Dinoprostone vaginal indwelling preparation (PROPESS^®) is a cervical ripening drug used to promote cervical ripening after 37 weeks of pregnancy. To assess the efficacy and the safety of PROPESS^®, we compared the cervical ripening success and blood loss during delivery between patients who were administered PROPESS^® and those who were not.

The target patients were pregnant women who were admitted to our hospital between July 2021 and April 2023 with the intention of inducing labor. These patients were administered 24 of PROPESS^® or 24 of PGE₂ tablets after 37 weeks. The Bishop score (BS) was calculated after dividing the patients into two groups: those who were administered PROPESS^® during induction; and those who were administered PGE₂ tablets, and not PROPESS^®. The number of days from the start of induction to delivery and the amount of blood loss during delivery were retrospectively investigated using electronic medical records.

Both the PROPESS^® and PROPESS^® nonuser groups had 50％ of patients who either achieved a BS of 7 or higher or underwent vaginal delivery within 12h after administration. Blood loss during delivery showed no significant difference between the PROPESS^® and nonuser groups. In addition, a case of placental abruption and amniotic fluid embolism was also observed in the group administered with PROPESS^®. The cervical ripening effect when PROPESS^® was administered was the same as that when PROPESS^® was not administered. Our findings suggest that caution should be exercised during delivery, given the higher blood loss in the PROPESS^® group compared to nonuser group.

Pharmacists on an antimicrobial stewardship team (AST) play a crucial role in improving outcomes for patients with serious infectious diseases. However, although AST pharmacists are often involved in the selection of treatment or dosage adjustments, few studies have investigated AST-led interventions for the diagnosis and treatment of severe infections. Herein, we present a case in which an AST pharmacist helped diagnose and treat pyogenic spondylitis and an iliopsoas abscess suspected to be caused by Salmonella. After admission, a primary care physician treated the patient with meropenem for severe sepsis. On day 4, Salmonella spp. was identified in two sets of blood cultures. After confirming antimicrobial susceptibility, an AST pharmacist recommended an additional intravenous dose of 500 mg of levofloxacin once daily. This 2-week treatment regimen for Salmonella bacteremia was terminated because of improvement in the patient’s condition. However, during the posttreatment follow-up, the AST pharmacist observed a gradual onset of pain in the patient’s back, hip joints, and groin. Consequently, the AST pharmacist recommended blood culture and whole-body assessment using computed tomography and magnetic resonance imaging. Although the blood cultures were negative, diagnostic imaging confirmed psoas abscess and pyogenic spondylitis. The AST pharmacist recommended a 6-week treatment regimen of 2.0 g ceftriaxone twice daily combined with 500 mg levofloxacin once daily. Salmonella was later identified as Salmonella Johannesburg (O1, 40, n, x) via biochemical testing and serotyping using commercial antisera. This case highlights the importance of continuous patient monitoring and the vital role of AST pharmacists in guiding comprehensive treatment.

An approximately 70-year-old woman was diagnosed with distal cholangiocarcinoma during a routine visit for liver dysfunction. She underwent subtotal gastric-sparing pancreaticoduodenectomy, and postoperative adjuvant therapy with S-1 was initiated. Thirteen months after surgery, liver metastasis recurred, and the patient received the first dose of durvalumab + gemcitabine + cisplatin in the same month. At the beginning of the second course (day 29), her serum myogenic enzyme and cardiac troponin I (cTnI) levels were elevated, leading to hospitalization. After admission, she exhibited decreased left ventricular ejection fraction, impaired left ventricular wall motion, muscle weakness, and respiratory failure. We diagnosed durvalumab-related myocarditis, myasthenia gravis (MG), and myositis based on clinical symptoms, elevated muscle enzyme levels, and anti-acetylcholine receptor antibody seropositivity. Additionally, anti-titin and anti-Kv1.4 antibodies were detected. After steroid pulse therapy and intravenous immunoglobulin (IVIG) were administered, her cTnI and creatine phosphokinase–creatine kinase-MB isoenzyme (CK-MB) levels decreased rapidly, but they later rebounded. She required mechanical ventilation because of complications of myasthenic crisis with severe cardiac conduction disturbance. We decided to administer infliximab, which resulted in reduced cTnI and CK-MB levels and a slow improvement of myocarditis. Additional treatment with oral prednisolone, plasma exchange, and IVIG was administered for myasthenic symptoms. She was successfully extubated, and her symptoms gradually improved. To the best of our knowledge, this is the first report describing successful treatment of immune checkpoint inhibitor-related myocarditis complicated by MG with infliximab. Infliximab is a promising treatment for steroid-refractory myocarditis.

The satisfaction and motivation of pharmacy students in clinical practical training vary between hospitals and community pharmacies, but the reasons for these differences are unclear. This study investigated items for improving clinical practical training, based on students' perspectives, to increase pharmaceutical problem-solving capability at hospitals and community pharmacies. We conducted a questionnaire survey to evaluate student satisfaction with clinical education and learning environments. The results were analyzed using customer satisfaction analysis. After practical clinical training at hospitals (n = 179) and community pharmacies (n = 207) during the 2021 – 2022 academic year, questionnaires were distributed to pharmacy students at Fukuyama University. In hospital training, “The frequency of patient care experience for a wide variety of diseases was sufficient (improvement factor: 12.073)” and “The frequency of patient care experience was sufficient (10.307)” were identified as items that required improvement. Conversely, in training at community pharmacies, “The practice hours per prescription or pharmacotherapy screening and intervention (17.553)” and “The discussion hours for optimization of prescribing and rational medication use, or patient education with pharmacist (14.627)” were identified. On the basis of the results, universities, in cooperation with hospitals and community pharmacies, should improve their learning strategies and environments. Such academic interventions may enhance student satisfaction and enhance the development of practical pharmacy skills, which affect patient outcomes.

