During quality control audits for dispensed medications, tablet coloration is frequently checked along with the subjectivity of pharmacists in pharmacies. This study developed an objective method for evaluating tablet coloration using color difference values derived by analyzing tablet images. We took photographs of the test tablets and imported these images into ImageJ to obtain the RGB (red, green, blue) color code chart values. Next, the RGB values were used in the CIE2000 calculator to calculate the color difference between each reference tablet that was immediately removed from packaging. We induced color changes in telmisartan (TEL) tablets of 19 products as test tablets by contacting them with the levodopa–carbidopa (LEV) tablet, and the color difference values for these tablets were calculated. Subsequently, the same tablets were evaluated by 10 clinically experienced pharmacists, auditing the acceptance of the coloring of these tablets. The receiver operating characteristic curve analysis between the color difference values and acceptable evaluation by pharmacists indicated a cutoff color difference value of 2.08, with an area under the curve of 0.756 as acceptable. After storing TEL tablets in one-dose packaging with LEV tablets for 1 month at room temperature in care facilities, 36％ of the tablets showed color difference values exceeding the cutoff threshold. Using color difference values in objective tablet coloration evaluation suggests its applicability in assessing tablet coloration in clinical settings.

We surveyed community pharmacy pharmacists regarding their awareness of the glycemic control goal of the Guidelines for Diabetes Mellitus in the Elderly (GL) and the status of auditing prescriptions for patients with diabetes based on their test results. The survey items were as follows: recognize the lower limit of GL, whether and how often HbA1c was checked during a prescription audit, and how to deal with hypoglycemia during medication counseling. Results showed that only 28.2％ of the pharmacists knew the detailed HbA1c lower limit established in the GL, indicating that insurance pharmacists may be unfamiliar with target glycemic control values for elderly patients with diabetes. The frequency and method of checking HbA1c during the prescription audit was 93％ among pharmacists; however, 36.5％ of the pharmacists checked HbA1c >2 months before the correct value was reflected. Moreover, 98％ of patients reported that pharmacists explained the symptoms of hypoglycemia and how to manage them. However, 28.2％ and 19.7％ of the patients provided information to the prescribing physician by submitting a tracing report and making a questionable inquiry to the prescribing physician. Certified pharmacists should take the lead in conducting training sessions.

Discarding expensive anticancer drugs during preparation can lead to substantial economic losses. This study aimed to identify a practical formulation standard for preparing the prostate cancer drug cabazitaxel (CBZ) by comparing healthcare cost savings with the current standard and assuming the existence of a low-dose standard formulation. We retrospectively reviewed the electronic medical records of body surface area, total number of treatments, and volume discarded. With five different low-dose standard vials (50, 40, 30, 20, and 10 mg), we calculated and compared the total number of treatments assigned to the existing 60-mg vials, amount discarded, cost of drugs, and closed drug transfer systems for each standard as medical costs. The median disposal was lower for the 10 (4.1 mg), 50 (9.3 mg), and 20 (14.3 mg) mg vials than that for the 60-mg vials (28.2 mg; all P < 0.01). The median disposal was the lowest for the 10-mg vial (4.1 mg), followed by the 20- and 40-mg vials (both 8.2 mg), compared with the 60-mg vial (28.2 mg; all P < 0.01). The median medical cost was lowest for the 40-mg vial (¥ 354,899) compared with the 60-mg vial (¥ 511,456; P < 0.01), indicating that the practical formulation standard for CBZ preparation should be 40-mg vial. Using the same technique and preparation time as the marketed formulation can reduce medical costs.

Recently, there has been a growing trend for hospitals to display laboratory data on out-of-hospital prescriptions. The display methods and specific laboratory data are independently determined by each hospital. We commenced the display of laboratory data on out-of-hospital prescriptions at Kagoshima University Hospital in January 2018. We identified 16 fixed laboratory data for display considering the components of high-risk drugs specified in package inserts. Moreover, tests were considered mandatory if the sections of “warnings” or “important precautions” mentioned “the need for testing” or if the sections of “contraindications” or “dosage and administration” specified criteria for laboratory data related to “initiation,” “reduction,” or “discontinuation.” In such cases, we identified supplementary laboratory data beyond the fixed 16. Consequently, the laboratory data for 121 (4.0％) of the 2,994 drugs available for out-of-hospital prescriptions were needed for display. We conducted a web-based survey targeting community pharmacists to assess the utilization of the displayed laboratory data. The utilization rate of the laboratory data among the 16 fixed items showed that serum Cre and eGFR were frequently used in prescription audits and clarification inquiries. HbA1c was frequently used for patient counseling, along with AST and ALT to confirm side-effects. For each medication, PT-INR was frequently cited in prescription audits, clarification inquiries, and confirmation of side effects. For medication counseling, TG, T-chol, HDL-chol, and LDL-chol were mentioned frequently. Displaying clinically required laboratory data on out-of-hospital prescriptions in a hybrid manner is considered useful.

