[Pilot study of dementia medication compliance conducted among pharmacists providing home visits which evaluates the degree of drug compliance, as defined by numerous attributes, between patients at home and patients in a medical facility].

A survey was conducted among pharmacists providing "home-visit guidance on drug management" to patients taking medication for dementia. Factors related to medication adherence among patients and pharmacists' acquisition of patient information were then verified. The survey items were: (1) patient attributes (degree of care received, bed-ridden, family composition, and living environment); (2) the person controlling medications; (3) drug storage method and location; (4) dispensing method; (5) patient management of visiting nurses; (6) patient management of visiting physician; (7) details of pharmacist's home-visit guidance; (8) medication adherence; (9) five items related to cognitive function (short-term memory, autonomous judgment, fluctuations in level of consciousness, excitation and loss of orientation, understanding); and (10) ten items related of ADL (mobility in bed, transferring, mobility within the home or outdoors, dressing upper/lower body, eating, toilet use, individual hygiene, bathing). The t test was used to verify the number of items of patient information concerning cognitive function and physical function that pharmacists could acquire at a visit. It was suggested that pharmacists were able to acquire more patient information (①cognitive function and ②ADL) when they visited patients cared for at home, compared to facility residents (①p=0.008, ② p=0.006). Thus, it was suggested that there is a latent risk concerning the pharmacist's ability to discover problems with administration of medications among facility residents. These findings demonstrate that it is essential for pharmacists to be more proactive about providing home-visit guidance.

[Research survey on the information gathering methods, attitudes, and requests from care managers about the pharmaceutical service by pharmacists in home care].

Care Managers (CMs) were surveyed to clarify the issues involving the promotion of cooperation between care managers and pharmacists in long-term-care and explore solutions. The length of work experience, occupational background, experience of pharmaceutical service; pharmacist visit patients' home for providing medicine and pharmaceutical care into a care plan, degree of understanding on pharmaceutical service, and awareness of work involved in pharmaceutical service were studied to see whether there made differences in the requests from CMs for information on pharmacists and for information gathering methods. The χ(2) test was used to this end. The opinions and requests described by the CMs were validated through text mining. More CMs tended to obtain information and knowledge through training sessions and professional magazines than those who did so through cooperation with pharmacists on a practical level. However, the survey strongly indicated that CMs with high level of understanding and awareness of pharmaceutical service wished to obtain information on pharmacists through cooperation with them on a practical level, and CMs with low level of understanding and awareness of pharmaceutical service wished to obtain such information through training sessions and professional magazines. Results of text mining showed that CMs wished pharmacists to strengthen the cooperation with physicians and provide information on pharmaceutical service. These findings have led to the conclusion that the issues surrounding the promotion of cooperation between CMs and pharmacists centered around "work cooperation on a practical level" and "provision of information to CMs about the roles of pharmacies and pharmacists and their work."

[Study on incorporation of "management and guidance of home-visiting by a pharmacist" into a care plan -observation based on a survey of care managers-].

A survey of care managers ("CMs") was conducted to identify top priority issues in promoting the management and guidance of home-visiting by a pharmacist ("management and guidance") by focusing on the experience in incorporating the management and guidance into a care plan and its relevant factors. Major survey items included (1) number of years working as a CM, (2) basic occupation, (3) experience in incorporating the management and guidance into care plans, (4) understanding the management and guidance content, and (5) an awareness of the need for pharmacists' involvement in care plans. A χ² test was conducted to determine if the experience in incorporating the management and guidance into care plans caused a difference in the distribution of the number of years as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans. A regression analysis was conducted to determine the degree of association between the incorporation experience and each item. The numbers of years working as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans, were found to be associated with the experience in incorporating the management and guidance into care plans. Understanding of the management and guidance content was most closely associated. To promote pharmacists' management and guidance for home-based care, CMs need to deepen their understanding of this service.

[Present status and the future issues of the ethics education in the department of pharmacy].

The 6-year pharmacology education aims at teaching graduating pharmacists necessary knowledge, techniques and appropriate attitude as medical professionals. To attain these goals, a core curriculum model for pharmacology education has been presented. Based on this model, each university is to draw up an individualized new curriculum. As a result, along with subjects not so familiar to the 4 year education such as Clinical Communication Theory and Medicinal Therapy, long-term practical training is to be implemented. It is essential that pharmacists as medical professionals need to have high ethical standards. As for the core curriculum model, contents concerning ethics have been shown in "A. Learning about Humanism". In our country, "Pharmacist Ethics Regulation" has been established and serves as a model for standards of conduct for pharmacists. Education of these ethical standards needed by pharmacists is considered necessary and important and should be routinely performed within the 6 years of pharmacology education. Therefore ethics education in our schools is given from the 1st year to the first half of the 5th year. Moreover, it is considered important to learn ethical standards not only through lectures but also through on-site experience such as long-term practical training. All kinds of advice concerning the contents necessary for adequate ethics education and for promoting a suitable image of the faculties in charge are welcome.

