In order to establish pharmaceutical care resulting in improved quality of life of patients, we performed clinical pharmacy studies directly related to the quality of life of patients and clinical education studies widely targeted at pharmacy students, pharmacists and patients.

Clinical pharmacy studies:

1) Impact of outpatient chemotherapy-related adverse events on the quality of life and labor productivity of breast cancer patients

2) Elucidation of new risk factors for falls and analysis of cost of falls for inpatients

3) Implementation of dosage adjustments by dispensing pharmacists for patients with renal dysfunction and the effects

Clinical education studies:

4) Lecture to pharmacy students in clinical training about practical and clinical pharmacy to enhance the education level of pharmacists

5) Education program of outpatient chemotherapy for pharmacy students in clinical training

6) Effect of patient education for the use of a medication notebook on purchasing over-the-counter drugs and health foods

The results regarding clinical pharmacy clarified in the studies 1)－3) provide evidence for the establishment of pharmaceutical care. The clinical education　conducted in the studies 4)－6) would provide pharmacists with the expertise to provide pharmaceutical care to patients. We believe that these findings are important evidence for improving the quality of life of patients, which will be the basis for clinical pharmacy and clinical education.

We report the case of a woman with rheumatoid arthritis (RA) who had two successful pregnancies (at 31 and 35 years old). Her RA was diagnosed when she was 23 years old. The first pregnancy was established while she was taking etanercept (ETN) and prednisolone (PSL) after In Vitro Fertilization - Blastocyst Transfer (IVF-BT). Her RA was controlled well by ETN/PSL during pregnancy and she gave birth to a healthy female infant weighing 2650 g with Apgar scores of 7 and 9. The RA worsened transiently after childbirth and methotrexate (MTX) was administered. Based on her desire to have a second child, MTX was discontinued. Her second pregnancy was established while on PSL/tocilizmab (TCZ) after IVF-BT. The TCZ was halted until gestational week (GW) 8, two doses of TCZ were given at GW 9 and 14 to stabilize RA, TCZ was switched to ETN on and after GW 18, and she gave birth to a healthy male infant weighing 3225 g with Apgar scores of 8 and 9. Counseling was provided several times by a pharmacist to support her RA treatment during her pregnancy.

Helicobacter pylori (H. pylori) infected patients have a high-risk of developing stomach cancer and gastroduodenal ulcers. Eradication therapy is recommended because gastritis improves by eradicating H. pylori. We assessed the factors influencing eradication therapy. In the eradication success group, the percentage of treatments using vonoprazan (VPZ) was significantly higher than in the eradication failure group (odds ratio 4.71, P < 0.01). Chronic gastritis (odds ratio 1.04, P < 0.01) and gastroduodenal ulcers (odds ratio 2.76, P < 0.01) were found to be important factors influencing eradication. The eradication rates of chronic gastritis were lansoprazole (LPZ): 76％, rabeprazole (RPZ): 73％, esomeprazole (EPZ): 79％, and VPZ: 96％. VPZ had a high eradication rate, significantly more than that of LPZ, RPZ, and EPZ. The eradication rates of gastroduodenal ulcers were LPZ: 89％, RPZ: 91％, EPZ: 89％, and VPZ: 96％, and there were no significant differences. VPZ demonstrated a high eradication rate (96％) of chronic gastritis and gastroduodenal ulcers. Our results confirm that VPZ is more effective in eradication therapy than LPZ, RPZ, and EPZ. LPZ is expensive for eradicating chronic gastritis, and EPZ is relatively cheap. On the other hand, VPZ is expensive for eradicating gastroduodenal ulcers, and RPZ is relatively cheap. We think that it is important to consider which disease is being targeted when choosing the medicine for eradicating H. pylori.

The number and outcome of articles on clinical studies change over time, and reflect the outcome of the studies as shown by meta-analyses. Thus, meta-analyses should be precisely timed. We fragmentally and cross-sectionally assessed articles describing the antihypertensive effects of incretin-related drugs to determine the optimal timing and feasibility of meta-analyses.

We searched PubMed and ICHUSHI Web databases for clinical articles describing the effects of incretin-related drugs on blood pressure, and longitudinally evaluated the number and quality of the articles.

We analyzed 54 English articles published between 2000 and 2015: 79.6％ studies were randomized, 42.6％ were analyzed in a double-blind comparative manner, and 83.3％ described cancelled and dropout cases. The mean Jadad score was 2.7 ± 1.7 (Mean ± SD). The correlation coefficient of the quality and sample size was –0.916.

Our meta-analysis revealed that compared to placebo, liraglutide 1.2 mg, exenatide 5 μg, and liraglutide 1.8 mg reduced systolic blood pressure by –5.38 mmHg, and –5.27 mmHg, and –3.89 mmHg, respectively [95％ confidence intervals: –7.91 to –2.84, –9.18 to –1.36, and –6.41 to –1.37 respectively].

The quality level was retained in studies published between 2000 and 2011. Therefore, the quality and quantity may be balanced at the time of the meta-analysis of the first published article. A similar approach may determine the optimal timing of meta-analyses in other fields.

This study was conducted to investigate the safety (adverse events) and efficacy (drug absorption rate, blood concentration, blood pressure, and pulse rate) of a transdermal bisoprolol formulation in perioperative patients. There was a strong positive correlation between the apparent absorption rate and water content of the stratum corneum. The blood concentration correlated with the apparent absorption rate and water content of the stratum corneum. The systolic blood pressures at the start of patch attachment and after 24 hours were 136.0 ± 8.9 and 116.2 ± 17.0 mmHg, respectively, showing a significant decrease (P < 0.05). The diastolic blood pressures at the start of patch attachment and after 24 hours were 82.8 ± 12.9 and 69.4 ± 5.6 mmHg, respectively, showing a significant decrease (P < 0.05). The pulse rates at the start of patch attachment and after 6 hours were 93.0 ± 7.2 and 78.2 ± 6.7 bpm, respectively, showing a significant decrease (P < 0.05). The effect persisted until 24 hours after patch attachment. There were no adverse events. In this study, the bisoprolol patch influenced the pulse rate earlier than the blood pressure; therefore, the dose must be regulated while monitoring the pulse rate.

Acetaminophen is approved up to 4,000 mg per day as an analgesic agent in Japan and displays analgesic effects depending on dosage. On the other hand, acetaminophen has some interactional effects. The mechanism of the interaction between acetaminophen and warfarin has not been elucidated, and no interactional cases have been reported in Japan either. However, two cases of marked PT-INR elongation were recognized by two inpatients in our hospital, Japanese males in their 50s and 60s who were treated with concurrent chemoradiotherapy using 70 Gy radiotherapy delivered as 2 Gy daily and triweekly 100 mg/m² cisplatin, that had been prescribed both drugs. Each PT-INR lapsed into loss of control; the maximum for one was more than 20 which was unmeasurable and for the other, 9.48, given vitamin K2 (VK2) immediately was antagonistic to warfarin. Concomitant drugs of warfarin were promptly checked again to see if it was related to the plasma protein binding ratio and hepatic cytochrome P450 inhibition reaction. Furthermore, each liver function test was also normal. As a result of consideration on these two, the dosage of acetaminophen has possible implications. It could be caused by the active metabolite of acetaminophen, NAPQI (N-acetyl-para-benzoquinone imine), as reported by basic research of VK cycle inhibitory action; however, the mechanism is not completely clear yet so future research is required to clarify this point. In any case, it is necessary to regularly measure PT-INR through the combination of warfarin and acetaminophen.