Albumin-bound paclitaxel (nab-PTX) plus gemcitabine (GEM) therapy (GnP) is often administered to patients with unresectable metastatic pancreatic cancer. However, chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect. In this study, we investigated the risk factors for CIPN in patients who were receiving GnP therapy for pancreatic cancer at our hospital and had a history of prior chemotherapy. The patientsʼ background, laboratory data, previous treatment history, concomitant medication, dose and number of medicines, and occurrence status of side effects were examined. The frequency of CIPN in patients receiving GnP therapy at our hospital was 72％. Multiple logistic regression analysis revealed that a history of FOLFIRINOX therapy (FFX), including oxaliplatin (L-OHP) administration, (odds rate: 3.864, 95％ CI: 1.160-12.868) and female sex (odds rate: 3.673, 95％ CI: 1.102-12.242) were risk factors for CIPN. In addition, the severity of CIPN was significantly higher in patients with a history of FFX administration (P = 0.011). Further, the cumulative dose and the administration period of nab-PTX until the onset of CIPN were significantly lower in patients with a history of FFX administration (P = 0.016, P = 0.004, respectively). We suggest that special care in monitoring GnP therapy is necessary in female patients with a history of FFX administration.

Pharmaceutical care clinics, wherein hospital pharmacists intervene to resolve the issues of outpatients, have been established in many hospitals in Japan. The purpose of this study was to verify the usefulness of pharmaceutical care clinics in the treatment of diabetes. Between April 2014 - March 2016, among type 2 diabetic outpatients who received pharmaceutical care, 34 patients who had a glycated hemoglobin (HbA1c) value ≥7.5％ were included in the pharmacist intervention group and 45 patients who had been consulted only by a nurse or a nutritionist were included in the pharmacist non-intervention group. HbA1c was determined and compared for 9 months among the two patient groups. Although a decrease in HbA1c value was observed in the pharmacist non-intervention group, HbA1c increased gradually from 6 months onwards. After 9 months, a significant difference in HbA1c was found between the pharmacist intervention and non-intervention groups (P = 0.047). With the intervention of nurses and nutritionists alone, it was impossible to suppress the rise in HbA1c value in type 2 diabetic outpatients continuously for 9 months. In the pharmacist intervention group, patients with poor glycemic control and problems of adherence were extracted and instructed more firmly. Because pharmacists spent adequate time identifying patients and improving medication adherence and lifestyle, favorable glycemic control could be achieved for the long term. Therefore, hospital pharmacists play an important role in providing appropriate medication for outpatients.

PreAVOID (“Prevent and avoid an adverse drug reaction”) is a pharmaceutical intervention that contributes to the improvement of drug safety and efficacy. It is considered important for pharmacists to spend time in the ward and carry out numerous PreAVOID interventions. At present, however, there have been no reports on the relationship between working hours of pharmacists in the ward and the number of PreAVOID interventions performed. Therefore, we investigated this relationship in Chiba University Hospital.

The working hours of pharmacists in each ward gradually increased and were 13.5-38.3 h per week from April 2015 to March 2017. The number of PreAVOID interventions also increased from 630 in fiscal year 2015 to 1116 in fiscal year 2016. The number of interventions that prevented adverse drug reactions increased from 402 in fiscal year 2015 to 550 in fiscal year 2016. The number of interventions that improved drug efficacy increased from 188 in fiscal year 2015 to 508 in fiscal year 2016. The working hours of pharmacists in the ward showed a positive and statistically significant correlation with the number of PreAVOID interventions (r = 0.688, P < 0.001). Therefore, our findings indicate that longer working hours of pharmacists in the ward probably result in an improvement in the efficacy as well as safety of drug therapy in association with increased PreAVOID interventions. Thus, it is important to ensure that pharmacists spend sufficient time in the ward in order to contribute to the improvement of drug safety and efficacy through PreAVOID interventions.

Pediatric patients who are nutritionally dependent on total parenteral nutrition or some type of therapeutic formula during perioperative periods or intensive chemotherapy are at a high risk of selenium (Se) deficiency. We herein report that the pediatric nutrition support team (pNST) was successfully able to perform early alimental interventions in 2 cases with selenium deficiency. Case 1: A ten-month-old girl with Langerhans cell histiocytosis developed protein-loss gastrointestinal disease with hypoalbuminemia and Se deficiency with nail whitening. The serum Se concentration was at an extremely low level (2.2 μg/dL ). The administration of sodium selenite recovered serum levels of Se up to 7.7 μg/dL one month later. Case 2: A five-year-old boy that had Tetralogy of Fallot with severe cyanosis had received long-term total parenteral nutrition for refractory diarrhea after surgery. The pNST diagnosed asymptomatic Se insufficiency by a low level of serum Se (7.0 μg/dL). Thus, the pNST recommended the administration of sodium selenite for the patient. The patient was successfully treated with Se supplementation to prevent overt Se deficiency. Our experiences suggest that the monitoring of serum Se concentrations is important to prevent or improve Se deficiency in pediatric patients receiving intensive care.

The administration of narcotic injections is an effective method of palliative pharmacotherapy for pain management in patients with terminal-stage cancer. Tokuhisa-chuo Pharmacy is therefore involved in supporting narcotic-injection administrations for patients receiving home care medicine. The present study is based on the intervention of our pharmacy from April 2013 to March 2016 through a survey on the status of pharmacist intervention for 99 patients with cancer who were already deceased. The results indicate that in the administration of narcotic injections for 60 patients receiving home care medicine, the median period of narcotic injection was 4 days. The chief reasons for the introduction of narcotic injections were pain management and dyspnea management. The survey was comprised of intervention details and intervention frequencies of pharmacists. The results show that the pharmacists fulfilled a variety of roles, including formulation planning (97％), administration route planning (27％), guidance for patients and their caregivers (97％), and sterile preparations (60％), among others. The present study revealed the active participation of the pharmacy in administering narcotic injections for patients receiving home care medicine. This report constitutes a case study of the handling of home palliative care support by a single health insurance pharmacy.

Pharmacists regularly use test values that are either provided by patients or that are recorded in out-patient prescriptions to identify potential adverse reactions to medications, to verify prescription accuracy (e.g., confirm the dose), and to provide patients with guidance on how to take their medications. However, there are no published evaluations of actual submissions from patients to pharmacies of test results that they received from their medical institutions. We administered a questionnaire and found a strong correlation between the submission of test results to pharmacies and test-result requests from both primary-care pharmacies (odds ratio: 2.4; 95％ confidence interval: 1.5-3.5; P value < 0.001) and general pharmacies (odds ratio: 2.9; 95％ confidence interval: 2.0-4.1; P value < 0.001). Primarycare and general pharmacy requests for test-result reports are useful measures for encouraging patient submission of test-result reports. In the future, non-hospital pharmacists should gain experience in explaining the significance of sharing test values with patients, verifying prescriptions, and helping patients avoid adverse reactions according to their test values, and pharmacists should work hard to change the existing preconceptions of their role in regional medicine. It is important for the patient community to understand that non-hospital pharmacists not only distribute their medicine, but they also play a beneficial role in guiding patientsʼ drug therapies.