Innvestigation on patient's and pharmacist's attitudes toward medical services in community pharmacies.

An investigation of patients' and pharmacists' attitudes toward medical services provided in community pharmacies was conducted in September, 2007. Respondents to the survey were patients and pharmacists in 160 stores of a chain pharmacy. The questionnaire consisted of 15 question items about pharmacy functions and three comprehensive evaluations of the pharmacy. The degree of importance and satisfaction was surveyed among 8995 patients, and the degree of importance and sufficiency was surveyed among 408 pharmacists. Multivariate analyses were performed using these data. Patients considered pharmacy functions as less important than did pharmacists for all items. The difference in attitude toword "the medication notebook" was particularly marked. Next, factor analysis was performed of the degree of importance in patients' and pharmacists' responses and three potential factors were extracted for each. However, the items constituting potential factors differed slightly between patients and pharmacists. Finally, multiple-regression analyses using three comprehensive evaluations as the independent variable and satisfaction with 15 items as a dependent variable were performed. In all three models, the standardization regression coefficient of "explanation of medicine" was large in the regression model of patients. On the other hand, the standardization regression coefficient of "consideration for patients" was large in the model of pharmacists. The influence of some patient attribute dummy variables was significant. Differences in the attitudes toward medical services and pharmacy functions were found between patients and pharmacists, and some items that should be improved were revealed.

An investigation on pharmacy functions and services affecting satisfaction of patients with prescriptions in community pharmacies.

Various functions expected by patient expects are needed with progress in the system for separation of dispensing and prescribing functions. In this investigation, the relationship between patient satisfaction and pharmacy function were analyzed quantitatively. A questionnaire survey was conducted in 178 community pharmacies. Questions on pharmacy functions and services totaled 87 items concerning information service, amenities, safety, personnel training, etc. The questionnaires for patients had five-grade scales and composed 11 items (observed variables). Based on the results, "the percentage of satisfied patients" was determined. Multivariate analysis was performed to investigate the relationship between patient satisfaction and pharmacy functions or services provided, to confirm patient's evaluation of the pharmacy, and how factors affected comprehensive satisfaction. In correlation analysis, "the number of pharmacists" and "comprehensive satisfaction" had a negative correlation. Other interesting results were obtained. As a results of factor analysis, three latent factors were obtained: the "human factor," "patients' convenience," and "environmental factor," Multiple regression analysis showed that the "human factor" affected "comprehensive satisfaction" the most. Various pharmacy functions and services influence patient satisfaction, and improvement in their quality increases patient satisfaction. This will result in the practice of patient-centered medicine.

Effects of patient-pharmacist communication in the treatment of asthma.

We studied the relationship between patient-pharmacist communication and asthma treatment, including patient understanding of drug therapy, ability to self-treat with inhaled drugs, and control over asthma. The study was among adult patients who had received inhaled steroidal or other drugs from community pharmacies in Hokkaido, Ibaragi, Tochigi, Kanagawa, and Osaka prefectures for at least one year. During the month of November 2007, pharmacists explained the study to patients and obtain consent before distributing questionnaires to be filled out and mailed back. Survey items covered the nature/extent of the pharmacist's explanation, the patient's degree of understanding, frequency of inhaled steroid use, frequency of asthma attacks, degree of improvement with inhaler use, skill in using inhaled drugs, and self-evaluation of communication with the pharmacist. Analysis was carried out using the 114 valid data sets obtained. The ratio of men to women was 4: 6, and the average age was 61.8 years. Compared with patients citing communication problems with pharmacists, those who had good communication received significantly higher scores in terms of understanding the purpose of inhalers, drug interactions, and side effects, and coping with attacks, as well as in indices of skill in using inhaled drugs. The degree of improvement in asthma attacks was also significantly higher among patients with self-evaluation of good communication with pharmacists. We suggest that communication between patient and pharmacist is associated with understanding of pharmacotherapy, as well as their ability to use inhaled medications and gaining good control over their asthma.

