The main way that methicillin-resistant Staphylococcus aureus (MRSA) is spread is through contact in hospitals but there is also the possibility of horizontal transmission of the methicillin resistance gene mecA among S.aureus since mecA is located on the mobile element SCCmec .In this study,through the typing of MRSA and methicillin-susceptible S.aureus (MSSA) by pulse field gel electrophoresis (PFGE),MSSA and MRSA belonging to a similar genetic group were identified.When mecA was deleted from the MRSA,its PFGE pattern became similar to that of MSSA.Our results therefore suggest that there is a strong possibility that MRSA spreads by the horizontal transmission of mecA to MSSA as well as through contact.

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We investigated Oxaliplatin (L-OHP)-related hypersensitivity reactions in 20 Japanese patients with advanced colorectal adenocarcinomas treated with the FOLFOX 4 or mFOLFOX 6 regimen,after separating patients into a non-severe group with reactions of grade 1-2 and a severe group with reactions of grade 3-4.The total number of patients was 90,and the proportion with hypersensitivity reactions was 22.2%,rated as non-severe in 13.3% and severe in 8.9%.
We observed the following : 1)hypersensitivity reactions occurred only after the 6th course in the severe group,but this was not true for the non-severe group,and 2)hypersensitivity reactions appeared within 30 min of the start of L-OHP infusion in the severe group,whereas it took more than 30 min for them to be manifested in the non-severe group,with the difference in time being statistically significant (p=0.001 ; Mann-Whitney’s U test).These results strongly suggest that the severe hypersensitivity reactions were of type I and thus could be predicted from various skin tests.

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Since physical rehabilitation is a primary therapy for patients in a cerebrovascular disease recovery unit,it is important to prevent accidental falls due to impaired physical functioning in such patients.In the present study,we retrospectively investigated the risk factors of in-hospital accidental falls,taking administered drugs and activities of daily living into account.To do this,we did a search of the electronic medical records of all patients who had been admitted to our hospital from May to October 2005.
Falls due to seizures or apparently caused by careless mistakes made by medical staff were excluded from the accidental fall count.Patients’age,sex,primary disease,date of fall,and prescriptions (e.g.antihypertensives,antipsychotics,anticonvulsants) were taken from the records for statistical screening for fall risk factors,which was performed by multiple logistic regression analysis.There had been a total of 144 accidental falls in 447 patients.There were no statistically significant differences in patients’demographics between the falls group (n=144)and no falls group (n=303).Multiple logistic regression analysis showed that administration of minor tranquilizers and the Barthel index at hospital admission were statistically significant risks for accidental falls with odds ratios of 2.2[95% confidence interval : 1.1 to 4.4 ; p <0.01]and 4.9[2.4 to 10.1 ; p <0.05],respectively.We concluded that patients taking minor tranquilizers should be monitored more carefully to avoid accidental falls,and such careful monitoring would be particularly important for patients with a low Barthel index following a cerebrovascular disease.

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We have introduced a computerized prescription checking system for cancer chemotherapy that helps ensure medical safety.In developing it,we incorporated a regimen ordering function into the electronic medical record system (EMRS) and registered chemotherapy regimens for which prescriptions could be ordered,restricting orders for antitumor drugs from physicians to those in the regimens.All registered regimens were reviewed and approved by an in-hospital pharmacotherapy committee.Under the primary check system,doses of antitumor drugs are automatically calculated based on patient body weight or body surface area.The limit on the highest dose of each antitumor drug is 110% of the automatically calculated dose.When ordering chemotherapy regimens,doses of antitumor drugs are ordered without converting to the number of vials of each size.In the pharmacy subsystem,orders are sent to the pharmacy and totals made of all prescriptions.Then,doses of antitumor drugs are automatically converted into the number of each size of vial based on cost performance and the numbers of vials is printed on prescriptions to support dispensing.The system also makes chemotherapy administration records to help ensure that doses of antitumor drugs for each patient are reasonable.
The introduction of our system has made chemotherapy dosage errors much less likely and the total prescription error rate was reduced to 0.15% (0.10% for outpatient chemotherapy,0.21% for inpatient chemotherapy).It has also greatly reduced pharmacists’workload in prescription checking.We feel that our prescription checking system has decreased the chemotherapy prescription error rate for the errors that were most likely to harm patients.

