著者

大橋 健吾 松岡 知子 篠田 康孝 吉田 真也 新井 かおり 加藤 未紗 森 卓之 吉村 知哲

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.137, no.5, pp.643-650, 2017 (Released:2017-05-01)

参考文献数

19

被引用文献数

6

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In recent years, hospitals have routinely implemented antimicrobial stewardship (AS) programs, and it is important that these programs are effective. Consequently, we utilized a customized computer system to support infection management and implemented a pharmacist-driven AS program in our hospital. Using this computer system, a pharmacist monitored the daily usage of carbapenems and agents against anti-methicillin-resistant Staphylococcus aureus and generated a patient database. With the use of this computer system, we found that the patient database entry time significantly decreased from 24 to 12 min (p<0.01). Subsequently, we were also able to monitor tazobactam/piperacillin usage owing to the increased efficiency of our AS program. As a result, the average number of monitored patients significantly increased from 51 to 72 per month (p<0.01) and the number of proposed prescriptions increased from 189 to 238 per year. Additionally, the usage of carbapenems and tazobactam/piperacillin significantly decreased (p<0.01) after implementation of this computer support system. In summary, we recommend that pharmacists utilize computer systems to implement AS programs because they increase the efficiency of interventions and monitoring of patients and promote appropriate antibiotic use.

著者

篠田 梨恵 篠田 康孝 森 卓之 吉村 知哲

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.141, no.2, pp.281-288, 2021-02-01 (Released:2021-02-01)

参考文献数

24

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Tolvaptan (TLV) carries the risk of serious side effects, and its introduction requires hospitalization. Therefore, it is important from the viewpoints of safety and medical economics to predict in advance, the patients for whom it will be effective and introduce it. The purpose of this study was to investigate the noninvasive and simple predictors for identifying TLV responders. We conducted a retrospective observational study of patients with heart failure who had TLV introduced at our hospital from January 1, 2017, to December 31, 2018. By using the body weight and BNP reduction as the effect indices, predictors of body weight and BNP reduction were extracted by logistic analysis. The sensitivity and specificity at the cutoff value obtained by ROC analysis were also examined. Among 85 subjects, urine sodium concentration >63 mEq/L [odds ratio (OR): 6.11, 95% confidence interval (CI): 1.36-27.4] was detected as a predictor of body weight reduction. The sensitivity at this cutoff value was 81%, and the specificity was 70%. Serum osmolarity>291 mOsm/L (OR: 3.76, 95% CI: 1.00-14.2), urine potassium concentration<21 mEq/L (OR: 4.45, 95% CI: 1.09-18.2), and urine sodium concentration>71 mEq/L (OR: 7.38, 95% CI: 2.05-26.6) were detected as predictors of BNP reduction. The sensitivities were 62%, 53%, and 73%, and the specificities were 58%, 68%, and 68%, respectively. Therefore, it was suggested that urine sodium concentration may be useful as a predictor of body weight and BNP decrease after TLV induction.

著者

郷 真貴子 川地 志緒里 宇佐美 英績 木村 美智男 吉村 知哲

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.44, no.6, pp.280-287, 2018-06-10 (Released:2019-06-10)

参考文献数

18

被引用文献数

3

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A pharmacist outpatient service for patients receiving monotherapy with oral anticancer drugs aims to improve safety and medication continuation through pre-examination interviews. We assess medication adherence and monitor chemotherapy-induced adverse events by referring to patientsʼ complaints of symptoms and their medical diaries. In addition, “unused prescribed medicines” can also be a useful information resource. However, unused medicines are becoming a large-scale problem in Japan, thus leading to lower therapeutic effects and higher healthcare costs. In this study, we interviewed 270 patients (cumulative total: 1,385, monthly average: 153.9) from January 1 to October 31, 2017. Adjusted numbers of unused anticancer drugs were 96 and those of unused medicines for supportive care were 420, including moisturizing creams and steroidal ointments (23.1%), antidiarrheal drugs (18.1%), and antiemetic drugs (8.1%). We calculated the reduction in healthcare costs as JPY 5,045,585.5 (monthly average: JPY 560,621) for all unused medicines and as JPY 4,699,791.6 (monthly average: JPY 522,199) for only unused anticancer drugs. Anticancer drugs went unused because of chemotherapy-induced adverse events (grade 1: 37.3%, grade 2: 60.8%, grade 3: 2.0%) and failure to take them as prescribed. However, the chemotherapy discontinuation rate caused by adverse events was only 6.8% through our continuous interventions. Chemotherapy with oral anticancer drugs needed to be discontinued appropriately in cases of developing grade≧2 adverse events; therefore, unused medicines exist. This pharmacist outpatient service can also lead to major reductions in healthcare costs through management of unused medicines.

