We require our students in the 4 th grade to undergo training at the pediatric outpatient clinic of 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 medical interviews with 287 patients’ guardians,in the presence of trainers using a questionnaire.This was followed by observation of consultation and treatment provided to patients.In the afternoon,students reported their findings from the medical interviews,participated in group discussions,and received supplementary lectures from the trainers.After completing the training,students were asked to fill in a questionnaire.When asked concerning their satisfaction with the training,62.5% and 37.5% of students said they were “very satisfied”and“satisfied”,respectively.Regarding their opinion of the observation of consultation and treatment,the percentage responses for“very good”,“good”,and“cannot say which”were 64.1%,29.7%,and 6.2%,respectively.Concerning the medical interviews,64.1% and 34.4%,respectively,said it was“very good”and“good”to do them,while 1.5% answered“cannot say which”.All students said they could determine the problems of guardians regarding drugs in the medical interviews.The training in on-site pediatric outpatient care was found to be“very useful”and“useful”by 62.5 % and 35.9% of students,respectively,while 1.6% responded“cannot say which”.
Students experienced great satisfaction from the medical interviews since they had been able to have good communication with the guardians through them.This was thought to be attributable to the use of OSCE interview techniques which the students had learned beforehand.

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Aripiprazole,an antipsychotic having a novel dopamine D₂ partial agonist mechanism of action was launched in Japan in June 2006.Since there is still not much experience of using this new drug in Japan,we decided to find out how doctors prescribe it and whether its prescription has been affecting chlorpromazine (CP) equivalent dosages of antipsychotics and concomitant use of anticholinergics by examining antipsychotic and anticholinergic prescriptions over 12 weeks for patients who were started on aripiprazole within 3 months of approval.We also sent a questionnaire to prescribers concerning their expectations of aripiprazole and the reasons if it had been discontinued.It was found that aripiprazole was much prescribed to patients receiving a single antipsychotic medication,and the most common expectation was further improvement of hallucinations and delusions.After the 12 weeks of the follow up,the prescription of aripiprazole increased the number of antipsychotics significantly but did not affect the CP equivalent dosage and percentage of concomitantly used anticholinergics.We found that the most common reason for discontinuation of aripiprazole was insufficient effectiveness for hallucinations and delusions,but in no patient was it withdrawn due to adverse effects.It seems that a complete switch to aripiprazole takes time even though it was prescribed to patients for whom switching was relatively easy,raising the possibility of polypharmacy and prolonged administration of anticholinergics.It is thus necessary to continuously monitor the administration of aripiprazole as well as that of other antipsychotics in order to prevent polypharmacy.

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We considered that an educational intervention to increase knowledge of medicines for home helpers of elderly patients would help ensure that they are administered properly.We conducted a questionnaire survey of home helpers regarding their interest in and knowledge of medicine,need of studying it,and experience of helping the elderly to take their medicines.The questionnaire was sent to 103 helper stations,and 121 home helpers from 23 stations responded.
Home helpers helped elderly patients to take various medicines,and many were interested in the medicines that they were taking.Despite feeling the need to know more about the medicines,they had few opportunities to do so.Based on these responses,we recently planned an educational program that was suited to the needs of the home helpers and included a study meeting since many of them had expressed the desire to participate in one.
We felt it was instructive for the pharmacist to understand the actual situation of elderly patients taking medicines at home and how they are helped in taking their medicines by home helpers.

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From the viewpoint of hospital and risk management,it is very important to manage prescriptions brought by patients when they are hospitalized.However,with the multifarious tasks that pharmacists now have to perform it is difficult to check prescriptions soon after patients are hospitalized.In view of this,we devised a system that checks medicines brought in to hospital,outputs check sheets on which the names of drugs,their usage,dosage,remaining quantities and those with the same ingredients as drugs used in our hospital.
The system also has a function for suggesting tests and items that need to be checked for drugs that require special caution (anticancer drugs,antidiabetics,antirheumatics,etc.) such as blood tests,adverse effects and therapeutic drug monitoring.It enabled us to check for interactions between drugs,or drugs and disease,and duplicated prescriptions quickly.
The results of a questionnaire on our system that we gave to doctors and nurses showed that they appreciated it.We consider that the reinforced management of pharmaceuticals that it provides will contribute greatly to ensuring the proper use of drugs.Furthermore,if this system is linked with various order entry systems in the hospital (for blood tests,diseases,etc),pharmacists will be able to further improve the quality of their pharmaceutical counseling services.

