In patients with blood diseases, maintaining a proper ward environment as regards temperature and humidity and effective drug treatment are important in preventing the development of deep mycosis. We investigated the influences of temperature and humidity and use of antifungal agents on the incidence of pulmonary aspergillosis in such patients. The subjects were 132 patients admitted to our hematology ward between January 1999 and December 2004. Of the 132 patients, 22 developed pulmonary aspergillosis but 110 did not. There were no significant differences in patient background between these patients. The incidence of pulmonary aspergillosis was high (observed significance level of test : 0.004) during summer when the mean humidity in the ward was high. Administration of the antifungal agent micafungin for prevention or treatment reduced incidence (observed significance level of test : 0.042). Based on these findings, we conclude that proper control of ward humidity and selection of an effective antifungal agent are important factors in reducing the incidence of aspergillosis in wards where patients are being treated for blood diseases.

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Clinical laboratory data are an important basis for understanding the patient’s condition when pharmacists examine the appropriateness of prescriptions. Since it is difficult for them to check patient clinical laboratory data at the time of dispensing, we developed a prescription checking system under which prescription data and clinical laboratory data are simultaneously transmitted to the pharmacy and any abnormal clinical laboratory data are marked on the prescription sheet and the prescription-checking list. Pharmacists can use these marks to check the patient’s condition.
Between December 2004 and November 2005, abnormal clinical laboratory data were marked on 245 prescriptions under our system, and based on this, pharmacists advised doctors of 25 cases in which drugs were contraindicated, and corrections were made. We therefore conclude that our system is useful in promoting the proper use of drugs.

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Though patient self-evaluation and defecation frequency are important parameters of constipation, the relationship between them and the use of laxatives had not been clarified. In this study, we investigated these parameters for inpatients on admission (N=117). They were divided into three groups according to whether their self-evaluation was“Constipated”, “Occasionally constipated”or“Not constipated”, with the defecation intervals being 2.2±0.8, 2.0±0.9, and 1.1±0.5 days, respectively, and the use of laxatives 57.0%, 16.7%, and 7.8%, respectively. While the difference in defecation frequency between the Constipated and Occasionally constipated groups was not significant (P=0.80), the defecation frequencies in both of these groups were significantly lower than in the“Not constipated”group (P<0.0001). Use of laxatives was significantly related to patients self evaluation of their degree of constipation. Our results suggest that the similar defecation frequencies in the“Constipated”and the“Occasionally constipated”groups were due to high laxative use in the“Constipated”group. Thus, having patients evaluate their degree of constipation themselves seems to affect their behavior and also defecation frequency.

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The new oxazolidinone antimicrobial, linezolid (LZD), has been approved for the treatment of infections caused by grampositive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). Though LZD-resistant strains have been reported in Europe and the United States, none have yet been discovered in Japan. We report the case of a patient with intractable retroperitoneal abscess infected with E. faecium who was initially treated successfully with LZD but E. faecium subsequently exhibited resistance to LZD. The patient was a 66-year-old female in whom most of the E. faecium infection was detected in the retroperitoneum. Neither teicoplanin (TEIC) nor vancomycin (VCM) had any effect so LZD was then administered at a dose of 1,200 mg/day. The subsequent clinical course was good but following withdrawal of LZD, the infection recurred and was aggravated. The administration of LZD was restarted and the patient recovered when it was continued over the long-term. However, during this period E. faecium became LZD-resistant with the resistance stemming from a G2576 T mutation of the 23S rRNA gene, which suggests that long-term administration can be a tolerance-related risk factor and that LZD induces the resistance mechanism at a certain frequency of use. Pharmacists responsible for infection control should therefore conduct sensitivity testing on isolates from the beginning of LZD treatment to monitor for resistance to LZD.

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Case-based Learning(CBL)employing video tapes has been used in drug counseling training for pharmacy school students at the Ehime University Hospital.This system aims to help improve students’counseling skills.
From our use of the system,we identified two issues that need to be addressed.One of them is improvement of the simulated cases by tailoring the information to individual abilities because the cases were not easy to understand for many students.The other is improvement of the training method and evaluation system.We attempted to address them by revising the curriculum to increase the number of simulated cases as well as repeating the CBL training.In addition to doing this,we sifted through the evaluations of individual student's counseling skills made by clinical pharmacists using a scoring system.This made it possible to evaluate their skills more easily and objectively,which was done by giving a score of 1 to 5 for 20 aspects of counseling skills.Thereafter,students evaluated the repeat CBL using our questionnaire on their training.
The total scores for students’counseling skills given by the clinical pharmacists for the second training session were significantly higher(p<0.0001)than for the first session.Also,many students felt that their counseling skills in the second session were better than they had been in the 1st session and most of them appreciated being able to repeat the CBL.These findings suggest that repetition of CBL would be a simple and productive way of enhancing pharmacy practice training for students.

