“Signals are useless until they are read and possibly subjected to intensive study by appropriate investigators in WHO or in national centres”, cited from Finney’s 1974 first article on the theory of signal detection. Recently, freely available large-scale spontaneous reporting systems databases and improved computational power of personal computers have made it easier to perform signal detection in personal researches. However, adequate knowledge for the limitations of source spontaneous reports and understanding the differences with conventional clinical and epidemiological studies are imperatives for valid interpretation of signal indexes. This review describes the basic theory, aims and limitations of the signal detection method using spontaneous reporting systems databases and practical considerations.

Objective: The importance of occupational exposure control in cancer therapy is widely recognized, and measurement of anti-cancer drug exposure during preparation, as well as comprehensive measures, including administrative control, patients’ excrements, and environmental pollution, among others, are becoming important. The Osaka Women’s and Children’s Hospital introduced the closed system drug transfer device (CSTD) for administering anticancer drugs, and conducted consistent exposure measures from preparation to disposal. We simultaneously conducted an awareness survey on anti-cancer drug exposure measures for health care workers,observed the changes in their awareness and behavior, and examined the issues that constantly challenge anti-cancer drug exposure measures.

Method: We surveyed doctors, nurses, and pharmacists who handle anticancer drugs belonging to the Osaka Women’s and Children’s Hospital from March 2018 to October 2018. The questionnaire was anonymous and was collected within one week after distribution. In the questionnaire survey, we obtained permission to present the contents on paper and orally.

Results: The questionnaire response rate was approximately 70%. Following the training and introduction sessions, the participants had an improved understanding of Hazardous Drugs and CSTD. The introduction of the workshops on anti-cancer drug exposure measures and CSTD encouraged the nurses to reflect on the exposure measures and revisit the manuals on in-hospital treatment with anti-cancer drugs; however, there was little or no change in the behavior of the pharmacists.

Discussion: Since nurses work primarily in the field of patient care, their awareness of anti-cancer drugs has gradually declined, and it was observed that procedures for exposure control were not being followed. In order to ensure that anti-cancer drug exposure measures are properly observed, pharmacists need to take initiatives and conduct in-hospital workshops once every six months. It is also necessary to educate the medical staff about electronic devices in order to ensure their easy participation in workshops and encourage e-learning.

Introduction: Voriconazole (VRCZ) is a triazole antifungal agent for which therapeutic drug monitoring (TDM) is recommended. At Juntendo University Hospital, the VRCZ TDM implementation rate was 42% between January 2011 and October 2017. Here, we report that modifications to the hospital’s drug ordering system improved the implementation rate of VRCZ TDM.

Method: In August 2018, the drug ordering system was modified so that a message appeared on the screen to notify clinicians of the need to monitor VRCZ blood concentrations and to recommend a date for sample collection. In addition, the laboratory orders for VRCZ levels were digitized. We compared two one-year periods before and after implementation of the modifications (August 2017 to July 2018 and August 2018 to July 2019) to verify the effect of the changes.

Result: Results showed an increase in the TDM implementation rate: 12 patients (42.8%) received TDM before modification of the system, and 26 patients (92.9%) received TDM after modification of the system. Further, the rate of blood sampling at the recommended time point for estimating blood concentration (day 5-7 after the start of administration) improved after system modification, i.e., blood samples were collected from 18 patients (64.3%) at the steady state point. In contrast, blood samples were collected from only 6 patients (21.4%) before system modification. When blood concentrations deviated from the target range in patients who received TDM, clinicians took appropriate actions, such as reducing drug doses, prescribing drug holidays, or discontinuing medications.

Conclusion: A system that provides information related to VRCZ blood concentration measurements can help clinicians provide patients with optimal pharmacotherapy.

Objective: This study aims to clarify the current attitude status of community pharmacists toward pharmacies and the roles of family pharmacists.

Methods: A questionnaire survey was administered to 196 community pharmacists involved in 52 community pharmacies.

Results: Overall, 189 pharmacists responded to the survey. More than 80% of the pharmacists responded to “Pharmacists supervise all the medicines for patients, even if they were prescribed from various medical institutions, and check the acceptability of taking medicines together to prevent duplicate medications and drug interactions,” and 91.5% responded to “The pharmacy is close to medical institutions and convenient” as the reason for selecting a specific pharmacy. In terms of the reasons for patients to select a couple of pharmacies, 95.8% of the pharmacists responded to “The pharmacies are close to hospitals and clinics respectively, and convenient.”Relatively high percentages of the pharmacists responded to the following four roles of a family pharmacists: “A family pharmacist explains medicines to the patients in a way they can easily understand” (62.4%), “A family pharmacist provides consultations for medicines” (79.4%), “A family pharmacist exactly understands all the medicines the patients take” (62.4%), and “A family pharmacist checks duplicate medications and drug interactions prescribed in various medical institutions” (78.8%). However, only 15.3% of the pharmacists responded to “A family pharmacist shares information with prescribing doctors and medical institutions enough.”

Conclusion: Although community pharmacists were conscious of several interpersonal activities, they believed that patients did not select a pharmacy on the basis of the qualities of the pharmacist but rather on the location of the pharmacy. Community pharmacists are facing challenges to become a true family pharmacist meeting the requirements of “Pharmacy Vision” and need to further improve their attitudes to play an important role in regional comprehensive healthcare with other medical professionals and institutions.