The present study aims to investigate the safe selection of sleeping medications for patients with acute stroke who were chronic users of benzodiazepine/non-benzodiazepine (BZD/Z-drugs). In this retrospective cohort study, we investigated sleep disturbances and delirium in patients with acute stroke who were chronic users of BZD/Z-drugs; these patients were treated with a BZD/Z-drug or a new type of sleep medication (ramelteon alone or in combination with suvorexant) in April 2013-March 2017. Overall, 155 patients were recruited, of whom 75 were prescribed a BZD/Z-drug and 80 were prescribed a new type of sleep medication. Patient characteristics showed no significant difference between the two groups. Subjective sleep quality was significantly improved in the patients receiving the new type of sleep medication compared with those receiving a BZD/Z-drug (difficulty in falling asleep: 25％ vs 10％, P = 0.019; difficulty staying asleep: 29％ vs 6.3％, P < 0.001). Further, a multivariable logistic regression analysis revealed that BZD/Z-drug use was significantly associated with sleep disturbance (OR 4.5, 95％ CI 2.1-9.6, P < 0.001). Delirium was significantly less frequent in patients receiving the new type of sleep medication compared with those receiving a BZD/Z-drug (16％ vs 3.8％, P = 0.013). Switching to the new type of sleep medication can improve subjective sleep quality without inducing delirium in patients with acute stroke who were chronic users of BZD/Z-drugs.

A solution containing xanthan gum (XTG), a thickening polysaccharide, as a main ingredient is used in taking medicines to prevent aspiration in patients with difficulty swallowing. Recently, there have been reports of XTG thickening solution (XTG-SOL) causing delays in the disintegration and dissolution of uncoated tablets and hindering the medicinal effects. However, studies on film-coated tablets have not yet been conducted. Since the film coating of tablets prevents direct contact with the thickening solution, we investigated whether film coating reduces delays in disintegration and dissolution of tablets.

Tablets were first immersed in XTG-SOL for 1 minute and then subjected to disintegration and dissolution tests. Disintegration tests on water-soluble coated placebo tablets were conducted in the first Japanese Pharmacopoeia solution (JP1, pH 1.2), and the results were compared with those of uncoated tablets and orally disintegrating (OD) tablets. Likewise, commercially available OD tablets containing film-coated multi-particulates, uncoated tablets, and OD tablets were also subjected to identical tests in JP1. For enteric-coated tablets, a disintegration test was conducted in JP1 and JP2 (pH 6.8).

Compared with the uncoated and OD placebo tablets, the film-coated tablets immersed in XTG-SOL showed the shortest delay in disintegration. Although a delay in the disintegration time was observed for the OD tablets containing film-coated multi-particulates, no delay in the dissolution rate or profile of the active ingredient was evident. XTG-SOL showed no effect on disintegration of the enteric-coated tablets, indicating no influence on the enteric property. These results demonstrate that film-coated tablets appear unaffected by immersion in XTG-SOL.

Although it is important to determine the risk factors for postoperative delirium (POD) to prevent the onset of POD, most previous studies that focused on risk factors for POD analyzed small cohort groups. Therefore, we aimed to explore the risk factors for the onset of POD by analyzing the National Health Insurance Claims Database (NDB) in Japan, which covers most Japanese residents.

We compiled the clinical data of patients who emerged from POD after eight types of surgical procedures from August 2015 to August 2016 from the NDB. We subsequently developed a logistic regression model to determine the factors that affected the onset of POD.

From the logistic regression analysis, we found that four factors (being over 75 years old, previous history of delirium, administration of a blood product during the operation, and emergency hospitalization) increased the odds ratio of POD. These factors may decrease physiological function, thereby leading to the onset of POD. We also clarified that the odds ratio of POD in patients administered inhalation anesthetic alone was lower than in patients administered combined inhalation and intravenous anesthetics for coronary artery bypass grafting. This finding was in line with the results of a previous small cohort study.

These findings imply that, to prevent the onset of POD, appropriate precaution for and appropriate selection of anesthetic agents is necessary for patients with the four POD risk factors.

