A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

Objective: To clarify challenges and strategies to execute pharmaceutical care by community pharmacists and obtain pragmatic implications for further improvement. Design: Cross-sectional study.. Methods: We conducted a nationwide internet-based questionnaire survey about pharmaceutical care by the Japanese community pharmacists in June and July 2016. Using text data of 161 respondents, we investigated their challenges and strategies in implementing pharmaceutical care. The text data were reviewed and determined for categorization through stepwise process and reconciliation between reviewers. Results: Fourteen categories were retrieved and integrated into 4 domains (pharmacists, patients, other medical professionals, and environment) from 2 dimensions (challenges and strategies). In the challenge dimension (total n＝142), communication capability (n＝26), participation in medical team (n＝17), patients’ understanding of pharmacists’ work (n＝14), lack of timeand staff (n＝14),patient- and people-centered viewpoint (n＝13). Whilein thestrategy dimension (total n＝72), communication capability (n＝21),lack of patients’ medical information (n＝18), patient- and people-centered viewpoint (n＝11), lack of timeand staff (n＝9), and self development (n＝5). As strategies for the communication capability, attitude of acceptance and collaboration, brief explanation,utilization of visual aids, adoption of objective evaluation, various acquisition of patients’ information, active listening, and sharing patients’ information were retrieved as subcategories. The highest level of attention to communication capability implies that community pharmacists certainly recognize their expected responsibility described in the government document titled “Vision for patient-centered pharmacies”. Conclusion: Community pharmacists face many challenges but have some practical strategies. Although part of such challenges is not for pharmacists themselves but for patients, other medical professionals, or entire health system, improving essential skills of pharmacists may havepositiveinfluenceto theother challenges.