To investigate the safety profile of amrubicin hydrochloride (AMR),we conducted a review of adverse drug reactions (ADRs) due to AMR in records of patients treated at Toyama University Hospital.Using the results,we designed a new AMR chemotherapy worksheet for lung cancer.The design of the new worksheet was based on that of existing reports.In 13 inpatients treated with a total of 30 courses of AMR chemotherapy during the period of the review,though the AMR dose was lower than the recommended dose,neutropenia and thrombopenia of grade 4 in the Common Terminology Criteria for Adverse Events v 3.0 (CTCAE) occurred in half of them.While non-hematological toxicities of grade 4 were not observed,some patients had persistent nausea,anorexia,and general malaise.Antiemetic 5-HT₃ antagonists were administered to most of the patients,and 3 courses of concomitantly administered dexamethasone achieved perfect remission of nausea and vomiting.In the new worksheet,AMR dose-limiting toxicities,history of taking anthracyclines,and previous hematological toxicities are recorded for checking prescriptions.It also includes a table of possible ADRs,their symptoms and time of occurrence for monitoring purposes,as well as a notice to patients to pay attention to nonproductive cough and dyspnea,the initial symptoms of interstitial pneumonia.

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Recently,the provision of pharmaceutical care by clinical pharmacists has been growing in importance.Although they perform diverse roles in wards,hospital pharmacists spend a lot of time in collecting patient information and preparing pharmaceutical care records.In Gifu University Hospital,an electronic medical records system was introduced in June 2004.At the time,we developed a pharmaceutical care support system which was compatible with this system by modifying a commercial pharmaceutical care services system.Our system facilitates the exchange of data between the pharmacy information system and the electronic medical records system.
To evaluate the effectiveness of our system,we compared the time required for confirmation of physicians' consent on pharmaceutical care services,collection of patient history information,preparation of pharmaceutical care service records,and searching for past records with previous times.We found that the system achieved considerable time savings in the provision of pharmaceutical care services and concluded that our system was potentially useful as a tool to support the work of clinical pharmacists.

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A questionnaire survey was conducted to investigate the use of health foods among outpatients with diabetes mellitus (DM) at the Health Sciences University of Hokkaido Hospital.Responses were obtained from 69.2% of the patients (180 out of 260).The proportions of patients who had used health foods previously or were using them at the time of the survey were 16.7 and 37.2%,respectively,indicating that more than half of the patients had experience of taking health foods and this was irrespective of sex and age.The most frequently consumed health foods were Aojiru (n=25)followed by Kurozu (n=24)and blueberry extract (n=17).Among the health foods taken,those that influence blood sugar considerably were guava leaves polyphenol (n=16),Gymnema sylvestre extract (n=1),Gymnema sylvestre tea (n=1),and Aloe Vera (n=1).One patient was taking a Chinese health food that contained glibenclamide.Many patients took health foods to keep healthy and as a nutritional supplement,and most of them had not consulted their doctors or pharmacists about the use of health foods.More than 70% of the patients targeted by this study had complications such as hypertension.Since there is a possibility of health foods aggravating DM and its complications and of interactions between them and drugs used to treat DM,doctors,pharmacists and other co-medical workers should provide patients with information on the ingredients of health foods as well the adverse effects that they could have.

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A questionnaire survey was conducted to investigate the use of health foods (HF) among outpatients with diabetes mellitus (DM) who were receiving medication at Hokkaido Health Sciences University Hospital.About 30% of patients who had used HF previously or were using them at the time of the investigation allowed some time between taking HF and their prescribed medicines.The proportion of patients who considered that HF enhanced the efficacy of drugs was 16.4% in the case of those who were using HF at the time of the survey,and about 40% for those them who had no experience of taking HF or stopped taking them.Half of patients using HF considered that they had little influence on drugs.These data suggest that the opinion of patients regarding the influence of HF on drugs was an indicator of their use.
Through further analysis of the concurrent use of prescribed medicines and HF,we discovered no particular tendency in the medicines prescribed to patients taking guava leaves polyphenol,which is known to suppress the absorption of sugar.Patients on metformin and/or sulfonylureas,the medicines most frequently prescribed to patients targeted by our survey,were the greatest users of Aojiru and Kurozu.In consideration of these findings,it is necessary to provide both outpatients and inpatients with information on HF and the possibility of reactions between them and drugs used to treat DM.

