Tracing reports (TRs) are widely used in Japan as follow-up tools to support safe and effective outpatient pharmacotherapy by sharing information such as adverse drug reactions and medication history between hospitals and community pharmacies. Since most TRs are currently transmitted via fax, challenges include rapid, reliable information sharing with physicians, bidirectional exchange of information between hospitals and community pharmacies, and the risk of personal information leakage. To address these challenges, Kyoto University Hospital introduced the electronic TR system “AAdE-Report” in March 2023. The introduction of the electronic TR system significantly reduced the time required to transcribe TR content into medical records from 3.1 minutes to 0.7 minutes per case. Furthermore, using the chat function integrated into the electronic TR system reduced the time required to provide feedback to community pharmacists from 7.2 minutes to 3.8 minutes per case. A survey of community pharmacists revealed that the shift to electronic TRs shortened the report preparation time, allowing more time for other tasks, such as patient-facing duties. In addition, feedback to community pharmacies increased after implementation, and the chat function was recognized as a practical tool for less disruptive communication than telephone calls.

These findings indicate that the introduction of an electronic TR system can shorten TR-related working time and may facilitate bidirectional information sharing between hospitals and community pharmacies.

Bevacizumab is an antineoplastic anti-angiogenic agent that inhibits vascular endothelial growth factor, and proteinuria is a representative adverse event associated with its use. Proteinuria is evaluated using qualitative urine protein testing, quantitative urine protein measurement based on 24-hour urine collection, or the urine protein-to-creatinine ratio (UPC ratio); however, criteria for treatment decisions differ according to the cancer type. In colorectal cancer, qualitative urine protein testing and 24-hour urine protein measurement are commonly used, whereas standardized UPC ratio-based criteria have not been established. Because bevacizumab enhances the efficacy of chemotherapy in colorectal cancer, inappropriate discontinuation owing to uncertain proteinuria assessment may reduce treatment intensity. We conducted a prospective, single-center, non-randomized interventional study to evaluate whether UPC ratio-based treatment decisions could improve bevacizumab continuation without compromising tolerability. The UPC ratio was prospectively applied to treatment decision-making, and a cutoff 2.0 for continuation was predefined with reference to ramucirumab, an anti-angiogenic agent with a similar mechanism of action. Patients with colorectal cancer who received bevacizumab at Juntendo University Nerima Hospital between September 2020 and March 2021 were enrolled. Proteinuria was assessed using the UPC ratio, and bevacizumab was continued in patients with a UPC ratio < 2.0. Tolerability was evaluated based on the occurrence of nephrotic syndrome and renal dysfunction. Sixteen patients with 84 measurements were analyzed. Among the 20 measurements with qualitative urine protein levels ≥ 2 +, 16 had a UPC ratio < 2.0, and bevacizumab treatment was continued. No nephrotic syndrome or clinically significant renal dysfunction occurred, but generalizability is limited.

Lithium carbonate is one of the first-line pharmacological treatments for mania and bipolar disorder, and its efficacy has been demonstrated in placebo-controlled trials. However, lithium is associated with adverse effects, including renal impairment, which can elevate serum lithium levels and increase toxicity risk. Although factors such as age, sex, comorbidities, dosage, and co-medications may influence renal impairment, previous findings have been inconsistent. This multicenter, retrospective cohort study aimed to identify risk factors for the onset and progression of lithium-induced renal impairment. Patients who initiated lithium therapy between April 2001 and December 2020 at participating institutions were included. Individuals with preexisting renal dysfunction, insufficient baseline data, or missing follow-up renal measurements were excluded. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at six predefined time windows within two years after treatment initiation. The primary outcome was the development of renal impairment (eGFR < 60 mL/min/1.73m²) within 2 years. Among the 183 patients analyzed, 26 (14.2％) developed renal impairment. Mixed-effects logistic regression revealed that older age, lower pre-treatment eGFR, longer treatment duration, and a dosing frequency of two or more times per day were significantly associated with increased odds of renal impairment. In contrast, the daily lithium dose was not significantly associated with renal function decline. These findings indicate that lithium-induced renal impairment is more likely to occur with increasing age, longer treatment duration, and higher dosing frequency. Once-daily dosing may help reduce the risk, and regular renal monitoring is recommended, particularly in high-risk patients receiving long-term lithium therapy.

