A survey of subcutaneous blood flow in patients with SMID and subcutaneous ceftazidime administration using mentholated warm compresses in healthy subjects.

OBJECTIVES: To investigate subcutaneous blood flow rate (SBFR) in healthy volunteers and patients with severe motor and intellectual disabilities (SMID), and evaluate the effect of mentholated warm compresses (MWCs) on SBFR and subcutaneous ceftazidime absorption in healthy volunteers. METHODS: SBFR at the forearm, chest and abdomen were evaluated in Japanese healthy volunteers and in adults with SMID. The effects of MWCs on blood flow rate and ceftazidime pharmacokinetics were evaluated in healthy volunteers. RESULTS: SBFR was significantly lower in the forearms of female patients with SMID (n = 11) than in the forearms of healthy females (n = 6); it was not significantly lower in the abdomen or chest. There were no significant differences between male patients (n = 18) or controls (n = 12) in SBFR at any site. MWC application increased SBFR 1.3- to 2.0-fold compared with baseline in healthy controls (n = 6). MWC application increased ceftazidime maximum blood concentration, SBFR and time above mutant prevention concentration in a single healthy subject. CONCLUSIONS: Abdominal SBFR in patients with SMID did not differ from that of healthy subjects. MWC application increases SBFR and subcutaneous drug absorption rate in healthy humans.

Absorption Kinetics of Subcutaneously Administered Ceftazidime in Hypoperfused Guinea Pigs.

BACKGROUND: Pneumonia is the most common cause of death in patients with severe motor and intellectual disabilities (SMID), and intravenous ceftazidime (CAZ) is a widely used treatment for such infections. However, intravenous administration in patients with SMID may be difficult because of insufficient vascular development. OBJECTIVES: The aim of our study was to determine the feasibility of subcutaneous drug administration by mentholated warm compresses (WMCs) as an alternative delivery method for ceftazidime in patients with SMID. METHODS: CAZ was subcutaneously administered to the abdominal region of naphazoline-treated hypoperfused guinea pigs, which were used as a hemodynamic model of patients with SMID. MWCs or warm compresses (WCs) were applied to the injection site to increase blood flow. We calculated the cumulative CAZ absorption over time by using the deconvolution method. RESULTS: Application of MWCs or WCs increased blood flow at the administration site and increased CAZ plasma levels. Application of MWCs or WCs after subcutaneous CAZ injection led to higher CAZ plasma levels than the mutant prevention concentration for a longer period than was observed for CAZ administration without the application of MWCs or WCs. CONCLUSIONS: The application of MWCs or WCs enhanced subcutaneous CAZ absorption by increasing blood flow. MWCs and WCs are considered to be safe and routine methods to induce defecation after surgery on the digestive system; thus, the combination of these methods and subcutaneous CAZ administration is a potential method for treating pneumonia in patients with SMID.

[Challenge of providing pharmaceutical products for use in home care].

Due to a rapidly aging society, the exact nature and organization of medical services in Japan are now being reviewed. Consequently, medical services have been divided into three distinct sectors; hospitalization services, outpatient services, and at-home services. In such a situation, the basic function of pharmacies is about to change radically. In this study, I report on the challenge of providing pharmaceutical products for use in home care.

[System for dispensing medicines in home medical care-pharmacy's function as medical care facility-].

The continually increasing pace of the graying of Japan's population has brought us tremendous changes in the function of pharmacy and role of the pharmacist responsible for medical treatment for regional populations. In 1994, the then-Ministry of Health and Welfare suggested a maturity model for dispensing pharmacies, announcing that pharmacies at the 4th level of maturity should participate in the home medical care system. This participation of pharmacies in the home medical care system involved a separation of the prescribing and dispensing of drugs and clinics have been separated, and pharmacy now furnishing medicines. With the separation of prescribing and dispensing, the total number of prescriptions filled by pharmacists exceeds 700 million prescriptions, over 60%of the total number of legal prescriptions, firmly established this system in society. However, problems still remain in regard to the system for dispensing injectable medicines and responding to demand for pediatric prescriptions. This report discusses issues related to the system for furnishing medicines as the home medical care system advances.

[The discharge adjustment of cancer patient with pain - the function of pharmacy and the role of pharmacist].

