Shimane University Hospital

In the field of team-based care, pharmacists are vital for optimizing medication therapy. However, many medical professionals lack the opportunity to learn how to propose prescription changes with precision. This study aimed to address this knowledge gap by developing and assessing a new educational program for pharmacy students focused on prescription support and interprofessional collaboration. We recruited 191 fifth-year pharmaceutical students during the 2022-2024 academic years. The program featured a 7-day intensive curriculum that included learning how to assist with prescriptions, analyzing clinical data, and engaging in role-playing exercises. A web-based questionnaire and a paper test were used to evaluate students' awareness and knowledge both before and after the program. Statistical analyses were performed to verify the significance of changes; we utilized the Wilcoxon signed-rank test for the ordinal data derived from the specific behavioral objectives and 2-tailed paired t tests for the interval data from the knowledge tests. The magnitude of change was quantified using r for Wilcoxon tests and Cohen dz for 2-tailed t tests, with 95% CI calculated to ensure the stability and reliability of the observed results. Analysis of the primary outcome specific behavioral objectives revealed statistically significant effects across all items (Wilcoxon signed-rank test; P<.001). Effect sizes (r=0.505-0.835) ranged from moderate to large, with particularly large effects observed in identifying contents issue (r=0.835, 95% CI 0.126-0.330; P<.001). Knowledge test scores showed significant improvement in the following 3 subjects: pharmacology (r=-0.504, 95% CI -0.215 to 0.127; P<.001), organic chemistry (r=0.254, 95% CI -0.148 to -0.193; P=.004), and communication (r=0.221, 95% CI -0.151 to -0.190; P=.01). No significant changes were observed in pathology or pharmacokinetics. This program provides strong evidence that practical, hands-on learning with hospital pharmacists helps improve pharmacy students' professional skills and optimize pharmaceutical therapies in interprofessional care. By teaching pharmacists to effectively propose prescription changes, the program equips them to become integral members of interprofessional care, ultimately leading to optimized pharmaceutical care for patients.

Tagraxofusp (TAG), a first-in-class CD123-targeted therapy, is a recombinant fusion protein of human interleukin-3 conjugated to a truncated diphtheria toxin payload. Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive orphan hematologic cancer with a poor prognosis, and is derived from plasmacytoid dendritic cells that overexpress interleukin-3 receptor subunit alpha (IL3RA or CD123). This open-label phase I/II study evaluated the efficacy and safety of TAG in 11 Japanese BPDCN patients, of whom seven were treatment-naïve (TN) and four had relapsed/refractory (R/R) disease. In the phase I portion, seven patients (five TN, two R/R) were treated, and no dose-limiting toxicity was observed, with 12μg/kg/day tolerated. In the phase II portion, four patients (two TN, two R/R) were treated. Among the seven TN BPDCN patients, the rate of complete response (CR) + clinical CR (CRc: CR with minimal residual skin abnormality) was 57.1% (90% confidence interval [CI], 22.5-87.1), and the lower limit of the 90% CI (22.5%) exceeded the pre-specified threshold of 10%. Common adverse events included increased alanine aminotransferase (81.8%) and aspartate aminotransferase (72.7%), hypoalbuminemia, hypokalemia, and capillary leak syndrome (54.5%). The results indicate that TAG was effective and had a manageable safety profile in Japanese BPDCN patients.

Patient safety remains a core concern in healthcare systems worldwide. While technological innovations and clinical protocols are indispensable, the role of leadership in shaping safety culture has garnered increasing attention. Supportive leadership, a style emphasizing psychological safety, open communication, and empowerment, has emerged as a crucial determinant of safety outcomes. This narrative review synthesizes current evidence, theoretical frameworks, and lived experience to explore how supportive leadership contributes to patient safety. We argue that fostering supportive leadership at all organizational levels, and across professional roles, can lead to improved incident reporting, inter-professional collaboration, and systemic learning, ultimately reducing preventable harm and creating resilient health systems. Furthermore, we discuss how supportive leadership must also encompass cultural transformation, inclusive decision-making, and empowerment of not only healthcare professionals but also administrative staff, assistants, and security personnel who collectively form the frontline of patient care.

ABSTRACTGiardia duodenalis can be incidentally detected during pancreatic tumor evaluation via cytology. Even in asymptomatic patients without risk factors, recognition is essential. Careful cytologic examination enables early treatment to prevent complications before surgery. Although rare, incidental detection is clinically significant and guides preoperative management.

