Bedridden patients are reported to have overestimated renal functions. The association between activity of daily living and vancomycin (VCM) trough concentration remains unclear. This retrospective study aimed to investigate the influence of trough VCM concentrations in non-elderly bedridden patients with an estimated glomerular filtration rate (eGFR) over 60 mL/min/1.73m². Hospitalized patients from July 2015 to January 2019 were classified into the bedridden (n = 32) and mobile group (n = 67) based on activity of daily life according to the criteria of Ministry of Health, Labour and Welfare. The bedridden group was defined as patients having scores of B or C over 28 days. We compared VCM trough concentrations and distribution of VCM concentrations (< 10, 10 - 20, and > 20 μg/mL) between bedridden and mobile patients. We compared the VCM trough concentrations after adjusting the propensity scores (n = 32 in each group). The median of the first VCM trough concentration was significantly higher in the bedridden than in mobile patients both before (10.2 μg/mL vs 13.9 μg/mL, P = 0.012) and after (9.7 μg/mL vs 13.9 μg/mL, P = 0.014) propensity score adjustment. The distributions of VCM trough concentrations of < 10, 10 - 20, and > 20 μg/mL were 51％, 42％, and 8％ in the mobile patients and 28％, 44％, and 28％ in the bedridden patients, respectively (P = 0.011). In conclusion, the present study suggests that in non-elderly patients with eGFR over 60 mL/min/1.73m², the first VCM trough concentrations were significantly higher in the bedridden than in mobile patients.

Infusion devices for the administration of injections used in various situations are manufactured according to their intended use. Among such devices, the infusion device for anticancer drug administration has been gaining acceptance in Japan. However, there are no clear standards for evaluating and selecting infusion devices conforming to each medical institution’s requirements. Therefore, this study constructed a stepwise evaluation method of selecting infusion devices, taking into consideration the importance of evaluation items that are difficult to quantify. We set a weighting coefficient for each evaluation item to relatively reflect the importance of the evaluation item systemized in three stages in the infusion device evaluation. For each infusion device, we performed a primary evaluation of its essential functions for anticancer drug administration, a secondary evaluation of its long-term safety from the viewpoint of the medical institution, and a tertiary evaluation of the possibility of its continuous and appropriate use from the perspective of medical professionals. Based on the evaluation method, one infusion device was selected from a list of five devices that were evaluated. This evaluation method, which was devised with reference to the public project evaluation conducted by the Ministry of Land, Infrastructure and Transport, is a logical and practical method that reflects the importance of evaluation items considered by the medical professionals of each medical institution during infusion device evaluation.

Recently, laboratory data have begun to be printed on prescriptions in many hospitals, and there are already many reports of its usefulness. However, the medical-economic impact of printing laboratory data on prescriptions is not clear. Hence, this study aimed to clarify this impact. We extracted prescription inquiries from laboratory data, for three years after printing laboratory data on prescriptions in our hospital, and we analyzed the change in drug costs and medical-economic effects of pharmaceutical intervention. There were 79 cases in the hospital and 159 cases in a community pharmacy during the target period. Approximately 90％ of the prescriptions reduced drug costs in the hospital and community pharmacies, and the average reduction in costs was 75 yen per day in the hospital and 351 yen outside of the hospital. In addition, pharmaceutical intervention-which can prevent serious side effects-results in medical-economic effects in the order of 16 million yen in the hospital and 120 million yen outside of the hospital. And, if laboratory data are printed on all national prescriptions and pharmaceutical interventions are performed as in this result, this will produce great medical-economic effects of 220 billion yen. It was shown that printing laboratory data on prescriptions affords great improvement in not only medical safety but also medical-economic effects. It is hoped that more hospitals will issue prescriptions with laboratory data printed, and that this will contribute to medical safety and medical-economic well-being.

