Recently,substantial epidemiological research has clarified that folic acid decreases the incidence of fetal dysraphia such as spina bifida and anencephaly.Consequently,the Ministry of Health,Labour and Welfare (MHLW) now recommends that women of child-bearing age take folic acid proactively.However,previous consumer surveys on folic acid performed by many organizations have shown that pregnant women have little knowledge of the usefulness of folic acid,and few women of child-bearing age take folic acid on initiative.In our research,we carried out a questionnaire survey on awareness of folic acid among females aged 10-39 years and provided information on appropriate folic acid intake.The information was provided by community pharmacists and we verified the effectiveness of doing this.In the initial questionnaire,many subjects selected“don’t know”for all items concerning folic acid surveyed.In particular,hardly any knew that folic acid reduces the risk of congenital abnormality occurrence,and that the MHLW recommends that child-bearing women take folic acid.One month after providing people with information on folic acid,the results of a survey showed that their understanding of it had increased significantly for all items but in a similar survey conducted after six months,indicated that their understanding had decreased significantly for several items,as compared to results for one month after receiving information.These results showed that a health promotion intervention by community pharmacists raised consumer awareness and strongly suggested that this is an effective approach in primary care practice.However,the temporary nature of this effect suggested that there is a need for repeated provision of information.

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It has been reported that antiemetic therapy based on the guidelines produced by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) is effective in reducing emetic risk.However,they have not been drawn up in assumption of daily administration of antineoplastic drugs.In the present study,we investigated the effectiveness of alternate-day administration of dexamethasone for the prevention of nausea,vomiting and anorexia induced by the daily administration of ifosfamide chemotherapy in 27 eligible patients.During the observation period,the incidence and grade of vomiting were not statistically significant different between the dexamethasone group and a control group in the acute and delayed period.However,the incidences and grades of nausea and anorexia during chemotherapy for the dexamethasone group were lower than those in the control group.These results suggested that the alternate-day administration of dexamethasone could be conducted prophylactically during the daily administration of ifosfamide.

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Polaprezinc (PZ) suppositories have been used for radiation proctitis in our hospital.In this study,we established methods to evaluate the quality of hospital-prepared PZ suppositories and investigated their stability.As PZ is dissociated at an acidic pH but not at a medium pH,the release of PZ from the suppository was carried out using chelatometric titration in weakly acidic buffer solutions (pH 3,pH 4,and pH 5).As the release of PZ from the suppository was fastest in the buffer solution at pH 3,we used this pH for the release test for PZ.Conducting this test in the stability investigation showed that the amount of PZ released from the suppository after 84 days was the same as that immediately after manufacture.
We also examined the clinical efficacy of the PZ suppository in 5 patients with radiation proctitis,finding that efficacy was satisfactory in 3 patients.These results indicated that the PZ suppository is a good treatment for radiation proctitis.

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As the aging of our society continues to progress and its needs become more diverse,the use of self-medication has been increasing.However,the over-the-counter (OTC) medicines on which this is based are often seen as hard to use.In this study,we conducted a survey on the status of use of universal design (UD) in the packaging and drug information of OTC medicines for the elderly,including visually impaired persons.The results of our survey showed that the essential requirements for OTC medicines to be used in self-medication by elderly individuals were easy-to-use packaging and containers,and easily understood drug information.They also allowed us to confirm that UD was an effective means of overcoming problems of OTC medicines.Specifically,we discovered that hand and finger function were crucial in the handling of OTC medicines by elderly persons,and they desired products that could be handled simply with a minimum of strength.Key issues for drug information provided to the elderly were having adequate contrast between background and text,text size and font used,use of visual effects,and effective combination of chromatics and brightness.
As in the case of prescription pharmaceuticals,the introduction of UD for OTC medicines would facilitate the use of self-medication by the elderly and many other types of consumer,so this should be actively pursued in view of the continuing aging of our society in the years to come.

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With the introduction of the Diagnosis Procedure Combination (DPC) into the medical service fee system,the number of hospitals in which drugs brought by patients on admission are used during hospitalization has been increasing.In this situation,it is considered very important to check the drugs that patients have brought to hospital on admission for risk management purposes.While it has been reported that the checking of drugs by pharmacists is an effective way of avoiding the risk of adverse drug reactions,nurses are also involved in this task in many hospitals.To our knowledge,however,no studies have been conducted to compare the thoroughness of checks carried out by pharmacists and nurses.
In the present study,we retrospectively evaluated the performance of pharmacists and nurses in checking the drugs that patients had brought to the Nagoya University Hospital on admission in the third week of June 2008.We investigated whether essential information including drug trade name,content,dosage and administration were checked or not using an electronic medical chart system.Both pharmacists and nurses recorded drug trade names correctly but there were significant deficiencies in the recording of content,dosage and administration by nurses in checking drugs,in comparison with pharmacists.These findings suggest that the checking of drugs that patients have brought to hospital on admission should be done by pharmacists for best risk management.

