Hypoglycemia is an acute complication of diabetes mellitus. In severe cases, it may lead to impaired consciousness, and glucagon nasal powder plays an important role as an emergency treatment. However, there have been no reports of pharmacist interventions using glucagon nasal powder. Therefore, we established a pharmacotherapy management-based protocol to prescribe glucagon nasal powder in educational hospitalization in patients with diabetes, and evaluated its efficacy by a questionnaire survey. According to this protocol, the pharmacist plays a central role in providing education about hypoglycemia and offering glucagon nasal powder to patients based on agreement with the attending physician. During the first year after its introduction, 31 patients received glucagon nasal powder following this protocol. The questionnaire survey revealed that patients who received glucagon nasal powder had a better understanding than patients who did not. Furthermore, 60％ of the patients stated that glucagon nasal powder reduced their hypoglycemia anxiety. The present study showed that glucagon nasal powder may be advantageous for reducing hypoglycemia anxiety, and this protocol has the potential to improve the understanding of hypoglycemia. Therefore, this protocol could contribute to improved adherence.

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“Secondary exposure to anticancer drugs” refers to exposure to anticancer drugs after chemotherapy via the patientʼs urine and other excretions. The necessity of countermeasures against secondary exposure to anticancer drugs has been recently highlighted. We investigated 1,000 Japanese participants without cancer in February 2022 and approximately 90 percent of them did not know about secondary exposure to anticancer drugs. In addition, approximately 90 percent of participants indicated that medical staff must explain the exposure controls to them and their cohabiting family members before commencing the chemotherapy. The risk perception analysis revealed that peopleʼs “dread” of secondary exposure to anticancer drugs was not amplified by providing information. Adverse impact on communication with close friends or colleagues who would share a restroom caused by providing information was also minimal. (P < 0.001, Effect size r = 0.22). Using logistic regression analysis, the background factors associated with the feasibility of secondary exposure control to anticancer drugs were male (odds ratio [OR] = 0.615; 95％ confidence interval [CI]: 0.458 - 0.827, P = 0.001), health literacy (OR = 1.387; 95％CI: 1.116 - 1.723, P = 0.003), family cooperation to implement countermeasures (OR = 1.901; 95％CI: 1.673 - 2.159, P < 0.001), and the psychological burden of communicating with family members about secondary exposure control (OR = 0.544; 95％CI: 0.458 - 0.646, P < 0.001). This suggests that consideration of patientʼs health literacy and provision of secondary exposure information to both the patient and household members are vital for risk communication to promote the relevant countermeasures.

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Risk factors for chemotherapy-induced nausea and vomiting (CINV) include young age, female sex, nondrinking status, motion sickness, and pregnancy-induced vomiting. Although the association between sleep disorders and CINV has been reported overseas, to the best of our knowledge, few Japanese studies have investigated this subject, and it has not been fully verified. We performed a questionnaire-based survey to investigate the sleep status in breast cancer patients who received epirubicin and cyclophosphamide therapy and to determine the risk factors for CINV. This study included 133 patients with breast cancer who received epirubicin and cyclophosphamide combination therapy for the first time at Yokohama Rosai Hospital between April 2017 and October 2020. The Japanese version of the Pittsburgh Sleep Questionnaire was used to investigate sleep status, and patients with scores ≥ 6 were diagnosed with sleep disorders. We compared the onset of the complete response (CR) rate (ie, no emetic responses and no rescue medication) during the acute and delayed phases with patientsʼ background. In both the acute phase CR group and the delayed phase CR group, the CR rate was significantly lower in young age and sleep disorders (P < 0.05). Multivariate analysis showed that sleep disorders were an independent factor in acute CR (odds ratio 0.22) and late CR (odds ratio 0.28). The study suggests that sleep disorders are risk factors for CINV. It is necessary to utilize antiemetic measures considering the risk factors including sleep status.

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Sleep hygiene instruction in conjunction with drug treatment is important for insomnia in the elderly. Community pharmacies can contribute to the improvement of insomnia symptoms by providing sleep hygiene instruction to elderly patients with insomnia. However, there are limited reports analyzing the sleep habits of elderly patients who visit community pharmacies and are taking sleeping pills, as well as their attitudes and conditions regarding taking their pills. Therefore, we conducted a questionnaire on attitudes toward sleeping pills and lifestyle habits for good sleep in elderly patients. The subjects were 428 patients aged 65 years or older who were taking sleeping pills. The analysis was performed with the mean value of the constituent variables of each concept as the explanatory variable and “insomnia group or non-insomnia group” as the objective variable. The results showed 35.5％ of patients were classified in the insomnia group despite taking sleeping pills. In terms of lifestyle habits, being unable or unlikely to “keep the same waking time,” “get out of bed in the morning even if unable to sleep,” and “avoid thinking in bed or make efforts to sleep” as well as strong refusal to take sleep medication showed an association with insomnia. Hence, it is important for community pharmacies to provide medication instruction that takes into consideration teaching lifestyle habits for good sleep and resolving the sense of refusal to take sleep medication.

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The revised TDM Clinical Practice Guidelines for Antibiotics published in February, 2022 recommend administering a loading dose of vancomycin (VCM) to patients with renal impairment (eGFR <80 (mL/min/1.73m²)). Herein, we investigated the efficacy and safety of administering a loading dose of VCM to our patients with an eGFR <80 compared with those with an eGFR ≥80. The nomogram of our hospital specifies VCM loading doses of 1 g and 1.5 g for body weights <55 kg and ≥55 kg, respectively. The maintenance dose was set to a fixed value for each creatinine clearance value (mL/min). Renal dysfunction was not detected in the eGFR <80 group (n = 59) compared with an incidence of 9.0％ in the eGFR ≥80 group (n = 11). The incidence of acute kidney injury did not significantly differ between groups (8.4％, eGFR <80 group; 9.0％, eGFR ≥80 group). The average value of the initial VCM trough concentrations did not significantly differ between groups (10.8 ± 4.1 μg/mL, eGFR <80 group; 10.6 ± 3.8 μg/mL, eGFR ≥80 group). These results indicate that administering a loading dose of VCM to patients with renal impairment (eGFR <80) is safe. The loading dose may be appropriate in this study.

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COVID-19 had socio-economic influence. There are no surveys on revenue in hospital pharmacies. Therefore, we conducted such a survey in one hospital that actively admitted patients with COVID-19 during the pandemic period. Although the decrease in medication counseling was smaller due to efficiency by preparing a pamphlet on the use of steroid therapy for COVID-19, revenue still decreased by about 660 dollars per month. The COVID-19 pandemic had a negative impact on hospital pharmacy revenue.

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