Many anticancer drugs have adverse effects such as hypersensitivity and allergic reaction. However, of these, the platinum line of anticancer drugs is associated with a comparatively high frequency of onset, and caution is required when monitoring serious anaphylactic symptoms. Oxaliplatin (L-OHP), a standard treatment drug for colon cancer, is known to be associated with hypersensitivity, and continuation of treatment may become difficult. As such, diphenhydramine prophylactic treatment was attempted to prevent hypersensitivity reactions to L-OHP. A decrease in incidence was observed with no serious hypersensitivity reactions occurring in the prophylactic treatment group. In addition, a pharmacoeconomic examination revealed a decrease in the calculated cost per treatment in the prophylactic treatment group, thus showing pharmacoeconomic efficacy. This suggests that diphenhydramine prophylactic treatment to prevent hypersensitivity reaction to L-OHP is highly cost effective and contributes to safe chemotherapy treatment.

Aozora Pharmacy is a community pharmacy that has acquired ISO9001-2015 certification and recognized as a “Health Support Pharmacy.” In order to improve the prescription service, we conduct an annual patient satisfaction survey. Using the results from the September 2018 survey (effective responses: 422 persons), a review was conducted on the usefulness of logistics regression analysis (LRA) and the factors that would enhance patient satisfaction at the health support pharmacy by running a conventional method of portfolio analysis (PA) and new LRA. By PA, “Staff’s greeting,” “Staff’s attitude,” “Easy language use,” “Pharmacist’s explanation,” “Environment of pharmacy,” “Privacy,” and “Waiting time” were classified as important items. On the other hand, by LRA, “Staff’s greeting,” “Pharmacist’s explanation,” and “Waiting time” showed a significant difference (P < 0.05). We have confirmed that LRA is available as a method of analysis. At a community pharmacy, importance is placed on the “functions to become a patient’s main pharmacy.” This time, the three items that showed a significant difference in LRA are all important factors for the “function to become one’s own pharmacy”; it is critical for a community pharmacy to make efforts with focus placed on these items.

Carperitide has been used clinically for management of acute heart failure because of its pharmacological actions; that is, vasodilation that reduces both preload and afterload, a natriuretic action, and inhibition of the renin-angiotensin-aldosterone system (RASS). However, carperitide often induces infusion-related phlebitis despite infusion at the recommended concentration and dosing rate at Oita Oka Hospital. Therefore, we retrospectively investigated the incidence and risk factors for carperitide infusion-related phlebitis. During January to December 2016, a total of 166 patients who received precision continuous infusion of carperitide from the peripheral vein were enrolled in this study. Carperitide infusion-related phlebitis occurred in 63 (38.0％) of 166 patients. Univariate and multivariate analyses revealed that “the dosing period over 72 hours” was significantly associated with an increased risk of carperitide infusion-related phlebitis. The odds ratio (OR) and 95％ confidence interval (95％ CI) for the occurrence of phlebitis with respect to “the dosing period over 72 hours” were 4.53 (2.07-9.91). To minimize the risk of carperitide infusion-related phlebitis, we propose that medical professionals consider changing the infusion site every 72 hours at least.

To prepare for a new practical training scheme starting in 2019 based on a revised-model core curriculum for pharmaceutical education that incorporates outcome-based education, rubric-based assessment of student performance was implemented in practical training between May and July of 2018. The goals were to evaluate the rubric-based assessment to identify ways to improve it for appraising pharmaceutical students. All fifth-year students of the Keio University Faculty of Pharmacy in 2018 (n = 160) self-assessed their performance during practical training using evaluation sheets in a rubric form comprising three general instructional objectives with 10 task descriptions developed by the Japanese Pharmaceutical Association or Japanese Society of Hospital Pharmacists. Compared to the commencement of the training, the median evaluations in all tasks significantly increased at the completion of the practical training in the community pharmacy and the hospital settings. Survey questionnaires were administered to the students after the practical training. Customer satisfaction analysis identified two main areas for improvement of the rubric-based assessment for student growth: (1) students' lack of understanding of the rubric-based assessment in hospitals and (2) mentors' lack of understanding of it in both settings. The results suggest that rubric-based assessment is a feasible method for assessing pharmaceutical student performance during practical training. Additionally, the Faculty of Pharmacy should provide and disseminate information to students and mentors about rubric-based assessment and support mentors' efforts for student progress during practical training.