Many injection solutions are kept in plastic containers that usually made of polyethylene. A previous study reported that photoinitiators from packaging ink were able to migrate into the food and juice within the container. However, harmful in vivo effects from exposure to such photoinitiators have not been reported. Since many chemicals are used in the polyethylene manufacturing process, we were similarly concerned that chemicals from polyethylene containers could also migrate into their contents. In our recent study, photoinitiators were detected in injection solution from polyethylene containers. To confirm the cytotoxicity of the photoinitiators, normal human peripheral blood mononuclear cell (PBMC) viability was assayed in the presence of photoinitiators, which resulted in almost complete PBMC death. In addition, levels of caspase-3/7 were increased. This result suggested that the mechanism for cell death promoted by photoinitiators was mainly through apoptosis. In a future study, we will determine the in vivo cytotoxicity of photoinitiators and address the safety of injectable solutions in the clinical setting.

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Fukui University Hospital has contributed to medication inside and outside the prefecture based on the principle of providing “The highest and the newest medication with confidence and trust.” Pharmacists have played three important roles in drug information, pharmacoepidemiology, and regulatory science. In drug information, we assessed the dosage and administration of teicoplanin from the viewpoint of PK/PD, and built a basal appropriate administration plan. In pharmacoepidemiology, we closely examined the clinical record after showing adverse drug reactions in vinorelbine, and discovered drug interactions between vinorelbine and clarithromycin. We assessed the influence of the interaction, and built evidence of the appropriateness of contraindications for coadministration. We have achieved a measure of success in securing medication by playing these roles in clinical services.

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The new advanced OSCE for “physical assessment in the hospital ward” using the patient simulator was conducted to evaluate clinical skills at the Department of Pharmacy of Kyushu University of Health and Welfare. Four items of the measurement of [pulse (achievement score 66.7％)], [blood pressure (71.8％)], and [cardiac sound (74.4％)] as practical exams and the detailed assessment item regarding “deflate the cuff at a rate of 2-3 mmHg per second (57.7％)” were significant different from the average achievement score of detailed assessment items (93.5％). The results revealed that it was particularly difficult to assess arrhythmia in the measurement of [pulse] and hypertension in [blood pressure], and detect the S3 gallop in the measurement of [cardiac sounds]. We analyzed the results of students who marked “incorrect” for practical exams, and found that these students had only judged heart sounds heard with a stethoscope, suggesting that they did not assess the mechanism of generating abnormal sounds and its subsequent course in a comprehensive manner. The results also showed a defect of the exam in which the difficulties associated with physical assessment can be lowered by understanding the characteristics of the patient simulator. We hope that this report can provide evidence for the implementation of the advanced OSCE for new pharmacy education at all Faculty of Pharmaceutical Sciences.

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Although the major ingredients in generic medicine are equivalent to those in brand-name medicine, generic medicines could be improved with regard to “easiness to take” and “availability of usage.” Such “advanced generic medicines” have been developed, for instance, taste-improved tablets, skin stimulation-reduced percutaneous absorbents, and solubility-improved preparations for injection. Gemcitabine, a deoxycytidine nucleoside analog, is the current standard chemotherapy used as first-line treatment for patients with pancreatic cancer. Gemcitabine preparations for injection are supplied as lyophilized dry powder contained in a vial, but the powder is slow to dissolve. It is thus necessary to thoroughly shake the vial after adding the solution and to confirm the presence or absence of insoluble particles. In this study, we investigated the solubility and dissolution of a brand-name and generic versions of gemcitabine preparation for injection. The solubility of gemcitabine, analyzed by HPLC, was different among the preparations. The average percentage of gemcitabine solubility in the brand-name preparation just after addition of saline was 78％. By contrast, those in generic preparations ranged from 57 to 98％. Furthermore, the dissolution time of lyophilized dry powder also differed significantly among the preparations. The brand-name preparation required 120 seconds, whereas the dissolution time of generic preparations ranged from 19 to 153 seconds. These results indicate that there are significant differences in the solubility and dissolution properties among the gemcitabine preparation for injection. The information may be useful for physicians or pharmacists when they select generic versions of gemcitabine preparation.

