We examined the pharmaceutical properties of 43 ophthalmic solutions adopted at our hospital. The values obtained varied considerably among the products. Total number of drops per bottle, the volume of each drop, the osmotic ratio to saline and the pH of each product were distributed within the ranges of 92-169 drops, 29.5-53.0μl 0.33-1.38 and 3.7-8.2, respectively. Listing such information onto the package-inserts will be helpful not only for physicians when prescribing such medication but also for patients to improve the rational use of these drugs.

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The data concerned with the photo-stability of ophthalmic solutions which were prepared by pharmaceutical companies are of little use for daily medication instructions because the test conditions employed by respective companies are not unified. Therefore, we established practical and systematic test conditions and conducted photo-stability studies on 24 types of ophthalmic solutions.
As a result, some of showed a significant loss in the potency of their active ingredient, thus indicating that a light shield is necessary using either a pocket-bag (Uni-Pack^®) attached to each product or a medicine paper bag. In addition, as a label stuck to a bottle or a wrapping film was also found to be very effective for shading, and thus patients should be careful not to strip them off at the time of use.
Furthermore, some of our findings were different from the data provided by each pharmaceutical company. Our findings provided important information regarding the appropriate storage conditions for each ophthalmic solution and such information can be utilized in our instructions on drug use.

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Kanto Teishin Hospital's drug information division has had a considerable amount of its time taken up by answering patients and doctors questions. A Q & A search was established with the objective of reusing past Q & A information, reducing the answer time, and also for unifying the answer content. An evaluation of performance was also undertaken.
An NEC 9821-BP, running database software, Kiri version 5.02, was utilized with a system containing a main menu of five headings: Search, Additional Input, Print List and Exit. Five types of searches were included. A secondary search, for adding additional conditions, appeared after the first. The search results and database input screens were identical, and are set to display data in a card-like form. Information for the system included Q & A data from January 1992 to June 1995.
For the evaluation, twenty-six subjects' search times, and six subjects' data processing times, were measured with a stopwatch (along with a quality check of the processed information). All subjects were also given a questionnaire regarding the system's usability.
As a result, whether or not the subject had any experience in such information oriented fields like DI, was found to be a statistically significant factor affecting the search. However, in searches between certain jobs or hospitals, no adverse effect was statistically possible. A quality check revealed a 70% compatibility with the systemindexing, while among experienced processors, this rate was 90.7%. One key word mentioned was “high search efficiency” . this system was thus found to be useful in a medical context and, in the future, the probability of utilizationboth with in, and between hospitals is high.

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Both low-sensitivity and labor-intensive liquid-liquid extraction have previously limited the use of high-performance liquid chromatography for the therapeutic drug monitoring of cibenzoline. A rapid solid-phase extraction method was developed to minimize the sample workup and provide analytical sensitivity to 0.05μg/ml using 1ml of serum. The serum samples were loaded onto C 18 solid-phase extraction columns, and cibenzoline and an internal standard (di-pmethyl analogue of cibenzoline) were eluted with 5% ammonium hydroxide in methanol, dried and reconstituted in 200μl of the mobile phase. Chromatographic separation was achieved using a Zolbax C 8 column at 40°C and a mobile phase of a mixture of acetonitrile and 0.06% phosphoric acid (40: 60, vol./vol.), at a flow rate of 1 ml/min. UV detection was carried out at 230 nm. The retention times of cibenzoline and the internal standard were 8 and 18 min, respectively. The standard curves were linear over a range of 0.05-1 μg/ml with intra-assay coefficients of variation of 6.4% and 2.9% at 0.05 and 0.5μg/ml, respectively. Fanally, no chromatographic interference from other anti-arrhythmic drugs was observed

