Early, high-quality resuscitation of patients experiencing sudden deterioration within medical facilities is a critical intervention directly influencing patient outcomes. To ensure rapid response, in-hospital emergency call systems have been established, enabling timely implementation of basic life support (BLS) and advanced cardiovascular life support (ACLS). As ACLS requires medications, the participation of a pharmacist is essential. At Kameda Medical Center, pharmacists receive BLS, ACLS, and departmental training and actively participate in emergency responses. The aim of this study was to clarify the effects of participation in emergency calls on professionalism and psychological stress of pharmacists. A hypothesis was developed and tested by surveying pharmacists who had participated in in-hospital emergency calls. The results suggest that emergency response provides pharmacists with opportunities to fulfill their professional roles, potentially enhancing professionalism. However, due to the high-pressure nature of these circumstances, pharmaceutical interventions do not always contribute to the development of professional identity. Pharmacists with >2 years of clinical experience reported greater confidence and a sense of accomplishment, indicating that early-career exposure is important for professional development. Additionally, 35% of respondents reported mental strain and 20% noted disruptions to routine duties, highlighting the requirement for improved training and psychological support systems.
Immune checkpoint inhibitors (ICIs) have significantly advanced cancer treatment, and their clinical indications continue to expand. At the same time, the importance of managing immune-related adverse events (irAEs) has been increasing, along with growing expectations for pharmacist involvement. Herein, we report a case in which prompt pharmacist intervention prevented the progression of cytokine release syndrome (CRS) following ICI therapy. A patient with lung adenocarcinoma received 4 cycles of carboplatin, pemetrexed, and pembrolizumab, followed by maintenance therapy with pemetrexed and pembrolizumab. During the first cycle of maintenance therapy, the patient presented with fever, chills, and fatigue. Despite antibiotic administration, the symptoms persisted. Given the low likelihood of infection and elevated laboratory markers such as ferritin and interleukin-6, CRS was suspected, and the patient was urgently admitted for corticosteroid therapy. However, the patient's respiratory condition deteriorated despite steroid administration. The attending pharmacist actively intervened by recommending additional laboratory tests, performing physical assessments, and suggesting therapeutic options. Following these interventions, the patient's symptoms improved, no further exacerbations occurred, and the patient was discharged. This case highlights the clinical significance of pharmacist intervention in managing ICI-related CRS.
Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease that leads to right heart failure and systemic venous congestion. Such congestion can impair multiple organs, including the gastrointestinal tract. Recent clinical studies have reported elevated circulating endotoxin levels in patients with PAH, suggesting a potential disruption of intestinal barrier function. However, whether PAH affects duodenal permeability remains unclear. This study aimed to elucidate the impact of PAH on duodenal barrier integrity. PAH was induced in rats through two subcutaneous injections of monocrotaline (20 mg/kg). Histological analysis was performed, and the mRNA expression levels of duodenal tight junction proteins were quantified using real-time PCR. Duodenal permeability was assessed by performing in situ and ex vivo experiments with paracellular probes. PAH rats exhibited characteristic signs of right heart failure, including reduced weight gain, elevated brain natriuretic peptide levels, and thickening of the right ventricular wall. Histological examination revealed duodenal villous atrophy and thickened muscularis mucosa. Claudin-1 mRNA expression in the duodenum of PAH rats was 70% lower than that in control rats. In situ permeability assays revealed 2.0- and 1.5-fold increases in the portal vein concentrations of polyethylene glycol 400 and 600, respectively. In addition, ex vivo experiments showed a 1.9-fold increase in the cumulative lactulose permeation from the luminal to the vascular side over 120 min. To the best of our knowledge, this is the first report to describe decreased duodenal barrier integrity caused by monocrotaline-induced PAH in rats.
