We three students of Saga Medical School visited medical centers in the United States and the United Kingdom as an elective course in the sixth year of medical education. One of us went to Sutter Medical Center, Santa Rosa, California, in the United States for 4 weeks, and two of us went to the University of Leicester in the United Kingdom for 4 weeks. These experiences led us to reconsider Japanese medical education, medical system, and hospital volunteers from different points of view.

Objective: There are some cases in which the original drug and generic, or various generic drugs have different flavors.  In prescription substitution, there is concern that difference in the flavor of the drug will influence on medication adherence.  Therefore pharmacists should sufficiently understand information regarding the flavors of drugs.  We investigated the source of information on flavor and an actual flavor.
Methods: The study was limited to antibiotic powders for pediatric patients, 43 original drugs and 68 generic drugs were examined.  We collected information on the flavor by the paper document, such as pharmaceutical reference issued by the pharmaceutical companies, and by telephone.  We investigated the inclusion of the paper document, presence of descriptive information on the flavor listed in the paper document and the concordance between the flavor of the original drug and that of the generic drug.
Results: For both the original drugs and generics, a flavor was added to many drugs (86.0 and 91.2%, respectively).  There were many cases in which the original drug and generic drug had different flavors.  However, information on the flavor was only described on the paper document of 28.6% of original drugs and 45.3% of the generic drugs.  Inquiry to the pharmaceutical companies by telephone was needed to know the flavor of drugs not described.  The inclusion of the paper document varied greatly with each pharmaceutical company.
Conclusion: In the promotion of prescription substitution, it is necessary to promote proper administration of generic drugs by maintaining and collecting information on the flavor, and providing sufficient information to patients.

BACKGROUND: Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. METHODS: Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. RESULTS: A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. CONCLUSION: We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.
Area Under Curve ; Blood Glucose ; Diabetes Mellitus ; Extracellular Fluid* ; Glucose* ; Humans ; Hydrogel ; Hyperglycemia ; Inpatients ; Mass Screening ; Plastics ; Sensitivity and Specificity ; Sodium