The Japanese Society of Social Pharmacy decided during the 34th Annual Meeting to work on and provide medication education, based on the assumption that deepening the basic level of understanding of medication will contribute to its dissemination and enlightenment regarding its appropriate use. Although medication education was introduced into junior high schools in FY 2012, considering the importance of teaching elementary school children, our society has held two training workshops for pharmacists to help them teach children about the appropriate use of medication. Offering medication education according to children’s developmental stages can help children with non-serious diseases appropriately use their necessary medication while consulting experts, and also prevents disease aggravation if children can notice side effects in the early stages. This indicates the possibility of children acquiring the ability to protect their own health (self-medication). We are convinced that medication education will serve as basic knowledge for children to understand medical care they receive in the future. Medication education is a task which should be addressed not only by school pharmacists or family pharmacists in the community, but also by all types of pharmacists as educators; thus, we hope that this workshop will be useful support for such pharmacists to provide medication education.

Objective: In previously reported comparisons of aminoglycoside antimicrobials administered once daily versus multiple administration, toxicity was found to be equal or lower while efficiency remained high.  However, there are few reports on the clinical condition of targeted elderly persons.  The objective of this study was to evaluate the once-daily dosing regimen of 400 mg of AMK involving elderly pneumonia patients aged 75 years or older with regard to clinical evaluation including the efficacy and toxicity.
Methods: A survey to clinically evaluate the efficacy and toxicity of 400 mg AMK administered once daily for 30 min at 24 h intervals was carried out.  One hundred twenty-seven patients with pneumonia and who were 75 years or older at Funabashi General Hospital were targeted, with the aim of an expected clinical effect of C_max/MIC≥ 8-10.  Serum concentration monitoring was carried out after administration began.
Results: There were 121 patients (95.3%) of controlled AMK concentration with a trough serum concentration of <10 μg/mL, which is a safe concentration range.  There were 6 patients (4.7%) where trough serum concentration in the toxic range >10 μg/mL, with an average at 15.1±5.0 μg/mL, and the average administration days were 7.5 ± 3.3 days.  Moreover, before/after AMK administration, there were 3 patients (2.4%) where CRE values increased more than a 150% over the previous values, and were evaluated as renal dysfunction.  Average trough serum concentration at that time was 3.6 ± 1.1 μg/mL, and average number of days of administration were 13 ± 1.4 days.  Patients of trough serum concentration in the toxic range >10 μg/mL were not included.  The average peak serum concentration calculated by Winter’s pharmacokinetic parameter and the 1-compartment model was 35.3 ± 8.0 μg/mL, and the average C_max/MIC which correlates with the AMK effect was 9.9 ± 2.2.  The treatment was effective for 83 (65.4%) of the 127 patients.
Conclusion: By once-daily administration of AMK 400 mg to aged persons 75 years or older, change in trough serum concentration into a safe range and C_max/MIC≥ 8-10, the level at which clinical effectivity can be expected, could be achieved.  This administration method is shown to be useful in maintaining AMK in the target serum concentration range for aged persons.

We conducted a questionnaire survey involving 270 interns in the year 2011 at the pharmaceutical department of Teikyo University, in order to clarify pre- to post-practical training changes in: 1) the degree of pre-clinical training’s usefulness, 2) desired workplace in the future, 3) degree of satisfaction, 4) confidence degree of practical training, etc. The degree of pre-clinical training’s usefulness exceeded 80% in all training periods. Regarding the desired workplace in the future, a large proportion of students answered that they want to become a pharmacist in a pharmacy or hospital, both before and after their practical training in all training periods. Also, it was estimated that students decide their career with reference to their practical training experience. In terms of the degree of satisfaction with practical training, the proportions of those who answered “Satisfied” or “Somewhat satisfied” were: 95.1% in the 1st, 95.6% in the 2nd, and 86.1% in the 3rd periods. The confidence degree significantly increased after practical training in all periods. Because the confidence degree showed a tendency to be higher before the 3rd period of training compared to the other two periods, it was considered that students’ experience of practical training led to increased confidence degree. Regarding communication abilities, the degrees of before-after confidence degree and pre-clinical training’s usefulness were low, and, hence, it was suggested that pre-clinical training needs to be further improved regarding these areas.

  We require our students in the 4th grade to take an on-site pediatric outpatient clinic course at the Teikyo University Hospital as part of a 4-week on-site training program.  This year, 64 trainees divided into groups of 3 or 4 students took the course between June and August.  In the morning, trainees were asked to conduct clinical interviews with 287 patients’ guardians in the presence of trainers.  This was followed by the observation of consultation and treatment services provided to patients.  In the afternoon, students reported the findings obtained in medical interviews, participated in group discussions, and received supplementary lectures from trainers.  After completing the course, students were asked to fill in a questionnaire.  When asked whether they were satisfied with the course, 62.5% and 37.5% of students said “very satisfied” and “satisfied,” respectively, while 64.1%, 29.7%, and 6.2% of students said the observation of consultation and treatment services was “very good,” “good,” and “cannot say which,” respectively.  About the medical interviews, 64.1% and 34.4% said that it is “very good” and “good” to conduct them, while 1.5% said “cannot say which.”  All students said they could determine the problems faced by guardians regarding drugs in the medical interview.  The on-site pediatric outpatient care course was found to be “very useful” and “useful” by 62.5% and 35.9% of patients, respectively, while 1.6% said “cannot say which.”  In conclusion, most students were greatly satisfied with the medical interview with guardians using a questionnaire and said that it made it possible for them to closely communicate with guardians.  This result was thought to be attributable to the use of the techniques of the medical interview OSCE which the students learned prior to conducing medical interviews with guardians.

