At Sapporo Medical University Hospital,170,000 to 190,000 prescriptions have been issued annually in the last 4 years (excluding those for injections).The number of dispensing errors made with respect to prescriptions was 71 in 2003 (incidence based on total number of prescriptions : 0.041%),and 75 in 2004 (incidence : 0.044%).However,owing to the hospital requiring identification codes printed in prescriptions to be checked in dispensing and in audits from 2005 onwards,the number of errors decreased greatly,to 25 (incidence : 0.014%) in 2005,and then to 20 (incidence : 0.01%) in 2006.The decrease in the 2 years following the requirement to check identification codes was significant when compared with the dispensing error rates in the 2 years before this requirement (p <0.001).The checking process requires an average of 1.58 seconds per medicine and facilitates risk avoidance in dispensing.We consider that it contributed to reducing dispensing errors,particularly when there was only 1 person working on the night shift.

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For the objective structured clinical examination (OSCE) used in pharmaceutical education,it is important to establish valid evaluation systems,especially for the evaluation of student communication skills in medical interviews.In the present study,we examined the evaluation scores obtained in the 2nd OSCE trial at Kyoto University,and discuss the OSCE evaluation system for communication skills.The results of kappa analysis,which was used to determine the proportion of agreement between the scores of two instructors,suggested that there was a large variation in the proportion of agreement,the extent of which depended on the type of evaluation questionnaire and the amount of ambiguity in it.In general,there was a higher proportion of agreement among the items of closed questions,and among open question items for evaluation of student behavior there was a lower degree of agreement.These results were confirmed by a review of recorded images and voices.Based on our results and considering that medical interview skill is evaluated through a conversation between a student and a standardized patient,we conclude that it is not practical to determine the evaluation standard for each questionnaire too precisely.We also feel that summarized scores would be preferable for the evaluation of student communication skill in OSCE.

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We surveyed the current use of lidocaine tape in hemodialysis (HD) patients and evaluated the condition of their skin.Nearly 80% of them complained of pain on needle insertion,and the evaluation of their skin condition indicated that the stratum corneum moisture content was significantly lower than that of healthy volunteers.In view of this,we investigated skin hydration as a simple method of enhancing lidocaine absorption in HD patients.Skin hydration reduced the amount of pain on needle insertion in half of the 16 HD patients.It stayed about the same or increased slightly in the other half.
To examine the effect of skin hydration in more detail,we investigated lidocaine concentrations in porcine ear skin and found that the skin lidocaine concentrations were significantly increased (8.97±2.44μg/cm² vs.24.51±12.26μg/cm² after 30 min of application) by skin hydration.We feel that it could be an effective means of alleviating the pain experienced by HD patients.

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Amino acid and glucose injection with electrolytes is widely used in clinical practice for supplying water,electrolytes,and nutrients to patients.However,poor hygiene management in the preparation of infusions will give rise to microbial contamination and the continuous administration of contaminated infusions will increase the risk of infection.We therefore inspected infusions and infusion lines (inside and outside of three-way stopcock,its connections and rubber stopper).Though no microorganisms were detected in 110 infusion solution samples,microorganisms were isolated from 28 of 95 samples taken from the infusion lines.The rate of microbial contamination for the inside of three-way stopcocks was 11.3 % (6/53 samples),and for the inside of 3-way stopcocks used in infusions that were indwelled for more than 96 hours the contamination rate was 33.3%,higher than that for shorter indwelling times.Staphylococcus epidermidis ,Staphylococcus warneri ,and fungi were isolated from the inside of the three-way stopcocks tested.The rates of microbial contamination for the three-way stopcocks and the rubber stoppers were 71.4% (15/21)and 33.3% (7/21),respectively.From samples taken from them,Acinetobacter radioresistens ,Staphylococcus lentus ,Burkholderia cepacia ,and Stenotrophomonas maltphilia were frequently isolated.
In conclusion,there is always the possibility of microbial contamination in infusion lines and in order to prevent it,it is necessary to exercise strict hygiene management regarding the preparation of infusions and infusion lines,and to use infusions rapidly once they have been prepared.

