We compared the in vitro performance of brand-name and generic spherical carbon absorbents by studying their physicochemical and adsorptive properties.There was no correlation between specific surface area and adsorption rate for pigment substances.The adsorption removal rates for pigment substances and uremic toxins were almost the same for Kremezin and Kyucal but the adsorption removal rates of some substances were lower for Merckmezin than those for Kremezin.In addition,the adsorption rates for digestive enzymes,important in vivo substances that should not be adsorbed,were high for Kremezin but low for Kyucal and Merckmezin.We found that Kremezin and Kyucal were comparable as regards the adsorption removal rate of indole in the presence of pepsin and sodium cholate,in vivo substances,but with Merckmezin,the adsorption removal rate for indole was lower.In our findings,we noted that the adsorption performance of the generic product Kyucal for most substances was equivalent to that of Kremezin while the adsorption performance of Merckmezin for some substances was lower than that of Kremezin.As a particular conclusion,the lower adsorption removal rate of Merckmezin for indole in the presence of vivo substances needs to be taken into consideration as this will affect clinical results.

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Depression in cancer patients not only reduces treatment compliance but may also lead to suicide and other problems.It is therefore advisable to screen patients so that it may be discovered and treated early.Using the Hospital Anxiety and Depression Scale (HADS),whose usefulness has been confirmed in cancer patients,we screened patients undergoing outpatient chemotherapy so that we could understand the extent of their feelings of depression and unease.We found that 40% of them suffered from slight depression and unease and about 10% were suspected of having depression.Further,many patients with biliary or pancreatic cancer,who were being treated with gemcitabine,had feelings of depression and unease.We feel that it is important for pharmacists to evaluate cancer patients for feelings of depression and unease and share our findings in this regard with other members of staff.By doing so,we can provide patients with emotional and other types of support.

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The aim of this study was to clarify the effects of pharmaceutical care on direct expenses in cancer chemotherapy,i.e.medicine costs,medical service fees,and medical treatment payments.To do this,35 patients at the Social Insurance Kyoto Hospital were surveyed from March to August 2005.All of the subjects were suffering from hematological malignant diseases,and receiving pharmaceutical care from a pharmacist.
There were 27 instances (14 patients) of prescription changes through clinical pharmacy interventions,causing an increase of ¥1,786/day in the mean cost of medicines for supportive therapy.However,when the medical service fees were examined using the Diagnosis Procedure Combination (DPC) we estimated that the prevention of adverse reactions by the prescription changes reduced medical costs by 4,732,360-yen.These findings implied that the increase in medicine costs of ¥51/ patient led to a reduction of ¥135,210/patient in medical service fees,suggesting that pharmaceutical care was both effective and relatively low in cost.The cost of pharmaceutical care was estimated to be ¥592,000 per pharmacist.
In cancer chemotherapy,pharmaceutical care had a beneficial effect on direct expenses for chemotherapy,i.e.medicine costs,medical service fees,and medical treatment payments.It was therefore effective in clinical terms as well as with regard to medical economics.

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To improve drug compliance after discharge,medication management was introduced for 16 patients who were hospitalized for schizophrenia.Changes in patients' attitudes toward medication management were evaluated from scores obtained when it was initiated and at the time of discharge using the 10-item version of the Drug Attitude Inventory (DAI-10).Scores increased from an average of 2.8 points when medication management was initiated to an average of 4.8 points at the time of discharge.
From this,we conclude that medication management improves the attitude of patients toward taking medication.

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In Japan,linezolid (LZD) was approved as a new agent for methicillin-resistant Staphylococcus aureus (MRSA) infection in April 2006,and its proper use is strongly recommended for preventing the occurrence of MRSA.In this study,we evaluated the efficacy of LZD in patients with MRSA infection who had been admitted to our hospital from April 2006 to March 2007.LZD was administered to 32 patients (sepsis : 14 cases ; pneumonia : 11 cases ; wound infection : 7 cases) for 12.8± 8.4 days (mean±standard deviation).Improper use was noted in 4 patients.
LZD proved excellent as regards transfer from blood to lung tissue in patients with MRSA infection.Thrombocytopenia is a major known adverse reaction of LZD and was observed in 6 patients,but they recovered as soon as LZD was withdrawn.Criteria for the administration of LZD will be of great value in ensuring the proper use of LZD as an anti-MRSA agent as well as in hospital infection control measures against MRSA.

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Post Marketing Surveillance (PMS) is conducted to obtain information on the frequency of adverse events,quality,efficacy,and safety of medicines when used in medical care.Rules for PMS are established in GPSP (Good Post marketing Study Practice) departmental regulations,and companies are required to determine the design of the survey sheets and survey items as well as the procedures for PMS in compliance with them.However,there are no rules for the design of the survey sheets and survey items.
With this in mind,we studied the standardization of survey sheets by investigating the information items and response choices used by pharmaceutical companies for PMS.The results of our investigation revealed that survey sheets lacked unity ; for example,the types and titles of survey items and the number of choices varied among companies.There was also variation among companies as regards the format of survey sheets (layout of information items and coloration).
We felt that there would be benefits from standardizing sheets by eliminating these variations.First of all,there would no longer be the need to conform to a particular survey sheet for each company which would decrease mistakes in filling them out as well as the time required,enabling more safety- and efficacy-related information to be collected.In addition,the cooperation of physicians with PMS would be likely to increase.The extra information obtained would contribute to further raising the quality of medical care provided to patients.

