Optimizing pharmacotherapy in pediatric intensive care requires an integrated understanding of developmental physiology and critical illness-related pathophysiology. Drug exposure in children cannot be interpreted as a simple scaled version of adult pharmacokinetics. Critically ill pediatric patients frequently experience rapid and dynamic changes in organ function, fluid balance, and treatment modalities, all of which can substantially modify drug disposition. Systemic inflammation, capillary leakage, and hypoalbuminemia often increase the volume of hydrophilic drug distribution in the intensive care setting, potentially leading to subtherapeutic exposure during the early treatment phase. Subsequently, augmented renal clearance or acute kidney injury may occur, resulting in underexposure or drug accumulation, respectively. Extracorporeal therapies further complicate dosing decisions by introducing additional clearance pathways and drug sequestration.

Therefore, individualized dosing in pediatric intensive care should be comprehensively optimized by integrating the fundamental principles of pediatric pharmacotherapy and critical illness. Visualization of drug concentration profiles and prediction of treatment trajectories are practical strategies that facilitate multidisciplinary decision-making. Pharmacists play a central role in this process by integrating pharmacokinetic-pharmacodynamic knowledge with clinical information to anticipate changes in drug exposure and propose timely dose adjustments. Future advances in pharmacometrics (eg, population pharmacokinetic modeling, time-varying physiological modeling), and digital clinical decision support tools are expected to further enhance precision dosing and improve therapeutic outcomes in pediatric critical care.

Improving the quality and safety of outpatient chemotherapy requires effective information sharing between hospitals and community pharmacies. However, achieving truly patient-centered care necessitates pharmacists to go beyond information exchange and develop a deeper understanding of patients’ concerns and needs before providing guidance. This study aimed to explore the needs of outpatients with cancer regarding hospitals and community pharmacists, as well as the factors underlying these needs. A 17-item questionnaire survey was conducted among patients receiving outpatient chemotherapy at nine facilities affiliated with the Aichi Hospital Pharmacists Association Oncology Division in 2023. Of the 315 questionnaires distributed, 270 were returned. Based on the median values of 5-point Likert scale responses, the perceived need for hospital pharmacists was higher than that for community pharmacists across all items. Simple tabulation indicated that the highest rated need for hospital pharmacists was “Q8: Explanation of and countermeasures for treatment-related side effects,” whereas for community pharmacists, it was “Q6: Information on drug interactions.” Factor analysis identified two factors for hospital pharmacists: “Understanding of pharmacotherapy” and “Coping with daily life during treatment.” In contrast, three factors were extracted for community pharmacists: “Comprehensive information about treatment,” “Questions and anxieties about treatment drugs,” and “Coping with daily life during treatment.” These findings clarify differences in patient needs between hospital and community pharmacists and the factors underlying them, providing a basis for improving information sharing and facilitating patient-tailored pharmaceutical interventions.

In August 2025, we implemented physician-pharmacist task sharing for therapeutic drug monitoring (TDM) of anti-methicillin-resistant Staphylococcus aureus agents. Before implementation, physicians entered initial and follow-up TDM orders after pharmacist feedback, but afterward, pharmacists entered orders (under physician direction) when they identified omissions or errors. In a retrospective before-after study, we compared Pre- (n = 153) and Post-task sharing groups (n = 139) in vancomycin- and teicoplanin-treated cancer patients. Primary outcomes were no physician order for initial or follow-up TDM, and urgent TDM orders. Secondary outcomes were days per TDM measurement, renal/hepatic dysfunction, and estimated monthly total physician time for TDM order entry. For vancomycin, no physician order for initial TDM showed no significant change (44.7％ vs 45.6％, P = 1.00), but significant decreases were seen in no physician order for follow-up TDM (12.3％ vs 1.9％, P = 0.01) and urgent TDM orders (6.3％ vs 0.0％, P < 0.01). Similar initial and follow-up TDM order results were obtained for teicoplanin (35.8％ vs 43.9％, P = 0.29, and 3.9％ vs 0.0％, P = 0.03, respectively). Mean days per TDM measurement decreased significantly for teicoplanin (5.2 vs 4.6, P < 0.01) but not vancomycin (4.2 vs 4.1, P = 0.72). Rates of renal/hepatic dysfunction did not change. The estimated monthly total physician time for TDM order entry significantly decreased after task sharing implementation (median, 334.8 min vs 72.8 min, P = 0.03). The task sharing program was associated with fewer missed follow-up orders and urgent add-on orders and reduced estimated physician workload related to order entry.

