The purpose of this study was to compare the efficacy and safety of using duloxetine and tramadol acetaminophen for the pain of knee osteoarthritis during the perioperative period of total knee arthroplasty (TKA). For pain, the difference between resting and postoperative body movements was investigated based on the absolute value of the numerical evaluation scale (NRS) before and after surgery during rest and body movement and the NRS immediately after surgery (postoperative). In terms of efficacy, the absolute values of NRS were significantly lower in the duloxetine group than in the tramadol acetaminophen group, both at rest and during physical activity. On the other hand, when comparing the difference in NRS immediately after surgery and at some other timepoint after surgery, the duloxetine group and tramadol acetaminophen group were almost the same at any time after surgery. Adverse events occurred in the duloxetine group and tramadol acetaminophen group, which were almost the same as the frequently occurring adverse events in the package inserts. Since chronic postsurgical pain (CPSP), which causes a deterioration in quality of life for patients after TKA, interferes with daily life, it is important to perform appropriate pain management, and pain management with duloxetine may help.

The self-medication tax system is a new tax policy system that came into effect in 2017. The dissemination of this tax system is expected to promote changes in the people’s behavior toward self-medication and contribute to the optimization of healthcare costs. This study aimed to conduct an anonymous self-administered questionnaire survey on the self-medication tax system for 3,000 people, assigned based on vital statistics in an online survey system, and extract the reality of and issues surrounding the tax system. The results showed that approximately 55％ of the survey participants were aware of the self-medication tax system, but only 6％ were aware of all the application requirements for the tax system. This indicated that there was a misunderstanding among those who were familiar with the tax system. In addition, among the conditions for applying the system, the percentage of switch from over the counter drug purchases that met the application requirements was significantly lower than those of the other two requirements. Furthermore, 103 survey participants had received income deductions under the self-medication tax system, indicating that some potential applicants meet all the application requirements. The self-medication tax system was partially revised on January 1, 2022, with the application procedure partially simplified and the target products expanded. It is expected that these revisions will henceforth serve as a driving force to promote self-medication and popularize this tax system.

Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate that comprises an antihuman epidermal growth factor receptor 2 (HER2) antibody, a tetrapeptide-based linker, and cytotoxic topoisomerase Ⅰ inhibitor. It has demonstrated long-lasting antitumor activities in patients with HER2-positive metastatic breast cancer (MBC). However, there have been no reports on the efficacy and safety of T-DXd in patients undergoing hemodialysis. We report the case of a patient with HER2-positive MBC with coincidental end-stage renal failure on hemodialysis who received T-DXd therapy. A T-DXd dose of 2.7 mg/kg was administered to the patient via intravenous infusion on a non-dialysis day every 3 weeks. After completion of four cycles, computed tomography (CT) showed responses in an anterior thoracic wall mass and an unchanged lateral thoracic mass. After the ninth cycle the mass on the anterior thoracic wall showed regrowth; therefore, we attempted dose escalation of T-DXd to 4 mg/kg. However, the patient could not tolerate the 3-week interval due to neutropenia, and T-DXd was administered every 4 weeks thereafter. CT scan after three more courses showed no significant change in the lateral thoracic mass, but the mass on the anterior thoracic wall enlarged; thus, we decided to change the treatment. Except for grade-3 anemia, no interstitial pneumonia or drug-induced cardiac dysfunction was observed, and T-DXd was well-tolerated without severe adverse effects. Based on the outcomes of this case, T-DXd could be safely administered to patients with MBC undergoing hemodialysis. Further reports on the dosage and safety of T-DXd in patients undergoing hemodialysis are needed.

Considering the current situation of serious antimicrobial resistance, a national action plan on antimicrobial resistance (AP) has been passed in Japan. As it is essential to determine the extent to which dentists are aware of AP, a mail-based questionnaire survey regarding recognition of the AP was performed by targeting dentists in Sapporo city. The response rate for this questionnaire was 36.1％ (356/985). The results indicated that azithromycin is prescribed by dentists who recognize the AP (odd ratio (OR) = 1.75 (95％ confidence interval (CI): 1.03 - 2.95), P = 0.04). Simultaneously, dentists who do not recognize the AP choose antimicrobials based on the knowledge obtained at lectures in a university (OR = 0.23 (95％ CI: 0.10 - 0.51), P < 0.01) and faropenem is prescribed by dentists who do not recognize the AP (OR = 0.13 (95％ CI: 0.03 - 0.68), P = 0.02). Dentists who did not issue out-of-hospital prescriptions constituted 79.8％ (281/352), suggesting that dental doctors may hardly have any relationship with pharmacists. It is thus necessary to enhance coordination between dentists and pharmacists for promoting the proper use of antimicrobials.

Occasionally, we have experienced cases of patients with mild articulating pain who have been introduced to opioids. We considered the possibility that physician assessment alone might be insufficient. We developed and examined the usefulness of a system that helps pharmacists perform a pain assessment prior to consultation and suggest prescriptions for analgesics.

From March 1, 2020 to December 31, 2020, the number of prescription suggestions and the rate at which they were adopted were investigated in patients who were instructed before opioid introduction. The number of patients instructed was 226, whereas the number of prescription suggestions was 231, with an adoption rate of 98.3％. The 23 patients who did not use opioids showed significantly improved mean pain scores, from a median NRS of 3 - 2 (P = 0.0123), with the most intense pain decreasing from a median NRS of 7 - 5 (P = 0.0154). We believe that pain assessment before opioid induction facilitated the selection of an appropriate analgesic. However, among the nine patients who were instructed after opioid introduction, two expressed minor pain. We believe that the pharmacist's prescription suggestion, which is tailored to the patient’s life background and general condition, promoted the selection of an appropriate analgesic.

In conclusion, pharmacists should evaluate pain and prescription suggestions before introducing opioids as a strategy to support medical treatment and promote appropriate opioid use, thereby suggesting their active utilization in clinical practice throughout Japan.