Elderly cancer patients need to be evaluated from multiple perspectives, taking into account not only age-related decline in physical, organ, and cognitive functions, but also psycho-psychological and socioeconomic factors. The Cancer and Aging Reserch Group (CARG) score comprehensively scores the functional assessment items in the elderly, and it has been reported overseas that the CARG score was able to predict the incidence of serious adverse effects of chemotherapy. However, in Japan, functional assessment of elderly patients with cancer has not yet been fully implemented in clinical practice. Therefore, we investigated the prediction of serious side effects of chemotherapy by the CARG score in elderly patients with colorectal cancer and their impact on treatment. The treatment continuation rate due to overall side effects was significantly shorter in patients with a CARG score of 10 or higher. The continuation rates of treatment for hematologic toxicity and non-hematologic toxicity were also significantly shorter in patients with a score of 10 or higher. Thus, the CARG score is expected to be useful in predicting serious side effects in elderly Japanese cancer patients and will contribute to supporting treatment when the CARG score is used in daily practice.

Regarding the administration method of tocolytics, short-term administration is beginning to be recommended in Japan, in line with Europe and the United States. However, there are cases where long-term administration is performed for the purpose of maintaining pregnancy, and the method of administration is being debated. In order to examine the safety of ritodrine hydrochloride injection, we attempted to analyze the incidence of maternal adverse events, administration period, and patient background. We analyzed the period from April 2004 to December 2020 using the Japan Spontaneous Adverse Event Report (JADER) database created by the Pharmaceuticals and Medical Devices Agency (PMDA). Pulmonary edema, agranulocytosis, rhabdomyolysis, and liver dysfunction etc, which are already known side effects of ritodrine hydrochloride injection, were confirmed as characteristic adverse events. There were no clear differences in the tendency of adverse events depending on age, body size, or dose. Regarding the incidence and the duration of treatment, the duration of treatment for musculoskeletal adverse events was the shortest (median 3 days), and the longest for hematologic adverse events (median 22 days). In addition, Weibull analysis revealed that adverse events are more likely to occur as the administration period increases, and it is considered desirable to avoid long-term administration of ritodrine hydrochloride injection. Furthermore, a high rate of pulmonary edema was reported in cases where ritodrine hydrochloride injection and steroids were used together, even when ritodrine hydrochloride was administered for less than 48 hours.

Pharmacists play an important role not only in improving the safety and efficacy of drug therapy, but also in improving the efficiency of healthcare financing by prescription inquiries and provision of information to prescribing physicians. The purpose of this study was to survey prescription inquiries and provide information to physicians by pharmacists and to estimate the annual reduction in drug costs resulting from changes in prescriptions due to inquiries and information provision. The survey was conducted with the cooperation of the Japan Pharmaceutical Association and Nippon Pharmacy Association, requesting individual members of each organisation to respond to survey forms posted on the pharmacy website. The survey period was one week from December 2018 to March 2019. Responses were received from 2,783 pharmacies and 5,724 pharmacists, of which 2,117 (76％) and 5,024 (88％) were valid, respectively. The drug cost savings per prescription change due to prescription inquiries were –894 yen. The estimated annual drug cost savings due to prescription inquiries were –19,231,998,137 yen. The estimated drug cost savings per prescription change due to information provision were –1,103 yen. The estimated annual drug cost savings due to information provision were –944,257,363 yen. From these results, we conclude that prescription inquiries and the information provided by pharmacists contribute to community medicine through the efficiency of healthcare financing.

Resource availability for antimicrobial stewardship (AS) differs according to the size of the clinical setting. In small- to medium-sized hospitals, guideline-based AS programs should be selected to implement AS. This study evaluated the effectiveness of AS strategies on the antimicrobial resistance of bacteria in a 126-bed community hospital. Participant data obtained from the electronic medical records in the hospital’s centralized database were analyzed using a retrospective chart review methodology. The AS team undertook weekly rounds and provided recommendations for the appropriate use of antimicrobials. Additionally, pharmacists conducted post-prescription audits and bedside pharmaceutical care to closely communicate with the AS team to assist with the AS implementation. As a process measurement, the antimicrobial use density (AUD) of antimicrobial agents was quantified. The rate of antimicrobial resistance of bacteria was examined as an outcome of AS. The AUD of fluoroquinolone (P < 0.05) and carbapenems (P < 0.01) decreased significantly from before to after the implementation of AS, and the rate of fluoroquinolone resistance of E. coli decreased significantly (P < 0.05) from 41.2％ before AS (from 2018.1 to 2019.5) to 22.5％, 24.0％ in 2021 and 2022, respectively. The recommendation rate to prescribers and recommendations on the selection of antimicrobials significantly increased (P < 0.01) after AS. The implementation of AS in this hospital improved the appropriate use of antimicrobials and affected outcomes. These results may be attributed to close communication between pharmacists who performed the post-prescription audits and bedside pharmaceutical care and the AS team.

In a community-based integrated care system, hospitals and community pharmacists must cooperate to support drug therapy of patients. Information-sharing tools support sharing; however, individual hospitals have unique forms of information-sharing tools. To clarify the situation, we reviewed the websites of 775 hospitals, including hospitals with special functioning and regional medical care support hospitals. We surveyed the types and management status of information-sharing tools used by hospital pharmacists and community pharmacists. Fifteen hospitals (2％) listed information-sharing tools used by hospital pharmacists. In contrast, 486 hospitals (63％) listed at least one type of information-sharing tool used by community pharmacists, with the highest percentage in the category of oncology, listed by 308 hospitals (40％). The second highest was a general drug information tool, which was listed by 294 hospitals (38％). Considering hospitals, the highest percentage of actual recipients of information sharing tools in all categories was in the pharmacy department. The percentage of hospitals using electronic information sharing was less than 10％. This survey clarified the actual situation and operational status of information-sharing tools between hospitals and pharmacies.