Objective: The use of generic products is a solution to the increasing healthcare cost in Japan. The pharmaceutical companies are trying to develop several generic products suitable to patient’s taste. The contribution of pharmacist by selecting generic product to each patient and a collection of patient’s opinion for products may accelerate the development of generic products improved usability for patients and medical workers. The present study examined the storage of generic products of sennoside in pharmacies and the patient preference for selection of generic products in 2003 and 2016 in Kumamoto, Japan.

Methods: Sennoside was selected as a model drug, since it developed several generic products for long period. The survey on storage of sennoside pharmaceutics and the questionnaire survey for its generic products to patients were conducted at ethical pharmacies. The appearance and the dissolution of sennoside from generic tablets were compared with original product, Pursennid.

Results: Thirteen sennoside products were stored in 2003 and 2016. The number of pharmacies that stored generic products increased from 33 to 54% in 13 years. The largest number of patients preferred Pursennid in 2003. In contrast, two generic products were more preferred than Pursennid in 2016. Interestingly, the reasons for preferring products were almost the same between 2003 and 2016, and their majority was color and size of tablet. The generic products tend to have a thinner thickness and larger diameter than Pursennid. The most preferred generic product in 2016 showed a faster dissolution of sennoside than Pursennid. However, the use of generic products is mainly related to their tablet appearances due to unrelation between the pharmacological effect of sennoside and its dissolution in GI tract.

Conclusion: In the development of generic products of sennoside, as well as quality, the appearance is an important factor.

Objective: Hematological toxicity, including neutropenia and thrombocytopenia, is a typical side effect of ganciclovir (GCV). We previously developed a risk-prediction model for GCV-induced neutropenia using decision tree (DT) analysis. By employing the DT model, which is a flowchart-like framework, users can predict the combination of factors that may increase neutropenia risk. However, a risk-prediction model for thrombocytopenia has not been established. Here, we aimed to identify the risk factors associated with GCV-induced thrombocytopenia and construct risk-prediction models.

Method: We retrospectively evaluated the medical records of 386 patients who received GCV between April 2008 and March 2018 at Hokkaido University Hospital. Thrombocytopenia is defined as a decrease in the platelet count (PLT) to ＜50,000 cells/mm³ and to a ＜75% decrease. Risk factors of thrombocytopenia were extracted from the medical records using a multiple logistic regression analysis. Moreover, we employed chi-squared automatic interaction detection (CHAID) and classification and regression tree (CRT) algorithms to develop the DT models. The accuracies of the established models were evaluated to assess their reliability.

Results: Thrombocytopenia occurred in 47 (12.2%) patients. In the multiple logistic regression analysis, data of patients with white blood cells ＜7,000 cells/mm³,PLT＜101,000 cells/mm³ and total bilirubin ≥ 0.8 mg/dL were extracted. Two risk-prediction models were constructed, and patients were divided into six and seven subgroups. In both algorithms, data on hematopoietic stem cell transplantations, PLT ＜101,000 cells/mm³, serum albumin ＜ 2.8 g/dL, total bilirubin ≥ 0.8 mg/dL, and residence in intensive care unit were extracted. The predictive accuracy of both the CHAID algorithm and the logistic regression models was 87.8% and that of the CRT algorithm was 88.3%, indicating they were reliable.

Conclusion: We successfully identified the factors associated with GCV-induced thrombocytopenia and constructed useful flowchartlike risk-prediction models.

Objective: It has been recognized that most medical institutions preferred the printed medium for their information sheets for patient education of inhaler usage. However, some questions have arisen. In a case where patients are not sufficiently informed of drug administration guidance due to limited information with only pictures and text, they might not be able to obtain a proper understanding. Contrarily, it is assumed that video medium, with audio and visual elements, is a format for education conveying a larger amount of information. We conducted comparative research regarding patient’s degree of understanding of inhalation guidance, comparing two groups of print- and video-medium-based instructions for inhaler usage and examined how effective two types of media explanations were on patients.

