Recently there has been an increasing need for pharmacists to become more specialized and play a more important role in hospitals and with this in mind, we participated in infection control in various ways.
Our hospital has a large number of elderly patients and about 65% of them have circulatory or respiratory tract diseases.There is thus a high risk of them contracting infectious diseases and preventive measures are urgently required.Our contribution to this has been through therapeutic drug monitoring, antiseptic control, drug control guidance and preoperative autologous blood donation.As a result of our activities, the incidence of catheter infections decreased and so did antimicrobial usage and amounts of antiseptics purchased.Through such activities, we have established a clear role for pharmacists in hospital infection control.

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The temperature and humidity in our dispensary and that in the cartridge of a fully-automatic tablet packaging machine were analyzed based on the simple assumption that the humidity in the dispensary and the cartridge are about the same every morning and that the water content of the cartridge stays constant over the whole day.From the results of the analysis,an equation for predicting the temperature and the humidity in the cartridge was derived.It enables the temperature and humidity in the cartridge of the fully-automatic tablet packaging machine to be simply predicted solely on the basis of the temperature and humidity in the dispensary.Good agreement between the predicted temperature and humidity in the cartridge and actual measurements confirmed the applicablilty of the equation to this situation and we conclude that it is a useful means of predicting the temperature and humidity in the cartridge.

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Though it has been reported that the incidence of extrapyramidal symptoms with risperidone oral solution is lower than that for risperidone tablets,there has still been no detailed comparision of the 2 dosage forms in this respect.With this in mind,we investigated the usage of anti-parkinsonism drugs for a period of 1 month from starting to take risperidone oral solution or tablets,and compared the incidence of extrapyramidal symptoms between a risperidone oral solution group of subjects and a tablets group.The incidence of extrapyramidal symptoms for the oral solution group (4.8%) was significantly lower than that for the tablets group (23.2%)(p=0.022; χ²-test)(p=0.011; Log rank test) and the number needed to treat was 5.4.From this,we concluded that risperidone oral solution is safer to use than risperidone tablets in virew of the lower incidence of extrapyramidal symptoms.

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We examined the occurrence of itching in 310 patients in whom allergic drug eruption was suspected and studied various aspects of itching for 221 leukocyte migration test (LMT)-positive patients.
The incidence of itching was 75.1% in the LMT-positives and 64.0% in LMT-negatives,a significant difference (p<0.05,χ²-test).In the former,there was a negative correlation between the incidence of itching and aging (correlation coefficient ; r=-0.78,p<0.01).As regards latent period,the incidence of itching was 65.0% in less than 3 days and 83.0% in more than 4 days,and this difference was also significant (p<0.05,χ²-test).Regarding leucocyte migration factors (LMFs),there was a signifant difference between the incidence of itching for the leukocyte migration activating factor (LMAF) which was was 82.2% and that for the leukocyte migration inhibitory factor (LMIF) which was 69.2% (p<0.05,χ²-test).In terms of causative drugs,the incidence of itching was 80.2% for antibacterial drugs and 62.5% for non-steroidal antiinflammatory drugs (NSAIDs),the difference again being significant (p<0.02,χ²-test).The detection rate of LMAF was significantly higher than that of LMIF for the antibacterial drugs (p<0.05,χ²-test),but in the case of NSAIDS,the LMIF detection rate was significantly higher than that for LMAF (p<0.00001,χ²-test).
Our findings indicate that the itching may arise as an allergic reaction in drug eruption and is present in 3/4 of allergic drug eruption cases.It also seems to be decreased by aging and to be influenced by the latent period,causative drug and LMFs.

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At the National Cancer Center Hospital,serotonin (5-HT₃) receptor antagonists are used in chemotherapy regimens including anticancer agents with a strong emetic action to prevent nausea and vomiting.With a view to standardizing usage,we conducted a survey to determine how 5-HT₃ receptor antagonists were being used in our hospital.
It was found that the type of 5-HT₃ receptor antagonist, diluent volume and infusion time varied among cancer therapy groups and among the 4 intraveneous 5-HT₃ receptor antagonists available in our hospital,granisetron was the most frequently used,though the administration method varied with the regimen.
While the therapeutic goal of treatment with 5-HT₃ receptor antagonists is to completely eliminate nausea and vomiting due to anticancer agents,they should be used as efficiently as possible and for this purpose it is important to standardize the volume of the diluent and intravenous infusion time.

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We developed a novel management system for inpatient emergency medicines using a tray exchange system for their delivery.A major feature of the system is that the emergency medicines in it have been standardized through the selection of a limited number of representative injections and oral drugs (28 of the former and 3 of the latter) for all wards in our hospital.These medicines are placed on trays in the pharmaceutical department,and then delivered by means of a tray exchange system.The trays with medicines are placed on a trolley located in each ward,and later trays return to the pharmaceutical department with prescriptions written on a special form we developed.Through a questionnaire survey of ward staff,we discovered that the use of the management system had resulted in a decrease in the frequency of medicines not recorded on prescriptions from 9.4% to 5.8 as well as drop in taking medicines in error.It is therefore expected to be useful in drug supply management.

