Background : This questionnaire survey was performed to clarify the present status and especially the problems with dispensing herbal medicines and counseling patients.Objectives : To survey 15 pharmacies approved under the National Health Insurance System to dispense herbal medicines prescribed by Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital.Results : Twelve pharmacies responded that 1,900, the present fee allowed for dispensing herbal medicines, was low. The time for dispensing herbal medicine via an automatic packaging machine was half of that dispensed by humans. Many pharmacies requested a re-evaluation of the fee based on the length of a prescription and the number of herbs in a formula, and requested a re-evaluation of the drug price standards. About half of the pharmacists surveyed also had a poor knowledge of herbal medicines.Conclusion : We suggest that economical aspects of dispensing herbal medicine should be improved to secure more insurance pharmacies which can dispense herbal medicines. There is also a need to construct education systems for pregraduate and postgraduate university students in order to train pharmacists who will have a thorough knowledge of Kampo Medicine.
Medicine, Herbal ; seconds ; Surveys ; Insurance ; Analysis

Objective: Optimizing the time of ingestion and avoiding overdose are important aspects of medication therapy.  However, seeking explanations for selecting the time of ingestion and maximum dose for a certain drug is time consuming.  The aim of this study is to develop a database (DB) that enables a rapid search of the basis for the time of ingestion and maximum dose setting.
Methods: The basis for the time of ingestion and maximum dose setting were surveyed for 38 and 184 drugs, respectively.  Package inserts, interview forms, and other documents preserved in our department were surveyed, and this was followed by an inquiry of the staff of pharmaceutical companies.  Standard responses to a prescription with incorrect timing or dosage were determined and included into a DB together with information whose quality was dissected.  The efficiency of DB was evaluated: the time taken to obtain information and consistency of inquiries to clarify doubts concerning prescription with the use of DB and without the use DB were compared.
Results: The information of newer drugs, but not of the older drugs, were easily obtained without the need to inquire the staff of the pharmaceutical companies.  Operation of the DB was convenient and was acceptable for most pharmacists working in our department.  The DB markedly reduced the time taken to obtain information.  Further, with the aid of DB, the consistency in the responses to inquiries to clarify doubts concerning a pharmacist’s recommendation was remarkably increased.
Conclusion: The DB developed in the present study may contribute to the improvement of not only the efficiency but also the quality of dispensation.

We reevaluated our heparin and protamine administration protocol during and after cardiopulmonary bypass (CPB). In 12 patients who underwent cardiac surgery using a heparin-coated circuit under mild hypothermia, heparin concentration was measured with the Hepcon^®/HMS. Before initiating CPB, 1.5mg/kg of heparin was given to maintain the activated clotting time (ACT) at more than 400sec. Patients were divided into two groups. In group I (n=6), heparin was neutralized with an empirical dose of protamine (1.5mg protamine/mg initial heparin). In group II (n=6), the protamine dose was determined by the residual heparin concentration, measured with the Hepcon^®. Patients in group II received a lower dosage of protamine than group I (1.7±0.0 vs. 3.6±0.4mg/kg, p<0.001). There were no significant differences in the intraoperative bleeding, postoperative bleeding and activated clotting time between the groups. By determining the appropriate protamine dosage, this heparin analysis system may be useful in managing CPB.

Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.
Medicine, Kampo ; perceived risk ; seconds ; Therapeutic procedure ; Risk

BACKGROUND/AIMS: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later. METHODS: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. RESULTS: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. CONCLUSIONS: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.
Adenoma ; Biopsy ; Colon ; Colonoscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Multivariate Analysis ; Polyps ; Prospective Studies ; Recurrence ; Surgical Instruments

A woman in her 80s who had difficulty walking due to back pain was admitted to our hospital. Until two months earlier, she had been able to live independently in daily life. She was not severely constipated, did not take laxatives, and had not received an enema or undergone stool extraction. She had no abdominal symptoms, such as abdominal pain or distension. Surprisingly, however, computed tomography showed lower rectal perforation with subcutaneous emphysema in the pelvic retroperitoneum, hip, and left inguinal region. Therefore, we urgently performed abdominoperineal resection to save her. The lower rectum is a relatively uncommon site of perforation in the large intestine, and nontraumatic cases are rare. Elderly patients in particular may have only atypical symptoms and thus require careful attention.