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In cancer chemotherapy,pharmacists play an important role by checking dosages,dosing schedule and other prescription details.For this purpose,we created a“Cancer Chemotherapy Regimen Sheet”for common use among medical staff.The sheet makes it easy for doctors to input data into the electronic medical recording system.
It features automatic calculation of body surface area when the height and body weight are input,automatic selection of the proper standard for the anticancer drug to be used and their numbers when dosages are input and automatic calculation of the necessary volumes of anticancer drugs and drip injection speed.It also functions as a work sheet for the mixing of anticancer drugs in a sterile condition by pharmacists and administration of medications to patients by nurses,and may be used by doctors to explain chemotherapy regimens and the details of pharmaceutical care to patients.
In December 2006,we made 37 Cancer Chemotherapy Regimen Sheets for 23 regimens for gastric,colorectal,pancreatic,liver,breast and urothelial cancer.Further,after introducing our electronic medical recording system,its monthly mean use in outpatient and inpatient chemotherapy was 39.9 and 28.4 times,respectively and the use of the Cancer Chemotherapy Regimen Sheet was 100% and 68.8%,respectively.
The making of the sheet has produced standardized information which may be used by all medical staff and shared with patients,and it has contributed to reinforcing risk management.

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Hospitals prepare ulinastatin vaginal suppositories for use in the treatment of threatened abortion.As it is important to ensure that suppositories are uniform,we developed an analytical procedure for ulinastatin in the suppository and examined the suitability of the preparation procedure.
We could successfully use the spectroscopical analysis procedure for ulinastatin described in JP XIV when the suppository base was removed from the mixture after the color reaction with trypsin,but not when it was removed before.The reproducibility and accuracy of our analytical procedure were very good.The preparation of the ulinastatin suppository from its injection was found to require careful control of the water loss from the mixture.When this was done,ulinastatin content in the suppository was the same as in the original injection,and the content uniformity was good.Testing for change in ulinastatin content and microbial growth during the storage of suppositories in a refrigerator for 3-months produced satisfactory results.
In conclusion,the method for the preparation of this drug from the injection and that for the analysis of the ulinastatin in the suppository that we developed should be useful to hospitals.

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Much evidence for the usefulness of anti-hyperlipidemic agents is now available and clinical guidelines for the treatment of hyperlipidemia (HL) have been established so we thought that prescription trends might have changed in the last few years.Since it is important for pharmacists to be aware of the prescribing situation and evaluate it from the pharmaceutical aspect,we conducted a study to determine what changes had occurred from 2004 to 2006 at St.Luke's International Hospital regarding the use of anti-hyperlipidemic agents.We took our data from the drug ordering system.
Statins were the most frequently prescribed type of anti-hyperlipidemic agent in any year and prescriptions for atorvastatin had grown particularly sharply over the three years of the study.However,there was some variation among departments regarding these changes,for instance in kidney-related departments where the frequency of prescribing statins was noticeably higher.The package inserts of statins state that they require careful administration in patients with renal dysfunction so doctors and pharmacists should observe this in order to avoid adverse effects.
In conclusion,our findings indicate that evidence-based standard pharmacotherapy for HL has been practiced at St.Luke’s International Hospital and we feel that the results of this study on prescription drug use will be useful in ensuring the proper use of pharmaceutical products.

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In this paper,we report the case of a patient with terminal esophagus cancer whose cancer pain was well controlled by transdermal fentanyl.
The subject was a 68-year-old man who was diagnosed with esophagus cancer in February 2005.Chemotherapy and radiotherapy were started in June but were stopped due to adverse effects and he was hospitalized for the purposes of esophagus extension and pain control.The pain was controlled by sustained morphine injections at 400 mg/day and there were no adverse effects.He underwent percutaneous endoscopic gastromy due to difficulty in oral intake and was then switched to transdermal fentanyl.Since the morphine been given at a high dose,we made the switch to transdermal fentanyl over two weeks.The cancer pain could be controlled with transdermal fentanyl at 50 mg/3 days and betamethasone syrup at 1 mg/ day.Our findings indicate the necessity of pharmacist intervention in switching from high dose morphine to transdermal fentanyl.