The 2018 Clostridioides difficile infection (CDI) treatment guidelines recommend the selection of therapeutic agents based on the severity and recurrence of CDI. To optimize the selection of CDI treatment agents, we systematized the evaluation methods for the severity and recurrence of CDI and integrated them into the prescription order system. This study reports changes in CDI cure rates and therapeutic agent selection associated by introducing a new system. This study included patients diagnosed with CDI who received treatment between March 2015 and April 2023. According to the CDI treatment guidelines, the selection rates of first-choice drugs were 96.7％ and 4.8％ for nonsevere and severe patients, respectively, at initial onset in the preintroduction group (before the new system was introduced). The selection rates were 98.0％ and 90.0％ for nonsevere and severe patients, respectively, in the postintroduction group. The rates of recurrent patients were 38.9％ and 95.2％ in the pre- and post-introduction groups, respectively. However, the cure rates for nonsevere and severe patients at initial onset were 76.3％ and 52.4％, respectively, in the preintroduction group, and 82.0％ and 70.0％, respectively, in the postintroduction group. Recurrence rates were 55.5％ and 81.0％ in the pre- and post-introduction groups, respectively. According to the CDI treatment guidelines, the implementation of a system for evaluating the severity and recurrence of CDI while selecting treatment drugs considerably improved the selection rate of the first-choice drug, according to the CDI treatment guidelines. However, this did not affect the cure rates.

Herein, we investigated the presence or absence of communication troubles among pharmacists at dispensing pharmacies and drugstores, assessed self-evaluation of professional competencies of pharmacists, and surveyed their social skills using the KiSS-18 scale. A total of 317 anonymous questionnaire forms were collected. Concerning the experience of communication troubles, 64.0％ and 33.1％ answered “yes” and “no,” respectively. Regarding “professionalism” and “ability to utilize information and scientific technology,” the group that responded that they experienced trouble had higher self-evaluation than that which answered that they had no trouble (P = 0.031 and 0.046). However, no differences were observed in social skill measurements using KiSS-18 based on the presence or absence of such troubles. To prevent communication errors from evolving into such troubles, training and self-improvement in “professionalism” and the “ability to utilize information and scientific technology” are considered effective. However, because professionalism is not universal and may change with time and social demands, continuous training and self-improvement are necessary for understanding and practicing professionalism. This will enable pharmacists to provide high-quality medical and pharmaceutical care. In this medical field, there is a mix of graduates and pharmacists from 4- and 6-year pharmacy education programs. Therefore, training and self-improvement tailored to the needs of each pharmacist, bridging the generational gap, are necessary.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors cause an initial dip after early administration, which can be severe in some cases. However, the relationship between SGLT2 inhibitors and severe initial dips remains unclear. This study aimed to evaluate the association between risk factors and the occurrence of severe initial dips due to SGLT2 inhibitors. This retrospective cohort study was conducted at a single center. Data were retrieved from electronic medical records. Patients who received SGLT2 inhibitors at Kido Hospital between January 2014 and December 2021 were included in the study. Of the 810 patients identified, 270 were included in this analysis. The occurrence of initial dips due to SGLT2 inhibitors was observed in 68％ of cases, 5％ of which had a severe initial dip and 63％ had a mild-to-intermediate initial dip. Moreover, a multivariate analysis revealed that SBP (hazard ratio [HR]: 0.989, 95％ confidence interval [CI]: 0.982 – 0.997, P = 0.007) and heart failure (HR: 1.756, 95％ CI: 1.045 – 2.948, P = 0.033) were independently associated with severe initial dips. This study suggests that the induction of a severe initial dip due to SGLT2 inhibitors is associated with heart failure and SBP. These factors are considerably associated with baseline hemodynamics in patients treated with SGLT2 inhibitors. Therefore, considering a severe initial dip and avoiding discontinuation of SGLT2 inhibitor treatment in patients with heart failure is necessary.