The inhaler technique and medication adherence are highly important for the management of asthma and chronic obstructive pulmonary disease (COPD), but they are often inadequate due to highly variegated and complicated inhalation drug devices. Kyoto University Hospital established a collaborative inhalation support team which consisted of pulmonologists, hospital- and community-pharmacists to support outpatients taking inhalation drugs since December 2013. In this study, we evaluated clinical outcomes of the collaborative team services. After the implementation of services, the patients who were hospitalized urgently due to the exacerbation significantly decreased among patients with COPD, and the ratios of urgently hospitalized patients / total outpatients were 2.4％ (22 / 919) to 1.2％ (15 / 1,233) after one year, and to 1.0％ (14 / 1,446) after 4 years. On the other hand, the number of urgently hospitalized patients with asthma remained unchanged. This collaborative system by medical doctors, hospital- and community- pharmacists may contribute to the therapeutic outcomes of inhalation medicines.

Akathisia is one of the extrapyramidal side effects induced by antipsychotics, such as aripiprazole (ARP). Although ARP is used widely in the treatment of various psychiatric disorders, such as schizophrenia, mood disorders, and autism spectrum disorders, there is a higher risk of developing akathisia following treatment with ARP than with other second-generation antipsychotics. However, the risk factors for acute akathisia induced by individual antipsychotics, including ARP, have not been fully established. In this study, we retrospectively analyzed the risk factors for the development of acute akathisia in patients treated with ARP. In total, the study included 160 patients who received ARP between April 2010 and March 2017. We found that 16.3% of all patients (n = 26) experienced ARP-induced acute akathisia within 6 weeks of receiving the first dose. There were significant differences in age (P < 0.01), sex (P = 0.04), and diazepam equivalent dose (P < 0.01) between patient groups with and without akathisia. Moreover, multivariate analysis indicated that age (younger than or equal to 31 years of age, P < 0.01) and diazepam equivalent dose (less than or equal to 4.2 mg, P = 0.03) were relevant factors in the development of ARP-induced acute akathisia. The results of this study suggest that scrupulous clinical attention should be paid to younger patients and patients receiving a relatively low diazepam equivalent dose during treatment with ARP to prevent the development of acute akathisia.

In recent years, the intervention of pharmacists in the proper use of eye drops in the elderly has led to improved adherence. It is also said to have been effective in preventing postoperative complications, preventing infections and avoiding adverse events. However, confirmation of eye drops adherence is subjective patient information. For this reason, it is often impossible to confirm the actual procedure, and it is not clear whether it was used correctly. Therefore, we conducted questionnaire surveys of patients undergoing cataract surgery to confirm the instillation status. In addition, we measured the weight of the ophthalmic solution after use and considered the relationship with the questionnaire. The subjects of the questionnaire were elderly people aged over 70 years old. The eye drops techniques were the upper and lower opening method (44.3％), the lower eyelid drooping method (42.3％), and others (13.4％). Subjects replied that they were generally properly instilled. As a result of measuring the solution weight, the actual value of the Moxifloxacin ophthalmic solution was significantly less than the appropriate value (P < 0.01). In addition, as a result of multivariate analysis, the factor that decreased the eye drops weight by more than 5％ was the patient who answered, “I can't apply well” (OR: 5.98, 95％CI: 1.31 - 35.29, P = 0.021). The subjective information of the elderly may be unreliable. Therefore, we need to conduct detailed interviews about the situation of instillation. In addition, training of techniques and periodic re-evaluation will lead to optimization and improvement of eye drops adherence.

Antimicrobial resistance (AMR) has become one of the biggest health threats across the world, and AMR action plan was launched in Japan in April, 2016. The importance of appropriate antibiotic use was mentioned in the plan, and one of the goals is to reduce the use of oral antibiotics, such as cephalosporins, macrolides and fluoroquinolones. An inappropriate antimicrobial use for children against acute respiratory tract infection (ARTI) caused by the virus has been indicated. The aim of this study was to clarify the chronological prescription of oral antibiotics for ARTI in pediatric outpatients at acute diagnosis procedure combination (DPC) hospitals. We used MDV analyzer^® (medical data vision (MDV) Co., Ltd.) as a health insurance claims data analysis tool to investigate retrospectively. The investigation period was from January 1, 2013 to December 31, 2018. Subjects were outpatients aged 0 to 14 years who were recorded in clinical data as ARTI (ICD-10: J00, J01, J02, J20). Cochran-Armitage trend test was used for statistical analysis. The prescription rate of oral antibiotics and each category were evaluated. The prescription rate of antibiotics significantly decreased from 44.4％ to 31.7％ during 2013-2018. The prescription rate of each antibiotic significantly decreased from 20.1％ to 10.9％ for cephalosporins, from 20.8％ to 12.4％ for macrolides and from 2.6％ to 2.0％ for fluoroquinolones, respectively. Our results showed that the prescription rate of oral antibiotics decreased in pediatric outpatients with ARTI at acute DPC hospitals over time from 2013 to 2018 and each category was influenced by AMR action plan.

