著者
福浦 啓史 青 孝明 佐々木 暢琢 福本 紗与 木村 匡男
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.8, pp.1009-1013, 2021-08-01 (Released:2021-08-01)
参考文献数
11

The dose of direct oral anticoagulants (DOACs) must be determined based on package insert recommendations. There are reports on the rate of inappropriate DOAC dose usage defined as a dose deviating from the approved dose in the package insert but no reports on factors that led to such deviations. Thus, patients who were admitted to the Suzuka Kaisei Hospital between 1 April 2016 and 31 March 2017 were chosen as subjects. Moreover, the factors that during hospitalization led to dose deviation from the package-insert DOAC dose were retrospectively examined. The characteristics of patients administered doses deviating from the package insert were compared with those of patients in the appropriate-dose group. The finding was that the proportion concomitantly administered antiplatelet agents was higher in the underdose group. In contrast, deviations from the recommended dose did not occur when DOACs were combined with CYP3A4 inhibitors or P-glycoprotein (P-gp) inhibitors. It was suggested that increase in the risk of hemorrhage by antiplatelet agents in combination with oral anticoagulants could explain deviations from the stipulated DOAC dose. In addition, a higher proportion of patients in the overdose group showed depressed Ccr, and gastrointestinal bleeding. In future, it will be necessary to propose principle-based dose changes for patients administered doses deviating from the package insert. If an underdose is administered, it is important to make a dose change that takes the concomitant drugs into consideration.
著者
清水 賢二 酒井 浩 木村 匡男 田後 裕之 髙橋 守正
出版者
一般社団法人 日本作業療法士協会
雑誌
作業療法 (ISSN:02894920)
巻号頁・発行日
vol.39, no.4, pp.495-502, 2020-08-15 (Released:2020-08-15)
参考文献数
13

要旨:聴覚失認とは,聴覚による言語や環境音の認知が困難になる状態であり,横側頭回や聴放線の損傷によって生じるとされている.今回,聴覚失認を呈した60歳代の症例を経験した.もともと社交的な本症例であったが,聞き取りの困難さから周囲との交流を避けるようになっていった.作業療法において読話を用いた視覚的代償戦略を用いることで,聴覚失認の症状自体は変化を得られないなかでもコミュニケーションの困難さを克服しだし,周囲との交流を取り戻し始めた.コミュニケーションの障害を言語機能障害ととらえず,生活障害としてとらえて,作業療法士も積極的に介入していく必要がある.