It has now become possible to perform a computer-aided inspection of prescriptions, due to a recent trend of introducing an order entry system to medical facilities. A checking system of drug interactions at the level of physicians' order entry, although tested in some hospitals, is not yet established as a practical system in the actual situations, due to its delaying effect on the response of the order entry system and thus on the patients' staying time. Therefore, we have devised an on-line method by which a prescription information paper can be printed out with patient's drug history records regarding selected, problem-inducible drugs prescribed over the past five visits of the patient's to any of the wards in our hospital. This method enabled us to construct a prescription-inspecting supporting system, with which pharmacists can rapidly and accurately inspect prescriptions focusing on the drug interactions without any effect on the response of the present order entry system. Subsequently, we evaluated the 5465 outpatient- and 1550 inpatient-prescriptions using the present inspection-supporting system from the viewpoint of proper drug usage. It was found that as much as 17% and 28% of the outpatient- and inpatient-prescriptions, respectively, contained selected problem-inducible drugs, not only from a single department (55%) but also from multiple departments (45%) of our university hospital. Moreover, approximately 11% of the prescriptions which contained problem-inducible drugs (i. e., 1.2% of all the prescriptions) were actually inquired to physicians to avoid possible drug interactions, which was a reasonable frequency of inquiry. Taken all together, the present system was suggested to be a simple but practical method for avoiding adverse drug interactions.

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Since we started both active and passive consultation regarding drug compliance for outpatients at the department of pharmacy, University of Tokyo Hospital in 1991, the records of such consultation have been carefully kept on ‘drug consultation sheets’. In the present study, we analyzed the consultation records from April to September in 1998. The case number of consultation during this period was 627; among them, active instructions were given to 409 cases (65%) while passive instructions were given to the others. The analysis showed that 28 cases (14patients) out of 627 cases experienced our consultation more than once; 13 (93%) of such patients were advised by different pharmacists and 10 (71%) were advised regarding the same drug, thus suggesting the need for a quick retrieval of past records. As a result, we designed a software system to integrate an electronic database for consultation records, including the contents of consultations, a list of the prescribed drugs and any OTC drugs which have been taken, the patient's characteristics, and a history of using a medication diary (so-called ‘Okusuri Techo’). We set up a local area network (LAN) using the database inside the hospital so that all accumulated information could be easily retrieved from any hospital terminal. The intranet-based management system of outpatient consultation records has now enabled a high consistency and efficiency in consultations by different pharmacists while also allowing for a quick compilation of all medical records.

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We investigated the outpatients' understanding and compliance with taking “medication after meals”, a typical timing of medication, and examined the factors influencing patients' noncompliance. The subjects (35 men and 69 women, aged 56±8) were randomly chosen from the outpatients at Tokyo University Hospital, to whom a drug listed in our active guidance system as “ medication required after meal” had been prescribed at a community pharmacy. The patients were interviewed at the outpatient counter to examine the following points: 1) whether they understood and actually took the medications after meals, 2) whether or not they routinely having breakfast, 3) when and why some patients cannot comply with taking medications after meals, and 4) whether or not they had received drug compliance instructions at community pharmacies and if so what instructions were received. As a result, almost all patients (97%) understood that they have to take particular medicines “within 30 min after meals”, but approximately 30% of the patients failed to do so, indicating a discrepancy between the patients' understanding and actual compliance. The occurrence of noncompliance was as high as 47% after lunch and 21% after breakfast, and the major reason for the former case was time restrictions due to work or going out, thus suggesting the need to consider the patients' life style when pharmacists give instructions. 61 % of the patients answered that they have not received compliance instructions at community pharmacies; the ratio of those who have not received compliance instructions at community pharmacies was 52% among the patients who corrected took the drugs after meals, but 71% among the patients who sometimes failed to take the drugs correctly (one-sided P<0.05;χ² test), thus suggesting the importance of giving compliance instruction at community pharmacies. In conclusion, our study suggested that pharmacists need to make greeter efforts to instruct patients, such as a more individualized instructions based on the lifestyle of each patient, in order to improve patients' compliance with medication after meals and thus to promote the rationaluse of medicine.

