatics”.  Related problems raised are the shortness of the history and lack of originality in the study.  From different viewpoints, it was also pointed out that the methodology of the research is not well established and no systematic education is provided.  Taken together, major problems in drug informatics are concluded to be the lack of definition and the lack of systematizations, and will be solved to a certain extent by defining the outcome of the researches in drug informatics.