著者

齋藤 佳敬 山田 武宏 小林 正紀 榊原 純 品川 尚文 木下 一郎 秋田 弘俊 井関 健

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.12, pp.1601-1608, 2019-12-01 (Released:2019-12-01)

参考文献数

20

被引用文献数

1

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Paclitaxel (PTX)-associated acute pain syndrome (P-APS) is characterized by disabling but transient arthralgia and myalgia in up to 80% of patients administered with PTX. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely administered to patients with cancer who have pain or fever, and are mainly used to manage P-APS. In this study, we investigated how P-APS appear in the patients who were administered NSAIDs prior to PTX injection. The incidence or severity and duration of P-APS in patients previously administered NSAIDs were compared to those of patients who were not administered NSAIDs. The relationship between previously administered NSAIDs and rescue administration for the relief of P-APS was also evaluated. It was revealed that the incidence and duration of P-APS were 72% and 4.67±2.30 d, respectively, in the control group and 84% and 6.19±3.30 d, respectively, in the NSAIDs group. There was no significant difference in the incidence and duration and the severity of P-APS between the two groups. Patients who were previously administered NSAIDs tended to obtain less pain relief from NSAIDs administered as rescue medications, and needed other medication. Univariate and multivariate analysis revealed no correlation between previously administered NSAIDs or patient characteristics and the incidence of P-APS. In this study, it was found that clinical condition that needs NSAIDs and previously administered NSAIDs prior to PTX injection do not affect the incidence, severity, and duration of P-APS. These results will help in educating patients about their medications and will contribute to the management of P-APS.

著者

山田 武宏 鏡 圭介 今井 俊吾 秋沢 宏次 岩崎 澄央 福元 達也 石黒 信久 井関 健

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.7, pp.917-925, 2017 (Released:2017-07-01)

参考文献数

16

被引用文献数

3

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Bacteremia is one of the most serious infectious illness resulting from nosocomial infection. Therefore, appropriate antimicrobial chemotherapy should be provided as soon as possible to patients exhibiting symptoms of infectious disease and having positive blood culture results. Antimicrobial stewardship (AS) guidelines were recently released by the Infectious Diseases Society of America. The guidelines recommend “proactive intervention and feedback” as one of the core strategies for implementing optimal antimicrobial drug use to improve patient outcomes in clinical settings. We began using the AS program for optimizing antimicrobial chemotherapy in patients with positive blood culture results. The results of blood cultures and antimicrobial prescriptions for the corresponding patients were daily reviewed by a pharmacist and a physician, members of the infection control team (ICT). If the antimicrobial agents selected were inappropriate, ICT made a recommendation to the attending physicians who prescribed the antibiotics. To evaluate the outcomes of this program, we conducted a single-center, retrospective investigation for near a hundred of patients who underwent intervention by infection-control physician and pharmacist. Resolution of bacteremia (determined by blood culture results) was 96.3% in the group that accepted intervention, whereas only 16.7% of the cases resolved in the group that did not accept intervention. These results strongly suggest the importance of the infection disease-specialist team intervention. This program could become an important method for improving clinical outcomes in patients with bacteremia.

著者

今井 俊吾 山田 武宏 西村 あや子 沖 洋充 熊井 正貴 宮本 剛典 笠師 久美子 井関 健

出版者

Japanese Society of Drug Informatics

雑誌

医薬品情報学 (ISSN:13451464)

巻号頁・発行日

vol.16, no.4, pp.169-178, 2015 (Released:2015-03-10)

参考文献数

13

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Objective: To attain optimal blood concentration rapidly, it is needed to perform initial dose setting appropriately when vancomycin (VCM) used.  In order to design initial dose settings of VCM more currently, we compared the predictive performance of two types of VCM therapeutic drug monitoring (TDM) analysis software retrospectively.Method: We utilized two TDM analysis software, SHIONOGI-VCM-TDM ver.2009 (VCM-TDM) and “Vancomycin MEEK TDM analysis software Ver. 2.0” (MEEK), based on patient’s background. 112 patients who received VCM and performed TDM were analyzed during the period from October 2011 through September 2012 and compared the actual trough level with the predictive trough level.  The predictive performance was evaluated by calculating ME (mean prediction error), MAE (mean absolute prediction error), and RMSE (root mean squared error).  Age, gender, and a renal function were evaluated as patient’s background.Results: VCM-TDM gave good predictive performance for patients overall.  When classified patient’s background complexly (sex, age, and renal function), as for male patients, VCM-TDM showed good predictive performance except for the group over 65 years old and CCr over 85 mL/min.  For female patients, the difference of predictive performance was not accepted by all groups.Conclusion: These results suggest, for male patients, we should use VCM-TDM for initial dose settings except for the group over 65 years old and over CCr 85 mL/min.  For the other patients, we consider that both of software can be used.  These new findings seem to contribute to proper dosage settings of VCM.

