We have established a collaboration system between community pharmacies and our hospital using the sharing tools of patient information such as tracing reports and continuous training sessions by the team-based learning method. In this study, we evaluated the clinical effectiveness of this collaboration system in patients treated with oral anti-cancer drugs as adjuvant chemotherapy for gastrointestinal cancers. This retrospective study involved outpatients who started adjuvant chemotherapy including tegafur-gimeracil-oteracil potassium or capecitabine during the pre-collaboration period (from January to September 2016) and the post-collaboration period (from August 2018 to April 2019) of 9 months, respectively. Forty-five and 65 outpatients visited our hospital in the pre-collaboration and post-collaboration periods, respectively. The rate of treatment discontinuation due to side effects within 3 months of the start of treatment was significantly lower during the post-collaboration period than the pre-collaboration period (2 patients (3.1％) versus 7 patients (15.6％), P = 0.03). There were no significant differences between pre- and post-collaboration periods in the rates of emergency consultation and emergency hospitalization for 3 months after the start of treatment (emergency consultation: 9 patients (20.0％) versus 12 patients (18.5％), P = 1.00; emergency hospitalization: 6 patients (13.3％) versus 4 patients (6.2％), P = 0.31). These results suggest that this collaboration system could contribute to the reduction of treatment discontinuation due to the side effects of adjuvant chemotherapy for gastrointestinal cancers.

Background: After the Kumamoto earthquake in April 2016, a temporary dispensing station and a mobile pharmacy (MP) received post-disaster prescriptions in Minamiaso village, which was isolated following obstructed traffic.

Methods: In total, 114 pharmacists supported the temporary dispensing station and MP. In 2017, 75％ of them responded to our questionnaire.

Results: The underdeveloped temporary dispensing station was utilized for 13 days, while the MP, which had the necessary facilities, was operated for 43 days. Although a community pharmacy is unable to receive post-disaster prescriptions, the community pharmacy in Minamiaso handled some prescriptions owing to the limited availability of drugs. The drugs prescribed in the temporary clinic were mainly analgesics, cold medicines, gastrointestinal drugs, antihypertensive drugs, and sleeping pills. In contrast, the community pharmacy, and later, the MP, frequently received prescriptions related to chronic diseases. The remaining drugs at the MP were discarded. According to the responses to the questionnaire, pharmacists prepared medications, provided medication-related guidance, substituted drugs, and wrote prescriptions for medical doctors based on the patient’s drug history handbook/medication. Many pharmacists vocalized the need for maintaining an economical system to handle post-disaster prescriptions in community pharmacies as the amount of discarded drugs generated by support activities was high.

Conclusion: In preparation for large-scale disasters, we will establish a drug supply method in the affected areas by utilizing MPs and community pharmacies, supporting the issuance of post-disaster prescriptions, etc. Furthermore, we must discuss how to support and prevent the collapse of medical services in disaster-stricken areas.

Recently, dexmedetomidine (DEX) has been used for endoscopic sedation. Conversely, hypotension has been reported to occur with DEX. However, the presence or degree of hypotension is variable, with adverse events, such as sedation, interfering with endoscopy. This study investigated the predictive factors related to DEX-associated hypotension for safe sedation with DEX during endoscopy. This retrospective study was conducted among 234 patients who had been administered DEX for sedation during endoscopy between January 2017 and December 2018 at Hiroshima City Hiroshima Citizens Hospital. Hypotension is defined as a decrease in systolic blood pressure ≥30％ from baseline. In this study, hypotension was reported in 149 of the 243 analyzed patients, resulting in an incidence of 63.7％. The results of the multivariate analysis demonstrated that body weight was associated with DEX-associated hypotension. Notably, the median body weight of the DEX-associated hypotension group was less than that observed in the DEX-associated non-hypotension group. Furthermore, based on the results of the receiver operating curve analysis, we observed that patients weighing less than 58.1 kg may be more likely to report DEX-associated hypotension when administered DEX during endoscopy. Hence, we revealed the predictive factor of DEX-associated hypotension in endoscopy, which could contribute to the safe use of DEX in endoscopy.

