RESUMEN
In Japan, the Pharmaceutical and Medical Device Act was amended in December 2019, and now requires pharmacists to follow-up on patients during treatment. Although there have been some studies on the effectiveness of follow-ups by pharmacists, there are no reports on the status of implementation in clinical practice. We conducted a nationwide survey on follow-up care to investigate the actual situation. We randomly selected 10% of community pharmacies in each prefecture and conducted a survey. We built a web-based system for the collection of basic information on the pharmacies and follow-up cases. A total of 561 pharmacies were pre-entered. Of these, 110 pharmacies (19.6%) reported 326 follow-up cases. Information was provided to doctors in 129 cases (39.6%), of which prescription proposals were made in 10 (7.8%) instances. The follow-up implementation rate based on the number of prescriptions dispensed was estimated to be 0.84% (95% confidence interval: 0.76-0.94%). This study revealed the status of follow-ups in clinical practice. Pharmacists can contribute to the optimization of drug treatment by providing follow-up information to doctors and making prescription proposals.
Asunto(s)
Servicios Comunitarios de Farmacia , Farmacéuticos , Japón , Humanos , Encuestas y Cuestionarios , Rol Profesional , Cuidados Posteriores/estadística & datos numéricos , Pueblos del Este de AsiaRESUMEN
In recent years, evidence-based medicine is practiced in medical care, and meta-analysis is positioned as the highest quality research paper. However, there are no unified criteria to evaluate meta-analysis. Thus, we developed and evaluated objective criteria of meta-analysis paper. Meta-analysis was evaluated from the standpoint of format and quality. Format score was developed based on QUOROM statement. Quality scores were evaluated in each step of meta-analysis. We evaluated meta-analysis for advantageous or adverse effect in the relationship between Renin-angiotensin system (RAS) inhibitor and diabetes mellitus. Research articles either in English or Japanese were searched in PubMed and the Cochrane Library in July 2009. Fifty-five studies were evaluated for format and quality score. Format score was 64.5+/-25.3% (Mean+/-S.D.), and quality score was 57.1+/-21.6%. After plotting each score along the X-Y coordinate, format score was correlated with quality score (R2=0.702, p<0.001). In studies with quality score of 70% or higher, RAS inhibitor prevented new-onset diabetes mellitus. Angiotensin converting enzyme (ACE) inhibitor reduced risk of myocardial infarction, however, angiotensin receptor blockers (ARB) increased the incidence in odds ratio 1.21 (95%CI: 1.04-1.40). We evaluated meta-analysis by format and quality score, and these factors showed correlation. Therefore, assessment of quality score leads to prompt and reliable evaluation of meta-analysis. According to articles evaluated by quality score, RAS inhibitor showed effectiveness on diabetes mellitus. However, careful attention must be given in ARB therapy on patients with myocardial infarction risk.
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Medicina Basada en la Evidencia , Metaanálisis como Asunto , Sistema Renina-Angiotensina , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Humanos , Sistema Renina-Angiotensina/efectos de los fármacos , Sistema Renina-Angiotensina/fisiologíaRESUMEN
To clarify the contribution of autologous transplantation of mesenchymal stromal cells (MSCs), an atelocollagen gel containing or not containing fluorescently-labeled canine MSCs was transplanted into an osteochondral defect which did not repair spontaneously and the histological repair of the defect was compared. Although an early repair of the cartilage was not observed in either defect, the reproduction of subchondral bone was remarkable in the MSCs-implanted defect. Moreover, in 2 weeks after operation, the implanted MSCs were located in the deeper regions of the defect, suggesting the differentiation of osteoblasts. There was a possibility that the movement of the implanted MSCs was due to an increase in intra-articular pressure from postoperative inflammation.
Asunto(s)
Colágeno/farmacología , Enfermedades de los Perros/tratamiento farmacológico , Osteocondritis/veterinaria , Células del Estroma/metabolismo , Animales , Perros , Miembro Posterior , Artropatías/terapia , Artropatías/veterinaria , Osteocondritis/terapia , Factores de TiempoRESUMEN
Growth in the use of generic drugs remains flat in Japan, and one of the reasons cited is information availability. We previously showed that the amount of information available on generic drugs differs greatly from one pharmaceutical industry to another, though, on average, it is inferior to that for original, brand name drugs. This report looks at information on individual generic drug products, rather than the active ingredients contained therein. In May 2004, we studied ingredients sold by at least 20 pharmaceutical industries. Here, for the same, particular ingredient, we evaluate current availability of generic-specific information (as of August 2005), as well as change over time. On the basis of ingredient, the amount of information provided for generic drugs is 31.1+/-17.5-57.3+/-11.7% that for the corresponding original drugs (Mean+/-S.D.), but in the company-by-company comparison, a large dispersion of 16.6+/-5.0-69.4+/-11.9% (Mean +/-S.D.) is observed. In terms of information content, generic drugs provided less than 50% as much information on "drug interactions", "clinical efficacy", and "outline of side effects", as that for original drugs. The difference between generic and original drugs was smaller in comparisons focusing on information specific to generics than on those including all drug information. Our study also revealed that, over time, some pharmaceutical industries have added to the amount of information provided. When information is a deciding factor, the quantity available at the current time is not the only relevant aspect; it is best to select a pharmaceutical industry that is proactive about supplementing information post-release.