A 76-year-old man was admitted to our hospital because of sudden upper abdominal pain and shock status. The patient had undergone Miles' procedure with a colostomy on the left lower abdomen due to rectal cancer at the age of 70 years. CT scans revealed a thoracoabdominal aortic aneurysm. In view of the clinical findings, ruptured aneurysm requiring emergent operation was diagnosed. A left spiral skin incision was made, keeping away from the colostomy. An extraperitoneal approach was selected. The thoracoabdominal aorta was replaced with an artificial graft under partial extracorporeal circulation with femoral arterial and venous cannulation. The postoperative course was uneventful. No paraplegia occurred in spite of no reconstruction of the intercostal arteries due to severe atherosclerotic changes of the aortic wall. The fact that bleeding due to ruptured aneurysm was localized in the extrapleural and extrapritoneal spaces seemed to be an advantageous factor for the success in this case.

Sound management of hospital in Japan in general has become more and more difficult with frequent reductions in the fees officially paid to medical institutions for medical examinations and treatments, and this current situation obviously necessitates a more efficient way of hospital management and ardent efforts at improvement on the part of our hospital as well. The Division on Nursing has set the goals to implement thoroughgoing cost-management strategies and to strengthen cooperation with other divisions. For this purpose we visited the hospital wards jointly with other personnel from the Divisions of Medical Materials and Dispensary to check inventories of medical materials and to make them optimum. As a result, it was found that medical materials were often improperly placed, stored excessively, or returned inaccurately. The instructions for redefining the proper quota of the medical materials per ward, putting them in order and returning them properly in case of excess facilitated direct communication and cooperation between divisions, and resulted in inventory reduction and thus the annual costs of returning them. These efforts successfully inspired each staff member to participate voluntarily in the management of our hospital, which eventually led to reasonable inventory control of medical materials. It would be important for each division, while demonstrating its specialty, to realize the importance of cooperation to reach far greater achievements.
Hospitals ; Materials ; seconds ; cooperation ; Medical

A 47-year-old woman complained of dyspnea on exertion. Ultrasonic cardiography revealed coronary sinus type atrial septal defect. At operation, the drainage veins to the left atrium from the coronary arteries were observed but no anomalies of the vena cave or any other veins were observed. The defect was closed with a pericardial patch under cardiopulmonary bypass. The post-operative course was uneventful. Coronary arteriography performed on the 14th post operative day confirmed that the coronary veins drained individually into the corresponding atria. Unroofed coronary sinus is rare and difficult to diagnose prior to operation. Ultrasonic cardiography and coronary arteriography are considered useful for preoperative diagnosis.

The patient was a 63-year-old man with a history of multiple mononeuritis with hypergammaglobulinemia since 1980. The symptoms gradually worsened, and he had been bed-ridden since 1992. On February 28, 1997, he had sudden dyspnea after defecation. Echocardiography demonstrated a large thrombus in the right atrium and the right ventricle. Enhanced chest computed tomography revealed thrombi in the bilateral pulmonary arteries. The patient was considered to have acute pulmonary thromboembolism, and an emergency operation was indicated. Thrombectomy was performed under extracorporeal circulation through a median sternotomy. No thrombi were found in the right atrium or the right ventricle, and thrombi in the bilateral pulmonary arteries were removed completely. Four days after the operation, a Greenfield filter was implanted in the vena cava inferior because venography detected a thrombus in the right common iliac vein. The postoperative course was uneventful. No pulmonary rethromboembolisms were noticed after the operation. The long duration of being bed-ridden seemed to be the chief cause of thrombosis in the deep veins, and hyperviscosity due to hypergammaglobulinemia may have caused hyperthrombogenicity.

Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA’s diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

Pain is a common problem all over the world. A previous report estimated that the prevalence of pain is 40% in Japan. One of the roles of pharmacist is to build evidence with more patient-centered care, but less in region of pain. Our objective was to identify pharmacists’ contributions to patient care through pain-management using PainVision (PV) in an outpatient pain clinic and interventions with polypharmacy. We investigated 28 patients who underwent nerve blocks. Pain were assessed relatively and subjectively using PV and numerical analogue scale (NRS), respectively. The pharmacist intervened pre- and post-nerve block. Interventions focused on evaluations of pain, drug efficacy, complications, blood pressure, pulse rate, and oxygen saturation. Wilcoxon signed-rank test, Spearman rank correlation coefficient and Friedman test were used to analyze the data. The mean age of the patients was 77 (interquartile range 69-84) years, and 12 patients were diagnosed with zoster-associated pain. The pharmacists consulted with patients 213 times and evaluated pain 426 times. We found that the analgesic effect of nerve block were evaluated PV (70; 23-162→20; 5.0-49) and NRS (4; 2-6→1; 0-2) by pharmacist, significantly. It was significant correlation between PV and NRS (r=0.799: P<0.001). Our study showed similar results to previous studies in which doctors and nurses used PV. It is clinically valuable for pharmacists to using PV in outpatient clinics to evaluate pain. Greater roles for pharmacists in hospital outpatient department should be considered, especially pharmacist-led clinical research.