In the 6-year pharmacy education program,long-term training in clinical practice based on the Model Core Curriculum for Practical Training will start in 2010.Though the objectives and strategies for clinical practice are shown specifically in the Model Core Curriculum for Practical Training,the plan for evaluation procedures proposed by the Pharmaceutical Society of Japan in November 2006 has yet to be adopted.With this in mind,in the present study,we devised assessment tools for each specific behavioral objective (SBO) for such areas as knowledge,skills and attitude,based on the examples in the plan of the Pharmaceutical Society of Japan,and used them in the evaluation of a 4-week training course in clinical practice.
Six fourth-year students from Shujitsu University were subjected to the evaluation.They were divided into 3 groups of 2 students and underwent the 4-week course of practical training at Kaiei Pharmacy which is operated by the Okayama Pharmaceutical Association.
Assessment tools such as oral interviews,essays,practical tests,reports,observation records,simulations and objective tests were provided for 87 SBOs and 80% of the assessment tools were in accordance with the content of the Pharmaceutical Society of Japan’s plan.We found that about 90% of the content of the Model Core Curriculum for Practical Training could be evaluated within 4 weeks using these assessment tools and they verified that uniform,high-quality clinical training was provided to all 3 groups.In conclusion,our findings indicate that such assessment tools would be essential for ensuring uniform and high-quality training in clinical practice in the 6-year pharmacy education program.

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Hiccups often occur in patients receiving cisplatin (CDDP)-based chemotherapy.In the present study,we investigated the incidence of hiccups in 162 patients who received CDDP as well as risk factors for developing hiccups.
Hiccups occurred in 40 (25%) of the 162 patients,and 93% were men.Twenty-six of the patients had hiccups within 48 hr of CDDP,and in 31 of them the hiccups continued for between 1 and 4 days.Twenty-eight of the patients received medication (shitei-decoction,chlorpromazine,metoclopramide,etc.) to relieve hiccups,which was effective in 30% of them.Hiccups developed in patients with osteochondro sarcoma (56%),lung cancer (49%),pancreatic cancer (40%) and esophagus cancer (23%) receiving the following 4 chemotherapy regimens : CDDP+ADM+CAF (56%),CDDP+DTX (50%),CDDP+5 FU (40%),and CDDP+TS 1 (20%) respectively.
The CDDP dosage (mg/m²)was higher in patients who had hiccups than in those who had none (80±22 vs 45±33,p< 0.0001)and there was a positive correlation was between CDDP dosage and incidence of hiccups (p<0.001),though all patients developing them received corticosteroids and 5 HT₃ antagonists.
Multiple logistic regression analysis showed that there were significant differences for the male sex (odds ratio (OR)=8,95% CI=1.5-45.6),CDDP dose (1.03,1.01-1.06),dexamethasone(≥16 mg) (19.4,3.9-95.2)and granisetron (6 mg) (20.9,3-143).We therefore concluded that the independent risk factors influencing the development of hiccups were the male sex and a high dose of CDDP in combination with dexamethasone(≥16 mg),and granisetron (6 mg).

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Bone cements have been widely used to fill the dead space of bone tissues in orthopaedic surgeries.Loaded with antibiotics,these materials are also administered for the prevention and treatment of infections,infectious osteomyelitis for example.We made polymethylmethacrylate cement preparations of five commercial vancomycin (VCM) products and compared the in vitro dissolution profiles of the VCM in them and mechanical strengths of the cements.When immersed in phosphate buffer (PB) for 30 days,dissolved amounts of VCM ranged between just 5 and 19% of the calculated contents and after immersion in PB for 40 days mechanical strengths were significantly decreased (50-75% of the control without VCM).
Further,on testing a cement preparation containing pharmaceutical additives as well as VCM,the amount of antibiotic released was significantly larger than that for other preparations and the release was more rapid as well.This cement preparation also had the lowest strength among those studied.By doing this,we showed that pharmaceutical additives could have marked effect on the dissolution of the antibiotic and mechanical strength for antibiotic-laden bone cements for the first time,though these were in vitro findings.
The present study clearly demonstrated that the antibiotic products used can cause functional differences in antibioticladen bone cements and also suggested that pharmaceutical additives influence cement functions.It is therefore necessary to pay attention to both the antibiotic content of commercial VCM products and types of pharmaceutical additive in the preparation of such cements.