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A comparison was made between a mixed preparation of Pandel^® corticosteroid ointment with zinc oxide ointment (hereafter referred to as “Pan: Z” ) and a mixed preparation of Pandel^® corticosteroid ointment with Urepal^® urea ointment ( “Pan: U” ), regarding the therapeutic effect and safety, moisturizing effect, the feel of the ointment, and usefulness as an overall evaluation, in 6 patients with atopic dermatitis (AD).
With regard to the therapeutic effect, although differences were observed between the mixed ointments in some cases for certain periods, ultimately the degree of improvement in the symptoms was approximately the same for all cases. The reason for this is considered to be the presence of corticosteroid ointment as the central therapy in both mixed ointments. No side effects were caused by either of the mixed ointments.
With regard to the moisturizing effect, Pan: U was found to be superior to Pan Z. This is considered to be mainly due to the difference between zinc oxide ointment and Urepal^®, with Urepal^® which has a direct moisture-restoration effect on dry skin in AD.
Regarding the feel of the ointment as well, Pan: U was considered to be superior to Pan: Z. This difference is considered to reflect the moist feeling of Urepal^®.
As a result, Pan: U was evaluated to be superior to Pan: Z in terms of usefulness.
Prior to the clinical study on AD patients, the moisturizing effect of 5 ointments was examined in subjects with healthy skin. As a result, the ointments were divided broadly into 2 categories including emollients and moisturizers in line with the mechanism of the moisturizing effect according to the properties of the base.
The moisturizing effect of the ointments themselves was significant, ranking in the following order: Urepal^®>Hirudoido^®> Sahne^® zinc oxide ointment > Keratinarnin^®.
Pan: Z and Pan: U are selected for use according to the skin symptoms. When the moisturizing effect and feeling of use are also taken into account, however, Pan: U is considered to be superior to Pan: Z. Among the 5 ointments, Urepal^® and Hirudoid^® are also considered to have a particularly good moisturizing effect.

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The effects of concomitant antiepileptic drugs on the serum valproic acid concentration (Cs) were investigated. Primidone (PRM), phenobarbital (PB), carbamazepine (CBZ), phenytoin (PHT), zonisamide (ZNS), clonazepam (CZP) and ethosuximide (ETS) were coadministrated with valproic acid (VPA).
The routine therapeutic drug monitoring data, obtained from epileptic patients who were treated with the repetitive oral administration of the sustained-release preparations of VPA (VPAR), were used for the analysis. A total of 233 patients were administrated VPA-R alone, and 87, 21 and 6 patients were coadministrated one, two and three different antiepileptic drugs, respectively
Using the data obtained from the patients administrated VPA-R alone, Ct could be expressed conveniently as a function of X as C_t=AX^B (X: VPA daily dose per modified body weight. A, B: parameter)
By comparing the regression line on logG vs. logX for VPA-R alone with that for VPA-R plus one concomitant drug, C_t was thus found to be affected at each definite ratio by PB, CBZ, PHT, but not by ZNS.
Next, we defined the parameter Ri (i=1, 2, ..., 7) as a coefficient representing the effect of each concomitant antiepileptic drug on G. All data were analyzed to estimate R_i, using a model based on the assumption that each R_i was independent from one another and multiplicative. The analysis clarified that PB, CBZ and PHT lowered C_t to 0.879, 0.812 and 0.833 times, respectively. On the other hand, ZNS did not affect C_t. The number of patients coadministrated PRM, CZP and/or ETS was not sufficient to detect the effect on C_t based on a test of significance.

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The relation between the serum valproic acid (VPA) concentration and the daily dose was studied using the therapeutic drug monitoring data obtained from epileptic patients who were treated with the oral administration of the sustained-release preparations of VPA. The 233 data at steady-state after repetitive dosing were used.
A multiple regression analysis revealed the serum VPA concentration to be dependent on only one variable regarding the daily dose per ideal body weight.
An 1-compartment model including two assumptions that VPA binds to plasma protein and the distribution volume of VPA is proportional to the ideal body weight, was postulated for this analysis. The plasma protein binding ratios were calculated based on the values estimated by the nonlinear least squares method and they were found to be 96.0, 94.7, 92.6 (%) when the serum VPA concentrations were 40, 70, 100 (μg/mL), respectively. These values showed a good correlation with those reported by previous investigators and this model also seemed to demonstrate good confidence level.

