With the advent of an aging society, the number of patients with dysphagia due to diseases such as eating disorders, dementia, and cerebrovascular disorders is increasing. To help such patients safely take oral drugs, pharmacists in nutrition support teams (NST) must have a good knowledge of swallowing.  A survey of swallowing conducted by a medical team of our hospital has rerealed causes of choking, nutritional status, intraoral conditions, etc in patients with difficulties in swallowing. Based on the survey findings, the team has come up with pamphlets on training in how to swallow easily and started to implement the training program.  When pharmacists are involved in the swallowing training, they need to recognize the problems associated with dysphagia in patients, and provide swallowing training according to the situation so that patients can take drugs orally. In addition, selection of oral drugs that can be taken easily, selection of drugs, such as adhesive skin patches and inhalants are important. It is also necessary to exrcise ingenuity in administring safe drugs oraly using thickening agents.  It is considered that maintenance of a good swallowing function in elderly persons is related to an improvement in their quality of life (QOL). To contribute to QOL improvement in patients and their families, knowledge and skills for solving swallowing problems are necessary for pharmacists.

  Negative pressure wound therapy is a method for promoting wound healing by closing and applying negative pressure to the wound to protect the wound surface, promote granulation tissue formation, and remove the exudate and infectious waste products. Special equipment known as V.A.C.®ATS Therapy System (KCI USA, Inc., San Antonio, USA) has recently been developed for negative pressure wound therapy and has come into wide use.
  The fibroblast growth factor (FGF) trafermin is a therapeutic agent that works well for bedsores and skin ulcers by promoting the growth of fibroblasts and by specifically binding with FGF receptors present in the vascular endothelial cells and fibroblast cells; further, trafermin promotes angiogenesis and granulation tissue formation. We encountered a patient with a bedsore of the National Pressure Ulcer Advisory Panel classification state IV with damages to the joint cavity and the body cavity. Negative pressure wound therapy was selected for promoting granulation tissue formation. We studied the advantages, including whether the use of trafermin has a favorable effect on wound healing, as well as disadvantages of producing possible side effect.

  Various kinds metals are present in varying concentrations in living bodies. They play important roles in the preservation of life functions. Owing to the recent advances in multidisciplinary research on biochemical and nutritional functions of trace elements, their deficiency and excess, etc., close attention is being paid to the importance of trace elements. During nutritional therapy, it is important to check for shortage of trace elements as nutritional indicators. It is known that prolonged nutritional therapy is associated with the risk of developing trace element deficiency.  We recently encountered patients suspected of having trace element deficiency. For a case of selenium deficiency, we added a selenium solution (homemade parental solution) to the solution for intravenous hyperalimentation. For a case of zinc deficiency accompanied by pressure ulcer, polaprezinc (a zinc-containing preparation for the treatment of gastric ulcers) was used. In both the cases, the serum trace element level improved, and the outcome was favorable.  Adequate precautions need to be exercised when the methods of medication, test, etc., are decided upon in the cases of trace element deficiency. Herein, we also discuss problems associated with tests and treatment of patients with trace element deficiency.