Introduction: A health assessment sheet was developed to establish a new method for post marketing surveillance (PMS) for nonprescription drugs, the status of which has recently been switched from prescription (Rx) to over-the-counter (OTC) to confirm the efficacy and safety of Rx-to-OTC switched drugs.  The assessment sheet was designed to evaluate adverse reactions that may be possibly induced by the drugs and to elicit spontaneous complaints from consumers.  An investigation using the assessment sheet had been conducted earlier for famotidine tablets.  While the earlier investigation suggested the effectiveness of the assessment method, it also revealed some issues.  After making improvements in the assessment sheet, another investigation was conducted for Loxonin®S.
Method: Purchasers of Loxonin®S were asked to tick symptoms that were applicable to them among those listed in the sheet.  They were asked to revisit the pharmacy and complete the sheet for the second time after drug administration.  The possibility of adverse reactions was considered for the symptoms additionally chosen at the second visit and they were then compared with the adverse reactions described in the package insert of Loxonin®S.
Results: Total 284 people completed the health assessment sheet at their first and second visits.  Of them, 44 people (15.5%) reported additional symptoms at the second visit.  Commonly reported symptom was “frequent experience of sleepiness,” “persistent headaches” and “fatigability.”
Conclusion: The study suggested that the health assessment sheet can be an effective tool for PMS for nonprescription drugs immediately after the Rx-to-OTC switch and contributes to detecting adverse reactions of the drugs.

Objective
  The purpose of this study was to examine health professionals’ perceptions of barriers to medication adherence in patients with non-communicable diseases (NCDs) in Fiji.
Methods: Interviews were conducted with 25 health professionals (physicians and pharmacists) treating patients with NCDs in Fiji. The interview contained questions regarding barriers to medication adherence for specific NCDs.
Results
  Health professionals’ perception of these barriers were identified and divided into patient-related and non-patient-related factors. The patient-related factors included lifestyle, knowledge, technique, language, and beliefs and culture. The non-patient-related factors were cost and access to medication, therapy-related factors, and support from other people.
Conclusion
  Traditional medical beliefs, medication access and affordability, negative lifestyle habits, and insufficient knowledge about illnesses, medical devices, and medications were identified as barriers to medication adherence in Fiji. Barriers to medication adherence differ according to diagnosis. Knowledge was considered an important factor with respect to adherence to medication regimens, particularly for patients with asymptomatic conditions (e.g., diabetes, hypertension, and stable asthma).

Objectives: The patterns of purchasing prescription antimicrobials with or without a prescription from retail pharmacies in Ulaanbaatar, Mongolia, were examined in relation to purchasers’ socioeconomic status and price of the product.
Methods: A survey was conducted at 250 randomly selected pharmacies in Ulaanbaatar. A total of 619 customers were interviewed, and the medicines they bought at the stores were examined by medical doctors. The use of prescriptions and advice in purchasing medicines and sociodemographic characteristics of the subjects were determined.
Results: Interviews were conducted with 297 customers who purchased prescription antimicrobials in front of the store in which they made their purchase. Among these 297 customers, only 19.5% (n=58) purchased medicine with a formal prescription, and 37.4% (n=111) purchased medicines on their own initiative and without the guidance of medical professionals. Purchase without a prescription was not associated with the subjects’ gender, age, educational status or area of residence. Lower-priced antimicrobials were purchased without prescriptions more frequently than those with a higher price (P<0.05).
Conclusion: The purchase of antimicrobials without prescriptions is common across all sociodemographic strata in Ulaanbaatar, Mongolia. Considering the increases in number of retail pharmacies and in sales of antimicrobials associated with economic development, measures to enforce regulations and to promote education among the general public and pharmacy professionals are required.

Thrombomodulin is an endothelial cell membrane protein that is released into the blood in soluble forms in response to endothelial damage. We evaluated thrombomodulin in blood samples taken from the femoral vein before, during and after elective surgery for abdominal aortic aneurysm in 9 patients. Thrombomodulin was measured using an ETA assay. Thrombomodulin decreased significantly just before aortic declamp from before surgery (p<0.001), and remained unchanged just after and 1 hour after aortic declamp. Three hours after aortic declamp, thrombomodulin increased significantly from 1 hour after aortic declamp (p<0.01), peaked at 6 hours after aortic declamp and then decreased. These data suggest that thrombomodulin did not increase significantly during surgery for abdominal aortic aneurysm.

We experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (p=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.

We encountered an unusual disruption of an expanded polytetrafluoroethylene (EPTFE) axillofemoral bypass graft apart from that anastomoses. We suspected the possible robe of the physical effects of body movement provoking the disruption of the axillofemoral bypass graft and therefore examined the physical effect of body movement on the axillary-to-femoral artery graft in 15 healthy men. At the lower part of the graft, the physical effect was significantly stronger. The disruption of this axillary-to-femoral artery graft was associated with the physical effect of body movement.

