The objective was to clarify the effect of the practical training with the Model Core Curriculum for Pharmacy Education -2015 version- on Professional Competencies for Pharmacists, social skills and pharmacist communication skills. We performed a questionnaire survey for students at pre-training, post-pharmacy training and post-hospital training. The subjects were 81 fifth grade students and non-degree-seeking students in Gifu Pharmaceutical University. The survey items contained Professional Competencies for Pharmacists, KiSS-18 (Kikuchiʼs Scale of Social Skills: 18 items) and TePSS-31 (Teramachiʼs Pharmacist Communication Skill Scale: 31 items) and were compared between pre-training, post-pharmacy training and post-hospital training statistically. Professionalism, Patient-oriented attitude, Communication skills, Interprofessional team-care, Medication therapy management and Community health and medical care increased significantly in Professional Competencies for Pharmacists. The total score and the subscale scores of Basic skills, Emotional management skills and Offense management skills increased significantly in KiSS-18. The total score and all the subscale scores increased significantly in TePSS-31. It was clarified that students recognized the enhancement of these competencies and skills owing to the practical training. The competencies and skills that students should learn and acquire was considered to be enhanced in the practical training although those were the results of self-assessments. Therefore, we confirmed the certain efficacy of the practical training with the Model Core Curriculum for Pharmacy Education -2015 version-.

The isolation frequency of strains with genetic features of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in inpatients. Additionally, the number of infectious diseases caused by Panton- Valentine leukocidin (PVL)-positive highly pathogenic MRSA strains has been increasing in communities. However, the prevalence of CA-MRSA strains in outpatients of hospitals is unknown. This study investigated the prevalence of CA-MRSA including PVL-positive MRSA strains among inpatients (n = 362) and outpatients (n = 184) between 2013 and 2017 at Tokai University Hachioji Hospital. The proportion of staphylococcal cassette chromosome (SCC) mec type IV, which is a major SCCmec type of CA-MRSA, increased significantly in inpatients (P < 0.01). In contrast, SCCmec type IV strains accounted for >50％ in outpatients every year. The isolation rate of PVL-positive MRSA strains in outpatients (12 strains, 6.5％) was significantly higher than that in inpatients (1 strain, 0.3％) (P < 0.01). Furthermore, the incidence of PVL-positive MRSA strains in 2016 to 2017 (8/70 strains, 11.4％) was significantly higher than that in 2013 to 2015 (4/114 strains, 3.5％) (P < 0.05). All PVL-positive MRSA strains were susceptible to minocycline, vancomycin, and linezolid. This study shows that the number of cases of PVL-positive MRSA strains is increasing in outpatients of a university hospital. Surveillance of PVL-positive MRSA strains for both inpatients and outpatients is necessary to prevent outbreaks of highly pathogenic MRSA strains.

Warfarin (WF) has been reported to interact with various other drugs, but there are no reports of nivolumab or ipilimumab directly interacting with WF. In the current case, a patient taking WF had a prolonged PT and increased INR after combination therapy with nivolumab and ipilimumab. The patient was a 71-year-old man who was started on combination therapy with nivolumab and ipilimumab 2 months after excision of a renal tumor. PT-INR was 2.04 before admission. After combination therapy started, PT-INR increased to 8.58 according to a blood test performed on Day 22. The patient also developed hyperthyroidism, which is an immune-related adverse event (irAE) caused by nivolumab and ipilimumab. PT-INR increases as a result of hyperthyroidism, so the increase in PT-INR in the current patient is presumably due to irAE-induced hyperthyroidism. Thyroid dysfunction due to irAE may cause both hyperthyroidism and hypothyroidism and it may affect the efficacy of WF. PT-INR should be monitored when WF is used in combination with immune checkpoint inhibitors.

The criteria for palliative chemotherapy discontinuation have not been adequately systematized. We evaluated the relevance of the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognostic nutritional index, modified Glasgow Prognostic Score (mGPS), and clinicopathological factors as potential factors for chemotherapy discontinuation in patients with recurrent and unresectable pancreatic cancer.

We retrospectively analyzed the data of 91 patients who received palliative chemotherapy for recurrent and unresectable pancreatic cancer at Hiroshima City Hospital between April 2014 and March 2018. Factors significantly related to chemotherapy discontinuation were extracted using Coxʼs proportional-hazard model, and a prognostic model was established by combining these factors.