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An antiepileptic drug, zonisamide, which has a wide antiepileptic spectrum, is commonly prescribed concomitantly with other antiepileptic drugs. However, there appear to be a little data on the drug interaction between zonisamide and other antiepileptic drugs. Especially, the effect of zonisamide on the plasma concentration of phenobarbital in epileptic patients has not yet been reported. The effect of zonisamide on the plasma concentration of phenobarbital was therefore investigated in epileptic patients. The ratio of plasma phenobarbital concentration to the administered dose of phenobarbital when coadministered with zonisamide was found to be significantly higher than that of phenobarbital alone (P<0.05). The plasma concentration of phenobarbital was increased by zonisamide in a dose-dependent fashion. The present findings provide useful information that the monitoring of the plasma concentration of phenobarbital is needed to adjust the dosage regiments of phenobarbital in combination with zonisamide.

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The purpose of this study was to assess the incidence of the adverse reactions of low-osmolar non-ionic contrast media and its risk factors in patients receiving this contrast media for coronary angiography. We investigated all clinical data of 1386 patients who received non-ionic contrast media (Iopamidol, Iomeprol) from September 1995 to August 1996 for coronary angiography. The overall incidence of the adverse reactions of the drug was 31.5%, but there were no severe or fatal adverse reactions. The predominant adverse reactions were nausea (20.8%) and vomiting (12.2%). The incidence of the adverse reactions in females (51.9%) was definitely higher than that in males (24.7%). In females in the menopause age period, the incidence of adverse reactions occurred at rate of 69.8%, while in females in the non-menopause age, its incidence occurred at a rate of only 43.2%. The incidence of the adverse reactions was much higher in the patients who had a history of allergy, renal impairment or previous adverse reactions to the contrast media. In addition, adverse reactions in the patients undergoing a coronary spasm test were also observed at a higher frequency. Furthermore, it was shown that the incidence of a delayedreactions to the drug was 8.7%(12 patients). These findings suggest that the monitoring of the adverse reactions after patients ingest a low-osmolar iodine contrast media is a necessary in order to acute adverse reactions as nausea and vomiting, as well as any delayed-reactions that may be induced by this contrast media. Furthermore, we propose that the menopause, which is peculiar to females may also be one of the risk factors for an increased occurrence of adverse reactions to this contrast media.

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Delayed onset epilepsy after intracranial surgery has been observed in our neurosurgery ward. We performed a clinical pharmacy service using therapeutic drug monitoring (TDM) during treatment with zonisamide (ZNS) for a 46-year-old woman who had a high risk of postoperative epilepsy. We administered medication of ZNS 200 mg/day a week before surgery and assessed its prophylactic efficacy against postoperative late epilepsy. On the fourth day of therapy, the plasma concentrations of ZNS measured using HPLC just before and 2 hours after drug administration were 9.3 and 12.3μg/ml, respectively. On the seventh day of therapy, the plasma concentrations just before and immediately after surgery were 10.6 and 7.0μg/ml, respectively. On the second and third days after surgery, transient sensory seizures developed and the plasma concentrations were 9.0 and 11.0μg/ml, respectively. Subsequently the dosage of ZNS was increased to 300 mg/day. On the sixth and tenth days after surgery, similar seizures again developed and the plasma concentrations at that time were 15.2 and 15.6μg/ml, respectively. Therefore, the dosage of ZNS was further increased to 400 mg/day. On the twenty-fourth day after surgery, the plasma concentration was 21.0μg/m1 and no further seizures were subsequently noted. The patient was discharged one month after the operation with no complications.
Prophylactic anticonvulsant therapy after intracranial surgery remains controversial, but our observations suggested that ZNS may thus be useful for preventing postoperative late epilepsy. TDM was thus found to provide important pharmacokinetic information to effectively control the medication dosage in patients at high risk for developing postoperative epilepsy.

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Improving the patient's QOL is an important matter for guaranteeing proper pharmacotherapy. Lugol's solution (LS, iodine content: I₂ 3.4%, KI 6.6%) for internal use is a useful drug for the inhibition of radioiodine uptake to the thyroid gland. However, it is difficult for patients, especially children to take this agent or ally due to its unpleasant taste, terrible smell, and peculiar color. The present study was conducted to improve both the taste and the smell of LS, by using soft drinks containing ascorbic acid. Iodine (I₂) molecules in LS are reduced to iodide (F) by ascorbic acid, and the peculiar color of LS thus vanished. The amount of L (+)-ascorbic acid (VC) required to remove the color was in good agreement with the rational value. The improvement in the taste, smell, stimulation on the tongue, and the overall ease in taking the following four LS preparations, i.e., the control LS (LS-I), added by Simple Syrup solution (LS-II), by VC solution (LS-III), and by POCARISWEAT^® (LS-IV), were then evaluated in the ten healthy adult volunteers. LS-II, -III and -IV, significantly improved all the elements compared with LSI, and eight volunteers selected LS-IV as the easiest preparation. The inhibitory effect of LS-IV to the radioiodine uptake to the thyroid gland was also confirmed in a patient with neuroblastoma based on a clinical diagnosis using ¹³¹I-metaiodobenzyl-guanidine scintigraphy. These results suggest that the medication method for taking LS with soft drinks containing VC improves the compliance and QOL of these patients.

