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A requirement, which students must satisfy, for a diploma at the Showa University School of Pharmacy is the ability to "plan, practice, and assess pharmacotherapy". To continuously assess the ability of students to meet this requirement and to provide patients with proper pharmacotherapy during student clinical rotations, we formulated the "Rubric assessment for pharmacotherapy" and evaluated its usefulness in tutorial learning classes. Clinical pharmacy faculty members created the rubric based on the Subjective, Objective, Assessment, and Plan (SOAP) note guidelines of the university. Third- (2016) and fourth-year students (2017) were required to self-assess their SOAP notes to analyze six clinical cases using the rubric. The rubric consists of three domains: (1) Evaluation of patient condition, (2) Proposal of pharmacotherapy, and (3) Plan for an assessment of pharmacotherapy. The rubric comprises 31 subdomains and is evaluated according to four levels of performance. In this study, 978 rubric sheets that were used by students to evaluate their own SOAP notes were analyzed. We found that the students were able to continuously self-assess their performance using the rubric while continuously improving their achievement level (p<0.05). The results of this study suggest that rubric assessments may be used as a tool for supporting students to plan, practice, and assess pharmacotherapy.

Sunitinib has been shown to offer clinical benefits during the treatment of advanced renal cell carcinoma. However, molecular targeting drugs are expensive and can have a significant impact on medical expenses. The purpose of this study was to assess the cost-effectiveness of sunitinib as a first-line therapy compared with interferon-alpha (IFN-α) in metastatic renal cell carcinoma patients. A Markov model was used to show the clinical courses of patients with metastatic renal cell carcinoma who received sunitinib or IFN-α. The transition probabilities and utilities employed in this Markov model were derived from two sources. This study focused on the perspective of public healthcare payer, as only direct medical costs were estimated from the treatment schedule for metastatic renal cell cancer. In the cost-effectiveness analysis, outcomes were valued in terms of life years (LYs) and quality-adjusted life years (QALYs). We calculated the incremental cost-effectiveness ratio (ICER) during the cost-effectiveness analysis. The results were tested using Monte Carlo simulations. Sunitinib and IFN-α treatment resulted in LYs of 2.40 years and 2.03 years, QALYs of 1.58 and 1.25, and expected costs of 13,572,629 yen and 6,083,002 yen, respectively. As a result, the ICER associated with replacing IFN-α with sunitinib was 22,695,839 yen/QALYs. Our results suggest that compared with IFN-α, sunitinib prolongs LYs and QALYs, but the increases in quality achieved by sunitinib are more expensive than those produced by IFN-α.

Polyunsaturated fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) occur in biological membranes as acyl groups of phospholipids and exhibit remarkable physiological activities. In human, they have various beneficial effects on health such as protective effects against cardiovascular disease, inflammation, and cancer. We have been studying their physiological functions in bacteria, which have a much simpler membrane structure than eukaryotes. We found that the cell division of a marine bacterium, Shewanella livingstonensis Ac10, is inhibited and shows growth retardation by disruption of its EPA biosynthesis genes. We synthesized a fluorescent analog of EPA-containing phospholipids (EPA-PLs) as a chemical probe to analyze their subcellular distribution and found that it is localized at the center of the cell undergoing cell division. This localization was shown to depend on the structure of the hydrocarbon chain of the phospholipids. We also examined the effects of EPA-PLs on the folding of Omp74, a major membrane protein of this bacterium, by using liposomes and found that EPA-PLs facilitated the folding process. The results imply that EPA-PLs function as a chemical chaperone in the folding of membrane proteins. These findings would contribute to understanding of the physiological function of phospholipids with polyunsaturated fatty acyl chains in various biological membranes.

We retrospectively evaluated clinical data before therapy to determine the risk factors for severe neutropenia in advanced non-small-cell lung cancer (NSCLC) patients treated with third-generation agents. We analyzed 100 patients who received such agents (paclitaxel, docetaxel, gemcitabine, irinotecan, or vinorelbine) for advanced NSCLC. The endpoint of the survey was the occurrence of severe neutropenia (grade 4). Risk factors significantly related to severe neutropenia were identified using logistic regression analysis. Of the 100 patients studied, the median age was 62.0 (32-81 years), and 77 (77.0%) were male. CEA 6.6 (0-2220) ng/dL and cytokeratin 19 fragment 21-1 (CYFRA) 4.8 (0.2-173.8) ng/dL before chemotherapy were higher than normal range. Severe neutropenia occurred in 36.0%, the incidence being highest in the first cycle (61.1%). In the univariate analysis, variables associated with severe neutropenia were sex, chest pain, absolute neutrophil count (ANC), Cr, CRP, and CYFRA. In the multivariate analysis, low CYFRA level was identified as a significant risk factor that contributed independently to chemotherapy-induced severe neutropenia (p<0.05). Our analysis suggests that low CYFRA level is the most important risk factor for severe neutropenia in advanced NSCLC patients after the first course of chemotherapy with third-generation agents.

The growth of the dietary supplement in Japanese market suggests that the patient's need for assistance with self-care will also continue to grow. Patients' burgeoning acceptance and use of alternative therapies is another indication that patients seeking more from the health care system. The questionnaire showed that the most of them are expecting the pharmacists to provide their knowledge of dietary supplements. However, only limited amount of information is available. We founded the group Alterna in 2003, that compose the pharmacists working in community pharmacies accompanied with those in pharmaceutical universities. We have published the journal named "Alterna" that includes the information of dietary supplements, and it attained Vol. 9 in 2008. In the past studies, we evaluated the content and solubility of coenzyme Q10 dietary supplements in Japanese markets, some of which showed poor solubility. In others, we had taken up the information about vitamin and minerals, tea catechins, DHA and EPA, cooking oils to reduce body fat, collagen, etc. Findings in these studies present the opportunities for the pharmacists to provide the significant positive impact on health care outcomes and costs to patients.