加藤 博史

First Online:01 September 2016

Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe cancer pain at step 2 of the WHO analgesic ladder. There is little experience of its use in Japan; there are few reported detailed surveys on the usage of tramadol and its usefulness in patients who changed from taking tramadol to taking stronger opioids. The present study included inpatients who took tramadol hydrochloride capsule for cancer pain in the Nagoya University Hospital between October 2011 and March 2014; these patients were retrospectively examined based on electronic medical records. We observed that, out of 143 patients, 101 (71%) were started on a dose of 100 mg/day tramadol. Fortyeight of these 101 patients (48%) were changed to administration of stronger opioids, of which only 4 patients had their tramadol dosages increased to 300 mg/day before being changed to stronger opioids. However, among patients whose administration was changed from tramadol to stronger opioids, the incidences of nausea/vomiting when changing drugs were significantly lower than that among patients who had not taken tramadol (tramadol used group 19.4% vs non-tramadol used group 41.5%: P < 0.05). These results indicate that the incidence of nausea/vomiting may be reduced when changing from taking tramadol to taking stronger opioids after having used tramadol.

In a cisplatin (a highly emetogenic anti-cancer agent)-containing regimen, administrations of fluid replacement and/or of diuretic drugs are performed to relieve nephrotoxicity. Such treatments will alter the body's water balance, which may be partially responsible for chemotherapy-induced vomiting progression. We thus examined whether the body's water balance correlates with the incidence of chemotherapy-induced vomiting and/or the risk factors of chemotherapy-induced nausea and vomiting (CINV) in women (a CINV risk factor) inpatients receiving treatment with a cisplatincontaining regimen. The severity of chemotherapy-induced vomiting was significantly associated with increased body water in the patients with multiple (double), but not single CINV risk factors. Therefore, our findings suggest that the severity of chemotherapy-induced vomiting is decreased by keeping the body water balance constantly by restriction of hydration (eg short hydration) and/or consolidation of antiemetics, when the female patients with multiple (double) CINV risk factors receive treatment with a cisplatin-containing regimen.

Over recent years, use of self-medication by patients to help prevent and treat their own medical conditions has become increasingly widespread. However, despite provision of warnings and the taking of precautions, health hazards due to medication have occurred and continue to occur. In order to ward off such incidents, it is necessary for both children and adults to be educated about appropriate drug use. And, it is desirable that pharmacy students participate in this medicinal education as a means of affirming what they have learned and improving their communication skills at an early stage in their professional development. In 2008, we held medicinal education classes for pupils and parents at three elementary schools in Aichi Prefecture with the aim of promoting appropriate drug use. Each class comprised of two parts: an introductory lecture in quiz form, lasting about 30 minutes, and a 30-minute participatory group experiment. Subsequently, the activities carried out in both parts were evaluated across 6 items and 3 items respectively, and scored from Satisfied to Unsatisfied (4-step scale) by the pupils and their parents. We also conducted a questionnaire survey on this activity to the pharmacy students. We achieved successful results, gaining high Satisfied levels (better than 90%) in all items. This activity benefited both the children and the pharmacy students. It not only provided education for the general public regarding the appropriate drug use, but is also helping to foster the development in Japan of well-trained future pharmacists.<br>

本学では薬学部1年生への教育方法として、様々な医療機関を訪問させることにより医療全般に対する強い印象を体感させ、「患者を理解させる」「薬学を学ぶことに対するモチベーションを高める」「医療現場で活躍する薬剤師について理解させる」ことなどを目的として、平成18年度から独自の体系による早期体験学習を行っている。また、体験学習前に従来の講義形式による学習(事前講義)を行い、体験学習に必要な基礎知識を補うことにより、体験学習で得た経験と知識をより充実させ、その後、少人数グループ学習(以下SGL)によって体験学習課題や体験学習内容のまとめを行う「ハイブリッド型SGL」方式を導入している。SGLでは学部教員に加え、高学年の学生(4年生)がファシリテータとして低学年(1年生)を指導することにより、学年の枠を超えて学びあう方法である「エイジ・ミキシング法」を導入した。平成18年度の本取り組みにおいては、終了後のアンケート調査から、「エイジ・ミキシング法」に対して1年生・ファシリテータとも学習の流れを充分把握できていないなどの問題点が見出された。そこで19年度には、前年度(1年次)に早期体験学習を経験している2年生をファシリテータとして「エイジ・ミキシング法」を実施した。今回、その効果を検証するため、早期体験学習終了後に受講者とファシリテータおよび教員に対してアンケートを行った。その結果、18年度に比べて「エイジ・ミキシング法」に対する理解度や評価が有意に高くなっていることが確認された。一方で、ファシリテータに対する教員の評価が18年度よりも低くなっており、これは18年度のファシリテータ(4年生)に比べて19年度のファシリテータ(2年生)に「薬学の基礎知識不足」や「指導経験不足」があったからではないかと考えられた。

In February 2005, Meijo and Nagoya Universities concluded an agreement with Nagoya University Hospital under which a resident faculty is stationed at the hospital. Nine graduate students are assigned to the resident faculty under whose guidance they engage in a variety of activities which include inpatient and outpatient pharmaceutical services under pharmacists and clinical research in collaboration with doctors at Nagoya University Hospital. In addition, our universities conduct practical training for fourth-year students for four-week periods each year from May to July. In 2007, a total of 41 students participated in the practical training at Nagoya University Hospital. Under the guidance of the resident faculty, graduate students instructed the students in activities conducted in hospital wards and the outpatient asthma clinic (we call this "age-mixing"). After the four-week training programs, a questionnaire survey was conducted to determine the participants' views concerning the training schedule, content of the training and the "Age-mixing Method". The trainees had a favorable impression of the training with many selecting the responses "Our training went very well thanks to the support of the resident faculty", "We learned a lot form graduate students", "The Age-mixing Method is very useful for trainees" and "We realized that 'teaching is learning'". The introduction of the Age-mixing Method not only allowed trainees to learn from graduate students, it also enabled graduate students to review and reinforce their knowledge and skills through teaching. We therefore believe that the Age-mixing Method is useful for both student trainees and graduate students.