著者

Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.16, no.1, pp.3-4, 2015-03-20 (Released:2015-03-27)

参考文献数

6

被引用文献数

1 7

著者

Tomoko Sakihama Yasuharu Tokuda

出版者

National Institute of Infectious Diseases, Japanese Journal of Infectious Diseases Editorial Committee

雑誌

Japanese Journal of Infectious Diseases (ISSN:13446304)

巻号頁・発行日

pp.JJID.2015.489, (Released:2016-02-19)

参考文献数

26

被引用文献数

7 10

---

The risk factors are unclear for peripheral venous catheter-associated bloodstream infections (PVCBSI) by Bacillus cereus (B. cereus). Thus, we aimed to examine the risk factors in patients with B. cereus PVCBSI by conducting a 2-year case-control study in a large teaching hospital. We analyzed all adult cases of B. cereus PVCBSI (37 patients) and 180 controls, who were randomly selected from among patients who had a PVC in place for 2 days or longer. Multivariate analysis using the conditional logistic regression model indicated that independent risk factors were use of a peripheral parenteral nutrition(PPN) solution with adjusted odds ratio (OR) of 88.7 (95% confidence interval [CI], 17.4-451.9), and steroid therapy [adjusted OR, 5.7 (95% CI, 1.3-24.4)]. In conclusion, use of PPN solutions or steroids was independent risk factors for B. cereus PVCBSI. Appropriate use of PPN solutions may help prevent B. cereus PVCBSI. Prospective studies are needed to confirm these results.

著者

Takayuki Watanabe Yasuharu Tokuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.22, pp.2661-2662, 2014 (Released:2014-11-15)

参考文献数

2

著者

Yoko Fushiki Kensuke Kinoshita Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.15, no.2, pp.110-116, 2014-12-20 (Released:2014-12-24)

参考文献数

17

被引用文献数

13

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Background: Elderly patients are considered to be at risk of developing adverse drug events (ADEs) because they tend to receive a greater number of medications. The purpose of our study is to determine the prevalence of ADEs related to polypharmacy and causative admissions of patients in Japanese acute care hospitalization.Methods: In retrospective cohort study, we analyzed 700 consecutive elderly patients admitted to the department of medicine of a Japanese community hospital in 2011. ADEs were defined by World Health Organization–Uppsala Monitoring Centre criteria. Polypharmacy was defined as five or more medications.Results: The mean age was 79.5 years (men, 54%). The mean number of medications was 6.36 +/− 4.15 (maximum, 26). Polypharmacy was observed in 63% of cases. ADEs were identified in 4.9% (95% CI, 3.5–6.7%). The mean numbers of medications among patients with ADEs and those without ADEs were 9.3 +/− 3.4 and 6.2 +/− 4.1, respectively. A greater number of medications was significantly associated with ADEs (p < 0.001). Polypharmacy was identified in 91% of patients with ADEs, while it was noted in 62% of patients without ADEs (p = 0.001). Using logistic regression analysis, polypharmacy was significantly associated with ADEs (Odds ratio 5.89, 95% CI 1.74–19.9). The highest number of ADEs were identified among patients on antiplatelets or anticoagulants (n = 8), followed by benzodiazepines and NSAIDs (n = 4 for both). The most common ADEs were gastrointestinal bleeding, nausea and congestive heart failure.Conclusion: ADEs complicated to about 5% of acute care elderly hospitalizations in Japan. Polypharmacy was significantly associated with these ADEs.