Abemaciclib, a cyclin-dependent kinase 4/6 inhibitor, is the standard treatment for hormone receptor-positive and human epidermal growth factor receptor type 2 (HER2)-negative inoperable or recurrent breast cancer. The high incidence of hepatic dysfunction is a clinical issue. However, the factors associated with severe liver dysfunction related to drug interruption or discontinuation are unclear. Therefore, we retrospectively investigated risk factors for abemaciclib-induced severe liver dysfunction in female patients with hormone receptor-positive and HER2-negative metastatic breast cancer at the Osaka International Cancer Center from November 2018 to June 2022. Severe liver dysfunction was observed in 18.3％ of patients after the initiation of abemaciclib. Body mass index (BMI; ≥25 kg/m²) before treatment initiation was identified as a risk factor for severe liver dysfunction. Additionally, patients who experienced grade 2 elevations in aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) during prior palbociclib administration developed abemaciclib-induced severe liver dysfunction. Therefore, alternative drug treatments should be considered for patients with grade 2 AST/ALT increases who were previously treated with palbociclib. Close monitoring of abemaciclib administration in patients with a BMI of ≥25 kg/m² will facilitate early detection of severe liver dysfunction and prevent its worsening. For such patients, alternative treatments may be warranted.

COVID-19 has been downgraded from a Class 2 disease to a Class 5 disease under the Infectious Disease Control Law in Japan on May 8, 2023. Previously, patients with COVID-19 were treated in specialized isolation wards. Patients with mild-to-moderate COVID-19 are now being treated in general wards, similar to seasonal influenza. Thus, more clinical pharmacists should be involved in COVID-19 patient care. Although the effects of pharmacological interventions for severe COVID-19 have been reported, they have not been reported for mild-to-moderate COVID-19. In this study, we evaluated the effects of pharmacological interventions for drug-related problems (DRPs) in patients with mild-to-moderate COVID-19 symptoms. We investigated patients hospitalized in isolation wards exclusively for COVID-19 from January 2022 to March 2023 at our institution. Among the 393 patients enrolled, 271 DRPs were identified by clinical pharmacists. There were 48 and 223 DRPs related to COVID-19 treatment and other factors, respectively. Clinical pharmacists provided 271 interventions on DRPs, of which 247 (91.1％) were accepted by the prescriber. These results indicate that patients with mild-to-moderate COVID-19 frequently receive DRPs, and clinical pharmacist interventions have positive effects on COVID-19 treatment and medication safety.

Eventually, medicines may be administered in pillow packaging more frequently because of the need for moisture resistance in accordance with SDG specifications. Additionally, barcodes are important to prevent misuse and ensure traceability. This study aimed to examine the necessity of barcodes on packaging to understand the precautions, such as moisture resistance indicated on widely used aluminum pillow packaging, and the actual dispensing status of aluminum pillow packaging units. For the drugs adopted by our hospital (612 items), we calculated the proportion of prescriptions for weekly sheets (W packaging) that can be dispensed in aluminum pillow packaging for 1 year starting on March 2022 and investigated the packaging format and state of written precautions. A total of 66.7％ (32/48 agents) of aluminum pillow packaging without a barcode had warnings, such as moisture-proofing. Of these, 50.0％ (16/32) were dispensed in aluminum pillow packaging. Conversely, 12.5％ (6/48 drugs) of aluminum pillow packaging without barcodes contained a high percentage of prescriptions (≥25％) that could be dispensed as pillows, although there were no warnings, such as moisture-proofing. These drugs included the high-priced antitumor drugs Alecensa^®, Xeloda^®, Nexavar^®, and Extandin^®. Approximately 50％ of all W packaging is dispensed in aluminum pillow packaging; therefore, we believe that barcodes could be used for moisture-proofing and medical safety reasons.

To prevent the inadvertent administration of contraindicated medications, electronic health records incorporate a feature that automatically issues warnings at the time of prescribing based on the registration of the relevant medication. However, no single drug code encompasses all variations in dosage forms, specifications, and suppliers, consequently posing challenges for many healthcare institutions. In March 2022, Nagasaki University Hospital introduced the Prescription Checking System, called IRIS (IRIS), a database of drug information organized by pharmaceutical ingredients. Accordingly, they commenced the operation of a system for querying and alert notification at the time of prescribing. The number of cases detected during the period of September 2022 to October 2023 was investigated by defining drugs that cannot be used because of patient-specific side effects as contraindicated drugs and those that require caution as cautionary drugs. Subsequently, the number of cases detected exclusively by IRIS, including different dosage forms, specifications, formulations, manufacturers, and prodrugs, was then evaluated. The number of contraindications and side effects detected exclusively by IRIS was 412 and 1623 cases, accounting for 35％ and 64％ of the total, respectively. In conclusion, the system is deemed effective in efficiently detecting contraindications and side effects.

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