Objective: The present study aimed to investigate the identification codes of tablets used in clinical practice, and to clarify the influence of these codes on the differentiation of drugs brought in by patients, and those that have been dispensed as one-dose packages at Tottori University Hospital.
Methods: We obtained the identification codes of tablets, which were released on the market before December 2013, based on their package inserts.  Concerning drugs without identification codes, we conducted a questionnaire survey involving companies releasing these drugs in order to clarify the reasons for the absence of these codes.  Among the drugs brought to the Hospital by patients who were hospitalized in 2013, we investigated the identification codes of tablets dispensed as one-dose packages, and the accuracy of the differentiation of these tablets.
Results: We investigated a total of 5,797 tablets. Among the tablets in which the identification codes imprinted on one side of these tablets were the same, the other side did not have codes for 65 tablets (28 pairs), and had different codes for 1,836 tablets (198 pairs).  A total of 244 tablets did not have identification codes.  The most common reason for releasing drugs without such codes was the cost.  Investigation of the drugs brought in by patients hospitalized revealed that some pharmacists mistook Grinolart®50 mg for Glucobay®50 mg due to them having the same code.
Conclusion: To prevent the misidentification of drugs brought in by patients, hospital pharmacists need to cooperate with other hospitals and health insurance pharmacies, and dispense drugs while regarding their distinguishability as of major importance.  In addition, to increase the distinguishability, identification codes need to be imprinted on both sides of tablets, and there is a need to avoid manufacturing drugs whose identification codes are the same.

A 79-year-old man was admitted for thoracoabdominal aortic aneurysm repair. He had already twice undergone coronary artery bypass grafting, 19 and 2 years previously. The value of the ejection fraction of the left ventricle was 36%, measured by ventriculography; and transthoracic echocardiography revealed moderate aortic valve regurgitation. In the presence of aortic valve regurgitation or coronary artery disease, myocardial perfusion under hypothermic fibrillatory arrest may be significantly impaired. Therefore, to maintain a beating heart we used separate perfusions of the upper and lower body that enabled individual temperature control of each organ. The femoral and axillary arteries were cannulated, and a long cannula was inserted into the right common femoral vein and positioned in the right atrium. Cardiopulmonary bypass was established, and the upper body was mildly cooled until the pharyngeal temperature was 33°C, while the lower body was cooled until the bladder temperature reached 20°C. Mild hypothermia of the upper body maintained the beating heart, and deep hypothermia in the lower body provided adequate protection to the spinal cord. Furthermore, in a case of aortic valve regurgitation and low left ventricular function, left ventricular venting is essential for the heart. However, it was difficult to insert the venting tube through the apex of the left ventricle or through the left inferior pulmonary vein; therefore, we selected the left main pulmonary artery for left ventricular venting, and maintained a non-working beating heart. After cardiopulmonary bypass was discontinued, cardiac function was good although a bleeding tendency became apparent. Postoperatively, the maximum dose of dopamine we needed was only 3γ. There were no remarkable complications and the patient was discharged on postoperative day 30. This experience suggests that pulmonary artery venting and separate perfusion of the upper and lower body to individually control organ temperatures is a useful procedure for thoracoabdominal aortic aneurysm repair in patients with low left ventricular function.

A 72-year-old man suffering from postinfarction angina and atrial septal defect (ASD) underwent a combined operation of four bypass graftings and direct closure of ASD. The great saphenous vein was harvested with the use of a bipolar Nd-YAG laser dissector without scissors or threads. Nd-YAG laser (wavelength: 1.064um) was irradiated to the branches of the saphenous vein through the ceramic tips of the dissector. After about five minutes exposure, the branch was dissected and bleeding from the dissected edge was not seen. Postoperative angiogram six months after grafting showed all grafts were patent, and morphological abnormalities such as reginoal shrinkage, diffuse narrowing and aneurysmal dilation were not observed. We conclude that laser graft harvesting using the bipolar dissector is safe and effective in saving time.

Objective: There is little information on the effectiveness and safety of health foods for pregnant women. The purpose of this study was to analyze the risk of health food to pregnant women and fetuses from pharmaceutical interventions and clarify the problems for standardization of pharmaceutical management and guidance.Methods: Among 243 pregnant inpatients who received consultations from our pharmacists, 61 subjects were taking health food products were recruited from May 2015 to April 2017. We developed novel guidelines for the use of health food products for pregnant women, and used the guidelines to provide pharmaceutical interventions. Results of these interventions were reviewed retrospectively to identify issues associated with pharmaceutical management of the use of health food products.Results: Among 61 subjects, 10 (16%) received a total of 11 interventions for the use of health food products. Suggestions to discontinue the use of health food products were accepted by 9 subjects (82%). The majority of interventions (n=7, 64%) were related to therapeutic disadvantages of health food products, such as “bleeding complications during childbirth” and “interaction with other medicines”. Information on the number of weeks of pregnancy, drug history, and treatment status were used to trigger and determine appropriate pharmaceutical interventions.Conclusion: From the intervention cases, the potential disadvantages associated with the use of health foods were confirmed, and the risk status of pregnant women and fetuses associated with the use of health foods was clarified. It is necessary to intervene before embarking on using health foods, to make judgements based on risk assessment considering the number of weeks of pregnancy and patient background, and to provide accurate information to pregnant women. We anticipate that future studies will provide additional insights into the effects of health food intake on pregnant women, and that support systems for pregnant women will be established by medical professionals.

Objective: Self-medication is promoted to extend healthy life expectancy. Accordingly, it is important for general consumers to properly use over-the-counter drugs. We investigated whether graphical symbols to visually aid the understanding of drug information (i.e., precautions and instructions to consult with a medical professional) provided in over-the-counter drug package inserts are easily understood in light of the International Organization for Standardization (ISO) criterion of 66％ comprehension. Methods: First, two questionnaire surveys were conducted with pharmacy students to calculate their comprehension level of the illustrations. The first round was for modifying illustrations that did not meet the ISO standard, and the second round was for seeing if comprehension had improved. Then, a questionnaire survey targeting general consumers was conducted to see if these illustrations functioned as graphical symbols. Results: When the referent of “Do not take this medicine if your experience falls under the following conditions” was placed in the upper left corner of the symbol, some students answered that this meant, “If you do not take this medicine, you will be under the following conditions,” but when it was placed in the lower right corner, many students accurately understood the intended information. In the student surveys, one illustration each for “cannot be taken/under treatment/heart,” “cannot be taken/under treatment/stomach,” “cannot be taken/under treatment/liver,” and “cannot be taken/under treatment/kidney” all exceeded 66％. Since none of the illustrations exceeded the 66％ comprehension in the survey of general consumers, it was found to be difficult for general consumers to understand drug information from the present illustrations. However, there were several illustrations that improved in comprehension compared to the previous study, which makes the continuation of this study significant. Conclusion: Although there were no illustrations exceeded 66％ comprehension of general consumers, the study shows that continued improvement may result in establishing pictograms for general consumers.