[Mindset for Pharmacists as an Expert of Pharmacotherapy-Case of Home-Care Rheumatoid Arthritis Patients with Multiple Diseases].

The number of older adult patients with rheumatoid arthritis(RA)is increasing. As older adult patients tend to have multiple diseases requiringmedications, they are likely to experience side effects from the decline in their physiological functioning. In addition, suppression of disease activity leads to a decline in ADL in the case of patients livingalone, even leadingto difficulties in livingat home. In the 3-years clinical course on older adult RA patients livingalone with multiple diseases, we show the mindset that community pharmacists must have for three events(namely, hypoalbuminemia, chronic heart failure, and dehydration)in which inflammation influences medicinal or side effects.

[Current State of Process of Dispensing Prescription for Pediatric Patients Who Need Home Visiting for Intervention for Pharmaceutical Management].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, there are concerns that many pharmacies are not actively involved in, because the dispensing fee does not match their prescriptions, which are very complicated and contain some high-risk medicines. We analyzed the burden of dispensing prescribed medicines so that we can quantitatively discuss from prescription contents. The essence of the burden of a pharmacy regarding home medical care for children is to cover the transportation of heavy pharmaceuticals and the combination of multiple medication including high-risk medicines and lack of pediatric drug formulations with the efforts of the on-site pharmacist. It became clear that the pharmacist's objective work supports pediatric pharmacotherapy.

[Role of Pharmacists in the Care of Pediatric Patients Needing Home Visiting Intervention for Pharmaceutical Management and Their Life Depending on Medical Care].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, currently, few medical personnel of both medical institutions and pharmacies are aware of home visiting intervention for pharmaceutical management. Home visiting intervention should be utilized more for severely impaired children who are highly dependent on medical care to effectively reduce the nursing care burden of the family and to secure pharmaceutical supply path.

[Case Study - A Successful Cooperation of Clinic Pharmacist and Pharmacies in Home Palliative Care with PCA Pump].

To make a good end at home and provide good palliative care for patients with cancer are urgent issues in Setagaya ward, as shown by certain statistics. Medical opioids are greatly needed for palliative care; as patient controlled analgesia(PCA) develops, it can lead to decisions by patients and their families to receive end-of-life care at home because the patient can choose to receive the same advanced palliative care received at the hospital. With in-home palliative care, given the rapid change in the medical condition of the patient and the sentiment of the family, the role of pharmacists is to quickly and reliably supply the pharmaceuticals and medical equipment that doctors need. The following are important in order to enable this; 1 ) a pharmacy stocked with medicalopioids in accordance with needs, 2 ) a pharmacy with a system that can provide support quickly, 3 ) the presence of people who understand the area of resources, and 4 ) a constant face-to-face relationship. The "Sakura-HOPPS(Sakurashinmachi Homecare Pharmacists PartnershipS)"is a group intended to provide exchange and cooperation of pharmacists beyond the framework of organizationalaffil iation, and authors hope to encourage the participation of increasingly more pharmacists to develop a close-cooperation system of acute care hospitals and community medical/home care.

Effects of hypothyroidism on the estrous cycle and reproductive hormones in mature female rat.

The present study was undertaken to examine the systemic role of thyroid hormones by analyzing changes in reproductive functions in hypothyroid female rats. Serum concentrations of triiodo-thyronine (T3) significantly decreased 1 week after the initiation of propyl-thiouracil treatment or thyroidectomy. The estrous cycle became irregular 3 and 2 weeks after the initiation of propyl-thiouracil treatment and thyroidectomy, respectively. Serum luteinizing hormone (LH) levels significantly reduced in both groups on the day of diestrus-1 about 1 month later. Hypothyroid rat shows the high progesterone and low testosterone levels. No significant changes in inhibin and estradiol levels were detected. The serum levels of FSH decreased in the thyroidectomy group. The irregular estrous cycle and the above changes in hormone levels were recovered by administration of T4. Compensatory secretions of FSH and LH induced by ovariectomy were enhanced by thyroidectomy and suppressed by T4 treatment. These results suggest that thyroid hormones play a role in the regulation of reproductive hormones secretion in the cyclic rat ovary.

Effect of thyroid hormone on CYP19 expression in ovarian granulosa cells from gonadotropin-treated immature rats.

The present study was designed to determine the mechanisms by which serum estradiol levels are enhanced during gonadotropin-induced ovarian development in hypothyroid immature rats. Thyroidectomized (Tx)-immature rats receiving thyroidectomy on day 22 were treated with 8 IU equine chorionic gonadotropin (eCG) at 26 days of age to induce follicular development in ovaries. Ovaries or ovarian granulosa cells were collected on the first proestrus (day 28). Enhanced expression of aromatase (CYP19) mRNA induced by eCG treatment was inhibited by injection of thyroxine (T(4): 5 microg x 6 times) in Tx rats. Ovarian granulosa cells harvested from Tx rats were cultured for 24 h in chemically defined serum-free medium containing gonadotropin in the presence of 3,5,3'-triidothyronine (T(3)). Addition of low doses of T(3) (10(-8), 10(-7) M) to the medium significantly decreased 17beta-estradiol (E(2)) levels, whereas high doses of T(3) (10(-6), 10(-5) M) did not inhibit the levels. Similar effects of T(3) on CYP19 mRNA expression were observed. These results indicate that augmentation of E(2) production in hypothyroid animals may be mediated, in part, via the stimulation of CYP19 mRNA expression in granulosa cells, which is suppressed by thyroid hormone.