BackgroundCorticosteroids (CSs) are widely used to treat autoimmune diseases, allergic conditions, and cancers, but they are often associated with psychiatric side effects, such as insomnia, anxiety, depression, mania, and psychosis. Comprehensive evaluations of psychiatric risks, including acute and long-term effects, as well as their associations with dose and cumulative exposure, remain limited. Understanding these relationships is crucial for optimizing therapeutic strategies and minimizing psychiatric risks.Aims & ObjectivesThis study aimed to systematically evaluate the psychiatric risks associated with corticosteroid use, focusing on both acute and long-term settings. The primary objectives included assessing the risks of depression, mania, and psychosis, and examining their associations with dose, and duration.MethodA systematic literature search was conducted in MEDLINE and Embase databases up to March 22, 2024, using keywords related to corticosteroids and psychiatric symptoms. Observational studies with clearly defined psychiatric outcomes and quantifiable data were included. Data were analyzed using a random-effects model, and heterogeneity was assessed with the I² statistic. For studies reporting multiple non-independent outcomes, we conducted a three-level meta-analysis to account for the dependency between effect sizes within studies. In addition, qualitative data were synthesized to explore patterns of symptom progression and their relationship with treatment characteristics. The risk of bias was evaluated using the Newcastle-Ottawa Scale.ResultsA total of 69 studies were included, comprising cross-sectional, cohort, pre-post, case-control, and other observational study designs. The three-level meta-analysis of depressive symptoms, based on six studies with seven groups and 10 effect sizes, revealed a pooled standardized mean difference (SMD) of 1.01 (95%Confidence Interval (CI)=0.40–1.61, p<0.01) with significant heterogeneity (I²=84%). Six acute-phase studies on mania and depressive symptoms demonstrated that mania was more frequently reported than depressive symptoms, with a pooled odds ratio (OR) of 2.37 (95%CI=1.52–3.69, p<0.01) and low heterogeneity (I²=0%). For psychosis, a meta-analysis of six studies reported a pooled proportion of 3.0% (95%CI=1.0%–8.6%), with high heterogeneity (I²=92%) indicating variability across studies. Qualitative assessments suggested that high doses and prolonged use of CSs were consistently associated with an increased risk of psychiatric symptoms. Acute symptoms, such as mania and psychosis, were often reported within 3–14 days of treatment initiation, whereas depressive symptoms were more frequently associated with long-term exposure.Discussion & ConclusionsThis meta-analysis highlighted the differential risks of psychiatric symptoms associated with CS use. Mania and psychosis were more frequent during acute treatment, particularly at high doses, while depression was predominantly observed in long-term use. These findings underscore the importance of early monitoring and individualized treatment strategies, especially for patients receiving high-dose or prolonged CS treatment. The high heterogeneity observed in studies on depression and psychosis reflects the complexity of these risks and the need for further research to explore contributing factors. This study provides new insights into the dose- and time-dependent effects of CS-induced psychiatric symptoms, offering effective risk management strategies.

A woman in her third trimester of pregnancy presented with acute-onset, sharply localised abdominal and back pain that impaired her mobility. Physical examination revealed focal tenderness, positive Carnett's sign and reproducible pain on the pinch test. Laboratory tests and imaging findings revealed no abnormalities. Based on these clinical features, the patient was diagnosed with pregnancy-related abdominal wall neuropathy (PRAWN), with anterior, lateral or posterior cutaneous nerve entrapment. Treatment with ultrasound-guided nerve blocks using local anaesthetics led to rapid resolution of symptoms. This case highlights the importance of considering PRAWN in the differential diagnosis of pregnancy-related pain, which is often underdiagnosed based on laboratory tests and imaging investigations that frequently yield negative results. The rapid response to local anaesthetic injections confirmed the diagnosis.

Hyperkalemia is a potentially life-threatening condition, particularly in patients with chronic kidney disease (CKD). Potassium-enriched salt substitutes are increasingly promoted as a dietary intervention for hypertension, but may pose risks in patients with impaired renal function. We report the case of an 88-year-old male with CKD who developed asymptomatic but marked hyperkalemia (7.5 mEq/L) during hospitalization for osteomyelitis. The patient had unknowingly consumed a potassium-enriched salt substitute brought in by his family to improve the taste of hospital meals. His renal function had previously declined due to septic and prerenal acute kidney injury. Following identification of the hyperkalemia, the patient was treated with glucose-insulin therapy, intravenous fluids, diuretics, and sodium polystyrene sulfonate, leading to normalization of serum potassium levels. This case highlights the importance of monitoring dietary potassium sources in hospitalized patients with CKD and underscores the need for patient and caregiver education regarding the risks of unregulated dietary supplements, especially potassium-based salt substitutes.

This study aimed to develop population pharmacokinetic (PK) models of cefoperazone and sulbactam through simultaneous analysis of plasma and urine data in pediatric patients and to optimize dosing regimens based on PK/pharmacodynamic (PD) simulation. Population PK models of cefoperazone and sulbactam were separately developed by simultaneously fitting plasma and urine data from pediatric patients described in 9 published articles. Probabilities of attaining the bactericidal target of 70% of free time above minimum inhibitory concentration (70% fT > MIC) for cefoperazone against clinical isolates of common bacteria were estimated based on the final model. Seventy-eight pediatric patients were the subjects for PK modeling (0.83-14.6 years old and 6-51.6 kg of body weight). A total of 439 plasma concentrations and 138 urinary excretions up to 7 hours after administration were used for population PK modeling. The data were adequately described by 2-compartment models for cefoperazone and sulbactam. Age was not a statistically significant covariate in the PK of both drugs. For empiric therapy of community-acquired pneumonia, the PK/PD breakpoint of 0.5-hour infusion of 20 mg/kg (cefoperazone-sulbactam dose ratio of 1:1) 4 times daily was 0.13 μg/mL and could cover MIC 90 of Streptococcus pneumoniae (MIC 90 = 0.125 μg/mL) and Haemophilus influenzae (MIC 90 = 0.125 μg/mL). However, since MIC 90 values for nosocomial pathogens are high (MIC 90 = 2 μg/mL for Staphylococcus aureus and MIC 90 = 4 μg/mL for Morganella morganii ), a 4-hour infusion of 60 mg/kg (cefoperazone-sulbactam dose ratio of 2:1) 4 times daily might be better to cover many pathogens. This study described population PK models of cefoperazone and sulbactam detailing the excretion process with urine data in pediatric patients and developed optimal dosing regimens of cefoperazone-sulbactam including extended infusion in consideration with pathogens, based on PK/PD simulation.