[Investigation on safety climate for preventing dispensing errors in community pharmacies].

We investigated consciousness of the prevention of dispensing errors with the pharmacists and clerical staffs which work in community pharmacies and analyzed the structure of those subconscious to examine preventive measures of dispensing errors. Questionnaire survey was performed for all pharmacists and clerical staffs working in community pharmacies where each is affiliated with four pharmacy groups. The questionnaire consisted of 38 questions about "atmospheres for the prevention of dispensing errors" in the pharmacy along their attributions. And data were analyzed by occupation to confirm the difference. As a result of factor analysis, five factors such as "the posture of the boss", "information exchange", "the order of the pharmacy" were extracted from the pharmacists. Moreover, in the case of the clerical staffs, five similar factors have been extracted besides "a sense of responsibility to duties" replaced "the order of the pharmacy". As a result of structural equation modeling, the pass model with high goodness of fit to which "measures for dispensing error prevention" and "consciousness to the dispensing error of a pharmacy" were assumed to be a subordinate concept respectively by each occupational category. It became clear that a suggestion of the concrete preventive measures drafting was provided even from the investigation of the consciousness level.

[Investigation on patient satisfaction at community pharmacies: analyzing questionnaire survey by structural equation modeling and multiple regression analysis].

Separation of the dispensing function and the prescribing function, Iyaku Bungyo, has been progressing in Japan. We are now witnessing the advent of a new society where patients select pharmacists and their satisfaction is recognized as one of the healthcare outcome indicators. It is necessary to clarify which factors affect patients' satisfaction with the services provided at community pharmacies and how they do so. A survey was conducted among 104 community pharmacies and their patients around the Tokyo metropolitan area in Japan. The questionnaire comprised 11 items (observed variables), each with a five-grade scale. With the transformed data-oriented pharmacy, the percentage of being not unsatisfactory was examined in two multivariate analyses of the relation and structure of patient satisfaction with a community pharmacy. Structural equation modeling (SEM) with factor analysis (FA) was performed using the observed variables and latent factors. Multiple regression analysis was performed with comprehensive satisfaction as an independent variable, examining the factors that affect comprehensive satisfaction with the pharmacy. The result of the FA indicated three latent factors of instruction on the use of drugs, quality of staff, and environment, based on which SEM model was constructed with a relatively high goodness of fit index. The result of multiple regression analyses indicated almost all variables such as satisfaction with reception by the pharmacist affected the comprehensive satisfaction, but privacy did not show a significant effect. These results, notably the relationship between each variables and latent factors, suggested the importance of higher skills of pharmacists, service qualities at pharmacies, and their functions adjusted to the community.

Circadian pharmacokinetics of mycophenolic Acid and implication of genetic polymorphisms for early clinical events in renal transplant recipients.

BACKGROUND: We investigated the mycophenolic acid (MPA) chronopharmacokinetics and the relation between MPA circadian exposure and the incidence of acute rejection (AR). The association between selected genetic polymorphisms and clinical events or MPA circadian exposure was also studied. METHODS: Thirty recipients were studied one month after renal transplantation. Mycophenolate mofetil (MMF) was administered twice a day at a single dose of 0.5 g in four patients, 0.75 g in eight patients, and 1 g in 18 patients. RESULTS: The daytime area under the concentration-time curve (AUC0-12) was larger than the nighttime AUC0-12 (55.09 vs. 50.54 microg.hr/ml, P=0.049). The Cmax and tmax of MPA after the morning dose were respectively higher and shorter than those after the night dose. Seven patients (23.3%) had AR episodes. The MMF single dose per body weight (12.46 mg/kg in patients with AR vs. 16.99 in patients without AR), daytime and nighttime AUC0-12 (32.41 vs. 62.00 and 24.44 vs. 57.88 microg.hr/ml) and morning trough level of MPA (1.03 vs. 3.83 microg/ml) were significantly lower in patients with AR than in those without AR. The percentage of patients requiring diminished dose of MMF due to diarrhea was higher among patients with the multidrug resistance 1 (MDR1) C3435T T allele than among those with the CC genotype (P=0.049). CONCLUSION: MPA pharmacokinetics showed circadian variations, and a lower MPA AUC in both daytime and nighttime was associated with the occurrence of AR in the early stage after renal transplantation. The MDR1 C3435T polymorphism might be associated with diarrhea due to MPA.

[Analysis by structural equation modeling of the questionnaire about the risk and its preventive measures in a pharmacy].

