The creation of the National Health Insurance program has greatly contributed to giving Japan the world’s highest level of life expectancy.  However, the cost of medical care in Japan has increased as a result of an aging society.  In response to this reality, the Japanese government initiated a campaign to promote the use of generic drugs (GEs).  In order to clarify some of the trends that contribute to different clinical medicine department usages of GEs, we carried out a survey of 400 pharmacies.  The survey data was analyzed using linear regression analysis.  Analysis of linear equations derived “utilization” that indicated ease of use of GEs, and a “saturation acceptable value (maximum allowed)” that indicated usage of GEs.  The breakdown for different clinical medicine department usages of GEs was determined as the following: psychosomatic medicine or psychiatry was 11±0.13%, internal medicine was 29±0.18%, orthopedics was 18±0.14%, ophthalmology or otolaryngology was 15±0.14%, other departments was 17±0.15%.  Furthermore, the highest utilization derived by linear regression analysis was orthopedics.  The highest acceptable saturation value was for psychosomatic medicine or psychiatry, while the lowest acceptable saturation value was orthopedics.  The results of the study confirm the importance of establishing evaluation methods for GE usage, and that linear regression analysis is a powerful tool for revealing trends in GE usage among different departments.  Additionally, the study suggests that determining GE spread measures is valuable, since they can serve as an aid to future pharmaceutical administration consideration.

Objective: Recently, the cost of medical care in Japan has increased as a result of an aging society.  In response to this reality, the Japanese government initiated a campaign to promote the use of generic drugs.  In spite of this campaign, Japanese consumers have doubts about the safety and reliability of generic drugs, resulting in lower usage of these drugs compared to usage in Europe and the US.
Methods: In order to clarify some of the factors that contribute to low rates of generic drug use, we carried out a survey of 400 pharmacies.  The survey data was analyzed using factor analysis and cluster analysis, which is a technique known as multivariate analysis.
Results: The results from factor analysis derived four factors: 1) generic drug usage related to generic drug prescription class, 2) the amount of generic drug prescriptions related to patient preferences, 3) patient willingness to use generic drug prescriptions, and 4) pharmacy willingness.  Cluster analysis was used to classify pharmacies participating in the survey.  The results of cluster analysis revealed three main pharmacy groups: a) low usage of generic drugs, b) moderate usage of generic drugs, and c) high usage of generic drugs.
Conclusion: The results of multivariate analysis showed that pharmacists are more willing to issue generic drugs unless doctors instruct them to use a brand-name drug.

Objective: In The Hospital of Hyogo College of Medicine, a oral rinse containing polaprezinc (PZ), a zinc-containing drug for gastric ulcers, was used as a hospital preparation to treat radiotherapy-related oral mucositis, and its efficacy was reported.  However, the dispersibility of PZ for carboxymethylcellulose sodium (CMC), which was used as the base of the oral rinse, was unfavorable, raising an issue.  In this study, we newly prepared a PZ oral rinse containing carboxyvinyl polymer (CP) as a base, and examined its usefulness.
Methods: A questionnaire survey regarding the usefulness involving 10 healthy volunteers and a pharmaceutical test were conducted.
Results: The results of the questionnaire survey showed that the optimal concentration of CP was 0.5%.  There were no serial changes in the pH, adhesiveness, or PZ content for 7 days after preparation.  Furthermore, there were no differences between CMC and CP.  The dispersibility of PZ in the oral rinse containing CP as a base was more favorable than that in the oral rinse containing CMC.
Conclusion: The results of this study suggest that the PZ oral rinse containing 0.5% CP as a base is useful, and that its stability is similar to that of the oral rinse containing CMC as a base.

Objective: Oral mucositis is one of the serious and frequent acute side effects due to chemoradiotherapy (CRT) for head and neck cancer.  In this study, we prepared an oral rinse as a hospital preparation for the treatment of oral mucositis, which was a suspension of polaprezinc (PZ), a zinc-containing therapeutic agent for gastric ulcer, in carboxyvinyl polymer (CP), a water-soluble large molecule.
Methods: We carried out stability tests of the PZ-CP oral rinse, and investigated its effects on the radiation-induced oral mucositis in patients who received CRT for head and neck cancer.
Results: In the stability test, the pH, viscosity, adhesion and PZ content in the preparations did not change throughout 28 days after preparation.  In the clinical evaluation on the basis of the distribution of the Grade of oral mucositis, the Grade of oral mucositis in the PZ group was significantly lower than in the control group at 6 and 7 weeks (p=0.016, p=0.018).  The incidence of severe oral mucositis of Grade 3 was 15.0% (3 cases) in the PZ group and 41.7% (10 cases) in the control group at 6 weeks, and was 15.0% (3 cases) in the PZ group and 33.3% (8 cases) in the control group at 7 weeks.
Conclusion: These results suggest that PZ-CP oral rinse inhibits the aggravation of oral mucositis induced by CRT or promotes its healing.

