Online health consultations may help consumers obtain appropriate information more conveniently and quickly; however, the actual usage patterns in Japan remain unclear. This study aimed to assess the current situation of online consultations from a consumer perspective. In March 2021, we conducted two internet-based surveys: a screening survey and a main survey. The main survey examined whether the participants regularly visited a hospital or clinic (“regular visits” group vs “no regular visits” group), the specialization consulted, and topics discussed during the consultations. In the screening survey (response rate: 23％), 4.6％ (723/15,806) of respondents reported taking online consultations. Two hundred fifty-two of these cases were included in the main survey. Notably, 17.5％ (44/252) of the respondents consulted non-medical professionals. The “regular visits” group (n = 67) sought advice on topics such as “psychiatric symptoms,” “autoimmune diseases,” “treatment-related questions,” and “medication usage.” In contrast, the “no regular visits” group (n = 185) primarily consulted regarding “cold symptoms,” “pediatric diseases,” “general health knowledge,” and “the necessity of medical exams.” The most common outcome of these consultations was a general recommendation to seek an in-person medical examination, which was provided to 28.1％ (74/252) of the participants. This study suggests that a wide range of consumers use online health consultations to address various health concerns. However, some issues, particularly those requiring reference to the medical or medication histories of individuals with regular hospital visits, cannot be adequately resolved through online consultations alone. Our findings highlight the importance of online consultations in encouraging face-to-face consultations with healthcare providers when necessary.

This study investigated the effects of perioperative pharmacist audit and feedback (PPAF) on drug utilization in patients undergoing general anesthesia at Ogaki Municipal Hospital. In PPAF, pharmacists documented medical records based on a checklist on pre- and postoperative days and provided necessary recommendations to the attending physician or anesthesiologist to ensure appropriate medication use. A public relation analysis was conducted on 1,639 cases following PPAF. Perioperative pharmacists made 215 recommendations to 208 patients (12.7％), with an acceptance rate of 84.7％. PPAF required approximately 3 hours of pharmacist work per day. The primary recommendations included the use of 5-HT₃ receptor antagonists for the prevention of postoperative nausea and vomiting (PONV) (74 cases, 34.4％ of recommendations) and antimicrobial dose adjustments based on patient weight (73 cases, 34.0％).

The use of 5-HT₃ receptor antagonists showed a strong positive correlation with time after PPAF (Spearman’s rank correlation coefficient, ρ = 0.86, P < 0.001), with a significant reduction in the incidence of PONV from 27.8％ before PPAF to 24.5％ after PPAF (P = 0.039). Furthermore, the proportion of patients discharged in recovery or remission significantly improved from 96.5％ to 98.4％ (P < 0.001). However, no significant differences were observed in the length of hospital stay (15.7 vs 14.3 days, P = 0.074) or surgical site infection rates (4.3％ vs 5.4％, P = 0.807).

The findings suggest that PPAF contributes to improving patient outcomes through appropriate medication use, particularly PONV prophylaxis and perioperative antimicrobials. Further research is required to establish optimal PPAF methods.

Xerostomia is a syndrome characterized by subjective or objective findings of oral dryness. One quarter of the elderly population suffers from xerostomia owing to a decline in salivary secretion function with age and problems with oral closure. Additionally, many ethical drugs have xerostomia listed as an adverse drug reaction. Xerostomia reduces the self-cleansing action of the mouth and can cause problems in maintaining oral health. In this study, we created a list of drugs associated with xerostomia from these package inserts. Then, electronic medical record data from Keio University Hospital were analyzed to investigate prescribing trends among elderly patients and to identify patient characteristics associated with these drugs. Patients who received continuous prescriptions from April 2019 to March 2020 were included in this study based on age, prescribed drugs, and associated diseases. Among the 575 patients analyzed, 464 (80.7％) were prescribed at least one xerostomia-inducing medication. Compared with the early-stage elderly, a significantly higher proportion of late-stage elderly patients received these medications (P < 0.001) and had multiple prescriptions (P < 0.001). Logistic regression analysis examined the presence and multiple prescriptions of xerostomia-inducing drugs, showing significant associations with late-stage elderly patients and polypharmacy. The most common conditions among patients prescribed xerostomia-inducing drugs were endocrine, nutritional, metabolic, cardiovascular, and gastrointestinal diseases. Accordingly, vasodilators, peptic ulcer drugs, and hyperlipidemic drugs were frequently prescribed to these patients. The results suggest that the risk of xerostomia should be a point of consideration when prescribing multiple medicines to elderly patients.

