[Present and Future of the Japanese Pharmacopoeia in the Clinical Setting and Pharmacy Education].

The Japanese Pharmacopoeia (JP) has played a major role in ensuring the quality of drugs used in Japan as the ultimate source of information on pharmaceuticals. Physicians and pharmacists can reliably use drugs in the clinical setting because they trust the quality when medical treatment progresses smoothly. When there is a problem or challenge, they can refer to the JP. For pharmacists, both the quality of the drug and information on its efficacy and safety are indispensable. Twelve years have passed since the introduction of a 6-year course in pharmacy education, but the weight placed upon the JP has not increased in the educational curriculum. A specific behavioral objective of describing the significance and structure of the JP is included in the revised model core curriculum for pharmacy education. However, fewer than 60% of pharmacy schools have courses specifically focusing on the JP. Professors of physical chemistry, analytical chemistry, pharmaceutics, and pharmacognosy often teach the relevant sections of the JP in their lectures. The foundations of the Japanese manufacturing industry have been questioned because data falsification and inspection fraud have been disclosed in numerous fields. Therefore, ethical education for those who use the JP is a prerequisite for ensuring the reliability of pharmaceuticals.

Considerations for the incorporation of mindfulness into pharmacy education.

INTRODUCTION: A range of approaches are needed to bolster the mental health and well-being of pharmacists and student pharmacists. COMMENTARY: In recent years, medical and nursing educators have been training students to use mindfulness-oriented meditation (MOM) techniques such as Mindfulness-Based Stress Reduction (MBSR) for mental health, wellness, and greater attention and presence. MOM training should be considered for incorporation into pharmacy education. Mindfulness can be included in the pharmacy curriculum in a variety of ways. These include introducing students to the topic didactically, encouraging and facilitating students to take an MBSR course, workshop, or online self-study, and integrating mindfulness through mindful moments during critical educational activities like product verification and communication assessments. IMPLICATIONS: Mindfulness may be a valuable skill for student pharmacists, thus we encourage schools to expose students to the concepts of mindfulness and MOM techniques like MBSR. Additionally, more robust and rigorous research is needed to better understand the effects of MOM in different settings and contexts.

A Hospital-based Pharmacy Internship Program in Jordan.

Objective. To develop a hospital-based pharmacy internship program in a comprehensive cancer care center in Jordan and review its outcomes over a 10-year period.Methods. King Hussein Cancer Center developed a two-year internship program for pharmacy students in Jordanian universities. The program included training in operational and clinical settings during the academic year and school holidays. In addition, the students completed rotation-related assignments and met weekly with the program director. During the rotations and at the end of the program, interns were asked to assess their level of satisfaction with the program and to comment on its content and structure. Results. From a pilot phase with only three interns and a simple training structure, the two-year internship program has become more structured now training six interns annually. During the first 10 years of the program, 51 students from four universities in Jordan enrolled in the program, with six current interns, 34 graduates, and 11 withdrawals. Graduates reported improved academic performance and satisfaction with the program's structure and the skills obtained. Their main challenge was time management during the academic year. Conclusion. A hospital-based pharmacy internship program is feasible and sustainable. Participation in the program improves interns' academic performance and clinical and professional skills, despite the challenges of highly demanding conditions on both the hospital and the students.

The Shrinking of Formalized Nutrition Education in Health Professions Curricula and Postgraduate Training.

The quantity of formalized nutrition education is shrinking in curricula of health professions, such as physicians, nurses, dietitians, and pharmacists. The current nutrition education being taught in U.S. schools of healthcare professionals does not appropriately prepare students for identification of patients at nutrition risk or management of undernourished hospitalized patients with specialized nutrition therapies. In U.S. schools of pharmacy, parenteral nutrition is considered a highly specialized and advanced practice so little time is devoted to this area and more attention is focused on chronic disease state management (ie, hypertension, diabetes mellitus, and congestive heart failure). Nutrition support fellowships for physicians and nutrition support residency programs for pharmacists have dwindled in number over the years so that only a handful of these healthcare professionals are produced each year from the remaining formalized programs. Physicians, nurses, pharmacists, and dietitians can positively affect patient care, but each profession must first determine how best to integrate basic and applied nutrition concepts into their professional curricula and training programs. There must also be consensus among the healthcare professions as to the depth of nutrition education and the stage of training at which these integrations should occur. Only by having these crucial conversations among all disciplines will we be able to develop new strategies to expand nutrition education in the training of future medical practitioners.

