In recent years, cancer chemotherapy has been shifted from inpatients to outpatients. In outpatient cancer chemotherapy, patients manage side effects by themselves. Therefore, it is very important that pharmacists provide information of side effects to patients. In Shiga University of Medical Science Hospital, pharmaceutical care to all outpatients by pharmacists was started from October 2010. However, starting the service incurred some problems. One of them was understaffing. When we constructed a novel original outpatient chemotherapy system, the manpower shortage problem was dispelled. Throughout this service, various symptoms caused by chemotherapy were more significantly improved in intervention cases than in non-intervention cases. A medication leaflet was used when providing medical information for pharmaceutical care. It was also expected to provide information to medical facilities outside the hospital. We consider that the medical leaflet may contribute to promoting collaboration between hospital and community pharmacies.

Micafungin is a novel, semisynthetic antifungal lipopeptide with an echinocandin-like chemical structure. This agent exerts its fungicidal action by inhibiting biosynthesis of 1,3-b-D-glucan, an essential component of the cell wall of most pathogenic fungi, leading to osmotic instability, and ultimately, cell rupture.1-3) Micafungin demonstrates potent antifungal activities against Candida spp. and Aspergillus spp. in vitro, and its therapeutic efficacy has been confirmed in the treatment of infectious disease caused by these fungi species.4,5) Because of its poor intestinal absorbability, micafungin is administered via an intravenous route in clinical practice. As urinary recovery of the unchanged form is less than 1% of the total dose, it is believed that micafungin is eliminated mainly by non-renal removal. 6,7) In view of the severity of disease conditions requiring antifungal therapy, micafungin is often administered to critically ill patients with hepatic damage. However, there have not been any reports regarding the impact of hepatic dysfunction on the disposition of micafungin, even though the total body clearance is probably dependent on the metabolic capacity of the liver.In the present study, we examined the pharmacokinetic behavior of intravenously administered micafungin in acute hepatic failure in a rat model intoxicated with carbon tetrachloride (CCl 4 ). MATERIALS AND METHODSReagents Standard solutions of micafungin and FR195743 (internal standard (IS) for HPLC) were generously donated by Fujisawa Pharmaceutical Co., Ltd. (Osaka, Japan). Sodium salt of micafungin for injection (Funguard TM , containing 50 mg micafungin per a vial) and cyclosporine for injection (Sandimmun TM , containing 250 mg cyclosporine per 5 ml ampoule) were purchased from Fujisawa Pharmaceutical Co., Ltd. and Novartis Pharma KK (Tokyo, Japan), respectively. CCl 4 was obtained from Attest (Kyoto, Japan). All other chemicals and solvents were of the highest quality commercially available.Experimental Animals and Treatment Male SpragueDawley rats were obtained from CLEA Japan, Inc (Tokyo, Japan). The rats were acclimatized for at least 2 d before assignment to experimental groups at 5-6 weeks of age (140-190 g), and were housed in a clean room maintained at 23Ϯ2°C with a relative humidity 55Ϯ10% and 12-h light/dark cycle. They were allowed free access to regular animal diet and drinking water except when fasted for 24 h before administration of micafungin. Acute hepatic failure in rats was induced by intraperitoneal injection of 50 % CCl 4 in olive oil (5 ml/kg) 24 h before administration of micafungin. The rats used in this study were handled in accordance with the Guidelines for Animal Experimentation of Shiga University of Medical Science, and the experimental protocol was approved by the Animal Care and Use Committee of the Research Center for Animal Life Science of this institution.Administration of Micafungin and Blood Collection Rats were anesthetized by ethyl ether, and a polyethylene cannula (outer diameter, 0.8 mm; i...

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Background: There are no universal tools to predict the necessity of high-dose opioid use for cancer-related pain. Early recognition and interventions for intractable cancer pain could minimize the distress of palliative patients. Objective: We sought to identify the clinical factors associated with high-dose opioid use in advanced cancer patients to recognize palliative patients who would develop intractable cancer pain, as early as possible. Setting/Subjects: Among 385 in-hospital cancer patients from April 1, 2014 to July 31, 2019, who were referred to the palliative care team for cancer-related pain, clinical factors significantly correlated to high-dose opioid use were retrospectively analyzed. Measurements: We conducted a multiple logistic regression analysis to identify variables significantly related to high-dose opioid use (>120 mg/day oral morphine equivalent dose). Results: Independent factors of high-dose opioid use included younger age (odds ratio [OR] 0.965, 95% confidence interval [CI] 0.944-0.986, p = 0.001), respiratory cancers (OR 1.882, 95% CI 1.069-3.312, p < 0.001), and opioid switch (OR 2.869, 95% CI 1.497-5.497, p = 0.001). The percentage of correct classifications of the regression equation was 86.9%. Conclusions: Younger age, respiratory cancers, and opioid switch were related to high-dose opioid use. Our findings may help palliative caregivers to deal with intractable cancer pain in palliative patients, and thus relieve their distress.

The adequate fatigue appears to be dependent on survival time, and PNI might be useful for identifying patients that will benefit from betamethasone use. It is hoped that these results will contribute to individualized pharmacotherapy of terminally ill patients with CRF.