Chemotherapy has shifted from hospital care to ambulatory care. To ensure safe and certain ambulatory chemotherapy, a community pharmacist is expected to feed back information about the medicine-taking situation at home to hospital staff. In this study, we estimated the establishment of a tracing-report system using telephone communication, with the aim of organizing concerted intervention among physicians, hospital pharmacists and community pharmacists. Among the outpatients who were treated S-1 from June 1, 2014 to April 30, 2015, 25 patients agreed to receive an inquiry call at home. Medication compliance and the number of unused medicines were monitored by a community pharmacist and this information was reported to a physician via a hospital pharmacist by using 'The Tracing Report.' The names of diseases were confirmed in 24 patients, and the chemotherapy method was confirmed in 23 patients. Physicians accepted recommendations from pharmacists in 30 out of 47 cases.In conclusion, the results suggest that an inquiry call from a community pharmacist during ambulatory care, verifying their medicine taking situation, contributed to safe chemotherapy.
We report a case of liver metastasis of renal cell carcinoma with portal venous tumor thrombus. Abdominal computed tomographic images showed a large hepatic mass that enhanced slightly during arterial phase. Multiple hypoattenuating lesions were seen in the intrahepatic portal venous branches and were traced directly from the mass. The histologic specimen confirmed metastatic liver tumor of renal cell carcinoma with portal venous tumor thrombus.
ObjectivesContinuous subcutaneous injection (CSCI) followed by a once-daily transdermal patch is a reasonable strategy for rapid titration of fentanyl in patients with cancer pain who are unable to take oral medication or have renal impairment, but the effectiveness and safety have not been demonstrated.MethodsMedical records of patients with moderate to severe cancer pain who underwent titration of fentanyl by CSCI between October 2019 and October 2021 at Kitano Hospital, Osaka, Japan, were retrospectively reviewed. The dose of fentanyl was increased to a maximum of 0.05 mg/hour. If the dose was inadequate, the fentanyl patch was added on CSCI. When pain relief was adequate, CSCI was completely converted to the patch.ResultsThirty-three patients were enrolled. Titration was completed successfully in 28 patients (85%) over a median of 2 days. The average Numeric Rating Scale for pain decreased by at least 66% in 22 patients (67%) and by at least 33% in 7 (21%). After conversion to the patch, two patients (6.1%) required to increase the dose of fentanyl within a week. Two patients (6.1%) experienced moderate drowsiness during titration.ConclusionsFentanyl titration by CSCI is an effective and safe method for achieving rapid pain control.
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