Therapeutic extracellular vesicle (EV) products, including those containing exosomes (hereinafter referred to as EV products), are expected to have potential as a new therapeutic modality. Many EV products are currently under development in Japan or other countries; however, there are no guidelines specific to this product category and there is a need for establishing regulatory requirements that supports product development. EVs have an extremely complex structure and show high levels of heterogeneity, and their mechanisms of action remain unclear. Additionally, because therapeutic EV products are often manufactured using cells, and it is difficult to sufficiently remove product- or process- related impurities during the purification process, thus posing challenges for impurity control. To ensure the quality of EV products, it is necessary to conduct sufficient characterization of EV products and to identify critical quality attributes that require control to ensure efficacy and safety. Thus, establishing a strategy for controlling the critical quality attributes within the intended limits, ranges, and distributions is key. Furthermore, it is important to set specifications to confirm that EV products of the intended quality have been obtained. This article describes the current state of research on establishing characterization methods for EV products, and recent topics related to quality issues that need to be considered for the development of therapeutic EV products.
Voriconazole (VRCZ) is a first-line agent for treating invasive fungal infections, but its pharmacokinetics vary widely, necessitating therapeutic drug monitoring (TDM) to maintain trough concentrations within the therapeutic range (1.0-4.0 µg/mL). C-reactive protein (CRP) is an inflammatory marker reportedly associated with VRCZ concentrations. However, its precise impact in machine learning models remains unclear because of missing values in previous studies. Thus, this study aimed to identify factors associated with supratherapeutic VRCZ concentrations using a classification and regression tree (CART) model incorporating CRP in Japanese patients. We retrospectively analyzed 121 patients who received VRCZ (2-4 mg/kg/dose) and underwent TDM. The patients were classified into a therapeutic range group (1.0-4.0 µg/mL; n=51) and a supratherapeutic group (>4.0 µg/mL; n=70). We excluded outpatients to ensure strict sampling timing, patients whose maintenance doses were changed before the first TDM, and patients with missing laboratory data immediately prior to administration. The CART analysis identified dose (threshold: 2.7 mg/kg/dose) as the primary predictor, followed by CRP (threshold: 5.0 mg/dL) and age (threshold: 74 years). The model demonstrated moderate performance in predicting the therapeutic range group, with an area under the curve of 0.770 [95% confidence interval (CI): 0.689-0.851], sensitivity of 78.4%, and specificity of 71.4%. Dose, CRP, and age were significant factors associated with supratherapeutic VRCZ concentrations. Our findings suggest that a decision-tree-based approach incorporating inflammatory status and age could provide valuable clinical insights for optimizing initial VRCZ dosing.
Risk management plan (RMP) utilization in clinical settings has been reported to be insufficient, particularly in community pharmacies. To facilitate the utilization of RMPs in pharmacists' practice, we created an "RMP Pocket Edition" by summarizing the RMPs. This exploratory study conducted a questionnaire survey to evaluate the usefulness of the RMP Pocket Edition in pharmacists' practice in community pharmacies within Iwate Prefecture. This study targeted managing pharmacists from 89 community pharmacies who intended to use the RMP Pocket Edition. Responses to specific survey items were measured using a five-point Likert scale (1=strongly disagree to 5=strongly agree). Of the 89 pharmacies, 56 responded (response rate: 62.9%), and 40 of them utilized the RMP Pocket Edition. The RMP Pocket Edition was most commonly utilized to check patient materials during counseling, assess drug risks while dispensing new medications, and for personal study. All median scores for the pocket book's perceived usefulness across various aspects of pharmacists' practice, including the understanding of RMPs, the identification of adverse drug reactions, and the facilitation of RMP utilization, were 4 or higher on a five-point scale. Further, the median score for the intention to continue utilizing the RMP Pocket Edition in the future was 5 (interquartile range, 4-5). In conclusion, the findings suggest that the RMP Pocket Edition contributes to facilitating the utilization of RMPs in pharmacists' practice in community pharmacies.
