Factors associated with medication amounts considered excessive among university students: a questionnaire survey of pharmacy students and those in non-medical schools.

BACKGROUND: Better insight and knowledge on factors associated with perception of medication numbers and amounts would contribute greatly to our current understanding of patient psychological response regarding taking medications, and would allow us to improve drug administration support and adherence. This study explored associations between attitudes toward medication dosage in a questionnaire survey that examined demographic characteristics, the number of tablets and types of prescription medications considered excessive by participants, current medication and supplement use, personal experiences with medications, and perceptions surrounding medications. METHODS: An original anonymous questionnaire was used for this survey. A total of 934 university students completed and returned surveys with no missing data. RESULTS: Mean values ± standard deviation for excessive thresholds for tablets and types of medications reported by all participants were 4.21 ± 1.63 tablets and 4.00 ± 1.25 medications, respectively. The number of tablets considered excessive was analyzed using a multiple regression model, which accounted for the variance (model-adjusted R 2 = 0.095, p < 0.001) between statistically significant factors, including personal experience with a major illness, supplement use, aversion to taking medications, gender, university departmental affiliation, and experience with family members or acquaintances who took excessive amounts of medications (|beta| > 0.094, p < 0.01). The number of medications considered excessive was subject to a multiple regression analysis (model-adjusted R 2 = 0.087 p < 0.01), which revealed statistically significant factors, including personal experience with a major illness, prescription medication use, aversion to taking medications, gender, university departmental affiliation, and experience with family members or acquaintances who took excessive amounts of medications (|beta| > 0.084, p < 0.01). CONCLUSIONS: Individual attitudes toward medication dosage are influenced by individual factors. Thus, patients should be provided with personalized advice when they receive medication instructions.

Reducing Health Anxiety in Patients With Inflammatory Bowel Disease Using Video Testimonials: Pilot Assessment of a Video Intervention.

BACKGROUND: Health anxiety has many damaging effects on patients with chronic illness. Physicians are often unable to alleviate concerns related to living with a disease that has an impact on daily life, and unregulated websites can overrepresent extreme anxiety-inducing outcomes. Educational clinician video interventions have shown some success as an acute anxiolytic in health settings. However, little research has evaluated if peer-based video interventions would be a feasible alternative or improvement. OBJECTIVE: This pilot study assesses the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. It investigates the degree to which patient testimonials can affect state anxiety, and whether patients are comfortable enough with the technology to share their stories. METHODS: Patients with CD (n=51) and those with UC (n=49) were shown testimonial videos of patients with CD during their physician consultations at Kitasato University Kitasato Institute Hospital in Japan. The video testimonials were collected from Dipex Japan, the Japan branch of an international organization specializing in understanding patient experiences. Patients completed a Visual Analogue Scale for Anxiety before and after viewing the videos, a Hospital Anxiety and Depression Scale (HADS) survey before the videos, and satisfaction surveys. Patients receiving infusion therapy participated in the study while receiving treatment to minimize hospital workflow disruption. RESULTS: Anxiety reduction, on the Visual Analog Scale for Anxiety, was significant in the entire cohort both when viewed as an ordinal variable (P=.003, t98=1086.5) and as a continuous variable (P=.01, t94=-2.54, 90% CI -3.47 to -0.72). Eighty percent (n=15) of patients with high HADS Anxiety (HADS-A) scores and 71% (n=24) of patients with high starting state anxiety experienced reduced anxiety after watching testimonials. Patients with high state anxiety but low HADS-A scores experienced anxiety reduction (69%, n=16). Forty-two percent (n=100) of patients responded that they would share their stories for future users. When patients with UC received testimonials from patients with CD, 71% (n=49) of patients reported that they were relevant despite differences in condition. CONCLUSIONS: Our pilot results suggest that patient testimonial videos can reduce illness-related state anxiety for patients with CD and those with UC, especially in those with higher baseline state anxiety. The success of this study in reducing anxiety and achieving patient involvement suggests that video interventions for reducing anxiety might be a low-cost intervention that could scale to any number of hospitals, suggesting that technology can help scale up efforts to record and share patient testimonials. Future work can establish whether patient testimonials can be helpful in other contexts, such as before major surgeries or when a family member receives a difficult diagnosis.

