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Few studies have reported the changes in the peptide YY (PYY) levels in the intestinal tissue of rats with ulcerative colitis (UC) following oral administration of mesalazine and prednisolone. We investigated the effects of these drugs on the intestinal mucosal PYY levels in a rat model of UC. We confirmed that the PYY levels in the rat intestinal mucosal tissue were high in the lower intestinal tract. The leukocyte count and hemoglobin levels approached the normal values after administering mesalazine or prednisolone to rats treated with 3% dextran sulfate sodium (DSS). The PYY levels in the caecum and colon decreased significantly after administering DSS but increased when mesalazine was administered in a tissue-specific manner. Unlike mesalazine, the PYY levels increased in the ileum in addition to the colon and rectum after administering prednisolone. However, neither of the drugs induced any changes in the plasma PYY levels. These findings indicate that changes in the intestinal tissue PYY levels may be partially involved in the improvement of DSS-induced UC in rats following the administration of these drugs.

Previous studies have reported that elderly assisted-living residents use multiple drug combinations and inappropriate drugs.The aim of this study was to assess the drug use and its consequences in residents of a nursing facility.We examined the prescriptions of all residents in a nursing facility in Osaka from their medical records.Of the total 67 residents, 48 were women.The average age of the residents was 86 years, the average number of prescription drugs they took was 6.4, and the average number of diseases present was 4.9. Correlation between the number of diseases and the drugs taken was significant (p0.05), but the correlation between the degree of independence for activities of daily living and the number of the drugs taken was not significant.The most commonly present health condition was bone fracture.About 50% of the residents used a psychotropic drug and prescription drugs such as amantadine and hydroxyzine, which are not advisable for elderly people.It is necessary for the elderly to avoid the use of drugs that cause delirium and drowsiness, and future studies should focus on methods to prevent disuse syndrome in the elderly.

Despite an increase in the number of reports on medical safety interventions conducted by ward-based pharmacists, only a few reports have classified intervention cases in detail. We classified and compared the types of medical safety intervention conducted by ward-based pharmacists since the introduction of their services. The interventions were classified into: cases that were identified by pharmacists or through asking questions about physicians' prescriptions before dispensing medications (active interventions); and those in which pharmacy technicians could contribute to medical safety by receiving inquiries from patients or healthcare providers (passive interventions). The numbers of the two types of intervention were compared. The number of interventions significantly increased after the introduction of ward-based clinical pharmacy services. Especially, the numbers of cases identified during ward rounds conducted by ward-based pharmacists (active interventions) and those identified by receiving inquiries from physicians or nurses (passive interventions) significantly increased, possibly because the collection of patient information was performed more efficiently by conducting ward rounds, and an environment where physicians and nurses can easily make inquiries to pharmacists was established after increasing the time pharmacists spend on hospital wards. The results demonstrate that the introduction of ward-based clinical pharmacy services has improved communication with patients, facilitated information-sharing among physicians, nurses, and other healthcare providers, contributed to the safer management of pharmaceutical operations, and increased interest of patients.

We investigated the ability of eicosapentaenoic acid (EPA) to prevent high-fat diet (HFD)-induced obesity and non-alcoholic fatty liver disease (NAFLD). Male C57BL/6J mice were fed standard chow (5.3% fat content), an HFD (32.0% fat content) or an HFD + EPA (1 g/kg/day EPA for the last 6 weeks) for 12 weeks. Serum total cholesterol, hepatic triglyceride and total cholesterol levels were significantly increased in the HFD group, in comparison with those of normal mice (p

A gargle solution(L-P/AG)for the treatment of painful stomatitis was prepared by adding lidocaine to a polaprezinc/sodium alginate gargle solution(P/AG), and its pharmaceutical stability was evaluated.L-P/AG was stored at 5, 25, and 40°C. The strengths of polaprezinc and lidocaine were determined. The viscosity and pH of L-P/AG were also determined, and its appearance was evaluated.When stored at 5 or 25°C in a dark place, L-P/AG showed neither reduction in the strength of either drug nor did it show a change in the viscosity, pH, or appearance. When stored exposed to light at 40°C, L-P/AG showed reductions in the strength of both drugs, as well as in viscosity and pH; furthermore, a change in appearance was noted.L-P/AG prepared for the treatment of painful stomatitis remains pharmaceutically stable for 28 days when stored at 25°C in a dark place.