Pembrolizumab is an immune checkpoint inhibitor that has been widely used in cancer treatment, and its approved indications have expanded rapidly in recent years. However, the effects of this increase on immune-related adverse events (irAEs) remain unclear. Using data from the Japanese Adverse Drug Event Report (JADER) database and the National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data), we analyzed trends in the number and characteristics of spontaneously reported adverse events associated with pembrolizumab from fiscal years 2016 to 2024. The number of adverse event reports in JADER generally increased in parallel with prescription volume. Following the expansion of indications for gynecological cancers (such as breast, uterus, and cervix cancers) around 2021, a marked increase in reports was observed from 2022. During this period, the demographic profile of reported patients shifted from predominantly older males to middle-aged females. Regarding cancer types, the proportion of reports on breast and uterus cancers increased significantly, whereas those on lung cancer declined. In addition to pulmonary disorders, endocrine disorders became increasingly reported and represented the most frequent category in fiscal year 2022. The distribution of irAEs by cancer type suggested potential associations; pulmonary toxicity was more frequent in lung cancer, whereas endocrine toxicity was predominant in breast, uterus, and cervix cancers. Our findings indicate that the expansion of pembrolizumab indications has substantially altered the profile of reported immune-related adverse events in Japan, highlighting the need for ongoing pharmacovigilance tailored to cancer type and patient demographics.
As human pharmaceuticals are physiologically active substances, it is essential to assess their potential risk to ecosystems after being released into the environment. In Japan, the "Guidance on the Environmental Risk Assessment in New Pharmaceutical Development" (hereafter referred to as "the guidance") was issued in 2016. The guidance includes the environmental risk assessment (ERA) workflow, in which novel pharmaceuticals subjected to ecotoxicity testing are selected based on n-octanol/water partition coefficient (log Kow), action limit (0.01 µg/L), and predicted environmental concentration (PEC). However, for the ERA workflow, neither the action limit has been completely validated nor a method to calculate PEC has been sufficiently established. The objective of this study was to demonstrate the effectiveness and issues of the ERA workflow in the guidance. Using data accumulated from ecotoxicity studies and measured environmental concentration (MEC) data of human pharmaceuticals, we evaluated the validity of the action limit and PEC values. The action limit was found to be sufficiently on the safe side, and the PEC values (to median or 95th percentile MEC values) were generally on the safe side for the evaluated pharmaceuticals. Conversely, issues were also identified, which included a need to establish exemption rules for some specific pharmaceuticals with toxicological concerns at a concentration below the action limit and to refine the PEC calculation method based on the consideration of drug metabolism and environmental fate. The endeavor to address these issues will increase the reliability and effectiveness of the workflow.
Oral lichen planus (OLP) causes chronic pain and functional limitations. In a randomized, placebo-controlled crossover trial of ibuprofen gargle, short-term analgesia on the visual analog scale (VAS) was not statistically significant, although patient-perceived functional gains were suggested. This study aimed to characterize the long-term patient-centered response patterns to ibuprofen gargling using predefined responder definitions. We performed a secondary exploratory analysis of a single-center trial and its long-term extensions (jRCTs051220009 and jRCTs051220010). Twenty-four participants were followed up on day 176. Endpoints combined within-day analgesia on VAS at 0, 5, and 15 min (VAS0, VAS5, VAS15) with multidimensional symptoms from the 10-item Patient-Reported Oral Mucositis Symptom (PROMS) scale. Time-to-first achievement (TFA) was summarized, and responses were evaluated descriptively and visually. Overall PROMS response (Definition C) occurred in 21/24 participants (median TFA, 5 d). Domain-level responders were frequent (e.g., pain domain D 20/24, eating domain F 18/24; both median 5 d). In contrast, fewer participants met VAS-based endpoints: A 16/24 (between-day VAS) and B 17/24 (within-day VAS) over the observation period. Visual summaries suggested that improvements tended to emerge early and were sustained or recurrent across subsequent weeks in some participants. Although immediate analgesia was modest, this exploratory analysis indicated that regular use of ibuprofen gargling may be associated with early and durable improvements in patient-reported symptoms and function in OLP. These exploratory findings suggest that patient-centered endpoints may be useful for evaluating topical NSAIDs, and should be examined in future studies with larger sample sizes.