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Residents in the mountainous northern areas of Miyazaki prefecture find it difficult to access medical institutions and care facilities, and they have little contact with healthcare professionals. In this study, we investigated community access to medical services and proper drug use among residents in areas affected by depopulation and aging. We conducted canvassing interviews with elderly people (aged 65 years and older) in an urban district and four mountainous districts. When problems were identified, we gave instructions for proper drug use, and encouraged medical consultations. Although the number of residents who had access to a family physician differed between districts, many residents had a family physician. However, the number of residents who had a family pharmacy was lower than the number of residents who had a family physician in all districts. The role of pharmacies in proper drug use may not have been recognized in some districts. We found that some residents had side effects by multiple prescriptions and there was a lack of understanding about the meaning of medication in mountainous areas. There were problems regarding over-the-counter and household drugs in districts with a high rate of having these drugs, and we also discovered double medications of prescription and over-the-counter drugs. We conclude that the current situation of community access to medicine has become more difficult for residents in mountainous areas. Nevertheless, pharmaceutical interventions are useful for the promotion of proper drug use for residents in mountainous areas.

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Pharmacists should prevent cross contamination in the process of dispensing powder medicine in order to assure the quality of medicine. Cross contamination is mainly found by observing the external appearance of dispensed powder medicine; however, visual inspection has its limitations. Therefore, in this study, we developed a simple method using the iodine-starch reaction, which occurs based on potassium iodide. This method is useful for identifying the cross contamination that occurs on dispensing-tools and packaging-machines used in our daily work, and we found cross contamination in mixing-cups and packaging-machines by using this method. Taking these results together, we revised the process of dispensing and the way of handling the packaging-machines. In conclusion, the method using iodine starch reaction is very effective for finding cross contamination.

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Aprepitant is a neurokinin-1 (NK₁) receptor antagonist that has been shown to improve the control of chemotherapyinduced nausea and vomiting. Aprepitant is administered for 3 days with a 5-HT₃ receptor antagonist and dexamethasone to patients receiving highly emetogenic chemotherapy as antiemetic prophylaxis according to the guidelines of the American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), and the Japanese antiemetic guidelines used in the National Cancer Center Hospital East. In the Japanese phase II clinical trial, the effectiveness of aprepitant was certified by a 5-day duration of administration. The package insert and the antiemetic guidelines recommend 3 days of administration. However, the optimal duration of administration for Japanese is not yet clear. The purpose of this study was to evaluate the efficacy of a 3-day administration period for aprepitant in high-dose cisplatin-containing regimens. Between June 2009 and June 2010, 224 chemotherapy-naive patients (aprepitant group: 92 patients and non-aprepitant group: 132 patients) received high-dose (≥ 50 mg/m²) cisplatin-containing regimens as 1st line chemotherapy. The primary end point was complete response (no vomiting and no use of rescue therapy) in the overall phase (Day 1-5 post-cisplatin). The complete response rates were significantly higher in the aprepitant group than in the non-aprepitant group in the overall phase (62％ vs 40％; P < 0.01), as were rates of no vomiting (91％ vs 64％; P < 0.001). The 3-days regimen of aprepitant, which was recommended based on antiemetic guidelines, was effective in improving the complete response rate and also percentage without vomiting.

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Hand hygiene is important to prevent nosocomial infection, but healthcare workers' compliance with the practice of hand hygiene seems to be low. The hand hygiene technique is usually assessed by the Glitterbug or a bacterial culture method, but the Glitterbug method is an objective assessment because it is judged visually, and a cell culture using agar medium method requires a lot of time for the incubation process. In this study, we developed a quicker and easier method of assessing hand hygiene techniques using fluorescence detection, which is applicable to both scrubbing and rubbing methods. In the scrubbing method, fluorescent paint is regarded as bacteria, and the area of paint that is removed by scrubbing is measured. In the rubbing method, fluorescent paint is regarded as alcohol-based hand rub, and the area over which the paint is applied is measured. These areas are obtained by detecting fluorescence emission by image analysis using a computer program that we originally developed. We applied this method for evaluation of handhygiene techniques of volunteers under several conditions, and the time course profiles for the ratio of scrubbed or rubbed areas on hands were obtained. The results suggest that the method can evaluate hand hygiene techniques quickly and easily based on computer-based image analysis.

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