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Scabies is a major form of dermatitis and in the second edition of clinical management guidelines for scabies drawn up by a committee of the Japanese Dermatological Association in 2007,ivermectin was recommended as a drug of choice for its treatment.Ivermectin had been approved as a treatment for scabies and launched in Japan in August 2006.
On administering ivermection to 6 patients who developed scabies in our geriatric mental ward,3 of them subsequently developed hepatic function disorders.In order to investigate the cause of these disorders,we examined their weights,ages,drug interactions,and metabolism.
We found that blood levels of ivermectin were easily affected by fat in the diet due to its liposolubility.In addition,since CYP3A4,an enzyme considered to be involved in the metabolism of ivermectin,may increase the toxicity of its metabolic products,we concluded that use of ivermectin should be reviewed.It is recommended that hepatic function tests are carried out a week before and after administering ivermectin,and that it should be given at bedtime to avoid drug interactions.

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Many out-patients with mental disorders are prescribed hypnotics at mental hospitals.Although we explain in detail how hypnotics should be taken when they are first prescribed,we do not always explain their use to patients who have been taking hypnotics for a long-time.In consideration of this situation,we performed a questionnaire survey on the actual usage of hypnotics by out-patients,with the purpose of raising awareness of the proper way of using them.
The total number of patients responding was 161,78.9% of whom went to bed within 30 minutes of taking hypnotics,and 74.5% fell asleep within 60 minutes.The average total sleeping time was 7.1 hours and 71.4% felt that hypnotics were effective.On the other hand,21.1% did not go to bed for more than 30 minutes after taking hypnotics.Based on these findings,we should advise patients on the use of hypnotics more frequently.

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Burow’s solution,a hospital preparation,exhibits antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and other microorganisms that are commonly observed in chronic supprative otitis media.However,it takes several days to prepare Burow’s solution by the method commonly employed in Japan and it is difficult to ensure constant quality.With this in mind,we examined the pharmaceutical and pharmacological characteristics of Burow’s solution and developed a new prescription for it (Neo-Burow’s solution) having an aluminum acetate base.The new prescription takes only a few hours to prepare,is convenient,and ensures a solution of constant quality.
In this study,we examined the clinical effects of Neo-Burow’s solution in external and internal otitis.We prepared NeoBurow’s solution in the Department of Pharmacy and used it for 13 patients in whom commercially available antibiotics had had no effect,in the Department of Otorhinolaryngology of Hiroshima University Hospital.Nine of the patients completely recovered after treatment with Neo-Burow’s solution,and it had some effect in 1 patient but was completely ineffective in the remaining 3 patients.No adverse reactions were observed.
Our results indicated that Neo-Burow’s solution was effective and safe in the treatment of chronic suppurative otitis,even that accompanied by MRSA.We have received a lot of inquiries about Neo-Burow’s solution from pharmacies and other hospital facilities,most of them relating to its preparation and preservation.Our manuscript includes a summary of the inquiries and the answers given to them.

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The number of contract clinical trials conducted at the Shizuoka Cancer Center has been increasing every year and in them there has been a marked increase in patients undergoing combination chemotherapy.The number of investigational agents being dispensed has also increased and a need has arisen for greater efficiency in investigational agent distribution,the preparation of injectable anti-cancer drugs,and the management of concomitant drugs.In addition,it was noted that clinical pharmaceutical management counseling for clinical trial participants had not been fully put into practice.In response to these issues,we created a special tool for the management of concomitant drug use based on commercially available software and made efforts to reduce human error in the preparation and distribution of investigational agents as well as in promoting pharmaceutical management counseling for trial participants.
The software tool that we created has significantly shortened search times as compared with the previous paper records,leading to an overall increase in efficacy.There has also been an increase in counseling on pharmaceutical management for clinical trial participants.This is partly due to the clinical path we created and allows us to quickly track all of the participants.
In conclusion,there is a need for pharmacists to actively contribute to clinical trials,not only through the management of investigational agents but also through that the management of concomitant drug use and pharmaceutical management counseling.