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.

In the areas of home medical care and self-medication, the role of the pharmacist is growing, partly as a result of Japan’s aging society and the need to reduce medical costs. In response, the Kinki University Faculty of Pharmacy implemented a physical assessment practical training seminar in order to improve the physical assessment skills of practicing pharmacists. A series of questionnaires were conducted among pharmacists to investigate their perceptions of physical assessment practical training seminars. The results of the questionnaires were analyzed using Customer Satisfaction (CS) analysis and text mining. Based on a 5-point scale (1-low∼5-high), questionnaires revealed satisfaction for physical assessment practical training seminars was 4.6±0.6 (Ave.±S.D.). CS analysis revealed that the items “lectures” and “case seminars” had the highest level of satisfaction. However, items showing low levels of satisfaction were “auscultation of respiratory sounds” and “SBAR (Situation, Background, Assessment, Recommendation).” Results of text mining suggested a relationship between “physical assessment” and “difficult”. Analysis of the questionnaires showed a high level satisfaction with physical assessment practical training seminars, notably physical assessment practice methods. However, CS analysis and text mining indicate the finer techniques of physical assessment were difficult to acquire.

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

The expansion of home medical care and the growth in sales of OTC, coupled with Japan’s aging society and the need to reduce medical costs has broadened the role of the pharmacist to include physical assessment. In response, the Kindai University Faculty of Pharmacy, implemented the Physical Assessment Practical Training Course (PAPTC) to improve the physical assessment skills of pharmacy students and practicing pharmacists. In order to investigate pharmacy students’ and practicing pharmacists’ perceptions of PAPTC, a questionnaire using a five-part, forced- choice Lykert type scale was conducted. The results of the questionnaire were analyzed using factor analysis and cluster analysis. The total number of respondents was 456. Three hundred thirteen of the respondents were students, and 143 of the respondents were practicing pharmacists. Factor analysis revealed four factors which we titled, “Physical Assessment Skills”, “Physical Assessment Course”, “Pharmacist Jobs” and, “Knowledge Required by Pharmacist”. Subsequently, cluster analysis identified two distinct groups. Group A which constituted primarily of pharmacy students, and Group B which consisted primarily of practicing pharmacists. Each group displayed notable differences in perceptions related to PAPTC. These differences may be influenced by perceptions toward “skills” and/or “knowledge”. These findings suggest that in order to better address the motivational needs of the participants, PAPTC should be divided into two courses. One, for knowledge-based instruction, and other for skill-based practice.

The expansion of home medical care and the growth in sales of OTC, coupled with Japan’s aging society and the need to reduce medical costs has broadened the role of the pharmacist to include physical assessment. In response, the Kindai University Faculty of Pharmacy, implemented the Physical Assessment Practical Training Course (PAPTC) to improve the physical assessment skills of pharmacy students and practicing pharmacists. In order to investigate pharmacy students’ and practicing pharmacists’ perceptions of PAPTC, a questionnaire using a five-part, forced- choice Lykert type scale was conducted. The results of the questionnaire were analyzed using factor analysis and cluster analysis. The total number of respondents was 456. Three hundred thirteen of the respondents were students, and 143 of the respondents were practicing pharmacists. Factor analysis revealed four factors which we titled, “Physical Assessment Skills”, “Physical Assessment Course”, “Pharmacist Jobs” and, “Knowledge Required by Pharmacist”. Subsequently, cluster analysis identified two distinct groups. Group A which constituted primarily of pharmacy students, and Group B which consisted primarily of practicing pharmacists. Each group displayed notable differences in perceptions related to PAPTC. These differences may be influenced by perceptions toward “skills” and/or “knowledge”. These findings suggest that in order to better address the motivational needs of the participants, PAPTC should be divided into two courses. One, for knowledge-based instruction, and other for skill-based practice.