Serum creatinine (Cr) elevation is frequently observed after the initiation of abemaciclib treatment. Because abemaciclib inhibits tubular creatinine secretion, Cr may increase without a true decline in glomerular filtration rate. In Japan, cystatin C is not routinely measured in many clinical settings, highlighting the need for practical markers based on standard laboratory tests. Therefore, we investigated longitudinal changes in the blood urea nitrogen-to-creatinine (BUN/Cr) ratio after abemaciclib initiation in a single-center retrospective observational study. A total of 51 female patients who received abemaciclib were included in this study. The BUN/Cr ratio was assessed at baseline (Day 0) and follow-up time points, and the early change (ΔBUN/Cr) was defined as the difference between Day 14 and baseline. Subgroup analyses were performed using two creatinine-elevation thresholds: ≥ 0.3 mg/dL (absolute increase) and ≥ 1.25-fold (relative increase) from baseline. The BUN/Cr ratio decreased significantly after the initiation of abemaciclib, with a median decline from 21.29 at baseline to 17.65 at Day 14 (P < 0.001), and the decrease persisted through Day 28 and Day 56. The median ΔBUN/Cr was −4.39, and 76.5％ of the patients showed a negative ΔBUN/Cr. Similar decreases were observed among patients with elevated creatinine levels, and the findings were consistent in sensitivity analyses excluding patients who received intravenous fluids or systemic corticosteroids. Longitudinal assessment of the BUN/Cr ratio may provide practical supportive information for interpreting Cr elevations that may not reflect true renal dysfunction in routine clinical practice, where cystatin C measurement is not readily available.

A 75-year-old woman presented to an orthopedic clinic at another hospital for periarthritis of the shoulder and was prescribed nijutsuto. On day 24 after initiation, she developed exertional dyspnea. On Day 26, she discontinued nijutsuto on her own because she perceived no improvement in her shoulder symptoms.

On day 37, she again experienced exertional dyspnea, with oxygen desaturation below 90％ on pulse oximetry, prompting a visit to an internal medicine clinic at another hospital. Chest computed tomography suggested interstitial pneumonia, and she was referred to our institution. Upon admission, intravenous prednisolone was initiated under a provisional diagnosis of idiopathic interstitial pneumonia.

Her medication history was reviewed using her medication notebook and the brought-in drugs. On hospital Day 3, a ward pharmacist identified through the online eligibility verification system that she had been taking nijutsuto. Drug-induced interstitial pneumonia caused by nijutsuto was suspected and reported to the attending physician.

Her symptoms subsequently improved, and prednisolone was gradually tapered. After completion of prednisolone therapy, a drug-induced lymphocyte stimulation test was performed and yielded negative results. Based on the clinical course and bronchoalveolar lavage findings, she was finally diagnosed with acute drug-induced eosinophilic pneumonia caused by nijutsuto.

The online eligibility verification system enabled more comprehensive medication history retrieval than conventional methods, which contributes to accurate diagnosis and appropriate pharmacotherapy.

Rubella vaccination is recommended postpartum for women with low rubella antibody titers to prevent congenital rubella syndrome. At our hospital, we have introduced protocol-based pharmacotherapy management (PBPM) for postpartum rubella vaccination, with pharmacists actively involved. This study aimed to evaluate the impact of the COVID-19 pandemic on the rates of postpartum rubella vaccination and assess the effectiveness of PBPM during the pandemic. Data from before (fiscal year 2019) and after (fiscal years 2020 – 2023) the COVID-19 pandemic were compared. The study population consisted of postpartum women with low rubella antibody titers who gave birth at our hospital between April 1, 2019, and March 31, 2024. The results showed that the pharmacist vaccination recommendation rates declined in fiscal years 2021 and 2022 but recovered in fiscal year 2023 due to improved ward pharmacist staffing. Conversely, the overall vaccination rate showed a declining trend annually since the onset of the COVID-19 pandemic. The COVID-19 pandemic appears to have impacted pharmacist recommendation and overall vaccination rates. However, because all vaccinated postpartum women received pharmacist recommendations and all ineligible individuals were appropriately excluded, PBPM is considered to have provided a certain level of utility during the pandemic by contributing to safety and providing vaccination opportunities. In conclusion, given the observed decline in the overall vaccination rate, it is necessary to continue awareness activities and vaccination recommendations while considering a review of PBPM operations.