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A 65-year-old woman inpatient had been administered methyldigoxin, verapamil and warfarin for the treatment of artrial fibrillation and mitral stenosis disease. About six day after the start of treatment the dose of methyldigoxin was increased from 0.1 to 0.2 mg/day and, as a result, a visual disturbance occurred. However, no other side effects of digoxin were not presented and the serum digoxin concentration was found to be within the normal therapeutic range. The dose was decreased and about five days later, her side effects disappeared. This case suggested that such side effects of digoxin as visual disturbance therefore need to be carfully monitored when ever digoxin and verapamil, which is one of the inhibitors of P-glycoprotein, are coadministered.

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A sodium gualenate gargle (Az-G) for the treatment of pharyngitis, tonsilitis, stomatitis and oral wound was prepared by using various thickening agents carboxymethylcellulose sodium (CMCNa), sodium polyacrylate (PANa) and sodium alginate (AGNa), and the effect of such thickening agents on the release-profiles of sodium gualenate (Az) from Az-G were evaluated both in vitro and in vivo. The mean dissolution time in vitro (MDT_{in vitro}) of Az from preparations with 1.0% or more CMCNa and 2.0% AGNa were significantly higher than that of the control preparation (without thickening agent). However, the preparation with 0.2% PANa did not increase the MDT_{in vitro} significantly despite the fact that the preparation had a higher viscosity than the control preparation. In the application of Az-G to healthy volunteers, the amount of Az adhering to the oral mucosa increased significantly in proportion to the concentration of CMCNa. On the other hand, MDT_{in vivo} increased significantly at 1.0% of CMCNa, though it did not increase significantly at 2.0%. There was no significant rise in the amount of Az adhered on oral mucosa and MDT_{in vivo} in the preparations with PANa and AGNa. The highest values regarding the amount of Az adhering to the oral mucosa, MDT_{in vivo} and the amount of Az released in saliva obtained at 30-33 min after application were observed in the preparation with 1.0% CMCNa. These results suggest CMCNa to be the most excellent thickening agent for the preparation of Az-G and the optimum content was 1.0%.

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Recombinant human granulocyte-colony stimulating factor (rhG-CSF) is administered either by i. v. drip infusion or a subcutaneous injection depending on the indications for which it is administered. In the case of i.v. drip infusion, binding to the infusion set and in-line filter has great impact on its efficacy because it is given in very small doses (micrograms). In the present study, we conducted a series of experiments to deterrmine the degree to which rhG-CSF binds to infusion containers, sets, and filters. The Pall PD1 Filter with a low protein binding profile was thus found to be the only infusion filter through which commercially available rhG-CSFs could almost be completely recovered regardless of the solvents used.

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To standardize and develop a convenient inputting method for prescriptions, the frequency and directions of use were examined in an ordering system. A total of 552 kinds of directions have so far been registered on our system. However, 250 derections (45%) had not been used for 1 month. The probability of selecting some directions on the first guide screen was analyzed. Of the drugs used, 95% of internal and 96% of external drugs could be prescribed on the first guide screen. The directions consisted of words and phrases, and these were classified into 4 types of information, how to use, how many times, when and where to use the medication. Based on our results, we also evaluated the inputting method.

