Objective: This study aimed to elucidate how the physical properties of containers and formulations of glaucoma eyedrops contribute to differences in squeezing force and drop volume among products within the same pharmacological class. This study seeks to generate valuable insights for product selection, patient guidance, and formulation improvement.Design: Physical measurements of multiple glaucoma eyedrop products were made under various conditions, followed by comparative analyses of the data and the characteristics of each product's container and solution. The study determined how the product selection and instillation technique affected the squeezing force and drop volume.Methods: Eyedrop products commonly used as first-line treatments were evaluated, including all brand-name drugs and high-usage generic drugs. Based on the clinical guidelines and NDB open data, 17 products were selected, consisting of prostanoid receptor-related drugs and beta blockers. Each product was tested at various angles to measure squeezing force and drop volume. These measurements were combined with basic container characteristics, including the material, design, and size, to compare and identify trends. Multivariate regression analysis was conducted to examine the factors affecting squeezing force.Results: The squeezing force varied significantly among the products (0. 68-1. 57 times the average), whereas the drop volume exhibited relatively minor differences (0.79-1.12 times the average). Some products showed marked variability in squeezing force and drop volume between drops, depending on residual volume and container angle. Additionally, containers with smaller finger-contact areas, made of materials other than polyethylene, non-cylindrical designs, and formulations with higher viscosity were estimated to require greater squeezing force.Conclusion: Squeezing force and drop volume vary significantly by product and instillation technique, which highlights the importance of understanding these differences when prescribing and guiding patients. Further systematic studies on other eyedrop products should be carried out to enhance appropriate drug use and inform the development of user-friendly formulations.

Anxiety and difficulty in administering medication to nursery school children has been reported among nursery school teachers. This study aimed to elucidate these issues and explore the possibility of pharmacist support and collaboration. We conducted a postal survey in September 2019 among nursery schools in Tokyo that are categorized as government-authorized schools, certified childcare centers, and prefectural governor-certified schools. A total of 1,537 schools responded to the self-report questionnaires (response rate: 41.2%), and 1,533 responses were analyzed. Of these, 1,488 schools were asked if they would accept requests to administer medication to their school children, and 60.1% of the nursery schools responded that their staff (including teachers and nurses) found it difficult to administer medication. The issues identified included psychological burdens (such as nervousness and pressure about giving the correct medication), staff shortage, insufficient time with the children, and human factors (such as personal perceptions of medication). Additionally, excessive requests to administer medication, caregiver behavior such as low awareness of children’s health and appropriate medication, and poor medication adherence at home were identified as issues. It was suggested that pharmacists could help alleviate these problems through their daily work at the pharmacy. Approximately 49-62% of schools responded that they would request the collaboration of community pharmacists to conduct training sessions for nursery school staff, provide health support for caregivers, and provide general health and medication consultations. The collaboration between nursery schools and community pharmacists may gain importance in the future.

Objective: Pharmacists at insurance pharmacies play an important role in the pharmaceutical care of outpatients receiving cancer chemotherapy. This study aimed to clarify the actual status of insurance pharmacies' involvement in cancer chemotherapy and associated issues, based on an analysis of prescription inquiries made to doctors by pharmacists at an insurance pharmacy.Design: This was a retrospective observational study.Methods: The data was collected in one insurance pharmacy, which received prescriptions mainly from Gunma Prefectural Cancer Center. Among 2, 258 inquiries recorded from January 2015 to May 2018, inquires related to oral anticancer drugs or supportive care medicine were extracted. The frequency of inquiries for each item, or the frequencies of factors that lead to inquiries were calculated. Inquiries considered to have potentially led to the prevention or avoidance of adverse drug reactions (ADRs), so-called “preavoidance” inquiries, were also extracted.Results: Four hundred and forty inquiries related to 20 oral anticancer drugs were included in the analysis. The prescriptions were changed after 92.7% of all prescription inquiries. Prescription inquiries for drugs with rest periods were more frequent than those for drugs without rest periods. The most common inquiries were about the medication schedules stated on the prescription, followed by inquiries about supportive care drugs. Approximately 60% of the pharmacy inquiries were related to“pre-avoidance”inquiries. Most of the pre-avoidance inquiries concerned prevention of ADRs, though these inquiries also contributed to“reduction or avoidance of mental anxiety”. The prescription inquiries were triggered by information collected by pharmacists from patient interviews and from medication histories.Conclusion: Our findings suggest that inquiries to the prescribing doctors by pharmacists at insurance pharmacies contribute significantly to the appropriate use of anticancer drugs.

A 6-year pharmaceutical education system was initiated over a decade ago in Japan because highly skilled pharmacists are needed by communities and hospitals. The current national examination for pharmacists consists of three sections, and its primary purpose is to assess the ability of students to apply the pharmaceutical knowledge they attained at university or college to real-world practice in medical care. We aimed to examine the attitudes of clinical pharmacists working in community pharmacies and hospitals regarding the practical section of the national examination for pharmacists. An online survey was conducted between November 2018 and January 2019. The results of this survey showed that 15 out of the 50 total pharmacists surveyed attempted to answer or skimmed through some questions from the practical section of the 103rd national examination for pharmacists. On the contrary, a little less than half of the pharmacists disregarded the examination content. The participants answered 10 questions extracted from the 103rd national examination that were related to real-world practice. They considered most information to be necessary knowledge in clinical situations, e.g., that concerning drug and food interactions. Furthermore, self-medication and treatment at home that are and will be increasingly required for pharmacists in the future were considered relevant and important.

