Recently, the number of physicians using Kampo (Japanese traditional herbal) medicines has been increasing in Japan, and it is becoming more common for pharmacists to dispense Kampo medicines. As Kampo medicines become more popular, in addition to extract formulae, the use of decocting formulae that are more suited to each patient's predisposition and symptoms has increased. Therefore, more pharmacists are dispensing such decocting formulae. However, dispensing decocting formulae can be a complicated task. The risk of dispensing errors is not small. In present paper, we examined preventive measures based on investigations of errors involving decocting formulae in our Kampo clinic. From 1990 to 1999, there were 54 cases in which errors were found after patients received their medicines, and 44 of these cases were dispensing errors. To prevent such errors, in addition to having the knowledge of Kampo medicine and medicinal herbs that is needed for dispensing decocting formulae, it is also necessary to understand the contents of the prescription. The most important preventive measures are to re-inspect the weight and contents of the prescription after preparing it, and to do a final inspection of the medicine contents with the patient. It is expected that this report will play a role in preventing dispensing errors of Kampo medicines by pharmacists.

For the dispensing of Kampo formulas, only an adult dose is described by conventional formulary. Therefore a child's dose is often prescribed by reducing instructions for the fraction-times of an adult dose. However, it is necessary to study whether the content of Kampo-extract pharmaceutical preparations at a child's dose, are similar to decoctions prepared by reducing the dose of crude drugs, and reducing the quantity of water by fraction-times. Therefore it was compared whether the constituents of a decoction liquid at an adult dose, were equal to those of a child's dose. In the decoction method of our clinic, adult doses are decocted with an initial 600mL quantity of water to half volume, as per the normal decoction method, whereas children's doses are reduced to 2/3 or 1/3 times that of adult dose, and decocted to half of the early-stage quantity of water that they are with adults. In the present study, three Kampo formulas which have been used frequently in our clinic and have different prescription weights i.e., Oren-gedoku-to (9g), Keishi-bukuryo-gan-ryo (20g), and Juzen-taiho-to (33g) were studied. When child and adult doses were compared, a difference was noted in pH, extraction rate and extracted constituents. Extraction rates for a child's dose of Oren-gedoku-to and Juzen-taiho-to were lower than that of an adult dose. Extraction rates of component gradients? ferulic acid in Oren-gedoku-to, pae-oniflorin in Keishi-bukuryo-gan-ryo, and paeoniflorin and liquiritin in Juzen-taiho-to? for a child's dose were lower than those of an adult dose. However, extraction rates of component gradients? albiflorin in Keishi-bukuryo-gan-ryo and albiflorin and trans-cinnamic acid in Juzen-taiho-to ? for a child's dose (quantity of 1/3 times) were higher than those of an adult dose. These results suggest that the content of a decoction, which was prepared by reducing an adult dose to the fraction-time of a child's dose, is not the same as reducing the amount of Kampo-extract pharmaceutical preparation to the fraction-time of a child's dose.

  Recently, the number of outpatients who visit the hospital only for the examination is increased in Ofuna Chuo hospital.  It is important that the pharmacists manage the contrast media used to these outpatients for the rational drug therapy.  However, there are a few hospitals where the pharmacists work in the laboratory.  Therefore, we investigated the effect of the providing drug information by pharmacists to the patients received magnetic resonance cholangiopancreatography (MRCP) in the laboratory.  The subjects were consisted of 38 patients who were taken with Bothdel®Oral Solution 10 during receiving MRCP.  The pharmacist instructed the patients about Bothdel®Oral Solution 10 before MRCP.  The percentage of patients who were already treated with the other drugs was 92.0%.  The 4 patients were taken the drugs interacted with Bothdel®Oral Solution 10 and then were able to prevent the drug interaction by the pharmacist.  Also, the patients were taken the questionnaire form about the adverse events of this drug and sent it to the pharmacy by mail after more than 5 days.  As the results, the gastrointestinal symptoms such as a loose stool and a diarrhea were reported 28.5% of the patients.  In addition, as the adverse events other than listed in the package insert, epigastric distress, heaviness of the head and hot flash, were shown in each of a patient, respectively.  In conclusion, it was very important that the pharmacists provide the information of rational use of contrast media to the patients who received examination.

The purpose of this study was to investigate differences between first-year (n=97) and second-year medical students (n=102) in their reactions to a community-based early clinical exposure program. Questionnaires completed after their participation in the program showed that first-and second-year students did not differ in their interest in practical training in nursing homes and wards of the university hospital or in a presentation given by a family member of a cancer patient who had died in the hospital (Chi square test, p<0.05). However, second-year students were more likely to report that they understood the family's presentation well, whereas first-year students were more likely to report they could communicate with elderly or disabled persons. Several facilities in the community criticized the students' attitudes toward practical training. We believe the reason for the criticism was insufficient advance preparation.