Journal of Pharmaceutical Health Care and Sciences最新文献

{"title":"VEGF inhibitor-induced proteinuria: the role of hypertension and vascular endothelial dysfunction.","authors":"Satoru Nihei, Kazuki Saito, Kenzo Kudo","doi":"10.1186/s40780-026-00586-y","DOIUrl":"10.1186/s40780-026-00586-y","url":null,"abstract":"<p><p>Vascular endothelial growth factor (VEGF) inhibitors are widely used anticancer agents that suppress tumor angiogenesis and improve outcomes in various solid tumors. However, these therapies are frequently associated with adverse renal and vascular events, particularly hypertension and proteinuria, which may compromise treatment continuity and patient quality of life. Although hypertension has long been considered a major contributor to VEGF inhibitor-induced proteinuria, the precise relationship between these complications remains incompletely understood. In addition, accumulating evidence suggests that endothelial dysfunction-characterized by impaired nitric oxide bioavailability, increased endothelin-1 signaling, and microvascular injury-plays a central role in the pathogenesis of these adverse events, potentially linking hypertension and proteinuria through a shared underlying mechanism. This review summarizes current evidence regarding the role of blood pressure and vascular endothelial dysfunction in the development of proteinuria during VEGF inhibitor therapy. Multiple clinical studies have demonstrated that both baseline and on-treatment blood pressure are associated with an increased risk of proteinuria. However, the causal relationship between hypertension and proteinuria remains uncertain. Hypertension may contribute to glomerular injury by increasing intraglomerular pressure, but it may also represent a parallel manifestation of endothelial injury caused by VEGF signaling blockade. Emerging evidence suggests that vascular endothelial dysfunction plays a key role in this process. Studies using flow-mediated dilation and reactive hyperemia index measurements have demonstrated impaired endothelial function during VEGF inhibitor therapy. In addition, alterations in endothelial-derived vasoactive mediators, including reduced nitric oxide bioavailability and increased endothelin-1 signaling, have been reported. Taken together, VEGF inhibitor-induced proteinuria likely results from complex interactions between systemic hypertension, endothelial dysfunction, and glomerular microvascular injury. Further translational and prospective clinical studies are needed to clarify the causal mechanisms and optimize strategies for prediction, prevention, and management of this complication.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of community pharmacists on improving polypharmacy in elderly outpatients: a community-based intervention study.","authors":"Takahiro Furuta, Kazuyoshi Fujitani, Eriko Minami, Yuka Kushida","doi":"10.1186/s40780-026-00577-z","DOIUrl":"10.1186/s40780-026-00577-z","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy, defined as the inappropriate use of multiple concomitant medications, represents a major concern in elderly care and is associated with drug-drug interactions, adverse effects, and poor medication adherence. Previous studies have emphasized the importance of proactive pharmacist involvement in addressing polypharmacy. However, evidence regarding patient outcomes following pharmaceutical interventions remains limited. This study aimed to evaluate whether community pharmacists could contribute to optimizing medication therapy among elderly patients living in the community. Pharmaceutical interventions targeting polypharmacy were implemented with consideration of patient characteristics and caregiver perspectives.</p><p><strong>Methods: </strong>Questionnaire surveys were conducted among elderly patients receiving six or more daily medications and among caregivers, including helpers and visiting nurses. Cases involving potentially inappropriate prescriptions were identified in elderly outpatients, and deprescribing proposals were communicated to the respective prescribing physicians with patient consent. Follow-up assessments were conducted at least four weeks after intervention in patients whose medications had been deprescribed.</p><p><strong>Results: </strong>Among elderly respondents, 32.7% expressed a desire to reduce the number of oral medications. Caregivers frequently reported challenges associated with patients receiving multiple prescriptions. Following pharmacist-led interventions, the number of prescribed medications decreased, particularly within the gastrointestinal and pain medication categories. Most patients reported no worsening of symptoms, and some indicated that medication administration had become easier.</p><p><strong>Conclusions: </strong>These findings suggest that community pharmacists may contribute to improving the quality of medication therapy in elderly outpatients through community-based interventions targeting polypharmacy.