We developed a symptom monitoring system that facilitates collaborations among physicians, hospital pharmacists, and community pharmacists using an electronic Patient-Reported Outcome (ePRO) application. The present study investigated the feasibility and acceptability of this system. Before and after the introduction of the system, participants completed a questionnaire assessing the burden, anxiety, and satisfaction using a 0-10 numeric rating scale. The rate of application input implementation, the number of times alert and free messages sent by patients, adherence, the incidence of adverse events (AEs), and admission due to AEs were assessed as secondary endpoints. Twenty-one patients with breast cancer initiating abemaciclib (300 mg/d), 10 community pharmacists, and 5 physicians participated in this study. Patients reported a reduced burden in both explaining their symptoms and having their symptoms confirmed (p<0.005), as well as a decrease in anxiety related to treatment (p<0.001). Healthcare professionals reported a reduced burden in symptom monitoring (p<0.05), and also experienced reduced anxiety about not knowing the status of patients (p<0.05). The rate of application input implementation was 94.3%. The total numbers of alert and free messages sent were 316 and 426, respectively. The median medication adherence rate based on pill counts and the medication possession ratio were 94.7% and 0.97, respectively. The rate of grade ≥2 diarrhea was 80.9%, with no emergency admissions due to AEs. The implementation of application input was well accepted and participants actively engaged with it. These results warrant further confirmation in large-scale studies.
Chemical substances are an indispensable part of the development of civilization; however, there are many known cases of health hazards induced by exposure to chemicals and their byproducts. In particular, the effects of exposure on the developing cerebral nervous system, even after a single exposure, may have lifelong effects; therefore, careful evaluation is required. In this paper, we provide examples of assessments conducted by our research group regarding the effects of exposure to chemicals in the environment during development, as well as the endpoints at which we were able to assess these effects. This will ultimately deepen our understanding of developmental neurotoxicity. Here, we demonstrate a case of late-onset abnormalities in female behavior and reproductive physiology due to developmental exposure to tris(2,6-dimethylphenyl)phosphate (TDMPP), a phosphorus-based flame retardant that exhibits typical estrogen-like effects. Also, we used IntelliCage, a fully automated behavioral measurement system for group-reared mice, to assess basal activity and adaptation to the social environment. An example of how IntelliCage can be used to assess behavior is dioxins, which are chemicals that are unintentionally produced. We focused on brominated dioxins and reported a case of abnormal exploratory behavior in a novel environment. Currently, there is growing public concern regarding substances and particle bodies that have not been adequately evaluated for use in the developing brain, such as PFAS and micro/nanoplastics. We believe that the establishment of more sophisticated evaluation methods and endpoints, including those introduced here, will continue to be necessary for building a foundation for a safe and secure society.
Although still controversial in some aspects, the human papillomavirus (HPV) vaccine is widely recognized as a tool for preventing cervical cancer. However, Japan has historically struggled with vaccine hesitancy due to misinformation and public concerns about side effects. This cross-sectional preliminary study investigated an emerging social media trend, the "praise movement," in which users on X (formerly Twitter) commend individuals for receiving the HPV vaccine. Although the data collection period was short in 17 d and limited volume of posts were included in the analysis (n=70), we identified the movement when the term "HPV vaccination" appeared on Japan's trending list on X. Through sentiment analysis and content categorization of posts, we found that the majority of posts (91.4%) exhibited positive sentiment, whereas 5.7% were negative. While previous studies have documented negative reactions to HPV vaccination on social media, this study highlights a shift toward positive reinforcement. The praise movement may reflect a broader shift in public attitudes toward HPV vaccination, influenced by both grassroots advocacy and official efforts, including the catch-up vaccination program. Given this study is just a snapshot of a short period and a small volume of trend, a further in-depth study should be warranted. Nevertheless, our findings suggest that online communities can play a meaningful role in influencing public health behaviors, providing insights into potential strategies for improving vaccine uptake. This study offers valuable perspectives on digital health communication and its implications for addressing vaccine hesitancy in Japan and beyond.
