Our objective was to investigate pharmacists’clinical performance regarding the collection of information on herbs and dietary supplements (HDS),reporting of adverse events due to them and their interventions in this regard.To do this we sent a questionnaire to pharmacists who were registered users of the Internet-based Pharmacist’s Information-Sharing System.The respondents were 219 community pharmacists and 104 hospital pharmacists.Of the community pharmacists,29% said that they always checked patients’use of HDS,58% that it depends on the circumstances and 12% said they never checked HDS use without a particular reason.Most pharmacists thought they had insufficient information on HDS,15% of all respondents had taken courses to obtain more information and 12% were qualified or going to be qualified as an HDS adviser.Fifty-five respondents (17%) had observed adverse events that were presumably associated with the use of HDS.Pharmacists who always checked on HDS use when dispensing both OTC and prescription medications had a higher chance of noticing HDS-associated adverse events.On observing adverse events,more than 80% of the pharmacists investigated the causes or mechanisms to some extent,while 40% did not record or report them.
In conclusion,pharmacists’active acquisition of information on the safe use of HDS does not always lead to better clinical performance in this regard.Therefore,it is essential to make efforts to improve their performance concerning HDS and create a system for providing reliable information on them in order to promote their proper use.

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We investigated the extent of environmental contamination due to the preparation of antineoplastic drugs and the exposure of pharmacists to them in the course of their work.
In 2006,we determined the levels of cyclophosphamide (CP) in 5 samples taken from different areas of our pharmacy.The CP levels in the work area of the Biological Safety Cabinet (BSC),on the airfoil in the BSC,outside the BSC in the antineoplastics preparation room and outside the preparation room were 6.82 ng/cm²,26.19 ng/cm²,0.59 ng/cm² and 0.15 ng/cm²,respectively.No CP was detected in the delivery box.The mean level of CP in 24-hour urine samples taken from the 6 pharmacists engaged in the preparation of antineoplastic drugs was 17.7±18.7 ng/24 hr.
Based on these results,as a means of preventing exposure to antineoplastic drugs,we conducted improvement programs with regard to the following : (1)operation manuals for cleaning,(2)disposal methods for medical devices,(3)location for dissolution of CP,(4)gowns for pharmacists,(5)having utensils for exclusive use in the preparation of antineoplastic drugs and (6)training of pharmacists.
In 2008,we investigated the situation again.CP levels in the work area of the BSC,on the airfoil in the BSC,outside the BSC in the preparation room and outside the preparation room were 0.02 ng/cm²,0.04 ng/cm²,0.25 ng/cm² and 0.01 ng/ cm²,respectively.No CP was detected in the delivery box.The mean 24-hour urine sample CP level in the 4 pharmacists engaged in the preparation of antineoplastic drugs was 39.0±14.3 ng/24 hr,which was similar to that for 2 pharmacists not engaged in preparation of antineoplastic drugs.
These results suggest that the intervention programs we conducted after the 1st CP investigation had been effective in reducing environmental contamination,especially in the BSC,but had not reduced the exposure of pharmacists to CP.

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Arbekacin sulfate (ABK),an aminoglycoside antibiotic agent,is widely used for the treatment of patients infected with methicillin-resistant Staphylococcus aureus (MRSA).Since efficacy and safety depend on its peak and trough concentrations,respectively,therapeutic drug monitoring (TDM) is recommended to ensure the proper use of ABK.However,ABK peak concentrations have often been lower than expected making dose setting difficult in the early stage of treatment.
The aim of this study was to determine factors influencing ABK peak concentrations.We first performed multiple regression analysis on the peak concentration to dose ratio as the dependent variable.The results showed that infusion time,creatinine clearance,body mass index,serum albumin and chronic heart failure significantly influenced the peak concentration to dose ratio.We also investigated the effects of these factors on pharmacokinetic parameters estimated by the Bayesian method finding that creatinine clearance,daily volume of infusion and serum albumin were factors influencing terminal half-life,body mass index,serum albumin and chronic heart failure were factors influencing distribution volume.
In conclusion,our findings suggest that factors influencing distribution volume are important in setting doses of ABK.

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Teicoplan is a mixture of six major components (A 2-1 to A 2-5 and A 3-1).The aim of this study was to develop a method for evaluating variations in composition between the branded teicoplanin product and the 7 generic versions of it on the market.The branded product was designated as product A and it was compared with 3 generics-product B,C and D.
The results of an assay by HPLC showed that product B was very similar to product A regarding percentage contents and ranking order of the 6 major components while product C and D differed from product A in these respects.The percentage contents of the A 3-1 component in product C and D were relatively high.Further,analysis by FPIA indicated that percentage contents of the 6 main components affected plasma concentration sensitivity and protein binding.Total plasma concentrations were measured and observed concentration to theoretical concentration ratios were calculated for each sample as an indicator of sensitivity.In terms of plasma concentration sensitivity,there was no significant difference between product A and B,but sensitivity was significantly lower in product C and D than in product A.As regards unbound concentrations,there was no significant difference between product A and B,but they were significantly higher in product C and D than in product A.
Our results showed that variations in sensitivity and protein binding were connected with percentage contents,and that of A 3-1 was negatively correlated with sensitivity and protein binding.
In conclusion,these findings suggest that differences in percentage contents of teicoplanin mixtures would affect pharmacokinetics and pharmacodynamics and we consider that the method we developed for evaluating such differences would be useful.

