The purpose of this study was to identify the characteristics and risk factors of adverse drug reactions(ADRs) in the elderly. In a search of the case reports of adverse drug reactions and poisoning information system(CARPIS) database, which contains over 53,000 case reports of ADRs and poisoning, we obtained 949 cases in elderly patients and 824 cases in young patients. A comparison of ADR characteristics between the two groups using logistic regression analysis revealed that pharmacological ADRs, such as hypoglycemia and syndrome of inappropriate ant-diuretic hormone secretion(SIADH), tended to be more common in the elderly, while allergic ADRs, such as anaphylaxis and hepatic damage, were less common. ADRs in the elderly are more strongly associated with poor prognosis. Renal damage, comorbidities and polypharmacy were risk factors for ADR in the elderly, and the risk of ADRs in the elderly was significantly higher with leuprorelin, valacyclovir and cibenzoline. Renally excreted drugs also had a higher risk of ADRs in the elderly, and dosages were not adjusted in most ADR cases with renally excreted drugs. This information should be helpful in detecting and preventing ADRs in elderly patients.

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An oral scabicide, STROMECTOL^® Tablets (ivermectin) is often administered to patients as a simple suspension by feeding tube. However, it was reported that the administration by this method was less effective than oral administration of tablets. One reason for this lower efficacy might be that the devices and technique for this method of administration are not appropriate. The aim of this study is to propose an appropriate technique.
In this report, we compare the recovery ratio when a simple suspension is pushed through a syringe under various conditions. As a result of washing the syringe with distilled water after the first use, the recovery of ivermectin was higher than that without washing. The recovery of ivermectin from syringes set at an angle of 90° and 45° to the horizon was significantly higher than that at 0° and -45°. And recovery from previously used syringes was about 10% higher than that from new syringes (p<0.05). Furthermore, after having orally administered STROMECTOL^® Tablets and gavaged its suspension with an appropriate delivery technique to rabbits, we measured the ivermectin concentrations in plasma by LC-MS/MS. The AUC_0-192h of ivermectin was almost equivalent for both methods of administration.
In conclusion, to secure the same dosage of administration with a simple suspension as that of tablets, it is highly recommended to employ a previously used syringe at an angle of over 45°, and to inject by a technique that washes out the entire residue in the syringe after first injection.

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Many drugs used in cancer treatment are considered hazardous to healthcare workers. These drugs require special handing because of the health risk associated with direct exposure. However, occupational exposure to antineoplastic drugs is common in many hospitals. Gowns are worn as protective garments. Guidelines recommend the use of lintfree gowns made of low-permeability fabric, such as polyethylene-coated materials. In this study, we compared the permeability properties of various polypropylene-based protective gowns against a battery of anticancer drugs (fluorouracil and paclitaxel). We determined the risk associated with the use of inappropriate gowns. Permeability, humidity, and repellency of 5 unwoven fabric gown samples were determined according to the Japanese Industrial Standards (JIS). The results show that none of the samples of unwoven fabric gowns provided the same level of protection as the polyethylene-coated gowns. In addition, low-permeability gowns, especially those with a high repellency, may pollute the working area when contaminated. The risk of occupational exposure was thought to be higher in hospitals where inappropriate gowns are worn. Therefore, individuals being exposed to hazardous drugs should adhere to the guidelines regarding protective clothing in order to minimize occupational exposure.

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Hepatitis C virus (HCV) is a leading cause of liver disease in Japan. Standard care of pegylated-interferon alfa as monotherapy and in combination with oral ribavirin has been used for the treatment of chronic hepatitis C in outpatient clinics. However, such treatments are associated with patients'anxiety concerning high medical costs, adverse events, the burden of weekly hospital visits, the impact on attendance at work, and the eventual outcome of treatment.In this study, we investigated the impact on patients when a pharmacist-managed education program about interferon therapy was provided prior to their final acceptance of treatment. Educational intervention significantly reduced patients' anxiety about medical costs (p=0.004), adverse events (p=0.001) and impact on work (p=0.002). Patients in both the treatment group and the no-treatment group rated each section of the education program as being necessary. The patients expected answers regarding their personal concerns about the treatment. They thought it necessary that information such as that regarding severe adverse events should be explained by a pharmacist.Moreover, the sustained virological response rate differed significantly between the educated group and the group not educated by the pharmacist. Adherence to the recommended doses of the drugs during the initial period (first 12 weeks) of treatment is important for the efficacy of pegylated-interferon therapy. The educational intervention prior to the treatment may have raised the SVR rate. Also, a single session of the pharmacist-initiative education may be expected to compensate for the shortage of physicians and be cost effective.

