In general, older adults have decreased stratum corneum moisture content, and most of them exhibit dry skin. If the dry skin is not treated, itching may occur, leading to dermatitis. In this study, we examined the use of moisturizers among 15 older adults residing in a special nursing home. The participants applied topical products on their backs twice daily. For a period of 3 weeks in the study, an over the counter (OTC) drug was used in the first week, Hirudoid^®Lotion (lotion) in the second week, and Hirudoid^®Foam (foam) in the third week. The water content of the stratum corneum increased when switching from OTC to lotion or foam, and the application time decreased by approximately 2 h per person per year. This suggests that the choice of moisturizer should not be based solely on price but should also include the burden on a caregiver who uses the product.

Protocol-based pharmacotherapy management (PBPM), which involves predefined protocols to change physician prescriptions, has been reported to improve the work efficiency of physicians and pharmacists in handling outpatient prescription inquiries from community pharmacists. However, recent drug shortages have led to an increase in outpatient inquiries and inquiries requiring complex responses for which PBPM does not apply, thus increasing the workload of hospital pharmacists. Herein, we evaluated improvements in work efficiency using a community pharmacist–managed PBPM with digital transformation, which includes an electronic data capture (EDC) system and a robotic process automation (RPA) tool. Before the community pharmacist–managed PBPM with digital transformation implementation, community pharmacists inquired via telephone whether a prescription change was acceptable. Hospital pharmacists responded using hospital pharmacist–managed PBPM and recorded the data in the electronic medical record. After implementation, community pharmacists modified the prescriptions using the community pharmacist–managed PBPM and entered the changes into the EDC system, which automatically generated the text to be recorded by the RPA tool in each patient’s medical record. Median response time of community pharmacists for each outpatient prescription inquiry was 1.9 (1.6 – 2.8) min before and 2.0 (1.8 – 2.5) min after implementation (P = 0.132), while that of hospital pharmacists was 5.4 (4.6 – 7.1) min before and 0.2 (0.1 – 0.3) min after implementation (P < 0.001). The results indicate that PBPM coupled with the EDC system and RPA tool significantly improves the efficiency of hospital pharmacists in processing outpatient prescription inquiries without increasing the time burden on community pharmacists.

Hospital pharmacists can reduce the burden on physicians and improve the quality of cancer chemotherapy through task shifting and task sharing in cancer treatment. However, the specific needs and expectations of patients toward hospital pharmacists have not yet been clarified. We conducted an anonymous, self-administered questionnaire survey to assess the types of requests hospital pharmacists have for patients undergoing outpatient cancer treatment. A total of 310 outpatients with cancer attending Kyoto University Hospital, Gifu University Hospital, or Ise Red Cross Hospital were surveyed. The questionnaire response rate was 78.7％. The questionnaire survey revealed that approximately 30％ of the patients were unable to fully communicate their wishes to medical doctors, and most of them preferred to consult with hospital pharmacists. The primary request of the patients for hospital pharmacists was an explanation about the adverse effects related to cancer treatment and anticancer drugs. There was also a high demand for advice on daily life precautions, lifestyle habits, and consultations on issues that patients feel unable to discuss with their primary doctor. However, some patients are still unable to consult with either their doctor or pharmacist. Therefore, there is a strong expectation for establishing a system that allows patients to consult with hospital pharmacists in outpatient cancer care. In conclusion, outpatient patients with cancer have a high need for hospital pharmacists. Hospital pharmacists must secure time to meet outpatients and effectively promote task shifting/sharing that benefits both medical doctors and patients.

Supportive therapies, such as mirogabalin (M) and duloxetine (D), are used to manage chemotherapy-induced peripheral neuropathy (CIPN) associated with taxane- and platinum-based anticancer agents. This study compared the efficacy and safety of M and D in patients with CIPN. Patients newly initiated on M (32 cases) or D (10 cases) for CIPN at the Ogaki Municipal Hospital between July 2023 and October 2024 were included. The numerical rating scale (NRS) score, NRS change rates, and adverse events were compared between the two groups 1 month after initiating supportive therapy.