Objective: In order to ensure the safety of nursing home residents, it is very important to implement appropriate assistance to ensure compliance with necessary medication. The purpose of this study is to identify issues and to plan solutions for medication assistance.Design: We conducted a workshop involving care workers (CWs), nurses and pharmacists together.Methods: Using the KJ method, participants extracted problems related to medication assistance and planned solutions in a mixed group of CWs, nurses and pharmacists. Questionnaire surveys were conducted for the participants before, immediately after, and 3 months after the workshop.Results: A number of important and urgent issues related to medication assistance were identified. There were differences in the recognition patterns of the importance and urgency of the issues among the three categories of participants. In addition, many possible solutions were proposed. Among these solutions, 25% had been implemented by at least two participants. More than 75 % of participants felt that their awareness of the value of cooperation in medication assistance had been improved by participating in the workshop.Conclusion: These results suggest that a workshop with a group of CWs, nurses and pharmacists in one place is a useful approach for extracting problems and planning effective solutions related to cooperation in medication assistance.

Objective:Marketing specialists (MSs) from pharmaceutical wholesalers might shore up post-marketing surveillance (PMS) by pharmaceutical manufacturers. The purposes of this study were as follows: to research problems in PMS found by market specialists, to find solutions for these problems, and motivating MSs to work on PMS. Methods: We conducted a workshop with 12 MSs, who were already working on PMS operations. Participants were divided into three groups. Each group discussed problems with their PMS operations using the KJ method, discussed the potential solutions for the problems, and finally presented them in a plenary debate session. Questionnaire surveys were conducted for the participants before, immediately after, and 6 months after the workshop. Results: This workshop revealed two crucial and urgent problems on PMS faced by MSs: lack of feedbacks to clinical site and lack of publicity of the significance of PMS by MSs. Several solutions were suggested: browsing system of collected information, publication of the stages of improvement in pharmaceutical preparations and packaging, and distributing leaflets about PMS by MSs. In addition, this workshop conferred a positive influence on the participants: in the post-workshop questionnaires, most of the participants answered that they could well understand the problems (92%) and the solutions (75%) on PMS, and that they could improve their attitudes toward PMS operations (83%). . Conclusion: This workshop was quite effective for most of the participants in searching the problems, considering the solutions, and improving their attitudes. Organization of several such workshops might result in better PMS by MSs.

Objective: Generic drugs similar in appearance to their brand-name counterparts have both advantages and disadvantages.  This study aimed to investigate patient preferences regarding the appearance of generic drugs.
Design: A cross-sectional survey.
Methods: We conducted a web-based survey between 2013 and 2014.  Patients aged ≥40 years who reported taking prescription drugs for >6 months were asked to provide their opinions on the appearance of generic drug formulations and press-through packages (PTPs).  Medical doctors and pharmacists were asked as to what type of appearance of generic drugs would be suitable as well as whether the appearance of these drugs and PTPs should be similar to that of their brand-name counterparts.
Results: A total of 911 patients, 238 pharmacists, and 81 medical doctors responded to the survey.  Most of the patients (45.3%) surveyed reported that the similarity in the appearance of generic drug formulations and PTPs to those of their brand-name counterparts was not important, whereas only 15.6% of patients preferred generic drug formulations and PTPs similar in appearance to their brand-name counterparts.  In contrast, most of the medical doctors (53.1%) and pharmacists (88.2%) reported that the appearance of generic drug formulations and PTPs should be similar to that of their brand-name counterparts.
Conclusion: Patients’ opinions on the appearance of generic drugs differ from what medical doctors and pharmacists perceive them to be.  Therefore, health care professionals should select generic drugs with an appearance as per the individual patient’s preference.

Objectives: First steps to promote the proper use of medicines in remote islands and rural areas are as follows: (1) recognition of the profession of “pharmacist” from secondary-remote-island residents who do not have a pharmacy or drugstore or the opportunity for pharmacist contact and (2) an understanding by remote-island residents of the advantages of having a “family pharmacist.”
Methods: Repeated “medicine information and consultation sessions” for secondary-remote-island residents of Japan’s Nagasaki Prefecture were held.  Residents were then surveyed for changes in awareness of or demand for pharmacists and the nature of such changes.
Results: Before the information sessions, 29.7% of residents did not recognize the profession of pharmacy, but the extent of their recognition increased after information sessions were concluded.  They were asked “Who explains medicines in a way that is easy to understand ?”; more than half responded “doctors” before the information session, but after information sessions were concluded, those who said “pharmacists” increased.
Conclusion: Conducting “medicine information and consultation sessions” for residents of secondary-remote islands and rural areas enabled them to understand the profession of pharmacy.  The initiatives in the present study are first steps toward promoting proper use of medicines by residents of remote islands and rural areas who use “family pharmacies/pharmacists.”

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.

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.