[Effects of E-learning on Pharmacists' Recognition and Practice in Medication Education for Patients with Hearing Loss].

Pharmacists are required to provide and collect medication information based on patients' health literacy and communication abilities to provide effective pharmaceutical care. Due to a lack of understanding of hearing loss and awareness of the inconvenience that patients with hearing loss face, appropriate actions for effective communication in medication education are not fully implemented. An e-learning system consisting of two courses, a learning course and an evaluation course, has been developed. The learning course explains hearing loss and appropriate actions in medication education and investigates pharmacists' recognition of medication education, while the evaluation course assesses the implementation of necessary actions in medication education and changes in pharmacists' recognition of medication education with patients compared to before the e-learning. From February to September 2022, 41 pharmacists completed the learning course, with 22 advancing to the evaluation course. Prior to learning, they had difficulty in communicating with patients with hearing loss. However, after the learning course, their confidence in medication education improved with a better understanding of hearing loss and practice of appropriate actions. They also felt that pharmacists who were unfamiliar with the system should understand hearing loss and take actions tailored to patients' hearing loss. Further examination may be needed of the effects of the e-learning on patients with hearing loss.

[Analysis of Factors to Hinder Self-directed Learning about Medication Education to Patients with Hearing Loss].

To improve medication education for patients with hearing loss, pharmacists must better understand hearing loss and provide and collect medication information based on patients' health literacy and communication abilities. However, no systematic educational e-learning systems for hearing loss are currently available. Therefore, an e-learning system based on instructional design, microlearning principles, and multimedia teaching materials was developed. The e-learning system used Moodle, an open-source e-learning system, and included two courses: one for self-directed learning by watching videos and answering quizzes, and another for evaluating medication education after learning. A study was conducted on 84 pharmacists and 36 pharmacy students who took the learning course to investigate the factors that hinder their understanding and progress of self-directed learning. Although they fully understood the content by watching videos, students with no experience in medication education required an explanation to understand how to communicate with patients. As the learning course was self-directed and related to communication lectures, all students completed it; however, the completion rate for pharmacists was approximately 50%. The following factors could have slowed pharmacists' e-learning progress: difficulty accessing the learning course through system login and long-duration content, such as answers to free descriptions. This survey found that this e-learning method can be used for self-directed learning about medication education for patients with hearing loss. Further improvement of the e-learning system is necessary so that recognizing the need to understand hearing loss and take appropriate actions for patients with hearing loss in medication education can lead to self-directed learning among pharmacists.

Use of Nonprescription and Prescription Drugs and Drug Information Sources among Breastfeeding Women in Japan: A Cross-Sectional Study.

Breastfeeding women may experience various health issues that require medication. This survey aimed to gain insights into the use of nonprescription and prescription drugs by breastfeeding women in Japan. A cross-sectional study involving women with children aged under two years was conducted in Fukuoka, Japan. Nonprescription drugs were used by 26% of participants in the breastfed-only group, 41% in the breastfed more than half the time group, 55% in the formula-fed more than half the time group, and 82% in the formula-fed-only group. We found that when breastfeeding rates decreased, the use of nonprescription drugs increased (p < 0.05, Cochran-Armitage test for trend). There were significant differences in the use of nonprescription cold medicines and oral analgesics between the formula-fed and breastfed groups, but a nonsignificant difference in prescription drugs use between the groups. These results indicated breastfeeding had a significant influence on use of nonprescription drugs, which was not observed with prescription drugs. Breastfeeding women commonly used the Internet to obtain information on both nonprescription and prescription drugs; however, this did not influence medication use.

Mechanisms and Safety of Antidepressant-Like Effect of Nutmeg in Mice.

Nutmeg, a dried seed kernel of a tall evergreen Myristicaceae tree, is widely used as a spice and herbal medicine and is known to have antidepressant-like effects. This study evaluates the mechanisms underlying this antidepressant-like effect and safety of nutmeg n-hexane extract (NNE) in mice. Tail suspension and open field tests showed that NNE (10 mg/kg, per OS (p.o.)) significantly decreased the immobility time of mice without effecting their spontaneous locomotor activity. The reduction of immobility time of mice elicited by NNE was significantly inhibited by ketanserin (5-hydroxytryptamine (5-HT)2A/2C receptor antagonist), ondansetron (5-HT3 receptor antagonist), and yohimbine (α2 receptor antagonist). WAY100635 (5-HT1A receptor antagonist) tended to inhibit the effect of NNE but without significance. Testing according to the Organisation for Economic Co-operation and Development Guidelines, no mice died due to administrated NNE (2000 mg/kg, p.o.), and behavioral and weight changes were not seen in the acute toxicity test. In the Ames test, no increase in the number of revertant colonies for each bacterial strain test strains TA98 and TA100 by nutmeg powder was observed either with or without metabolic activity by S9 mix. These results suggest that NNE shows an antidepressant-like effect involving various serotonergic and noradrenergic nervous systems and maybe a highly safe natural preparation.