At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one ward pharmacy dispense drugs to be administered by injection and injectable preparations delivered to patients' bedsides was introduced in April 2000. This system was aimed at minimizing risks related to injections. Initially, however, on holidays, nurses played the roles of pharmacists in terms of the injections, and there were concerns over a possible rise in the incidence of errors (adverse events/near-misses) related to injections on these days compared with weekdays. Later, when planning to introduce a new holiday work system in the ward pharmacy, we took into account such factors as the number of pharmacists needed on holidays, their duties on holidays and the influence on weekday pharmacy activity of compensatory days-off taken by such pharmacists. In May 2004, the new holiday work system was introduced in the ward pharmacy. Under the new system, 5 pharmacists work at the ward pharmacy on holidays. After this system was put into operation, the number of injections dispensed at the ward pharmacy averaged 230 per day, and 177 per holiday. To evaluate the validity of this system, we recently conducted a questionnaire survey of nurses at our hospital. The survey involved 139 nurses. Of these nurses, 69.1% responded that the number of incidents (adverse events/near-misses) related to dispensing injections on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease in incidents related to the delivery and administration of injectable preparations. More than half of the nurses answered that the new system had made it easier for them to collect information on medicines and helped them provide better nursing services. When the nurses were asked to make a general assessment of the new system, 90% rated the system as "good." The results of this survey indicate that keeping the ward pharmacy open on holidays contributes to the promotion of the proper use of medicines, reduction of risks related to injections and improvement in the quality of medical care.

Many medical accidents concerning errors in the administration of injections have been reported in recent years but many of them could be prevented through the active involvement of pharmacists in this respect. At the Department of Pharmacy of the Municipal Ikeda Hospital, a ward pharmacy was established in April 2000 and the dispensing of injections, including the mixing of injections, was commenced. In October, 2001, an injection distribution surveillance system was also established. Under the system, injections are distributed to the patients' bedsides, information provided on the drugs in them and monitoring performed.We conducted a survey of the dispensing of injections and the surveillance system. The mixed injection preparations targeted by the survey were drip infusions for administration between 10 : 00 and 22 : 00 whose prescriptions were received by the Department of Pharmacy by 17 : 00 on the day before use, and injection preparations were mixed 4 times a day.The dispensing of injections was divided into 5 tasks : receipt of dispensing requests, preparation of labels, measuring of quantities, mixing of preparations, and preparation of infusion sets and each task was investigated for dispensing errors.Warnings were issued under the distribution surveillance system when pharmacists misidentified patients in distributing injections to the patient's bedside and the situation was investigated.The rate of pharmacist errors in mixing injection preparations was 2.23 % in a 4-month period and though 0.04% of the preparations in error were sent to wards, they were not administered to patients. Out of the 7, 690 instances in which injections were distributed to the patient's bedside by pharmacists in the 4-month period, in 3 instances (0.04%) pharmacists were warned about misidentifying patients. All of errors were human errors, but did not lead to errors in administration. This study suggests that risk of errors made with injections could be avoided by the close involvement of pharmacists in the work of administering injections. Greater use of codes was suggested for preventing human errors in future, since codes were printed on the injection in only 14.5 % of the injections distributed during our survey. Besides the increased use of such codes, the development of an injection dispensing surveillance system using them is also necessary.

