Journal of Pharmaceutical Health Care and Sciences最新文献

Background: In 2021, the Education and Training Committee of the Japanese Society for Pharmaceutical Palliative Care and Sciences established an educational training program for pharmacists in palliative care, named Palliative care-Situational Motivating Interactive Learning and Education (pSMILE), based on web-based and face-to-face workshops. The program aims to enhance pharmacists' knowledge of palliative care and develop communication and cooperation skills.

Methods: We constructed a web-based pSMILE training program, which was later adapted for face-to-face workshops. This program consisted of two sessions, with the first half at a hospital and the second half at a clinic or community pharmacy. The participants could choose from three learning scenarios. A post-survey (within 1 week of the workshop) assessed usefulness, difficulty, length, and satisfaction. Participants also completed a web-based survey on behavioral changes related to daily palliative care following the workshop. Nine items on behavioral changes were assessed before and 1 month after the workshop, which was held from April 2021 to March 2024.

Results: Twelve pSMILE workshops were held during this period (10 web-based and two face-to-face). A total of 296 pharmacists participated, 152 (51.4%) of whom were Board Certified Pharmacist in Palliative Pharmacy, and 292 (98.6%) responded to the before/after workshop survey. Usefulness ratings were 4.39 for Session I and 4.20 for Session II. Satisfaction ratings were high (≥ 4.5), with no significant differences based on affiliation, training format, or certification. All confidence scores of nine daily palliative care behaviors (symptom assessment; multidisciplinary information sharing; proposing pharmacotherapy; polypharmacy intervention; palliative pharmacotherapy with awareness of pharmacokinetics; explanation of delirium; response in the discharge conference; information sharing between hospitals, clinics, and community pharmacies; and pharmacotherapy suggestions in view of the post-discharge) improved significantly post-workshop (p < 0.01), across both web-based and face-to-face workshops. Certified participants had higher confidence scores both before and after the workshop, and each group showed a significant improvement.

Conclusions: These results suggest that either web-based or face-to-face pSMILE workshops improve the quality of pharmacists' contribution in daily palliative care. This is the first report on the effectiveness of an academically approved web-based educational program for palliative care pharmacists, comparable to face-to-face workshops.

Background: Shift workers experience regular changes in their waking hours due to fluctuating work schedules. The timing of their medication intake differs depending on whether they are working a day or night shift. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are prescribed once a day and are often taken before or after breakfast. However, studies on the optimal dosing times for the effective treatment of shift workers are lacking. In this study, we investigated whether the effects were different by the pattern of SGLT2 inhibitor intake for shift workers with diabetes.

Methods: Seven shift workers with diabetes who were taking an SGLT2 inhibitor were analyzed. All participants took the medication upon waking for 14 days, followed by administration at a fixed time for another 14 days. Glucose levels were measured over 14 days when the drug was administered either upon waking or at a fixed time of day. The time in range (TIR), which indicates the percentage of time during which the glucose level is within the range of 70-180 mg/dL, was used as the main evaluation index.

Results: The mean HbA1c of the participants was 7.1%. The TIR was 88.5% in the administration upon waking group and 84.9% in the administration at a fixed time group. No significant difference in TIR values was observed between the two administration groups.

Conclusion: A TIR of 70% or higher is recommended to prevent the onset of diabetic complications. Consistent intake of SGLT2 inhibitors, regardless of whether it is during the day or night shift, may help stabilize blood glucose levels in shift workers throughout the day and night, thereby preventing the development of complications.

Background: Hypertension is a major global health problem that often develops without noticeable symptoms. Current treatments and complementary approaches focus on improving endothelial function and enhancing nitric oxide (NO) production to promote vasodilation and lower blood pressure. Isosakuranetin, a flavanone found in Chromolaena odorata leaves, has shown potential antihypertensive properties. This study aimed to investigate the effects of isosakuranetin on L-N^G-Nitroarginine methyl ester (L-NAME)-induced hypertension, focusing on its ability to enhance NO production and reduce oxidative stress.