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The penetration of low-priced generic drugs of good quality leads to not only a lower financial burden on patients, but also financial improvement of Japan's medical insurance system. In this study, we investigated the relationship between the usage conditions of generic products (GE) and attitudes toward the reduction of national medical expense for pharmacists in chain community pharmacies in Japan using a questionnaire survey. The 20 - 25% usage conditions of GE were the highest in this study. The majority (89.2%) of pharmacists in the community pharmacy (positive group) have a positive attitude toward the reduction of national medical expense using GE, and the usage conditions of GE in the positive group are higher than that in the pharmacists that have a negative attitude toward the reduction of national medical expense using GE (negative group). In addition, the results of the questionnaire survey show that the pharmacists in the negative group still have doubts about the quality, effect and supply of GE in comparison with the positive group, and the pharmacists in the positive group were more interested in the generic drug dispensing fee in comparison with the negative group. In conclusion, the present study demonstrates that most pharmacists in this study have a positive attitude toward the reduction of national medical expense using GE, and the attitude toward GE in pharmacies relates to the usage conditions of GE. These findings provide significant information on the need for a reduction of national medical expense using GE.

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In previous studies, we showed that cancer pain management at community pharmacies was inadequate and that there was a significant lack of essential knowledge and experience regarding palliative care among community pharmacists. With these shortcomings in mind, we developed a training program on palliative care for community pharmacists, and evaluated the effectiveness of the program. Pharmacists working in health insurance pharmacies were divided into two groups, and the training effectiveness was measured employing Kirkpatrick's four-level evaluation model. As a result, positive effects were demonstrated in the trained group, showing marked improvements at each level, in terms of learning satisfaction, learning comprehension, behavior modification, and attainment. These findings support the validity and effectiveness of the program.

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The number of cancer patients has been constantly rising, and it is difficult to make them understand how to use opioids within a limited time for ambulatory care. As a result, there are cases of inadequate pain control and deterioration in adherence to medication due to adverse effects.
With the goal of improving various problems in symptom relief for cancer patients, pharmacists of a palliative care team of the Pharmaceutical Department in Jichi Medical University Hospital launched their involvement in explaining opioid introduction and pain control for outpatients receiving chemotherapy. Pain assessment was conducted using a Numeric Rating Scale.
There were 32 cases of initial instructions for opioid introduction, 86 cases of ongoing assessment of pain/side effect, 42 cases of telephone support after the patient returned home, 49 cases of involvement in pain-killer prescription, and 27 cases of inadequate drug adherence.
In research on NRS at the initiation of involvement in pain management as well as at the end of chemotherapy in 84 patients whose treatment was shifted to palliative-based therapy, verification of the results by Wilcoxon t-test (p<0.01) showed a significant reduction in pain.
The significant reduction in NRS shows that pharmacists of palliative care teams with experience of pain management are able to perform appropriate patient education and pain management by being involved from the stage of opioid introduction in outpatients receiving cancer chemotherapy.

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The simple suspension method has now gained much popularity. Saiseikai Matsuyama Hospital introduced this method in August 2005. Five years after its introduction, we aimed to investigate its application and user opinion of the method by carrying out a questionnaire-based survey. The questionnaires were distributed among 114 ward nurses, responses were collected, and data were collated. We obtained 57 valid and justified responses (overall response rate, 50%). On the basis of the collected responses, it was found that 47.4% of the ward nurses had experienced feeding tube obstruction. We therefore analyzed the data of the questionnaire-based survey focusing on factors related to tube obstruction. Data analyses were performed by applying a decision tree algorithm, which is used as a data mining technique.
Analyses revealed the possibility that the feeding tube obstruction in the simple suspension method was caused by the use of drugs that could not be suspended in hot water. In addition, another contributory factor that was proposed was adherence of the suspension to fingers or other part of the hand during administration.

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