Municipal Ikeda Hospital established a palliative care team consisting of physicians, pharmacists, and nurses in February 2002. We investigated the amounts of narcotics used during a period of 5 years, and evaluated the role of pharmacists in the palliative care team based on the trend in the amounts used. The total amounts of narcotics administered varied irregularly during the period but the use of rapid-release morphine hydrochloride products rapidly increased after fiscal 2002. On comparison of the numbers of administration days and the amounts of narcotics used between fiscal 1999 and 2003, the distributions were similar with no significant differences. The proportion of patients treated with rescue prescriptions, both internal and external use preparations, was about 10% until fiscal 2001, but this rapidly increased after fiscal 2002, and reached 71.4% in fiscal 2003. Rescue prescriptions are essential for setting dose escalation for narcotics and sudden appearance of severe pain, and thus the rescue prescription rate could be a means of evaluating the palliative care team. The rapid increase in the amount of rapid-release morphine hydrochloride products administered and the increase in the rescue prescription rate may have resulted from case study meetings, inauguration of cancer pain therapy programs, and subsequent instruction provided by pharmacists to the palliative care team.

At Ikeda Municipal Hospital, we created an order entry system for the dispensing and mixing of injections in November 2003. We then compared the numbers of injections that pharmacists mixed and administered to patients, the rates for injections mixed by pharmacists, return rates for injections mixed by pharmacists and dispensing error rates between the four months before and after introducing the system. Compared to before the introduction of the system, the number of injections that pharmacists mixed and administered to patients increased by about 40%, the rate for injections mixed by pharmacists increased by 2% and the return rate for injections decreased by approximately 1%. The dispensing error rate decreased to 0.26%, a marked drop from the 2.23% error rate before introducing the system. Based on these results, we felt that our order entry system for the dispensing and mixing of injections was very useful.

Codes printed on injections can be used to prevent errors in dispensing injections. We therefore carried out a survey on the present status of code printing on injections in 81 pharmaceutical companies. The questionnaire recovery rate was 98.8%. The total number of injections was 2, 200. Code printing was observed on 14.5% of the injections. Some codes could only be utilized by Pharmaceutical companies, while others could not be scanned due to a low terminal accuracy. However, many companies are now considering the necessity of code printing. The findings of this survey suggested a gradual increase in code printing on injections as pharmaceutical companies are increasingly becoming aware of this necessity. In the future, code printing on all injections should be mandatory. In addition, a check system using codes printed on injections should be established at each medical institution in order to prevent the occurrence of medication errors.

We organized a home medical care training workshop to offer community pharmacists an opportunity to advance home medical care by allowing pharmacists in regional medicine to collaborate with local pharmacist groups. A questionnaire was administered to all participants after the workshop. On average, participants rated the overall quality of the workshop as 8.46 out of 10. Our results revealed that 72.5% of participating pharmacists were experienced in home medical care, with the majority having between 5 and 10 years of experience. Participants suggested that the qualities necessary for effective home medical care were knowledge of home-based care, positive attitude, and coordination with different home medical care staff members. Participants also made suggestions for lectures in future workshops (e.g., upskilling to improve home medical care expertise). In conclusion, participants in a home medical care training workshop primarily desired to learn skills for home medical care. To this end, consecutively holding the workshop and a cooperation support system with other medical and care professionals would be indispensable.

The system of intravenous injections (i.v.) being mixed by pharmacists is necessary to prevent contamination and dispensing errors. Such a system was started at the Municipal Ikeda Hospital on April 2000. The dispensing of injections consists of five steps, including the labeling, dispensing, setting and mixing, and the application of check systems. Dispensing errors that induced serious medical complications were examined over a 4-month period (2000.10. 1-2001. 1.31). In addition, resource management during dispensing errors were researched, and countermeasures against dispensing errors were developed. Dispensing errors involving i.v. mixing, which were identified after the preparation had been taken to the ward by nurses, were also surveyed for a 4-month period (2001. 6. 1-9.30). There were 9, 611 i.v. mixing by pharmacists in a 4-month period (2000.10. 1-2001. 1.31). There were 214 dispensing errors (2.23%) during those 4 months, those discovered in the final check comprised 0.28% (27cases), while those involving i.v. mixing taken to the ward by nurses was 0.04% (4 cases). The percentage of serious dispensing errors was 0.01 % (1 case). Fortunately, these mixed i.v. preparations were not administered to patients. In the second survey, there were 10, 478 i.v. mixings by pharmacists in a 4-month period (2001. 6. 1-9.30). There was only 1 case (0.01 %) of a dispensing error involving i.v. mixing identified after being taken to the ward by nurses. There were no cases involving serious dispensing errors. These erroneous instances of i.v. mixing were not administered to patients. When these two surveys are compared, no significant difference was observed, but the number of errors decreased after the establishment of countermeasures to reduce dispensing errors. As a result, it became clear that dispensing errors could occur at any step, but they were preventable by both making several checks and by developing countermeasures against dispensing errors at each step.