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A major use of rice is as cooked rice, which is a staple food in Japan. Furthermore, rice is also used as a raw material for various food items such as rice crackers, rice flour and sake by making use of its characteristics. However, the recent decrease in rice consumption has led to strong demands for the expanded use of rice. Therefore, research has been undertaken into various developments in the use of rice flour in Niigata Prefecture over the past 30 years. Two milling methods to make rice into fine rice flour have been established, the ‘two-step milling method” and the ‘enzyme-treated milling method”. These two methods have resulted in the use of rice flours in place of wheat flour in the production of foods such as breads and noodles. Rice flours produced by the two-step milling method and the enzyme-treated milling method have been used in western-style confectionery, as well as the production of breads and noodles, respectively. Niigata Prefecture holds the patents to these methods, which are used by 8 companies in Niigata and other prefectures. As for the processed food items from rice flour, two types of noodles have come into the market. Rice noodles are made only from rice flour, and therefore contain no wheat flour or gluten. The other type of noodle is made with koshinomenjiman, a high-amylose rice variety bred in Niigata Prefecture. This has the characteristic quality of an elastic texture, and has therefore been brought to market. These technologies are used as the basis for the Rice flour 10% Project (‘R10 Project’), which is a policy of Niigata Prefecture. This project aims to replace the use of wheat flour with rice flour by more than 10%.

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We conducted a Study to establish a more effective way of providing drug-related information using a light emitting diode (LED) board at the waiting hall for outpatients to improve both the patients, interest in medication and the quality of medication consultation at the medication counter.
We provided various of information with characters as well as still and animated pictures in color on an LED board installed beside the electric bulletin board for finished prescription numbers at the waiting hall for outpatients.
Three kinds of information were presented; including in formation on patient education, general information on medication and recent topics on medication.
Of 253 outpatients, 86% noticed the existence of this information, which thus suggested that the information on the LED board had a good visibility. In addition, 80% of the patients understood the importance of the rational use of medication which 46% of the patients asked a pharmacist about their own medicine.
Furthermore, this method of providing drug-related information was be an effective means to make the patients aware that they should play a primary role in achieving successful pharmacotherapy, to improve their interest and understanding in medication, and to increase the degree of individualized medication consultation.

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In recent years, considerable attention has been focused on the subject of drug-drug interactions and the extensive drug informations concerning to these occurrences have been widely provided to health care professionals by many ways and means. However, there are few previous studies in the concrete guidelines for the prescribers to avoid significant harmful drug-drug interactions, the understanding of the guidelines by the prescribers, and the effects of the guidelines on the drug therapeutic regimens.
In this study, we issued a booklet for the drug information about new quinolones-metal cations interactions, which contained informations about how to avoid this drug-drug interactions. We also provided this booklet to all prescribers in our hospital by direct mail, and then we analyzed the effects of the booklet on the therapeutic alteration when the pharmacists detected this drug combinations in the prescriptions and recommended how to avoid the interaction. After the booklet was provided to the prescribers, the prescriptions with both drugs dramatically decreased and remained on a stable level. Furthermore, the 93% of the prescriptions containing both drugs are changed appropriately based on our recommendations. It is suggested that such information is very useful educational program for the health care professionals. In future, in order to support the rational drug therapeutic regimens by the prescribers, it is necessary to introduce the prescription checking system to the hospital.