The Model Core Curriculum for Pharmacy Education (2013 version) presents eight disease areas as the minimum medical conditions that require student trainees to be continuously engaged in pharmacotherapy, during practical training at a community pharmacy followed by a hospital-based pharmacy. However, the relationship of the number of those who continuously experienced the minimum medical conditions and the outcome of rubric assessment that is newly introduced in this study remain unknown. We clarify the effect of the number of those who continuously experienced the minimum medical conditions and pharmacy training on rubric assessment using the uniquely developed “Individual Student Report Form.” Twenty inexperienced students and 21 experienced students in pharmacy practice were evaluated on the following subjects related to medication guidance: “(2)-2 Medication Order Review and Medication Therapy Management,” “(2)-4 Professional Attitudes and Behaviors of Practice, Patient Education, and Counseling,” “(3)-1 Collection of Patient Information,” “(3)-2 Management of Drug Information,” “(3)-3 Pharmaceutical Care Plans and Recommendations,” and “(3)-4 Evaluation of Effectiveness and Safety.” The number of eight disease experiences in any subjects were not shown to affect the students’ rubric evaluation. On the other hand, the pharmacy practice experiences were significantly increased in the “(3)-1 Collection of Patient Information” (partial regression coefficient B = 1.305, P = 0.044; 95％CI: 0.036-2.575). It is important to be flexible in the eight disease areas as the minimum medical conditions and to practice the problem solving of the patient with a certified pharmacist.

Novel coronavirus disease 2019 (COVID-19) caused a worldwide pandemic, requiring medical institutions to take measures against nosocomial infections and to establish a medical care framework for COVID-19 patients. Hospital pharmacists have taken measures to provide medical support to COVID-19. Through preparation for use of unapproved or off-label COVID-19 therapeutic agents, pharmacist work conducted in the ward by a delegated full-time pharmacist, and drug arrangement for the fever clinic, we evaluated infection control measures and evaluated and monitored the safety and efficacy of COVID-19 therapeutic agents. We believe that the medical support provided reduces the burden on medical staff, and COVID-19 patients were able to receive treatment with peace of mind by deepening their understanding of medication for COVID-19. In preparation for the re-emergence of COVID-19, it was considered important for hospital pharmacists to determine issues of medical support for patients by practical application and to take measures.

Oral third-generation cephalosporins are broad-spectrum antimicrobial agents and constitute one of the most used classes of antibiotics in Japan. The Japanese government introduced the National Action Plan on Antimicrobial Resistance in 2016 and emphasized the necessity of antimicrobial stewardship. Therefore, to promote appropriate use of oral antibiotics in a children’s hospital, we investigated the usage of oral third-generation cephalosporins and found that most of these antibiotics were prescribed for prevention of postoperative surgical site infections (SSIs) in the pediatric urology department. Additional investigations revealed that inappropriate intravenous antibiotics were used to prevent SSIs. Based on these results, we published guidelines on the prevention of SSIs to optimize the use of perioperative antibiotics, and introduced a permission system for using oral third-generation cephalosporins.

We investigated the changes in urological perioperative antibiotic use (days of therapy per 1,000 patients-days: DOT), the incidence of SSIs, and changes in costs pre- and post- intervention.

Regarding perioperative antibacterial drugs, cefotiam DOT decreased from 140.2 to 2.3 and cefazolin DOT increased from 0 to 173.6. Oral third-generation cephalosporin DOT after surgery decreased from 481.4 to 0. Moreover, SSIs did not appear during pre- and post- intervention, and drug costs were declined.

In conclusion, the introduction of guidelines on the prevention of SSIs and a permission system for using oral third-generation cephalosporins was useful for the appropriate use of urological perioperative antibiotics. In addition, it contributed greatly to the improvement of medical service quality by reducing drug costs, and potentially the burden on patients and their families.

The COVID-19 pandemic has significantly affected every aspect of social life. Even in the education field, flexible measures were required beyond conventional wisdom. We provided remote practical hospital pharmacy training (remote training) using online systems such as Zoom and Moodle. We conducted a questionnaire survey with 38 subjects and 34 respondents, who were students that underwent remote training. The students self-evaluated their achievement level regarding specific behavioral objectives (SBOs), from the 2013 revised edition of pharmaceutical clinical practice related to hospital pharmacy practical training, in four stages. In addition, we analyzed the words used in the free comments using a text mining method for their characteristics. The SBO classifications exceeding the overall average were “clinical attitude”, "acknowledgement of patient information”, “prescription and question inquiry”, and so forth. The SBO classifications falling below the overall average were “team medical care at medical institutions”, “preparation of drugs based on prescription”, “safety management”, and so forth. The analysis of the positive aspects of remote training suggest that it was useful in sharing information about Subjective, Objective, Assessment, Plan (SOAP) records in case analysis, and evaluating the effects and side effects of drug treatment. Conversely, the analysis of the required improvements in remote training showed concerns regarding the considerable amount of homework and issues within the communication environment. We consider that remote training has a certain educational effect and can be expected to complement clinical training.