The Therapeutic Drug Monitoring (TDM) Guidelines for Antibiotics (the “Revised guidelines”) were revised in June 2016. The Revised guidelines are followed to determine dosage and provide treatment at Osaka City University Hospital. The current study investigated VCM administration before and after the guidelines were revised as well as their effectiveness and safety. The period from January to December 2015 before the guidelines were revised (“before Revision”) and the period from January to December 2017 after the guidelines were revised (“after Revision”) were compared. One hundred and six patients received VCM therapy before Revision, and 184 received VCM therapy after Revision. Initially, 17.4％ of patients had the recommended serum VCM level of 10-15 µg/mL, but that increased to 41.7％ as a result of a pharmacist’s involvement; 72.8％ of patients had serum VCM below 10 µg/mL after Revision. Acute kidney injury (AKI) was evaluated based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The incidence of AKI was 12.3％ before Revision and 5.4％ after Revision, so it was significantly lower before Revision. The 30-day survival rate was 94.6％ before Revision and 95.3％ after Revision, so the rate did not differ significantly.

When VCM therapy was administered in accordance with the Revised guidelines, the initial serum trough level of VCM was lower than 10 µg/mL in most patients, and VCM slightly affected the kidneys. Most patients had a serum VCM of 10-15 µg/mL as a result of a pharmacist’s intervention, suggesting that the serum VCM level did not affect prognosis.

Providing spill kits when using anti-cancer drugs is recommended in the domestic and foreign guidelines, but there are few reports about the situation of their use. We investigated the use of spill kits from September, 2016 to February, 2018 based on the spill kits use situation report (spills report). The number of spill kit reports was 72 cases. For job type in which spill kits are used, nurses occupied 91.7％. For place of use, use in the ward was 79.2％. In addition, spill kits were mainly used to prevent toxin spillage during intravenous administration of anti-cancer drugs around beds. The compliance rate of personal protective equipment after the medical safety workshop was 100％ (P = 0.026).

These results suggest that the use of the spills report is useful for perceiving the occupational exposure of health caregivers to anti-cancer drugs.

In Japan, purchasing drugs via Internet auction is prohibited by law. The aim of the present study was to clarify the current status of unapproved drug transactions via Internet auction in Japan. We created five sets of keywords corresponding to five therapeutic categories, ie, hair growth, gastrointestinal treatment, skin care, anti-aging therapy, and anti-cancer therapy. The searches were first performed on the website “Yahoo-oku” (Yahoo auction, Japan) using the above sets of keywords within five days, followed by secondary searches in the same manner after a forty-day interval. The searched items together with their explanations were evaluated independently by two researchers to determine whether they were illegal. The illegal items in the anti-cancer category were further monitored after submitting violation reports to the website. In two search phases within five days each, 571 and 581 illegal items were identified, respectively. After submission of the violation reports, only 1.1％ and 3.4％ of the items in the anti-cancer category were withdrawn by the site administrator and seller, respectively, and 38％ of the monitored items were sold. Taken together, unapproved drug transactions via the Internet are a serious problem. The government and site administrators may need to take effective measures to monitor and avoid such transactions, as well as providing notices and education to customers.

Model Core Curriculum for Pharmacy Education (2013 version) presents eight disease areas as the minimum medical conditions, and it requires student trainees to be continuously engaged in pharmacotherapy for these diseases. We developed an “Individual Student Report Form” (Report Form) in order to investigate and evaluate each student trainee's engagement and continuity with the eight diseases. The Report Forms were shared between the community pharmacy, hospital, and university, and the effectiveness of collaboration among these institutions was examined.

Participants were 25 student trainees who were planning to do their clinical practicums in our hospital in the second term of 2017. During the earlier pharmacy practicum, the trainees were asked to complete the Report Form regarding the diseases they handled. Trainees took notes on the Report Form during their daily reflection time in their hospital practicums about their engagement with the eight diseases. We calculated the cumulative total numbers and percentages of their engagement with the eight diseases to examine engagement rates and continuity across terms.

The percentages of trainees who were engaged with all eight diseases were 36％ (9/25 persons) at the pharmacy, 24％ (6/25) at the hospital, and 68％ (17/25) overall at the two locations. The average numbers of the eight tracked diseases that trainees were engaged with were 2.3 at the pharmacy, 3.8 at the hospital, and 4.5 in total. The findings of this study suggest that this tracking tool could help facilitate and efficiently transfer information about the disease engagement of trainees during their two pharmacy practicums.