Pharmacists are now facing a problem of developing measures for dispensing mistakes, because there recently is increasing social awareness on medical accidents and a tendency to increase medical accidents in pharmacies due to popularizing separation of dispensing and prescribing functions. In this study, questionnaire survey was conducted to investigate pharmacist's views on human error measures and the relationship between mistakes and the preventive measures. To clarify relationship between human error measures and preventive measures for avoiding mistakes, questionnaire result was analyzed based on structural equation modeling (SEM). Questionnaire survey was sent to community pharmacies in Hokkaido. The result was analyzed by SEM. The recovery rate of the questionnaire was 71.0%. Human error measures were classified into "The measures against deficient knowledge and insufficient experiences". "Attention problem measures" and "The measures against a cognitive error". While attention problem was strongly related to the cognitive error, there was no relationship between "Attention problem measures" and "The measures against a cognitive error". Moreover, it were clarified that to develop human error measures for deficient knowledge and insufficient experiences was effective for the preventive against the mismatch of the cognitive mechanism and the intentional mistake and for bridging the gap between knowledge and experiences. This study showed that SEM was effective for adopting efficient preventive measures for medical accident and analyzing risk management in pharmacies. Applying these results to the medical accident preventive measures contribute to improvement of the risk management.

[Construction and evaluation of a cancer chemotherapy regimen database using an electronic medical chart network].

PURPOSE: There are many regimens for cancer chemotherapy, and thus information management is complicated. It is thought that the safe and appropriate use of cancer chemotherapy can be achieved by developing a system that involves information-sharing among medical staff. A system facilitating the choice of regimen was developed in our institution using an electronic medical chart network. In addition, a questionnaire was distributed to evaluate the usefulness of the cancer chemotherapy regimen database (DB). METHODS: Microsoft Access 2000 was used for the DB. Microsoft Internet Information Services Ver. 6.0 included in the Windows 2003 Server was used as the management software of the Web-version DB. RESULTS: With the Web-version DB, it was possible to offer chemotherapy regimen information to all departments in the hospital. The DB received an excellent evaluation based on the questionnaire results. The reasons for this were the exceptional ability to share information among medical staff and the appeal of a checking system. CONCLUSION: Obtaining information regarding cancer chemotherapy regimens became easier with the Web-version DB, which received an excellent evaluation by all medical staff. Proactive use of the Web-version DB can contribute to proper cancer chemotherapy choice and strengthening of hospital risk management.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

Chronopharmacokinetics of tacrolimus in kidney transplant recipients: occurrence of acute rejection.

The circadian variation of clinical pharmacokinetics of tacrolimus was studied using 16 adult renal transplant recipients 1 month after the operation. The recipients were administered tacrolimus twice a day (9 a.m. and 9 p.m.), and whole-blood samples were obtained just prior to and 1, 2, 3, 6, 9, and 12 hours after oral administration. Histological specimens of transplant kidney were collected by an allograft core biopsy on day 28 after the transplantation. There were no circadian changes in the area under the concentration-time curve (AUC0-12) (214 ng.h/mL during daytime vs. 223 ng.h/mL during nighttime) resulting from morning and night doses. A slight delay in mean residence time (MRT0-12) and time to the peak concentration (tmax) was found after night doses, but there was no statistical significance. Three patients (18.8%) had a clinical acute rejection (AR) episode 4 to 6 weeks after transplantation, and AUC0-12 at nighttime was significantly lower (18.4% on average) in patients with AR in comparison to those without AR. There was no statistical significance in maximum concentration (Cmax) or morning/night trough levels between patients with and without AR. In regard to the correlation between tacrolimus concentrations in each sampling time and AUC0-12, the morning trough concentrations were less predictable for daytime AUC0-12 (r2 = 0.125), but there was a weak correlation to nighttime AUC0-12 (r2 = 0.424). Tacrolimus concentrations at 2, 3, and 6 hours after the morning dose (C2, C3, and C6) had a good correlation against daytime AUC. The results of this study indicate that the variance on the clinical pharmacokinetics of tacrolimus between daytime and nighttime in renal transplant patients is not significant, while the lower nighttime AUC corresponded to the occurrence of AR.

[Problems of the separation of prescription and dispensing].