How Community Pharmacists Perceive Ethics in Clinical Research: A Qualitative Study.

In recent years, the importance of building evidence in clinical practice that is increasingly acknowledged globally has been recognized in Japan as well, and it is expected that clinical research by community pharmacists will grow. In Japan, however, community pharmacists have few opportunities to learn about research ethics and may lack the training to make ethical decisions. We conducted a questionnaire survey of community pharmacists (n = 200) using a free descriptive format to understand how they perceived research ethics. Our qualitative analysis of 170 respondents revealed various perspectives (, , and ) of Japanese pharmacists on ethics in the context of clinical research. With respect to how to understand research, the following perspectives were found: "research that prioritizes researchers," "research that prioritizes research subjects (patients)," and "research that enters into regular work." The perspectives on "research that prioritizes research subjects (patients)" and "research that enters into regular work" may inadvertently lead to ethically inappropriate research due to mismatch in professional values or poor understanding of research. These findings can contribute to the development of an educational program for community pharmacists on research ethics.

[Why Pharmacists Need Education in the Humanities: A Medical Professional Educator's Viewpoint].

Over the past few decades, pharmacists' work has changed from product-centered tasks to patient-centered care. In response to such social changes and needs, the pharmacy education course was also extended from 4 to 6 years, and the importance of the humanities in the curriculum (e.g., medical psychology, medical ethics, and communication) is now recognized. The Model Core Curriculum for Pharmacy Education, 2013 version, described 10 professional competencies for pharmacists (professionalism, patient-oriented attitude, communication skills, interprofessional team care, basic sciences, medication therapy management, community health and medical care, research, lifelong learning, and education and training) and stated that the humanities are a foundation of pharmaceutical education. However, a report by the Pharmaceutical Society of Japan (2014) expressed concern that clinical practice was not connected with knowledge of the humanities. It is educationally meaningful when pharmacists who studied the humanities can then offer the best medical care to patients. In order to utilize knowledge of the humanities in the clinical setting, educators need to provide opportunities for active learning. Furthermore, the humanities are useful to help pharmacists acquire meta-cognition.

Teaching Research Ethics to Pharmacists: The Practice of Participatory Learning.

The research history of community pharmacists in Japan is short, and ethical responses may not be mature. Therefore, the Japan Pharmaceutical Association and universities are working on research ethics education to help pharmacists make appropriate ethical responses. In this study, we evaluated whether an educational program using participatory learning was effective in research ethics education for pharmacists. Regarding the educational effects of our workshop, the score for motivation to learn about research ethics was high, and that for judgment and applied skills related to research ethics was low. Overall, participants' assessment of the program contents was extremely favorable, indicating their satisfaction. Participatory learning was widely accepted and suggested to be effective in improving learning motivation. Additionally, to be able to apply the knowledge of research ethics to own research, it was considered necessary to continue learning through participatory learning. This will help pharmacists gain judgment and applied skills related to research ethics.

Research Using the Roter Method of Interaction Process Analysis (RIAS) for Communication Education in the Pharmaceutical Sciences.

The ability to communicate effectively as a healthcare professional has come into greater focus as the role of pharmacists expands from "medicine-based" to "client-based" (e.g., working with patients, their families, and in multidisciplinary interactions). The ability to communicate cannot be acquired solely in the classroom; a large part of acquiring such skill is based on practical experience. Role-playing with simulated patients has already been implemented in pharmaceutical education; in that sense, opportunities to receive education in practical communication are increasing. However, in order to assure that these educational opportunities are more than "experiences" in theory alone, aspects of communications training that are satisfactory or need improvement must be clarified through empirical studies. While data used in pharmaceutical studies have mainly been quantitative in nature, data required for medical communication studies is generally more qualitative. Only recently the importance of qualitative research has been recognized in pharmaceutical studies, a field in which any aspect difficult to express numerically has been considered subjective, and thus less acceptable. Against this backdrop, this report introduces an aspect of communication research that employs the Roter method of interaction process analysis (RIAS), a medical communication analyzing method by Professor Debra Roter at Johns Hopkins University. RIAS is a quantitative analysis of qualitative data. I want to discuss the significance of using results of research based on qualitative data to improve the quality of communication.