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The purpose of this study was to evaluate the effect of low-dose theophylline on airway resistance(Raw),respiratory muscle strength and high-sensitivity CRP in patients with chronic obstructive pulmonary disease(COPD).The subjects were 11 patients with COPD(8 males ; 3 females).Raw and other pulmonary function parameters were measured by means of body plethysmography.Maximal expiratory pressure(MEP)and the maximal inspiratory pressure(MIP),the parameters of respiratory muscle strength,were measured after 4 weeks of administering low-dose theophylline when serum concentrations of theophylline were 4.7±2.9 micro g/mL.The administration of theophylline decreased Raw,significantly increased FEV 1.0,decreased CRP levels and increased MEP.High-sensitivity CRP levels were negatively correlated with MEP and MIP (R²=0.474,R²=0.657 respectively).The results of the present study suggested that high-sensitivity CRP can be used as an indicator of respiratory muscle strength in patients with COPD.

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The checking of prescriptions by pharmacists is a fundamental practice in ensuring the proper use of prescription drugs.However,the amount of information on prescription sheets is limited making it difficult for pharmacists to evaluate whether the drugs prescribed are actually suited to individual patient’s conditions.However,at the moment,it is not possible for pharmacists to seek extra clinical information from patient charts or databases for each individual prescription they receive.To overcome this,we have developed a system under which check sheets are prepared from information on patients’clinical histories,test results and previous medications taken from hospital and pharmacy databases,which are used to examine prescriptions in advance.The check sheets enable pharmacists to routinely evaluate prescribed drug regimens more extensively and accurately.Furthermore,taking both clinical and pharmacological data relating to the patient into consideration allows pharmacists to conduct a higher level examination of prescriptions irrespective of their individual capabilities.

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Pharmacists counsel patients on chemotherapy at the Outpatient Chemotherapy Center of Hokkaido University Hospital which opened in September 2004.However,a lack of detailed information on patients is sometimes an obstacle to counseling patients and conducting effective pharmaceutical management.Since pharmacists who have taken care of patients in wards have much useful information on patients,we developed a software tool for information sharing between wards and the chemotherapy center.In doing this,we first conducted a questionnaire survey and from the results,selected nine types of information which would be useful in counseling patients and pharmaceutical management in the chemotherapy center.We then developed the software tool giving access to a database of patient information collected by ward pharmacists and used this to prepare information sheets.Patient chemotherapy history,time of appearance of adverse effects and preventive treatment for adverse effects were selected as the most useful items of pharmaceutical information.Following the introduction of the software tool,pharmacists in the chemotherapy center were able to obtain detailed profiles of patients in about half of the time that was required before its introduction.

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We prepared a work sheet for monitoring adverse reactions in the treatment of advanced cervical cancer with concurrent chemoradiation therapy(CCR)using nedaplatin.We used the worksheet to monitor adverse reactions and their grade.Thirty eight patients(80.4%)out of 46 developed adverse reactions during the CCR,which corresponded with the data on our work sheet.We therefore felt able to use the worksheet in explaining the adverse reactions occurring during CCR to patients.Through its use,the grade and duration of diarrhea occurring as an adverse reaction decreased in most patients.It has enabled us to provide highly useful information on adverse reactions in CCR to physicians and nurses in a timely manner.

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A very important instruction given to patients prescribed warfarin potassium(Wf)is to seek urgent medical help if bleeding occurs.However,it is a good idea for patients to seek help and ensure that they are being adequately treated with vitamin K(VK)injection before bleeding actually occurs.We retrospectively investigated the causes of enhanced international normalized ratio(INR)in outpatients prescribed Wf and using VK injection from 2000-2004.Owing to a higher INR,nine outpatients(mean age : 72.3)were injected with VK in this period.Two of them were injected with VK at the first consultation after hospitalization during which Wf therapy had been started,and the remaining 7 had appetite loss due to various causes,exacerbation of their underlying disease,overwork or drinking.Therefore,patients prescribed Wf should be instructed to seek immediate medical help when they have appetite loss of various causes before actual bleeding occurs and pay attention to bleeding,especially soon after the dose of Wf is determined.

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The 4-week clinical training taken by students in the latter half of the third year of the School of Pharmaceutical Sciences,Kyushu University of Health and Welfare consisted of three sections in three rotations,one of the sections devoted to bedside training.The content of this report comprises the students’evaluation of the training and discussion of the results of an opinion-based survey on how students saw themselves as pharmacists and direction the work of the pharmacists would take in the future.Students’interest in the training content and opinions on the importance of each training item and its degree of difficulty were investigated by means of a questionnaire survey(anonymous),and individual evaluations of training items were made according to a five-point scale.Students highly evaluated the use of role plays in the training.They item they found the most interesting was evaluation of the ease of swallowing of a medicinal wafer and a jelly.The next most interesting item was drug administration design using TDM.The items they felt were difficult included discussion on tools for improving pharmacists’skills,drug history records,and analysis of pharmacokinetic distribution.The need for certain improvements was found when the bedside training was first carried out.
More importantly,perhaps,through the training,the students not only learned aspects of the work of the pharmacist other than dispensing and basic hospital pharmaceutical skills,but also recognized their responsibilities as pharmacist in the future and realized the need for a patient-centered attitude towards medical care.

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