著者

小林 洋平 山岡 怜央 三上 龍生 山崎 浩二郎 熊井 正貴 山田 武宏 武隈 洋 菅原 満 井関 健

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.23, no.6, pp.771-779, 2020-12-28 (Released:2020-12-28)

参考文献数

14

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目的:救急/ 集中治療室(以下,ICU)における薬剤師介入の実態や医療経済効果を明らかにすることを目的とした。方法:2017年7,8月に,救急科に入院した患者を対象とし,疑義照会記録を用いて後方視的に調査した。薬学的知識を要しない介入を単純エラー,薬学的知識を要する介入を薬学的介入と定義し,介入の内容および処方反映率を調査した。また,能動的な薬学的介入(薬剤師からの提案)に関して医療経済効果を算出した。結果:介入は391件あり,そのうち76%(297件)が薬学的介入であった。薬学的介入では,抗微生物薬関係の介入がもっとも多く117件(反映率91%)であった。また,医療経済効果は,2カ月間で3,832,000 円であった。結論:薬剤師の救急/ICUへの参画は,医療経済的に有益であることが明らかとなった。また抗微生物薬関係の介入が多く,今後プロトコル作成などにより適正使用推進に寄与できると示唆された。

著者

粟屋 敏雄 長谷部 直幸 梶野 浩樹 石谷 麻里子 山田 武宏 小野 尚志 大滝 康一 山下 恭範 三好 敏之 田崎 嘉一 松原 和夫

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.35, no.9, pp.615-621, 2009 (Released:2011-01-14)

参考文献数

11

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After an overdosing incident at our hospital,we developed an upper limit alert system that checks doses of injection drugs for individual patients as the physician uses the computerized order entry system.Based on each patient’s converted body surface area (BSA),the upper limit for an injection is estimated through comparison with the standard upper limit in a patient with a BSA of 1.6 m2.This is done automatically in accordance with a compensation formula provided by our hospital’s safety committee.Standard upper limits for each injection are based on past records of actual injection dosages administered in our hospital and discussion with clinical departments.When a physician tries to enter an order for an injection at a dose over the upper limit,the computer system issues the alert“non-enterable”and the order cannot be placed.In the case of a regimen for which there is a legitimate reason for using a dose higher than the upper limit,the physician must explain this to the pharmacist who will then unlock the alert system using a secret password that he or she has designated.Passwords are only valid for one day.As far as we know,this is the first computerized injection dosage upper limit alert system in the world.On doing a search of our database,we found that there had been 742 overdose alerts (0.47% of all injection prescriptions) during the 3 months following its introduction.Owing to the alerts,physicians altered 155 prescriptions (21.1% of all alerts).Our computerized alert system for checking injection dosages has proved to be very necessary in ensuring medication safety.

著者

山神 彰 山田 武宏 北川 善政 大廣 洋一 佐藤 淳 石黒 信久 今井 俊吾 小林 正紀 井関 健

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.45, no.5, pp.254-261, 2019-05-10 (Released:2020-05-10)

参考文献数

20

被引用文献数

2 4

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Third-generation oral cephalosporins are broad-spectrum antimicrobial agents and constitute one of the most used antibiotic classes in Japan. In the “National Action Plan on Antimicrobial Resistance (AMR),” the Japanese government declared implementation of efforts to reduce the use of oral cephalosporins by 50% by 2020, compared to 2013. Antimicrobial resistance generally occurs due to inappropriate use or low-dosage exposure to antibiotic agents. Therefore, the choice of appropriate antibiotics is essential for implementing antimicrobial stewardship. To evaluate the prophylactic effects of antibiotics in impacted mandibular third molar surgery, we compared the rate of surgical site infection (SSI) in patients who were administered cefcapene-pivoxil (CFPN-PI) orally with that in patients who received amoxicillin (AMPC) orally. We conducted a retrospective study by reviewing the medical charts of patients from Hokkaido University Hospital from April 2016 to March 2017. The patients evaluated were classified into two groups: the AMPC group (n = 164) and the CFPN-PI group (n = 129). The SSI ratio of the CFPN-PI group was significantly higher than that of the AMPC group (CFPN-PI group, 11.6% (15/129); AMPC group, 2.4% (4/164); P = 0.002). Multivariate logistic regression analysis demonstrated that “use of CFPN-PI for prophylactic treatment” and “hospitalization after surgery” were independent factors related to the onset of SSI following impacted mandibular third molar surgery. These results demonstrated that AMPC was more effective than CFPN-PI in the prevention of SSI after impacted mandibular third molar surgery, and its regulated dosage can effectively contribute to the optimal use of antimicrobial prophylactic treatment.

