A Study of Pharmacist-Patient Communication: Examining Optimal Distance and Angle Using an Eye-Tracking System

This study focuses on seating arrangement and interpersonal distance as important aspects of nonverbal communication and aims to elucidate the optimal distance and angle between pharmacist and patient through an analysis based on the subjective evaluation of the patient and the objective evaluation of eye movements. Seven female simulated patients and one male and one female pharmacist cooperated as patients and pharmacists, respectively. The medication teaching scenes were set up with three pharmacist placements (face-to-face at 50 cm and 70 cm, 90-degree at 70 cm) and three hospital rooms (0-degree, 45-degree, 90-degree). Pupil diameter, blink rate, saccades, and fixation rate of the patient at each of these locations were measured using a Tobii Pro Glass 2. The patient’s subjective evaluation at each placement was also investigated using the conversation scale, which assesses the optimal distance for conversation. The results for the pharmacy setting revealed that pupils were significantly more mydriatic at the 50 cm point than at the other points. The results for the hospital room setting showed the greatest mydriasis at the 0-degree point. The result of the 50 cm point for the pharmacy setting and the 0-degree point for the hospital room setting was similar to that of the subjective evaluation. When the likelihood of saccades occurrence in the hospital room setting was compared, saccades were found to be most likely to occur when medication instructions were given to patients at the 0-degree point. We believe that using pupil diameter for interpersonal distance, and saccades for angle will enable more accurate determinations of the optimal distance and angle between pharmacist and patient. The results of the present study suggest that the 70 cm face-to-face point in the pharmacy and the 45-degree point in the ward may be suitable for medication instruction.

Direct Measurement of Medical Linear Accelerator Electron Beam Width at Scattering Foil Position

Purpose: The aim of this study was to develop a method for the direct measurement of electron beam width and distribution at the scattering foil on the carrousel in a medical linear accelerator gantry head, which differs from an existing indirect method for measuring the focal spot size using a camera or metallic slit located outside the gantry head. Methods: The electron beam emitted by the linear accelerator was used to irradiate radiochromic film mounted on the scattering foil on the carrousel, which was not used for clinical treatment. The electron beam width at the scattering foil position was then evaluated using the full width at half maximum of the Gaussian distribution approximated from each one dimensional distribution of the irradiated radiochromic film. Results: The electron beam width at the scattering foil position was found to be 3.1 to 6.4 mm in the crossline direction and 2.8 to 5.5 mm in the inline direction with electron energy of 4 to 16 MeV. The two-dimensional distribution of the electron beam was therefore elliptical or distorted in shape, not circular. Conclusions: Direct measurement of the electron beam width at the scattering foil in the carrousel of a medical linear accelerator is possible, though the use of lower sensitivity film in addition to indirect methods is expected to bring about better results. However, as this method does not allow for direct measurement of the incident angle of the accelerated electron beam, further improvements and refinements are still needed.

Investigation of Patients’ Mood on Their Distance from the Pharmacist during Medication Instruction

Background: Pharmacists must adjust their distance from patients to facilitate communication during interviews and gain their trust. The distance between the patients and the pharmacists varies depending on many factors, such as gender, posture and the patients’ mood. Only a few of these papers have actually measured and validated distance with patients. In this study, we validated our method of assessing mood and measuring distance before beginning a survey with patients. Methods: We measured comfortable interpersonal distance among men and women using an ecological scenario, in which a pharmacist approaches the subject, and the subject is asked to stop the pharmacist at the distance he/she feel comfortable with. Five pharmacists and 33 subjects participated in the study. The Japanese version of the Brief Mood Questionnaire Checklists (BMC-J) was used to quantify the subject’s mood for the day, and then the distance from the pharmacist that the subjects considered comfortable was measured at the bedside. The relationship between the mood and distance obtained was examined. Results: The comfortable distance of subjects was influenced by gender, posture, and mood. The shortest distance was 94.7 ± 11.1 cm (mean ± SD), for the male subjects versus the female pharmacists in the sitting position. The distance of male subjects shorted when they had positive emotions and lengthened when they were worried. Female subjects maintained a long distance from both male and female pharmacists when they had positive emotions and a short distance when they were worried. Conclusion: Findings show that the distance changes depending on the subjects’ mood at the time of measurement. It was found that the present measurement method can be used to determine the psychological state of the patient and measure the comfort distance at that time, and can be used as a simple method to examine these relationships. Therefore, it is also considered a practical method for the next step, which is a clinical study on patients.

