Journal of Pharmaceutical Health Care and Sciences最新文献

Background: The aging of the population in many countries has made rehabilitation an essential part of improving the quality of life of older individuals. The risk factors for falls during rehabilitation include a history of falls, gait disturbances, dizziness, and medication use. Although numerous studies have explored various fall prevention measures, stratified or detailed analyses of the relationship between the activities of daily living (ADL) and drugs have not been performed. This study aimed to examine the effect of drugs on ADLs in patients undergoing rehabilitation and explored the factors affecting patients' ADLs identify the characteristics of patients requiring proactive pharmaceutical interventions.

Methods: Participants aged ≥ 20 years admitted to the Kaifukuki Rehabilitation Ward at Hyogo Medical University Sasayama Medical Center underwent functional independence measure (FIM) assessments and were evaluated for medication use. The complexity of the medication regimen was assessed using the Japanese version of the medication regimen complexity index (MRCI-J) based on prescription data. Hierarchical cluster analysis was used to classify the participants based on their FIM scores.

Results: No correlation was found between FIM motor gain and MRCI-J differences among all participants. Hierarchical cluster analysis was used to classify participants into four groups based on their FIM motor and cognitive scores at admission and discharge. Decision tree analysis was performed using the four identified groups as objective variables and yielded eight nodes. The algorithm included length of hospital stay, sex, age, units of rehabilitation performed, and the MRCI-J score. The group with a hospital stay < 74 days, aged < 90 years, and who underwent > 77 units of rehabilitation during the study period was further divided into fourth tiers based on the MRCI-J scores, with the non-increased MRCI-J group assigned as Node 7 and the increased MRCI-J group as Node 8.

Conclusions: No relationship was found between ADLs and prescribed drugs in the overall participant population. In participants from Nodes 7 and 8, who had a relatively short length of hospital stay and were discharged with preserved physical and cognitive functions, prescription changes appeared to have some effects on patient's ADLs.

Background: Bisphosphonates are the mainstay drugs for osteoporosis, but in clinical practice, they are often ineffective due to low compliance. However, there have been few studies examining compliance on a product-by-product basis or in detail in Japan. This study aimed to clarify the bisphosphonate compliance from the viewpoints of product selection, formulation, and patient characteristics using medical insurance claim data in Japan, to generate useful knowledge for improving bisphosphonate compliance.

Methods: Bisphosphonate records for osteoporosis treatment were extracted from Japanese medical insurance claim data (2021-2023), and the Medication Possession Ratio (MPR) of each patient was calculated from the records. The calculated MPR and compliance classification (Compliant/Non-compliant/Dropout) based on dispensing status were statistically analyzed from viewpoints of drug product, dose form/frequency, and patient sex/age to investigate the influence of each factor on compliance.

Results: The mean MPR for all patients (N = 63,197) was 76.7%. Product choice influenced compliance, with significance in 230 pairs among the 71 major products. Tablet was the most compliant formulation, and compliance was better with longer dose intervals. Women showed significantly better compliance and older age was associated with better compliance.

Conclusions: This study generated new data regarding product-specific MPRs, and clarified that product selection influences patient compliance. The study also supported previous findings that sex, age, and dose frequency influence compliance. It is expected that the findings of this study will be utilized for drug development, drug selection and patient guidance in clinical practice, to improve the treatment environment for osteoporosis.

The management of adherence, exposure risk, and adverse effects in oral anticancer agents (OAAs) is essential for optimizing patient outcomes in oncology pharmacy. This review highlights key efforts to enhance adherence, reduce occupational exposure, and improve adverse effect management in OAA therapy.(1) Adherence management.We evaluated adherence to trifluridine/tipiracil hydrochloride (TFTD) in metastatic colorectal cancer (mCRC) patients, revealing an overall adherence rate of 85.0%. Common factors affecting adherence included nausea, vomiting, and cancer-related pain. Pharmacist-led interventions, including antiemetic therapy and patient education, significantly improved compliance.(2) Exposure risk management.A study on spill kit usage found that 91.7% of incidents involved nurses, with most spills occurring in hospital wards. Following a medical safety workshop, compliance with personal protective equipment (PPE) protocols improved to 100%. These findings emphasize the need for continuous safety training and enhanced spill management protocols.(3) Adverse effect management.We examined regorafenib-induced adverse effects, particularly hand-foot skin reaction (HFSR) and hypothyroidism. HFSR occurred in 81.4% of patients, with severe cases (≥ Grade 2) associated with prolonged survival. Routine thyroid function monitoring was essential, as 42.8% of patients developed thyroid dysfunction, with 5.7% requiring hormone replacement therapy. Early intervention and supportive care strategies improved treatment tolerability.This review underscores the importance of pharmacist-driven interventions in enhancing adherence, ensuring occupational safety, and managing adverse effects. Continued research and collaboration are essential to optimize OAA-based therapy and improve patient care in oncology pharmacy.

