Therapeutic drug monitoring (TDM) was instituted as a routine task in our hospital from 1985. Examination of the frequency of digoxin toxicity was conducted during the 9-year period from 1985 to 1993. Though the frequency was about 8% in 1985 and 1896, however, it gradually decreased every year to the level of about 1% for the last two years. This suggests that TDM is an effective measure for decreasing the frequency of digoxin toxicity.

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THEODUR^®syrup (TDRsyr) is the first liquid dosage form of a long-acting theophylline in Japan. The dosage form design, a matrix form containing theophylline, is suspended in Dsorbitol solution having a high viscosity. To ensure its efficacy, it is necessary to develop precise dispensing technigue. The content of theophylline in TDRsyr was measured by highperformance liquid chromatography (HPLC) after methanol extraction. The concentration of theophylline, after being shaken in a container of TDRsyr (20mg/ml), was 101.5w/v% of the indication value. And its coefficient of variation was 0.7%(n=5), conforming that the quantitative method has good reproducibility. For reliable dispensing, shaking the commercial TDRsyr for longer than 40 minutes is required, and shaking must be done in an up-and-down manner 8 times (8 cycles) per second. Moreover, prior taking it as a dosage, it must be shaken for longer than 2 minutes for 4 cycles per second. When a patient measures out the TDRsyr dosage, a measuring cup is found to be more suitable for reliable dispensing than a small pipette.

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The water vapor permeation behavior of the child resistant package (CRP) with a pressand-turn closure, the polyethylene bottle with a screw cap and the glass bottle with a screw cap was investigated. The water vapor permeation increased in the order of the glass bottle, polyethylene bottle and CRP. The amount of water vapor permeated through the CRP showed a linear increment with the passage of time. The effect of applied sealing torques on the water vapor permeation was also investigated. There was not affect on the water vapor permeation of glass bottle and little influence on the of the polyethylene bottle. On the contrary, the water vapor permeation of the CRP showed dependency on the applied sealing torque. These results suggest that the differences in water vapor permeation were due to the specific structure of the CRP closure. Additionally revealed was that in the CRP the relationship between the log applied sealing torque and the water vapor permeation rate produced a nearstraight curve.

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Removal torque of caps on child resistant packages (CRPs) with the press-and-turn closure, and on the polyethylene bottles and glass bottles with screw caps were investigated. The removal torque of the caps on CRPs and on polyethylene bottles decreased markedly on the first day and then gradually with time. Conversely, the removal torque of caps on glass bottles increased rapidly. The variations in the removal torque of cap ware observed to be dependent on storage temperature. These phenomena were attributed to the container and packing materials used. The results obtained concerning the break torques, return torques and the water vapor permeation which was examined in previous reports revealed that suitable applied sealing torquewas 20-30kg·cm. The press strength of the CRP cap exhibited a low value, confirming that the CRP used in this experiment was easy to use.

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The bactericidal effect of four kinds of disinfectant-benzethonium chloride, benzalkonium chloride, chlorhexidine gluconate and alkyl diaminoethyl glycine-was evaluated against 30 strains of Staphylococcus aureus which comprised of 24 strains of Methcillin-resistant Staphylococcus aureus (MRSA) and six of Methicillin-sensitive Staphylococcus aureus (MSSA). The effect was measured by the phenol coefficient method and the MRSA strains were classified by typecombination of coagulase and enterotoxin as IIA, IIB, IIC and IINT (non-typable)
The results were as follows: 1) All strains except for three strains of MRSA and MSSA became growth-inhibited within 15 seconds due to each disinfectant at a rate of 0.1% which was the ordinary dose in clinical use. 2) There were differences in inhibition time by 0.02% of the disinfectants among the MRSA type-combinations.
So far as our materials were concerned, we concluded that there was no necessity to distinguish MRSA from MSSA when “disinfection” is considered.

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The Japanese Society of Hospital Pharmacists started a continuing education (CE) system for its members in April 1993. The program issues a certificate of completion to those who earn more than 70 credits a year. This paper presents the one year's trial of the CE activities conducted during April 1993 to March 1994 for the pharmacists working in the Fukushima Medical College Hospital Pharmacy.
The average pharmacists partipated in 64.5 credits of CE activities. The average credits earned by 11 male pharmacists and 11 female pharmacists at our hospital pharmacy were 68.4 and 60.7, respectively. A total of 32%(7/22) of our pharmacists were able to earn 70 credits. No relationship was noted between the credit values earned by the pharmacists and their ages. Sixty-three percent of the total credits earned by the pharmacist were achieved in our hospitalbased and pharmacy-based conferences and 13% of total credits earned by pharmacists was responsible for lectures and studies held out-of-hospital, for example, at meetings sponsored by the branch of the Japanese Society of Hospital Pharmacists.
It is necessary to encourage all pharmacists to keep up-to-date and improve their knowledge and judgment through CE.

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One of the preconditions for correct drug treatment is that outpatients must understand and obey the directions relating to use of drugs which are printed on drugs envelopes. Therefore, we conducted a number of surveys of outpatients to investigate the utility of pictograms in conveying drug information. In the surveys relating to the utility of pictgrams, 94% of patients said that pictogram display of information related to drug administration was easy to understand. However, with respect to drug usage directions, 95% of the patients thought that written information alone was sufficient.
In another survey which used different methods of information display (large letters, colored letters (red), pictograms, and pictograms combined with simple written information) to determine which was easiest to understand, 61.2% of the patients responded that pictograms combined with simple written information were easiest to understand. From these results, it was found that pictograms are an easy-to-understand way of conveying information about drugs, which suggests that they could be of value in providing patients with correct information about drug use.

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Pharmacoeconomics has become a topic of great interest throughout the world. It broadens the analysis of drug products beyond safety and efficacy issues and evaluates the costs and consequences (outcomes) of drug products. It goes beyond focusing primarily on drug product acquisition cost and evaluates the total costs and benefits to the health care system. The four types of pharmacoeconomic analysis are cost-minimization, cost-effectiveness, cost-utility, and cost-benefit. These four methodologies differ in their measurement of the costs (inputs) and outcomes (outputs) of drug therapy. These methodologies are useful in determining the highest quality of care for the money spent. Pharmacists, physicians, hospitals, insurance companies, pharmaceutical manufacturing companies, and governments are interested in pharmacoeconomic analysis in order to provide efficient outcomes and cost-effective assessments. Direct costs describe health care resources used in providing a product or service. Indirect costs describe the loss of human productivity that may be seen from lost work because of illness or its treatment. Intangible costs describe costs such as pain or quality of life issues. The study perspective (viewpoint) significantly determines how costs and benefits are evaluated, such as governments, hospitals, insurance providers, or pa.-dents. Sensitivity analysis is important to determine the effectand extent of analysis uncertainties. Common pharmacoeconomics uses and a description of methodologies are reviewed.

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To recognize the existing state of simultaneous use ( “Gappo” ) of Kampo extract medicines, we investigated the medicines from 3099 prescription preparations.
The results were as follows: 1) The rate of two and three combined preparations was 10.1% and 0.8%, and combined kinds being 98 and 14, respectively. 2) Rate of non-reducing dose prescriptions among combined preparations was 19.1%. 3) The rate of combined kinds of crude drug from single to three comprised 70% among two combined preparations, and the rate of the major crude drug, Glycyrrhizae Radix, was 25.6%.

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