Comparison of Anticancer Drug Preparation Techniques between Chemotherapy Specialist Pharmacists and Non-Chemotherapy Pharmacists Using Eye-Tracking Techniques

Anticancer drug preparation by pharmacists is a critical task directly related to medical incidents. This study examined the factors influencing medical errors in chemotherapy, that is, errors by specialist pharmacists (CPh) and pharmacists in other departments (NCPh), by measuring their gaze during the preparation of anticancer drugs. The eye-tracking results showed that the gazing time of NCPh was significantly longer than that of CPh for items such as “preparation of a closed-system device” and “preparation of the syringe” and all preparation times (P < 0.05). The NCPh were not assigned to prepare drugs on a regular basis, indicating their lack of familiarity with the process. There was no significant difference in gaze ratio between CPh and NCPh. This outcome was suggested to be a result of the use of an anticancer drug preparation support system. The results for the pupil diameter variation rate showed that NCPh were significantly more mydriatic in the “mixing injections” category than CPh. However, CPh tended to be more mydriatic in the “checking” category. CPh exhibited a smooth workflow and focused on the important items to be checked. This study showed that the differences in procedure flow and concentration points may lead to errors. Furthermore, the results are of interest from the perspective of medical incident prevention. They will be useful in identifying potential human factors, such as where the pharmacist focuses their attention by measuring eye movements.

Emotion Measurement Using Biometric Signal

In recent years, research on the estimation of human emotions has been active, and its application is expected in various fields. Biological reactions, such as electroencephalography (EEG) and root mean square successive difference (RMSSD), are indicators that are less influenced by individual arbitrariness. The present study used EEG and RMSSD signals to assess the emotions aroused by emotion-stimulating images in order to investigate whether various emotions are associated with characteristic biometric signal fluctuations. The participants underwent EEG and RMSSD while viewing emotionally stimulating images and answering the questionnaires. The emotions aroused by emotionally stimulating images were assessed by measuring the EEG signals and RMSSD values to determine whether different emotions are associated with characteristic biometric signal variations. Real-time emotion analysis software was used to identify the evoked emotions by describing them in the Circumplex Model of Affect based on the EEG signals and RMSSD values. Emotions other than happiness did not follow the Circumplex Model of Affect in this study. However, ventral attentional activity may have increased the RMSSD value for disgust as the β/θ value increased in right-sided brain waves. Therefore, the right-sided brain wave results are necessary when measuring disgust. Happiness can be assessed easily using the Circumplex Model of Affect for positive scene analysis. Improving the current analysis methods may facilitate the investigation of face-to-face communication in the future using biometric signals.

Easy detecting signal of cognitive decline in healthy community-dwelling elderly people

The relationship between changes of elderly people’s participation in social activities and their cognitive functions was examined. Healthy, middle and upper-middle aged people (n = 407) responded to the Nagoya University Cognitive Assessment Battery and to a questionnaire inquiring about their participation in social activities. The results suggested that those whose participation in social activities increased in the last 6 months showed better verbal functioning than those whose participation was unchanged or decreased. Moreover, those whose social participation decreased showed inferior memory function compared to those whose social participation was unchanged, or increased. Furthermore, those whose social participation increased had better information processing speed than those whose social participation decreased. These results suggest that changes in social activities might act as an important signal that is indicative of the cognitive decline in elderly people, which would be useful to local health care managers in the elderly people’s community.

Survey of Bereavement Care Provided by Home-Visit Nurses for Bereaved Families in Japan

Purpose: This study aims to investigate the implementation conditions of bereavement care for bereaved families and the relationship between demographics of home-visit nurses and rates of provision of bereavement care. Methods: A self-rating anonymous questionnaire survey was conducted with 2200 facilities randomly selected from among the members of the Home-visit Nursing Stations of the National Nursing Business Association. Calculating the rates of provision of each pre- and post-bereavement care item of the survey, we performed a multiple logistic regression analysis to investigate the relationship between the demographics of home-visit nurses and rates of provision of care. Statistical processing employed SPSS ver. 21.0 with the significance level set at 5%. Results: A total of 688 responses were collected (collection rate, 31.3%), and 649 were included in the analysis. “Approval of the care that the family has provided” and “Involvement in the care together with the family and listening to their thoughts” were frequently provided in both pre- and post-bereavement care;however, the rate of provision of “Provided continued support/life planning until the family fully recovers social life” was low. More care services were provided by home-visit nurses working in facilities with 24-hour services in pre-bereavement, and by those with longer home-visit nursing experience in post-bereavement. Conclusions: Home-visit nurses provide many post-bereavement care services. However, continued care that helps bereaved families fully recover their social life, including life planning, is less frequently provided. Bereavement care provision rates vary depending on the facility type, whether the facility offers 24-hour services, and the length of home-visit nursing experience.