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In this study,the usefulness of the click sound produced on setting the dose of the following 3 types of prefilled insulin pen devices were compared : FlexPen^® (Novo Nordisk Pharma) (FLX),SoloSTAR^® (Sanofi-Aventis) (SOL),and MirioPen^® (Eli Lilly Japan) (MIR).The click sound of FLX and MIR was evaluated highly (n=50)in the clinical evaluation,in which subjects were asked to listen to recordings of the clicks and say which were“easy to count”and“pleasant to hear”.In a frequency component analysis of the clicks,FLX and MIR tended to have a higher sound pressure level (dB) in frequencies that were easy to hear for subjects but SOL did not have this characteristic.The mean duration of the click sound of FLX was 1.25 times and 1.82 times longer than that of MIR and SOL,respectively,indicating that the click sound of FLX would be easier to recognize than that of MIR and SOL.Based on the above results,we concluded that the FLX injector would be the most useful as regards dose setting using the auditory sense and therefore could be recommended to elderly and visually impaired patients,who need to set doses by listening to click sounds.

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To investigate the cause of an outbreak of epidemic keratoconjunctivitis (EKC) that occurred in the Department of Ophthalmology of our hospital,we conducted an environmental PCR test which produced adenovirus-positive reactions.The positive environmental factors included eye drops for treatment purposes that were shared by some patients,suggesting that eye drop contamination was a possible cause of the outbreak of EKC.Following this,our Department of Pharmacy started distributing small volumes of eye drops all of which were used by individual patients (none left to share with other patients).
In view of this,we conducted a questionnaire survey regarding the present status of the small-volume transfer of eye drops at 45 health care institutions.Replies were obtained from 37 institutions (78%).The methods of usage of eye drops for treatment purposes and those administered after surgery varied among institutions and there was also a difference in the way that they were used between inpatients and outpatients.Seven institutions distributed small volumes of eye drops for the treatment of individual patients.As for the desires of institutions concerning eye drops for treatment purposes and those for use after surgery,25 said that eye drop products should be standardized to contain a small volume just sufficient for administration to 1 patient.In conclusion,to prevent nosocomial infections,pharmaceutical companies should supply eye drops in small-volumes to prevent cross-contamination.

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The purpose of this study was to clarify the relationship between the inner-diameter of an ampoule and the amount of glass particle accumulation after opening ampoules.All of the ampoules used in the study were snapped open by hand and left to stand undisturbed for 120 seconds.Tilting the ampoules,the solutions in them were aspirated using an 18 G nonfiltered needle attached to a 5 mL syringe.The contents of the ampoules were then diluted with 0.6-4 mL distilled water and passed through a 0.20 mm membrane filter.Amounts of remaining particles were measured using a KL-04 particle counter after aspiration of the ampoule contents.Our results suggested that glass particulate contamination was positively correlated with the inner-diameter of the ampoule,but not with the thickness of the ampoule walls.This finding could help prevent the injection of glass particles into patients,and the use of filters may further decrease the risk of this happening.

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A survey of the literature was conducted to evaluate the influence of mothers’medications on breast-fed infants with regard to the excretion of drugs into breast milk,the adverse reactions produced in breast-fed infants and the factors influencing them.The reported adverse reactions were most frequently caused by central nervous system drugs,accounting for 52% of the total.They included sedation and lethargy.On examining the times after birth that reactions occurred and the estimated maximum doses received by infants in breast milk,we found that adverse reactions frequently occurred in the infants of less than 3 months old and were particularly frequent in those less than 7 days old.Also,the estimated maximum doses in breast-fed infants having adverse reactions were significantly higher than those in infants with no adverse reactions.For half of the drugs reported to cause adverse reactions,the estimated maximum doses were less than 5% of the maternal weight adjusted doses.An evaluation of total scores for maximum drug intake through breast-feeding,existence of adverse reactions in the literature,and infant development showed that 82% of drugs reported to cause adverse reactions had scores of 10 or above while 75% of drugs for which adverse reactions were not reported had scores of less than 10.
Our findings suggested that a comprehensive evaluation of such factors as mammary excretion and infant growth status could play a significant role in the prediction of adverse reactions in breast-fed infants.

