Influence on Learning of a Collaborative Learning Method Comprising the Jigsaw Method and Problem-based Learning (PBL).

Recently, the practice of active learning has spread, increasingly recognized as an essential component of academic studies. Classes incorporating small group discussion (SGD) are conducted at many universities. At present, assessments of the effectiveness of SGD have mostly involved evaluation by questionnaires conducted by teachers, by peer assessment, and by self-evaluation of students. However, qualitative data, such as open-ended descriptions by students, have not been widely evaluated. As a result, we have been unable to analyze the processes and methods involved in how students acquire knowledge in SGD. In recent years, due to advances in information and communication technology (ICT), text mining has enabled the analysis of qualitative data. We therefore investigated whether the introduction of a learning system comprising the jigsaw method and problem-based learning (PBL) would improve student attitudes toward learning; we did this by text mining analysis of the content of student reports. We found that by applying the jigsaw method before PBL, we were able to improve student attitudes toward learning and increase the depth of their understanding of the area of study as a result of working with others. The use of text mining to analyze qualitative data also allowed us to understand the processes and methods by which students acquired knowledge in SGD and also changes in students' understanding and performance based on improvements to the class. This finding suggests that the use of text mining to analyze qualitative data could enable teachers to evaluate the effectiveness of various methods employed to improve learning.

The Effect of Pharmacist-led Psychiatric Pharmacotherapy Conferences on the Appropriate Use of Antipsychotics.

The Hakodate Watanabe Hospital has held pharmacist-led multidisciplinary psychiatric pharmacotherapy conferences since September 2013 in order to optimize pharmacotherapy. The effects of holding regular conferences on the correction of high-dose antipsychotic polypharmacy, prevention and reduction of adverse reactions to antipsychotics, and reduction of the drug costs were investigated in psychiatric inpatients prescribed 4 or more antipsychotics. The results revealed that the number of antipsychotics and number of all drugs were significantly reduced by 1, the chlorpromazine (CP)-equivalent dose was significantly reduced by approximately 350 mg, and the drug costs were significantly reduced by 176.5 yen/d. In regard to the effects on the laboratory test data, the blood glucose and hemoglobin A1c (HbA1c) levels were significantly reduced. In addition, 84.8% of the patients were assessed as "unchanged" using the Clinical Global Impression of Change (CGI-C), indicating the absence of any significant changes in the severity of the clinical psychiatric symptoms. The results confirm that psychiatric pharmacotherapy conferences are effective for promoting appropriate use of antipsychotics, reducing the incidence of metabolic adverse reactions, such as elevation of the blood glucose, and also reducing the drug costs. The above results suggest that psychiatric pharmacotherapy conferences encourage psychiatric medical teams to adjust prescriptions while sharing information, and are effective for optimizing pharmacotherapy.

Use of psychotropics and the risk of falls in hospitalized psychiatric patients.

As hospitalized patients in psychiatry departments are often prescribed multiple psychotropics depending on their psychiatric symptoms, psychotropics are considered as important factors potentially associated with a high risk of falls. In this study, we attempted to investigate, from the aspect of drug prescription, to what degree the number and doses of psychotropics must be adjusted in order to reduce risk of falls in hospitalized psychiatric patients. The subjects were 526 patients, consisting of a fall group of 313 patients, who had experienced 1 to 5 falls (510 events) and a control group of 213 patients who had never experienced falls. Multiple logistic regression analysis was performed to determine the correlations between the occurrence of falls and the number and doses of psychotropics. The results showed that the risk of falls increased with increasing number of antipsychotics and anxiolytics/hypnotics prescribed, with the risk increasing, by 3.75-fold with the increase in the dose of chlorpromazine (CP)-equivalents to more than 600 mg, by 2.08-fold when the dose of diazepam (DAP)-equivalents to more than 15 mg, and by 7.80-fold with increase in CP-equivalents to more than 600 mg concomitantly with an increase in DAP-equivalents to more than 15 mg. In addition, a tendency towards increase in the frequency of falls was observed when more than 5 psychotropics were prescribed concomitantly. The above results suggested that the risk of falls may be reduced by appropriately adjusting the number of drugs and the doses of psychotropics used in the treatment of psychiatric disorders.

Innvestigation on patient's and pharmacist's attitudes toward medical services in community pharmacies.