We organized a home medical care training workshop to offer community pharmacists an opportunity to learn more about home medical care. The workshop consisted of lectures by the doctor, the nurse, and the pharmacist. A questionnaire was handed out to all the participants once the workshop had ended. On an average, the participants rated the overall quality of the workshop as 8.1 out of 10. Our results revealed that 62.7% of the participating pharmacists were experienced in home medical care, with the majority having between 1 and 5 years of experience. Most pharmacists with experience in home care had provided services such as delivering medicines to or instructing patients on the use of medicines at patient homes. Participants suggested that the qualities necessary for providing effective home medical care were knowledge of home-based care and a positive attitude, among others. Participants also made suggestions for lecture contents in future workshops, such as contract procedures or specific cases of home medical care. Furthermore, participants expressed many positive opinions such as the desire to hear the views of other professionals on home medical care. In conclusion, participation in the home medical care training workshop increased the participants' desire to learn and perform home medical care. This indicates that a subsequent workshop with the cooperation of other professionals is indispensable.

A system that included both images and voice using a personal computer was developed to provide pharmaceutical instructions for outpatients at the medication counter. A touch panel was adopted for easy use by a wide range of age groups. The system consisted of such items as the “usage of externally applied drug”, “information on disease”, “patient education” and comprised eight items over all. A survey of 105 patients was conducted and almost all patients (95%) understood the drug-related information provided. This system was found to be an effective method for providing patients with easily understood drug-related information and most patients actually enjoyed using this system which led to an improved dissemination of important medication related information.

To facilitate mutual understanding between doctors and nurses, prevent errors, and assure quality control in the mixing intravenous drip solutions at Ikeda Municipal Hospital, the Department of Pharmacy manages changes in the mixing of solutions and provides appropriate information for drug use. We mix solutions for intravenous injection under uniform standards and also set up a satellite pharmacy to perform these functions in April 2000. This satellite pharmacy accepts prescriptions for manual intravenous injections and manages two laminar air follow cabinets and a laminar flow biological safety cabinet. A ward trial was started in April, another ward was added in June and all wards were included in October 2000. We mix solutions for intravenous injection from Monday till Friday, based on prescriptions received the previous day, from four divisions. The hours of operation are from 10 : 00 Am to 8 : 00 Pm excluding weekends and holidays. The preparation of anticancer and narcotic drugs is not performed by the satellite pharmacy. We mixed 60 to 70 bottles of intravenous injections per day, over a six-month period. Of the intravenous injections mixed, about 70 percent were mixed by the Department of Pharmacy. 95.3 percent were used, 1.8 percent diverted, 2.9 percent were not used.

One of the side effects of cancer chemotherapy is the occurrence of stomatitis. Many studies have shown the effectiveness of a 0.1% allopurinol gargle for treating such stomatitis. Allopurinol gargle develops crystalline deposition a few days after preparation, and therefore it should befreshly prepared each time before use.We developed a prescription that delays crystalline deposition by adding glycerin to allopurinol gargle.Sterile allopurinol gargle (sterile ALT) was prepared by crushing allopurinol tablets, and then glycerin was added at various concentrations.The dissolved amount after 30 days was 0.65±0.05 mg/mL in sterile ALT without glycerin (sterile G0-ALT), 0.75±0.01 mg/mL in sterile ALT containing 1% glycerin (sterile G1-ALT), 0.79±0.03 mg/mL in sterile ALT containing 3% glycerin (sterile G 3-ALT), 0.89±0.06 mg/mL in sterile ALT containing 5% glycerin (sterile G 5-ALT), and 0.98±0.01 mg/mL in sterile ALT containing 10% glycerin (sterile G 10-ALT). The dissolved amount increased with the glycerin concentration.Allopurinol crystal deposition was observed after 2 days in sterile G 0-ALT, after 3 days in sterile G 1-ALT, after 6 days in sterile G 3-ALT, and after 10 days in sterile G 5-ALT, but could not be detected even after 30 days in sterile G 10-ALT.In tests of the sensation tastes during use in normal subjects, similar results were obtained between sterile G 10-ALT and sterile G 0-ALT. The xanthine oxidase (XOD) inhibitory activity was also similar between the two gargles.These results show that sterile G 10-ALT can be preserved for 30 days at 25°C, and its effects and sensation during use are similar to those of a prescription not containing glycerin.