When establishing new pharmacy services, they must be in line with the needs of individual community residents. In our research, it was clear that services provided by the newly implemented health support pharmacies and primary care pharmacist system in recent years satisfy the needs of patients as well as the public in general. We collected information via a survey that used a structured questionnaire. In addition to basic information (age/sex), it also covered details of their pharmacy use, their thoughts on pharmacy services, and the actual usability of pharmacy services. Differences in respondent’s opinions and the actual usability of each pharmacy service were compared between age groups and sexes. Female respondents had more favorable opinions about the antismoking, nutrition, and sickness prevention consultation services than male respondents did. The proportion of survey respondents in their 40s and 50s who proactively used pension and welfare consultation services was significantly higher than for other age groups. The younger generation perceived 24-hour pharmacies and the primary care pharmacy system as necessary. There is a large disparity between people’s thoughts and opinions on the actual usability of the services that primary care pharmacies aim to offer, and this differ in people’s ages and sexes. The younger generation tend to expect the pharmacy services. It is important for pharmacies to address the needs of the generation which is skeptical toward the separation of medical and dispensary practice and recognize them the new role of pharmacies.

The purpose of this study was to clarify the factor structure of the diversifying interpersonal work of pharmacists and its influential factors. A questionnaire-based survey was conducted for pharmacists registered with an internet research company. We collected data on respondents’ basic characteristics (gender and age), years of experience as a pharmacist, whether the respondents were certified as pharmacists, home-care experience, participation in study sessions and workshops, and experiences related to medication support. Factor analysis revealed three main factors from 26 items regarding pharmacists’ interpersonal work: Factor 1, “basic abilities of patient medication record management and medication counseling,” Factor 2, “clinical knowledge and assessment ability,” and Factor 3, “cooperation and support system.” Multiple regression analysis revealed a significant association between age and Factor 1 (β=−0.131, P<0.001). Home-care experience was associated with Factor 2 (β=0.076, P=0.013) and Factor 3 (β=0.115, P<0.001). Participation in study sessions and workshops were significantly associated with all the factors (Factor 1: β=0.103, P=0.001, Factor 2: β=0.247, P<0.001, Factor 3: β=0.238, P<0.001). This study clarified the factor structure of interpersonal work performed by community pharmacists. It is suggested that providing educational programs based on pharmacists’ ages and strengthening regional cooperation such as home medical care are necessary to standardize the quality of pharmacists’ interpersonal work.

We conducted a cross-sectional survey of pharmacists in clinical settings to assess the status and extent of challenges experienced by pharmacists in providing drug information to pregnant and breastfeeding women. The survey was completed anonymously via the internet using a structured questionnaire. The survey items included basic respondent characteristics, their experiences, attitude toward providing information to pregnant and breastfeeding women, and efforts toward obtaining relevant knowledge. Out of the 1,000 participating pharmacists, 96.8% received inquiries about pregnancy and breastfeeding. However, 92.5% of them recognized that the consultations they provided to pregnant and breastfeeding patients were not sufficient. The reasons for the sentiment were as follows: a lack of basic knowledge regarding pregnancy and breastfeeding and the effects of medications on pregnancy and breastfeeding (37.9% and 37.7%, respectively), a feeling that it is difficult to select appropriate information to share with patients (32.1%), lack of detailed information in the drug package insert (26.0%), lack of opportunities to learn about drug treatment during pregnancy and breastfeeding (20.9%), and the notion that pregnancy and breastfeeding are delicate and difficult topics to discuss (19.8%). While most pharmacists provided consultations regarding pregnancy and breastfeeding, only 7.5% felt that they provided sufficient consultations on this topic. Some pharmacists were concerned about their limited knowledge of pregnancy and breastfeeding. They also had difficulty addressing pregnancy and breastfeeding-related subjects, and communicating with pregnant and breastfeeding women. Pharmacists should advance their education by including elements regarding informed choice and make use of appropriate sources of information.

Objective: The study aimed to identify potential components of the collaboration between hospital and community pharmacists from the perspective of pharmacists in municipal hospitals. Methods: Following a preliminary study, an online survey was conducted among pharmacy directors and those on an equivalent managerial level in municipal hospital pharmacies. The survey used a 5-point Likert scale with 32 items about the components of collaboration between hospital and community pharmacists. We performed an exploratory analysis and structural equation modeling of the data. Results: The analysis proposed a five-factor model (“Organizational climate,” “Information sharing system,” “Community support system,” “Interest in healthcare policy,” and “Understanding of healthcare policy”), which consisted of 17 items. Subsequent confirmation with structural equation modeling created a model with good fit (in terms of partial evaluation and overall goodness of fit) with a chi-square of 86.218, P-value of 0.564, goodness of fit index of 0.907, adjusted goodness of fit index of 0.857, and other good model fit indices (comparative fit index of 1.000 and root mean square error of approximation of 0.000). Discussion: This study identified two core universal concepts and three concepts adhering to the current medical context, that seem to guide the behavior of municipal hospital pharmacists─who are major players in community healthcare─in their collaboration with community pharmacists.