In patients with metastatic colorectal cancer (mCRC), the risk factors of regorafenib (REG)-induced proteinuria and its clinical impact are poorly understood. Therefore, we retrospectively investigated the onset and characteristics of proteinuria, the effect of the interval between the final bevacizumab (BEV) administration and the initial REG administration on the onset of proteinuria, and proteinuria’s impact on overall survival (OS) in patients with mCRC who received sequential administration of BEV to REG. Among the 31 eligible patients, the incidence of grades 1, 2, and 3 proteinuria based on dipstick urinalysis was 25.8％, 58.1％, and 16.1％, respectively. The median (range) time to improvement in urinary protein ≤2+ in patients with urinary protein ≥3+ was 14 (7 – 14) days in the REG withdrawal/reduction group (n = 4) and 17 (7 – 33) days in the discontinuation group (n = 10). The incidence of urinary protein ≥2+ tended to decrease among patients with a longer interval between BEV and REG (P = 0.15). The median OS was significantly longer in patients with urinary protein ≥3+ than in those with urinary protein ≤2+ (365 days vs 153 days, P = 0.03). In patients with mCRC, REG-induced proteinuria can positively impact OS, and its occurrence can be predicted by the interval between the final BEV and initial REG. Given that severe proteinuria can improve following REG interruption, treatment continuation should be carefully evaluated.

Polypharmacy has become a major problem owing to the increasing complexity of diseases and drug therapies caused by the rapid development of a hyper-aged society in Japan. Among these, it has been reported that the concomitant use of renin angiotensin system inhibitors, diuretics, and NSAIDs increases the risk of acute kidney injury; this has been called for attention as “triple whammy.” Confirmation of concomitant medications in the community pharmacy is a crucial issue. In this study, with the objective of optimizing methods for detecting “triple whammy,” we investigated the impact of telephone follow-up on the detection ratio compared with the conventional method of verification at the pharmacy counter during the subsequent visit. Pharmacies in Shiga Prefecture that agreed to participate in this study were randomly assigned to two groups, and the results of the concomitant medication checks corresponding to each group were analyzed. The percentage of confirmed concomitant medications was significantly higher in the telephone follow-up group (97.6％) compared with 63.5％ in the conventional counter-confirmation group (P < 0.01), and the percentage of confirmed NSAIDs (ie, triple whammy detection) was also significantly higher in the telephone follow-up group (P < 0.01). The efficiency of the confirmation of concomitant medication was significantly improved, resulting in an increase in the detection rate of triple whammy, suggesting that telephone follow-up is an effective method for follow-up during the medication period in community pharmacies. This study protocol has been registered with the UMIN Clinical Trials Registry (UMIN‑CTR, University Hospital Medical Information Network: UMIN000047550).

The development of an efficient pharmaceutical stock management system is crucial for reducing hospital expenses. This study aimed to develop and evaluate a novel stock management system using electronic medical record (EMR) information. The system targeted 132 pharmaceutical items priced at 1,000 yen or higher and employed a medical data warehouse system (CLISTA!^® ver3.5) to automatically extract outpatient appointment and prescription data from EMRs. This data was processed using FileMaker Pro^® ver16 to calculate the maximum predicted prescription demand and its corresponding date, facilitating precise stock control. The inventory sufficiency rate was defined as the percentage of days from February to July 2024 when the predicted prescription volume remained within stock levels. Furthermore, financial losses owing to drug price revisions were analyzed between fiscal years 2022 and 2023. The system successfully predicted 74％ of the prescriptions, achieving an inventory sufficiency rate of 99.9％. The total inventory stock value decreased by ¥10,049,397, and financial losses owing to drug price revisions were reduced by 61.7％ (¥2,039,744) in FY2023 compared with FY2022. Furthermore, the introduction of the system significantly reduced the workload of pharmacists. The time spent on stock management decreased from 10 h per week (two pharmacists) to 2 h per week (one pharmacist), resulting in an 80％ reduction in operational hours. These results suggest the system’s effectiveness in optimizing pharmaceutical stock control, reducing economic losses, and improving operational efficiency.

The robotic dispensing system is a dispensing robot used in Japanese pharmacies, capable of automatically dispensing medicine packages from their internal storage. This study aimed to evaluate the effects of robotic dispensing systems on the dispensing workflow. The automated dispensing systems investigated were BD ROWA™ (Nippon Becton Dickinson Company, Ltd) and Drug Station^® (YUYAMA MFG Co, Ltd). The study was conducted at three community pharmacies: one using BD ROWA™, one using Drug Station^®, and a control pharmacy without robotic dispensing systems. We measured the time required for dispensing up to the final verification as well as the staff’s operational time. The number of analyzed prescriptions was 75 at the control pharmacy, 93 at the pharmacy with BD ROWA™, and 78 at the pharmacy with Drug Station^®. BD ROWA™ reduced dispensing time by up to 65.0 s (37.6％) and shortened operational time by 30.8 s (17.8％). Drug Station^® reduced the dispensing time by up to 40.0 s (23.1％) and shortened operational time by 46.6 s (26.9％). These results suggest that robotic dispensing systems are useful in Japanese pharmacies and can free up pharmacists’ time to focus on patient-facing services.

Heart failure, which is characterized by structural or functional abnormalities that result in symptoms such as dyspnea, fatigue, and edema, significantly affects mortality rates and healthcare expenditures. Anemia, which affects approximately 60％ of patients with chronic heart failure, intensifies the prognosis because of reduced oxygen delivery. This study examined the impact of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) on anemia in patients with heart failure and preserved ejection fraction (HFpEF). The study included inpatients aged >18 years who were diagnosed with HFpEF and treated with either ACE-Is or ARBs. The exclusion criteria were patients receiving concurrent ACE-I and ARB therapy, those with severe anemia (hemoglobin <8.0 g/dL), a history of gastrointestinal bleeding, or treatment with erythropoiesis-stimulating agents. The cumulative incidence of severe anemia (hemoglobin <8.0 g/dL) was significantly higher in patients treated with ACE-Is than in those treated with ARBs (P = 0.04). Despite their comparable efficacy in treating heart failure, ACE-Is may pose a greater risk of anemia, suggesting that ARBs may be a more suitable option for mitigating anemia in patients with HFpEF. This study emphasizes the importance of monitoring hemoglobin levels in patients with HFpEF undergoing treatment with ACE-Is. Additional large-scale prospective studies are required to validate these findings and to elucidate the underlying mechanisms.