著者

鹿村 恵明 高橋 淳一 大山 明子 根岸 健一 伊集院 一成 上村 直樹 青山 隆夫

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.131, no.10, pp.1509-1518, 2011 (Released:2011-10-01)

参考文献数

9

被引用文献数

2 4

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Community pharmacists can provide effective pharmaceutical care by questioning the physicians about their prescriptions. The regulatory authority (Ministry of Health, Labour and Welfare or the like) has been issuing instructions/advice to health insurance-covered pharmacies about the nature of questions to be asked to physicians under the national health insurance system. However, this practice has been facing similar kind of problems almost every year. To identify the reasons for repetition of the problems and facilitate proper application of drug therapy at hospitals, we recently examined the nature of questions asked to physicians by conducting a survey of 165 health insurance-covered pharmacies belonging to 8 district branches of the Japan Pharmaceutical Association. When the pharmacists were asked to express their view whether each of the 18 sample questions included in the past surveys was actually necessary, the most frequent answer from the respondents (n=1980) was “neutral” (42.9%), followed by “unnecessary” (29.0%) and “necessary” (26.6%). Further, 55.5% respondents answered that it is necessary to refer to publications of the concerned fields (guidelines, etc.) when questioning the prescriptions. However, the responses about the possible reasons for judging the necessity of the questions suggested that sometimes the pharmacists failed to understand the details of such publications. The results from this study suggest that a high percentage of community pharmacists believed that there was little need to ask questions about prescriptions if the suggestions made by the regulatory authority about the relevant questions were taken into account. Further, our study findings suggested that pharmacists working at clinics cannot present a clear-cut rationale for their judgment about the necessity of asking questions about prescriptions under the current circumstances where sufficient information collection and the evaluation of need for asking questions about prescriptions are not possible.

著者

鹿村 恵明 大山 明子 高橋 淳一 赤木 祐貴 根岸 健一 伊集院 一成 上村 直樹 青山 隆夫

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.132, no.6, pp.753-761, 2012-06-01 (Released:2012-06-01)

参考文献数

18

被引用文献数

13 8

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This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an “Incomplete entry in the prescription (compared with previous prescription, etc.)” should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.

著者

田村 美恵子 野田 誠 村上 輔 渡部 真吾 大山 明子 山本 康人 田代 宏徳 薄井 宙男 市川 健一郎 恵木 康壮 針谷 明房 高澤 賢次 磯部 光章

出版者

一般社団法人 日本不整脈心電学会

雑誌

心電図 (ISSN:02851660)

巻号頁・発行日

vol.32, no.1, pp.5-10, 2012 (Released:2015-06-18)

参考文献数

6

被引用文献数

1

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症例は47歳,男性.生来健康で,胸痛などの自覚症状はない.意識障害にて当院救急外来を受診したところ,心電図上完全房室ブロックによる最大10秒までの心停止を繰り返した.徐脈による症状と推定し,緊急入院のうえ経静脈ペーシングを行い,待機的に電気生理学的検査ならびにペースメーカー植込み術を施行した.冠動脈に異常はなく,左室収縮機能も正常であった.His束心電図ではHVブロックを認めたが,逆行性房室伝導はみられなかった.洞結節回復時間を確認するため洞調律より20bpm速い頻度(110bpm)で刺激を加えたところ,刺激直後から1:1の関係を保って持続的に心房刺激が心室を捕捉する所見がみられた.刺激停止後に再びHVブロックによる房室伝導障害が顕在化した.本現象は器質的心疾患の指摘されない健常心筋に生じた徐脈依存性ブロックと考えられ,その機序に第4相ブロックの関与が示唆された.

著者

大山 明子

出版者

日本フランス語フランス文学会関西支部

雑誌

関西フランス語フランス文学 (ISSN:24331864)

巻号頁・発行日

vol.26, pp.15-26, 2020-03-31 (Released:2020-07-10)

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La Poétique de Charles Perrault dans son essai de poème épique chrétien Le milieu du XVIIe siècle a vu paraître de nombreux poèmes épiques traitant de sujets chrétiens. Cette veine, souvent négligée par l’histoire littéraire, qui l’a jugée comme un échec, est fortement liée à la Querelle des Anciens et des Modernes. Le chef du parti moderne, Charles Perrault (1628-1703), est un des auteurs et promoteurs de ce nouveau genre. Dans cet article, nous étudions un de ses poèmes épiques intitulé Saint Paulin, évêque de Nole (1686), en concentrant notre analyse sur l’épître dédicatoire adressée à Bossuet, qui était un évêque puissant à l’époque. Nous nous employons à dégager les idées originales que Perrault met en oeuvre dans sa pratique du genre. Dans la première moitié de son épître, Perrault essaye de se justifier sur le choix du sujet de Saint Paulin en se fondant sur les règles générales de la poésie épique communément admises à cette époque. Plus originale est la seconde partie, où il propose sa propre poétique, qui vise à faire naître chez le lecteur des sentiments moraux et pieux à travers les descriptions de la nature et des choses humaines. Cette « poétique morale et pédagogique » dépasse l’opposition entre le christianisme et le paganisme, et pose les jalons vers l’oeuvre de ses dernières années, ses célèbres Contes.

著者

大山 明子

出版者

日本フランス語フランス文学会関西支部

雑誌

関西フランス語フランス文学 (ISSN:1341433X)

巻号頁・発行日

no.23, pp.15-26, 2017