Objective: Generic drugs similar in appearance to their brand-name counterparts have both advantages and disadvantages.  This study aimed to investigate patient preferences regarding the appearance of generic drugs.
Design: A cross-sectional survey.
Methods: We conducted a web-based survey between 2013 and 2014.  Patients aged ≥40 years who reported taking prescription drugs for >6 months were asked to provide their opinions on the appearance of generic drug formulations and press-through packages (PTPs).  Medical doctors and pharmacists were asked as to what type of appearance of generic drugs would be suitable as well as whether the appearance of these drugs and PTPs should be similar to that of their brand-name counterparts.
Results: A total of 911 patients, 238 pharmacists, and 81 medical doctors responded to the survey.  Most of the patients (45.3%) surveyed reported that the similarity in the appearance of generic drug formulations and PTPs to those of their brand-name counterparts was not important, whereas only 15.6% of patients preferred generic drug formulations and PTPs similar in appearance to their brand-name counterparts.  In contrast, most of the medical doctors (53.1%) and pharmacists (88.2%) reported that the appearance of generic drug formulations and PTPs should be similar to that of their brand-name counterparts.
Conclusion: Patients’ opinions on the appearance of generic drugs differ from what medical doctors and pharmacists perceive them to be.  Therefore, health care professionals should select generic drugs with an appearance as per the individual patient’s preference.

Hyaline ring granuloma (HRG) is a comparatively rare inflammatory condition occurring mainly in the oral region, and is characterized by hyaline rings (HRs) formed in the granulation tissue. This study describes a case of HRG occurring in the mandibular periosteum of an 18-year-old male. Histopathologic, histochemical and electron microscopic studies were performed on surgically excised materials. Histopathologically, ovoid bodies (OBs) surrounded by thin hyaline walls and HRs showing pale-stained eosinophilic thick hyaline walls were both detected. Histochemical study revealed that the OBs contained many granules chiefly composed of starch. Ultrastructurally, the HRs presented a stratiform structure due to the accumulation of cross-banded collagen fibrils with a basement membrane-like lining containing cellulose microfilaments. These results suggest that HRs are formed as follows: the exogenous vegetable materials are encapsulated by collagen, then the component is gradually degraded; the residual cellulose fraction adheres to the inner surface of the collagenous capsules, and the continuous deposition of collagen at the outer surface of the capsules increases its thickness. Finally, thick hyaline walls of HRs are formed. The possible pathogenesis of this curious lesion is discussed for stomatologists.

Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, n=31) and an OPCAB group (off, n=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, p=0.01), respiratory failure (on=58.1% : off=29.3%, p=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, p=0.01), and necessary inotropic support (on=51.6% : off=17.1%, p=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.

Objectives: First steps to promote the proper use of medicines in remote islands and rural areas are as follows: (1) recognition of the profession of “pharmacist” from secondary-remote-island residents who do not have a pharmacy or drugstore or the opportunity for pharmacist contact and (2) an understanding by remote-island residents of the advantages of having a “family pharmacist.”
Methods: Repeated “medicine information and consultation sessions” for secondary-remote-island residents of Japan’s Nagasaki Prefecture were held.  Residents were then surveyed for changes in awareness of or demand for pharmacists and the nature of such changes.
Results: Before the information sessions, 29.7% of residents did not recognize the profession of pharmacy, but the extent of their recognition increased after information sessions were concluded.  They were asked “Who explains medicines in a way that is easy to understand ?”; more than half responded “doctors” before the information session, but after information sessions were concluded, those who said “pharmacists” increased.
Conclusion: Conducting “medicine information and consultation sessions” for residents of secondary-remote islands and rural areas enabled them to understand the profession of pharmacy.  The initiatives in the present study are first steps toward promoting proper use of medicines by residents of remote islands and rural areas who use “family pharmacies/pharmacists.”

Objective: To compare effects of the fluoropyrimidines S-1 and capecitabine on prothrombin time international normalized ratios (PT-INR) of warfarin following coadministration and after discontinuation of each fluoropyrimidine treatment.
Methods: Medical records of patients receiving warfarin with either S-1 (6 patients) or capecitabine (7 patients) were obtained from four hospitals.
Results: Increased PT-INR was observed until peak levels of warfarin were achieved in all patients in S-1 and capecitabine treatment groups.　Moreover, PT-INR significantly changed after coadministration within each group (p＜0.05).　Specifically, ratios of peak PT-INR after coadministration of each fluoropyrimidine and those following administration of warfarin alone (PT-INR elevation ratio) were 3.31 and 3.29 in S-1 and capecitabine coadministration groups, respectively.　Moreover, numbers of days to peak PT-INR were 38.3 and 31.3 days, respectively, and did not significantly differ between the treatment groups.　Furthermore, PT-INR returned to pretreatment levels by 17.5 and 15.1 days after discontinuation of S-1 and capecitabine, respectively, and did not significantly differ between the treatment groups.
Conclusion: Coadministration of S-1 and capecitabine similarly prolongs PT-INR by approximately 3-fold compared with administration of warfarin alone; therefore, these drug-drug interactions were clinically suggested to be of high risk for episodes of bleeding and remarkable alterations in coagulation parameters.　Therefore, blood coagulation ability should be more carefully monitored with regard to PT-INRs in patients receiving warfarin with S-1 or capecitabine not only during coadministration but also after discontinuation of fluoropyrimidine treatments.