The median overall survival was 76 days. Multivariate analysis of the factors revealed that the mGPS (0/1-2) (hazard ratio [HR] = 3.053, P = 0.005), the presence of distant metastatic disease (HR = 2.605, P < 0.001), and the status of recurrent or initially unresectable disease (HR = 2.587, P = 0.013) were significantly associated with the discontinuation decision. One point was assigned to each of these three factors to create the prognostic model. A total score index of 0-3 was used to categorize three prognostic risk groups. The high-risk group (3 points) had a significantly lower overall survival than the low- (≤1 point) (P < 0.001) and intermediate-risk (2 points) groups (P < 0.001).

Our study shows that mGPS and this prognostic model can help determine whether chemotherapy should be discontinued in patients with relapsed and unresectable pancreatic cancer.

It is necessary to determine the expiration date and storage methods for in-hospital preparations. However, data on the physical properties and stability of in-hospital preparations for eye drops, especially in long-term storage, are limited. Therefore, the stability of in-hospital preparations for eye drops, 0.5％ vancomycin (VCM), 0.25％ DENOSINE^® (GCV), 0.1％ Funguard^® (MCFG), 1％ VFEND^® (VRCZ), and 5％ sodium chloride (NaCl), were evaluated for long-term storage.

All eye drops were stored for 12 weeks under the following conditions: cool (4℃)/darkness, room temperature(approximately 23℃)/darkness, room temperature (approximately 24℃)/scattered light (approximately 1,500 lx), or high temperature (37℃)/darkness. The concentration of eye drops over time was measured by high-performance liquid chromatography and automated clinical chemistry analyzer, and pH, appearance, and sterility were evaluated.

As a result, 0.5％ VCM eye drops can be stored for 3 weeks at room temperature when placed in a light-shielding bag or for 12 weeks at 4℃. The 0.25％ GCV, 1％ VRCZ, and 5％ NaCl eye drops can be stored for 12 weeks at 4 - 37℃. The 0.1％ MCFG eye drops can be stored for 6 weeks at 37℃, or for 12 weeks at room temperature or 4℃.

The stability of in-hospital preparations for eye drops during long-term storage under varying conditions was demonstrated. Therefore, the use of in-hospital preparations for eye drops is considered to be safer and more effective.

Duotrava^® ophthalmic drops (hereafter referred to as “brand-name drug”), a fixed-dose combination drug used for the treatment of glaucoma, has one commercially available generic equivalent at February, 2021. In the present study, we compared the brand-name drug and its generic equivalent with respect to viscosity, pH, and osmolality. We measured the mass of a single drop, squeezing force for dispensing a single drop, and number of drops per bottle. We also surveyed healthy individuals on product usability. In addition, we utilized a colorimeter to measure differences in bottle nozzle color and assessed nozzle color visibility among healthy individuals. Results showed that physical properties were nearly identical between the brand-name drug and its generic equivalent. However, bottle usability was significantly higher for the generic equivalent than for the brand-name drug. For both preparations, bottles containing a larger number of drops required greater squeezing force. However, subjects preferred bottles that discharged medication at a consistent squeezing force regardless of the number of drops remaining. The nozzle color assessment revealed that nozzles with high color contrast ratios were more visible than conventional white nozzles, and we observed a correlation between the nozzle color selection rate and contrast ratio. These results suggest the need for comprehensively considering patient usability, especially with regard to the design of the dispensing container, when developing ophthalmic drops.

We have been managing clinical trial-related documents electromagnetically since November 2018. The electromagnetism was conducted using the Clinical Trial Document Support System (CtDoS2) developed by the Center for Clinical Trials, Japan Medical Association. After the introduction of CtDoS2, we were able to improve our work, such as reducing work hours, but the evaluation from the monitors was not considered. Therefore, we conducted a questionnaire survey on the monitors under our charge and examined the evaluation of electromagnetic management of clinical trial-related documents using CtDoS2. The investigation was carried out on 59 monitors, and the response rate was 81.4％ (48/59). Using the Net Promoter Score (NPS), the respondents were classified into 14.6％ (7/48) promoters, 52.1％ (25/48) passively satisfied, and 33.3％ (16/48) detractors, based on their recommendation for CtDoS2, and NPS was -18.7. When we asked if they could choose CtDoS2 or paper as the method of submission and storage of documents, 81.3％ (39/48) of themonitors chose CtDoS2. The answer suggests that electromagnetic conversion using CtDoS2 is an acceptable system for monitors. The result that nearly half of the detractors chose CtDoS2 indicates that the merits such as improvement of convenience and reduction of resources were evaluated, but the fact that more than half of the monitors were passive indicates that the evaluation has not been determined due to the demerit of the occurrence of new workload.