Methods: Research participants were thirty persons visiting Jinjo Pharmacy, who were randomly assigned to the print medium group and the video medium group. After one group read and saw an explanation sheet of an inhaler where the maker wrote inhalation instructions and the other group watched an instruction video, the two groups practiced inhaler usage. Evaluation was performed with specified items and comprehensive assessment, and in addition, the time required for inhalation was measured.

Results: Score of the evaluation score was statistically significantly higher in the video medium group than in the print medium group in score of specified items and score of comprehensive assessment, and was also significantly shorter in the operation time of the inhaler.

Conclusion: This study clarified that the video medium group had fewer improper inhalation occurrences and shorter operation time and, therefore, showed the effectiveness of the video medium. It is recommended that the video medium should be actively utilized,which could improve patient medication adherence. Accessibility is required for patient education to achieve inhaler techniques by watching video-based instruction.

Objective: Avoiding injection incompatibilities is important. At our hospital, pharmacists are present at the intensive care unit (ICU),where they manage drip lines and use a lookup table for injection incompatibilities. We assessed the risk of injection incompatibilities in the ICU and the contribution of pharmacists toward their avoidance.

Methods: We investigated the number of injections and main drip lines used for outpatients admitted to the general ward and ICU from an emergency setting. We further investigated inappropriate drip line conditions, subsequent interventions by pharmacists, and the actual number of injection incompatibilities. The investigation period lasted 1 year from April 2016 onward.

Results: The number of injections and drip lines used in the ICU was significantly higher than that used in the general ward (p<0.001). Patients in the ICU received multiple continuous intravenous injections from one drip line despite the number of main drip lines being high. Even using the lookup table, 78.3% inquiries made by nurses were related to injection incompatibilities. Fourteen inappropriate drip lines selected by nurses were associated with a risk of injection incompatibility; these occurred during the absence of pharmacists and involved a combination of continuous intravenous injections to be administered from a side line. Subsequently,pharmacists intervened and avoided injection incompatibilities. There was no report of injection incompatibilities in the ICU.

Conclusion: At ICU, the risk of injection incompatibilities is high and it is necessary to focus on the combination of injections to be administered from main drip lines and side lines as well as incompatibilities of multiple continuous intravenous injections to be administered from side lines. A lookup table is insufficient to avoid injection incompatibilities. Therefore, pharmacists can contribute to avoiding injection incompatibilities by maintaining constant presence in the ICU, designing drip line layouts, and proposing line selections.

Objectives: The long treatment duration of glaucoma and multiple drug use have decreased patient adherence to anti-glaucoma drugs. This has prompted the recent marketing of a combination drug, Xalacom ® Combination Eye Drops (hereinafter referred to as the original drug), and its generic drugs (3 generics). In this study, we compared these eye drops from a pharmaceutical viewpoint,conducted research on usability, and evaluated the selection criteria for generics.

Methods: The viscosity and pH of the original drug and its generics were measured. The total number of drops per container, mean mass per drop, and the squeeze force needed for one drop of individual eye drops were measured using a digital force gauge. In addition, a questionnaire survey on the usability of each eye drop was conducted in patients.

Results: The total number of drops in the contain of the original drug and generics tested almost the same. The mean mass per drop of generics from two companies was significantly lower than that of the original drug, and the squeeze force of the generic from one company was significantly lower than that of the original drug. The usability of the containers some generics was significantly higher than that of the original drug.

Conclusion: No difference was observed in the total number of available drops between the original drug and generics. However,differences in squeeze force and usability were observed between the original drug and generics and among the generics. This information should preferably be described in the interview form, patient instruction manual, etc. for providing medication instructions to pharmacists. All products investigated in this study contained more than 100 drops in the containers. The expiration date of tested eye drops after opening is about one month. Reducing the volume of filling into a container may be contribute to the medical economy and avoid the risk of microbial contamination.