著者

Miyuki Shimizu Kensuke Kinoshita Kazuya Hattori Yoshio Ota Takao Kanai Hiroyuki Kobayashi Yasuharu Tokuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.10, pp.1207-1210, 2012 (Released:2012-05-15)

参考文献数

7

被引用文献数

7 25 2

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Objective Dehydration is a common condition and frequent cause of hospitalization in older people, despite the caregiver's high attention in attempt to avoid its occurrence. In this study, various physical signs were examined as clinical signs of dehydration in elderly. Methods A prospective observational study was conducted in an acute care teaching hospital. Consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Dehydration was defined as a calculated serum osmolality above 295 mOsm/L. The patients diagnosed as dehydrated or not dehydrated were observed for physical signs of dehydration. Data of blood and urine chemistry analysis were also compared between the two groups. Results A total of 27 elderly patients admitted with acute medical conditions were included in this study. For the physical signs, dry axilla had moderate sensitivity (44%) and excellent specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). For laboratory data, the mean concentrations of serum sodium of the dehydrated group (146 mEq/L) was significantly higher (p<0.01) than those of the non-dehydrated group (134 mEq/L). Conclusion Physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. The evaluation of the axillary moisture could help assess dehydration as well as laboratory data analysis such as serum sodium concentration.

著者

Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

Journal of General and Family Medicine (ISSN:21896577)

巻号頁・発行日

vol.17, no.1, pp.3-4, 2016-03-18 (Released:2016-03-25)

参考文献数

11

被引用文献数

4

著者

Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.16, no.2, pp.61-62, 2015-06-20 (Released:2015-06-22)

参考文献数

2

被引用文献数

1

著者

Yasuharu Tokuda Kyouko Maezato Gerald H. Stein

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.1, pp.23-28, 2007 (Released:2007-01-01)

参考文献数

42

被引用文献数

6 10

---

Objective: Our objective was to determine the causes and relative prevalence of hypercalcemia in patients at a major community hospital in Okinawa, Japan. Additionally, we compared these causes of hypercalcemia with the previously published international data. Materials and Methods: We analyzed all patients with hypercalcemia in a community teaching hospital in Okinawa, Japan, from 1999 to 2002 and determined the cause of hypercalcemia in each patient. We also performed a literature review of the original articles describing causes of hypercalcemia in patients from Eastern as well as Western countries. Results: We identified 145 patients with hypercalcemia (median age, 69; range, 22 to 97). Major causes included malignant disorders (n=100; 69%), primary hyperparathyroidism (n=31; 21%), vitamin D-induced (n=4; 3%), and miscellaneous or unknown cause in 11 (8%). Among malignant disorders, adult T cell leukemia was the most frequent (n=35), being followed by lung cancer (n=25). Breast carcinoma was less prevalent (n=4). Conclusion: The major causes of hypercalcemia are malignancy and primary hyperparathyroidism in Okinawan Japanese patients. Adult T cell leukemia and lung carcinoma are among the top leading malignancies, while breast carcinoma is less frequent in this patient population. The etiologic prevalence of hypercalcemia in the Eastern population including Okinawans is significantly different from that in the Western population.

著者

Yasuharu Tokuda Seishirou Miyagi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.23, pp.1885-1891, 2007 (Released:2007-12-03)

参考文献数

57

被引用文献数

2 8

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Among the various diagnostic strategies of chronic obstructive pulmonary disease (COPD), physical diagnosis is the quickest and requires no extra cost. Rapid physical diagnosis of COPD in primary care practice can lead to earlier actions of preventive measures and counseling for patients. Further, rapid physical diagnosis of COPD in an emergency department is also crucial for timely use of potentially lifesaving therapy specific for COPD patients. In this review, we will present a broad scope of physical findings for rapid physical diagnosis of COPD.

