Ophthalmic suspension formulations are commonly used in ophthalmology, and understanding the stability information for safe use is essential. Based on these backgrounds, we have previously clarified that fluorometholone suspension eye drops have risks, such as dispersed particle growth during storage and decreased redispersibility caused by adherence of the agglomerated suspension to the container. This study evaluated the redispersibility of the brinzolamide suspension eye drops; one original drug, “Azopt^® ophthalmic suspension 1％” and two generic drugs, A and B, after prolonged storage. Each brinzolamide suspension eye drop was stored at 10℃ for two years. After the eye drop container was stirred by hand using the agitation method, one drop was taken from the vial. The redispersibility of brinzolamide suspension in each eye drop was evaluated by appearance, particle size distribution, particle observation, and brinzolamide concentration. Azopt^® and the two generic products showed a uniform milky white character without solidifying precipitates at the bottom of the container, regardless of storage or redispersion. However, the two generic products showed a tendency toward particle coarsening. Furthermore, the drug concentration in the first drop of Azopt^® was ≥ 0.75％ regardless of storage or redispersion. In contrast, the two generic products were < 0.44％ for generic A and 0.60％ for generic B before dispersion. In conclusion, no difference in suspensibility was observed. However, differences in the drug amount in the first drop among products suggest that inadequate drug instruction may lead to reduced therapeutic efficacy.

In recent years, pharmacists have been increasingly involved in expanding their interpersonal work, and there has been a growing emphasis on task shifting from physicians to pharmacists. Consequently, the workload of pharmacists has increased, and it is essential to shift tasks to pharmacy assistants. This study aimed to investigate the impact of employing pharmacy assistants on workload reduction and the influence on interpersonal work, as the relationship between the employment of pharmacy assistants and increased efficiency or expansion of interpersonal work by pharmacists is still unclear. The survey was conducted from September 30 to October 31, 2022, targeting facilities that employed pharmacy assistants, and responses were obtained via Google Forms. After analyzing the responses from 135 facilities, the percentage of respondents who indicated that pharmacy assistants effectively reduced the workload of pharmacists ranged from 93.8 to 100.0％. The time saved by pharmacists per day was 0.5 hours for transport, 1.5 hours for injection dispensing, drugs and supplies management, assistance of pharmacists in checking the medications brought in, and 2.0 hours for internal medicine dispensing and advanced approach. This study revealed that pharmacy assistants could reduce the workload of pharmacists, and drug management guidance was increased in 64 facilities at 47.4％, suggesting that this will lead to an expansion of interpersonal work by pharmacists. In the future, task shifting to pharmacy assistants should be implemented appropriately by ensuring training and medical safety systems, since the training rate is 38.5％.

A man in his sixties, weighing 71 kg, experienced chronic heart failure due to dilated cardiomyopathy. He developed symptomatic hyponatremia (serum sodium, 124 mmol/L) 6 days after initiating treatment with duloxetine (20 mg) once daily and tramadol (25 mg) twice daily for chronic low back pain. After dismissing hyponatremia caused by congestive heart failure, which can lead to overhydration, the pharmacist recommended that the physician discontinue duloxetine because of its potential association with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Decreased serum osmolality, elevated urine osmolality and sodium levels, and a not-suppressed plasma arginine vasopressin level indicated SIADH. Following the discontinuation of duloxetine, short-term excess fluid restriction, and 1-day administration of tolvaptan (7.5 mg), hyponatremia was resolved instantly. Previous studies have shown that antidepressant-induced SIADH is likely to occur in older female patients with low body weight. This case indicates that duloxetine-induced SIADH may potentially occur in patients without risk factors. Therefore, careful monitoring of changes in serum sodium levels is essential when initiating duloxetine treatment in patients.

To benefit from inhalation therapy requires continuous and reliable inhalation with the correct technique. We investigated the effectiveness of a method in which a two-dimensional code (LogoQ^®) with blue cells on a white background and the word “how to use” in yellow with a red border in the center were attached to the inhaler and instructions for use were provided to direct patients to the video site of the Environmental Restoration and Conservation Agency for repeated review of the technique. Of the 123 patients, 46 (mean age 58.1 years) completed the post-distribution evaluation after obtaining consent, the video viewing ratio was 52.0％, and the access ratio from the inhaler itself was approximately four times higher than that from the instructions. Those who accessed the video tended to have a lower DAI-10, an index of treatment comprehension, and a shorter duration of treatment. Although there was no effect of video viewing on the effectiveness of inhalation in a short period of time, free opinions were obtained that it contributed to the improvement and reconfirmation of the technique. The smartphone ownership ratio was 61.5％ in the video viewing group, and other patients accessed the videos from smartphones owned by their family members or others. Attaching the LogoQ^® directly to the body of the inhaler led to the presentation of easy-to-understand instructions for accessing inhalation instructional videos. LogoQ^® is expected to be used effectively as a tool for patients and their families to learn how to inhale.

