Ward-based pharmacy interventions are effective for proper medical management. In Hiroshima University Hospital, clinical pharmacists participate in almost all inpatient cases. In addition to the regular clinical pharmacists for the 4 wards, a supervising pharmacist was allocated additionally to overview and to help them as a trial. The supervising pharmacist reviewed the prescriptions and assignments of physicians, and ordered authorized prescriptions. As a result, the number of drug-related incident reports for two months decreased from 17.3 to 3.0, compared to the number of reports of the past three years. The revision of prescriptions by a supervising pharmacist assembly might reduce the inspection workload and number of inquiries by the central pharmacy. On the questionnaire, 94％ of physicians expressed a decreased burden during this trial. Also a decreasing trend of overtime work of nursing staff was reported. Therefore, the allocation of a supervising pharmacist may contribute to medical safety and efficient work management of medical staff who are concerned with drug therapy.

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In response to the medical needs for human immunoglobulin, intravenous formulations of human immunoglobulin with various modifications have been developed after many years of research. However, few studies have been conducted for the detailed comparison of the characteristics of intravenous human immunoglobulin (IVIG) preparations. In the present study, physicochemical properties of six (6) IVIG preparations that are commercially available in Japan were investigated in detail. Consequently, it was found that there are differences among these IVIG preparations in terms of IgA contents, viscosity and Factor XI activities. It is necessary to promote the appropriate use of IVIG preparations in medical practice giving careful consideration to the characteristics of each IVIG preparation.

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Community pharmacies play a significant role in home healthcare. However, patient information from hospitals is not shared with community pharmacies. We attempted the bidirectional sharing of patient information regarding chemotherapy between hospitals and community pharmacies. We developed a “medicine message board,” which was a modified prescription format. Hospital pharmacists recorded information regarding patients taking tegafur/gimeracil/oteracil (S-1) on the message board. In turn, community pharmacists monitored side effects in the S-1 patients and returned the information by fax to our hospital also using the message board. A medical clerk entered the side effects into the electronic medical record, providing feedback to doctors. We distributed questionnaires to community pharmacies around our hospital between December 2013 and January 2014 and assessed their understanding using a five-point Likert scale (where 1 = insufficiency and 5 = sufficiency). The results showed that the mean scores on understanding about the presence or absence of cancer notification before and after the initiation of the message board were 2.10 ± 1.02 and 4.20 ± 1.06, respectively. The mean understanding about the name of a cancer patient's disease before and after the message board was 2.25 ± 0.91 and 4.45 ± 0.83, respectively. All these differences were significant. Understanding about the purpose of treatment, dose adjustments of S-1 due to body surface area and renal function, administration schedule, presence or absence of combination chemotherapy, pharmaceutical instructions, treatment adherence, and side effects monitoring were also significantly improved in community pharmacies after the initiation of the message board. These results suggest that there is scope to improve the support provided to oral chemotherapy patients by hospitals and community pharmacists.

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Although medication errors in pediatric patients often occur in the healthcare system in Japan, the influence of patient characteristics on medication errors is rarely clarified. The aim of this study was to evaluate the characteristics of medication errors in the prescribing, dispensing, and administration of medicines to pediatric patients in comparison with adult patients. Medication errors that occurred in the prescribing and dispensing of medicines at Hamamatsu University Hospital from August 2010 to July 2011 were compiled. The characteristics of these errors in pediatric patients (under 15 years old) were compared to those in adults (15 years old and over). Medication errors found by pharmacists in the pediatric ward were also collected. The annual number of inpatient beds was 182,284, 5.9％ (10,755) of which were pediatric patients. The total number of pharmacist referrals was 1,089. Pharmacist referrals for prescriptions to child patients accounted for 124 (11.4％). The most frequent pharmacist referrals were concerning dosage for the pediatric patients and administration for the adult patients. The total number of dispensing errors was 984. A dispensing error occurred most often when compounding a medicine for pediatric patients and when counting the number of tablets, capsules, vials, and so forth for adult patients. The total number of medication errors that were found by pharmacists in the pediatric ward was eight. Medication errors in pediatric patients were different from those in adults, and thus the respective countermeasures should also be different.

