Effective control of chemotherapy-induced nausea and vomiting is essential for treatment continuation; however, to date, the effects have not been adequately evaluated from a health-economic perspective. Therefore, in this study, we aimed to analyze the cost-effectiveness of outpatient cancer chemotherapy from a healthcare-payer perspective using a decision-tree analytical model. We compared a hypothetical case in which prophylactic antiemetic medication was added to standard prophylactic antiemetic therapy to increase by 10％ the proportion of total control with no emesis, nausea, and rescue therapy during the acute (day 1） and delayed (days 2 – 5） phases with those in which standard prophylactic antiemetic therapy alone was administered. Based on the incremental cost-effectiveness ratio (ICER） threshold of 7.5 million JPY/quality-adjusted life year, the appropriate prophylactic antiemetic therapy cost was 3,005 JPY when ICER was equal to the threshold value. Moreover, the cost of setting the ICER at the highest threshold of 15 million JPY/quality-adjusted life year was 5,605 JPY. The one-way sensitivity analysis results were most sensitive to utility values when no total control was achieved. Overall, this study estimated the appropriate prophylactic antiemetic therapy cost to be 3,005 JPY per 10％ improvement in total control during the acute and delayed treatment phases.

Multidisciplinary patient support, such as bi-directional information sharing between hospitals and community pharmacies (hospital–pharmacy collaboration), is crucial for the safe administration of outpatient cancer chemotherapy. At our hospital, patients are provided with documents detailing their treatment regimen, medication history, and laboratory results and are instructed to present them at the community pharmacy; this approach allows community pharmacies to utilize documents for medication guidance and adverse drug reaction monitoring. This study employed a questionnaire survey to investigate patients’ opinions, awareness, and behaviors regarding hospital–pharmacy collaborationand the pharmaceutical care provided at community pharmacies. Questionnaires were distributed to 414 patients receiving outpatient cancer chemotherapy at Iwate Medical University Hospital in February 2024, among whom 343 consented to participate in the study. Only 36.4％ of patients presented the information documents to a community pharmacy, with the most common reason for not doing so being “did not know” (n = 169). Patients who presented with the documents were more likely to receive adverse drug reaction monitoring (34.4％ vs 54.5％) and to consult pharmacists regarding side effects (33.5％ vs 58.7％) at the community pharmacy than those who never presented the documents. Patients also reported higher satisfaction with side effect monitoring and support (26.1％ vs 46.9％) and with pharmacists’ responses during consultations (30.3％ vs 50.4％). These results suggest that hospital-to-pharmacy information sharing improves patient satisfaction and access to specialized pharmaceutical care. However, the low document presentation rate underscores the need to raise patient awareness regarding the importance of this collaboration.

Voriconazole (VRCZ) is a target drug for therapeutic drug monitoring because of its complex pharmacokinetics and narrow recommended therapeutic range of 1 – 4 μg/mL in Japanese patients. Recently, blood was recommended to be drawn early after VRCZ administration to prevent adverse events. However, there is a concern that if the dose is changed based on the trough value at which the steady-state is not reached, VRCZ plasma concentrations will be outside the therapeutic range. Therefore, we implemented a dosing design based on plasma drug concentrations on day 4 after VRCZ administration and examined its usefulness.

The rates of achieving the VRCZ therapeutic range on day 4 after VRCZ administration and after the first dose change were 42.9％ and 70.0％, respectively. The number of dose changes required to reach the target therapeutic range was 0 for 28.6％, 1 for 85.8％, and 2 for 100％ cumulative doses. In addition, none of the 21 patients developed hepatic dysfunction before the plasma VRCZ concentrations reached the target therapeutic range.

These results suggest that a dosing design based on day 4 blood flow results may be effective for reaching the target therapeutic range of VRCZ early and continuing safe treatment.