In Japan, amrubicin hydrochloride (AMR) is occasionally administered to patients with recurrent small cell lung cancer (SCLC). AMR therapy can induce febrile neutropenia (FN), a complication that may be fatal or compromise therapeutic efficacy due to treatment interruption or dose reduction. Identifying risk factors for FN is therefore critical to ensuring safe and effective AMR administration. Current evidence on this issue remains limited to small case series, underscoring the need for more robust studies. We conducted a multicenter retrospective analysis to examine predictors of FN during AMR treatment for recurrent SCLC. Patients who received AMR between April 1, 2013, and March 31, 2023, were included. The cohort comprised 256 patients, divided into 192 without FN and 64 with FN. Multivariate analysis demonstrated that performance status (PS) >2 (odds ratio: 5.8, 95% confidence interval: 1.70-19.80, p=0.005) and hematocrit (HCT) (odds ratio: 0.93, 95% confidence interval: 0.877-0.994, p=0.033) were significantly associated with FN development. These findings suggest that PS and HCT may serve as key indicators for predicting FN during AMR therapy in patients with recurrent SCLC.
In response to the rapid advancement of digital transformation (DX) in healthcare, pharmacists are increasingly expected to interpret and apply electronic health record (EHR) information to support clinical decision-making and patient care. Despite this shift, the integration of educational EHRs into pharmacy curricula remains limited, and their educational effectiveness is underexplored in Japan. This study implemented a structured EHR-based educational program for fourth-year pharmacy students and evaluated its impact on their clinical reasoning, interprofessional perception, and information and communications technology (ICT) literacy. Nineteen students participated in a 240-min program, featuring a pediatric Kawasaki disease case, and utilizing an educational EHR platform. The instructional design included case analysis, group discussion, role-play, and reflection. Educational outcomes were assessed using pre- and post-intervention tests; rubric-based performance evaluations; Attention, Relevance, Confidence, and Satisfaction model questionnaires; and qualitative analysis of open-ended feedback. Statistical analysis using the Wilcoxon signed-rank test revealed significant improvements in knowledge and performance metrics (p<0.05). Students reported high motivation and satisfaction, and qualitative findings highlighted the program's effectiveness in fostering clinical thinking and team-based care perspectives. However, feedback also suggested the need for workload balance and instructional pacing refinement. These findings indicate that an EHR-based program can serve as a valuable model for developing essential competencies in pharmacy education aligned with evolving professional roles. Future iterations may benefit from incorporating flipped classroom elements, repeated exposures, and diversified assessment strategies to enhance long-term learning outcomes.
The Edmonton Symptom Assessment System-Revised (ESAS-r) is a simple, reliable, patient-reported outcome measure designed to assess nine symptoms experienced by cancer patients, including multiple myeloma (MM). While each symptom can be evaluated individually, limitations in time or resources may make it difficult to assess all items in routine practice. In such cases, asking about "well-being," the simplest and most general item in the ESAS-r, may still provide clinically meaningful insight into a patient's overall condition. Although "well-being" is an essential indicator of a patient's overall health, its correlation with the other eight symptoms remains poorly understood. In this hypothesis-generating cross-sectional study, we aimed to understand the symptoms of MM patients during initial treatment using the ESAS-r and analyzed the relationship between the patient's "well-being" and each symptom. The study included 36 patients with first-episode MM who had started induction therapy with bortezomib, lenalidomide, and dexamethasone. "Well-being" was found to be correlated with pain (rs=0.711) and anxiety (rs=0.638). In addition, pain (p=0.0053) and anxiety (p=0.0336) were also significantly associated with the clinical cutoff value. The findings of this study indicate that focusing on "well-being" can increase the likelihood of early intervention in MM patients for symptoms that are difficult to express, such as pain and anxiety. Thorough screening of "well-being" and early introduction of care as needed, even within the limited time of consultation, through multidisciplinary collaboration including pharmacists, may be significant in terms of improving the quality of life of MM patients.