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It has been reported that pilsicainide is effective for the treatment of paroxysmal atrial fibrillation (PAf).As pilsicainide is excreted from the kidneys,however,it is important to devise dosage regimens in consideration of individual patients’renal function.At Chugoku Rosai Hospital we monitor plasma concentrations of pilsicainide as well as its effectiveness,and reflect the findings in treatment.
We first adjusted the dosage of pilsicainide based on the creatinine clearance (Ccr) and then monitored plasma concentrations and the effectiveness of the drug.We found that in many patients,as the state of their disease changed,there was a change in Ccr which resulted in increased in plasma concentrations of pilsicainide.Thinking that more detailed dosage regimens were thus required,we calculated a linear regression equation based on Ccr and pilsicainide clearance,and prepared a table of estimated plasma concentrations from the equation.With reference to this table,we devised dosage regimens for pilsicainide and compared plasma concentrations of the drug with the effect as shown by electrocardiograms,and discussed the results with physicians.This system has made it possible to provide more useful drug management.

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It is important that anti-microbial drugs are used properly to prevent increases in resistant bacteria.The Infection Control Team (ICT) of Nagara Medical Center introduced a reporting system in which the use of specific anti-microbial drugs,such as fourth generation cephalosporins,carbapenems,new quinolones,and anti-MRSA drugs,was restricted.As a result,there was an increase in prescriptions for penicillin and third generation cephalosporins and a decrease in prescriptions for the restricted drugs.We consider that our reporting system made doctors think more carefully about selecting anti-microbial drugs,resulting in the change in usage pattern.
With this change in the use of anti-microbial drugs,the number of bacteria detected decreased and there was also a decrease in the minimum inhibitory concentration (MIC) for MRSA and Pseudomonas aeruginosa.
In conclusion,our restrictions on specific anti-microbial drugs decreased their usage and there was also a decrease in the number of bacteria detected.

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EMIT,a homogeneous enzyme immunoassay for the quantitative analysis of mycophenolic acid (MPA) in human plasma,was evaluated in comparison with high-performance liquid chromatography (HPLC).For EMIT,coefficients of variation (CV) for within-run measurements (1~12μg/mL,n=20)varied from 4.07% to 5.16% and CVs for between-day measurements (1~12μg/mL,n=20)ranged from 2.23% to 5.63%.The lower limit of detection was 0.20μg/mL.
When MPA plasma concentrations were simultaneously measured using EMIT and HPLC,there was a good linear relationship between the 2 assay methods showing a high degree of correlation : EMIT=1.13×HPLC+0.164 ; r₂=0.967,51 points in 16 liver transplant recipients,EMIT=1.10×HPLC+0.305 ; r₂=0.948,55 points in 15 renal transplant recipients and EMIT=1.06×HPLC-0.014 ; r₂=0.887,300 points in 8 islet transplant recipients.These results indicate that EMIT is a convenient means of measuring MPA in plasma.

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During the period November 2003 to April 2004,we conducted a survey of patients visiting Niigata Pharmacy with regard to their awareness of previous adverse effects due to medicines they had received at other pharmacies.Eight-hundredsixty-three patients had experienced adverse effects,12.0% of the total of 7,178 patients surveyed.In all,there had been 1,027 cases of adverse effects and 998 (97.2%) of them were based only on patients’memory.For approximately 50% of these cases,the adverse effects were due to medicines,the common ones central nervous system drugs and antibiotics.Approximately 93% of the patients could answer questions regarding the symptoms of the adverse effects,with many saying that they were dermatological and alimentary canal manifestations.
We have been noting the adverse effects reported in patients’drug history documents,and if necessary,have been enquiring about the prescriptions involved.Working in a health insurance pharmacy,it is very important for us to conduct good safety management for the drugs we dispense and in the future,we must teach patients to how they can participate in the safety management of the drugs they take.

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