The rate of de-escalation is considered to be a useful metric for evaluating the antimicrobial stewardship program for specific infectious diseases cases (eg, bacteremia, use of broad-spectrum antimicrobial agents) in healthcare facilities. However, the definition of de-escalation itself has not been standardized, and studies evaluating the rate of de-escalation have differed in their definitions. The purpose of this paper is to discuss the issues related to the definition of de-escalation, introduce the definition proposed by the Duke Antimicrobial Stewardship Outreach Network, which is currently considered to be useful and feasible, and explain the specific measurement methods.

Patients with overt or resolved hepatitis B virus (HBV) infection undergoing immunosuppressive therapy or chemotherapy for malignant diseases should be screened and monitored for their viral status under the Japan Society of Hepatology Guidelines for the Management of Hepatitis B Virus Infection to prevent the reactivation of HBV. To complete these recommendations, we have adopted a protocol-based pharmacotherapy management for HBV (PBPM-HBV) that allows pharmacists to order additional complementary blood tests on behalf of doctors in our hospital. We also constructed a support system that automatically detects and reports the cases with insufficient examinations by scanning the information of all the chemotherapy patients. By introducing PBPM-HBV, the screening implementation rate was improved significantly from 29.0％ to 81.8％ (P < 0.001). Also, by utilizing this support system, we were able to achieve remarkable labor and time savings compared to the conventional manual process of checking examination results by opening each electronic medical record. The average time taken to complete the checking process for each patient before and after the introduction of the support system was 1.93 minutes (n = 100) and 0.55 minutes (n = 300), respectively. By utilizing this support system, operating efficiency has been remarkably improved and appropriate HBV screening and monitoring for all cancer chemotherapy patients has become possible regardless of injection or oral administration of the drugs. PBPM-HBV using this support system is considered to be a good example of minimizing the increase in the workload of pharmacists as a result of task shifting from doctors.

Recently, society has been greatly affected by the 2019 coronavirus pandemic (COVID-19). In pharmacy education, various messages such as the limitation of entering university campuses and interruption of clinical training are being enforced. In Nagoya University Hospital, information and communication technology (ICT) is also used for pharmacy hospital practical training. In this survey, we reported the method and satisfaction of the hybrid pharmacy hospital practical training constructed in our hospital. ZOOM was used as the ICT, and the training was conducted according to the schedule created by us. In addition, at the beginning, middle, and end of the practical training, we conducted an anonymous WEB questionnaire after obtaining the consent of the students. The results suggest satisfaction with the hybrid pharmacy hospital practical training during the COVID-19 pandemic, but the limitations of ICT were also clarified. Taken together, considering the COVID-19 pandemic, it was speculated that combining ICT with hospital practical training would be the preferred form of current pharmacy hospital practical training.

Measures against obesity include the use of medication as well as lifestyle-related improvements such as diet and aerobic exercise. Obesity-improving drugs are prescribed under the diagnosis of severe obesity. Regarding such drugs, many general drugs, mainly Chinese herbs, are also on the market. Over-the-counter drugs (OTC) can be purchased and used at the discretion of the individual, and it is easy to imagine that they will be used for purposes other than their original therapeutic purpose, such as cosmetology. Unlike the side effects caused by drugs used for therapeutic purposes, the only side effects caused by the use of drugs that do not need to be used are the general health risks. Reducing these risks is an important part of the pharmacist's job. In this study, we analyzed the adverse effects of obesity-improving drugs using the “Japanese Adverse Drug Event Report” database. Furthermore, regarding user awareness, we conducted an analysis using social listening and a questionnaire for our students. As a result, many reports of adverse events due to the use of medicines by those who fell below the obesity standard were observed. This was especially noticeable in women. This group tended to be associated with losing weight from social listening. In addition, the questionnaire analysis of students suggests that their knowledge may not be effective in preventing the inappropriate use of diet drugs.

Cisplatin (CDDP), a platinum compound, is used in transcatheter arterial chemoembolization (TACE), the standard treatment for unresectable advanced hepatocellular carcinoma. Although the risk of emesis is high when CDDP is intravenously administered, that in TACE using CDDP (CDDP-TACE) remains unclear. Therefore, this study investigated the occurrence of nausea and vomiting and effects of antiemetic therapy. Seventy-one patients who underwent CDDP-TACE for the first time were examined. The backgrounds of patients with and without nausea/vomiting were compared. All patients were administered 3 mg granisetron as premedication on the day of CDDP-TACE. Complete response rates were 93.0％ in both the acute and delayed phases and 87.3％ in the overall phase. Total control rates were 81.7％ in the acute phase, 80.3％ in the delayed phase, and 69.0％ in the overall phase. Albumin (ALB) levels were significantly lower in patients with than in those without nausea and vomiting (P < 0.05). The cut-off value for nausea and vomiting was ALB 3.3 g/dL (sensitivity: 65.3％, specificity: 68.2％). The present results suggest the potential of 3 mg granisetron to control nausea and vomiting during CDDP-TACE. Furthermore, the risk of nausea and vomiting may increase at ALB < 3.3 g/dL.

Nalfurafine is a pharmaceutical agent used in the treatment of cutaneous pruritus. Although its orally disintegrating (OD) film agent is approved, noninferiority of its disintegration and elution to various OD tablet agents has yet to be demonstrated. This study aimed to evaluate the pharmaceutical characteristics of the nalfurafine OD film agent. Disintegration and elution performance were tested for 4 different types of nalfurafine OD pharmaceutical agents including 1 film agent and 3 tablet agents. Visual evaluation was employed for the disintegration test, while measurement of concentration using high performance liquid chromatography with ultraviolet was employed for the elution test. As a result of disintegration evaluation (n = 3), the OD film agent repeatedly exhibited the same complete disintegration time (60 s), while the other three OD tablet agents showed the time variability (120 s - 30 min). After the test start, the OD film agents began disintegration at 20 s while the OD tablet agents began disintegration immediately. As a result of elution evaluation (n = 6), after the test start, the OD film agent was eluted 100.6％ in 5 min, while the OD tablet agents were eluted 95.8％, 75.8％ and 80.5％, respectively. In conclusion, this study indicates that the nalfurafine OD film agent was not inferior to the OD tablet agents in terms of disintegration and elution.