Eldecalcitol (ELD), an active vitamin D3 analog, is extensively prescribed in Japan for the treatment of osteoporosis. However, hypercalcemia remains a significant concern, particularly in patients with impaired renal function. Data on the extent to which renal dysfunction increases the risk of hypercalcemia are limited. This retrospective study investigated the relationship between hypercalcemia and renal function in 212 ELD-treated outpatients at Matsuyama Shimin Hospital. Hypercalcemia was observed in 17.0% of the patients. A weak negative correlation was observed between follow-up serum calcium levels and estimated glomerular filtration rate (eGFR). Receiver operating characteristics (ROC) analysis identified a baseline eGFR cutoff of ≤45.9 mL/min, and propensity score matching (1 : 1) adjusted for 12 covariates, including baseline calcium, demonstrated a significantly higher incidence of hypercalcemia in patients with eGFR ≤45.9 mL/min. These findings indicate that a low baseline eGFR predisposes patients to hypercalcemia during ELD therapy. In clinical practice, patients with baseline eGFR ≤45.9 mL/min may require more frequent calcium monitoring and consideration of alternative treatments such as alfacalcidol, with close collaboration between physicians and pharmacists.
Chronic liver disease causes approximately 2 million deaths annually worldwide, accounting for nearly 4% of global mortality. Liver fibrosis is a central pathological feature driving the progression of chronic liver disease (CLD), irrespective of the underlying etiology-be it hepatitis viruses, alcohol consumption, or the increasingly prevalent metabolic dysfunction-associated steatosis. Liver fibrosis arises from a dysregulated wound-healing response following sustained liver injury and inflammation, leading to excessive extracellular matrix deposition that intersects normal liver architecture and function. Despite the significance of fibrosis in CLD progression, effective antifibrotic therapies have not been deduced. A limited subset of metabolic dysfunction-associated steatotic liver disease (MASLD) patients progresses to metabolic dysfunction-associated steatohepatitis (MASH) characterized by inflammation and fibrosis, which indicates that this progression involves specific triggering mechanisms or factors. Hepatic stellate cells (HSCs), located in the space of Disse as quiescent vitamin A-storing cells, are the key mediators of fibrosis. The activation and transdifferentiation of HSCs into myofibroblast-like cells following liver injury results in markedly increased collagen production. Our recent research has indicated that altered adenosine metabolism in hepatocytes leads to increased extracellular adenosine, which in turn drives the activation of HSCs, promoting the progression from MASLD to MASH. The regulatory mechanisms involving prostaglandin E2 and adenosine signaling in the activation of HSCs are complex and have not been fully elucidated. Further detailed investigations that would uncover the complete pathways controlling the activation of HSCs and enable the development of novel therapeutic strategies targeting liver fibrosis in CLD are warranted.
