In this study, factors in‰uencing patients adherence to ophthalmic solutions were investigated. Seventy-one subjects (aged 62.3±15.5 years) were randomly selected from patients admitted to the Ophthalmology Department at Hiroshima University Hospital. The patients (n=71) completed questionnaires, which were evaluated by clinical pharmacists. The patient group to which the ophthalmic solutions were applied once or twice daily was more compliant than other patient groups ( p=0.00057). A multivariate statistical analysis revealed that the factors in‰uencing patients adherence were the number of ophthalmic solutions used, patient age, taste, administration intervals, the number of drops used, and hand washing before the application of ophthalmic solutions. Patients who understood the signiˆcance of the medication made fewer mistakes than those who understood only the route of administration but not the signiˆcance. In conclusion, our study shows that patient counseling should emphasis the signiˆcance of the administered medicine as well as the route of administration.
This article reports detoxication treatments of a case of combined overdose of carbamazepine and lithium in a 38-year-old female with bipolar disorder. She was brought to the emergency unit after the family found her unresponsive and lying near empty packages for carbamazepine (corresponded to 7.7 g) and lithium carbonate (corresponded to 6.6 g) tablets. On admission, her blood pressure, heart rate and respiratory rate were 80/55 mmHg, 90 per minute and 13 per minute, respectively. Her GCS was 3 (E1, M1, V1). She received gastric lavage after intratracheal intubation, followed by administration of activated charcoal via gastric tube, and a large volume (800 ml/h) of lactate Ringer's solution by intravenous infusion. The serum levels of carbamazepine and lithium approximately 5 h after ingestion were 56.0 mg/ml and 3.56 mEq/l, respectively. The carbamazepine overdose was mainly treated by a 3 h charcoal hemoperfusion (CHP). The CHP treatment decreased serum carbamazepine levels by approximately 30 40% as compared with the levels simulated by Bayesian analysis using 1-point or 2-points serum level(s) (without detoxication treatment). For lithium overdose continuous infusion of Ringer's solution was eŠective, which increased serum sodium gradually and facilitated the elimination of lithium. In conclusion, the treatments with CHP and continuous infusion of Ringer's solution were considered to be eŠective for detoxiˆcation of carbamazepine and lithium overdose, respectively, when compared with those drug levels without detoxication treatment that simulated by Bayesian analysis method.
Ward-based pharmacy interventions are effective for proper medical management. In Hiroshima University Hospital, clinical pharmacists participate in almost all inpatient cases. In addition to the regular clinical pharmacists for the 4 wards, a supervising pharmacist was allocated additionally to overview and to help them as a trial. The supervising pharmacist reviewed the prescriptions and assignments of physicians, and ordered authorized prescriptions. As a result, the number of drug-related incident reports for two months decreased from 17.3 to 3.0, compared to the number of reports of the past three years. The revision of prescriptions by a supervising pharmacist assembly might reduce the inspection workload and number of inquiries by the central pharmacy. On the questionnaire, 94% of physicians expressed a decreased burden during this trial. Also a decreasing trend of overtime work of nursing staff was reported. Therefore, the allocation of a supervising pharmacist may contribute to medical safety and efficient work management of medical staff who are concerned with drug therapy.
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