Current Status and Issues of Dysphagia Care in Hospitals and Long-Term Care Facilities in Gifu Prefecture / 日本農村医学会雑誌

A survey was conducted to determine the current status and issues of dysphagia care in hospitals and long-term care facilities in Gifu Prefecture. Responses were obtained from 14 hospitals, 13 welfare facilities for elderly adults requiring long-term care (WFs), and 13 geriatric health services facilities (GHSFs). Dysphagia teams were present at 12 hospitals, 4 WFs, and 8 GHSFs. The teams primarily consisted of general nurses (hospitals = 12, WFs = 4, GHSFs = 8; same order below), certified dysphagia nurses (11, 1, 0), nutritionists (11, 4, 7), speech-languagehearing therapists (11, 0, 5), physicians (7, 2, 4), and pharmacists (7, 0, 0). Facilities that employed certified dysphagia nurses conducted screening for dysphagia, but many hospitals and long-term care facilities did not review patients’ medications to identify medications that could cause dysphagia. In addition, many hospitals did not educate care workers about assisting with eating and swallowing. This demonstrates a need to improve dysphagia-related screening and educational systems for nurses and care workers at hospitals and long-term care facilities.

A Survey of the Current Status of Fentanyl Sublingual Tablets and Evaluation of Problems Associated with Their Proper Use / 日本プライマリ・ケア連合学会誌

<p><b>Objectives: </b>A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.</p><p><b>Methods: </b>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.</p><p><b>Results: </b>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.</p><p><b>Conclusion: </b>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.</p>

Point of care testing for proper use of warfarin in physician-pharmacist cooperative practice : assessment of patient adherence to therapeutic regimens and time in therapeutic range / 日本プライマリ・ケア連合学会誌

<b>Objectives</b> : A pharmacotherapeutic system for safe and proper use of warfarin was developed through physician-pharmacist cooperative practice ; its effects on patient adherence to therapeutic regimens and the therapeutic benefit of warfarin were assessed.<br><b>Methods</b> : Subjects were 12 outpatients or home-care patients receiving warfarin. Patients' level of understanding of warfarin therapy and time in therapeutic range (TTR) were used as indices of adherence and therapeutic benefit, respectively. Before the physician examination, patients were interviewed by pharmacists using point-of-care testing with the CoaguChek ^®XS to check their prothrombin time-international normalized ratio (PT-INR). Pharmacists reported status of warfarin administration, any adverse effects, and medication management status to each patient's physician using the medication record or inter-institute information exchange sheet. Patient adherence was assessed before and after the pre-examination interview and changes in TTR were evaluated.<br><b>Results</b> : Levels of understanding of warfarin therapy were significantly higher after pharmacists provided medication counseling (immediately before 4.8±1.9 vs 24 weeks after 6.8±2.4 ; P=0.0079, Wilcoxon signed-rank test). TTR significantly improved at 24 weeks after the interview (pre-interview 20.9±29.8% vs post-interview 60.5±30.5%, respectively ; P=0.0024, Wilcoxon signed-rank test).<br><b>Conclusion</b> : The results suggest that patients'adherence to warfarin regimens and the therapeutic benefit of warfarin is improved by pharmacists'obtaining information on PT-INR before patients'medical examinations, as well as by utilizing this information to establish a cooperative pharmacotherapeutic system for good TTR management, as supported by a common protocol across pharmacies and medical institutions.

Efficacy and safety of fentanyl patch in cancer patients from the active treatment period to the terminal stage

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

Efficacy and safety of fentanyl patch in cancer patients from the active treatment period to the terminal stage

<b>Purpose</b>: 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. <b>Method</b>: 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. <b>Results</b>: 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. <b>Conclusion</b>: 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.

A case of successful treatment with a combination of morphine and a fentanyl patch in a patient suffering from cancer pain accompanied by coughing and dyspnea

<b>Objective</b>: Opioid analgesics are normally administered as monotherapy. However, we experienced a patient in whom alleviations of cancer pain, coughing and dyspnea were successfully achieved with the combination therapy of morphine and a fentanyl patch (FP), and the case is reported herein. <b>Case Report</b>: A woman in her fifties, suffering from sigmoid colon cancer, liver and lung metastases, and associated pain complicated with coughing and dyspnea, manifested symptomatic alleviations following the facilitation of treatment with morphine sulphate. Taking into consideration that oral intake would become difficult at some time in the future, treatment switchover to FP was planned. However, in view of the efficacy of fentanyl against coughing and dyspnea having not yet been firmly established, a low dose of morphine sulphate for coughing and dyspnea continued and cancer pain was controlled with FP. Thus, through continued combined use of the two ingredients, morphine and fentanyl, until treatment end, symptomatic alleviations of pain, coughing and dyspnea were able to be achieved. <b>Conclusion</b>: For patients experiencing difficulty with oral intake and suffering from coughing and dyspnea in addition to cancer pain, combined use of a low dose of morphine and FP is considered useful in achieving a stable alleviation of such symptoms.