Objective: The revised Pharmaceutical Affairs Act that came into force in June 2009 prohibits the sale of nonprescription drugs via mail.  However, as a provisional measure, regular users and inhabitants of remote islands who do not have access to pharmacies or drug stores are allowed to purchase nonprescription drugs via mail until the end of May 2013.  This study involves a survey on the purchasing of nonprescription drugs by Internet-illiterate inhabitants of the remote Goto Islands, Nagasaki Prefecture, Japan.
Methods: Our process began with the distribution of questionnaires via mail to inhabitants of the remote Goto Islands, of whom 3,819 were randomly selected.  The responses were sent between January 22 and February 26, 2011.  We analyzed problems presented by 522 inhabitants who were Internet-illiterate.
Results: The results revealed that 57.3% of the respondents living on large islands—with pharmacies, drug stores, and pharmacists— (e.g., Fukueshima) and 85.3% of respondents living on small islands scattered around large islands—with none of the abovementioned amenities— (e.g., Maeshima) were Internet-illiterate.  Additionally, a majority of the respondents (more than 80%) felt no need to purchase nonprescription drugs over the Internet.  However, considering that a handful of these inhabitants do, or will at some time need to purchase nonprescription drugs over the Internet, we strive to establish an optimal system for supplying medications to these Internet-illiterate inhabitants.
Conclusion: Community pharmacists need to establish close relationships with the Internet illiterate (particularly those living on small islands) and promote the overall appropriate use of medicinal products.

Anxiety and difficulty in administering medication to nursery school children has been reported among nursery school teachers. This study aimed to elucidate these issues and explore the possibility of pharmacist support and collaboration. We conducted a postal survey in September 2019 among nursery schools in Tokyo that are categorized as government-authorized schools, certified childcare centers, and prefectural governor-certified schools. A total of 1,537 schools responded to the self-report questionnaires (response rate: 41.2%), and 1,533 responses were analyzed. Of these, 1,488 schools were asked if they would accept requests to administer medication to their school children, and 60.1% of the nursery schools responded that their staff (including teachers and nurses) found it difficult to administer medication. The issues identified included psychological burdens (such as nervousness and pressure about giving the correct medication), staff shortage, insufficient time with the children, and human factors (such as personal perceptions of medication). Additionally, excessive requests to administer medication, caregiver behavior such as low awareness of children’s health and appropriate medication, and poor medication adherence at home were identified as issues. It was suggested that pharmacists could help alleviate these problems through their daily work at the pharmacy. Approximately 49-62% of schools responded that they would request the collaboration of community pharmacists to conduct training sessions for nursery school staff, provide health support for caregivers, and provide general health and medication consultations. The collaboration between nursery schools and community pharmacists may gain importance in the future.

A 6-year pharmaceutical education system was initiated over a decade ago in Japan because highly skilled pharmacists are needed by communities and hospitals. The current national examination for pharmacists consists of three sections, and its primary purpose is to assess the ability of students to apply the pharmaceutical knowledge they attained at university or college to real-world practice in medical care. We aimed to examine the attitudes of clinical pharmacists working in community pharmacies and hospitals regarding the practical section of the national examination for pharmacists. An online survey was conducted between November 2018 and January 2019. The results of this survey showed that 15 out of the 50 total pharmacists surveyed attempted to answer or skimmed through some questions from the practical section of the 103rd national examination for pharmacists. On the contrary, a little less than half of the pharmacists disregarded the examination content. The participants answered 10 questions extracted from the 103rd national examination that were related to real-world practice. They considered most information to be necessary knowledge in clinical situations, e.g., that concerning drug and food interactions. Furthermore, self-medication and treatment at home that are and will be increasingly required for pharmacists in the future were considered relevant and important.

Objective:Marketing specialists (MSs) from pharmaceutical wholesalers might shore up post-marketing surveillance (PMS) by pharmaceutical manufacturers. The purposes of this study were as follows: to research problems in PMS found by market specialists, to find solutions for these problems, and motivating MSs to work on PMS. Methods: We conducted a workshop with 12 MSs, who were already working on PMS operations. Participants were divided into three groups. Each group discussed problems with their PMS operations using the KJ method, discussed the potential solutions for the problems, and finally presented them in a plenary debate session. Questionnaire surveys were conducted for the participants before, immediately after, and 6 months after the workshop. Results: This workshop revealed two crucial and urgent problems on PMS faced by MSs: lack of feedbacks to clinical site and lack of publicity of the significance of PMS by MSs. Several solutions were suggested: browsing system of collected information, publication of the stages of improvement in pharmaceutical preparations and packaging, and distributing leaflets about PMS by MSs. In addition, this workshop conferred a positive influence on the participants: in the post-workshop questionnaires, most of the participants answered that they could well understand the problems (92%) and the solutions (75%) on PMS, and that they could improve their attitudes toward PMS operations (83%). . Conclusion: This workshop was quite effective for most of the participants in searching the problems, considering the solutions, and improving their attitudes. Organization of several such workshops might result in better PMS by MSs.