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering community pharmacists: expert consensus guidance for the effective management of peripheral neuropathy with neurotropic B vitamins.","authors":"Yolanda R Robles, Lusy Noviani, Kitiyot Yotsombut, Grace Chew, Kenny James Merin, Navin Kumar Loganadan, Camilla Bennett","doi":"10.1186/s40780-026-00600-3","DOIUrl":"10.1186/s40780-026-00600-3","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral neuropathy (PN) is a prevalent condition in the Asia-Pacific region with a significant proportion of undiagnosed cases. Despite heterogeneous pharmacy practices across the region, clinical and operational challenges remain consistent. Community pharmacists are well-positioned to overcome these challenges but lack specific guidance for managing PN in the pharmacy setting.</p><p><strong>Aim: </strong>This study aimed to develop expert consensus recommendations for community pharmacists on the early screening, assessment and management of PN.</p><p><strong>Method: </strong>A modified two-round Delphi process was adopted, involving a panel of seven pharmacists from across the region. The process included a targeted literature review, yielding a total of 41 articles, two rounds of anonymous survey, and a virtual expert round table discussion (ERTD) with the panel of pharmacists to achieve consensus.</p><p><strong>Results: </strong>The Delphi process yielded six consensus statements, covering the burden of PN, role of community pharmacists, early screening of patients at risk of PN, assessment and evaluation of PN patients, and guidance on management approaches of PN with neurotropic B vitamins.</p><p><strong>Conclusion: </strong>These consensus statements offer practical guidance for community pharmacists to improve the early detection and management of PN in the Asia-Pacific (APAC) region, potentially enhancing patient outcomes and quality of life.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between voltage-gated sodium channel gene polymorphisms and chronic oxaliplatin-induced peripheral neuropathy in Japanese patients with colorectal cancer.","authors":"Masato Matsuura, Ayumu Nagamine, Takashi Masuno, Akira Tabei, Teruko Nasaka, Hiromi Nishiba, Maho Koike, Yuta Takahashi, Kyoko Obayashi","doi":"10.1186/s40780-026-00601-2","DOIUrl":"10.1186/s40780-026-00601-2","url":null,"abstract":"<p><strong>Background: </strong>Polymorphisms in voltage-gated sodium channel (SCN) genes have been implicated in oxaliplatin-induced peripheral neuropathy (OXAIPN). However, their association with chronic OXAIPN in Japanese patients remains unclear. This study investigated the association between SCN gene polymorphisms and patient-reported chronic OXAIPN outcomes in Japanese patients with colorectal cancer.</p><p><strong>Methods: </strong>Seventy-six Japanese patients with colorectal cancer who received oxaliplatin-containing adjuvant chemotherapy were included. Seven polymorphisms, namely SCN4A rs2302237, SCN5A rs11720524, SCN9A rs6746030 and rs6754031, SCN10A rs6800541 and rs12632942, and GSTP1 rs1695, were analyzed. Chronic OXAIPN was assessed using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) score as the primary endpoint, while symptom severity assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was evaluated as a key secondary endpoint. Assessments were conducted at treatment completion (0 M) and 6 months after treatment completion (6 M).</p><p><strong>Results: </strong>The mean age of the patients was 64.6 ± 9.9 years, and 50 patients (65.8%) were male. The mean cumulative oxaliplatin dose was 792 ± 184 mg/m². In multivariate analyses, carriers of the SCN4A rs2302237 variant allele had lower FACT/GOG-Ntx scores than non-carriers at both 0 M (B = - 4.385, 95% confidence interval [CI]: -7.938 to - 0.831, p = 0.016) and 6 M (B = - 5.150, 95% CI: -8.975 to - 1.326, p = 0.009), indicating a lower patient-reported neuropathy-related symptom burden. In contrast, carriers of the SCN10A rs6800541 variant allele had higher FACT/GOG-Ntx scores at 0 M (B = 4.564, 95% CI: 0.393 to 8.735, p = 0.032); however, no similar association was observed at 6 M. PRO-CTCAE severity analyses showed similar trends for SCN4A rs2302237 and SCN10A rs6800541.</p><p><strong>Conclusions: </strong>In this exploratory study of Japanese patients with colorectal cancer, SCN4A rs2302237 was consistently associated with a lower neuropathy-related symptom burden at both 0 M and 6 M. These findings suggest that SCN4A rs2302237 may be a candidate marker associated with patient-reported chronic OXAIPN symptom burden; however, larger validation studies are needed to confirm its clinical significance.