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We performed a comparison between leukocyte migration tests performed by the chemotaxis chamber method (LMTchamber) and the agarose plate method (LMT-agarose) to study the usefulness of the LMT-chamber method in the identification of causative drugs in drug allergies.
For LMT-agarose,the positive rate among 210 patients suspected of hypersensitivity to drugs (subject patients) was 67.6 % and for the LMT-chamber the positive rate among 197 subject patients was 81.2%,a significantly higher positive rate for the latter (p<0.001,χ²-test).The positive rate for LMT-agarose was 6.9% in 102 patients without hypersensitivity to drugs (control patients) and 9.8% for the LMT-chamber in 82 control patients,but this difference was not significant.In addition,the LMT-chamber produced a higher positive rate than LMT-agarose for all hypersensitivity symptoms and all efficacy categories of the suspected drugs.It also produced a significantly higher positive rate than LMT-agarose in subject patients without addition of self serum (p<0.05,χ²-test) and there were no significant differences between males and females or young and old persons,as there were in the case of LMT-agarose.
Our findings indicate that the LMT-chamber may be more sensitive than LMT-agarose in identifying the causative drug in drug allergies and more useful than LMT-agarose for many hypersensitivity symptoms and suspected drugs.In addition,the LMT-chamber is much less influenced than LMT-agarose as regards patient’s own serum,or by sex and age.

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Public initiatives involving patients have been conducted in an effort to ensure their safety but it is not it known whether patients are willing to take part in such initiatives or not and what actions can be taken.The aim of this study was to clarify outpatients’attitudes towards medication and medication error avoidance and to explore patient characteristics that may affect their behavior in this regard.To do this we devised a cross-sectional questionnaire based on educational materials,the results of a community questionnaire survey related to patient safety,and interviews of 11 patients.It was given to adult outpatients at five pharmacies in Takatsuki-city,Osaka and out of the 394 questionnaires distributed,346 (87.8%) were eligible for data analysis.
Factor analysis revealed four domains in the attitude construct,which were“understanding and monitoring”,“relationship with doctor”,“pharmacist and medicine”,“barrier to medical care”,and two domains in behavior construct which were “practitioner cooperating behavior”and“information seeking behavior”.“Understanding and monitoring”,“relationship with doctor”,and“pharmacist and medicine”scored high marks (mean ; 86.8,81.4,81.6,respectively).“Practitioner cooperating behavior”had a medium level score (56.4),but that for“information seeking behavior”was much lower (39.4).Age was associated with both attitude and behavior domains.There were also strong associations between“pharmacist and medicine” and“practitioner cooperating behavior”and between“understanding and monitoring”and“information seeking behavior” (p<0.01).
The high scores obtained for attitude domains indicate that patients would be positive towards participating in their medication.Furthermore,pharmacist efforts to educate patients and enhancing their“understanding and monitoring”attitude would help in error prevention.

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We assessed the clinical results for 22 rheumatoid arthritis (RA) patients treated with 25 mg etanercept (ETN) for 3 months,once per week (half dose,11 patients) or twice per week (full dose,11 patients).We investigated the number of swollen and tender joints,C-reactive protein (CRP) concentration,disease activity score including a 28-joint count-CRP (DAS 28-CRP),and serum levels of rheumatoid factor (RF) and matrix metalloproteinase-3 (MMP-3),immediately before and after 3 months of treatment.In addition,serum levels of anti-cyclic citrullinated peptide antibody (anti-CCP),anticalpastatin antibody (anti-Calp),and hyaluronic acid (HA) were measured in the half-dose group.
While there was a marked improvement in both groups as regards number of swollen and tender joints,CRP concentration,and DAS 28-CRP,there was an improvement in MMP-3 levels only in the full-dose group.In the half-dose group,there was no change in the serum levels of anti-CCP,anti-Calp,and HA.The findings of this study suggest that 25 mg ETN administered once per week yields clinical results similar to those for administration twice per week and that once weekly administration would enhance the cost-effectiveness of ETN treatment.