Pharmacists in antimicrobial stewardship teams play a pivotal role in optimizing antimicrobial selection and dosing for patients with severe infections. Although AST interventions have been associated with improved antimicrobial use and reduced antimicrobial resistance, evidence evaluating the impact of pharmacist-driven interventions throughout the diagnostic and therapeutic course of severe infections remains limited. We report the case of a patient with a severe brain abscess in whom continuous intervention by an AST pharmacist contributed to favorable clinical outcomes through the optimization of specimen collection, and antimicrobial therapy based on pharmacokinetic/pharmacodynamic principles. Empirical therapy with meropenem (6 g/day) and vancomycin, under therapeutic drug monitoring, was initiated on admission. Surgical drainage of the brain abscess was performed on hospital day 8. The AST pharmacist recommended the intraoperative collection of purulent material using anaerobic transport media, enabling anaerobic culture. Gram staining revealed gram-positive cocci (4+), gram-positive rods (3+), and gram-negative rods (1+). The gram-positive cocci were subsequently identified as Streptococcus constellatus. Based on the Gram staining findings suggestive of a concomitant anaerobic infection, therapy with ampicillin and metronidazole was proposed. Given the anticipated prolonged duration of therapy, the potential risk of metronidazole-associated central nervous system toxicity was shared with the medical team, and careful neurological monitoring was implemented. Overall antimicrobial therapy consisted of meropenem and vancomycin for 2 weeks, followed by ampicillin and metronidazole for 8 weeks, and was completed without adverse events. This case demonstrates the clinical value of a continuous pharmacist-driven AST intervention for the management of severe infections.

Pharmacist secondment was initiated in 2024. This study aimed to evaluate the implementation of pharmaceutical care associated with pharmacist secondment and identify challenges in medication information sharing during care transitions. A 6-month period before and after the initiation of secondment was retrospectively compared, focusing on the number of pharmaceutical management interventions and pharmacist-led discharge counseling in the host hospital. During the six months following secondment, pharmacist-initiated queries and clinical proposals in the host hospital were descriptively assessed. For patients transferred from the core hospital during the period, discrepancies between medication information in referral documents and admission medication lists were assessed, and the implementation rate of pharmacist-led discharge counseling in the core hospital was examined. After the initiation of secondment, the number of pharmaceutical management interventions increased, and pharmacist-led discharge counseling tended to increase in the host hospital. During the six months following secondment, pharmacist-initiated queries and clinical proposals were made for 61 of 379 inpatients (16.1％), of whom 53 patients (86.9％) had their proposals accepted by physicians. Among the 98 patients transferred from the core hospital, discrepancies between referral documents and admission medication lists were identified in 44 patients, while pharmacist-led discharge counseling at the core hospital was provided to only seven patients (7.1％). Based on these findings, a “transfer medication management summary” was proposed as a tool to improve medication information sharing at hospital transfer. In conclusion, pharmacist secondment to other hospitals may contribute to strengthening systems for implementing inpatient pharmaceutical services and pharmaceutical interventions related to hospital transitions.

This study aimed to clarify the characteristics of medication errors (MEs) prevented by community pharmacists in patients transitioning from hospital to home or in-facility care.

We analyzed ME cases collected by the Japan Council for Quality Health Care in the Project to Collect and Analyze Pharmaceutical Near-Miss Events between January and December 2024. Patients were classified into the transition and non-transition of care groups. Patient backgrounds, details of MEs, and sources of information identified as ME by pharmacists were compared between the two groups.