Quality Evaluation of Carnitine for Proper Use of Supplement

In recent years, consumers are becoming more health-conscious. Supplements are becoming popular as they can be purchased easily. In Japan, the “Food with Function Claims” system began in 2015;the market for supplements is expected to continue to expand. However, the use of some supplements has not been supported with sufficient scientific evidence;some products have even caused health problems. In addition, consumers may not be able to make correct decisions based on the information from the Internet. Unlike medicine, the instruction on the usage of supplements is not precise. Therefore, improving the quality of the information on the supplements will become more necessary in the future. This study aims to improve the quality of the information on supplements by surveying the disintegration and dissolution behavior of the carnitine-containing supplements and evaluated their quality. The products tested here were supplements containing commercial carnitine. Disintegration test and dissolution test were conducted according to the Japanese Pharmacopoeia. Carnitine was quantified by high-performance liquid chromatography. The disintegration tests revealed that the products had different disintegration times, varying from 35 to 100 minutes;some products took more than 5 hours to disintegrate. Thus, some products had a slow rise in their dissolution rate. These results suggest that the carnitine-containing supplements used in this study may affect the absorption process. Therefore, in the case of oral administration, the expected effect might not be achieved depending on the product.

Kynurenine plays an immunosuppressive role in 2,4,6-trinitrobenzene sulfate-induced colitis in mice

BACKGROUND Inflammatory bowel disease,such as Crohn’s disease and ulcerative colitis,is characterized by chronic intestinal inflammation leading to intestinal mucosal damage.Inflammatory bowel disease causes dysregulation of mucosal T cell responses,especially the responses of CD4+T cells.Previously,we demonstrated that indoleamine-2,3-dioxygenase plays an immunosuppressive role in 2,4,6-trinitrobenzene sulfate(TNBS)-induced colitis.Although indoleamine-2,3-dioxygenase exerts immunosuppressive effects by altering the local concentration of tryptophan(Trp)and immunomodulatory Trp metabolites,the specific changes in immune regulation during colitis caused by Trp metabolites and its related enzymes remain unclear.AIM To investigate role of kynurenine 3-monooxygenase(KMO)in TNBS-induced colitis and involvement of Trp metabolites in maintenance of intestinal homeostasis.METHODS Colitis was induced in eight-week-old male KMO+/+or KMO−/−mice of C57BL/6N background using TNBS.Three days later,the colon was used for hematoxylin-eosin staining for histological grading,immunohistochemical or immunofluorescence staining for KMO,cytokines,and immune cells.Inflammatory and anti-inflammatory cytokines were measured using quantitative RT-PCR,and kynurenine(Kyn)pathway metabolites were measured by high-performance liquid chromatography.The cell proportions of colonic lamina propria and mesenteric lymph nodes were analyzed by flow cytometry.RESULTS KMO expression levels in the colonic mononuclear phagocytes,including dendritic cells and macrophages increased upon TNBS induction.Notably,KMO deficiency reduced TNBS-induced colitis,resulting in an increased frequency of Foxp3+regulatory T cells and increased mRNA and protein levels of antiinflammatory cytokines,including transforming growth factor-βand interleukin-10.CONCLUSION Absence of KMO reduced TNBS-induced colitis via generation of Foxp3+regulatory T cells by producing Kyn.Thus,Kyn may play a therapeutic role in colon protection during colitis.

Dose Distributions in Simulated Electron Radiotherapy with Intraoral Cones Using Treatment Planning System

Aim: This study aims to evaluate the difference between depth data from an intraoral cone and a conventional irradiation tube calculated using a treatment planning system (TPS), and that measured using an intraoral cone for electron radiotherapy. Background: A TPS is only compatible with conventional irradiation tubes. However, such systems are not suitable for determining dose distributions when a special cone is employed. Materials and Methods: Dose distributions were calculated using the beam data for mounted intraoral cones using a TPS. Then, the dose distribution by field size was calculated for a low-melting-point lead alloy using the beam data for a mounted conventional tube. The calculated data were evaluated against the measured intraoral-cone depth data based on the dose and depth differences. Results: The calculated data for the intraoral cone case did not match the measured data. However, the depth data obtained considering the field size determined for the lead alloy using the conventional tube were close to the measured values for the intraoral cone case. The difference in the depth at which the absorbed dose was 50% of the maximum value of the percentage depth dose was less than ±4 mm for the generalized Gaussian pencil beam convolution algorithm and less than ±1 mm for the electron Monte Carlo algorithm. Conclusion: It was found that the measured and calculated dose distributions were in agreement, especially when then electron Monte Carlo algorithm was used. Thus, the TPS can be employed to determine dose distributions for intraoral cone applications.