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To improve compliance for pediatric patients with hypophosphatemic vitamin-D resistant rickets or Fanconi syndrome, we studied the preparation of a tablet for sodium phosphate using Fujicalin Sr and Avicel PH-F 20^® as a direct-compression vehicle. Fujicalin S^® and Avicel PH-F 20^® consists of calcium phosphate dibasic and microcrystalline cellulose, respectively. The phosphorus content of the tablet increases by about 10% when using Fujicalin S^® compared with Avicel PH-F 20^®, which leads to a reduction in the dosage. The tablets prepared with Fujicalin S^® showed a faster disintegration time and release rate than the tablets prepared with Avicel PHF 20^®. However, the former showed an incomplete release profile in distilled water because of the insoluble property of calcium phosphate dibasic. On the other hand, the tablet prepared with Avicel PH-F 20^® showed a sustained release of phosphoric acid and completely released the phosphorus in the tablet in distilled water. Phosphorus is reported to be absorbed from the gastrointestinal tract by the carrier-mediated transport. Thus, it was suggested that Avicel PH-F 20^®was a better vehicle than Fujicalin 5^® for regarding its clinical use.

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To clarify the additional role of pharmacists in drug information services for out-patients in Chiba University Hospital, we investigated what kind of drug information was provided by physicians, and what kind of information was recognized by the out-patients. The drug informations which was explained by more than 80% physicians included the following: the effects of the drug, directions for use, adverse reactions and the prescribed period. In contrast, information concerning drug interactions was provided by only 30% of physicians. On the other hand, only 30% of out-patients recognized that information concerning adverse reactions was provided by physicians, indicating a clear difference in the recognition of medical information between physicians and out-patients. In addition, information regarding drug interactions was also not well recognized by out-patients.
Furthermore, the consultation counter for prescribing drugs, and medical information pamphlets which were provided by pharmacists at our hospital were also not well recognized by the out-patients.
Based on such evidence, more drug information especially concerning drug interactions and adverse reactions, should be provided by pharmacists to ensove the appropriate use of drugs.

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Kremezin, which is an adsorbent, is used to treat the uremia symptoms of chronic renal failure and to prolong before introduction of dialysis. These patients are obliged to take as much as 10 capsules of Kremezin at one time, which is difficult for them due to their restricted fluid intake and would reduce their QOL. In order to find a better way to administer Kremezin, we investigated 10 patients (average age: 59.1±13.8) with diabetic nephropathy who were taking Kremezin capsules. Although all were uncomfortable with the size and number of capsules, they were taking 5 capsules twice a day (10 capsules in total) with about 30ml of water at one time. Apparently, a healthy volunteer could take 5 capsules with 30ml of water as well as the patients. Roentgenograms, however, showed that some of the capsules were retained in narrow part of esophagus near bronchial furcation in the volunteer unless they took an additional 30ml of water.
It has been shown that 10 capsules of Kremezin can be taken by dividing them into two 5 capsule portions with 30 ml of water, but in order to transit all capsules to stomach completely it is necessary to drink additional water (about 30ml) immediately after taking the capsules.

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In recent years, the number of drug-induced cases of pneumonitis have been reporled to increase. In this study, a literature-based investigation was performed to review the cases reported after Tomioka's study. Moreover, the reported cases in Tokyo Metropolitan Tama Geriatric Hospital, National Tokyo Hospital and Seire Hamamatu Hospital were also retrospectively reviewed.
1. Between July 1993 and December 1996, 180 cases of drug-induced pneumonitis were reported in the domestic literatures. Twenty-one of which were related to antineoplastics or immunosuppressants while 49 cases were caused by antibiotics. Among the remaining 110 cases, interferon (s), herbal remedies and cold preparations constitued 34, 26, and 5 cases respectively. Within the 26 herbal remedy-induced cases, 21 of them were due to Shosaikoto. A whole variety of drugs including GCSF and an increased number of drugs were reported.
2. In the three hospitals, similar distributions of drug-induced pneumonitis cases were shown with the majority related to herbal remedies and interferon (s).
3. According to the reports in the literature and from the three hospital, the results of treatments and prognosis were related to the discontinuation of the suspected agents. Consequently, early detection and discontinuation of causative agents can improve the prognoses of drug-induced pneumonitis.
In order to detect drug-induced pneumonitis at an early stage, a database on the characteristics of the causative drugs should be systemically established and be readily available to health care professionals. Moreover, the early implementation of a centralized medication history system will facilitate the tracking of the causes of such drug-induced diseases.

