Introduction : This study examines the feasibility of providing end-of-life care at a residential aged care facility using advance patient directives from the perspective of the non-medical facility staff.
Methods : Efforts were made by the facility staff to obtain advanced patient directives (APD) from 240 residents. Compliance by staff and residents in documentation of APDs for cardiopulmonary arrest (CPA) was examined.
Results : APDs were obtained from 204 residents (85%) and all responded to questions regarding end-of-life care in the facility without resuscitation or emergency transfer, indicating their autonomous wishes. Of the 204 respondents, 196 indicated preferences for both resuscitation and emergency transfer, 62% of which indicated preference for no resuscitation and no emergency transfer. No statistical differences were noted based on age, sex, or diagnoses. Fourteen residents died eight (58%) of whom received end-of-life care in the facility.
Conclusion : Non-medical staff can effectively document resident's wishes using APDs addressing clinical deterioration and CPA.

Objective: Pharmacotherapy for patients with breast cancer is now administered in an ambulatory setting, and we assume that patients would benefit if clinical pharmacists perform all stages of pharmacological intervention up to prescription in an ambulatory setting as well, especially for medicines requiring chronic administration and those that affect the patient’s life, such as hormonal therapy.  A thorough understanding of guidelines and the clinical reports is paramount for effective pharmacological intervention.  Since ambulatory care clinical pharmacists are involved in the treatment of a large number of patients, effective utilization of evidence outlined in guidelines and clinical reports is difficult.  Therefore, we developed a system for utilizing evidence as outlined in guidelines and clinical reports with a focus on hormonal therapy for patients with breast cancer.
Methods: A database based on the 2013 version of the clinical practice guidelines for breast cancer and clinical reports was constructed using Microsoft® Access 2010.
Result: Clicking on a guideline algorithm according to the disease stage of the patient results in a clinical question being displayed, and the ambulatory care clinical pharmacist is immediately able to determine suitable medications based on clinical reports that are run through the database.
Conclusion: With the use of this database, which includes information required for pharmacological intervention, ambulatory care clinical pharmacists could care for a large number of patients.

Objective: To evaluate the efficacy and safety of niraparib in Japanese women with heavily pretreated ovarian cancer. Methods: This Phase 2 open-label, single-arm study enrolled Japanese women with homologous recombination deficiency-positive relapsed, high-grade serous ovarian, fallopian tube, or primary peritoneal cancer who had completed 3–4 lines of therapy. The starting dose of niraparib was 300 mg administered once daily in continuous 28-day cycles until objective progressive disease, unacceptable toxicity, consent withdrawal or discontinuation. The primary endpoint, objective response rate (ORR), was assessed by the investigator using RECIST version 1.1. Safety evaluations included the incidence of treatment-emergent adverse events (TEAEs), including serious TEAEs. Results: Twenty women were enrolled and the confirmed ORR in the full analysis set (FAS) was 35.0% (7/20), consisting of 1 complete response and 6 partial responses. Disease control rate in the FAS was 90.0%. The most frequently reported TEAEs (>50%) were anemia, nausea, and platelet count decreased. One patient (5.0%) had TEAEs leading to discontinuation of niraparib whereas reductions or interruptions were reported in 14 (70.0%) and 15 (75.0%) patients, respectively. The median dose intensity (202.9 mg daily) corresponded to a relative dose intensity of 67.6%. Conclusion Efficacy and safety of niraparib in heavily pretreated Japanese women was comparable to that seen in an equivalent population of non-Japanese women. No new safety signals were identified.