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In cancer chemotherapy,adverse effects are inevitable and occasionally fatal.Also,the use of appropriate measures against them can greatly influence the QOL of cancer patients so such measures should be taken rapidly.To do this,an extensive knowledge base containing information on the degrees and time of occurrence of various anticancer drug adverse effects is necessary.
In this study,we developed an evidence-based adverse effects manual for doctors.Six months after distributing the manual,we examined its usefulness by administering a questionnaire.More than 80% of the doctors responding said that the manual saved work in deciding on a prescription or examining medical treatments and more than 90% of them thought that the manual aided them in administering treatment.In conclusion,our manual provides doctors with a useful tool that enabled them to rapidly administer appropriate treatment for adverse effects due to cancer chemotherapy.

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Patient medication notebooks are an effective tool for preventing treatment-associated adverse reactions in patients who go to more than one pharmacy and are treated at more than one hospital.Community pharmacists usually check drugs in prescriptions against patient medication notebooks to reduce the likelihood that patients will receive duplicate treatment or have adverse drug-drug interactions using their pharmaceutical knowledge and experience.
In this study,we examined the usefulness of the prescription checking system in a dispensing fee invoicing computer for checking patient medication notebooks.From a total of 2,776 patients recruited in our pharmacy,1,621 (58.4%) used a patient medication notebook.Fifty-five patients (2.0%) were found to have been prescribed drugs in questionable combinations.Among the 122 instances of questionable combinations noted for these patients,13 concerned duplicate treatment and 109 interactions.Among the instances of duplicate treatment,10 involved treatment with drugs with the same brand name and the rest drugs with the same generic name but a different brand name.Of the 109 cases of drug interactions,14 concerned combinations of medicines that should not be taken simultaneously and the rest combinations of drugs that should be co-administered with caution.Our results showed that application of the prescription checking system in the dispensing fee invoicing computer to the audit of patient medication notebooks was useful for identifying questionable drug combinations.

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In the present study,we conducted a detailed examination of the drug dose history of patients who received generics in accordance with“generic substitution possible”prescriptions filled by an Asahi-Chozai Co.,Ltd.stores (total number of stores : 83)during the 6-month period from April to September 2006.We also investigated the classes of drugs for which patients had initially accepted generics but later switched back to the original drugs due to problems,as well as the reasons for such changes.
Among the total of 406 patients who met the inclusion criteria of the study,368 (90.6%) had no problems with the generic drug substituted but 38 patients (9.4%) changed back to the original drug.
In promoting generic drug substitution,pharmacists have to assume responsibility for informing patients concerning the effectiveness and safety of generics at the same time as giving them information regarding their economic advantages.If pharmacists clearly explain the safety and advantages of generics to patients,this will help ensure that they are used properly.

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Since anticancer agents are toxic,their preparation requires the attending pharmacist to have a high level of technical skill to avoid contamination from them.We conducted an educational program which taught the preparation of anticancer agents using fluorescein sodium (FL) as a placebo and a standard procedure-list for 15 persons who had either had no experience of preparation or less than 1 year’s experience.FL was chosen as contamination due to it could be detected under UV and the standard checklist was designed to aid confirmation that the standard procedure was being followed in preparation.In the program,after 1 try at preparation,there was 30 minutes of self study and then participants tried preparing the placebo anticancer agent again by the same procedure.The number of FL spots detected under UV,time for preparation,and score for preparation according to the checklist was compared between the 2 tries at preparation,and additional information was obtained using a questionnaire.
As for the results,the number of FL spots detected under UV decreased significantly from 2.3±0.4 to 1.1±0.2 (p= 0.018),the preparation technique score significantly increased from 13.9±1.1 to 17.9±1.0 (p=0.002)and time for preparation decreased from 13.0±1.3 min.to 10.2±0.9 min.(p<0.0001).Additional information obtained through the questionnaire indicated that the participants felt satisfied with the program.In conclusion,we feel that this program is highly beneficial in training on the preparation of anticancer agents.

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