[Kampo Education in the Faculty of Pharmaceutical Sciences at Toho University].

In the Faculty of Pharmaceutical Sciences at Toho University, Kampo education commenced 40 years ago through a course titeled "Kampo", which has since been renamed as "Kampo Pharmacology". The current university curriculum offers courses in subjects such as Pharmacognosy and Practical Pharmacognosy for sophomores, Kampo Pharmacology for juniors, and Clinical Kampo Medicine for seniors. Kampo Pharmacology is a subject that bridges "Pharmacognosy" to "Clinical Kampo Medicine". The functions of the crude drugs included in Kampo prescriptions are explained both in terms of efficacy from the perspective of Kampo and by contemporary evidence. Furthermore, the "Clinical Kampo Therapeutics" course offered for seniors involves lectures on the fundamentals of Kampo, determination of evidence and prescriptions, case analysis, and prescription analysis by physicians affiliated with our university's medical center. Acquiring an understanding of the effectiveness of crude drugs in herbal medicine and gaining practical clinical knowledge are considered beneficial for future pharmacists.

[Approach to Teaching Kampo Medicine at Kyoto Pharmaceutical University].

An approach to educating our pharmaceutical students about Kampo medicine in the six-year system of undergraduate pharmacy education at Kyoto Pharmaceutical University is introduced, including the author's opinions. Curriculum revisions have been made in our university for students entering after 2012. In teaching Kampo medicine at present, a medical doctor and an on-site pharmacist share information difficult to give in a lecture with the teaching staff in my laboratory. For example, before the curriculum revision, we conferred with a pharmacist and a doctor in the course "Kampo Medicine A, B" for 4th year students, in which students were presented a basic knowledge of Kampo medicine, the application of important Kampo medicines, combinations of crude drugs, etc. Further, in our "Introduction to Kampo Medicine" for 6th year students, presented after they have practiced in hospitals and community pharmacies, we again lecture on the pharmacological characteristics of Kampo medicines, on "pattern (Sho)", and on evidence-based medicine (EBM) and research studies of important Kampo medicines. After our curriculum revision, "Kampo Medicine A, B" was rearranged into the courses "Kampo and Pharmacognosy" and "Clinical Kampo Medicine". "Kampo and Pharmacognosy" is now provided in the second semester of the 3rd year, and in this course we lecture on the basic knowledge of Kampo medicine. An advanced lecture will be given on "Clinical Kampo Medicine" in the 6th year. We are searching for the best way to interest students in Kampo medicine, and to counteract any misunderstandings about Kampo medicine.

[How to Teach Kampo Medicine in the Age of Internationalization?].

Given the universal prevalence of complementary and alternative medicines, as well as integrative medicine, the usage of traditional medicine has been gaining in popularity worldwide. Japanese Kampo medicine and traditional Chinese medicine (TCM) are both derived from ancient medicines used in East Asia in the 5th-7th centuries, and have developed independently since the 14th century. Now Kampo medicine and TCM have different theories for the diagnosis and use of crude drugs. Unfortunately, Kampo medicine is not well known in Europe and the Americas; as a matter of practice, TCM is the international standard for traditional medicines derived from ancient East Asia. In the teaching of Kampo medicines to undergraduate students in a school of pharmacy, the author considers that a minimum requirement is to explain the differences between TCM and Kampo medicine. For graduate students of pharmaceutical science, the students must know the distinct medical theories of both TCM and Kampo medicine, and furthermore, must be able to read and write articles in English about traditional medicines, in order to help put Kampo medicine on the world map.

