Japan Hospital Association

Currently, no nationwide reports exist that describe the effects of drug shortages on the work of hospital pharmacists in Japan. Using a questionnaire survey, we evaluated here the impact of recent drug shortages on the work of hospital pharmacists in Japan. We distributed a questionnaire to the directors of the pharmacy departments of 853 hospitals belonging to the Japan Municipal Hospital Association. The questionnaire consisted of questions on the situation regarding recent drug shortages at the responding hospitals and the time spent by hospital pharmacists dealing with drug shortages between February 13, 2024, and March 15, 2024. The proportion of hospitals that answered at least one survey question was 25.7% (219/853). Almost all respondents (98.1% [214/218]) answered that the recent drug shortages negatively affected other practices of the hospital pharmacy. The median time spent dealing with drug shortages in all responding hospitals was 19.5 h of 32 days (including 23 weekdays). The estimated annual labour cost of hospital pharmacists required to deal with the recent drug shortages in the 8,110 hospitals of Japan amounted to 7.1 billion JPY/year (approximately 50 million USD/year). A survey of directors of hospital pharmacy revealed that recent drug shortages have been a burden on pharmacists at most hospitals, as they have spent a notable amount of time dealing with such drug shortages.

Abstract Background Antimicrobial resistance (AMR) disproportionately affects low and middle income countries (LMICs) including Bangladesh, driven by poorly implemented infection prevention and control (IPC) and misuse of antimicrobials. Robust Antimicrobial Stewardship (AMS) programs mitigate this risk by optimizing prescribing to best-practice standards. This study aimed to assess healthcare workers’ (HCWs) knowledge, attitude and perception (KAP) toward AMS. Methods An online questionnaire was shared via IPC Alliance BD to different health-related institutes and hospitals, inviting voluntary and anonymous participation of HCWs on KAP between January to March 2025. Results A total of 721 participants from 171 hospitals and institutes (78 public and 93 private), comprising 29% medical officers or equivalent, 29% nurses, 28% professors or equivalent and 14% administrative staff and other roles were enrolled. The average age was 36 years, and females accounted for 54% of respondents. Overall, 43% of respondents were familiar with the term AMS, reached through various sources. Only 11% received AMS training, and 18% had access to standard treatment guidelines. Despite 66% reporting availability of culture and sensitivity (C/S) testing, only 26% routinely recommended C/S and 15% shared an antibiogram. Empirical therapy predominated (> 94%), with a 60% preference for broad-spectrum agents. However, 67% believed rational use and proper IPC can reduce AMR. Knowledge, attitudes, and perceptions varied significantly by age, gender, and education (P < 0.05). Conclusion Antimicrobial resistance in Bangladesh necessitates strengthened laboratory capacity, expanded public awareness, and improved healthcare worker’s KAP via structured training and continuous monitoring, with robust antimicrobial stewardship as the operational benchmark.

Chemotherapy-induced neutropenia has been identified as a potential prognostic marker for multiple cancers. However, only one retrospective study, NN-2301, has investigated the relationship between neutropenia and treatment effects of nanoliposomal irinotecan/5-fluorouracil/folinic acid (NFF) in pancreatic cancer. In this prospective study, we aimed to clarify whether NFF-induced neutropenia could serve as a prognostic marker in pancreatic cancer. Data were analyzed from the prospective cohort of the NAPOLEON-2 trial, an observational study involving patients with unresectable pancreatic cancer treated with NFF. Neutropenia severity was categorized into three cutoffs: Cutoff A (Grade [Gr] 0 vs. Gr 1-4), cutoff B (Gr 0-1 vs. Gr 2-4), and Cutoff C (Gr 0-2 vs. Gr 3-4), using the Common Terminology Criteria for Adverse Events version 5.0, owing to conformity with previous studies and simplicity. The primary endpoint was overall survival (OS); progression-free survival (PFS) was the secondary endpoint. The neutropenic groups included Gr 1, 2, 3, and 4, with 79, 23, 34, and 7 patients, respectively. At each cutoff, OS and PFS were significantly better in the severe neutropenia groups. Higher neutropenia grades correlated with improved OS (log-rank trend test: χ2 = 8.62, p < .01). Multivariate Cox regression analysis revealed significant differences for all cutoffs: adjusted hazard ratios were 0.57 (95% confidence interval [CI] 0.40-0.83) (Cutoff A), 0.53 (95% CI 0.36-0.78) (Cutoff B), and 0.52 (95% CI 0.34-0.80) (Cutoff C). NFF-induced neutropenia is a valuable prognostic marker in pancreatic cancer and may guide treatment selection.

