The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

  Health service provision is one of the components in Universal Health Coverage (UHC). Medicines are vital for health services, and they should be affordable and accessible for safe and appropriate usage for everyone.  This article is a report on the symposium “Medicines for UHC,” held in the academic meeting of the Japanese Association of International Health in December 2017.  In Lao PDR, a study was conducted in urban and rural hospitals examining lists of available medicines, as well as their usage, distribution, and prices. The study showed that neurological medicines including anesthetics made up 29% of all medicines used in the urban central hospital, as it was one of the few hospitals that provided complex surgeries in Laos, resulting in a high concentration of patients. Anti-tuberculosis, ARV, and anti-Malaria medicines, as well as vaccines, were provided by Global Fund, GAVI, and other organizations, so that their costs were not included in the hospital’s procurement lists. While anti-microbial medicines only accounted for 13% of the medicines used at the urban central hospital, they accounted for 43% of those in rural hospitals, where most patients presented with upper respiratory and digestive infections. While the Ministry of Health sets the standards for evaluating and regulating the quality and cost of medicine, individuals can purchase medicines from private pharmacies without prescriptions, making it difficult to evaluate appropriate usage.  Regarding the quality of medicines, distribution companies, health workers, and patients cannot distinguish between authentic and falsified or substandard medicines. As an example, after a study in Cambodia revealed the existence of inappropriate medicines, the Cambodian government required companies to provide results of dissolution tests.  As the limitations on pharmaceutical regulatory authorities and their staff in developing countries impact their capabilities, we recommend supporting them in establishing effective pharmaceutical regulations internationally.

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.