Objectives : A pharmacotherapeutic system for safe and proper use of warfarin was developed through physician-pharmacist cooperative practice ; its effects on patient adherence to therapeutic regimens and the therapeutic benefit of warfarin were assessed.
Methods : Subjects were 12 outpatients or home-care patients receiving warfarin. Patients' level of understanding of warfarin therapy and time in therapeutic range (TTR) were used as indices of adherence and therapeutic benefit, respectively. Before the physician examination, patients were interviewed by pharmacists using point-of-care testing with the CoaguChek ^®XS to check their prothrombin time-international normalized ratio (PT-INR). Pharmacists reported status of warfarin administration, any adverse effects, and medication management status to each patient's physician using the medication record or inter-institute information exchange sheet. Patient adherence was assessed before and after the pre-examination interview and changes in TTR were evaluated.
Results : Levels of understanding of warfarin therapy were significantly higher after pharmacists provided medication counseling (immediately before 4.8±1.9 vs 24 weeks after 6.8±2.4 ; P=0.0079, Wilcoxon signed-rank test). TTR significantly improved at 24 weeks after the interview (pre-interview 20.9±29.8% vs post-interview 60.5±30.5%, respectively ; P=0.0024, Wilcoxon signed-rank test).
Conclusion : The results suggest that patients'adherence to warfarin regimens and the therapeutic benefit of warfarin is improved by pharmacists'obtaining information on PT-INR before patients'medical examinations, as well as by utilizing this information to establish a cooperative pharmacotherapeutic system for good TTR management, as supported by a common protocol across pharmacies and medical institutions.

In this study, we investigated total sweat rate per unit area of body surface per hour (TSR), the percentage of total sweat loss to initial body weight (%TSL) and the percentage of fluid intake volume to total sweat loss (%FIV) in children (during baseball or basketball practice), young adults (during softball or baseball practice), and the elderly (during gateball practice) in summer. During the practice all participants were given access to drink sports drink or Japanese tea ad libitum. In the basketball group of children no sex difference was observed in TSR, %TSL and %FIV. Although TSR and %TSL in the baseball group of children were significantly higher than in the basketball group due to a higher WBGT, there was no group difference for %FIV. Children drank sports drinks (with carbohydrate-electrolyte) of the similar volume with total sweat loss. The baseball group of children showed a significantly greater %FIV compared to the young adult group regardless of simi lar %TSL, when they drank sports drinks. Children showed a significantly higher %FIV in sports drinks than in Japanese tea, whereas the %FIV of young adults was not affected by the type of beverage. The TSR, %TSL and %FIV of the elderly group were significantly lower than in young adults and children. These results suggest that children can prevent voluntary dehydration by con-suming sports drinks with carbohydrate-electrolyte ad libitum regardless of sex and WBGT, and that periodic drinking should be actively encouraged for the elderly because of their blunted rehydration ability, to prevent heat disorders during sports activity in summer.