Background: Statins, hydroxymethylglutaryl-CoA reductase inhibitors, possess neuroprotective properties. Given the potential neuroprotective properties of statins and their prevalent use in clinical settings, we aimed to investigate their impact on chemotherapy-induced peripheral neuropathy (CIPN) in Japan by assessing both their safety and efficacy in this context.

Methods: We conducted a retrospective observational study using the Japan Medical Data Centre database, which includes data from 2005 to 2021. We included patients who underwent anticancer therapy and were categorized into non-statin (10,920) and statin (1,537) groups. These groups were matched using a propensity score, resulting in 2,548 non-statin and 1,274 statin users. The primary endpoints were the incidence of CIPN post-first prescription of each anticancer drug and overall survival.

Results: Treatment with statins did not increase the incidence of CIPN (non-statin 27.2% vs. statin 28.4%, P = 0.443). Nevertheless, the incidence of CIPN was significantly high among women (non-statin 28.0% vs. statin 33.2%, P = 0.025). Overall survival was not impacted by statin use (hazard ratio 0.98, 95%CI: 0.83-1.16, P = 0.8846). Among men treated with paclitaxel, we observed an improvement in overall survival (hazard ratio: 0.72; 95% CI: 0.56-0.92; P = 0.0110).

Conclusions: The use of statins in patients with cancer was not associated with CIPN incidence. However, in men receiving paclitaxel treatment, statins may be linked to improved overall survival. Further studies are necessary to clarify the factors influencing prognosis and CIPN severity.

The number of individuals with chronic kidney disease (CKD) is increasing worldwide, including in Japan. Patients with advanced CKD are at an increased risk of serious adverse drug events associated with hospitalization, life-threatening complications, and death.It is necessary to adjust the dosage of renally excreted drugs according to kidney function in patients with CKD. In addition, elderly patients and those with impaired kidney function are also at high risk of drug-induced nephrotoxicity due to nephrotoxic drugs, and special attention should be paid to changes in kidney function before and after administration. Hospitalized patients are more susceptible to acute kidney injury than outpatients, and care must be taken when administering renally excreted or nephrotoxic drugs. Clinical decision support systems (CDSSs) play an important role in preventing overdosage of renally excreted drugs and avoiding the inappropriate use of nephrotoxic drugs. This review discussed the effectiveness, issues, and potential of CDSSs for physicians' prescriptions and pharmacists' prescription audits before hospitalized patients with kidney impairment are administered renally excreted drugs or nephrotoxic drugs, and the follow-up of patients receiving them. Although inappropriate prescriptions of renally excreted drugs due to alerts to prescribers were reduced, prescribers may have ignored interruption alerts. Therefore, the acceptance rate of alerts by prescribers can be improved by minimizing interruptions to the prescriber workflow, specifying only high-severity alerts, and automatically inputting the dosage, administration frequency, and administration duration according to kidney function when the prescriber selects a drug when entering a prescription. Prescription audits by pharmacists using electronic alerts from the CDSS and dosage confirmation sheets were effective in preventing overdosing of renally excreted drugs. In addition, pharmacist interventions for patients at risk of acute kidney injury (AKI) using CDSS alerts may be useful in preventing a decrease in kidney function and the onset of AKI due to nephrotoxic drugs. Although the usefulness of CDSSs may be further improved in the future, further evaluation and improvement of CDSSs are required.

Background: Stenotrophomonas maltophilia (S. maltophilia) is a Gram-negative pathogen that causes opportunistic infections. Although the mortality rate among patients with nosocomial infections caused by S. maltophilia is high, the risk factors for infection vary among studies. Moreover, S. maltophilia is highly resistant to several classes of antimicrobial agents. To date, few studies on S. maltophilia have been conducted in Japan, and the details remain unclear. Therefore, the objective of this study was to investigate the risk factors associated with S. maltophilia infection and the antimicrobial susceptibility of S. maltophilia isolates identified in our hospital.

Methods: In this study, we investigated the risk factors associated with S. maltophilia infection and clinical characteristics isolated from patients at the NTT Medical Center Tokyo (Tokyo, Japan). We retrospectively examined the S. maltophilia isolates and the corresponding patients between March 2022 and August 2023.

Results: Fifty-eight patients with S. maltophilia isolated (median age, 80.5 years; age range, 49-100 years; 70.7% male) were enrolled in this study. Twelve cases (20.7%) were placed in the S. maltophilia infection group and 46 cases were placed in the S. maltophilia colonization group. Central venous (CV) catheterization and higher Sequential Organ Failure Assessment (SOFA) scores were identified as risk factors for S. maltophilia infection. In addition, the 30-day mortality rate was significantly higher, and the survival rate was significantly lower in patients with S. maltophilia infection. The antimicrobial susceptibility rates of S. maltophilia were as follows: 28.6% for ceftazidime, 2.4% for cefozopran, 96.6% for levofloxacin, 100% for minocycline, and 98.3% for trimethoprim-sulfamethoxazole.