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The six-year curriculum for students in pharmaceutical science programs was initiated in 2006 in Japan but the methods used for training pharmacy school students in hospital pharmacy services still need to be improved.
Patients may suffer discomfort under any type of pharmacotherapy and pharmacists often have to play an important role in helping patients to avoid such discomfort.The Japanese Society of Hospital Pharmacists has applied the term“preavoid”to avoidance actions taken by pharmacists in this respect.In this connection,a new type of training called“pre-avoid training”has been tried out on pharmacy school students.In it,students learn the“pre-avoid duties”of clinical pharmacists through small group discussion.Cases discussed are based on actual“pre-avoid”cases at Ehime University Hospital.
The training program consists of the following : explanation of the training procedure,presentation of cases one week before the small group discussion (SGD),self study of the cases for 2 weeks and then the discussion to identify the problems encountered in each case and solve them.Students conduct the SGD by themselves with pharmacists in attendance as facilitators and observers.
After the training,an anonymous survey was conducted so that students could evaluate the training procedure.Most of them considered it to be useful because it enabled them to gain a better understanding of pharmacotherapy as well as the detailed duties of the clinical pharmacist,and also helped them to improve their communication skills with respect to other medical staff.We consider that the program is a simple practical way for students to receive“pre-avoid”training from pharmacists at the site where it is practiced.

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Fingernail changes due to chemotherapy with therapeutic agents from the taxane group often diminish the quality of life of cancer patients and it has been reported that 30% of patients undergoing chemotherapy with these agents experience nail changes.
We examined the effectiveness of local hypothermia in preventing such changes in two patients who had already experienced them.Local hypothermia was achieved by simply keeping the patients’fingers in iced water from 15 minutes before the start of chemotherapy to 15 minutes after it ended,and the effectiveness of such treatment was evaluated using Common Terminology Criteria for Adverse Events Version 3 by a Japanese clinical oncology group.
In the 1 st patient,the nail changes slowly improved from grade 3 to grade 0 after 3 months,and after 8 months in the second.In addition,neither patient exhibited any signs of neuropathy associated with chemotherapeutic agents from the taxane group.The immersion of the fingers in iced water thus proved to be a simple,low-cost method of preventing nail changes due to chemotherapy with taxane group chemicals in these 2 patients.

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Based on the computer system for generating geriatric problem lists which we had developed already,we developed a new program to aid the resolution of geriatric problems and print out pharmaceutical care records.In consideration of efficiency and ease of viewing,records of pharmaceutical care and patient problems are made according to a checklist format.In January 2002 we started using the computer system and evaluated it objectively by comparing efficiency with previous levels.The time taken for each instance of pharmaceutical care decreased from 47.3 minutes to 34.7 minutes.As a result,the pharmaceutical care practice rate increased from 71.7% in 2001 to 90.0% in 2002 and 93.9% in 2003,all significant increases.In addition,about 40% of pharmaceutical problems were resolved through blood tests and about 50% of through examination of subjective and objective symptoms.The development of our pharmaceutical care recording system using checklists has raised the efficiency of pharmaceutical care as well as patient safety.

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Antibiotic combinations are frequently used to provide broad-spectrum empiric coverage for serious infections,and in critical conditions before confirmatory diagnosis.Up till now,studies on antibiotic combinations have mainly focused on their bactericidal and inhibitory activities and few have investigated the postantibiotic effect (PAE) of such combinations.However,it is important to determine the PAE since it is a factor that influences the antibiotic dosing interval.In the present study,we investigated the PAE of penicillin G plus gentamicin on Staphylococcus aureus FDA 209 P in vitro .The results showed that the combination of penicillin G and gentamicin provided a more prolonged PAE,with more rapid killing than penicillin G or gentamicin alone.