Temporary discontinuation of antithrombotic drugs during the perioperative period is crucial but carries the risk of forgetting to resume administration. To achieve continuous and efficient medication management, we developed a temporary discontinuation medication resumption confirmation process using Robotic Process Automation (RPA) and Data Warehouse (DWH). From April 2021 to March 2022, out of 1,147 cases of temporary discontinuation (990 resumptions and 157 terminations), there were no instances where instructions for resuming or terminating the medication were missed. There were no significant incidents or accidents associated with temporary discontinuation. All 56 cases (4.9％) that exceeded the scheduled resumption date were confirmed by pharmacists. The utilization of RPA and DWH for the continuous and efficient resumption of temporary discontinuation of medication enables the collaborative management of complex medication instructions during the increasingly complex perioperative period across multiple professions and departments. This approach contributes to safe and effective treatment practices, minimizing the risk of medication omission and enhancing patient safety during the perioperative period.

With the aim of promoting the health of the elderly, we collaborated with the Sakai City Pharmacists Association to conduct a current survey targeting elderly individuals who use insurance pharmacies to intervene in frailty prevention. The survey period was from October to December 2021, and a questionnaire survey was conducted for patients aged ≥65 years who visited the community pharmacies to collect their prescription medications. A total of 188 elderly patients were surveyed (mean age: 80.4 years). The mean total score of the basic checklist to assess frailty was 7.7, and a high percentage of patients were frail, with 87 cases (46.3％) overall and 41 cases (65.1％) among those aged ≥85 years who were considered to be in the frail group (≥8 points). Furthermore, among the group taking four types of medications that require special attention when administered to the elderly, the average score was 8.9 points, and there was a significant tendency toward frailty among medication users (P < 0.001). Community pharmacists need to pay attention to patients’ living conditions, physical function, and cognitive function when intervening in drug therapy as part of frailty prevention.

When a patient with cancer becomes infected with COVID-19, disease progression occurs due to the disease becoming more severe or treatment for the underlying disease being interrupted. We investigated the outcome of COVID-19 in cancer patients and the influence on the effect of chemotherapy. The subjects were 45 patients with COVID-19 among 258 cancer patients who were hospitalized and underwent chemotherapy from January 2022 to February 2023.

The incidence rate of COVID-19 for each cancer type was 26.8％ for blood cancer, 25.0％ for lung cancer, and 11.0％ for other cancers, with blood cancer and lung cancer significantly higher than other cancers. In addition, the median number of days required for Ct value ≥ 35 was 43.5 days in blood cancer patients, which was significantly longer than in lung cancer patients and other cancer patients. Of the 45 patients infected with COVID-19, 28 patients were infected during chemotherapy, and the median time from chemotherapy to infection with COVID-19 was 14 days. Twenty patients postponed chemotherapy, and the median number of postponed days was 20 days. Death within 30 days of infection with COVID-19 was observed in 2 cases of hematological cancer, 1 of which was due to exacerbation of the primary disease due to the postponement of chemotherapy. This study suggests that COVID-19 may affect the disease prognosis of cancer patients.

Counseling and provision of information regarding the safety and benefits of medications for pregnant women or nursing mothers are useful for determining the treatment plan during the perinatal period. However, the involvement of hospital pharmacists has been unclear. The present questionnaire study aimed to elucidate the involvement of hospital pharmacists in the counseling and provision of information regarding perinatal pharmacotherapy. Subject facilities included hospitals with pharmacists belonging to Yamagata Society of Hospital Pharmacists. The recovery rate of the questionnaire was 86.9％ (53/61). The proportions of responding hospital categories that were hospitals with delivery facilities, and those without delivery facilities were 18.9％ (10/53) and 81.1％ (43/53), respectively. The median number of questions to the pharmaceutical department about drug safety during the pregnancy period in each hospital category was 2.0 (range: 0.0 – 5.0), and 0.0 (range: 0.0 – 1.0) whereas the median number of questions during lactation in each hospital category was 2.5 (range: 0.0 – 5.0), and 0.0 (range: 0.0 – 1.2), respectively. Both questions significantly were more common in hospitals with delivery facilities (P < 0.001); however, some hospitals without delivery facilities also showed a certain frequency of questions. Among hospitals with delivery facilities, the proportion of involvement by hospital pharmacists in the counseling for pregnant women or nursing mothers was 30–50％, suggesting that this may not be common. The results of this study provide basic important information to promote a safer system for medication usage by pregnant women and nursing mothers.