Proton pump inhibitors (PPIs) are classified as potentially inappropriate medications for older adults. Indiscriminate long-term use of PPIs after symptom resolution (indiscriminate PPIs) may increase the risk of adverse events and healthcare costs, emphasizing the need for appropriate prescribing. However, indiscriminate PPIs are often prescribed, and the awareness of community pharmacists regarding this issue remains unclear. This study aimed to assess pharmacists perceptions of indiscriminate PPIs and identify barriers to resolving them. A self-administered questionnaire survey was administered to community pharmacists (N = 314). The survey included pharmacists’ experiences with dispensing and providing medication counseling for PPIs and their attitudes toward indiscriminate PPIs. Among the respondents, 70.8％ recognized the presence of indiscriminate PPIs, yet 92.3％ reported that they could not adequately address the issue. The most common intervention among the effective respondents (7.7％) was advising patients to discuss discontinuation with their physicians on their next visit (41.2％). In contrast, those unable to intervene mainly inquired about the patient’s situation (36.8％). The primary barriers were “insufficient information from the prescribing physician, such as the rationale for the prescription” (83.3％) and “patients’ resistance to reducing medication” (79.4％). Although many pharmacists recognized indiscriminate PPIs and the need for deprescribing, the majority faced significant barriers to sufficient action. To overcome these barriers, strengthening communication with prescribing physicians regarding diagnoses and treatment intentions is suggested as essential to facilitate appropriate deprescribing. Furthermore, it is concluded that proactive and tailored medication counseling by pharmacists may help motivate patients to accept medication reduction.

Participation of pharmacists during physicians’ home visits is effective in home healthcare. However, substantial practical barriers exist in regions where medical resources are unevenly distributed. This study sought to clarify the effectiveness and limitations of a hybrid online model—where only the pharmacist joins remotely—by comparing it with conventional on-site accompaniment. We retrospectively reviewed all pharmacist accompaniments to physicians’ home visits at an older adult care facility in Chitose, Hokkaido, from April 2022 to March 2024. Pharmacist interventions that resulted in a claim for preventing medication-related problems were identified, and the nature of these interventions and patient outcomes were compared between the online and in-person groups. Of the total 1,986 visits, 138 involved online accompaniment and 1,848 involved on-site accompaniment. The rate of proactive interventions leading to prescription modification was similar in the descriptive comparison between the online and on-site groups (7.2％ vs 5.8％, respectively). The proportion of patients whose condition improved following these interventions was also similar in the descriptive analysis (50.0％ vs 49.5％, respectively). No patient deterioration was observed in the online group, Qualitative analysis revealed that all online interventions were based on objective clinical data or patient narratives, whereas interventions requiring direct physical assessment were confirmed only during on-site visits. In this exploratory descriptive study, no marked differences were observed in the proportion of prescription-modifying interventions or short-term clinical outcomes. These findings suggest that hybrid online accompaniment may represent a feasible alternative in settings where in-person participation is difficult, although larger comparative studies are required.

We investigated the impact of temperature and humidity on the convenience of handling over-the-counter (OTC) soft capsule drugs. Following a report of capsule rupture and liquid leakage in Product A, we performed controlled experiments using five products, including Product A. Capsules in the press-through packaging were stored under various conditions (20℃ or 35℃; high or low humidity) and evaluated for elongation rate under pressure, rupture rate, moisture absorption, and ease of removal from press-through packaging.

Product A was significantly susceptible to high temperature and humidity conditions; all capsules ruptured after 14 days at 35℃ and high humidity. Moisture absorption was 2.40％, which was significantly higher than that of all other products (0.53％ – 1.26％), except for Product D (3.23％). Deformation under 10 N pressure increased markedly for Product A (1.575-fold), whereas the other products showed minimal change. Sensory testing revealed a substantial decline in the ease of removal of Product A (0.75 points vs. 5.0 at baseline): 17 of 24 capsules leaked during handling.

In conclusion, a certain commercially available product is suggested to exhibit changes in physical properties and handling convenience. Because purchasers may store OTC drugs for a long time, establishing information that enables pharmacists or registered sellers of OTC drugs to provide appropriate advice is necessary.