An orientation is given to patients who are scheduled for chemotherapy in our ambulatory center by nurses, pharmacists and social workers. The pharmacists provide them with the necessary information on chemotherapy using a patient education sheet for each regimen. Each education sheet was prepared by a commercial spreadsheet program (Microsoft^® Excel 2003), so considerable time was required to update the sheets for many regimens. In this study, we developed and evaluated a new system of preparing patient education sheets using a commercial database (Microsoft^® Office Access 2003). The preparation time for a fixed form of patient education sheet for pegylated liposomal doxorubicin (Doxil^®) therapy was significantly shortened by implementing the new system from 61.2±26.4 min to 19.0±3.7 min (p<0.05). The preparation time for each patient education sheet using a fixed form was also significantly shortened from 17.1±7.0 min to 3.8±2.3 min (p<0.0001). This system is very useful in ensuring the efficient preparation of patient education sheets for various chemotherapy regimens.

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Many preparations containing ascorbic acid are commercially available as over-the-counter (OTC) drugs and dietary supplements. In this study, we compared the properties of various OTC preparations and prescriptions for the medical use of ascorbic acid, and investigated their antioxidative potencies. In each preparation, the total vitamin C content corresponding to the indicated amount was confirmed. Ascorbic acid release from the preparations was not influenced by the pH of the release media. Based on the results of the drug release examination, the dosage form and additives were assumed to control the drug release from the preparations. The ratio of the amount of dehydroascorbic acid to that of total vitamin C at 120 min after the start of the release test was about 4-7 and 6-12% in the first and second fluids respectively (pH 1.2 and 6.8), respectively, and the oxidation of ascorbic acid increased over time. The total antioxidant capacity in the tested medium of the drug release experiment corresponded to the concentration of ascorbic acid. Based on these results, it is considered that the total amount of ascorbic acid absorbed into the bloodstream is an important influence on the antioxidative potency in vivo when preparations containing ascorbic acid are orally ingested.

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The overall quality of generic drugs (GE) was assessed by sensory evaluation (questionnaire survey) taken by the patient side, a composition analysis by the pharmacist side, and a questionnaire by medical manufacturers, using an icosapentaenoic acid ethyl ester (EPA-E) product. In the sensory evaluation, the original product was superior to the two other GEs in terms of the ease of finding the wrapping's cutting point and its opening and external cutting points. In addition, there were GE products with a peculiar odor, which had residual beads (grain) in several wrappings. According to an analysis of the capsule's odors and surface cleaning solutions, the odor was attributed to the raw material itself adhering to the capsule surfaces during the manufacturing process, and/or by the deterioration of the capsules during the manufacturing period. The result of the stress test also supported this conclusion. The total dioxin content in the original product was extremely low compared to any other GE product. Questionnaires to manufacturers showed that all supplied product information for medical personnel and patients via various media, and were striving to innovate and improve the quality retention of the wrapping. It also emerged that GEs were not always superior to the original product, whereas it is expected that GE manufacturers will provide products that improve on the original drugs for the convenience of patients.

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Pain management is important in the care of cancer patients. However, narcotic drugs are still not well understood by either patients or medical staff in Japan, which is an obstacle to the development of appropriate pain management. In the present study, we attempted to improve pain management through pharmaceutical education support for nurses. We prepared explanatory materials on narcotic drugs for patients and asked nurses to use them for 2 months to improve pain management. We also held a lecture on pain management and narcotic drugs a month after distributing the materials. In addition, we carried out three questionnaire surveys on the nurses to evaluate the effect of pharmaceutical education support on the understanding of pain management, anxiety and implementation status. Our education support improved nurse's understanding of pain management (score: 4.7 to 6.4, p<0.01), lessened anxiety (score: 5.9 to 3.8, p<0.01), and led to appropriate practical pain management (score: 4.3 to 6.1, p<0.01). These results suggest that the pharmaceutical education support for nurses is useful for improving practical pain management.