[Education Program of Kampo-medicine for Undergraduates in Preparation for Clinical Setting].

Kampo-medicine has become popular in Japanese medical practice combined with western medicine. For example, Daikenchu-To for intestinal obstruction after surgical operation, Shakuyakukanzo-To and Goshajinki-Gan for anti-cancer agents-induced neuropathy, and Yokkan-San for behavioral psychological symptoms of dementia are alternatively used in addition to conventional treatments in Japan. However, combined use of Kampo-medicine and western medicine may cause unexpected adverse events including undesirable drug-drug interactions because Kampo-medicine was not originally developed to be used with western medicine. Although adverse effects of Kampo-medicine are rare compared with those of western medicine, severe events such as liver dysfunction and interstitial pneumonia have been reported in increasing trends. Medical staff including pharmacists, therefore, should be aware of the onset of adverse events before the patients' symptoms become severe. Several adverse effects are caused by chemical constituents such as glycyrrhizin in licorice for pseudoaldosteronism and geniposide in Gardeniae fructus for mesenteric phlebosclerosis. To understand the adverse effects of Kampo-medicine, pharmacists should learn trends in current medication as well as pharmacology and toxicology of the chemical constituents in pharmacognosy. These issues should also be addressed in educational materials for students of clinical pharmacy and pharmacy practice.

[Kampo Medicine in the New Model Core Curriculum of Pharmaceutical Education].

What should we educate for Kampo medicine in the model core curriculum of pharmaceutical education? The curricular core should be discussed considering the points mentioned below. (1) Positioning of Kampo medicine in the Japanese medical care system. Kampo medicine is an authorized medical care category in the National Health Insurance (NHI) program in Japan. The NHI drug price list carries 148 Kampo formulations. According to the report of the Japan Kampo Medicines Manufacturers Association in 2011, approximately 90% of Japanese physicians prescribe Kampo medicines. (2) Differences between Kampo medicine and western medicine: In Kampo medicine, the most suitable formula among various Kampo formulas to normalize the psychophysical state of individual patients is selected. In other words, if there is a complaint, there are always some treatments. (3) A strong point of Kampo medicine: Kampo medicine enables physicians to deal with difficult-to-treat conditions by western medicine alone. Also, by using the scale of Kampo medicine, each patient can grasp his or her own systemic state and improve their lifestyle. To extend healthy life expectancy, a basic knowledge of Kampo medicine may play a significant role in integrated health care. "The guide book of the approval standards for OTC Kampo products", "the pharmaceutical advanced educational guideline", and "the manual of the exam questions preparation for registered sales clerks" should also be consulted before selecting the area and contents that should be covered.

Evolution of a Natural Products and Nutraceuticals Course in the Pharmacy Curriculum.

Objective. To develop, implement, and modify a required, second-year pharmacy course that provides an understanding of the scientific, therapeutic, and clinical principles, as well as the evidence-based medicine underlying the use of natural products. Design. A 28-hour, multi-faculty course was developed and offered in 2008. The course was modified over the years to enhance students' practice skills in the use of natural products. A course evaluation and survey were administered to assess the students' opinions. Assessment. Students performed well in the course and provided favorable evaluations, especially for the latest offering. Students reported significantly improved skills in providing advice to patients regarding the use of natural products. Conclusion. The course increased the students' knowledge and application of information and counseling skills regarding natural products.

A qualitative study of herbal medicine use in the Ukraine: implications for US pharmacy practice.