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In the operating theatre,the highest priority should be given to the proper use of medicines and proper stock management for them in order to avoid misuse and to ensure safety since high-risk medicines,such as narcotics,muscle relaxants and anesthetics,are used.In addition,there is a need to reduce operating theatre medicine stocks to efficient levels in order to improve hospital economy and reduce the workload of medical staff.
In November 2005,we established the first satellite pharmacy in an operating theatre at Mie University Hospital.Fulltime pharmacists working in it during the daytime started providing pharmacy services in which all the medicines used in the operating theatre came under management.The initiation of such services eliminated adverse incidents involving narcotics,muscle relaxants and anesthetics used in surgery.There had been an increase in the number of such incidents in the three years prior to starting the pharmacy services.
By providing sets of medicines for individual patients and checking billing data for medicines used during surgery,pharmacists were able to keep tabs on all the medicines used in the operating theatre and by ensuring that all medicines used for surgery were invoiced,prevented an annual loss of 2,000,000 yen.Moreover,by preparing sets of medicines for pediatric open-heart surgery,pharmacists were able to reduce the workload of anesthesiologists.
In conclusion,our findings suggest that the provision of pharmacy services by full-time pharmacists in the operating theatre is useful in improving safety management and raising the efficiency of medical care practiced in it.

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We established a reporting system for the use of antimicrobial agents for methicillin resistant Staphylococcus aureus (MRSA) infections in January 2003 to help ensure they are used properly.Then,in October 2005,we set up an infection control team (ICT) to monitor the use of four agents for MRSA infections : vancomycin,teicoplanin,arbekacin and linezolid.Changes in the antimicrobial use densities of the agents,the number of patients receiving them and the therapeutic drug monitoring (TDM) execution rate were investigated for three periods : I : before the reporting system (2002),II : while reporting system was in use (2004),III : during ICT monitoring (2006).
There was no significant change in the antimicrobial use densities of the agents for MRSA infection,while the number of patients receiving them decreased significantly in period III (p<0.05).Also in period III,the antimicrobial use density of teicoplanin increased significantly (p<0.05),there was a marked decrease in the number of patients receiving vancomycin (p<0.01)and the TDM execution rate increased significantly (p<0.01).
The systematic activities performed by the ICT were effective in ensuring the proper use of antimicrobial agents for MRSA infection.Further,by enabling us to share information with other medical staff and conduct rapid interventions,they have been playing an important role in infection control in our hospital.

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At many hospitals,basic information concerning medicines,such as package insert information,is entered into a database through the prescription-ordering system.However,up till now there has been no hospital where the sharing and evaluation of medical information (such as Q&A reports and prescription inquiry records) is conducted via an in-hospital local area network (LAN).The important points in making a system for this purpose are information sharing on Q&A reports (mainly questions from physicians and nurses) among pharmacists as well as physicians and nurses,making a database of records of prescription inquiries from pharmacists to doctors and ensuring that past records may be rapidly searched.
With this in mind,using FileMaker Pro 8.5 (FileMaker,Inc.),we configured a drug information database that is accessible via the in-hospital LAN and provides medical information such as the above.It was evaluated using a questionnaire survey targeting 20 physicians,23 nurses,and 18 pharmacists.The results showed that 80.0% of the physicians,82.6% of the nurses,and 94.5% of the pharmacists considered the Q&A database to be useful.We therefore conclude that establishing a system such as this is effective in enabling physicians,nurses,and pharmacists to share information not only in the pharmacy but also in wards in real time.

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Based on the premise that stimulating students to learn for themselves should result in a general improvement in their practical training and make it more effective,we developed a support system and a textbook for practical training conducted at Gifu Pharmaceutical University.Ten graduate students used the system and the text book in a pharmacy training trial based on the model core curriculum conducted at the pharmacy of Gifu Pharmaceutical University which lasted two months.At the end of the training,a questionnaire survey was carried out.As for the results,many of the students commented that the system and the text book increased their motivation in the practical training (respective mean score 3.8,4.0,on a 5.0 grade scale) and made it more meaningful (4.2).In addition,many of them were highly satisfied with the training.The execution rate for all the specific behavioral objectives (SBOs) was significantly higher for the optimal stage graduate students (n=5)than it was for the suboptimal stage graduate students (n=5).Further,a self-evaluation by students produced mean scores for all SBOs that were significantly higher for the former (3.6)than they were for the latter (2.6).We conclude that the use of the support system and textbook helped motivate students to learn on their own and enhanced the effectiveness of the practical training.

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