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Irinotecan, a topoisomerase I inhibitor, is widely used in the treatment of numerous malignancies, such as gastric, colorectal, ovarian, cervical, and lung cancer. The principal dose-limiting toxicities of irinotecan are neutropenia and delayed diarrhea. Genetic variants (*6/*6, *28/*28, and *6/*28) of uridine diphosphate glucuronosyltransferase (UGT) 1A1 have been shown to be correlated with adverse events during irinotecan chemotherapy. However, irinotecan-induced adverse events may also occur in patients without a UGT1A1 polymorphism.
We conducted logistic regression analysis to determine the principal patient characteristics other than UGT1A1 polymorphism that are associated with severe irinotecan-induced neutropenia.
Ninety-six patients who received irinotecan therapy between June 2009 and May 2013 were analyzed. Our univariate analysis showed that smoking history, combined with oral fluoropyrimidines and platinum-containing drugs, weekly irinotecan schedule, was associated with irinotecan-induced severe neutropenia. The multivariate analysis showed that the following factors were also correlated with irinotecan-induced severe neutropenia: the patient's first cycle of irinotecan (at doses ≥ 133 mg/m²), prior chemotherapy history, smoking history (non-smoker), simultaneous treatment with a platinum-containing drug, and total serum bilirubin before treatment (at levels ≥ 0.5 mg/dL).
These findings suggest that it is valuable to identify patient characteristics other than UGT1A1 polymorphism assessing severe neutropenia in patients treated with irinotecan.

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Clinical pharmacists are stationed in some wards in Asahikawa Medical University Hospital. In order to clarify the effectiveness of the pharmaceutical care provided by these ward pharmacists, we retrospectively reviewed the pharmaceutical interventions recorded from November 2010 through October 2012, irrespective of the physicians' acceptance or rejection.
There were 788 cases of interventions in total. Among these interventions, physicians accepted and subsequently changed the medical treatment provided in 709 cases (90.0%). The most frequent interventions (164 cases) were related to cancellation, resumption, non-execution of prescriptions, or change of dosing period. Above all, 31 cases were associated with a lack of cancellation or resumption before or after operations or medical treatments. In 5 of these cases, operations or medical treatments were postponed. Among all pharmaceutical interventions, there were 138 suggestions of prescriptions due to adverse drug reactions (ADR). In 37 cases (26.8%) of the suggestions, pharmacists successfully prevented ADR by proposing changes of prescriptions through a careful review of patients' drug history or information. In the other 101 cases (73.2%), further aggravation and prolongation of ADR were avoided after the onset of ADR. Fifty-five suggestions were based on renal function, which was the most common in all the 99 suggestions, indicating that ward pharmacists are paying special attention to the laboratory data of their patients.
In conclusion, these results provide further evidence that ward pharmacists help enhance the safety and efficacy of inpatients' drug therapy by performing pharmaceutical interventions through active listening to patients and careful examination of their medical records.

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In this study, a survey was conducted to examine a possible means by which pharmacists could intervene in the medical care of human immunodeficiency virus (HIV) patients. A questionnaire was distributed to 15 medical institutions in Japan, targeting relevant doctors and nurses. Among the respondents (45 doctors and 40 nurses), 92.5% of doctors and 91.1% of nurses were either “satisfied” or “somewhat satisfied” with the pharmacists' interventions. The responses of satisfied and dissatisfied professionals were compared. The results revealed that the satisfied group had significantly more doctors who understand the medication adherence support provided by pharmacists to patients (P = 0.006). Among doctors, items such as “improved quality of HIV medical care” or “reduction of the burden on doctors” were associated with various pharmacist interventions, particularly “proposing antiretroviral therapy (ART) prescriptions,” “support provided for side effects,” “support for drug interactions,” “proposing medical examination orders,” “strategic intervention in preventing opportunistic infections (OI),” “responding to consultations about drug information,” and “educating patients on ART” (P = 0.000 - 0.044). Among nurses, only “proposing ART prescriptions” was significantly associated with satisfaction (P = 0.040). To enhance pharmacists' contributions within the HIV medical care team, their role in the prescription of ART, medication examination orders, and OI preventive measures could be further encouraged. We believe that cooperation between pharmacists and other professionals is necessary in determining appropriate therapeutic strategies in HIV care.

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