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring staffing and hospital factors associated with WardPharm-1 filing in Japan: a nationwide observational study.","authors":"Masayuki Kaneda, Maho Taguchi, Hiroaki Yamada, Akihiro Koide","doi":"10.1186/s40780-026-00595-x","DOIUrl":"10.1186/s40780-026-00595-x","url":null,"abstract":"<p><strong>Background: </strong>The healthcare system of Japan faces mounting challenges, including population aging, medical complexity, and workforce shortages. Hospital pharmacists are expected to ensure the safe and effective use of medicines and contribute to multidisciplinary care; however, their availability and functions remain uneven. The \"Ward Pharmaceutical Care Fee I\" (WardPharm-1) serves as an indicator of the implementation of advanced ward-based pharmaceutical care. This study investigated the national trends and associated factors of WardPharm-1 filing, focusing on pharmacist-to-bed ratios and hospital characteristics, to explore factors that may enable high-quality pharmacist services.</p><p><strong>Methods: </strong>We examined national open datasets from the Ministry of Health, Labor, and Welfare for fiscal years 2021-2023, linking the \"List of Registered Medical Care Providers (Medical)\" and the \"Hospital Bed Function Report.\" Hospitals eligible for WardPharm-1 filing were identified, excluding psychiatric facilities and those not fulfilling minimum staffing standards. Per-100-bed staffing for eight healthcare professions and hospital bed counts were determined. Logistic regression and receiver operating characteristic (ROC) curve analyses determine the association between pharmacist staffing (Ph/100 beds) and WardPharm-1 filing, stratified by hospital type, Diagnosis Procedure Combination (DPC) group, and regional population density.</p><p><strong>Results: </strong>Among approximately 5,800 eligible hospitals annually, 31%-34% filed WardPharm-1. Pharmacists per 100 beds (Ph/100 beds) showed the strongest association with filing (odds ratio ≈ 1.2 yearly). Median Ph/100 beds were about 5.2 in filing hospitals and 2.6 in non-filers, with ROC cutoffs of 3.7-4.0 (AUC 0.83-0.84). Filing was most frequent in general hospitals (~ 50%) and DPC university or specified hospitals (~ 90%) and least frequent in long-term care hospitals (~ 3%) and depopulated regions (< 25%). Adjusted analyses confirmed that Ph/100 beds remained significantly associated with filing, though effect sizes were modest.</p><p><strong>Conclusions: </strong>Higher pharmacist-to-bed ratios were associated with higher WardPharm-1 filing rates. Filing was more common in larger and higher-function hospitals and less frequent in smaller or lower-density settings, patterns consistent with uneven workforce distribution. Although causality cannot be inferred, pharmacist staffing levels may serve as a practical indicator related to WardPharm-1 implementation.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in remimazolam plasma concentration associated with the Pringle maneuver during hepatectomy: a pilot study.","authors":"Shunya Ogawa, Hirotsugu Kanda, Takahiro Ito, Manabu Suno, Kazuo Matsubara, Sarah Kyuragi Luthe, Tomoyuki Kawamata","doi":"10.1186/s40780-026-00597-9","DOIUrl":"10.1186/s40780-026-00597-9","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam (RMZ) is an ultrashort-acting benzodiazepine used in general anesthesia, metabolized rapidly by carboxylesterase 1, an enzyme primarily located in the liver. The Pringle maneuver (PM), an established technique commonly employed during hepatectomies to reduce bleeding, involves clamping major vessels, potentially affecting drug metabolism and clearance. Therefore, we conducted a study to investigate the changes in plasma concentration (Cp) of RMZ associated with the PM during hepatectomy and the impact on bispectral index (BIS) values.</p><p><strong>Methods: </strong>This single-center prospective observational pilot study included ten patients undergoing hepatectomy using the PM.</p><p><strong>Results: </strong>Our findings showed that the changes in RMZ Cp immediately following each PM tended to be higher than those before PM in six cases, though this was not observed in others. However, there was no statistically significant difference between the median RMZ Cp after the final PM (1099 [723-1386] ng/mL) and before the initial PM (707 [641-856] ng/mL). Similarly, the median BIS value after the final PM (45 [40-46]) was comparable to the BIS prior to initiation of PM (46 [44-50]).</p><p><strong>Conclusions: </strong>This study suggested that RMZ may be safely administered during hepatectomies with PM in patients with Child-Pugh classification A.</p><p><strong>Trial registration: </strong>Clinical trial number: not applicable.