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Phenytoin (PHT), an anticonvulsant drug, has been reported to have different absorbing dispositions caused by differences in its preparation. With PHT there is a risk that toxic effects may appear after changing to improved absorbing preparations because of its narrow therapeutic range in the serum concentration. As a result, it is necessary to determine the appropriate prescription dose based on the serum PHT concentration and symptoms of the individual patients. In order to investigate the prescription dose of PHT during the exchange from PHT 10% powder (PHT 10) prepared in our hospital to ALEVIATIN^®10% Powder (ALV 10, Dainihon Seiyaku) which is reported to have improved absorption characteristics, we investigated the serum PHT concentrations, the doses of PHT 10 and ALV 10, and the symptoms of the patients before and after the change in the PHT preparations.
The mean serum PHT concentration and the mean serum PHT concentrations to the oral doses ratio (S/D ratio) with ALV 10 in the patients prescribed the same dose (n=11) during the exchange of preparations were 7.62 (μg/mL) and 1.69 (μg/mL)/(mg/kg/day), respectively, and were larger (but not significantly so) than those of PHT 10 (4.84 and 1.06, respectively). In the 21 patients receiving the reduced doses of ALV 10, the mean serum PHT concentrations treated by ALV 10 were 7.16 and were the same as those of PHT 10, however, the mean S/D ratio of ALV 10 was 1.91 and increased (not significantly) in comparison with those of PHT 10 (1.58). In the 21 patients receiving the reduced doses of ALV 10, the oral doses and the reduction rates during the change from PHT 10 to ALV 10 were the same between the patients that kept the reduced doses (n=12) and the patients required to have additional doses of ALV 10 (n=9) after a reduction of ALV 10 treatment during the change in preparations. In the patients requiring addi tional doses of ALV 10 after using the lower doses of ALV 10, the mean serum PHT concentration and S/D ratio for PHT 10 were 4.17 and 0.87, respectively, which were significantly lower than those in the patients who could be kept on the reduced doses of ALV 10 (9.39 and 2.11, respectively). The mean serum PHT concentratios and S/D ratio in the ALV 10 were 3.97 and 1.15, respectively, which were significantly lower than those of patients who were able to stay on the reduced dose of ALV 10 (9, 56 and 2.48, respectively).
When switching to the improved absorbing PHT preparations, usually the same dose should be prescribed as the PHT 10 because of the risk that a uniform reduction in the doses according to the conversion table might cause seizures especially in the patients with low serum PHT concentrations for the lower absorbing PHT preparations.

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The relationship between the kinds of drugs prescribed and age was investigated in 20990 outpatients (males; 11, 716, females; 9, 274) over the age of twenty at our hospital. No medicines for external application except for patch preparations for ischemic heart disease and injection preparations were caluculated in this studies. The following results were obtained: both preparation for the male and female outpatients increased with age. Although the mean kinds of drugs for patients in their twenties was 2.6, the mean kinds in patients in their eighties was 5.7. In addition, the number of outpatients with diabetes was increased significantly with age than in those without diabetes.

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The compatibility test was conducted between alfacalcidol powder (Alfarol^®powder) and other drugs which were frequent, used with alfacalcidol powder as combination drugs at dispensing, such as lactose (LA), precipitated calcium carbonate powder (CO), calcium lactate powder (CL), Calcicol^®powder (CG), Ulcerlmin^®finegranule (UL), Marzulene-S^®granule (MS), magnesium oxide fine granule (MO), Tagamet^®fine granule (TA).Gasterpowder (GA), Kolantyl granule (KO), Acenalin fine granule (AS), Temelin^®grannle (TN), Rizegranule (RZ), Loxionin^®fine granule (LO), Solantal^®finegranule (SO), Alnert^®granule (AL), and Panaldine^®fine granule (PA). Combination drugs were stored at 5°C and 25°C with 75% RH. A change in the drug appearance was observed just after, and 2, 4, and 8 weeks after dispensing. In addition, the contents of alfacalcidol were also determined using high-performance liquid chromatography at the same time points. In the assessment of change in appearance, TN and LO turned to yellow 4 and 8 weeks after dispensing under the conditions at 25°C with 75% RH, respectively, however, no change was observed in the appearance in other combinations under the above two conditions.
The residual rate of the alfacalcidol content declined by about to 90% or was lower at 8 weeks after dispensing in combination with GA when stored at 5°C. Under the conditions at 25°C with 75% RH, the residual rates declined by about to 90% or lower at 2 weeks after dispensing in combination with CO, UL, TA, GA, RZ, 4 weeks after dispensing in combination with KO, LO, and SO, and 8 weeks after dispensing in combination with MO and AS. The residual rates remained 90% or higher even 8 weeks after dispensing in combination with LA, CL, CG, MS, AL, and PA.