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When suppositories were prescribed for pediatric patients, they are inserted into the rectum of the patient by the mother in most cases. Therefore, counselling on the proper use of suppositories is essential. In an attempt to facilitate counselling for drug use, we surveyed via questionnaire how the mothers (ranging 26-39 years) of pediatric inpatients (2.5 months-15 years) of the University of Tokyo Hospital use suppositories. The collection ratio of the questionnaire was 100%(42 of 42). The suppositories exhibiting a systemic action such as antipyretic were used in 80% of patients. The directions for use of suppositories were not well appreciated in 15% of mothers. Twenty percent of mothers experienced trouble when inserting the suppositories into their children, and 54% of the trouble was “discharge after insertion of the suppository” . Most of this discharge occurred within 30 minutes after insertion. When the discharge occurred with a stool, 64% of the mothers coped with the trouble as “suspended the use of the suppository” and 36% as “inserted a new one”, and so on. Our results indicate that the study dealing with the problem of the loss of suppositories from the rectum is essential for the proper therapy of patients.

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One of authors in this paper developed glass fabrics reinforced thermoplastics (GFRTP) and carbon fabrics reinforced thermoplastics (CFRTP) using in-situ polymerizable ε-caprolactam as matrix. They had no voids and unfilled resin parts because the ε-caprolactam had very low viscosity before polymerization. Furthermore, their FRTPs not only exhibited superior mechanical properties, but also were suitable for high-speed molding, namely within a few minute process time because they could be released from the mold without a cooling process. In this paper, in order to apply the FRTPs for the wider area, the carbon/glass hybrid fabrics reinforced thermoplastics (HFRTP) using the in-situ polymerizable polyamide 6 as matrix was fabricated, and their mechanical properties were evaluated by bending test, izod impact, static compressive and tensile tests. Moreover, hybrid fabrics reinforced plastics (HFRP) was fabricated using same carbon/glass hybrid fabrics as the HFRTP and fast curable epoxy resin.

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We investigated the current situation of computerization of hospital pharmacies at 40 national university hospitals (national), 2 private university hospitals and 12 general hospitals (others), all utilizing computers at present.
The computerized system is now used in many hospitals for efficient administrative and accounting functions. For example, 59.0% of the nationals and 92.3% of the others use the system for registration of patients, and 56.4% of the nationals and 92.3% of the others for accounting. Moreover, computers are rapidly introduced into other sections: 43.6 % of the nationals and 53.8% of the others use them for laboratory systems, 41.0% and 84.6% for pharmacy systems, 12.8% and 23.1% for X-ray systems.
45.7% of the nationals and 84.6% of the others use computer in control of drugs, 22.5%and 38.5% in dispensing service, and 12.5% and 30.8% in drug information services.
The hospital pharmacy practices are closely related to the works of the other hospital sections. Therefore, they are very important for the progress of hospital function when designing systems and for the development of medical treatment.

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In an attempt to construct the rational use of suppositories, we developed an experimental method for the discharge of suppositories from rabbit rectum, and investigated the change of the pharmacokinetic behavior of the drug subsequent to discharge. Acetaminophen (ACA) was chosen as the model drug. The plasma concentration of ACA reached the maximum (Cmax: 25 μg/ml) at 17 minutes after rectal administration of one commercially available suppository containing 100mg of ACA. When the suppository was discharged from the rectum at 1 and 3 minutes after insertion using the pre-inserted device, the C_max decreased markedly (4.5 and 11 μg/ml, respectively). However, the plasma concentration of ACA still increased even after discharge at 1 or 3 minutes after insertion, with their times required to reach the peak concentration being 7 and 9 minutes, respectively.
Developed for the pharmacokinetic analysis of the plasma concentration after the discharge of suppository from the rectum was a pharmacokinetic model involving the assumption that only the undissolved portion (solid) of the suppository was discharged from the rectum and the dissolved portion (solution) remained. Consequently, the observed plasma concentrations well coincided with the predicted values.
In conclusion, the experimental method employing the device for the artificial discharge of the suppository from the rectum should be a useful model for depicting suppository discharge from the rectum. Accordingly, the drug remaining in the rectum (dissolved portion) following the discharge of suppositories from the rectum should be considered.