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We made semisolid nutrient preparations by mixing nutrients with agar,and administered them via a percutaneous endoscopic gastrostomy (PEG) tube.The viscosities of the nutrients were measured in the presence of digestive enzymes and under various temperature and acid conditions using a rotating viscometer.The results suggested that viscosities decreased with body temperature as well as in the presence of digestive enzymes,but were not affected by the acidic conditions.Thus,when administering semisolid nutrients via a PEG tube,we should be aware of the risk of complications associated with a decrease in viscosity.

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The package insert (PI) is a primary source of information for healthcare providers and their format in Japan was dramatically altered in 1997 to make them simpler and easier to understand.In order to investigate the attitude of hospital pharmacists toward current Japanese PIs and how they are used,we sent a questionnaire to 320 hospitals in cooperation with the Japanese Society of Hospital Pharmacists.It had a general section and a more detailed section that focused on drug interactions and pharmacokinetics.
We received responses from 266 hospitals (83.1%).The majority of respondents approved of the order of the current PI (94.2%) and all of them felt the need for background information when the details of a PI were revised.In the section of the questionnaire on drug interactions and pharmacokinetics,nearly all of the respondents approved the tabulation of drug interactions (99.2%).On the other hand,many responders considered detailed information such as that concerning drug names,quantitative pharmacokinetic data and specific metabolic enzymes to be insufficient,and many wanted to have note made when a pharmacokinetic effect was observed in healthy volunteers (67.7%).A large number of pharmacists also wished to have more information on drug interactions.
In conclusion,we feel that a minimal amount of quantitative data on drug interactions and other critical information needs to be included in PIs without spoiling the current easy-to-understand format.

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When the dry powder type inhalation steroid (DPI-ICS) device is selected,its suitability based on the inspiratory flow rate value is not checked for all patients.It was therefore considered necessary to establish standards for selecting inhalation devices.With this in mind,the relationship between the inspiratory flow rate and the device was investigated,and the application of this to the selection of inhalation devices was studied.
The subjects for this study were outpatients of the Mie Chuo Medical Center who were using DPI-ICS devices.The inspiratory flow rate was measured using an Incheck instrument and the suitability of devices was examined with an inhalation tester.
Though 13.5% of the subjects using Diskus and 25% of those using Turbuhaler satisfied the mimimum requirement of 30L/min,there was no reaction with the inhalation tester which suggested that inhalation might not be very good.However,inhalation was more effective when patients were given proper instruction on inhalation.Changing devices based on investigation of their suitability was also found to be effective.
In view of the above findings,we felt it necessary to develop a system for the prescribing of inhalers by doctors after pharmacists have investigated their suitability using the Incheck instrument and the inhalation tester.We have been trying out such a system.

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To ascertain the use of health foods by patients and the associated problems,we asked 364 patients who brought prescriptions to our pharmacy to fill out a questionnaire.The questions asked aimed to determine the percentage of patients using health foods,the purpose of using them and the kinds of health foods used as well as the period,the frequency,amounts,and the effects of using them.Other questions concerned the person advising them on the use of health foods,the side effects of health foods,and the awareness of patients regarding the interactions between drugs and health foods.The knowledge obtained from the responses received should enable us to provide better pharmaceutical care to patients.

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We evaluated the usefulness of“Minofit^®”glycyrrhizin injection,a prefilled syringe (PFS) product,as regards speed and ease of dispensing,β-glycyrrhizic acid (β-GZ) content,impurities,and clinical effects when administered intravenously.Compared with ampules,the PFS shortened the dispensing time to about 1/2 for 20mL of the drug and to about 2/5 for 40mL of the drug.Upon measuring the contents of β-GZ,α-glycyrrhizic acid (α-GZ),glycyrrhetic acid (GA),and glycyrrhetic acid monoglucuronide (MGGR) by HPLC,we found that the β-GZ content was 1.940mg/mL for Minofit^® and 1.833mg/mL for the Stronger neo-minophagen-C^® (SNMC) product.The α-GZ form accounted for less than 5% of the β-GZ content and GA and MGGR each accounted for less than 0.15% of the glycyrrhizic acid content.The contents of major impurities were similar for both Minofit^® and SNMC.
To evaluate the clinical effects in 28 patients with hepatitis C (excluding HCC) who were continuously treated using SNMC for 6 months and using Minofit^® for the next 6 months or longer,the ALT and AST values immediately before the change to Minofit^® were compared with those 6 months after the change.The mean ALT value was 54.8±25.9 IU/L before the change and 46.8±26.0 IU/L afterwards indicating that the clinical effects of Minofit^® and SNMC were similar.In conclusion,having a β-GZ content and clinical effects similar to those of SNMC,Minofit^® should demonstrate a high degree of usefuness as a glycyrrhizin injection product.

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