著者

長田 貴之 柴山 良彦 熊井 正貴 山田 武宏 笠師 久美子 倉本 倫之介 洲崎 真吾 赤澤 茂 真栄田 浩行 坂下 智博 折舘 伸彦 本間 明宏 福田 諭 菅原 満 井関 健

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.38, no.1, pp.51-55, 2012-01-10 (Released:2013-01-10)

参考文献数

14

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Intractable nausea and vertigo induced by opioid treatment are occasionally difficult to treat. It has been reported that antiemetic drugs and opioid rotation may be effective in treating nausea in such cases; however, this approach has been occasionally ineffective. Symptomatic treatment has not been developed for vertigo induced by opioid treatment. Here, we report a case study where combined treatment with perospirone and a histamine H1 receptor antagonist was used in 2 patients who developed intractable nausea and vertigo induced by opioid treatment. Treatment with a histamine H1 receptor antagonist drug (tablet form, containing 40 mg diphenhydramine salicylate and 26 mg diprophylline) suppressed the nausea and vertigo. However, increasing the opioid dosage exacerbated the symptoms, and treatment involving the histamine H1 receptor antagonist and opioid rotation was ineffective. Subsequently, combination treatment with the histamine H1 receptor antagonist (3 tablets per day) and perospirone (maximum daily dose, 16 mg) improved the symptoms. The results of the present study suggest that combination treatment with a histamine H1 receptor antagonist and perospirone might improve intractable nausea and vertigo induced by opioid treatment.

著者

熊井 正貴 加藤 信太郎 小柳 遼 敦賀 健吉 伊藤 陽一 山田 武宏 武隈 洋 菅原 満 川本 泰之 小松 嘉人

出版者

日本緩和医療学会

雑誌

Palliative Care Research (ISSN:18805302)

巻号頁・発行日

vol.17, no.2, pp.51-58, 2022 (Released:2022-04-15)

参考文献数

26

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【目的】緩和ケアに携わる医療提供者のターミナルケア態度の実態とそれに関連する要因を明らかにすることを目的とした.【方法】がん治療医と緩和ケア医を含む緩和ケアに携わる医療提供者を対象にFrommelt Attitude Toward Care Of Dying Scale Form B日本語版(FATCOD B-J)を用いて質問紙調査を実施した.【結果】解析対象は223例であった(回収率42.2%).FATCOD B-J総得点を目的変数とした重回帰分析の結果,偏回帰係数は年代で40代と比較して30代以下が低く(−3.8),業務から得られる満足感を感じているほうが高く(+5.7),緩和ケアへの関心が強いほうが高かった(+6.2).【考察】緩和ケアへの関心と業務から得られる満足感がターミナルケア態度の涵養に重要である可能性がある.

著者

堤 竹蔵 今井 俊吾 山田 勝久 山田 武宏 笠師 久美子 小林 正紀 井関 健

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.7, pp.1055-1061, 2019-07-01 (Released:2019-07-01)

参考文献数

20

被引用文献数

2

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Linezolid (LZD), an antimicrobial agent against methicillin-resistant Staphylococcus aureus, demonstrates good bone and joint penetration, and is used for prosthetic bone and joint infections. Recently, we observed vomiting in several patients administered LZD. However, there are few reports on the incidence rate of, and risk factors for, LZD-induced nausea and vomiting. In this study, we aimed to verify the relationship between LZD administration and vomiting. Patients administered LZD at the Department of Orthopedic Surgery of Hokkaido University Hospital between November 2008 and December 2017 were enrolled in the study. The primary endpoint was the comparison of the vomiting rate between patients administered LZD (LZD group) and those administered other antibiotics (non-LZD group). For the secondary endpoint, to verify the risk factors of vomiting, a univariate logistic regression analysis was performed. In total, 130 patients were included in this study; 77 patients in the LZD group, and 53 in the non-LZD group. Vomiting occurred in 18 patients in the LZD group and 4 patients in the non-LZD group (23.4% and 7.5%, respectively); this was significantly higher in the LZD group. In the univariate logistic regression analysis, LZD administration, gender (female), age ≥65 years, renal impairment (creatinine clearance <60 mL/min) and concomitant use of rifampicin were extracted as potential risk factors of vomiting. The results of this study reveal a possible relationship between LZD administration and vomiting.

著者

粟屋 敏雄 大滝 康一 石原 昌司 小野 尚志 千葉 薫 板垣 祐一 山田 武宏 須野 学 早勢 伸正 田崎 嘉一 松原 和夫

出版者

日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.31, no.6, pp.425-434, 2005-06-10

参考文献数

11

被引用文献数

1 5

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出版社版新規システム導入後のオーダシステム内の記録から,処方が試みられた併用禁忌の組み合わせなどを解析した.相互作用チェックは,その処方の投与期間内に重複しているすべての薬品を自処方内および他処方内の薬歴データファイルから抽出し,チェック対象薬剤が重複した場合,チェックメッセージを表示した.システム運用開始以降,13ヵ月間における処方せんおよび注射指示せんの枚数はそれぞれ290956枚,299017枚の計589973枚であった.調査期間内にチェックのかかった回数は299件であった.警告としたものを除く173件中,96件は処方が中止された.時間外の併用禁忌の処方の危険率は時間内に比べ実に4倍近くにも上った.オーダ別にみると,実に80%近くの併用禁忌の組み合わせは注射薬が関与するものであった.最もチェックのかかった頻度が高かった薬剤の組み合わせはトランサミン注とトロンビン細粒の組み合わせであった