Few hospitals in Japan have pharmacists stationed in secondary emergency rooms, and there are limited reports on their roles. This study aimed to investigate the activities of pharmacists in the secondary emergency rooms of Fukuoka Tokushukai Hospital, in addition to providing drug-related information to other healthcare professionals. The study examined the impact of pharmacists on medication errors in secondary emergency rooms. Pharmacists primarily performed tasks ranked by frequency, including “collecting medication history,” “interviewing patients and their families,” and “transporting medications.” The most commonly provided drug information was related to “dosage and administration” for physicians and “route of administration and changes in drug combinations” for nurses. The proportion of medication errors significantly decreased (P < 0.01) during weekday shifts when the pharmacists were on duty. This study highlights the roles and contributions of pharmacists stationed in secondary emergency rooms in promoting medication safety and supports the future development of resident pharmacist services in these settings.

The purpose of this study was to investigate patients’ quality of life (QOL) for ischemic heart disease using the SF-12. We studied the QOL of 85 inpatients diagnosed with IHD between April 1, 2021 and June 30, 2021, at the Mie Heart Center. The three QOL scores representing physical (PCS), mental (MCS), and role/social (RCS) aspects were calculated, and their relationship with patient background was investigated. Higher scores indicate better QOL. Seventy-four of the 85 patients were included in the analysis, and 11 were excluded. Forty-nine (66％) were men and 25 (34％) were women with a mean age of 70 ± 10 years; RCS was significantly lower in women than in men (P = 0.008). PCS was significantly lower in patients with effort angina pectoris than in the other patient groups (P < 0.001). PCS was also significantly lower among obese subjects (P = 0.049), while MCS was significantly lower among diabetic subjects (P = 0.017). Regarding medication use, PCS was significantly lower in the group using nitrates, β-blockers, and diuretics than in the group not using them (P < 0.001, P = 0.015, P = 0.004, respectively), and MCS was significantly lower in the group using diabetes medication (P = 0.042). The multivariate analysis showed that the factors influencing QOL were age, sex, nitrate use, medication adherence, and diabetes complications. Since the QOL of patients with IHD depends on the medications they take and their condition, treatment approaches that also take QOL into account are needed.

The elimination of bosentan (BOSE) is involved in several metabolic enzymes and transporters, including CYP3A4 and OATP1B1/3. Clarithromycin (CAM) has the potential to inhibit these activities, leading to an approximately threefold increase in BOSE exposure when combined. Hepatic impairment, a common adverse effect of BOSE, is reportedly induced in a dose-dependent manner. This study comprehensively evaluated the adverse events of BOSE in combination with CAM. A total of 12 patients who received BOSE and CAM for more than 7 days at Oita University Hospital between June 2005 and December 2022 were included. The adverse events documented in the BOSE clinical trial were not observed within the 2-week period following the initiation of combination therapy. None of the patients exhibited an increase exceeding threefold the institutional reference threshold, which serves as the standard for BOSE suspension or discontinuation. No patient experienced a rise in liver function parameters necessitating the suspension or discontinuation of BOSE within 180 days of initiating the combination therapy. The findings suggest that concurrent use of BOSE and CAM does not increase the incidence of adverse events, including liver impairment. However, given that the daily dose in this study was approximately half the usual dose, caution is necessary when administering BOSE at the usual maintenance dose.

Insomnia is one of the most common sleep disorders and is frequently observed in older patients. It is recommended that older patients select hypnotics considering the adverse events owing to increased sensitivity to hypnotics and their prolonged effect. Lemborexant (LEM), an orexin receptor antagonist, has a low potential dependence and a low risk of fall, rebound insomnia, and withdrawal, such as benzodiazepines; therefore, it is considered as one of safety pharmacological treatments of insomnia in older patients. We retrospectively conducted a stratified analysis by age for the safety of LEM in real-world practice. A total of 224 inpatients from Nagoya University Hospital who were prescribed with LEM from September 1, 2020 to December 31, 2021, were analyzed. These patients were divided into 117 general adult patients (18 – 64 years), 60 young-old patients (65 – 74 years), and 47 old-old patients (over 75 years). The rate of LEM prescription discontinuation owing to adverse events was 4.3％ in general adult patients, 5.0％ in young-old patients, and 8.5％ in old-old patients; there was no significant difference among the three groups. The all-adverse events rate after introducing LEM was 22.2％ in general adult patients, 18.3％ in young-old patients, and 27.7％ in old-old patients; there was no significant difference among the three groups. This study revealed that there was no difference in the rate of LEM prescription discontinuation owing to adverse events during the early period after LEM initiation among the three groups.