Conclusions: In actual clinical practice, S. maltophilia was more frequently isolated from sputum. However, most of the cases were colonization, and cases of infection were rare. Early treatment initiation should be considered for S. maltophilia infection in cases where the pathogen is detected from sterile sites, such as blood cultures and pleural fluid or from sputum in cases with a high SOFA score and CV catheter insertion.

Background: Arthrobacter woluwensis (A.woluwensis) is gram-positive rod that is endemic to natural environments such as soil, but reports of infections caused by this species are limited, and effective treatment methods have not been established.

Case presentation: An 89-year-old man was hospitalized for dysmobility due to anorexia and was started on peripheral intravenous nutrition. He had a fever of 39.5 °C, shivering, and hypotension. Gram-positive rods were detected in two sets of blood cultures. The treatment using vancomycin (VCM) was started due to suspicion of catheter-related bloodstream infection. The organism was identified as A.woluwensis by MALDI-TOF MS. The MIC₅₀ for VCM was 2 µg/mL. Treatment was continued with the goal of achieving an area under the concentration-time curve (AUC) of ≥ 400 µg·h/mL, which is an indicator of the efficacy and safety of VCM in treating MRSA infection. The fever resolved after starting treatment, and the patient's condition stabilized. Further blood cultures became negative, a transthoracic echocardiogram confirmed the exclusion of infective endocarditis, and the treatment was completed after 14 days.

Conclusions: This is the first case report using VCM for the treatment and therapeutic drug monitoring (TDM) of A. woluwensis bacteremia. Our results will provide useful information for appropriate infection treatment.

Critically ill patients are susceptible to serious infections due to their compromised conditions and extensive use of medical devices, often requiring empiric broad-spectrum antimicrobial therapy. Failure of antimicrobial therapy in this vulnerable population has a direct impact on the patient's survival; hence, selecting the optimal dosage is critical. This population, however, exhibits complex and diverse disease-related physiological changes that can markedly alter antimicrobial disposition. Inflammatory cytokines overexpressed in the systemic inflammatory response syndrome increase vascular permeability, leading to higher volume of distribution for hydrophilic antimicrobials. These cytokines also downregulate metabolic enzyme activities, reducing the clearance of their substrates. Hypoalbuminemia can increase the volume of distribution and clearance of highly protein-bound antimicrobials. Acute kidney injury decreases, while augmented renal clearance increases the clearance of antimicrobials primarily excreted by the kidneys. Furthermore, continuous renal replacement therapy and extracorporeal membrane oxygenation used in critical illness substantially affect antimicrobial pharmacokinetics. The complex interplay of multiple factors observed in critically ill patients poses a significant challenge in predicting the pharmacokinetics of antimicrobials. Therapeutic drug monitoring is the most effective tool to address this issue, and is proactively recommended for vancomycin, teicoplanin, aminoglycosides, voriconazole, β-lactams, and linezolid in critically ill patients. To streamline this process, model-informed precision dosing is expected to promote personalized medicine for this population.

Background: Baloxavir marboxil (baloxavir) is a new anti-influenza drug that works as a cap-dependent endonuclease inhibitor. It is approved for prophylactic use against influenza in Japan, but there are few reports on this usage in hospitalized in-patients. It reportedly reduces patient susceptibility to influenza through a mechanism involving amino acid substitution.

Methods: Between August 2023 and July 2024, we investigated the efficacy of baloxavir as a prophylactic against influenza among in-patients at our hospital who had close contact with patients who were infected with influenza viruses in the same rooms. We also investigated the I38T influenza virus variant to baloxavir through samples taken from patients with the virus at the hospital.

Results: We enrolled a total of 45 in-patients who had close contact with other patients who were confirmed to be infected with influenza in the same room. Among 34 of them who were prescribed baloxavir prophylactically, none developed influenza within 5 days from their last contact with infected patients. Conversely, among the other 11 who did not use baloxavir, three became infected with influenza within 5 days following contact with the infected patient (P = 0.012). In 85 samples taken from the patients with influenza, 25 were H1N1 types and 60 were H3N2. We detected the I38T variant of the cap-dependent endonuclease-baloxavir complex structure in two of the H3N2-type samples. Both of these patients had contracted influenza from their children.

Conclusions: According to our results, Baloxavir represents an effective prophylactic against influenza for hospitalized in-patients. However, patients with genetic mutations related to decreased susceptibility to influenza, such as I38T variant, should nevertheless exercise higher levels of caution-particularly around children.