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We conducted a trial course based on the model-core curriculum for trainees over a period of 2.5 months,investigating temporal changes in the level of mastery acquired during practical training on medicine management guidance.Trainees were asked to evaluate their level of mastery based on a specific behavioral objective comprising 24 items and the results were subjected to correspondence structural (CS) analysis.We then evaluated the usefulness of CS analysis as a means of ascertaining trainees’levels of mastery and temporal changes in mastery awareness,and also regarding usefulness as a technique for evaluating study results.
We found that this type of analysis aided the formulation of a concrete plan regarding areas for improvement,which enhance the practical training experience,the visit questionnaire and the mastery level questionnaire.Furthermore,a comparison of temporal changes in improvement levels based on CS analysis aided understanding of trainees’mastery levels and changes in mastery awareness.The CS analysis technique was therefore useful in evaluating the results of the study we conducted during the period of the trial course on medicine management guidance.

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On the Web,many documents regarding the proper use of prescription drugs are available to medical professionals and to the public but such documents are difficult to use since they are scattered throughout the Web.In an attempt to solve this problem,we created a support system that provides easier access to drug information relating to proper use by integrating Web documents containing it.
The selected documents were as follows : package inserts for prescription drugs,interview forms (supplementary information on package inserts),summaries of product information,summaries of new drug applications,Kusuri-no-Shiori (drug information sheets),pharmacologically similar drugs,generic drugs,and the Merck Manual.Instead of providing a drug information database,our system lists the URLs of the Web sites (of their top and subsequent pages) that the documents are provided on.The URLs are listed in a table on the top page of our system’s website,and in a sub-window there is a retrieval procedure guide.This enables users to perform document searches more efficiently and easily.
This system enables comprehensive searches of drug information relating to proper use as well as those on pharmacologically similar drugs,generic drugs and drug therapy to be conducted with ease.

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Recently,the importance of self-medication with over-the-counter (OTC) drugs has come to be recognized.Pharmacists are asked to recommend suitable OTC drugs to patients and such recommendations must be based on accurate information obtained by interviewing patients.In this study,24 pharmacists interviewed a standardized patient complaining of dyspepsia (Scenario 1)and a standardized patient suspected of having a peptic ulcer caused by nonsteroidal anti-inflammatory drugs (NSAIDs) (Scenario 2).Interviews were evaluated using the Roter method of interaction process analysis system (RIAS) and pharmacist communication patterns were categorized as follows : activating and partnering with patient (Scenario 1,27.1% ; Scenario 2,29.9%) ; providing information and counseling (Scenario 1,28.5% ; Scenario 2,24.2%) ; forming a good relationship with patient (Scenario 1,25.2% ; Scenario 2,21.6%) ; and gathering patient information (Scenario 1,13.1 % ; Scenario 2,18.8%).Most conversation content dealt with the condition/disease state and medical treatment of the patient but none dealt with lifestyle or social psychological topics.The level of experience of the pharmacist was directly correlated with the amount of utterances but not with the amount of open-type question- or empathy-related content.We noted that pharmacists generally consider forming good relationships with patients to be important when selling OTC drugs.
Our findings suggest that pharmacists place great importance on gathering information from patients in triaging suitable OTC drugs.Although experienced pharmacists used more utterances,they did not all use desirable communication patterns for showing empathy or ask open-type questions.They therefore need training in communication skills if they are to form really good relationships with patients.

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