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The need for pharmacists to practice hand hygiene is increasing but few surveys have been conducted on this subject.In order to understand the situation of hand hygiene better,we conducted a questionnaire survey of pharmacists at Iizuka hospital and held a study meeting on it.A short written test on hand hygiene was given before the meeting and after it to gauge its effectiveness.
The questionnaire survey found that pharmacists were aware that they needed to have an adequate knowledge of hand hygiene and that there were situations in which they had to practice it.In the written test given before the study meeting,judging by the number of wrong answers concerning hand hygiene procedures,pharmacists did not seem to wash their hands thoroughly.In the test given after the seminar,there was a significant increase in the number of correct answers showing that it had been effective.

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Although the pain of inpatients suffering from cancer inpatients can be effectively controlled with opioids and other medications by the palliative care team,the pain of many cancer outpatients receiving medication from community pharmacies remains unrelieved.The reasons for inadequate pain control have yet to be clarified but several studies suggest that patients’poor understanding of opioids or lack of instruction by pharmacists are behind it.
In order to determine the situation of pain control among cancer outpatients,we conducted a questionnaire survey of patients to whom opioids were dispensed by fifteen community pharmacies.The results showed that 23.3% of the patients achieved complete pain relief through the use of opioids,22.0% experienced partial pain relief and 54.7% received no benefit.We also discovered that 55% of these patients experienced the adverse effects of constipation,nausea and vomiting and that prescriptions for opioids given to some patients were inadequate.These results suggest that poor pain control is due to inadequate treatment by the primary care physician,especially with regard to opioid prescriptions,and insufficient instruction given to patients by community pharmacists.

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In recent years,remarkable progress has been made in cancer chemotherapy.Pharmacists play an important role in ensuring the safety and effectiveness of chemotherapy by checking chemotherapy regimens,monitoring patients after treatment and providing information on chemotherapy to other medical staff and patients but at busy times it can be difficult to perform all of these tasks due to lack of time and manpower.
To speed up the management of cancer chemotherapy and enable us to conduct it more easily,we created a database using Microsoft Access which uses three main categories of data,that relating to patient backgrounds,drugs and regimens.The system is equipped with a function for retrieving and modifying such data and it has enabled us to easily prepare explanatory leaflets containing dose schedules and precautions in treatment.It also facilitates the creation of several types of worksheet for checking prescriptions and monitoring patients for respective regimens.
We next evaluated the usefulness of our database and also conducted a questionnaire survey targeting patients and nurses on the explanatory leaflets produced using it.For almost all chemotherapy regimens,the creation of the database enabled us to check prescriptions and provide information on them in advance.Further,all of the respondents to the questionnaire replied that the leaflets produced would be useful in helping patients to understand their therapy better.From the results of this study,we consider that our database would be an effective tool in pharmaceutical management for cancer chemotherapy.

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Pharmacy preparations have been playing an important role in self-medication which is now being actively promoted.However,most pharmacy preparations lack objective data as evidence of their quality and efficacy.In view of this,we conducted pharmaceutical and pharmacological testing to obtain such data on the pharmacy preparation Indometacin M Ointment,an analgesic salve containing 0.75% indometacin that is often sold at pharmacies.In our study we conducted chronological testing of the physical properties of softness and spreadability,of stability under various storage conditions and absorption of indometacin by the skin,and compared its pain-relieving effect with similar commercial drug preparations by the Randall-Selitto method.
We found that Indometacin M ointment retained its softness and spreadability when stored at 27-29°C for 56 days,but it became too hard to use when kept at 6-8°C for the same period.However,under the former conditions the indometacin content decreased to 92.6% but remained stable under the latter conditions.The pain-relieving threshold increased rapidly one hour after the application (p<0.01)and was found to be equal to that of commercial products containing 1% indometacin.Further,since Indometacin M ointment contains no additives which can induce dermatitis,it may have fewer adverse effects than commercial preparations and therefore be more appropriate for people with sensitive skins.
The essential data we obtained will help pharmacists advise patients on the use of Indometacin M Ointment in selfmedication for pain relief.

