Most patients suffering from chronic kidney disease (CKD) are outpatients, and renally excreted oral drugs are frequently dispensed at community pharmacies. Therefore, community pharmacists must verify the appropriateness of prescribed medications in such patients by examining their renal function profiles. This study aims to clarify the current status of pharmaceutical management of patients with impaired renal function at community pharmacies, and identify existing issues. A self-administered questionnaire survey was sent to randomly selected community pharmacies throughout the country, and 1,184 pharmacies returned completed response forms. Only about 7％ of all prescriptions filled by community pharmacists were accompanied by laboratory tests based on our calculation. Approximately half of the respondents reported prescription inquiries concerning overdosage of renally excreted drugs, which was virtually unchanged from a preceding study in 2013. Logistic regression analysis was employed to identify factors related to the prescription inquiries. Our results showed that “Experience with adverse drug events caused by inappropriate dosage for patients with CKD” (odds ratio: 9.59) and “Knowledge of the CKD sticker” (odds ratio: 2.04) were strongly associated. Nearly 80％ of the respondents recognized a lack of information about a patient’s renal function as a barrier to inquiries. Awareness of the CKD sticker was on an average about 23％, but varied across prefectures, correlating with the prescription inquiries in each prefecture (r = 0.32). Collectively, our findings emphasize a need to reconsider the mechanism by which medical institutions provide information to community pharmacies.

We conducted a questionnaire survey to elucidate the current status and issues of mental health facing hospital pharmacists during the long-term COVID-19 pandemic, and to obtain information for providing mental health support. The questionnaire collection rate was 87.8％. The study finally involved 448 hospital pharmacists in 32 Rosai hospitals. The results revealed that 61.8％ of hospital pharmacists reported feeling stress. From the logistic regression analysis, it was clarified that “prejudice or discrimination against healthcare workers” was significantly associated with work stress and high levels of anxiety. It was considered that feeling stress and anxiety about “prejudice or discrimination against healthcare workers” is a common problem among all health care workers, and it requires immediate solution. In this study, psychiatric symptoms were observed in 216 hospital pharmacists (48.8％). In addition, the onset of psychiatric symptoms was significantly higher among hospital pharmacists who reported feeling high levels of work stress and anxiety. These findings suggest that psychiatric symptoms among hospital pharmacists due to high levels of work stress and anxiety is of great concern as it may lead to mental health disorders. The factors that influence mental health are interrelated, and it is necessary to enhance organizational mental health support. We hope that these findings will be useful for preventing mental health disorders during the long-term COVID-19 pandemic.

Cefmetazole (CMZ) is a widely used antimicrobial agent against various infectious diseases. Few studies have determined the appropriate daily dose, and the dose adjustment criteria based on renal function are unclear. Therefore, this study evaluated the clinically effective dose of CMZ and the validity of dose adjustment using the Giusti-Hayton (G-H) method. Patients who received CMZ at Ebara Hospital from April 2019 to March 2021 were included. The basic daily dose was set at 4 g, which is the maximum dose approved in Japan, and a dose adjustment standard table was prepared with variables calculated using the G-H method. The patients were grouped according to whether their dosage of CMZ was adjusted using G-H method or not into the G-H and non-G-H groups. We set the primary endpoints as the efficacy and safety of CMZ, and the secondary endpoint as the pharmacokinetics/pharmacodynamics parameter (PK/PD parameter). There were 107 and 99 target cases in the G-H and non-G-H groups, respectively. The G-H group included several elderly people with a poor prognosis for infectious diseases; however, there was no significant difference in the efficacy and safety of CMZ between the groups. The time above MIC was significantly higher in the G-H group. Therefore, dose adjustment using the G-H method, based on a dose of 4 g/day, can be useful in terms of PK/PD parameters. Moreover, it has been shown to be highly effective and safe. Thus, the results of this study may help in determining the dose and dose adjustment of CMZ.