The transition of care group included 1,835 cases, whereas the non-transition of care group included 89,693 cases. Patient background characteristics significantly associated with the transition of care include age ≥ 60 years. Among causative medications, significant associations were observed for antihypertensive drugs, peptic ulcer drugs, antidiabetic drug, and anticoagulants.

Dosage, duplication of the same component, and omission of prescriptions were significantly associated with the transition of the care group. The sources of information identified as ME by pharmacists were prescription records and information sheets.

This study clarified the characteristics of MEs prevented by community pharmacists during the transition of care. Sharing patient information between hospital and community pharmacists should be enhanced, and pharmacists should confirm and evaluate pharmacotherapy before and after transition of care.

Remdesivir has been approved for use in patients with severe renal impairment following evidence from a phase 3, randomized, double-blind, placebo-controlled study (the REDPINE trial) demonstrating its safety in those with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m². However, subsequent meta-analyses have reported safety concerns. Therefore, reduced-dose regimens may offer potential benefits, including a lower likelihood of concentration-dependent adverse events and reduced drug-related costs. Despite these considerations, clinical evidence comparing the effectiveness and safety of reduced-dose vs standard-dose remdesivir in this population remains limited. This single-center retrospective observational study included patients with COVID-19 and eGFR < 30 mL/min/1.73m² who received remdesivir between January 2022 and December 2024. Patients were categorized into a reduced-dose group based on the regimen proposed by Sukeishi et al, or a standard-dose group according to the package insert. The primary outcome was 28-day mortality. The secondary outcomes included adverse events (hepatic enzyme elevation, potassium abnormalities, and acute kidney injury). This study included 36 patients in the effectiveness analysis and 24 patients in the safety analysis. The 28-day mortality rate was identical between the groups (16.7％ vs 16.7％). No clear differences were observed in the overall safety outcomes, although aspartate aminotransferase (AST) elevation and acute kidney injury tended to occur more frequently in the standard-dose group. Reduced-dose remdesivir was associated with no apparent difference in 28-day mortality and no clear overall safety disadvantage compared with standard dosing in patients with severe renal impairment.

In the Model Core Curriculum for Pharmacy Education, clinical practice training is expected to provide “opportunities for students to acquire fundamental knowledge, ways of thinking, skills, and attitudes required of pharmacists.” Universities are therefore responsible for instructing the participating students on desirable attitudes as members of society and healthcare professionals, including preparedness for training, appropriate manners, and health management. These foundational social skills, which form the basis of daily life, have generally been assumed to be acquired during the developmental process and mastered by the time of university admission. However, our previous surveys suggested that many students not have fully acquired them. This study aimed to support the acquisition of essential “basic social skills” required of pharmacy students by developing a rubric-style self-assessment sheet. We identified issues faced by pharmacists in teaching social skills to students and evaluated the usefulness of the assessment sheet in the context of clinical training. Questionnaire results indicated that the introduction of the assessment sheet enhanced trainees’ self-awareness and served as an effective instructional guide for supervising pharmacists. Furthermore, many pharmacists recognized the importance of social skills, suggesting that their systematic cultivation will be important in future educational settings.

To address antipsychotic polypharmacy and high-dose usage, a dose-reduction protocol based on the safety correction of antipsychotics polypharmacy and high-dose (SCAP) method has been proposed. However, the SCAP method is not universally applicable. This study conducted a prescription survey focusing on medication reduction and tapering of antipsychotics in patients with schizophrenia and examined more effective and safer methods for medication reduction, tapering, and switching.

The study revealed that dose reduction was performed more rapidly than that recommended by the SCAP method. Patients who were administered higher chlorpromazine-equivalent doses underwent dose reduction more gradually than those administered lower equivalent doses. Patients receiving long-term high-dose antipsychotic treatment are at a higher risk of developing dopamine supersensitivity psychosis; therefore, gradual medication reduction, tapering, and switching are recommended to reduce this risk.

These findings suggest that medication reduction, tapering, or switching based on the SCAP method and adjusted for hospitalized patients can be completed safely at an early stage according to the individual dosage.