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Despite the generally adequate dosages that have been established for patient-controlled epidural analgesia (PCA) following upper abdominal surgery such as gastrectomy and hepatectomy,in our experience,patients who have undergone gastrectomy need a higher PCA dosage than those who have undergone hepatectomy.The aim of this study was to review the efficacy and dosages of PCA in the case of simultaneous epidural administration of ropivacaine and fentanyl following upper abdominal surgery,and the adverse reactions that appeared.The gastrectomy and hepatectomy patients numbered 51 and 55,respectively,with the hepatectomy comprising that for metastatic hepatic cancer (47 patients) and that for primary hepatic cancer (8 patients).
The visual analog scale (VAS) and Prince Henry Scores (PHS) for the patients who underwent hepatectomy were significantly lower than those for patients who underwent gastrectomy.Further,the analgesic effect of PCA,was weaker in patients with metastatic liver cancer than those with primary hepatic cancer,and Indocyanine green retention at 15 minutes (ICG-R) was significantly correlated with the VAS scores of hepatectomy patients.These results suggested that the dosage of PCA following upper abdominal surgery should be determined based on a hepatic function indicator such as ICG-R.

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We used the antiarrhythmic drug lidocaine as a sedative adjuvant for cancer pain management in patients with chest malignancy.Good results were obtained for 9 out of the 10 patients treated and 4 were able to switch to home care or that in which they were basically hospitalized but could spend some of the time at home.Terminal cancer patients usually wish to receive treatment at home.
The most important point in home care is pain control and the second most important is to have as few restrictionss as possible in treatment.In this regard,normal continuous intravenous infusion therapy is much more restrictive than continuous lidocaine infusion therapy using a portable disposable infusion pump.The latter achieves good pain control,enhances ADL,and enables home care to be included in treatment.

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Advances in treatment have significantly improved cure rates in childhood malignancies as well as long-term survival.Some malignancies,like acute lymphocytic leukemia or non-Hodgkin lymphoma,require long-term maintenance therapies and recently chemotherapy has been switched to an outpatient basis to improve quality of life.In the present study,we investigated the current situation of adverse events due to chemotherapy in pediatric outpatients and gathered information for use in devising measures to prevent them.We studied 572 instances of chemotherapy in 43 outpatients (two to 28 years old) from April 2005 to March 2006.The regimens were mainly for maintenance therapy and they were mild in intensity.The three major adverse events that we observed were neutropenia,infection and liver dysfunction,and in some cases they were treated symptomatically.Owing to adverse events,chemotherapy was postponed in 63 instances and in 13,hospitalization was necessary.However,in no instance was discontinuation of chemotherapy required.The chemotherapy execution ratio was 89%.Our findings indicate that chemotherapy was well-tolerated in pediatric outpatients and that it would be feasible to conduct it largely on an outpatient basis.

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A questionnaire was given to students before and after the‘Early Exposure’programme,which was introduced in the first year of the 6-year pharmaceutical education course at the Faculties of Pharmaceutical Sciences at Kobe Gakuin University and Mukogawa Women’s University,and Kobe Pharmaceutical University in Hyogo Prefecture.The objective of the questionnaire was to evaluate the success of the programme and a total of 847 students completed it.
The major facilities participating in the programme were hospital and community pharmacies.The major method of study was observation of the work of pharmacy facilities and it was used for more than 90% of the students.About 30% studied through lectures and 25% through actual work experience.Though almost half of the students learned about dispensing medication,fewer learned about medication history management and medication management.
We asked students to evaluate their educational experience using scores from 4 (good) to 1 (poor) and 2 major questions asked were whether the work of pharmacists was patient-oriented and whether they had good communication with other staff and patients.The students who observed the work of hospital or community pharmacies gave higher scores than those who did not and those who had actually experienced the work of pharmacies gave higher scores than those who had only observed their work or studied through lectures.The students were generally positive about the programme.
The Early Exposure programme seems to be appreciated by the participating students and we feel that maintaining close collaboration between community and hospital pharmacies and universities is important in achieving a high-quality educational syllabus for pharmacists.

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