[Comparison in the Recognition about Medication Education between People with Prelingual Hearing Loss and Pharmacists].

Providing medication information according to a patient's health literacy and communication ability is needed for safe and effective healthcare. Communication barriers due to hearing loss prevent pharmacists from providing medication information to patients with hearing loss. A questionnaire about the difficulty in understanding medication information and the feeling of inconvenience during medication education was conducted from September to October 2020 with 84 people with prelingual hearing loss and 346 pharmacists. The 84 hearing loss participants were divided into low- and high-scoring groups based on their understanding of medication use. Pharmacists did not realize that low-scoring group participants did not understand items with homonyms, abstract expressions about medication use and medical terminology. Pharmacists were also unaware that the low-scoring group felt the inconvenience in medication education because of the difficulty to communicate, inform not understanding medication information and consult about medication use with a pharmacist. Prior learning about hearing loss led to higher responses in recognition of the aforementioned issues. However, even pharmacists with prior experience of learning did not fully recognize that speaking out loud is not useful for effective communication and that hearing loss patients need contact methods other than the phone. This indicates the need to learn about hearing loss to improve provision of medication information and effective communication in medication education to people with hearing loss.

Practical Synthesis of α-Trifluoromethylated Pyridines Based on Regioselective Cobalt-Catalyzed [2+2+2] Cycloaddition using Trifluoromethylated Diynes with Nitriles.

Regioselective cobalt-catalyzed [2+2+2] cycloaddition using fluorine-containing diynes with nitriles was described. Cycloaddition of fluorinated diynes with nitriles under the influence of CoCl2(phen), zinc bromide, and zinc dust in dichloroethane at 80°C for 3 h took place smoothly, exclusively affording the corresponding α-fluoroalkylated pyridines in excellent yields. In addition, dinitriles as substrate were also found to be suitable for this reaction, giving the corresponding fluoroalkylated bipyridine derivatives in excellent yields.

Cobalt-Catalyzed C-H Activation/Annulation of Benzamides with Fluorine-Containing Alkynes: A Route to 3- and 4-Fluoroalkylated Isoquinolinones.

The C-H activation/annulation reaction of various benzamides with fluoroalkylated alkynes in the presence of a Co(acac)2·2H2O catalyst proceeded very smoothly to give the corresponding 3- and 4-fluoroalkylated isoquinolinones in excellent yields with approximately 70% regioselectivities. These regioisomers could be successfully separated and obtained in pure form. Major or minor regioisomers were determined as 4- or 3-fluoroalkylated isoquinolinones, respectively, based on X-ray crystallographic analyses.

Comparison of quality of life and activity of daily living status of patients with myasthenia gravis treated with low-dose and high-dose prednisolone.

OBJECTIVES: To compare the effect of low-dose prednisolone (PSL) (≤5 mg/day) and high-dose PSL (>5 mg/day) therapy on the QOL and activity of daily living (ADL) in patients with MG. METHODS: A total of 679 patients with MG underwent a survey using Japanese versions of the MG-QOL 15-J and MG-ADL scales. Higher scores of these scales suggest deterioration of the QOL and ADL, respectively. RESULTS: The total MG-QOL 15-J scores of the high-dose group (27.0±13.8) were significantly higher than those of the low-dose group (20.9±14.6). Similarly, the total MG-ADL scores of the high-dose group (6.3±4.1) were significantly higher than those of the low-dose group (5.3±4.1). CONCLUSION: These results showed that the QOL of patients in the low-dose group appeared better than that in the high-dose group. Low-dose PSL therapy may help achieve minimal manifestations level in Japanese patients with MG.

[Survey of Pharmacists' Knowledge, Actions and Confidence in Medication Education to Patients with Hearing Disabilities].