The purpose of this study was to investigate the influence of antibiotics on the antitumor effects of immune checkpoint inhibitors (ICI) in Japanese patients with non-small-cell lung cancer (NSCLC). We enrolled 31 Japanese patients with NSCLC who received monotherapy with nivolumab, pembrolizumab, or atezolizumab at the Japan Community Health care Organization Hoshigaoka Medical Center between May 2016 and November 2019. Patients who received antibiotics from 2 months before the start of ICI treatment to 1 month after the treatment were defined as the antibiotic (+) group. The patients were divided into two groups: antibiotics (-) group (n = 13) and antibiotics (+) group (n = 18). There were no significant differences between the two groups in age, driver mutation, or number of prior treatment regimens. The median time from the start of ICI treatment to disease progression after subsequent therapy (second progression-free survival: PFS2) was significantly (P = 0.002) shorter in the antibiotics (+) group (6.0 months) than in the antibiotics (-) group (18.2 months). Furthermore, multivariate analysis showed that antibiotics (hazard ratio (HR): 4.45, 95％ confidence interval (CI): 1.33 - 14.87, P = 0.015) and a neutrophil to lymphocyte ratio ≥ 5 (HR: 3.72, 95％ CI: 1.02 - 13.59, P = 0.046) were significant risk factors for PFS2.

These results suggest that the antitumor effects of ICI are attenuated caused by the influence of antimicrobial agents on gut microbiota in Japanese patients with NSCLC.

This study aims to evaluate the usefulness of the Medication Management Summary, which is a tool of information sharing between hospital pharmacists and pharmacists at insurance pharmacies, based on patient-centered outcomes. Patients whose hospital pharmacists provided the Medication Management Summary to the pharmacists at the insurance pharmacy were assigned to the Medication Management Summary group (Group A), and patients before the introduction of the Medication Management Summary were assigned to the control group (Group B). Each group consisted of 90 patients, among which 30 were cardiac arrest patients, 30 were ischemia heart disease patients, and 30 were arrhythmia patients. The primary endpoint was the number of events, and the secondary endpoints were the presence or absence of readmission, evaluation of medication adherence, and changes in the number of medications in 6 months. The information on the Medication Management Summary in Group A was as follows: medication changes: 20; start of medication: 43; adverse effects: 4; medication management: 29; adjustment of leftover medication: 8; monitoring: 6 (including duplicates). The number of events was significantly lower (P = 0.032) in Group A (2 events) compared to that in Group B (9 events). The number of patients who were readmitted to the hospital was not significantly different between Group A and Group B. The medication adherence was unchanged in Group A but significantly worsened in Group B (P = 0.001). The number of medications did not change significantly in both groups. In conclusion, the provision of the Medication Management Summary by hospital pharmacists to insurance pharmacy pharmacists can help control patient events.

Although the package insert of Respia^® injection or oral solution (a caffeine preparation) states, “Efficacy and safety for preterm infants with a gestational age of < 28 weeks (at the time of administration) have not been established,” our previous study found that caffeine was also used for such preterm infants. We therefore examined the efficacy and safety of caffeine for preterm infants of < 28 weeks of gestational age in comparison to those of ≥ 28 weeks of gestational age. The rate of improvement in apnea attacks from days 1 to 10 was significantly higher in the ≥ 28 weeks group. From day 3 onward, the percentage of cases that showed “improvement” did not differ to a significant extent, with the exception of day 6. Adverse events occurred in 100％ of the patients in the < 28 weeks group and 84.8％ of the patients in the ≥ 28 weeks group; however, the difference was not statistically significant. In addition, there was no significant difference between the two groups in the incidence of adverse events that were suspected of having been caused by caffeine. These results suggest that although the effects took slightly longer to occur in the preterm infants of < 28 weeks of gestational age at the start of administration, the efficacy and safety of caffeine treatment in preterm infants of < 28 weeks of gestational age were generally similar to the efficacy and safety in those of ≥ 28 weeks of gestational age.

Steroid pulse therapy (SPT) refers to the administration of high doses of corticosteroids over a short period of time. SPT is widely used for the management of various diseases. Steroid treatment is associated with a risk of delirium, and reportedly, the risk of psychological symptoms increases with long-term treatment. Few studies have reported SPT-induced delirium. We retrospectively investigated factors associated with SPT-induced delirium.

We investigated 258 patients who received SPT for 3 consecutive days between January 2017 and December 2018. Delirium occurred in 6 (2.3％) patients (all elderly men). Univariate analysis of 79 elderly men showed that liver injury (odds ratio [OR] 9.2, 95％ confidence interval [CI] 1.2 - 69.1), trazodone hydrochloride administration (OR 10.1, 95％ CI 0.7 - 49.6), and cerebrovascular disease (OR 5.7, 95％ CI 0.9 - 112.0) were associated with SPT-induced delirium. The percentage of correct classification with these factors was 93.7％. Preventive strategies are important in patients presenting with the aforementioned risk factors associated with delirium in elderly men.