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Previously, warfarin potassium (WF) was only marketed in tablet form. When the dose needed to be prepared in a form other than tablets, it was necessary to either grind or cut the tablets. When grinding such tablets, some degree of drug loss occurred due to adherence to the grinders, mortar and pestles, and power folders. These issues were finally solved by the sale of fine-grain WF products. However, it was thought that the prothorombin time-international normalized ratio (PT-INR) might be increased in patients who changed from ground tablets to the administration of fine-grain WF. Therefore, we investigated the PT-INR of such cases while also comparing the findings in cases of patients continuously administered with WF in tablet form. The average PT-INR in patients that changed from the ground form to the administration of fine-grain WF was 1.81 (before the change) and 1.94 (after), thus showing a slight increase, but not one that was statistically significant. When the fluctuation range of PT-INR was compared with patients continuously taking WF tablets, the fluctuation ranges of PT-INR were 0.13 and 0.067, respectively, and no significant difference was observed. As a result, there is a possibility that the change to fine-grain WF may cause an increase in PT-INR, but such increase was restricted. In this study, an increase in PT-INR did not have any effect on the medical examination.

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In patients with type 2 diabetes mellitus being treated with existing antidiabetic agents, we investigated the effect of adding sitagliptin with the aim of improving glycemic control and differences in this effect based on patientbackground factors. This study involved 65 outpatients with type 2 diabetes mellitus who were followed up for 6 months after starting sitagliptin treatment. Hemoglobin A1c(HbA1c)began decreasing significantly 1 month after starting sitagliptin and had decreased from 8.14±1.11% to 7.14±1.15% in 6 months(p<0.001). There was no difference in the hypoglycemia frequency before versus after starting sitagliptin treatment and greater improvements in glycemic control were observed in younger patients and those with higher HbA1c levels at the start of the treatment. The effect of sitagliptin did not differ with respect to the presence or absence or the number of concomitant antidiabetic agents. It was shown that adding sitagliptin to patients with type 2 diabetes mellitus under oral antidiabetic treatment could further improve glycemic control, regardless of the number of concomitant agents.

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The anticoagulant drug warfarin is used to prevent conditions such as venous thrombosis and so on. Since warfarin has many interactions with other drugs and a large inter-individual pharmacodynamic variability, its dosage must be adjusted based on the prothrombin time international normalized ratio (PT-INR) in each patient. Oxycodone is often used to control cancer pain. In the drug package insert, care should be taken when co-administering oxycodone with warfarin, but the mechanism of the interaction between the two remains unknown. In addition, there have been no reports on interaction between oxycodone and warfarin in patients.In this study, we retrospectively investigated the effect of oxycodone on the blood coagulation activity in 9 cancer patients who were treated with warfarin. After combination with oxycodone, the total dosage of warfarin in two weeks was significantly decreased to 78.6% of that without oxycodone. The median of PT-INR was also significantly increased from 2.03 to 2.30 compared to that without oxycodone. Moreover, the median of the warfarin sensitivity index, which was defined as PT-INR/warfarin dose (mg/day), was also significantly increased from 0.78 to 0.96 after coadministration with oxycodone.These results suggest that the anticoagulant effect of warfarin was increased after the co-administration of oxycodone in cancer patients treated with warfarin. Therefore, PT-INR should be frequently monitored after the start of co-administration of oxycodone.

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The purpose of this research was to noninvasively evaluate the influence of aromatherapy on work performance in 14 healthy young adults. Participants in a room filled with the fragrance of lavender completed a self-reported questionnaire and multi-dimensional fatigue inventory-20 (MFI-20). Further, as an objective measure, blood flow in the inferior frontal cortex was evaluated via near-infrared spectroscopy (NIRS) as a parameter of working memory capacity. Compared to the control stage (no aromatherapy), exposure to aromatherapy achieved a significant reduction in general and mental fatigue according to MFI-20. Self-reported questionnaires also indicated improvement, but the differences were not statistically significant. NIRS measurement during the task performance of an N-back program indicated that regional blood flow in the inferior frontal cortex was significantly increased through exposure to aromatherapy, compared to without. The prefrontal area in the brain is involved in working memory, attention concentration and judgment. These results suggest that lavender may improve both cognitive ability and mood. A larger study with more aroma oils seems warranted.

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