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All senior students at our university experienced 2 weeks of practical training at one of 22 hospitals in three prefectures in the Tokai district. We investigated the students' awareness regarding this practical training at a hospital before and after the training.
After practical hospital training, many of the students became aware of the importance of seeing and experiencing the pharmacist's daily practice.
The students often expressed that they wanted to know how to talk to patients, how to teach patients about taking medicine and how to express concerm or associate with other hospital staffs (doctors and nurses), none of which are addressed in the university. Other comments indicated that students wanted to think about the future of pharmacists based on their role and function, or that students wanted to refer to these experiences in deciding which course to follow.
Through questionnaires sent to the students asking if they were interested in becoming pharmacists, we obtained similar distribution of responses before and after the practical hospital training with answers being “Yes”, “No” or “Does not apply”, when the data of all students were collected together. However, their attitudes changed considerably after training when each students was considered individually.
The answer to another question regarding the image of a hospital pharmacist (or the work performance) indicated that students who felt that pharmacists were positively tackling complex affairs were more interested in actual training in the hospital.
Based on these findings we need to further consider ways of improving the content of training over a longer period.

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A transdisciplinary team for diabetic education has been formed at our hospital since 1975. An admission dedicated to the education for patients, including counseling by pharmacists, has also been provided. In this paper we report how pharmacists contributed to the treatment of a 47-year-old man with diabetic ketosis who showed allergic symptoms to human insulin. Human insulin therapy was started after his admission to our hospital. The patient, however, 4 months later claimed that he was anxious about delayed appearance of the insulin allergy characterized by a local-itchy, wheal-and-flake reaction at the site of the injections. The specific lgE for human insulin was positive (7.28 phoebes rast U/ml, score 3). Although these reactions were reduced after changing the sites of the injections together with the administration of anti-allergic agents, the patient was likely to interrupt the insulin treatment by himself. We therefore explained the results from the inspection and previously reported cases in detail. These efforts helped to decrease his fear against an insulin allergy so that we could continue to provide the insulin therapy. The patient was finally discharged from the hospital. This case suggests several important points regarding compliance counseling by pharmacists.

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We have developed a patient medication instruction provision system linked to a prescription order entry system in Oita Medical University. We have provided basic information, efficacious information and safety information of the drugs for each patient. Basic information was registered by pharmacists while other information was inputted by doctors on the entry system. Such information was combined, sent to a dispensing support system and outputted as a patient medication instruction sheets, namely, “OKUSURINITSUITE” .
In this system, it is possible to provide drug information which reflects the doctor's intention to the patient. Also, it is capable to cope with the prescription of anti-cancer drugs and their nonapplicable use.
We evaluated the provision rate of the instruction sheets to the prescription for 4 months. As a result, the whole rate was about 25% and on the increase to out-patients. In the clinical division, surgery and pediatrics gave a higher rate. On the other hand, the rate for inpatients has remained almost unchanged.

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The intravenous injection for inpatients is frequently combined with other therapies. For that reason, the route, method and time of medication is complex and is considered to be one of factors resulting in an increased workload for nurses and a decline of the patient's quality of life.
Therefore, we constructed a research system for an improved method of intravenous injection, while evaluating the plan of medication, incompatibility and the parameter of pharmacokinetics, using a personal computer.
Using this system, we could review the traditional methods of medication and thus select the most appropriate methods.

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We accomplished a database of hospital preparations. This database included several items, such as manufacturing, information for doctors, clinical evaluation and inventory management. Using this database, not only the information of the hospital preparations could be easily obtained and offered to the medical staff, but the standardization of the preparation skills could also be achieved. In addition, using this system is possible to perform inventory management both rapidly and exactly, resulting in the rationalization of the pharnracy service.

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