Multiple drug use is very common in the elderly， which will significantly increase drug interactions and adverse drug reactions. Cardiovascular disease complicated with neuropsychiatric disease is the most common multi-disease comorbidity among the elderly， and it is also one of the disease combinations involving the most multiple drug use. In order to reduce the adverse clinical outcomes of the elderly in China， Chinese Society of Clinical Pharmacy of Chinese Medical Association organized relevant experts to develop Expert Consensus on Risk Prevention and Control of Multiple Drug Use in Elderly Patients with Cardiovascular Diseases and Neuropsychiatric Diseases in China by using foreign drug use risk assessment tools and combining relevant evidence-based results， and further promote its application in clinical disease treatment practice to reduce the adverse clinical outcomes of the elderly in China.

The purpose of this study is to investigate whether regular visits to community pharmacies to take medications contributes to the prevention of frailty in the elderly and whether it also contributes to the improvement of leftover medications. The patients showed a significant increase in the number of steps taken after interventions, and the frailty index using J-CHS criteria also showed a significant improvement after interventions. In addition, two patients were found to have leftover medications, but improvement was observed after interventions. In the post-intervention patient satisfaction survey, all seven patients responded positively to the following questions: “Effectiveness of medication management,” “Improvement in medication adherence,” “Improvement in physical condition,” “Increase in the number of outings,” “Increase in the amount of exercise,” and “Appropriateness of the number of visits.” On the other hand, two patients responded negatively to the following questions: “Improvement of sleep,” and “Improvement of diet.” As a result, it can be inferred that this initiative is beneficial for the prevention of frailty in elderly patients.

Objective: Antibiogram preparation is important for the proper selection of antimicrobial agent in empiric therapy. It is recommended to prepare the antibiogram separately for inpatients and outpatients. However, the antimicrobial agent susceptibility of bacteria detected from an inpatient is thought to be different when detected at an early date after admission and after a certain period after admission.Methods: In this study, we defined the bacteria detected from an inpatient within 3 days after admission as “brought bacteria” and those over 3 days after admission as “bacteria detected after admission.” Antimicrobial agent susceptibilities of brought bacteria and bacteria detected after admission in our hospital between April 2018 and March 2019 were compared for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.Results: The occurrence rate of Escherichia coli producing an extended β-lactamase of bacteria detected after admission was found to be significantly higher compared with that of brought bacteria. The sulbactam/ampicillin susceptibility rate of bacteria detected after admission was significantly lower than that of brought bacteria. The occurrence rate of the two drug-resistant Pseudomonas aeruginosa detected after admission tends to be higher compared with that of brought bacteria.Conclusion: Our findings showed that the susceptibility rate of some drugs differed substantially between brought bacteria and bacteria detected after admission. Therefore, the inpatient’s antibiogram is thought to be prepared by separating bacteria detected at an early date after admission and after a certain period after admission, leading to the proper selection of antimicrobial agent in empiric therapy tailored to a patient’s number of days in the hospital.

In Japan, the revised Immunization Law was enacted in December 2020, and municipalities have promoted a free vaccination project against COVID-19 with the aid of upper prefectural governments under the management of the Minister of Health, Labour and Welfare. To support prompt vaccination for residents over 65 years old, Kawachinagano City Pharmaceutical Association supplied a Prevaccination Screening Questionnaire to all pharmacies in Kawachinagano in cooperation with the local governments and medical associations. We conducted a questionnaire survey on the handling of questionnaire forms at pharmacies and the content of consultation by residents regarding vaccination, and investigated the significance of community pharmacy in regional medical activities by analyzing the responses. By the end of May 2021, the number of questionnaire forms provided to residents from pharmacies of the Kawachinagano City Pharmaceutical Association was approximately 3,000, which was attributable to the efforts of each pharmacist in almost all pharmacies to individually offer sincere consultation services to residents. In addition, residents were markedly concerned about pharmacotherapy, with the frequency of consultation by residents being higher about “treatment details, including drug use” and “adverse reactions of the vaccine.” Our study revealed that community pharmacies of the Kawachinagano City Pharmaceutical Association largely contributed to the smooth implementation of vaccination by performing routine work originally dealt to the local governments and medical institutions, which strongly suggests that community pharmacies fulfill their mission corresponding to social needs even during a pandemic.