This study was conducted based on a questionnaire survey addressed to physicians and nurses, who were in direct contact with pharmacists on their wards, in order to explore and stratify the factors contributing to the improvement of physicians’ and nurses’ satisfaction with the pharmacists’ ward pharmacy services. The participants were physicians and nurses working in wards of Tokyo Teishin Hospital who had given their consent to participate. The questionnaire asked the pharmacists to respond to seven questions regarding their ward pharmaceutical services and their overall evaluation. The customer satisfaction (CS) analysis showed that, for physicians, the priority improvement areas were participation in discussion rounds and conferences and participation in team medicine; for nurses, in addition to these points, confirmation of prescription content and monitoring of drug effects and side effects were priority points. Factor analysis showed that three factors were extracted for physicians and two factors for nurses, and they were categorized into several clusters. The CS analysis showed that both physicians and nurses desired more active involvement of pharmacists in discussion rounds and team care, and different factors were extracted for physicians and nurses, suggesting that the evaluation of ward pharmacy services differed between occupations.

Although several pharmaceutical inquiries made by community pharmacists meet the PreAVOID criteria, the frequency of PreAVOID reports by community pharmacists is lower than that by hospital pharmacists. We aimed to clarify the characteristics of adverse events (AEs) in pharmaceutical inquiries to increase the number of PreAVOID reports and to improve their quality. We identified AEs using MedDRA/J and compared the types of AEs, information source, and drug efficacies between detected and prevented AEs. In this study, detected AEs were defined as AEs leading to pharmaceutical inquiries after the last visit; prevented AEs were defined as AEs leading to pharmaceutical inquiries before dispensing medicine based on patient interviews, medical records, and laboratory data. We evaluated prescriptions for adults against inquiries at a community pharmacy between April 2016 and March 2019. The chi-squared or Fisher’s exact test was used to compare the number of system organ classes (SOCs) between detected and prevented AEs. We identified 57 detected AEs and 121 prevented AEs from 5,545 prescription inquiries. Gastrointestinal disorders (30 AEs) and skin and subcutaneous tissue disorders (30 AEs) were the most common SOCs that showed a significantly higher number of detected than prevented AEs (P = 0.011 and P < 0.001, respectively). Renal disorder (22 AEs) was the second most common SOC that was associated with prevented AEs (P = 0.001). The results can be used to develop strategies to resolve clinical problems at community pharmacies. Our study contributes to an increase in PreAVOID reports through pharmaceutical inquiries.

Tacrolimus is used for various organ transplants, suppressing autoimmune diseases like rheumatoid arthritis and myasthenia gravis. Tacrolimus is metabolized by cytochrome P450 and a substrate of P-glycoprotein, and many drugs affect the pharmacokinetics of tacrolimus. In Kagoshima University Hospital, tacrolimus is administered to patients after renal transplantation, and continuous therapeutic drug monitoring (TDM) is performed. There're two cases that tacrolimus blood levels significantly increased after receiving therapy against SARS-CoV-2; these patients were taking tacrolimus to suppress rejection after renal transplantation. The first case was a kidney transplant performed six years ago. The patient was hospitalized for COVID-19. On the first day, remdesivir was started. The dose of tacrolimus was reduced from the third day due to decreased renal function. Afterward, the blood concentration of tacrolimus remained high until the sixth day of hospitalization despite decreasing the administration dose. After discharge, the blood concentration of tacrolimus on the 17th day showed a decrease and returned to the pre-hospital concentration on the 49th day. The second case was a kidney transplant performed 11 months ago. The patient was hospitalized for COVID-19 and started remdesivir on the third day. The tacrolimus blood concentration increased on the fourth day. During hospitalization, the concentration of tacrolimus remained high while the administration dose was decreased. After discharge, the concentration gradually decreased while still being controlled. These cases suggest that blood concentration of tacrolimus, and hepatic and renal function, should be monitored and the dose should be carefully adjusted when administered in combination with remdesivir.