Objective: It is well known that opioids are the dominant medication for the palliative care of cancer pain.  Although the enhancement of palliative care has been shown as the social issue in Japan, our opioid consumption is 1/7-7/8 of its global average.  These actual conditions of “low consumption of opioid” may affect the enrichment of palliative care in Japan.  In this study, we performed attitude surveys on the current situation of opioid usage for the palliative care in Japan by questionnaire method intended for hospital pharmacists.
  Design and Methods: The questionnaire was mailed to pharmacists in randomly selected 100 hospitals among the general clinics involved in palliative care (October 10-16, 2006).  The collection rate was 63% (63 person/100 hospitals).
  Results: About 94% of respondents recognized that the palliative care is poor in Japan, of which about 78% considered that there are relationship between the amount of opioid usage and enrichment of palliative care.  Furthermore, the problem of medical staff was considered as the most important factor contributing to the current status of palliative care in Japan.  In addition, in the order, legal barrier (8%)>problems in regard to patients (7%)>problems in regard to medical agents are considered to affect the current status of palliative care in Japan.  Specifically, it is considered that some problems such as deficiency of education (57%), deficiency of number of specialized staff (21%), and lack of experience of opioid usage (10%) or viased view of opioid (5%) are included in the problems of medical staff in Japan.
  Conclusions: As the specific issue to achieve advanced palliative care and to improve quality of life in cancer patients, the improvement of curriculum and the training of medical staff for clinical opioid usage in the palliative care seems to be the most important in Japan.  In addition, the improvement of information provision by pharmacists toward the medical staff may be important for the promotion of palliative care using opioid in the future in Japan.

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  We require our students in the 4th grade to take an on-site pediatric outpatient clinic course at the Teikyo University Hospital as part of a 4-week on-site training program.  This year, 64 trainees divided into groups of 3 or 4 students took the course between June and August.  In the morning, trainees were asked to conduct clinical interviews with 287 patients’ guardians in the presence of trainers.  This was followed by the observation of consultation and treatment services provided to patients.  In the afternoon, students reported the findings obtained in medical interviews, participated in group discussions, and received supplementary lectures from trainers.  After completing the course, students were asked to fill in a questionnaire.  When asked whether they were satisfied with the course, 62.5% and 37.5% of students said “very satisfied” and “satisfied,” respectively, while 64.1%, 29.7%, and 6.2% of students said the observation of consultation and treatment services was “very good,” “good,” and “cannot say which,” respectively.  About the medical interviews, 64.1% and 34.4% said that it is “very good” and “good” to conduct them, while 1.5% said “cannot say which.”  All students said they could determine the problems faced by guardians regarding drugs in the medical interview.  The on-site pediatric outpatient care course was found to be “very useful” and “useful” by 62.5% and 35.9% of patients, respectively, while 1.6% said “cannot say which.”  In conclusion, most students were greatly satisfied with the medical interview with guardians using a questionnaire and said that it made it possible for them to closely communicate with guardians.  This result was thought to be attributable to the use of the techniques of the medical interview OSCE which the students learned prior to conducing medical interviews with guardians.

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Object: For cancer chemotherapy with injection, oral agents are also frequently prescribed.  In checking injection prescriptions for cancer chemotherapy, mistakes in the prescription of oral agents have been found.  In this study, we analyzed inquiries for clarifying questionable points, and confirmed the importance of checking oral agents prescribed in cancer chemotherapy.
Methods: We investigated the following items between January and December 2006: the number of prescriptions in which the checking system for combined oral agents associated with cancer chemotherapy at the outpatient clinic was required, number of prescription errors regarding injection in which the prescription was changed based on inquiries for clarifying questionable points, and number of prescription errors regarding combined oral agents.  Furthermore, we classified precautions necessary for checking these prescriptions.
Results: From January to December 2006, the number of prescriptions was 5,132.  In 2,806 (54.7%) of them, it was necessary to check prescriptions for combined oral agents associated with chemotherapy.  The oral prescriptions were classified into 3types: agents described as pretreatment agents for chemotherapy in the package inserts, supportive therapy agents for reducing side effects, and oral anticancer agents.  There were 59 errors regarding injection, and 54 errors regarding combined oral agents.  Among the 54 errors, supportive therapy agents for reducing side effects comprised the highest percentage.
Conclusion: It was necessary to check prescriptions for oral agents in more than 50% of patients undergoing cancer chemotherapy at the outpatient clinic.  In addition, in cases in which adverse reactions could be avoided based on the inquiries, the percentage of injection errors was similar to that of oral preparation errors, confirming the importance of checking prescriptions for oral agents.

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Object: A multicenter survey was conducted to investigate the status of use of supplements and related problems in patients with diabetes mellitus.
Methods: A questionnaire was mailed to institutions where members of the Drug Information Section, Tokyo Hospital Pharmacists Association, worked, and hospitalized patients with diabetes mellitus were surveyed with a questionnaire.
Results: The response rate of the questionnaire was 85%, and 22 patients reported taking supplements.  The most common motivation to purchase supplements was a recommendation from an acquaintance, followed by a recommendation from a family member and TV. Only 9.1% of the patients consulted healthcare professionals when purchasing supplements.  The patients who did not follow the dosage and administration instructions and those who were not aware of precautions regarding proper use accounted for 31.8% and 63.6%, respectively.  The proportion of patients who did not inform their physicians about the use of supplements was 65.2%, and 4.5% reported some health damage (rash).
Conclusion: Our results revealed that supplements were used without careful consideration and were not administered properly, suggesting that scientific evaluation of efficacy and safety was warranted in future studies.  It is important for pharmacists to actively collect information on patient use of supplements and share the information within the medical team.

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Objective: In the Drug Informatics in Department of Pharmacy, Kitasato Institute Hospital (hereinafter “the hospital”), we have had question-and-answer sessions regarding doping agents (banned drugs) among doctors and other workers and prepared an Anti-doping Quick Reference List (hereinafter “the list”), facing an urgent need to provide precise information quickly.
Methods: The list consists of drugs adopted by the hospital and over-the-counter drugs according to package inserts, interview forms, and other sources of information.
Results: In the list, hospital and over-the-counter drugs are classified into three categories in terms of a doping test: (1) “Non-banned” (drugs that can be used), (2) “Banned” (drugs that cannot be used), and (3) “Suspected” (unclear drugs) with their half lives for elimination as an indicator of the disappearance time from the body and divided by medicinal effect.  In addition, we indicated any drug for which the Therapeutic Use Exemption (TUE) application (hereinafter, TUE application) is required before use.
Conclusion: The list prepared in this investigation offers many benefits, including precise and quickly available information on banned and non-banned drugs, ease in suggesting alternatives, and avoidance of failure in TUE application.

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Purpose: With the aim of improving the efficiency of smoking cessation treatment, we analyzed and classified various factors to identify the relationships between the background of patients and effects of treatment, and examine their characteristics.
Methods: We conducted a questionnaire survey to collect information on the situation of patients, and obtained their treatment data from medical records.  Decision tree analysis, a data mining method, was employed to examine these data.
Results: According to the results of the survey, the smoking cessation rate was 80.4%.  The rate was associated with CO concentrations in the breath at the initial examination, nicotine content in cigarettes smoked by patients, and the daily and total number of cigarettes smoked.  The smoking cessation rate among patients under emotional stress was 76.2%; the rate was higher when patients were able to reduce their mental stress levels.
Conclusion: We identified characteristic relationships between the background of patients and the effects of treatment, and they proved to be useful for the improvement of the smoking cessation rate.

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