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of factors affecting the usefulness and sustainability of inter-pharmacist case conferences.","authors":"Shun Tsujimura, Kanayuki Kitahara, Shin Tanaka, Tatsuya Isezaki, Ryohkan Funakoshi","doi":"10.1186/s40780-026-00599-7","DOIUrl":"10.1186/s40780-026-00599-7","url":null,"abstract":"<p><strong>Background: </strong>Inter-pharmacist case conferences, in which practitioners routinely discuss drug therapy, are expected to improve the validity of clinical judgements and provide educational benefits. However, evidence regarding their utility and factors associated with sustainability is scarce. Therefore, this study aimed to clarify the utility of a year-long inter-pharmacist case conference program at Kameda Medical Center (Kamogawa, Japan) and explore factors associated with its continuity.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 40 pharmacists who participated in inter-pharmacist case conferences initiated in November 2023. A 16-item questionnaire that incorporated the Attention, Relevance, Confidence, Satisfaction model and psychological safety perspectives was administered. Exploratory factor analysis was performed as the primary endpoint. As a secondary analysis, the association between the extracted factors and motivation for continuity was examined using multiple regression analysis. Furthermore, the impact of experience as a facilitator or case presenter on factor scores was evaluated using two-way analysis of variance.</p><p><strong>Results: </strong>Three factors were extracted from the questionnaire data with a cumulative contribution rate of 75.5%. Factor 1 was interpreted as confidence and professional growth through conferences, Factor 2 as improvement in clinical judgement and quality of drug therapy, and Factor 3 as promotion of communication and improvement of the environment for expressing opinions. The mean factor score was highest for Factor 2. Motivation for continuity was significantly associated with Factors 1 and 2. Case presenter experience was associated with higher scores for Factor 1, suggesting that case presentation may be related to perceived professional growth.</p><p><strong>Conclusions: </strong>Inter-pharmacist case conferences may be a valuable practice-based initiative related to clinical judgement, self-efficacy, and team communication. The study results suggest that perceived professional growth and practical application to clinical judgement may be important elements associated with sustainability. Overall, this study provides fundamental insights into the institutionalization and dissemination of inter-pharmacist conferences.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolongation of prothrombin time-international normalized ratio by concomitant use of warfarin and combination therapy with lenvatinib and pembrolizumab in a patient with renal cell carcinoma on dialysis: a case report.","authors":"Shota Torii, Tomoya Narita, Aya Torii-Goto, Takamasa Homma, Hideki Esaki, Takashi Sakakibara, Atsuya Kondo, Norio Takimoto","doi":"10.1186/s40780-026-00598-8","DOIUrl":"10.1186/s40780-026-00598-8","url":null,"abstract":"<p><strong>Background: </strong>Acquired polycystic kidney disease is associated with an increased risk of developing renal cell carcinoma (RCC), which is commonly observed in patients on dialysis and may present with inferior vena cava tumor thrombus. However, there are no prior reports on the use of warfarin for inferior vena cava tumor thrombus in patients on dialysis with RCC receiving combination therapy with lenvatinib and pembrolizumab.</p><p><strong>Case presentation: </strong>We describe a 64-year-old Japanese man with RCC complicated by tumor thrombus extending into the renal vein and inferior vena cava who was undergoing hemodialysis. Warfarin was initiated at 2 mg/day due to the risk of thrombus progression. His baseline prothrombin time-international normalized ratio (PT-INR) was 1.80 before the initiation of combination therapy with lenvatinib and pembrolizumab. After 8 days of warfarin administration, combination therapy with lenvatinib (10 mg/day) and pembrolizumab (200 mg every 3 weeks) was initiated. Nine days later, the PT-INR elevated to 3.02 despite no change in warfarin dose. The patient remained asymptomatic. Adjusting warfarin to 2-2.5 mg/day and close PT-INR monitoring successfully restored values to the therapeutic range of 1.6-2.6 by day 80, without reducing the lenvatinib dose.</p><p><strong>Conclusions: </strong>Neither warfarin nor lenvatinib is eliminated by dialysis; therefore, potential pharmacokinetic interactions should be managed with the same caution as in non-dialysis patients. Concomitant use of warfarin and combination therapy with lenvatinib and pembrolizumab in patients with RCC undergoing hemodialysis may enhance anticoagulant effects via multiple interacting factors, including cytochrome P-450-related interactions, systemic inflammation, and hypoalbuminemia. Therefore, careful follow-up, including shorter intervals between outpatient visits (e.g., weekly monitoring), is essential for safe PT-INR management.