[The association between dispensing error factors and behavioral characteristics of pharmacists].

We evaluated error prevention education by clarifying the association between dispensing error factors and behavioral characteristics of pharmacists. The subjects were 98 pharmacists (27 men and 71 women) with a mean age of 29.7 years who gave informed consent for participation in our survey. Between November 2001 and January 2002, a questionnaire survey on dispensing errors was performed using the "Tokyo University Egogram, New Version" for the assessment of behavioral characteristics and the "Safety Behavior Questionnaire" for the assessment of error factors. An association was observed between the incidence of dispensing errors and behavioral characteristics. There was also an association between error contents and behavioral characteristics as well as error factors. With more experience, errors associated with becoming accustomed increased, suggesting that error prevention education is necessary not only for newly qualified pharmacists but also for managers.

[Nationwide research on communication education curriculum in the faculty of pharmaceutical science. Second report: study of communication education curriculum before on-the-job training].

With the recent rapid shift in pharmaceutical education to the development of clinical experts, emphasis on education in humanism and communication has increased. However, there is a lack of experience in these fields of pharmaceutical education in Japan, and there have been few studies on the curriculum, from admission to the pharmaceutical science to the stage before on-the-job training. Also our previous survey of communication-related education revealed there is no consensus on the interpretation of communication-related education. In this study, therefore, we investigated communication-related education is incorporated before on-the-job training at 46 schools of pharmaceutical science in Japan. Communication-related education was carried out at 26 (56.5%) of the 46 schools, and role-playing was incorporated in the program at 23 (88.5%) of these 26 schools. However, SP (simulated patient/standardized patient) was adopted at 12 (46.2%) of these 26 schools. There was a psychologist or a communication specialist on the staff at only 10 (38.5%) of these 26 schools, revealing the lack of instructors in these fields. Interest in education related to communication was generally weak at national and public universities, and marked differences in the approach to pharmaceutical education among university types were observed. The preparation of basic guidelines and textbooks for stepwise communication education from lower to higher grades and the training of instructors are urgently needed.

[Randomized controlled study on the effectiveness of community pharmacists' advice for smoking cessation by Nicorette--evaluation at three months after initiation].

We conducted a randomized, controlled study to evaluate whether pharmacists' advice on smoking cessation would result in a higher smoking cessation rate using Nicorette (nicotine gum preparation). Fourteen pharmacies in Tokyo, Kanagawa, and Nagano participated. Smokers who visited pharmacies to buy Nicorette from March 1, 2002, through August 31, 2002, were recruited and randomly assigned to two groups. For the intervention group (A), pharmacists provided both regular instructions on Nicorette use and smoking cessation advice at the first sale and then gave follow-up advice just before starting a cessation and 1, 3, and 8 weeks and 3 months thereafter. For the control group (B), pharmacists provided regular instructions alone. The primary outcome measure was the self-reported smoking cessation rate and the secondary outcome measure was the relationship between the smoker's egogram and effectiveness of intervention. Twenty-eight smokers were enrolled and randomized into group A (n=11) or group B (n=17). The absolute abstinence rate in groups A and B at 3 months was 45.5% and 31.2%, respectively. The odds ratio was 1.83, which was not statistically significant. There was no difference in egogram score between absolute abstinence subjects and nonabstinence subjects in group A. The egogram scores in Adapted Child of absolute abstinence subjects in group B were significantly higher than in nonabstinence subjects. In conclusion, instructions and advice given by pharmacists may improve the smoking cessation rate in smokers receiving nicotine replacement therapy.