Cancer is the leading cause of death in Japan. The Cancer Control Act was established in June 2006 to advance a comprehensive and systematic approach to deal with cancer, and efforts are now promoting measures in accordance with local characteristics. We, pharmacies, have seen an increase in the number of patients receiving care at home. During the year from April 2009 to March 2010, 19 out of 24 new home-care patients receiving consultations(approximately 80%)were cancer patients. Excluding 4 cases from that number, opioids were used in 15 cases. In cases not permitting oral administration, a control of acute pain was achieved with the use of suppositories or fentanyl patches. However, there were some cases presented a difficulty in controlling acute pain other than an injection, Hence, an inpatient consultation was performed by other professionals. This paper reports the adjustments involving pharmacies in those 2 cases and problems in dealing with home care treatment along with future topics.

[Functions of pharmacy as medical care provider].

With the 2006 amendment of the Medical Services Law,pharmacy dispensing of prescription drug orders was specified as medical care provider. As a result of specialization in pharmacy going forward, 60% of outpatients now use community pharmacies to fill their prescriptions. Meanwhile, pharmacy has been establishing a procedural system for insurance pharmacy operation. It also is a common practice for a pharmacist to visit home care patient under the physician's direction with the patient's consent. With pharmacy's function has been changing as well as undergoing major changes in the law, a prefectural pharmacy search system was used to carry out a study of home care-based pharmacy functions. In fact, conducting a study over the month of February 2010, we used a questionnaire survey targeting 226 pharmacies in Tokyo and three other prefectures. The questionnaire return rate was 42.6%. The results of the study showed the followings; 59 pharmacies conducted home visits, 59 pharmacies accepted payments covered by insurance, and 24 pharmacies participated with patients in joint discharge guidance. It is clear that pharmacy has broadened their functions from a filling of outpatient prescriptions to home based healthcare services.

[Pharmacies and home-care--today's status quo and problems].

As the trend towards home-care rises, the pharmacy's role in the home-care environment evolves. Now, upon discharge, the pharmacist must confer with the attending physicians and nurses, from the patient's hospital concerning medications which must be prepared for the patient's home-care, since April, 2008. Also, care insurance itself was revised in April, 2009 and patients who are in the terminal phase of their cancer or are receiving home parenteral nutrition can request helpers to visit them up to 8 times per month, like under medical insurance. However, as we look through the current situation, there are still many problems remaining which involve managing home-care and preparing medicines for outpatients, dealing with the dead stock of medicines, and insurance claims. In this issue, we report on the current situation and point out the problems pharmacies are facing with home-care, based on the real world experiences of small pharmacies.

[The role of the pharmacy as a medical facility].

As the separation of dispensary from medical practices has developed over the last 20 years, pharmacies have changed their function accordingly. Pharmacies are now actively participating in medical care, covered by insurance, by preparing medicines for out patients. Also, pharmacists play a integral role in the collaborative approach to health care of home care patients by promoting the proper use of medicines. As pharmacies became the personal pharmacy for local residents, pharmacies which dispense drugs were authorized as medical facilities from 2006. Thus, pharmacies are now facing a new era, in which their role to offer medical products is clear, and that since the collaborative approach by a multidiscipline medical group is now being promoted in local healthcare, the ability to dispense clinical judgment and the capability to cooperate with other professionals from different health care fields is required.

[How to supply information to pharmacies during the inpatient transition to home care-information supply booklet required of pharmacies when collaborating on regional medical care].

Recently, medical institutions have been actively trying to reduce the number of inpatients. When inpatients make a transition to home care, the first step is to ensure that they have a homecare doctor, and that a visiting nursing station and pharmacy are available. Next, home care services must be determined once hospital care information has been obtained and the wishes of the patient and their family have been established. However, pharmacies are often only contacted the day or the day before a patient is discharged from the hospital, so they are burdened with a considerable amount of preparation. Based on the information pharmacies need, we therefore created an Information Supply Booklet that medical institutions can hand to pharmacies upon discharge of patients. The entries have been classified according to core and non-core issues for pharmacies. This type of Information Supply Booklet is needed to help patients efficiently adjust to their post-discharge environment. In the future, we would like to revise this booklet into a common national format which would incorporate the views of medical institutions.

[The problems with pediatric home care].

It is obvious that we are facing serious problems with development of home medical care for children who have severe physical difficulties. One of the problems is a shortage of pediatricians who have a sufficient and specialized knowledge to take care those patients. In this paper, we report some actual problems with the care of the child suffering from mitochondrial encephalomyopathy at home TPN.