Obesity contributes to the development of insulin resistance and the subsequent incidence of Type 2 Diabetes Mellitus (T2DM). The effects of co-administration of sitagliptin (dipeptidylpeptidase-4 inhibitor) and pitavastatin (lipid-lowering drug) on hyperinsulinemia and fatty liver damage accompanied by obesity in the preclinical stages of T2DM have not yet been investigated. We aimed to evaluate the additive effects of co-administration of sitagliptin and pitavastatin on hyperinsulinemia and fatty liver damage in obese ob/ob mice. Normal male C57BL/6J mice and obese ob/ob mice were divided into four groups, each receiving different drugs: standard mice chow, n = 8 (Normal); ob/ob mice with vehicle, n = 8 (Control); sitagliptin, n=8 (SG); pitavastatin+ sitagliptin, n = 8 (SG + PS). At the end of the study period (8 weeks), blood samples were drawn from all mice to determine Glycated Hemoglobin (HbA1c), serum glucose, insulin, triglyceride, total cholesterol, High-Density Lipoprotein (HDL) cholesterol, Aspartate-Aminotransferase (AST), Alanine Aminotransferase (ALT) and leptin levels. The SG+PS group had significantly (P < 0.05) lower levels of HbA1c, serum insulin, total cholesterol, AST, and ALT, and liver weight ratio, than did the Control group. And also, the SG+PS group had significantly (P < 0.05) higher levels of leptin than did the Control group. Body weight and serum glucose levels in the SG+PS group did not significantly decrease compared to those in the Control group. Serum triglyceride and HDL-cholesterol levels were unchanged among the four groups. These results suggest that combination treatment with sitagliptin plus pitavastatin may be a promising therapeutic approach in the management of T2DM because it has a beneficial effect on the pathophysiological processes of obesity.

We surveyed the nutritional status of patients with colorectal cancer undergoing outpatient chemotherapy using the malnutrition universal screening tool(MUST)to examine its usefulness and association with adverse events.We examined the use of the MUST and the incidences of adverse events in 34 patients with advanced or recurrent colorectal cancer who had undergone outpatient chemotherapy between April and December 2010.The high-risk patients requiring nutritional care intervention comprised 47. 1%(16 patients)of the study population, and these patients exhibited significant decreases in body weight and body mass index. The incidences of appetite loss and fatigue were significantly higher in the high-risk group than in the low-risk group.Precautions against adverse events may prevent a worsening of the nutritional status of patients with colorectal cancer. Thus, nutritional assessment is necessary in patients undergoing outpatient chemotherapy. Furthermore, the MUST appears to represent a very useful simplified nutritional screening method for the nutritional management for these patients.

The Chinese herbal medicine, Goshajinki-gan (GJ) (Niu-Che-Sen-Qi-Wan), has been widely used for treating patients with melalgia, lower back pain, numbness, and diabetic neuropathy. We investigated the effects of GJ on the regulation of serum insulin and triglyceride levels in obese Zucker fatty rats (fa/fa; ZFR). We administrated GJ to 6-week-old ZFR and non-obese lean rats (LR) for 12 weeks. Body weight and serum glucose, insulin, total cholesterol, and triglyceride levels were significantly increased at 18 weeks in ZFR as compared to the LR. GJ treatment in ZFR significantly suppressed elevation in serum glucose, insulin, and triglyceride levels, but no significant differences were observed in body weight and serum cholesterol levels in the ZFR group with GJ treatment compared to the ZFR group without GJ treatment. These results suggest that GJ may improve hyperinsulinemia and hypertriglyceridemia in ZFR and that GJ may be useful for preventing or delaying the onset of diabetes mellitus in a pre-diabetic state.

