Hyperammonemia is an adverse effect of valproic acid,though it is rarely associated with fatal encephalopathy or disturbance of consciousness.The purpose of this study was to investigate the clinical risk factors for hyperammonemia in patients with epilepsy undergoing valproic acid therapy.
To do this,we conducted a survey retrospectively from January 2006 to June 2008.We also performed a case-control study in which blood ammonia levels and other data were measured in inpatients and outpatients,defining hyperammonemia as a blood ammonia level exceeding 200μg/dL.There were 90 cases and 450 controls.
Multiple logistic regression analysis was also performed to investigate the risk factors for hyperammonemia,using the cases as a criterion variable.The explanatory variables were factors that showed significance (P<0.05)in univariate analysis.
According to multiple regression analysis,risk factors for hyperammonemia were phenytoin coadministration (odds ratio (OR),5.89;95% confidence interval (CI),3.41 to 10.2;p<0.001),phenobarbital coadministration (OR,2.30;95% CI,1.28 to 4.11;p=0.005),and dose of valproic acid (per mg/kg/day,OR,1.05;95% CI,1.02 to 1.07;p<0.001).However,slow-release valproic acid formulations reduced the risk of hyperammonemia (OR,0.51;95% CI,0.30 to 0.85;p= 0.010).
In conclusion,identification of risk factors for hyperammonemia due to valproic acid in epileptic patients can help minimize adverse effects.

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IMx^TM,an instrument using the Microparticle Enzyme Immunoassay,has been widely used in monitoring tacrolimus (TAC) blood levels. However,recently,ARCHITECT^® ,an instrument using the Chemiluminescent Immunoassay,and Dimension^® ,which uses the Affinity Column Mediated Immune Assay,have started to be used for this purpose in the clinical setting. Compared with IMx^TM, ARCHITECT^® has higher measurement accuracy and the measurement procedure is simpler with Dimension^®. In this study,we evaluated the 3 instruments as regards determining TAC concentrations. ARCHITECT^® was more accurate than IMx^TM and Dimension^® in measuring low TAC concentrations (5 ng/mL or less) and reduced the variation in measurements among people making them.However,as manual pretreatment is not required before the measurement procedure with Dimension^® ,it had the shortest measurement time (24 minutes) among the instruments.

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Resembling lipstick,Lidocaine Stick (LS) is used for pinpoint anesthesia of the skin prior to invasive procedures in dermatology or plastic surgery treatments,and has been shown to produce a quick and sustained anesthetic effect.We designed a formula and preparation method for LS,and evaluated its anesthetic effect by conducting a prick test in volunteers and a clinical study in patients undergoing pimple excision.We were able to design a surfactant-containing oily formulation for LS and a preparation method for it.
The results of the prick test indicated that the anesthetic effect of a 60% LS was comparable to that of a commercially available tape preparation containing the same volume of lidocaine.In the clinical study on patients undergoing pimple excision,the 60% LS produced an anesthesia rate of 65.5%.Furthermore in a questionnaire survey,both volunteers and patients responded favorably with regard to the smoothness and ease of use of the 60% LS.

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Somatic mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancers (NSCLC) are a well-established predictive factor for the response of tumors to EGFR tyrosine kinase inhibitors.In the present study,we developed a simple method for detecting somatic mutations in exons 19 and 21 of the EGFR gene,which covers approximately 90% of known mutations in Japanese patients suffering from NSCLC,and evaluated it.
Our findings indicated that the presence of around 1% of genes harboring L858R mutation was sufficient for detecting mutation by our method,although a mutation rate of at least 20% appeared to be necessary for direct sequencing detection.Molecular diagnosis to detect target mutations was successful when various DNA samples taken from fresh or frozen biopsy specimens,or formalin-fixed paraffin-embedded (FFPE) blocks or slices for pathological examination,or tumor materials obtained from surgical resection were employed.
These results show that our method is a simple,low cost means of achieving rapid,sensitive detection of the major EGFR mutations and that it would be a practical diagnosis procedure for hospitals.

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We developed a modified method of training on checking cancer chemotherapy prescriptions for inexperienced pharmacists.To do this,errors found by pharmacists in prescriptions at the Niigata Prefectural Koide Hospital from April 2006 to March 2008 were subjected to failure mode and effects analysis (FMEA).Based on the results,a checklist was prepared and then used in a preliminary drill to check its suitability for inexperienced pharmacists.The preliminary drill consisted of two tests on the prescription form:a learning test and a final evaluation test,and the risk priority number for each failure mode in FMEA was used for scoring tests.The checklist was used only in the learning test.Though the inexperienced pharmacists took more time to complete the final test than pharmacists experienced in checking prescriptions in their daily work,there was no difference in scores between them.Furthermore,the inexperienced pharmacists were as good as the experienced pharmacists in finding errors in the final test that might cause major adverse reactions in patients,missing none of them.These results indicate that our FMEA-based checklist would be a useful tool in training on the checking of cancer chemotherapy prescriptions for inexperienced pharmacists.