Long-term safety and efficacy of pemafibrate once-daily extended-release (XR) tablets, taken in morning or evening, were evaluated in dyslipidemic patients with high triglycerides (TG). In this multicenter, randomized, open-label, parallel-group, phase 3 long-term study, dyslipidemic patients with high TG were randomly assigned to morning or evening administration of XR for 52 weeks. The dose was started at 0.2 mg/day and increased to 0.4 mg/day for patients having fasting serum TG ≥ 150mg/dL during treatment. The primary efficacy endpoint was percent change in fasting serum TG. The study enrolled 121 patients, assigning 61 to morning and 60 to evening administration. The study population included 71.1% males. Mean age was 58.5±11.1 (mean±SD) years, body mass index 27.7±4.3 kg/m2, and fasting TG 264.0±109.2 mg/dL. Fasting serum TG decreased significantly from baseline to 52 weeks among patients overall and in the morning and evening groups (-45.7%, -44.8%, and -46.6%, respectively, p＜0.001 vs. baseline). The difference in least-squares mean between the morning and evening groups was 3.0%, not statistically significant. The dose was increased in 82 patients (44 morning and 38 evening), with 57.3% (95%CI 45.9, 68.2) achieving fasting serum TG ＜150 mg/dL. Adverse events occurred in 83.5% and adverse drug reactions in 19.0% but with no notable safety problems. Long-term, once-daily administration of XR was effective and safe in dyslipidemic patients with high TG. XR provided favorable TG-lowering effects regardless of morning or evening administration, and the XR dose increase proved effective in patients having initially inadequate response.

Background and objectives In recent years, the number of emergency transports for older patients has significantly increased, raising concerns about the strain on emergency medical services. This study aimed to assess whether the use of hospital ambulances can enhance collaboration between home medical care and hospitals while reducing the reliance on fire department ambulances for interhospital transfers. Methods This retrospective observational study analyzed 3,983 hospital ambulance dispatches from December 1, 2014, to March 31, 2024. We examined the annual dispatch volume, reasons for dispatch requests, types of transportation, and receiving medical institutions. We then compared the acceptance of ambulance transport and the frequency of interhospital transfers performed by hospital ambulances versus fire department ambulances at chronic care hospitals within the city. Results The number of ambulance calls increased annually until 2020 but began to decline in 2021 following the introduction of restrictions on transporting patients with COVID-19. Fractures and orthopedic disorders were the most common reasons for calls (1,040 cases, 26.1%). Interhospital transfer was the most frequent type of transport (1,514 cases, 38.0%), followed by transport from home to the hospital (1,096 cases, 27.5%). Overall, 2,179 patients (54.7%)were transferred to chronic care hospitals, with 3,752 (94.2%) remaining within the city. Regarding the number of ambulances accepted by chronic care hospitals and interhospital transfers, an increase in hospital ambulance utilization and a decrease in fire department ambulance utilization were observed until 2021 and 2020, respectively; however, these trends reversed thereafter. Conclusion The use of hospital ambulances facilitates patient transfers to chronic care hospitals and alleviates the burden on fire department ambulances, particularly for interhospital transfers. Hospital ambulances could serve as pivotal tools for reinforcing community-based care while optimizing the use of limited emergency resources.

To investigate patients with prolonged (≥9 months) super-refractory anti-NMDAR encephalitis (NMDARe).

Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.

Abstract Nanoliposomal irinotecan with fluorouracil and folinic acid (NFF) is a standard regimen after gemcitabine-based therapy for patients with unresectable or recurrent pancreatic cancer. However, there are limited clinical data on its efficacy and safety in the real-world. We therefore initiated a retrospective and prospective observational study (NAPOLEON-2). The results of the retrospective part were reported herein. In this retrospective study, we evaluated 161 consecutive patients who received NFF as second-or-later-line regimen. The main endpoint was overall survival (OS), and the other endpoints were response rate, disease control rate, progression-free survival (PFS), dose intensity, and adverse events (AEs). The median age was 67 years (range, 38–85 years). The median OS and PFS were 8.1 and 3.4 months, respectively. The objective response and disease control rates were 5% and 52%, respectively. The median relative dose intensity was 81.6% for nanoliposomal irinotecan and 82.9% for fluorouracil. Grade 3 or 4 hematological and nonhematological AEs occurred in 47 and 42 patients, respectively. Common grade 3 or 4 AEs included neutropenia (24%), anorexia (12%), and leukocytopenia (12%). Subanalysis of patients treated with second-line and third-or-later-line demonstrated no statistical significant difference in OS (7.6 months vs. 9.1 months, respectively; hazard ratio, 0.92; 95% confidence interval, 0.64–1.35; p = 0.68). In conclusion, NFF has acceptable efficacy and safety profile even in real-world clinical settings. The prospective study is in progress to validate these findings.