著者

種田 靖久 森 博美 吉村 知哲 山口 均 高須 昭彦 安田 忠司

出版者

一般社団法人 日本臨床救急医学会

雑誌

日本臨床救急医学会雑誌 (ISSN:13450581)

巻号頁・発行日

vol.16, no.5, pp.625-631, 2013-10-31 (Released:2013-11-25)

参考文献数

18

被引用文献数

2

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デクスメデトミジン(以下DEX)は,呼吸抑制作用が軽微な鎮静薬であるが,循環器系への作用に徐脈の危険性や血圧低下などの問題がある。今回DEXの使用適正化に向けてICU専任薬剤師として鎮静プロトコルを作成し介入を行った。鎮静プロトコル導入前と比較し,導入後ではBolus投与率が減少する傾向を示し(13.2% vs. 3.5%,p=0.0569),副作用発現率が有意に減少した(42.1% vs. 23.3%,p=0.0472)。DEX平均投与量,併用鎮静薬剤の投与量,挿管日数については導入前後で差は認められなかった。また,Bolus投与群では,非Bolus投与群と比較し副作用発現までの時間が有意に早くなり(1.8hr vs. 3.6hr,p=0.0085),Bolus投与と副作用発現の関連性が示唆された。ICU専任薬剤師として,薬剤の適正使用に積極的に関わることにより副作用軽減につながると考えられる。

著者

松岡 知子 宇佐美 英績 吉村 知哲 高田 裕子 安田 忠司

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.37, no.8, pp.487-493, 2011 (Released:2012-08-30)

参考文献数

13

被引用文献数

2 3

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Liposomal-Amphotericin B (L-AMB) may cause hypokalemia. This study was carried out to examine the occurrence of hypokalemia and its primary causes in 74 patients who were administered L-AMB. They were divided into 2 groups regarding the severity of hypokalemia that occurred: Grade 0-2 group: 35 patients (47.3%), and Grade 3-4 group: 39 patients (52.7%). The results of a comparison of the Grade 0-2 group and Grade 3-4 group showed that causes for the Grade 3-4 group were significantly different from those in the Grade 0-2 group, which were a serum albumin level of more than 2.82 mg/dL at the start of the L-AMB administration (p=0.004, OR: 8.711, 95%CI: 2.273-45.823), and a history of hypokalemia before L-AMB administration (p=0.009, OR: 7.859, 95%CI: 1.844-44.109) in the Grade 3-4 group.While combination with trimethoprim-sulfamethoxazole resulted in significant avoidance of Grade 3-4 hypokalemia (p=0.019, OR: 0.233, 95%CI: 0.063-0.750), administration of potassium for preventive or maintenance purposes did not affect the occurrence of hypokalemia (p=0.137, p=0.198). However, for 20 patients with an abnormal serum potassium level (Grade 1 and more) at the start of L-AMB administration, our findings suggested that the preventive/maintenance administration of potassium was indeed effective (p=0.011).It has been proven that L-AMB causes hypokalemia frequently and the primary causes have been clarified. In this regard, it is important to regularly monitor serum potassium levels and adjust them depending on the situation of patients with hypokalemia.

著者

川口 実希 木村 美智男 宇佐美 英績 川地 志緒里 郷 真貴子 池田 義明 吉村 知哲

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.139, no.3, pp.483-490, 2019-03-01 (Released:2019-03-01)

参考文献数

22

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This study aimed to clarify the situation of use of health foods by patients and the level of satisfaction of patients in order to make use of information on cases where patients undergoing cancer medication therapy use health foods. Between May 7, 2018 and June 29, 2018, we conducted a questionnaire survey of patients with progressive cancer who were undergoing cancer chemotherapy at Ogaki Municipal Hospital. In addition, we conducted a multivariate analysis of patients who were using health foods and those who were not. The questionnaire items included the objectives of use, product effectiveness and satisfaction, and QOL. The rate of health food use was 81/281 (29.5%). The primary objectives of use were, “to maintain health” (29.8%) and “to alleviate symptoms” (24.0%). The primary sources of information about health foods were “a friend” (50.6%) and “TV” (13.5%). The satisfaction level was 0-3 points in 8.3% of patients, 4-6 points in 38.1% of patients, and 7-10 points in 53.6% of patients. For “stage of illness (recurrence),” the odds ratio was 1.810 (95% CI, 1.040-3.150; p=0.035), and for “QOL value,” the odds ratio was 2.210 (95% CI, 1.220-4.020; p=0.009), indicating that these factors had a significant influence on health food use. Health foods tended to be used in patients who had recurring cancer with low QOL and various symptoms, and friends and other people close to the patient had a large influence on the patient's decision. It was clear that the patients' satisfaction level was high.