著者

Yasuharu Tokuda Makoto Aoki

出版者

日本プライマリ・ケア連合学会

雑誌

Journal of General and Family Medicine (ISSN:21896577)

巻号頁・発行日

vol.17, no.4, pp.270-271, 2016-12-18 (Released:2016-12-27)

参考文献数

1

著者

Kazuki Sakakura Norio Takayashiki Yasuharu Tokuda Hiroaki Satoh

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.52, no.8, pp.925-925, 2013 (Released:2013-04-15)

参考文献数

2

被引用文献数

5

著者

Tomoko Sakihama Yasuharu Tokuda

出版者

National Institute of Infectious Diseases, Japanese Journal of Infectious Diseases Editorial Committee

雑誌

Japanese Journal of Infectious Diseases (ISSN:13446304)

巻号頁・発行日

vol.69, no.6, pp.531-533, 2016 (Released:2016-11-22)

参考文献数

26

被引用文献数

7 10

---

The risk factors are unclear for peripheral venous catheter-associated bloodstream infections (PVCBSIs) caused by Bacillus cereus. We aimed to examine for these risk factors in patients with B. cereus PVCBSI by conducting a 2-year case-control study in a large teaching hospital. We analyzed all adult cases of B. cereus PVCBSI (37 patients) and 180 controls who were randomly selected from among patients who had a PVC in place for at least 2 days. Multivariate analysis using a conditional logistic regression model indicated that independent risk factors were use of a peripheral parenteral nutrition (PPN) solution with an adjusted odds ratio (OR) of 88.7 (95% confidence interval [CI], 17.4–451.9), and steroid therapy (adjusted OR, 5.7 [95% CI, 1.3–24.4]). In conclusion, use of PPN solutions or steroids was an independent risk factor for B. cereus PVCBSI. Appropriate use of PPN solutions may help prevent B. cereus PVCBSI. Prospective studies are needed to confirm these results.

著者

Yasuharu Tokuda Masahiro Koizumi Gerald H. Stein Richard B. Birrer

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.48, no.7, pp.537-543, 2009 (Released:2009-04-01)

参考文献数

33

被引用文献数

6 10

---

Objective To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients. Methods We developed the model using the derivation cohort in a community rural hospital in Okinawa and assessed its performance using the validation cohort in a metropolitan urban hospital in Tokyo. There were 66 (39.5%) and 5 (17.9%) adult patients with BM among the derivation (n=167) and the validation cohort (n=28), respectively. Recursive partitioning analysis was used to determine the important classification variables and to develop a sensitive model to safely exclude BM. Results The model produced high- and low-risk groups based on the following: 1) Gram stain, 2) CSF neutrophil percent ≤15%, 3) CSF neutrophil count ≤150 cells/mm3, and, 4) mental status change. Among the derivation cohort, there were 65 patients with BM in the high-risk group (n=76), while only one patient with BM was noted (sensitivity, 99%) in the low-risk group (n=91). Among the validation cohort, there were 5 patients with BM in the high-risk group (n=7), while no patient was classified with BM (sensitivity, 100%) in the low-risk group (n=21). Conclusion This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.

著者

Tomoharu Suzuki Yasuharu Tokuda Hiroyuki Kobayashi

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8769-16, (Released:2017-09-06)

参考文献数

7

被引用文献数

9

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Yellow nail syndrome (YNS) is characterized by yellowish nails, lymphedema, sinusitis, and pulmonary involvement and can be triggered by various underlying conditions, such as sinusitis or titanium exposure from an artificial joint or dental implant. Since YNS is potentially treatable, its timely diagnosis is important. The authors recently experienced a case of YNS in a patient who developed sinusitis, yellowish nails, bilateral edema of the extremities, and subclinical rheumatoid arthritis after the implantation of a cardiac pacemaker made from titanium. This case may be the first report of YNS induced by a titanium cardiac pacemaker.

著者

Ryota Matsuoka Norio Takayashiki Yusuke Chino Yasuharu Tokuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.15, pp.1733-1734, 2014 (Released:2014-08-01)

参考文献数

2

著者

Nobutaka Doba Yasuharu Tokuda Keiichirou Saiki Toshio Kushiro Masumi Hirano Yoshihiro Matsubara Shigeaki Hinohara

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.19, pp.2785-2792, 2016-10-01 (Released:2016-10-01)