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The key to the success of the six-year pharmacy education program in Japan is to adhere to the model core curriculum for clinical pharmacy training in hospitals and community pharmacies.To ensure the steady implementation of the model core curriculum for training in hospitals,hospital pharmacists have to provide students with 10 classes in pharmacy services,consisting of dispensing of medicines,dispensing of injections,aseptic preparation of anti-cancer agents and total parenteral nutrition,inventory control,pharmaceutical management and counseling services,drug information,drug formulation,risk management,therapeutic drug monitoring and pharmacy services for poisoning treatment.However,many hospitals cannot handle some of these practices.One of them is“contribution to poisoning treatment”the most difficult pharmacy service in the core curriculum to provide students with practice in,in the large majority of hospitals.
Our pharmacy department in Asahikawa Medical College Hospital provides screening for drug abuse (available 24 hours a day) and blood alcohol measurement as toxicological services in emergency medical care.In the drug abuse screening service,we use a Triage®DOA,a commercial kit with which it is very easy to carry out screening even in small hospitals.It takes only 15-20 min to do this.As a“contribution to poisoning treatment”,training in these pharmacy services will be provided in the student curriculum in pharmacy practices in our pharmacy department.In this paper,we describe the toxicological services we provide and our strategy for training students in them.

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Insomnia is one of the most frequently occurring psychological symptoms in cancer patients,and in most cases it is chronic (over six months).In order to improve the QOL of inpatients with hematological malignancies suffering from insomnia,we examined relationships among insomnia,insomnia causes,insomnia types,psychological backgrounds,and usage of sleeping medicines.
A comparison of Users of sleeping medicines with Non-users,revealed that 46% of Users had primary (psychological) insomnia,while 90% of Non-users had physical insomnia.Much of the insomnia started between the 1 st day of hospitalization and the 1 st cycle of chemotherapy,and 27.3% of patients with psychological insomnia expressed anxiety about chemotherapy.
Chronic insomnia may cause a decline in QOL and adversely affect treatment and the patient care.Our findings should be helpful in the earlier detection of insomnia and improving insomnia in patients with hematological malignancies.

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TDM based on serum vancomycin concentrations aids individual dosage design for patients with MRSA infections.In addition,the initial dose needs to be set appropriately to improve the effects of treatment and ensure safety.Since vancomycin clearance is correlated with creatinine clearance,a precise evaluation of creatinine clearance is required for setting initial doses of vancomycin.A new equation for estimated GFR (eGFR) was reported by the Japanese Society of Nephrology in 2009.In the present study,we investigated the predictability of the relationship between creatinine clearance and eGFR,initial dose setting for vancomycin using the eGFR equation,and compared the predictive performance of the vancomycin concentration estimated by the Cockcroft & Gault (CG) equation with that of the eGFR equation.
Although eGFR was well correlated with creatinine clearance,eGFR tended to be lower than the creatinine clearance as eGFR became higher.The predictive concentration of vancomycin using the eGFR equation and CG equation were biased positively in all patients.When the patients were divided into 4 groups based on age and renal function,the accuracy of prediction using the eGFR equation was significantly better than that for the CG equation in patients more than 70 years old -with eGFR<60 mL/min.This result suggested that the eGFR equation would be more useful for determining the initial dose setting of vancomycin in elderly patients with a decline in renal function.

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In this study,we determined the optimal dose of levofloxacin (LVFX) in elderly patients with Streptococcus pneumoniae infection.For this purpose,we performed the Monte Carlo simulation to determine pharmacodynamic target attainment rates for several LVFX dosage regimens against Streptococcus pneumonia .In the simulation,we calculated area under the blood concentration-time curve (AUC)/minimum inhibitory concentration (MIC) values (n=98citation=6)and those over 25 were considered to be effective.The percentages of the LVFX MIC against Streptococcus pneumoniae (n=1citation=29)were 3%,56% and 36% at 0.5μg/mL,1μg/mL and 2μg/mL,respectively.In the elderly patients,the target attainment rate was 78.2% for those receiving a 250 mg once-daily dose of LVFX and 94.4% in those receiving a 500 mg once-daily dose.In a quarter of the patients surveyed,the creatinine clearance was less than 50 mL/min.Taking all of these findings into consideration,a 250 mg once-daily dose LVFX may be the optimal dose for efficacy.

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Many patients are taking drugs they have been previously prescribed or have obtained over the counter,and inaccurate information on their medication history commonly causes medication errors,which is a serious problem.Various strategies for reducing medication errors use information on medication history obtained immediately after admission.Such information must be accurate and is an important means of preventing errors when prescribing new medications.With this in mind,we developed a computerized medication documentation system for generating medication orders that considers both drugs prescribed after admission and those that the patient has already been taking.A drug name search system using threecharacter agreement that is substantially the same as that used for prescription order entry systems was included to ensure accurate entry of the names of drugs prescribed before admission.
After the drug name search system was introduced,errors in new prescriptions,such as wrong strength,quantity,or dosage form,were reduced from 6.3% to 2.4%.Prescriptions for wrong drugs decreased from 1.5% to 0.8%.With our system,a physician signs every prescription form to confirm the final medication order.
Our medication documentation system will be useful for providing accurate medication histories to nurses and physicians,and for preventing medication errors due unclear medication orders regarding drug name,strength,quantity,and formulation.

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