The median NRS scores (range) 1 month after initiating supportive therapy were significantly reduced in both groups: M: 3 (0 – 6) and D: 3.5 (3 – 7), compared with the baseline scores: M: 4 (2 – 8) and D: 4 (3 – 10) (P = 0.004 and P = 0.021, respectively). The median minimum NRS scores were 3 (0 – 6) for M and 3 (2 – 4) for D. The median NRS change rates were −25.0％ (−100％ to 50％) and −29.2％ (−60％ to 0％) in the M and D groups, respectively (P = 0.309). Adverse events, such as somnolence, limb edema, and nausea, occurred in 46.9％ and 20％ of the M and D groups, respectively (P = 0.162). Somnolence was observed in 40.6％ and 10.0％ of the patients in the M and D groups, respectively.

These findings suggest that M and D have comparable efficacy and safety profiles for CIPN treatment. However, the higher incidence of somnolence (40.6％) in the M group warrants attention.

We report a case of left lower leg cellulitis caused by disseminated cryptococcosis in a patient with RA. As blood culture tests misidentified it as Candida spp., antifungal treatment with caspofungin was initiated. Furthermore, the patient was switched to oral voriconazole to treat the Schedosporium apiospermum complex that was detected in an upper arm skin ulcer before admission. However, Cryptococcus neoformans was identified in the blood culture tests; therefore, disseminated cryptococcosis was diagnosed. Despite the high concentration of voriconazole in the blood (>4.0 μg/mL) due to the continuation of the treatment, the fungus was identified in the tissue culture from the left lower leg cellulitis and in multiple blood culture tests. Therefore, voriconazole was deemed ineffective and the treatment was changed to liposomal amphotericin B infusion and oral administration of flucytosine as induction therapy, similar to meningitis treatment. Consolidation therapy with fosfluconazole injections and oral fluconazole was followed by oral fluconazole maintenance therapy. The patient recovered and was transferred to another hospital. In rare cases of cellulitis caused by disseminated cryptococcosis, antifungal therapy similar to that used to treat meningitis is considered useful when voriconazole is ineffective.

The elderly and patients with impaired renal function are at a higher risk of orthostatic hypotension (OH). We retrospectively investigated OH incidence during rehabilitation in patients who were prescribed silodosin and underwent out-of-bed rehabilitation by a physiotherapist and were admitted to our hospital between January 2023 and July 2024. OH was found in 22 of 60 patients (36.7％) in the renal impairment group and 5 of 42 patients (11.9％) in the patients with preserved renal function, with a significantly higher incidence in the renal impairment group. Among the renal impairment group, the OH frequency was 35.7％ in patients receiving reduced doses of silodosin and 37.0％ in those on regular doses. Estimated creatinine clearance (eCCr) < 50 mL/min OR 3.2 (95％ CI: 1.04 – 9.74, P = 0.04) was identified as an independent factor for OH occurrence in patients taking silodosin. The OH frequency during hospitalization in patients with eCCr < 50 mL/min taking silodosin is as high as about 37％, and efforts should be made to prevent adverse events such as syncope and falls through multidisciplinary cooperation.

Docetaxel (DTX) plus ramucirumab (RAM) therapy is an important option for second-line or later treatment in the treatment of advanced or recurrent non-small cell lung cancer; however, there are several cases of side effects leading to the discontinuation of treatment. In this study, we divided patients with non-small cell lung cancer who received DTX + RAM therapy into two groups: those who discontinued treatment due to side effects (side effect discontinuation group) and those who continued treatment until tumor progression without discontinuation due to side effects (non-side effect discontinuation group). The risk factors for side effects leading to the discontinuation of treatment were analyzed. Out of the 70 patients, 37 (52.9％) discontinued treatment due to side effects; the most common side effects leading to discontinuation were fatigue in 18 cases (48.6％) and loss of appetite in nine cases (24.3％). Regarding side effects leading to the discontinuation of treatment, we performed a multivariate analysis using factors with a P < 0.05 in univariate analysis as explanatory variables and found that age (≥71 years) and serum albumin level (ALB) before the start of the treatment (<3.7 g/dL) were independent risk factors. The study results suggest that age and ALB were significant predictors of adverse events leading to the discontinuation in DTX + RAM therapy.