[Show abstract][Hide abstract] ABSTRACT: To ensure the proper use of pharmaceutical products, it is very important to check outpatient prescriptions brought by patients when they are hospitalized. However, in recent years, this checking has become a huge task for medical staff to manage, especially with the increase in the number of generic medicines. On April 2010, the chief of the Health Policy Bureau, Ministry of Health, Labour and Welfare, released an important statement, “Implementation of team medical care by the cooperation and linkage of medical staff,” indicating legal pharmaceutical activities to promote team medicine. The Ministry has established a new role for ward-pharmacists related to medical fees. In Kyoto University Hospital, we established a protocol for outpatient medication management, which clarifies the division of the roles played by doctors, nurses and pharmacists, according to the statement of the chief of the Health Policy Bureau (protocol-based pharmacotherapy management, PBPM). In this protocol, ward-pharmacists check outpatient prescriptions and propose the most suitable prescription to physicians by entering the physician order-entry system. Although it is an examination in only one ward, the introduction of this protocol effectively reduced doctors' and nurses' workloads by about 20 minutes per patient. Ward-pharmacists increased the frequency of prescription interventions, and also obviated errors committed by doctors. The practice of this PBPM on the management of outpatient medications greatly contributed to a reduction in the burden on doctors and nurses, and simultaneously improved medication safety in our hospital. This report presents an example of how medical team care can ensure high-quality patient treatment in a hospital.
[Show abstract][Hide abstract] ABSTRACT: Tacrolimus pharmacokinetics and calcineurin activity in peripheral blood mononuclear cells (PBMCs) were investigated in adult patients undergoing primary living-donor liver transplantation (LDLT) in order to clarify the significance of monitoring the tacrolimus blood trough concentration during the early post-transplantation period.
Fourteen patients were enrolled in this study, and time-course data following the oral administration of a conventional tacrolimus formulation twice daily were obtained at 1 and 3 weeks post-transplantation. The concentration of tacrolimus in whole blood and calcineurin activity in PBMCs were measured.
The apparent clearance of tacrolimus significantly increased at 3 weeks versus 1 week post-transplantation, although the trough concentration did not significantly differ at these time points. The concentration at each sampling time, except at 1 h post-dose, correlated well with the area under the concentration-time curve from 0 to 12 h (AUC(0-12)). Neither the concentration at the trough time point nor AUC(0-12) was correlated with the area under the calcineurin activity-time curve from 0 to 12 h; however, calcineurin activity at the trough time point was strongly correlated with the latter (r (2) > 0.92).
Based on these results, trough concentration monitoring can be considered an appropriate procedure for routine tacrolimus dosage adjustment in adult LDLT patients. Monitoring of calcineurin activity at the trough time point was also found to be potentially useful for predicting the immunological status of the patient during the tacrolimus dosing interval.
Full-text · Article · Mar 2012 · European Journal of Clinical Pharmacology