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Helicobacter pylori eradication blister-pack handling on outpatient AWaRe access share: a Japanese community pharmacy-based sensitivity analysis.","authors":"Yuki Kishino, Yoshiharu Fukuda, Shinya Kiyokawa, Kaei Hiroi","doi":"10.1186/s40780-026-00594-y","DOIUrl":"10.1186/s40780-026-00594-y","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori (H. pylori) eradication regimens may influence outpatient AWaRe Access share when routine surveillance is based on oral antibacterials classified under the Anatomical Therapeutic Chemical (ATC) code J01. This study evaluated how commercially identifiable H. pylori eradication blister-pack handling affects the reported AWaRe Access share using community pharmacy dispensing data.</p><p><strong>Methods: </strong>We analyzed monthly outpatient dispensing data for oral antibacterials in ATC J01 from community pharmacies in Nayoro, Japan, from July 2022 to March 2025. AWaRe Access share was primarily compared between an unadjusted series and a pack-adjusted series in which commercially identifiable eradication blister packs were handled using a predefined pack-derived offset. An exploratory extended adjustment also considered probable non-pack eradication regimens. Blister packs were identified by product name. In the pack-adjusted series, pack days of therapy were conservatively converted into a DDD-equivalent offset and subtracted from both the numerator and denominator. The primary outcome was the monthly difference in Access share between the unadjusted and pack-adjusted series (ΔAccess).</p><p><strong>Results: </strong>Among 20,129 oral J01 records, commercially identifiable eradication blister packs accounted for a median of 1.13% of monthly records and 0.55% of monthly DOT. The difference between the unadjusted and pack-adjusted series (ΔAccess) was positive in all 33 months, with a median of 0.59% points (pp) (IQR, 0.47-0.83; range, 0.26-1.43). These findings indicate that the handling of commercially identifiable eradication blister packs had a consistent but modest influence on the reported Access share.</p><p><strong>Conclusions: </strong>The handling of commercially identifiable H. pylori eradication blister packs had a consistent but modest influence on outpatient AWaRe Access share derived from dispensing data. Although the observed difference was modest in this low-Access-share setting, explicit reporting of blister-pack handling may improve transparency, particularly in benchmark-based or close comparative evaluations. Routine AWaRe surveillance should therefore define how commercially identifiable eradication packs are handled, ideally using standardized adjustment or dual reporting.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of polymerase chain reaction-based antifungal stewardship on candidemia management in small- and medium-sized hospitals.","authors":"Koji Miyazaki, Tomoyuki Ishigo, Miyu Yamada, Ryoma Takeda, Naoki Wada, Marie Itaya, Masaji Saijo, Takanobu Hoshi, Yoshitaka Saito","doi":"10.1186/s40780-026-00596-w","DOIUrl":"10.1186/s40780-026-00596-w","url":null,"abstract":"<p><strong>Background: </strong>Candidemia has high mortality and requires early antifungal stewardship (AFS). Management by non-infectious disease specialists has been associated with worse outcomes, particularly in small- and medium-sized hospitals where infectious disease expertise is often limited. Rapid diagnostic tools such as polymerase chain reaction (PCR) may facilitate earlier stewardship support; however, their clinical impact in these settings remains unclear. This study aimed to evaluate the effect of PCR-based AFS on candidemia management in small- and medium-sized hospitals.</p><p><strong>Methods: </strong>We compared clinical data before and after the implementation of a PCR-based assay in patients aged ≥ 18 years with Candida species detected in blood cultures at Sapporo Tokushukai Hospital between June 2018 and May 2024 (n = 71 after exclusion). The primary endpoint was 30-day mortality rate. We also assessed the following secondary endpoints: rate of appropriate initial antifungal therapy, removal of central venous catheters (CVCs) within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, and time to antifungal therapy initiation.</p><p><strong>Results: </strong>No significant difference in 30-day mortality rate was observed between the pre-PCR and post-PCR groups (36.1% vs. 34.3%). Similarly, no significant differences were observed in rate of appropriate initial antifungal therapy, removal of CVCs within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, or time to therapy initiation. However, the proportion of physicians less familiar with candidemia care was significantly higher in the post-PCR group than in the pre-PCR group (68.6% vs. 36.1%, P = 0.01).</p><p><strong>Conclusions: </strong>PCR-based AFS might have allowed the quality of candidemia management and patient outcomes to be maintained, even in small- and medium-sized hospitals with a high proportion of physicians less familiar with candidemia care.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}