Medicine, Kampo ; Pulmonary evaluation ; Therapeutic procedure ; Geriatrics

We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.

In order to promote the proper use of medicines, it is important to conduct effective pharmaceutical education and establish a basic knowledge of medicines. We investigated to clarify the current situation and issues of pharmaceutical education. In June 2017, we administered surveys to 1,152 junior high school third graders and 23 health and physical education teachers who taught pharmacy in junior high schools. A total of 1,079 junior high school third graders and 23 health and physical education teachers answered the survey. We found that 6.5% of the students were taking health foods and supplements, and 17.9% always carried medicines. Further, 30.7% of the students regularly checked the effects and side effects of the medicines they took. Moreover, while only 9.0% of the students knew the word “self-medication,” 66.6% had a prescription notebook. Meanwhile, 39.1% of health and physical education teachers were conducting pharmaceutical education classes. Some of them developed their own textbook. All teachers answered that they would like to promote pharmaceutical education. As it was found that junior high school third graders take medicines daily, it is important to develop an educational system that enables them to further improve pharmaceutical education in junior high schools and to acquire correct knowledge. Therefore, it is important that school pharmacists actively participate in pharmaceutical education and promote close cooperation with physical education teachers.

In order to promote the proper use of medicines, it is important to conduct effective pharmaceutical education and establish a basic knowledge of medicines. We investigated to clarify the current situation and issues of pharmaceutical education. In June 2017, we administered surveys to 1,152 junior high school third graders and 23 health and physical education teachers who taught pharmacy in junior high schools. A total of 1,079 junior high school third graders and 23 health and physical education teachers answered the survey. We found that 6.5% of the students were taking health foods and supplements, and 17.9% always carried medicines. Further, 30.7% of the students regularly checked the effects and side effects of the medicines they took. Moreover, while only 9.0% of the students knew the word “self-medication,” 66.6% had a prescription notebook. Meanwhile, 39.1% of health and physical education teachers were conducting pharmaceutical education classes. Some of them developed their own textbook. All teachers answered that they would like to promote pharmaceutical education. As it was found that junior high school third graders take medicines daily, it is important to develop an educational system that enables them to further improve pharmaceutical education in junior high schools and to acquire correct knowledge. Therefore, it is important that school pharmacists actively participate in pharmaceutical education and promote close cooperation with physical education teachers.

BACKGROUND/AIMS: Venous thromboembolism (VTE) is a major extraintestinal manifestation in inflammatory bowel disease (IBD), regarded as an independent risk factor for VTE according to reports from Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. We aimed to reveal the incidence and risk factors of VTE in Japanese IBD inpatients. METHODS: The incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557), and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD inpatients with and without VTE were compared in univariate and multivariate analyses. Clinical courses of VTE in IBD were surveyed. RESULTS: VTE was detected in 7.1% of IBD inpatients, significantly higher than in gastrointestinal cancer inpatients (2.5%) and inpatients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.7%) was much higher than that in those with Crohn's disease (3.6%). In the univariate analysis, the risk factors were an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The in-hospital mortality rate of IBD inpatients with VTE was 4.2%. CONCLUSIONS: The incidence of VTE with IBD, especially UC, was found to be high compared with other digestive disease, which was almost equivalent to that of Western countries. The efficacy of prophylaxis needs to be investigated in Asian IBD patients.
Asian Continental Ancestry Group* ; C-Reactive Protein ; Central Venous Catheters ; Cohort Studies* ; Colitis, Ulcerative ; Crohn Disease ; Gastrointestinal Diseases ; Gastrointestinal Neoplasms ; Hospital Mortality ; Humans ; Incidence* ; Inflammatory Bowel Diseases* ; Inpatients* ; Multivariate Analysis ; Prednisolone ; Retrospective Studies* ; Risk Factors* ; Serum Albumin ; Venous Thromboembolism*

Objective: Owing to inconspicuous memory impairment during early disease stage, patients with dementia with Lewy bodies (DLB) are often diagnosed with mental disorders according to depressive symptoms and visual hallucinations. Severe sensitivity to antipsychotic agents, a DLB characteristic, increases mortality. Herein, we reviewed current challenges and approaches for early DLB detection and appropriate drug use by evaluating pharmacists' ability to recognition of DLB and their level of involvement in medication consultation with dementia patients.Designs: This is a cross-sectional study in Japan.Methods: We provided an anonymous self-administered survey questionnaire to 372 community pharmacists. Descriptive statistics,chi-square test (attributes, recognition, and experiences with medication consultation), and content analysis (free description of drug hypersensitivity) were used for data analysis.Results: The recognition rates for questions on DLB symptoms were as follows: visual hallucinations, 76%; delusion, 63%; other symptoms, including those categorized as core clinical features, such as fluctuating cognition, and REM sleep behavior disorder,＜40%. The rate of other symptoms was similar to that of false recognition of Alzheimer's disease symptoms. The recognition rate of certain DLB symptoms varied depending on pharmacists' experience in medication consultation with dementia patients and drug-induced evaluation during delirium/cognitive decline over the previous month. Approximately 65% of the participants did not respond to open questions on symptoms suggestive of drug hypersensitivity, whereas 55% of those who responded referred to allergic symptoms such as rashes.Conclusion: Owing to their lack of recognition of DLB symptoms, the current contribution of pharmacists to early DLB detection and proper drug use is limited. Thus, it is important to provide patients' observation points and method of questioning during interviews so that pharmacists can easily recognize DLB symptoms. It is critical to clarify that DLB drug hypersensitivity is attributed to mechanisms different from that of drug allergy.