Methods: This study investigated the antihypertensive effects of the flavanone isosakuranetin in male Wistar rats (n = 8 per group). Hypertension was induced by L-NAME, a nitric oxide synthase inhibitor, for four weeks, followed by treatment with isosakuranetin (10, 20, or 40 mg/kg) or enalapril (10 mg/kg) for an additional two weeks. Systolic blood pressure (SBP), heart rate, and body weight were monitored weekly. After six weeks, the effects of isosakuranetin on NO level and oxidative stress were assessed using the Griess reaction, 2',7'-dichlorofluorescein diacetate (DCF-DA), and superoxide dismutase (SOD) activity assays.

Results: The results demonstrated that the SBP was significantly reduced in the isosakuranetin treatment group when compared to the hypertensive group. Additionally, isosakuranetin treatment significantly restored plasma nitrate/nitrite levels and showed the potential to reduced oxidative stress, as indicated by the decrease in reactive oxygen species (ROS) levels and a significant increase in SOD activity.

Conclusion: These findings suggest that isosakuranetin is a promising natural compound for managing hypertension, demonstrating its potential for clinical application.

Background: Despite the increasing emphasis on safe prescribing, the impact of local formularies on physician behavior remains underexplored in community healthcare settings. To promote safer pharmacological practices, our institution implemented a hospital-originated sleep-medication formulary in January 2022, which was subsequently disseminated to other local medical institutions in early 2023. This study assessed physicians' awareness of this sleep-medication formulary, and its influence on prescribing behavior in local community healthcare settings.

Methods: A questionnaire survey was distributed via a regional medical-cooperation newsletter and responses were received from 84 physicians.

Results: Of the 84 physicians, 18% were aware of the formulary. Physicians in the awareness group were more likely to prescribe the recommended medications, particularly orexin receptor antagonists, and reported significantly less difficulty in initiating hypnotic therapy. Logistic regression analysis revealed a significant association between formulary awareness and reduced difficulty in prescribing a suitable hypnotic (odds ratio: 0.24; 95% CI: 0.073-0.78).

Conclusions: Local formularies may serve as valuable tools in clinical decision-making and promote safer and more consistent prescribing practices. Strategies such as physician education, concise formulary reference sheets or physician-oriented pocket references, and the development of patient-friendly information materials are warranted to support broader implementation.

Trial registration: Not applicable.

Background: National Action Plan on Antimicrobial Resistance in Japan recommends further strengthening of antimicrobial stewardship (AS) for acute upper respiratory infection (URI) in outpatients. AS initiatives for outpatients include the establishment of an AS implementation fee that can be claimed when a physician does not prescribe antibiotics to a pediatric patient diagnosed with acute URI that does not require antibiotics, after providing sufficient explanation. However, in Japan, unbeneficial effects of not prescribing antibiotics for acute URIs have not been clarified. This study aimed to investigate whether there were any unbeneficial effects in pediatric patients with acute URIs who claimed the AS implementation fee and were not prescribed antibiotics using a large Japanese medical insurance claim database.

Methods: This study used a large Japanese medical insurance claim database provided by IQVIA Japan. Patients aged less than six years of age and with a definitive diagnosis of acute URI and who claimed the AS implementation fee from January 2019 to December 2021 were selected. Among these patients, those with prescriptions other than antibiotics on the date of the first definitive diagnosis of acute URI were included in this study. The prescription of medicines and hospitalization within 10 days of the date of the first definitive diagnosis of acute URI in the target patients were investigated.

Results: There were 967,546 patients with a definitive diagnosis of acute URI in the outpatient. Of these, 32,489 patients below six years of age who claimed the AS implementation fee for children were prescribed medications other than antibiotics were considered the target patients for this study. Of these, 12,101 (37.2%) were again prescribed drugs in the outpatient clinic within 10 days, and 2,275 (7.0%) were prescribed antibiotics. The median (interquartile range) number of days until antibiotics were prescribed was 4 (2-7). Additionally, 105 patients (0.3%) were hospitalized within 10 days.

Conclusion: This study revealed that there may be at least one risk factor in patients with acute URIs who were not prescribed antibiotics. In case of acute URI diagnosis and absence of antibiotic prescription, patients should be warned of worsening symptoms for at least 4 days.