The vancomycin (VCM) treatment plan for patients with Enterococcus faecium (E. faecium) infection is based on the recommended dose for methicillin-resistant Staphylococcus aureus (MRSA) infection. However, the optimal dose of VCM for E. faecium infection remains unclear. Thus, this study evaluated the relationship between pharmacokinetics/ pharmacodynamics of vancomycin and clinical outcomes in E. faecium bloodstream infection based on the area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC) ratio. We retrospectively reviewed the records of 40 patients with bloodstream infections caused by E. faecium at Fukuoka University Hospital between 2010 and 2020. The efficacy of VCM was evaluated in terms of clinical findings, laboratory data, and bacterial culture test results. The AUC was estimated using the trough concentration of VCM in TDM analysis software. The incident rate of acute kidney injury (AKI) associated with VCM was evaluated based on Kidney Disease: Improving Global Outcome criteria. The improvement rate was higher in patients with AUC/MIC ≥ 400 µg･h/mL than in those with AUC/MIC < 400 µg･h/mL; 90.9％ (30/33) vs 57.1％ (4/7), P = 0.055, Fisher's exact test. Moreover, we found that when AUC/MIC increased in stages, the improvement rate increased (57.1％ in 300 - 399, 85.7％ in 400 - 499, 92.9％ in 500 - 599, 100.0％ in 600 - 699, 100.0％ in 700 - 799; P = 0.036, Cochran-Armitage trend test). However, all patients with AUC/MIC ≥ 700 µg･h/mL experienced AKI. These results indicate that the effective range of AUC/MIC for E. faecium is ≥ 400 µg･h/mL, and the optimal dose of VCM may be similar to that for MRSA infections.

The treatment and prevention of osteoporosis is crucial as fragility fractures, the clinical outcome of osteoporosis, are a common cause of bed confinement. We organized a multidisciplinary care team composed of physicians, nurses, pharmacists, physical therapists, dietitians, radiologists, and laboratory technicians in September 2020 to establish the Fracture Liaison Service (FLS) in April 2021. The attending pharmacist was dedicated to FLS, different from the one dedicated to orthopedic beds, where the pharmacist’s task is to ensure compliance with osteoporosis medication before and after admission. Alternatively, the pharmacist must propose prescriptions for osteoporosis medications according to the guidelines. In this study, we retrospectively evaluated the rate of osteoporosis medication initiation for secondary fracture prevention and the type of prescription drugs administered to patients with fragility fractures before and after FLS initiation in patients over 50 years of age admitted with proximal femur and vertebral compression fractures. Although pharmacists have been performing pharmaceutical services in wards, no drug prescriptions for osteoporosis have been proposed. The rate of osteoporosis medication initiation increased from 21.2％ to 83.3％ during the start of FLS activity. Moreover, the ratio of the continuing prescriptions not recommended by the osteoporosis guidelines decreased and that of the recommended prescriptions, such as eldecalcitol and bisphosphonate significantly increased. The study findings revealed that pharmaceutical care in FLS provided by pharmacists facilitated the initiation of osteoporosis medications according to the guidelines for secondary fracture prevention in patients with fragility fractures.

The implementation of community pharmacist-led follow-up of patients after dispensing drugs has been accelerating due to the enforcement of the revised Pharmaceutical and Medical Device Act and the revised Pharmacist Act in 2020. This study aimed to clarify the current situation and challenges of such follow-up. A self-administered questionnaire survey was conducted for pharmacists at community pharmacies, focusing on the current status and challenges of pharmacist-led follow-up. Follow-up cases that contributed to patient medication were also collected in the survey. Responses were obtained from 318 pharmacists in 34 prefectures throughout Japan. Follow-up was conducted by 283 pharmacies (89％) using phone calls (99％) and apps (12％). An analysis of 265 cases found that follow-up was generally conducted not only for patients with diabetes, respiratory disease, and cancer, but also for patients with other diseases. Pharmacist-led follow-up actions included monitoring of adverse drug reactions and effects associated with new prescriptions and prescription changes, confirming compliance of patients taking drugs with special dosages, and patient adherence to medication, etc. Respondents stated that the main challenges for implementation of follow-up were refusal of follow-up by patients, difficulty in follow-up by phone, inexperience of pharmacists, and insufficient pharmacy environments for follow-up. Text analysis showed that barriers to follow-up differed depending on how satisfied responding pharmacies were with their follow-up performance. Therefore, to make community pharmacist-led follow-up more effective, it is important to identify factors that inhibit and promote follow-up for each pharmacy and to take appropriate measures based on them.

In the pharmacy practice experience (PPE) component of the pharmaceutical education model core curriculum, factors by which achievement can best be evaluated in rubric format have not been empirically determined. In this study, multivariate analysis was conducted based on characteristic information obtained from PPEs.

Data were analyzed from a total of 146 fifth-year students of Keio University Faculty of Pharmacy who completed PPEs in 2021. Using “Learning Results Prior to PPE”, “Presence / Absence of Role Model in PPE”, “Number of Experience Areas focused on Representative Eight Diseases”, and “Number of People who were Provided Medication Instruction” as the explanatory variables, and “Number of Mentor-provided Performance Evaluations with Scores ≥3” and “Sum of Mentor-provided Performance Evaluation Scores” as the objective variables, multiple regression analysis was performed. For “Number of Mentor-provided Performance Evaluations with Scores ≥3” predictions in training at a pharmacy, training at a hospital, or both, the respective probability values were <0.001, 0.189, and 0.012. For “Sum of Mentor-provided Performance Evaluation Scores”, the respective probability values were 0.005, 0.046, and 0.048. The effect of “Number of Experience Areas focused on Representative Eight Diseases” on each objective variable was consistently large.

Multivariate analysis using PPE-relevant collected information identified factors that improve the evaluation of achievement at the end of a PPE.