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Hyogo Cancer Center has recently established a cancer care support center due to being designated as a regional cancer hospital in January 2007.Since then,the center has been providing consultations to cancer patients and their families.Certified nursing specialists are in charge of initial consultations concerning medical treatment and work together with pharmacists and other professionals as members of a medical team in providing them.
By verifying the content of individual consultation records,we were able to understand the feelings of unease and other concerns of cancer patients concerning cancer drug therapy as well as the type of information that they need,and also examined the knowledge and skills pharmacists need to provide high quality consultations.Our findings clarified the role that pharmacists are expected to perform as a member of the medical team in the cancer support center and suggested how they could be even more actively involved in consultations.

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Sentinel lymph node biopsy (SLNB) has recently been accepted as a standard diagnostic procedure in the treatment of early breast cancer.However,since there are no dyes for this diagnostic technique on the market in Japan,we conducted a survey of the situation of dye use and preparations for SLNB in regional cancer treatment centers.
We sent a questionnaire to 286 institutions for which the response rate was 75.2%.The results showed that 80.9% of the institutions had already introduced SLNB and the dye-guided method was used by more than 90% of them.The most common indication for SLNB was breast cancer.Patent blue prepared by hospitals and indigo carmine and indocyanine green (both off-label use) were commonly used dye preparations for SLNB.Although patent blue is the most satisfactory dye and has the highest identification rate,problems were reported with hospital preparations.There were also differences between institutions regarding storage conditions,validity dates,preparation standards and annual use of this dye.The survey also revealed that 74.4% of institutions wanted dyes for SLNB to be marketed and there were numerous opinions on which types of patent blue preparation should be available.
In conclusion,the present study indicated that there was a need for SNLB dye preparationsinclinicalpracticeandthatitwould be beneficial to make such preparations available on the market.

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Although calculations for the mixing of anticancer drugs are very complicated,they have been done manually by pharmacists in many institutions up to now.To address this issue,we have developed an“Information Sheet for Anticancer Drugs”,which lists the information necessary for mixing,and a“Supplementary Sheet for Mixing of Anticancer Drugs”,that enables calculations to be made automatically when checking doses.To evaluate the utility of the supplementary sheet,we conducted a questionnaire survey of staff who prepare injections for chemotherapy,such as pharmacists,nurses and physicians.
In the section of the questionnaire entitled“patient information”,73.6% of the respondents said that they could calculate the dose automatically by inputting the height and weight of the patient.In the“planning of pharmacotherapy”section,67.0 % noted the simplicity of regimen confirmation and in“instructions for preparation”,74.7% stated that they could calculate doses accurately and quickly.Overall,96.7% of the respondents evaluated the supplementary sheet as useful.
Our findings suggested that the supplementary sheet would be highly useful in the mixing of anticancer drugs and contribute to risk management.Further,since it can be easily adapted to the circumstances of individual institutions,it should be an extremely convenient tool for pharmacists,nurses,physicians and other medical staff.

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Rheological measurements were made on commercial jelly products for facilitating medication in children in order to examine their physical properties and effect on children’s compliance.The measurements were made on mixtures of the drug (Clarith dry syrup for pediatric use) and various jelly products.
There were large differences in rheograms as well as particularly remarkable differences regarding yield values,presence of thixotropy and thixotropy area.Children favoured jellies showing thixotropy,and the extent to which such jellies were liked increased as thixotropy increased.Moreover,we were able to predict children’s preference using the rheograms.These results indicate parameters that would be useful in the development of jellies that facilitate medication effectively.

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Showa University School of Pharmacy and Showa University Hospital introduced a“patient-oriented participatory clerkship”in 2006 and since then it has been further developed and improved by the Hospital Clerkship Development Working Group.As examples of its practical and novel approach,we included individual patient management training in the program and developed original keywords and clerkship evaluation scales,which were first used to evaluate the usefulness of the 2008 clerkship for fourth grade students.
Our analysis of the clerkship showed that it had a positive effect on students’learning,and that they were able to complete it with satisfactory grades and a sense of personal satisfaction.The original keywords and evaluation scale proved to be useful and were highly evaluated by preceptors.However,preceptors were short of time for instructing the students and some felt a lack of ability to teach under the new clerkship.These problems will be urgently addressed,the first by rescheduling and extending the hours of the clerkship in the six-year program and the second by implementing a teacher quality improvement program.

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In view of the long-term practical training that will be introduced in 2010,we established a program for group training in health care facilities to help instructors provide efficient training and reduce their workload.Students are trained in 4 groups in each department with the training for each one taking 13 days : A (prescriptions,etc),B (formulations,etc),C (DI,etc),and D (satellite pharmacy).On day six,students assess their level of achievement with respect to the core curriculum and those who have not achieved the required academic goals undergo intensive supplemental training.In addition to practical training sessions,the program includes lectures,small group-based discussion,PBL (problem-based learning) and portfolio programs,all designed to make learning even more effective.
To examine the effectiveness of the group training in hospitals,students assessed their performance levels on a five-grade scale.Students who underwent the previous type of training scored an average of 3.2±0.2 points while those underwent our training program in a health care facility scored 3.9±0.3 points (P<0.01).
Our group training program in hospitals has several benefits : it allows a large number of students to participate,reduces the workload of pharmacists in charge of teaching and assessing students and has a flexible design allowing it to accommodate a variety of unexpected situations (e.g.supplemental training or lessons in groups for students who have been absent for a long period).In conclusion,we consider that it will be effective in achieving the important goal of conducting quality long-term training in an efficient manner.

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