The practice guidelines for the appropriate use of prophylactic antibiotics for postoperative infection prevention recommend cefazolin (CEZ) for preventing surgical site infections (SSI) during orthopedic surgeries. For patients who are overweight/obese, an increased single dose of 2 g is recommended. Therefore, we selected patients weighing 80 kg or more who underwent surgery at our orthopedic surgery; then, we conducted a retrospective study of the preventive effect and safety of increasing antimicrobial agent dose, using the standard group (1 g per dose) from June 2018 to May 2021 and the increased group (2 g per dose) from June 2021 to May 2023. The standard group included 66 patients, whereas the increased group included 55 patients. SSI occurred in two patients in the standard group and zero patients in the increased group, with no significant difference between the groups (P = 0.295). The postoperative hospital stays were 11 days in the standard group and 12 days in the increased group (P = 0.938). Clinical laboratory values (ALB, ALT, Hb, and PLT) showed significant changes before and after surgery; however, no adverse events were observed owing to the increased CEZ dosage. The two patients who developed SSI in the standard group were relatively young and had good renal function, suggesting that the 1 g dose may not have reached an effective blood concentration commensurate with the increased distribution volume in patients who are overweight; therefore, dosage escalation should be considered for these patients. If the dosage is not increased, careful monitoring for postoperative infections is essential.

The heart failure seal was introduced in the Aso region of Kumamoto Prefecture to improve the quality of heart failure management. In this study, we investigated the actual state of medication adherence and physical condition management before and after affixing the heart failure seal to the medication record book of outpatients with heart failure. Questionnaires were administered to 57 heart failure patients to whom the heart failure seal was applied for the first time at the initial, intermediate (at least 56 days after the initial application), and final (at least 112 days after the initial application) time points. The primary endpoint was the change in medication status over time, which was assessed using the Morisky Medication Adherence Scale 4 Items (MMAS-4) and self-rated medication status score. The secondary endpoints were changes over time in body condition score and subjective symptoms associated with heart failure, with body condition score assessed by self-assessment of fluid, salt, and weight control. The MMAS-4 values at the midpoint (P = 0.004) and final (P = 0.008) were lower than the initial scores. The medication status self-rating scores were greater at the midterm (P = 0.014); however, there was no difference at the final point compared with baseline. Both self-rating scores for physical condition were also greater at the midterm and final. Furthermore, the above associations were confirmed by structural equation modeling. The results suggest that the heart failure seal is effective for medication adherence and physical condition management in patients with heart failure.

Warfarin potassium (WF) is widely used to treat and prevent thromboembolism. Rifampicin (RFP) induces various drug-metabolizing enzymes, whereas sulfamethoxazole/trimethoprim (ST) inhibits these enzymes. There is not enough information on drug interaction when WF, RFP, and ST are used together. In this case, when a combination of RFP and ST was used to treat pyogenic spondylitis in a patient taking WF, the prothrombin time-international normalized ratio (PT-INR) fluctuated, and the WF dosage was required to make frequent adjustments.

In many cases, ST and RFP have been used to treat infectious diseases in the orthopedics field. When using these drugs in patients taking WF, it is necessary to frequently monitor the PT-INR level and adjust the WF dosage until the PT-INR level stabilizes.

In clinical practice, Mohs paste is used to treat patients with inoperable skin tumors; however, its viscosity and stickiness increase dramatically immediately after preparation. Additionally, this enhanced viscosity and stickiness reduce its usability. In this study, we investigated whether the combination of a polyethylene bag (quick bag) with a narrow nozzle and cryopreservation improves the long-term storage and usability of Mohs’ paste. At 4℃ and 25℃, Mohs paste solidified nine months after preparation, rendering it unrecoverable from the polyethylene bag. In contrast, cryopreservation at –20℃ attenuated the hardening of Mohs paste in the polyethylene bag, and kneading also decreased the viscosity. After nine months of storage, the viscosity of Mohs paste subjected to cryopreservation and kneading was approximately 2.6 Pa∙s in the polyethylene bag. Moreover, tissue invasion with these stored pastes was similar to that with freshly prepared Mohs paste, and it was possible to easily treat the affected area using a narrow nozzle. In conclusion, we found that the combination of a polyethylene bag and cryopreservation allows the Mohs paste to be stored over extended periods and enhances its usability. This method may increase the usefulness of the paste for clinical use.