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We collected data on adverse reactions due to R-CHOP chemotherapy in our hospital from November 2005 to November 2006 from electronic clinical records and then conducted a retrospective analysis of adverse effect data for malignant lymphoma patients.The results of our survey for the first time R-CHOP therapy was administered indicated high incidences for infusion reactions (52.6%),constipation (71.6%),neutropenia (96.6%) and leukocytopenia (83.3%).Based on the results,we prepared a brochure entitled“Explanation of adverse effects of R-CHOP therapy”.The objectives of preparing the brochure were to minimize inter-individual differences between the pharmaceutical care and drug consultation provided by clinical pharmacists and ensure that patients had a good understanding of their treatment.We are sure that this kind of activity will help us to provide better pharmaceutical care for patients.

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The contamination of intravenous admixtures by glass particles arising from glass ampoules containing ingredients used in their preparation is The contamination of intravenous admixtures by glass particles arising from glass ampoules containing ingredients used in their preparation is now recognized as a potential health hazard.Previously studies have been done on changes with time in the size of glass particles and particle counts but there are shortcomings in the light obscuration or Coulter-based methods that were used.For instance,the necessity of having particles flowing for the counters used in these methods to count them has been controversial.In this study,therefore,we used a laser diffraction particle size analyzer (LDPSA) to determine glass particle size ranges and counts over a period of 15 minutes following the opening of ampoules.Fourteen ampoules containing 5-fluorouracil (anti-cancer drug) were studied in four experiments.At 15 minutes,the counts/1 A (5 mL) (mean±SD) for each of the size ranges indicated were 4,630±3,070 (0.5 to 2μm),8,860±2,590 (2 to 3μm),3,960± 1,360 (3 to 5μm),950±550 (5 to 7μm),510±200 (7 to 10μm),225±94 (10 to 15μm) and 64±55 (15 to 50μm).These results were confirmed by visual inspection and counting glass particles for the same samples using scanning electron microscopy.Further,the use of these techniques for samples after they had been passed through either a 0.45 or 0.8μm syringe filter failed to show any measureable levels of glass particles in the filtrate.Our results show that glass particles remain suspended for 15 minutes after opening glass ampoules and suggest that the use of syringe filters may reduce glass particle-associated risks in the intravenous administration of admixtures.

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The infection control team (ICT) of Nagano Prefectural Suzaka Hospital has been screening for MRSA and making efforts to ensure a clean hospital environment and the proper use of antibiotics since 2004.As a result,from June 2004 to May 2007 (divided into period I to VI ; 6 months each) the MRSA detection rate in the hospital significantly decreased (period I ; 1.18±0.42 vs.period VI ; 0.667±0.29,mean±S.D ; p<0.05)but the MRSA detection rate on admission changed hardly at all (period I ; 1.30±0.43 vs.period VI ; 1.70±0.43,mean±S.D.; p=0.14).ICT activities were therefore effective in the suppression of MRSA in our hospital.
There was a significant (p<0.05)correlation between the MRSA detection rate in the hospital and monthly use of antiMRSA agents,suggesting that they were being used properly.However,as total use of antibiotics during the period did not decrease,additional approaches need to be considered to achieve this aim.

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Inhalation medicines are the most effective way of treating asthma at present.However,when inhalers are not used properly,their effect will not be adequate.With this in mind,pharmacists at Nagoya University Hospital established“Pharmaceutical Care Clinic for Outpatient Inhalation Treatment”in June 2001,with the support of the Department of Respiratory Internal Medicine.Our pharmacists teach patients the proper inhalation technique and give them useful information on the pathophysiology of asthma and appropriate use of medicines.
In this study,we conducted an investigation to see if the counseling given by pharmacists enabled patients to learn the proper inhalation technique and helped in relieving their symptoms.They were able to learn the proper inhalation technique as well as the operation of the PEF (peak flow) meter,and there were improvements in PEF,adherence and symptoms.These findings indicate that counseling provided by pharmacists in such an outpatient clinic is a valuable way of improving the quality of life of patients.

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