It has been reported that antibiotic (ATB) use changes the gut microbiome and alters the outcome of treatment with immune checkpoint inhibitors (ICIs). In this retrospective, single-center cohort study, we investigated the effects of concurrent use of PD-1 inhibitors and medications known to modify the gut microbiome including ATBs on the clinical benefit or safety of PD-1 inhibitors across types of cancer in Japanese patients. In total, 143 patients were analyzed: 53 patients received systemic ATBs within 2 months before or 1 month after the first dose of PD-1 inhibitors (the ATB group); the remaining patients comprised the non-ATB group. There was a significantly higher proportion of patients under 65 years of age in the ATB group. Progression-free survival (PFS) in the ATB group was significantly shorter than that in the non-ATB group across types of cancer (HR = 1.82). It is suggested that anti-anaerobic ATBs may be associated with worse PFS. The higher disease control rate was associated with the non-ATB group compared with the ATB group. A multivariate Cox proportional hazard model constructed with PFS showed that the impact of ATBs remained significant for PFS and probiotic use was detected as another independent factor involved in shorter PFS. There were similar frequencies and conditions between the two groups in the incidence of adverse events of Grade 3 or above, and laboratory data. Our results suggest that the use of ATBs may negatively affect the anticancer treatment outcomes of Japanese patients who are administered PD-1 inhibitors.
PreAVOID, which refers to cases in which pharmacists avoid or reduce undesirable drug-related issues (eg, adverse drug reactions [ADRs], drug-drug interactions, and insufficient therapeutic effects) by pharmaceutical interventions, have been used as one of the indicators of pharmacists’ professional performance. In recent years, despite the efforts undertaken by community pharmacists to promote PreAVOID, PreAVOID reports by community pharmacists have not been adequately examined. In this study, we analyzed PreAVOID reports by community pharmacists to understand the characteristics of drug-related problems (DRPs) that required pharmaceutical interventions in outpatients and the profession of community pharmacists. We classified DRPs into eight categories and 33 subcategories and analyzed community pharmacists’ pharmaceutical interventions for various DRPs (eg, overdosage, duplication of drugs with similar effects, and history of ADRs). Of note, 70.9％ of the PreAVOID by community pharmacists led to the avoidance of ADRs, and it was estimated that interventions for the avoidance of ADRs in the reported cases alone potentially reduced medical costs by approximately JPY 83 million. These results indicate that community pharmacists contribute to the avoidance of undesirable pharmaceutical issues in patients, mainly by performing interventions that help prevent ADRs. The classification used for DRPs in daily medical practice in this study could help identify DRPs that could be resolved by community pharmacists.
In 2010, we established the unified management system of side effects and allergy information of patients based on collaborative evaluation by pharmacists and clinicians. We collected and evaluated 1,700 cases (2,810 drugs) of side effects and allergy information over 8 years until 2017, and registered this information in the electronic medical records. In addition, this information is shared with all the medical staff in our hospital by electronic medical records, and is utilized to restrict and avoid the prescription of the drugs which are suspected to cause side effects or allergy (hereafter, the suspected drugs) for each patient.
Between April 2018 and March 2020, 24,361 patients were admitted to our hospital, of which 399 patients had the side effects and allergy information registered in the electronic medical records. Eighty-five of these patients were likely to receive the suspected drugs, but 84 of these 85 patients were changed to alternative drugs. In addition, the remaining one patient was safely administered the suspected drug after taking appropriate measures for side effects and allergies. Of the 84 patients who were able to avoid the suspected drugs, 64 patients were able to avoid them by the action of clinicians, and 20 patients were able to avoid them by the intervention of pharmacists. None of the patients received the suspected drugs by mistake, and all patients appropriately avoided them. The results of our research indicate that this management system is a useful means to ensure the safety of pharmacotherapy.
Terminal cancer patients receiving home care medicine require emergency home visits by a medical professional during sudden changes in symptoms. However, the actual situation of these visits by health insurance pharmacists is yet to be clarified. Therefore, in this survey, we retrospectively analyzed the actual situation of emergency home visits to terminal cancer patients by the Tokuhisa-chuo Pharmacy during a 1-year period in 2020. We included 134 emergency home visits conducted for 76 terminal cancer patients. Results indicated that emergency home visits tended to be more frequently performed closer to the patient’s end-of-life stage. Patients’ symptoms during emergency home visits were predominantly pain, dysphagia, fever, and respiratory and gastrointestinal symptoms. Drugs such as opioids, gastrointestinal drugs, antimicrobials, and antipyretic analgesics were frequently used to control these symptoms. In particular, the number of emergency home visits intending to manage pain and provide opioids significantly increased in the week before death. This survey clarified the need for emergency home visits by health insurance pharmacists in cancer patients receiving home care medicine in their dying stages.
We newly introduced an on-site workshop of personality inventory, using the Myers-Briggs Type Indicator® (MBTI®) intended for pharmacy students in January 2022. The aim of this study was to evaluate the outcome of the MBTI® workshop to support pharmacy studentsʼ self-understanding via an online questionnaire survey. All third- to ?fth-year students of the Keio University Faculty of Pharmacy (n = 17) assessed the self-understanding, clarity of career path, and their own MBTI® type during the pre-workshop phase, and after the lecture of MBTI®, personality inventory of the MBTI®, and the MBTI® workshop. The recovery rate of the questionnaire was 100％. Notably, the self-guessed MBTI® typeafter the lecture of MBTI® was different from that after the personality inventory of the MBTI® and the MBTI® workshop (94.1％ and 88.2％, respectively). Respondents showed positive scores after participating in the workshop, compared with those before, as conveyed through the use of a seven-point Likert scale. The median scores of self-understanding and clarity of career path after participating in the workshop were signi?cantly improved from 5 (interquartile range [IQR]: 3.5 - 5.5) to 6 (IQR: 6 - 6) and 4 (IQR: 2 - 5) to 5 (IQR: 4 - 6), respectively. They also expressed high overallsatisfaction on the workshop (median 7 [IQR: 6.5 - 7]). In conclusion, this study demonstrated the usefulness of the MBTI® workshop as an educational program to support pharmacy studentsʼ self-understanding. The evaluation of their career path after the MBTI® workshop is warranted in the future.