INTRODUCTION: Half of nearly all new immigrants in the United States come from only 10 countries, including the Ukraine. Immigrants bring facets of their culture to their new country; therefore, it is important for health care providers to have an appreciation and understanding of cultural differences in regard to the use of herbal medicine. OBJECTIVES: To determine health care provider and patient preferences for herbal versus synthetic medications, health care provider didactic training in pharmacognosy and trends in herbal medication use in the Ukraine. METHODS: Ten health care providers, pharmacists and physicians, were interviewed to determine their views on herbal medicine use in Ukraine using semistructured in-depth face-to-face interviews. RESULTS: Ukrainian practitioners and patients viewed herbal medicines as safer than synthetic drugs, appropriate and preferable for use in chronic and preventative programs. Synthetic drugs were viewed as more desirable for use in the acute setting. Preference for synthetic versus herbal medication was not price driven. CONCLUSIONS: The inclusion of pharmacognosy training in the US pharmacy curricula is recommended to facilitate US health care professional's ability to provide pharmaceutical care both to new US immigrants and to the increasing number of US citizens utilizing herbal medications.

Educational opportunities and anti-doping roles and responsibilities for pharmacists.

Drug use and abuse by athletes has become a common problem. Pharmacists can assist by managing the legitimate medication needs of athletes to prevent them from accidentally using a banned substance. Pharmacists can also educate athletes and the public about the health consequences of using performance-enhancing substances. Pharmacists can play a variety of roles to assist with anti-doping. Such roles include educating, advising, dispensing and monitoring medications and supplements; and working with anti-doping agencies. There are few established educational opportunities for pharmacists and pharmacy students. Educational programs in sports pharmacy and doping control need to be developed for instruction in the classroom, for post-graduate training and for experiential programs. Classroom instruction should include information about performance-enhancing substances and general principles of doping control. Student activities for an established advanced pharmacy practice experience include education on performance-enhancing substances and assay technologies, preparing and providing presentations to athletes and others regarding these substances, performing literature research on drugs and dietary supplements used to improve athletic performance, writing a monograph on these substances, and participating in doping control programs.

[What does "pharmacognosy" mean for pharmacists?].

Pharmacists consider pharmacognosy to be a part of Kampo-related education. However, actually, pharmacists cannot generally apply pharmacognosy to their work in clinical settings because they do not have sufficient opportunities to learn about the relationship between pharmacognosy and Kampo in the Faculty of Pharmacy. Meanwhile, in the Faculty of Medicine, education in Kampo has spread at an accelerated rate since the amendment of the medical education core curriculum in 2001, leading to the present condition of 73 out of a total of 80 Faculties of Medicine in Japan already having adopted Kampo as a part of that curriculum. However, clinical education is often focused on, while items of pharmacognosy are hardly mentioned; therefore, pharmacognosy remains not as important in medical education. It is thus often very difficult for pharmacists who have only learned Kampo based on pharmacognosy to understand the prescription of a physician who has received Kampo education, and this remains a considerable problem for pharmacists who are required to explain how to take a drug to a patient in clinical practice. What role does pharmacognosy have to play to bridge the gap between such physicians and pharmacists? Here, I would like to describe what I believe is necessary regarding pharmacognosy education in the future, both from the perspectives of pharmacists and physicians who prescribe Kampo medicine.

[Thoughts on a program for pharmaceutical practice].

The educational curriculum for pharmaceutical students in Japan will be dramatically changed in April, 2006. There has been active discussion about how to manage the additional two years in the new program to educate students most effectively. In particular, the program of clinical practice in pharmacies, which will be undertaken for 10 weeks, has been received enthusiastically, because it was not considered sufficient in the previous educational program and it will be one of the most important issues in the new curriculum. I am neither a pharmacist nor a professional in pharmaceutical education, but I believe firmly that an effective program of clinical practice in community pharmacies will be indispensable in making the new curriculum successful. I also believe that community pharmacists educated in the new course will change medical systems in this country from the viewpoint of a general thoracic surgeon and chief executive officer of Pharmedico, Co., Ltd. which manages eight pharmacies in Osaka, Japan. In this article, I give my opinions on the advisable vector of clinical practice for pharmaceutical students and the direction of clinical training in the new educational program.

[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.