OBJECTIVE：To provide sugge stions for improving the variety of pediatric drugs and ensuring the safety of pediatric drug use in China. METHODS ：The historical evolution of laws and regulations on the marketing approval of pediatric drugs in the United States and the implementation results of relevant policies were summarized. Combined with the current situation of the development of pediatric drugs in China ，some suggestions were put forward to ensure the accessibility and safety of pediatric drug use in China. RESULTS & CONCLUSIONS ：Since 1994，the United States had issued a series of laws and regulations to encourage the development of pediatric drugs. At present ，the marketing approval of pediatric drugs were mainly based on the two laws of Best Pediatric Drug Act（BPCA）and Pediatric Research Equality Act （PREA）. From 1998 to 2019，the amount of supplements of pediatric drug information in drug instructions of the United States showed a fluctuating growth. As of April 2020，854 kinds of drugs had been modified in pediatric instructions ，792 of which had been carried out post marketing pediatric clinical research ，and the problem of incomplete pediatric instructions had also been greatly improved. At present ，China’s policies on pediatric drugs mainly included encouraging R&D innovation ，giving priority to review and approval ，and strengthening R&D technical guidance. Although certain achievements had been made ，there were still some problems ，such as imperfect policies and regulations ，and great difficulties carrying out pediatric drug clinical trials. It is suggested that our country should draw lessons from the American regulations on pediatric drugs ，pediatric research and the catalogue of pediatric drugs ，and establish a system and catalogue of ped iatric drug use suitable for China ’s national conditions ，so as to improve the effectiveness ，safety and accessibilityof pediatric drugs.

The common adverse reactions caused by poly (ADP-ribose) polymerase (PARP) inhibitors include hematological toxicity, gastrointestinal toxicity and fatigue. The main prevention and treatment of hematological toxicity include: regular blood tests, referral to hematology department when routine treatment is ineffective, and being alert of myelodysplastic syndrome/acute myeloid leukemia. The key points to deal with gastrointestinal toxicity include: taking medicine at the right time, light diet, appropriate amount of drinking water, timely symptomatic treatment, prevention of expected nausea and vomiting, and so on. For fatigue, full assessment should be completed before treatment because the causes of fatigue are various; the management includes massage therapy, psychosocial interventions and drugs such as methylphenidate and Panax quinquefolius according to the severity. In addition, niraparib and fluzoparib can cause hypertension, hypertensive crisis and palpitation. Blood pressure and heart rate monitoring, timely symptomatic treatment, and multidisciplinary consultation should be taken if necessary. When cough and dyspnea occur, high resolution CT and bronchoscopy should be performed to exclude pneumonia. If necessary, PARP inhibitors should be stopped, and glucocorticoid and antimicrobial therapy should be given. Finally, more attention should be paid to drug interaction management, patient self-management and regular monitoring to minimize the risk and harm of adverse reactions of PARP inhibitors.
Humans ; Poly(ADP-ribose) Polymerase Inhibitors/adverse effects* ; Phthalazines/pharmacology* ; Poly(ADP-ribose) Polymerases ; Fatigue/drug therapy*

The aging population in Japan continues to grow, leading to the emergence of complex issues. To understand the current awareness of these issues among member pharmacies of the Fukuoka City Minami Ward Pharmaceutical Association and promote various initiatives, support tools such as the “Consultation Flowchart” and “Consultation Checklist” were distributed to share information about the elderly with the local comprehensive support center. A survey was conducted to assess the awareness of complex issues and support tools. The survey revealed that about half of the pharmacy pharmacists were aware of the complex issues themselves, but the Consultation Flowchart had a recognition rate of 35.34%, and the Consultation Checklist had a recognition rate of 31.03%. It was also found that pharmacies with higher participation in regional collaboration meetings and a greater number of visits for medication management counseling had higher awareness of complex issues and support tools. To enhance efforts in addressing complex issues, the Fukuoka City Minami Ward Pharmaceutical Association needs to approach pharmacies with limited participation in regional collaboration meetings and a lower number of visits for medication management counseling. Building visible relationships with diverse professions in the community is crucial for improvement initiatives related to complex issues.