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In order to ascertain the use of health foods and over-the-counter drugs (OTC) in the Bingo area,we asked 205 members of the public visiting drug stores to fill out a questionnaire.The aim of the major questions asked was to determine the percentage of the general population using health foods and OTC,the purpose of using them and the kinds of health foods and OTC used.Other questions concerned the person advising people on the use of health foods and OTC,side effects of health foods and OTC,and awareness of general population regarding the interactions between drugs and OTC.
The results of the questionnaire revealed that about 25% of the general population was 60 years old or over providing evidence of marked aging of the population in the Bingo area.Also,following eye lotions,health foods accounted for large percentages of items purchased suggesting that awareness of self-medication was very high.Furthermore,70% of respondents desired the opinion of specialist regarding self-medication.
As these results were very different from those obtained in a suburban area of Okayama,in providing information on health foods and OTC,we should consider the needs of each area’s population.In this regard,the information obtained from the responses received will enable us to provide better pharmaceutical care to the general population in the Bingo area.

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In our hospital,intravenous patient-controlled analgesia (IV-PCA) with fentanyl is used for the relief of postoperative pain.In this study,we investigated the dosages,correlation between fentanyl dose and operation time,and the relationship between the fentanyl dose and surgical site in patients who had used IV-PCA following operations on digestive organs.We also investigated adverse events due to fentanyl.Regardless of the degree of invasiveness and the surgical site,pain control could be achieved at fentanyl doses lower than those stated in the package insert.When adverse events appeared,a 30% reduction in the dose of fentanyly permitted its administration to be continued.Our findings suggested that IV-PCA with fentanyl is a useful strategy for postoperative pain control.

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Little information is available on the level of satisfaction of pharmacy students with pharmacist education before clinical pharmacy practice,although the current pharmacy education is rapidly changing to place more importance on nurturing clinical experts.In view of this,we performed a questionnaire survey to investigate deficiencies in pharmacist education that affected the satisfaction level of pharmacy students.A questionnaire was given to 59 pharmacy students between February 2007 and July 2008 and the responses were analyzed using categorical regression in order to objectively reflect the results in future pharmacist education.The survey revealed that pharmacist jobs that reduced the satisfaction level of pharmacy students included“making in-hospital pharmaceutical preparations”,“compliance management”,“clinical research coordination”,“drug purchasing management and stock control”,and“payment for injection drugs”,etc.,listed in order of degree of deficiency.Other items that influenced the satisfaction level were“nurturing medical professionals”,“team approach to medical treatment”,and“communication”.In this regard,75.4% of the pharmacy students responded that communication education between pharmacists and other medical staff was insufficient.The findings of our survey suggest that satisfaction level is a useful index to target in improving pharmacist education.

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Pharmacists interview patients soon after their admission to Ehime University Hospital and check any drugs brought to hospital.As physicians often over-prescribe renally eliminated drugs for patients with renal dysfunction,we conducted a usage survey of drugs brought by patients with renal dysfunction.The subjects were 430 persons taking renally eliminated drugs for renal dysfunction admitted during April,2008,and they were classified by stage of chronic kidney disease (CKD) based on their estimated glomerular filtration rate using the simple Modification of Diet in Renal Disease (MDRD) formula.Patients and dosages were retrospectively investigated.There were 102 patients with CKD stage 3 to 5 (23.7%) and many of them were taking such renally eliminated drugs as allopurinol (17 patients) and histamine-2 receptor antagonists (13 patients).In 4 of the patients (23.5%) taking allopurinol and 4 of the patients (30.8%) taking histamine-2 receptor antagonists,the drug had been over-prescribed in consideration of their renal function.
In view of our findings,we attached an Excel^® spreadsheet incorporating a table of optimal dosages for renally eliminated drugs and formulas for estimating renal function to their patient medical charts.The use of this tool has resulted in an increase in the number of“pre-avoid reports”regarding renally eliminated drugs and we therefore feel that an intervention of this type by pharmacists based on evaluation of renal function will improve pharmaceutical care for CKD patients.

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