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We studied the effect of advising outpatients on the rational use of ophthalmic solutions and compliance by a questionnaire (n=158), in order to establish the optimal consultation method. A total of 41.8% of the patients answered the questionnaire. In compairing the actual use of ophthalmic solutions before and after consultation, the rates of rational use increased for all items except for “applications per day”, which decreased slightly from 93.4% before the consultation to 90.2% after that. In particular, “eyelid closure” and “nasolacrimal occlusion” after instillation, and “the 5 min interval of instillation in the case of plural medication”, considerably increased from 34.8% before the consultation to 60.6% after that, from 9.5% to 50.8% and from 45.9% to 73.8%, respectively. The compliance remarkably improved in glaucoma patients after consultation regarding “the 5min interval of instillation” .
Based on these results, our consultation method for the rational use on ophthalmic solutions was thus evaluated. However, since some patients who still did not appreciate the need for the rational use of such medication still presented, further improvements in the consultation method requires for the rational use.

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The mechanical properties of carbon fiber reinforced in situ polymerizable polyamide 6 resin (I-CFRTP) were investigated by using differential scanning calorimeter (DSC), resin flow tests, three-point bending tests and Izod impact tests for various kinds of molding conditions. The bending strength of I-CFRTP at 160ºC was the highest within all the specimens tested. For Izod impact strength of I-CFRTP, no correlation between the molding temperatures.

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In this review, we outline the new developments in pharmaceutical practice, education and research achieved by the Department of Pharmacy of the University of Tokyo Hospital in the 15 years from 1990 to 2004.
In pharmaceutical practice, we created 1) a computer-aided total dispensing system linked to a system for the efficient examination of prescriptions, a parallel dispensing system for countable and uncountable drugs incorporating several automatic dispensing support devices, and a drug usage consultation system for outpatients using Drug Information Sheets, Drug Information Cards and leaflets, and 2) a total dispensing system for injectable drugs including those for intravenous hyperalimentation (IVH) for inpatients and home parenteral nutrition (HPN).
In the area of new dosage forms, we developed several original non-commercial, high level medications designed to improve the QOL of patients, such as buprenorphine sublingual tablets and suppositories and retinoic acid aqueous gel ointment. We also started providing consultation to patients in wards and support for raising the quality of medical treatment, and created a drug information system for medical staff and patients. Other achievements were the development of a therapeutic drug monitoring system (TDM) for organ transplantation and a total clinical research trial management system based on new GCP.
In the area of education, we created a pharmaceutical education program for bed-side training (BST) for undergraduate students of the Faculty of Medicine and a training program on pharmaceutical practice for undergraduate students of the Faculty of Pharmaceutical Sciences. We also developed a practical training program for newly graduated trainee pharmacists and a continuing education program for post-graduate pharmacists.
In the area of clinical research, we review the following four major projects : 1) Drug interactions between the new quinolone antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), 2) PK/PD analysis of QT prolongation induced by drugs for non-cardiovascular diseases, 3) Quantitative evaluation of pharmacological effects and adverse effects of β-blocking agents based on the receptor occupancy theory, and 4) Clinical research on genotyping of drug metabolizing enzymes for the purpose of creating tailor-made treatments.

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As a general hospital that is aiming to provide regional medical care, our hospital has been actively involved in trying to establish a unified system for providing information on drugs to patients, through close cooperation with the Regional Pharmacists Association. We have been involved in promoting the spread of prescriptions to be filled at outside phrmacies, training pharmacists working in pharmacies, and providing information on drugs to patients through the issuance of a “medicine guidebook” and “drug-record pocketbook”, and thus have established a system for exchanging of information on drugs in order to monitor the side effects in patients, and thereby establish a system to exchange information among patients treated at home. The results of our efforts in these areas have indicated that, hospital pharmacists, in cooperation with pharmacists working at pharmacies, can therefore partitively contribute to the treatment of outpatients and to regional medical care.

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