The advent of immersive technologies such as the metaverse,extended reality,artificial intelligence,and blockchain offers novel possibilities to transform healthcare services.These innovations coincide with clinicians'aspirations to deliver more comprehensive,patient-centered care tailored to individuals'singular needs and pref-erences.Integration of these emerging tools may confer opportunities for providers to engage patients through new modalities and expand their role.However,responsible implementation necessitates deliberation of ethical implications and steadfast adherence to foundational principles of compassion and interpersonal connection un-derpinning the profession.While the metaverse introduces new channels for social prescribing,this perspective advocates that its ultimate purpose should be strengthening,not supplanting,human relationships.We propose an ethical framework centered on respect for patients'dignity to guide integration of metaverse platforms into medical practice.This framework serves both to harness their potential benefits and mitigate risks of dehuman-ization or uncompassionate care.Our analysis maps the developing topology of metaverse-enabled care while upholding moral imperatives for medicine to promote healing relationships and human flourishing.

Objectives: “Adverse Drug Reaction Relief System” (hereinafter called the Relief System) has been established to provide prompt relief to patients experiencing health damage caused by adverse drug reactions. Since 2018, the Relief System has required community pharmacies that acquire additional points as local support system to actively report adverse drug reactions. Here, we investigated the recognition and utilization of the relief system among community pharmacists.Method: A questionnaire survey was conducted among community pharmacists between August 1 and September 30, 2019.Results: The survey achieved a response rate of 58.1%. The recognition rates of the relief system and Pharmaceuticals and Medical Devices Agency (PMDA) as its application destination were 98.9 and 74.5%, respectively. Of the community pharmacists, 2.6% had experience in utilizing the relief system; and 8.8% did not want to recommend the utilization of the relief system for patients mainly because of the “low recognition of the system” and “the complicated and troublesome preparation of the necessary documents such as medical certificates.” The community pharmacists who acquire additional points as local support system, compared with those who do not, achieved significantly higher rates in two items, including that for preparation of the documented procedures pertaining to adverse drug reactions.Conclusion: Despite the high recognition of the relief system among community pharmacists, the percentage of pharmacists with experience in actually utilizing the relief system and applying to the PMDA was low. One reason that the use of the relief system was not widespread was the low recognition particularly of the destination and procedures of reports on adverse drug reactions. In the future, educational campaigns to improve pharmacists’ comprehension of the relief system will be needed. Moreover, pharmacists must play a central role in enhancing the recognition of the public relief system and promoting medical safety.

Advances in information and communication technology (ICT)-especially, the spread of social networking services (SNSs)-have facilitated the dissemination of information and an explosion of health information lacking scientific evidence. Therefore, we believe that community pharmacies are the most suitable bases for distributing health information. In 2019, we launched the health support pharmacy “Toyonaka Model” in collaboration with the pharmaceutical association, municipal government, and university. Touch-panel digital signage (DS) was used for real-time distribution of ever-changing information and a rapid grasp of pharmacy users’ responses to various types of information. Between September 2019 and August 2021, one DS was installed in a pharmacy in each of Toyonaka City’s seven areas along with 14 questions on the usefulness of the delivered information. Respondents answered the 14 questions by a tablet or questionnaire; touch logs for DS were collected. When a pharmacy user consulted with a pharmacist about information delivered via DS, the contents were recorded and described by the pharmacist on a 4-point scale (e.g., “inquiry only,” “went through to execution”). From the 850 completed questionnaires and 61,565 touches, 88.7% of the respondents indicated that the information was useful, and 90.0% expressed interest in receiving more health information in the future. Thus, health information provided by DS may be useful to pharmacy users, as demonstrated by 113 cases in which the pharmacist was consulted regarding such information. In 62 of these cases, there were indications that the DS information might have influenced users’ behavior and intended actions.