参考文献数

24

被引用文献数

24

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Objective It has been increasingly recognized in various clinical areas that self-efficacy promotes the level of competence in patients. The validity, applicability and potential usefulness of a new, simple model for assessing self-efficacy in the elderly with special reference to frailty were investigated for improving elderly patients' accomplishments. Methods The subjects of the present study comprised 257 elderly people who were members of the New Elder Citizen Movement in Japan and their mean age was 82.3±3.8 years. Interview materials including self-efficacy questionnaires were sent to all participants in advance and all other physical examinations were performed at the Life Planning Center Clinic. Results The internal consistency and close relation among a set of items used as a measure of self-efficacy were evaluated by Cronbach's alpha index, which was 0.79. Although no age-dependent difference was identified in either sex, gender-related differences in some factors were noted. Regarding several parametric parameters, Beck's inventory alone revealed a significant relationship to self-efficacy in both sexes. Additionally, non-parametric items such as stamina, power and memory were strongly correlated with self-efficacy in both sexes. Frailty showed a significant independent relationship with self-efficacy in a multiple linear regression model analysis and using Beck's inventory, stamina, power and memory were identified to be independent factors for self-efficacy. Conclusion The simple assessment of self-efficacy described in this study may be a useful tool for successful aging of elderly people.

著者

Yasuharu Tokuda Tomoya Okubo Haruo Yanai Nobutaka Doba Michael K. Paasche-Orlow

出版者

日本疫学会

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.20, no.4, pp.319-328, 2010-07-05 (Released:2010-07-05)

参考文献数

28

被引用文献数

11 10

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Background: Health literacy affects the acquisition of health knowledge and is thus linked to health outcomes. However, few scales have been developed to assess the level of health knowledge among the general public.Methods: The 15-item Japanese Health Knowledge Test (J-HKT) was developed by using item response theory to score an item pool. We examined the construct validity of the J-HKT in relation to health literacy items, and analyzed the sociodemographic and behavioral factors associated with poor health knowledge.Results: We enrolled 1040 adult participants (mean age, 57 years; women, 52%). The 15 items that best identified people with poor health knowledge were selected. For all items on the J-HKT, the information function curves had a peak in the negative spectrum of the latent trait. As compared with participants reporting high levels of income, educational attainment, and literacy, those with low levels of income, education, and literacy had a lower total score on the J-HKT. As compared with non/light drinkers, moderate and heavy drinkers had lower total scores on the J-HKT.Conclusions: The J-HKT may prove useful in measuring health knowledge among the general public, and in identifying and characterizing those with poor health knowledge.

著者

Jun Hamano Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.15, no.2, pp.117-125, 2014-12-20 (Released:2014-12-24)

参考文献数

28

被引用文献数

3

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Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan.Methods: This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services.Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40).Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.

著者

Aya Sawa Toshikazu Abe Miyoko Omoto Kazuya Fujihara Hiroyuki Kobayashi Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.14, no.1, pp.72-75, 2013 (Released:2013-07-05)

参考文献数

12

被引用文献数

1

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Metformin is widely prescribed for patients with type 2 diabetes mellitus (DM). Its use for patients with type 1 has been considered a contraindication because of possible adverse effects such as lactic acidosis. However, metformin has been recently used with insulin therapy to reduce insulin-dose requirements in Type 1 DM.An 81-year-old Japanese woman with type 1 DM was treated with insulin and metformin. She was admitted to our hospital due to altered mental state and hypotensive shock via a referral from her primary care physician. The patient had severe lactic acidosis and acute kidney injury with hyperkalemia with the suspected cause being the use of metformin. She was treated successfully with hemodialysis (HD).Although the independent predictive factor of mortality due to metformin-associated lactic acidosis is a prothrombin time (PT) activity of less than 50% in 24 hours, we recommend that HD should be performed for a patient with severe lactic acidosis even if the initial PT activity is normal.

著者

Taro Shimizu Yasuharu Tokuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.12, pp.1051-1057, 2010 (Released:2010-06-15)

参考文献数

80

被引用文献数

30 91

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Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.