Health professionals should adopt best practices that are cognizant of the communication skills of their patients. Pharmacists should be knowledgeable about hearing disabilities to effectively provide medication education to deaf and hard-of-hearing (HH) patients. The Act for Eliminating Discrimination against Persons with Disabilities requires pharmacists to take the appropriate actions to their patients. However, awareness about the appropriate actions for eliminate discrimination has not increased among medical professionals. This survey examined the knowledge about hearing disabilities, practice of appropriate actions and confidence in medication education to deaf and HH patients on 216 pharmacists in Yahata Pharmaceutical Association in November 2019. Pharmacists had poor awareness about hearing disabilities and about 30% of participants misunderstood appropriate actions in communication to deaf and HH patients. Practice of appropriate action in medication education were taken by only about half of the participants. In particular, placing Ear symbol had not be taken at all. Participants felt that they could provide medication education sufficiently by written materials in spite of poor understanding about the literacy of deaf individuals. On the other hand, they felt unconfident due to lack of understanding about hearing disabilities and how to communicate with their patients. This survey suggests that pharmacists need to learn about hearing disabilities for effective communication and practice of appropriate action in medication education to patients with hearing disabilities. Learning hearing disabilities may enable them to take the actions that are necessary to eliminate discrimination and enhance their confidence in providing medication education.

Survey of satisfaction regarding palliative care provided to patients who died at home or in a hospital.

BACKGROUND: Improvement in quality of life (QoL) of patients is one of the most important goals of palliative care, but evaluation of QoL of patients is difficult. AIM: To evaluate QoL of patients who died at home or in a hospital. METHODS: We administered the Good Death Inventory (10 core and 8 optional domains) to the bereaved families of patients who died at home or in a hospital. A total of 107 bereaved families undertook a survey. FINDINGS: If a bereaved family chose 'somewhat agree', 'agree' or 'absolutely agree', the answer was regarded as a 'satisfactory answer'. Regarding the 10 core domains, of patients who died in a hospital, <50% respondents gave a 'satisfactory answer' to three questions, whereas of patients who died at home, >60% of respondents gave a 'satisfactory answer' to seven questions. Regarding the eight optional domains, of patients who died in a hospital, <50% respondents gave a 'satisfactory answer' to five questions, whereas of patients who died at home, >60% of respondents gave a 'satisfactory answer' to four questions. CONCLUSIONS: QoL of patients who died at home appeared higher than that of those who died in a hospital. Patients prefer to remain at home rather than in a hospital, probably because at home they are surrounded by familiar things and can live according to their usual habits.

Syntheses of α-CF3-α-quaternary ketones via p-quinone methides and their derivatization to compounds with successively congested stereogenic centers.

New and successful results for the construction of new and structurally interesting compounds are reported via N-heterocyclic carbene (NHC)-catalyzed 1,6-conjugate additions of a variety of aldehydes to δ-CF3-δ-substituted p-quinone methides generated in situ, and the products are used for the 1,2-addition reactions of appropriate metal nucleophiles, enabling us to furnish highly diastereoselective products with a unique successive quaternary carbon-tertiary alcohol framework (up to dr = >99 : 1).

[Effects of Learning on the Confidence to Provide Medication Education for Pharmacy Students].

Japan passed a law that eliminated discrimination against persons with disabilities in 2016. Health care providers must comply with this law and are required to deepen their understanding of disabilities and take action to eliminate discrimination based on a higher level of awareness. Pharmacists need to better understand hearing disabilities to effectively communicate and provide medication education to deaf and hard of hearing (HH). This study examined the understanding about deaf and HH communities and the effects of learning through a lecture and hearing loss simulation experiences on 151 students in Daiichi University of Pharmacy to improve their understanding deaf and HH communities and ability to communicate effectively with deaf and HH patients in providing medication education in April 2018. Before the learning, 125 students indicated a lack of confidence in their ability to communicate medication education due to a lack of understanding. However, 26 students responded that they could communicate with deaf and HH patients despite their misunderstandings about deaf and HH communities and the features of such communication. After the learning 132 students indicated they had the confidence to interact with deaf and HH patients in communication for medication education. This study suggests that students need to learn about deaf and HH communities and develop communication skills to interact with them for medication education. Taking these steps may contribute to creating an educational program to facilitate communication and improve medication education for deaf and HH through effective communication by pharmacists.

Clarification of the Reactivity of 1,3,3,3-Tetrafluoropropene Oxides.