By October 2002, the separation of prescribing and dispensing in Japan had already been implemented for 28 years since the system was inaugurated in 1974. Although the separation rate reached 44.5% in 2001, the questions, "Is the separation necessary in Japan?" or "Has the system been working successfully?" are often heard. These questions are raised because people have not noted the advantages of the system yet, and because the separation itself has many problems or shortcomings. These questions are not only from pharmacists, but also from physicians, patients, or medical and educational institutions. If the problem concerns pharmacists, it is assumed to stem from their lack of ability required for the separation. A breakthrough for an early solution of the problem will be found in a change in education, which includes a range of clinical subjects and long-term clinical practices.

[The development and operation of a package inserts service system for electronic medical records].

To promote the appropriate use of pharmaceuticals and to prevent side effects, physicians need package inserts on medicinal drugs as soon as possible. A medicinal drug information service system was established for electronic medical records to speed up and increase the efficiency of package insert communications within a medical institution. Development of this system facilitates access to package inserts by, for example, physicians. The time required to maintain files of package inserts was shortened, and the efficiency of the drug information service increased. As a source of package inserts for this system, package inserts using a standard generalized markup language (SGML) form were used, which are accessible to the public on the homepage of the Organization for Pharmaceutical Safety and Research (OPSR). This study found that a delay occurred in communicating revised package inserts from pharmaceutical companies to the OPSR. Therefore a pharmaceutical department page was set up as part of the homepage of the medical institution for electronic medical records to shorten the delay in the revision of package inserts posted on the medicinal drug information service homepage of the OPSR. The usefulness of this package insert service system for electronic medical records is clear. For more effective use of this system based on the OPSR homepage pharmaceutical companies have been requested to provide quicker updating of package inserts.

Inhibitory effect of murine kidney extracts on mast cells derived from human umbilical cord blood.

We examined the effect of aqueous murine kidney extract (MKE) on the growth of mast cells prepared from the liquid culture of human umbilical cord blood CD34+ cells in the presence of a combination of recombinant human stem cell factor (SCF) and interleukin-6 (IL-6). Cultured cells were mature mast cells that expressed CD117 antigen on their surface, a specific marker for human mast cell, and they contained 6.53 pg histamine per cell. Adding MKE resulted in a 53% inhibition of mast cell growth and a 40% decrease in histamine content in mast cells in a serum-free liquid culture stimulated by SCF and IL-6. The inhibitory molecule for the growth of human mature mast cells was estimated at about 30 kDa of protein from gel-filtration HPLC. This fraction also inhibited the growth of murine peritoneal cells-derived mast cells. These results suggest that MKE contains regulator(s) that suppress the growth of mast cells and histamine synthesis. and that act beyond species specificity.

Effects of amifostine on the proliferation and differentiation of megakaryocytic progenitor cells.

This study investigated the effects of amifostine, a clinically usable radioprotector or chemoprotector, on the proliferation and differentiation of normal and X-irradiated cluster of differentiation 34 positive (CD34+) megakaryocytic progenitor cells (colony-forming unit in megakaryocytes, CFU-Meg) from human placental and umbilical cord blood (CB) in vitro. Amifostine significantly accelerated megakaryocyte colony formation in a plasma clot culture supplemented with recombinant human thrombopoietin because of an increase in immature CFU-Meg-derived large megakaryocyte colony formation. An analysis of the cells that were harvested from the culture showed that amifostine induced a 70- and an 83-fold increase in the total cell and CFU-Meg numbers, respectively, and produced hyperploid megakaryocytes of more than 8 N ploidy. The radioprotective effect of amifostine on the clonal growth of X-irradiated CD34+ CFU-Meg was observed by treatment before or after irradiation. These findings suggest that the action of amifostine extends from immature CFU-Meg to the terminal differentiation of megakaryopoiesis, and its radioprotective effect is shown in megakaryopoiesis and thrombopoiesis.

Quantitative analysis of intracellular glutathione levels in murine bone marrow cells by using reverse-phase high-performance liquid chromatography.

Intracellular reduced glutathione (GSH) and oxidized glutathione (GSSG) amounts in murine bone marrow cells were determined by using a simple and rapid quantitative analysis that used reverse-phase high-performance liquid chromatography. Freshly prepared murine bone marrow cells lysed with water were applied to C18 double columns, were eluted with 0.1% trifluoroacetic acid-H2O at 35EC and were detected by ultraviolet absorption (220 nm). GSH and GSSG peaks with retention times of 9.2 and 27.5 min, respectively, were clear and were free of interference from the peaks of contaminated molecules in the cells. The results of this study indicate that our simple method to determine intracellular GSH and GSSG amounts can be used for a small number of cells (>3 x 10(6) cells).