Recombinant thrombomodulin (rTM) is used for the treatment of disseminated intravascular coagulation (DIC). We investigated the dosage pattern of rTM for DIC associated with infectious diseases during 2017 in Asahikawa Medical University Hospital. Consequently, some cases did not meet the criteria for dose reduction and were underdosed. Then, we developed dosage criteria for rTM and according to the criteria a ward pharmacist suggested dosage to physicians from 2018. This study investigated the pharmacist’s intervention by comparing the rTM dosage and DIC withdrawal rates in 2017 with those in 2018.

From our prescribing status, the target patients (n = 113) were classified into a standard dose group (SDG) (23 cases in 2017 and 20 cases in 2018) and a low dose group (LDG) (53 cases in 2017 and 17 cases in 2018). In the SDG, 84％ in 2017 and 95％ in 2018 met the dosage criteria of 380 U/kg. In the LDG, the number of cases that did not meet the criteria for dose reduction or the criteria of 380 U/kg decreased from 79％ to 59％. For the DIC withdrawal rate, we included patients with a score of 4 or more points using the DIC diagnostic criteria of the Japanese Association for Acute Medicine before rTM administration (n = 78). The DIC withdrawal rate for SDG was improved from 42％ to 80％, and that for LDG from 35％ to 58％.

The results of this study indicate that the pharmacist’s suggestion optimizes rTM dosage according to the patient’s condition and consequently improves the DIC withdrawal rate.

Surveillance of antimicrobial use is essential for predicting the emergence and preventing the spread of drug-resistant bacteria. This retrospective study aimed to estimate denominators in surveillance and correlation of carbapenem use, expressed as either days of therapy (DOTs) per 1,000 patient-days or DOTs per 1,000 admissions, and compare them with the resistance rates of Pseudomonas aeruginosa in 14 hospitals in Tottori prefecture. The DOTs per 1,000 patient-days data format was significantly correlated with the imipenem/cilastatin (IPM/CS; R² = 0.393, β = 0.008, P = 0.016) and meropenem (MEPM; R² = 0.407, β = 0.007, P = 0.014) resistance rates of Pseudomonas aeruginosa. Moreover, there was a strong correlation between the DOTs per 1,000 admissions and resistance rates of IPM/CS (R² = 0.621, β = 0.011, P = 0.001) and MEPM (R² = 0.706, β = 0.011, P < 0.001). When exploring the association between carbapenem use and resistance rates of Pseudomonas aeruginosa, the best fitted linear regression model (R²) was obtained for use in admissions. Our findings suggest that carbapenem use per admissions may be a more useful indicator than that of per patient-days in predicting carbapenem resistance in Pseudomonas aeruginosa.

Cancer genome medicine is personalized medicine based on genetic information through cancer gene panel testing, in which cancer tissue and blood are analyzed by next-generation sequencers. Pharmacists participate in the expert committee in cancer gene medicine at Hiroshima University Hospital and provide clinical trial information based on the genetic mutation of each case. We have established a new database (Hirodai-DB) to improve the efficiency of providing clinical trial information and to increase the amount of clinical trial information provided. Six out of 123 cases actually proceeded to clinical trials using Hirodai-DB, and 2 out of 6 cases (33％) that proceeded to clinical trials used Hirodai-DB that was the only source of information. The establishment of the Hirodai-DB was considered to be useful for cancer genome medicine at this hospital.

In accordance with the revision of the model core curriculum for pharmacy education, clinical clerkship was modified to emphasize practical experience as well as the introduction of patient care from the early stages of clinical clerkship and new evaluation criteria. This may be perceived as an increased burden on pharmacists. In this study, we used a 43-item questionnaire based on a visual analog scale to investigate pharmacy pharmacistsʼ attitudes toward clinical clerkship. We obtained 105 valid respondents from pharmacists who had experience in accepting trainees for clinical clerkships at pharmacies and used factor and multiple regression analyses to evaluate their responses. The descriptive statistics revealed that the respondents were positive about accepting trainees and felt a sense of accomplishment; however, they were anxious about dealing with trainees. Using factor analysis, four factors, including “recognition of instruction contents,” “benefits of accepting trainees,” “relationship with trainees,” and “functions of universities,” were extracted from 31 items. Multiple regression analysis, with “willingness to accept trainees” as a target variable, revealed that the positive perceptions of “recognition of instruction contents,” “benefits of accepting trainees,” and “functions of universities” increased that willingness. These results indicate that countermeasures are required to improve the understanding of the revised model core curriculum and to promote information sharing about trainees between faculty and pharmacy pharmacists.

There is a need to reduce unnecessary antibiotic prescriptions in order to avoid increasing antibiotic resistance. However, patients may be prescribed antibiotics if they are not convinced about the issue and insist on receiving these drugs. Here, we clarify the factors that cause the opinions of Japanese mothers who are not convinced by the fact that antibiotics were not prescribed for their children. We investigated the factors to which these opinions were attributable among these mothers so as to facilitate antimicrobial stewardship. The study participants included mothers with children aged 3 months to 8 years as of September 2020. We employed a mixed-method approach that included a questionnaire and an interview. The questionnaire survey showed that 34.1％ (75/220) of the mothers surveyed were not convinced that antibiotics should not be prescribed. Many of the mothers were part-time and temporary employees and had misconceptions about and excessive expectations from antibiotic use. Seven mothers were interviewed. Qualitative theme analysis of response data revealed factors associated with the opinions of unconvinced mothers. These factors were categorized into 4 themes: “positive experience with antibiotics,” “excessive expectations from antibiotics,” “illness-associated concerns,” and “a lack of dialogue with doctors.” The unconvinced mothersʼ opinions were influenced by excessive expectations from antibiotic use, including misconceptions due to personal experience, concerns caused by illness in children, and a lack of sufficient dialogue with doctors. Hence, to reduce unnecessary antibiotic prescriptions, it is necessary to conduct educational activities to eliminate the aforementioned contributing factors and increase awareness about the issue.