Our computation has successfully clarified the reluctant behavior of trans- and cis-1,3,3,3-tetrafluoropropene oxides 1c toward nucleophiles and led to the expectation that these epoxides would react under the Brønsted acid activation conditions. Actually, this was the case, and these epoxides smoothly opened with CF3SO3H, whose elimination after the protection of the resultant OH group afforded the enol benzoates as the enolate precursors, which nicely allowed us to construct the corresponding aldol products by reactions with various aldehydes.

Construction of trifluoromethylated quaternary stereocenters via p-quinone methides.

Development of a new synthetic method for the construction of quaternary centers with a trifluoromethyl group was realized by way of 1,6-addition of various nucleophiles including active methylene compounds to highly reactive δ-trifluoromethylated p-quinone methides generated in situ from the corresponding tertiary carbonates with a catalytic amount of an appropriate base.

A new brain CT reference line: the lower eyelid to the inner occipital base line closely parallels the Talairach-Tournoux line.

BACKGROUND: There is no standardized brain computed tomography (CT) reference line that can be determined on both scout and reformatted sagittal CT images. Here, a tangential line from the anterior edge of the lower eyelid to the inner table of the occipital base (LEL/O line) appears nearly parallel to the Talairach-Tournoux (T/T) line, which shows a consistent intracranial anatomical relationship among subjects, and acts as a standard reference line for magnetic resonance (MR) imaging. PURPOSE: To quantitatively validate the LEL/O line as a new standard brain CT reference line. MATERIAL AND METHODS: We measured: angle 1 = the LEL/O line on scout images from the LEL/O line on parasagittal CT images (n=93); and angle 2 = the LEL/O line on scout images from the T/T line on high resolution midsagittal MR images (n=97). Angles in a clockwise direction were defined as positive and were expressed as mean±SD with the 95% confidence interval (CI) of the SD. Angle 2 was measured independently by two observers and intraclass correlation coefficients (ICCs) were calculated. RESULTS: Angle 1 was -0.4°±1.2° (95% CI of SD 1.1°-1.5°); angle 2 was -0.4°±2.0° (95% CI of SD, 1.8°-2.4°). The ICC in the angle 2 measurement was 0.780 (P<0.001), which indicated high inter-observer reliability. CONCLUSION: The LEL/O lines on scout and parasagittal CT images show practically the same gradient, and these LEL/O lines are almost parallel to the T/T line. Use of the LEL/O line either for direct scanning or reformation can minimize intra- and inter-subject variations on CT images and mismatch between CT and MR images.

Synthesis and characterization of bent fluorine-containing donor-π-acceptor molecules as intense luminophores with large Stokes shifts.

Herein, we prepared novel bent fluorine-containing donor-π-acceptor (D-π-A) molecules from commercially available octafluorocyclopentene using a facile two-step procedure, revealing that the above molecules absorb UV-light and exhibit yellow photoluminescence (PL) with high PL efficiencies (ΦPL) in solution. The corresponding Stokes shifts exceeded 10 000 cm-1, and the maximum PL wavelength (λPL) strongly depended on solvent polarity or intermolecular interactions in the solid state. On the basis of a Lippert-Mataga plot, PL was confidently assigned to radiative relaxation from an intramolecular charge-transfer excited state. Moreover, the synthesized luminophores showed intense PL even in the crystalline state and exhibited alkoxy chain length-dependent PL behavior (e.g., high ΦPL, λPL = 486-540 nm).

Promoting Patient Care Through Communication Training in a Pre-clerkship Pharmacy Education Course in Japan.

Objective. The purpose of this study was to teach communication skills for patient care to pre-clerkship students and observe changes in student perspectives towards communication from pre- to post-training. Methods. Two cohorts of fourth-year pharmacy students completed an eight-week pre-clerkship training course designed to improve their communication skills. The course involved class discussions and in-class research of medications, practicing communication skills, learning to give science-based responses, and developing an awareness of patient education for lifestyle, self-medication, quality of life, and medication adherence. A comparison of students' pre- and post-training responses to a questionnaire were used to assess changes in students' ability and confidence in communicating with patients. An exploratory factor analysis was used to analyze and compare the data results. Results. Students' mean post-training scores for perceived ability to make small talk and confidence to communicate with patients increased compared to pre-training scores. Based on the results of the exploratory factor analysis, the greatest increase in students' scores was in the area of patient education skills. Conclusion. The pre-clerkship communication training improved student understanding of the pharmacy communication skills needed to conduct effective patient education and pharmacist-patient interaction beyond dispensing, affirming the theory that specialized communication training before students' begin a clerkship may be essential.