To prescribe drugs or check a prescription, it is very important to understand the contraindications. We developed an original drug information system utilizing commercialy available application software. On the base of this system, we made a list of drugs sequenced due to each contraindication and a list of drugs contraindicated due to drug interactions for combination use. Thus, this list enables us to save times in our searching for the information.

To clarify the issues associated with promoting pharmacists' participation in home medical care(HMC), we performed a questionnaire survey for pharmacists who participated in a HMC training workshop. The cumulative number of participants in the workshop was 284; the majority of the participants was from mid-sized pharmacies and had been working for over 10 years. The rate of pharmacists engaged in HMC was 69% and their main practices were "drug delivery to patients" and "drug administration guidance for patients at home". Many participants responded that the key items for HMC were "cooperation with people with different type of jobs", "a wide pharmaceutical knowledge", and "effective involvement with patients and their families". The present main issues regarding HMC were "low pharmaceutical care fees", "deficiency of pharmacists", and "insufficient collaboration with people with different type of jobs". In order to resolve these issues, it is necessary to construct a cooperation system with other medical and welfare-related societies and to continuously organize such workshop.

In February 2002, the palliative care team was established in Ikeda Municipal Hospital to improve palliative care. We investigated changes in the incidences of side effects related to opioids, and evaluated palliative care team activities.Regarding inpatients for whom narcotics were prescribed in our hospital in the years of 2002 (from October 1, 2002 until September 30, 2003), 2004 (from October 1, 2004 until September 30, 2005), and 2006 (from October 1, 2006 until September 30, 2007), we surveyed the rates at which laxatives or antiemetics were prescribed, frequency of defecation/its state before and after the start of narcotic therapy, frequency of nausea/vomiting, and dietary intake.The proportions of patients in whom laxatives were simultaneously prescribed during opioid therapy in 2002, 2004, and 2006 were 43.5%, 78.7%, and 75.6%, respectively. The proportions of those in whom antiemetics were combined with opioids were 45.7%, 78.7%, and 78.0%, respectively. The incidences of constipation were 50.0%, 39.3%, and 37.8%, respectively. Those of nausea/vomiting were 30.4%, 21.3%, and 9.8%, respectively. Those of anorexia were 65.3%, 39.4%, and 15.4%, respectively.These results suggest that palliative care team activities facilitated appropriate drug prescription during opioid therapy, reducing the appearance of side effects, with likelihood of improved quality of life.

The absorption spectra of ceftazidime and its generic versions (Modacin, Mosyl, and Mobenzocin) have been measured by terahertz time domain spectroscopy (THz-TDS). Differences in the THz absorption were observed between the original and generic versions. The results show small, but significant differences in the states of ceftazidime hydrate between the original and generic versions. THz-TDS can be used to evaluate the stability of medicines as well as to control their quality.

We established the Terminal Care Study Group, consisting of physicians, pharmacists, and nurses, in September 2001, and developed the group into the Palliative Care Team. We have surveyed the state of concomitant medications immediately before and at the beginning of opioid usage (except injections) to assess the role of the Palliative Care Team. The survey period was 3 years from October 1, 2002 to September 30, 2005. While the frequency of the prescription of non-steroidal anti-inflammatory drugs (NSAIDs), laxatives, or antiemetics before the beginning of opioid administration did not differ significantly among the 3 periods, that at the beginning of opioid administration increased significantly in 2003 compared with 2002, and increased further in 2004. Many of the drugs used were those that were recommended in our cancer pain management program. Thus, the activities of the Palliative Care Team are considered to have led to proper measures for the control of the major adverse effects of opioids such as constipation and nausea/vomiting in addition to pain control in accordance with the WHO's pain ladder, and also contributed to improvements of the patients' QOL.