Asunto(s)
Evaluación de Medicamentos , Industria Farmacéutica , Servicios de Información sobre Medicamentos , Medicamentos Genéricos , Servicios de Información sobre Medicamentos/normasRESUMEN
Limited use of generics in Japan has been justified on the basis of problematic quality, distribution and information. Of these three problem areas, the state of provision of information in particular has never been objectively evaluated. We therefore sought to evaluate information according to its necessity and importance to medical practice. To establish criteria for evaluation, we weighted 36 separate pieces of drug information found in package inserts and interview forms according to necessity and importance, based on the results of a survey of nationwide medical institutions with DI offices. We then used the evaluation criteria to evaluate currently available drugs with 20 or more products per formulation. We evaluated 14 formulations (324 products). Generic drugs were found to have 25.3+/-18.7 to 46.1+/-14.2% (Mean+/-S.D.) the information of brand name drugs when products were compared for quantity of information by formulation. However, comparison according to manufacturer returned a larger range of variation at 14.4+/-8.6 to 64.3+/-14.2% (Mean+/-S.D.). These data reveal that manufacturer differences play a large role in the provision of drug information. Drug information was also compared separately by category for both brand name and generic drugs. Generic drugs were found to have insufficient information on clinical data, pharmacokinetics, safety, side effects, and nonclinical tests. Brand name drugs also scored low points for information on pharmacokinetics. It is imperative that both brand name and generic drugs provide more information on pharmacokinetics.
Asunto(s)
Industria Farmacéutica , Servicios de Información sobre Medicamentos , Medicamentos Genéricos , Servicios de Información sobre Medicamentos/normas , Servicios de Información sobre Medicamentos/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Medicamentos Genéricos/efectos adversos , Medicamentos Genéricos/farmacocinética , Humanos , Encuestas y CuestionariosRESUMEN
Pharmacists active in health care venues need to be able to evaluate generic drugs in terms of effectiveness, safety, and economy to ensure that they are used appropriately. As part of the ongoing study of these factors, we carried out an objective evaluation of information provided for generics. A minimum of 20 commercially available products was considered for each pharmaceutical ingredient. The information subjected to evaluation consisted of the text of drug package inserts and information noted on interview forms. Using our own criteria for evaluating drug information, we attempted to quantify the amounts of information provided. Then, based on the numerical values obtained, we calculated information quantities with reference to drug prices to study the relationship between prices and available information for original drugs and their later-developed, generic equivalents. A total of 14 different pharmaceutical ingredients (327 product items) were considered, with the information quantity for generics amounting to 27.9+/-17.8-46.3+/-21.4% (Mean+/-S.D.) that for the original drugs. Examined on the basis of individual pharmaceutical companies, the corresponding ratio came to 15.1+/-7.8-62.4+/-6.4% (Mean+/-S.D.). For generics, the relationship between drug price (expressed against a value of 1.0 for original drugs) and information quantity (Qua(i)) came to 0.79+/-0.46-1.90+/-0.79% (Mean+/-S.D.). These results clearly point to the importance of evaluating information quantity for generic drugs on a maker-by-maker basis.
Asunto(s)
Servicios de Información sobre Medicamentos , Medicamentos Genéricos , Equivalencia Terapéutica , Comercio , Industria Farmacéutica , Servicios de Información sobre Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/economía , JapónRESUMEN
The utilization of generic drugs has been promoted, but there is concern about the insufficiency of the information provided on generic drugs. To make an objective evaluation of the amount of information supplied by generic drug manufactures, we tried to quantify the information supply. The information described in the package insert and the interview form were used in the evaluation. We sent a questionnaire to 1000 randomly selected hospitals nationwide to determine the necessity of each information item in medical practice, and weighted the score allotted to each item based on replies from 524 hospitals. We applied these procedures to diclofenac sodium products and found that the score for a branded drug was 60.5 points and that for generic drugs ranged from 1.6 to 58.3 points. This indicates that there were great variations in information supply activities among the manufacturers. The Qua value, which was the ratio of the points of a generic drug per unit price in the drug tariff to the points of the branded drug, ranged from 0.1 to 2.4. We think that these procedures will make it possible to select the appropriate generic drugs in medical practice.