Effects of magnesium oxide on pharmacokinetics of L-dopa/carbidopa and assessment of pharmacodynamic changes by a model-based simulation.

BACKGROUND: Magnesium oxide (MgO) is often co-prescribed with L-dopa/carbidopa (LDCD) to improve constipation in Parkinson's disease patients. The mixing of L-dopa and MgO has been shown to degrade L-dopa; however, there is no interaction study on humans. We proposed mechanisms for the interaction between LDCD and MgO and conducted pharmacokinetic studies on rats and humans. To assess pharmacodynamic changes with the MgO treatment, we applied a model-based meta-analysis (MBMA). METHODS: The effects of MgO on the stabilities of L-dopa and carbidopa were evaluated in in vitro studies. We conducted pharmacokinetic interaction studies of MgO and LDCD on rats and healthy volunteers. A clinical study was conducted with an open-label, non-randomized, single-arm, and two-phase study. In MBMA, we constructed a population pharmacokinetic/pharmacodynamic model of L-dopa and predicted the effects of the MgO treatment on the pharmacodynamics of L-dopa. RESULTS: In vitro results suggested that carbidopa was unstable under alkaline pH conditions. Reductions in plasma LDCD concentrations were observed after oral-MgO/oral-LDCD, but not in oral-MgO/i.v.-LDCD treatments in rats, suggesting that the gastrointestinal tract is an interaction site. A healthy volunteer study showed that MgO was also associated with significant decreases of 35.3 and 80.9% in the AUC0-12 of L-dopa and carbidopa, respectively. A model-based simulation suggested that the MgO treatment was undesirable for the effectiveness of L-dopa. CONCLUSIONS: This is the first study to show a clear pharmacokinetic interaction between LDCD and MgO in humans. Further investigations to confirm the effects of MgO on the pharmacodynamics of L-dopa are required.

[Effects of Using the Adherence Score Sheet According to Application Timing in Improving Medication Adherence in SETSUYAKU-BAG Campaign].

Maintaining medication adherence is a critical issue in determining health outcomes in patients with chronic diseases. However, many patients do not adhere to their prescribed regimens. This study aimed to determine the effects of using adherence score sheets according to application timing in improving medication adherence among non-adherent outpatients. In community pharmacies, both patients and pharmacists evaluated medication adherence based on application timing (morning, noon, evening, and before going to bed) in 11 levels (0-10) for >4 months. A total of 58 outpatients were included in the study. The median scores among application timing at intermediate (patient 9.3, pharmacist 9.0) and final (patient 9.5, pharmacist 9.5) analyses were significantly higher than that at baseline (patient 7.6, pharmacist 7.0). At the end of the investigation, the ratio of non-adherent patients prescribed with hyperlipidemic medications was higher than those prescribed with medications for other lifestyle diseases. Approximately 80% of the patients reported improved medication adherence based on the questionnaires regarding their understanding on diseases and medications, medication awareness, and communication with pharmacists. Therefore, the utilization of an adherence score sheet according to application timing improved medication adherence of patients with chronic diseases.

Fluorine-Containing Dibenzoanthracene and Benzoperylene-Type Polycyclic Aromatic Hydrocarbons: Synthesis, Structure, and Basic Chemical Properties.

Intramolecular photocyclization of stilbene derivatives (Mallory reaction) is one of the efficient methods for building polycyclic aromatic hydrocarbon (PAH) frameworks, and is also expected to be applicable to synthesis of fluorine-containing PAHs (F-PAHs). In this study, dibenzoanthracene-type (4a) and benzoperylene-type (4b) F-PAHs were synthesized using the Mallory reaction of the 1,4-distyrylbenzene-type π-conjugated molecule (3a), which was prepared by addition-defluorination of available octafluorocyclopentene (OFCP) and aryllithium in three steps. The structure of 4a originating from π⁻π interaction was characterized by X-ray crystallographic analysis. The absorption maxima of UV-Vis spectra and emission maxima of photoluminescence spectra of the PAHs were positioned at a longer wavelength compared to those of the corresponding unsubstituted PAHs, presumably due to the electron-withdrawing nature of perfluorocyclopentene (PFCP) units. The effect of PFCP units in F-PAHs was also studied by time-dependent density functional theory (TD-DFT) calculation.