Cutaneous adverse events associated with tirabrutinib have been reported in clinical trials; however, their overall incidence and severity vary, and real-world data remain limited. This study aimed to assess the incidence and management of tirabrutinib-associated cutaneous adverse events in patients with primary central nervous system lymphoma (PCNSL). This single-center case series included patients with PCNSL who received tirabrutinib treatment between March 1, 2020, and February 29, 2024. Cutaneous adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 5.0. Patient characteristics, tirabrutinib dosage, concomitant medications, disease severity, time to onset, treatment, and outcomes were analyzed. Seven patients (mean age: 71.1 years, range, 52-88 years) were included herein. Skin disorders were observed in 5 patients (71.4%), including maculopapular rash (grade 2) in 3 patients, erythema multiforme (grade 3) in 1 patient, and eczema-like lesions (grade 2) in 1 patient. The median onset was 22.4 d (range: 1-56 d), with 4 cases occurring within 1 month. Treatments included oral antihistamines (4 cases) and topical corticosteroids (4 cases). One patient discontinued tirabrutinib treatment because of severe cutaneous adverse events. Tirabrutinib-associated cutaneous adverse events were common but manageable, except in 1 case. As most cutaneous adverse events develop within a month, early monitoring is crucial. Large-scale studies are needed to assess the risk factors and preventive strategies for tirabrutinib-associated cutaneous adverse events.
Piperacillin/tazobactam (PIPC/TAZ) and vancomycin (VCM) are frequently used in combination (PTV) to manage severe healthcare-associated infections, but are also associated with an increased risk of acute kidney injury (AKI). In 2019, Ogaki Municipal Hospital implemented pharmacist-led interventions aimed at reducing PTV use and mitigating AKI. This study evaluated the impact of these interventions on antibiotic safety and patient outcomes. This retrospective study included hospitalized patients treated with PTV between January 2010 and December 2023. Details of these pharmacist interventions were reviewed retrospectively. Patients were categorized into pre- and post-intervention periods. The primary outcomes reported were the duration of PTV therapy and the incidence of AKI. Multivariable regression analyses were performed to evaluate the association between the intervention, therapy duration, and AKI incidence. Mediation analysis was conducted to assess whether the reduction in PTV duration mediated the effect of the intervention on AKI incidence. As a result, AKI incidence decreased from 19.8% in the pre-intervention period to 7.7% in the post-intervention period (p=0.038). In the PTV cohort, multivariable models showed lower AKI risk in the post period [adjusted odds ratio (OR) 0.283; 95% confidence interval (CI) 0.086 to 0.803; p=0.024] and a shorter PTV duration (β=-2.011 d; 95% CI -3.459 to -0.563; p=0.007). In mediation analysis, the shortening of PTV duration partially mediated the AKI reduction (ACME p=0.016). In conclusion, pharmacist-led interventions effectively reduced PTV duration leading to a decrease in AKI incidence, highlighting the critical role of pharmacists in promoting antimicrobial stewardship and improving patient outcomes.
This study utilized real-world data from the "Setsuyaku-Bag Campaign" conducted by the Hokkaido Pharmaceutical Association to investigate the actual status of leftover medications among patients with diabetes and identify factors associated with pharmacists' pharmaceutical care interventions aimed at addressing this issue. The primary analysis focused on patients who brought their antidiabetic medications,a examining factors related to the implementation of pharmaceutical care. In addition, a supplementary analysis including all patients was performed. The implementation rate of pharmaceutical care activities in the Setsuyaku-Bag Campaign (3.5-67.0%) substantially exceeded national statistics. Patients who brought antidiabetic medications had a significantly greater number of medications (p=0.015) and higher dosing frequency (p<0.001). Multivariate analysis revealed that, in addition to hypoglycemia-risk drugs such as sulfonylureas and glinides, the use of biguanides and α-glucosidase inhibitors was associated with pharmaceutical care activities. These findings suggest that pharmacists provide support and assess medication adherence based on the pharmacological characteristics of drugs. Furthermore, regarding the pharmaceutical care of patients with diabetes, interventions tend to depend on factors such as collaboration with related medical institutions and the establishment of information-sharing systems as opposed to the outcomes of prescription inquiries. Through these frameworks, pharmacies notify prescribing physicians of patients' leftover medications, and under such collaboration, measures against polypharmacy and adjustments of medication regimens are carried out. To realize more effective pharmaceutical care in the future, a comprehensive management system that includes collaboration between physicians and pharmacists needs to be constructed.