An investigation of patients' and pharmacists' attitudes toward medical services provided in community pharmacies was conducted in September, 2007. Respondents to the survey were patients and pharmacists in 160 stores of a chain pharmacy. The questionnaire consisted of 15 question items about pharmacy functions and three comprehensive evaluations of the pharmacy. The degree of importance and satisfaction was surveyed among 8995 patients, and the degree of importance and sufficiency was surveyed among 408 pharmacists. Multivariate analyses were performed using these data. Patients considered pharmacy functions as less important than did pharmacists for all items. The difference in attitude toword "the medication notebook" was particularly marked. Next, factor analysis was performed of the degree of importance in patients' and pharmacists' responses and three potential factors were extracted for each. However, the items constituting potential factors differed slightly between patients and pharmacists. Finally, multiple-regression analyses using three comprehensive evaluations as the independent variable and satisfaction with 15 items as a dependent variable were performed. In all three models, the standardization regression coefficient of "explanation of medicine" was large in the regression model of patients. On the other hand, the standardization regression coefficient of "consideration for patients" was large in the model of pharmacists. The influence of some patient attribute dummy variables was significant. Differences in the attitudes toward medical services and pharmacy functions were found between patients and pharmacists, and some items that should be improved were revealed.

[Analysis by structural equation modeling of the questionnaire about the risk and its preventive measures in a pharmacy].

Pharmacists are now facing a problem of developing measures for dispensing mistakes, because there recently is increasing social awareness on medical accidents and a tendency to increase medical accidents in pharmacies due to popularizing separation of dispensing and prescribing functions. In this study, questionnaire survey was conducted to investigate pharmacist's views on human error measures and the relationship between mistakes and the preventive measures. To clarify relationship between human error measures and preventive measures for avoiding mistakes, questionnaire result was analyzed based on structural equation modeling (SEM). Questionnaire survey was sent to community pharmacies in Hokkaido. The result was analyzed by SEM. The recovery rate of the questionnaire was 71.0%. Human error measures were classified into "The measures against deficient knowledge and insufficient experiences". "Attention problem measures" and "The measures against a cognitive error". While attention problem was strongly related to the cognitive error, there was no relationship between "Attention problem measures" and "The measures against a cognitive error". Moreover, it were clarified that to develop human error measures for deficient knowledge and insufficient experiences was effective for the preventive against the mismatch of the cognitive mechanism and the intentional mistake and for bridging the gap between knowledge and experiences. This study showed that SEM was effective for adopting efficient preventive measures for medical accident and analyzing risk management in pharmacies. Applying these results to the medical accident preventive measures contribute to improvement of the risk management.

[Construction and evaluation of a cancer chemotherapy regimen database using an electronic medical chart network].

PURPOSE: There are many regimens for cancer chemotherapy, and thus information management is complicated. It is thought that the safe and appropriate use of cancer chemotherapy can be achieved by developing a system that involves information-sharing among medical staff. A system facilitating the choice of regimen was developed in our institution using an electronic medical chart network. In addition, a questionnaire was distributed to evaluate the usefulness of the cancer chemotherapy regimen database (DB). METHODS: Microsoft Access 2000 was used for the DB. Microsoft Internet Information Services Ver. 6.0 included in the Windows 2003 Server was used as the management software of the Web-version DB. RESULTS: With the Web-version DB, it was possible to offer chemotherapy regimen information to all departments in the hospital. The DB received an excellent evaluation based on the questionnaire results. The reasons for this were the exceptional ability to share information among medical staff and the appeal of a checking system. CONCLUSION: Obtaining information regarding cancer chemotherapy regimens became easier with the Web-version DB, which received an excellent evaluation by all medical staff. Proactive use of the Web-version DB can contribute to proper cancer chemotherapy choice and strengthening of hospital risk management.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

[The development and operation of a package inserts service system for electronic medical records].

To promote the appropriate use of pharmaceuticals and to prevent side effects, physicians need package inserts on medicinal drugs as soon as possible. A medicinal drug information service system was established for electronic medical records to speed up and increase the efficiency of package insert communications within a medical institution. Development of this system facilitates access to package inserts by, for example, physicians. The time required to maintain files of package inserts was shortened, and the efficiency of the drug information service increased. As a source of package inserts for this system, package inserts using a standard generalized markup language (SGML) form were used, which are accessible to the public on the homepage of the Organization for Pharmaceutical Safety and Research (OPSR). This study found that a delay occurred in communicating revised package inserts from pharmaceutical companies to the OPSR. Therefore a pharmaceutical department page was set up as part of the homepage of the medical institution for electronic medical records to shorten the delay in the revision of package inserts posted on the medicinal drug information service homepage of the OPSR. The usefulness of this package insert service system for electronic medical records is clear. For more effective use of this system based on the OPSR homepage pharmaceutical companies have been requested to provide quicker updating of package inserts.