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

Akihiko Miyamoto Shigeyuki Watanabe

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.51-60, 2011 (Released:2011-12-28)

参考文献数

24

被引用文献数

10

---

Background: Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal “influenza follicles” in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.Methods: Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition9, and new exclusion criteria were developed.Results: Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.Conclusion: Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.

著者

Shuya Takahashi Machi Suka Hiroyuki Yanagisawa

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.15, no.2, pp.126-135, 2014-12-20 (Released:2014-12-24)

参考文献数

18

---

Objective: We performed a meta-analysis to examine the effectiveness of face masks for preventing influenza infection.Methods: A literature search was conducted to identify clinical trials that compared the incidence of influenza infection among family members with and without the use of antiviral face masks; some trials also contained the use of hand hygiene in the intervention group. Data from each trial were combined using a random effects model with the DerSimonian-Laird method to calculate pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).Results: The meta-analysis included seven randomized controlled trials that met our inclusion criteria. With the use of antiviral face masks, the pooled ORs (95% CIs) of laboratory proven infection were 0.69 (0.22–2.18). The pooled ORs (95% CIs) of influenza-like illness (ILI) were 1.07 (0.65–1.78). With the use of antiviral face masks and concomitant hand hygiene, the pooled ORs (95% CIs) of laboratory proven infection were 0.70 (0.35–1.39) in early intervention cases, and 0.93 (0.66–1.30) in all cases. The pooled ORs (95% CIs) of ILI were 1.01 (0.47–2.19) in early intervention cases, and 1.06 (0.53–2.13) in all cases.Conclusion: No statistically significant differences were detected in the incidence of influenza infection by wearing antiviral face masks, suggesting that distribution of face masks in primary care settings may not be enough to prevent influenza-like illnesses amongst family members.

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

---

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

Ryohei Goto Hiroki Watanabe Naoki Tanaka Takeshige Kanamori Hisako Yanagi

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.68-75, 2015-06-20 (Released:2015-06-22)

参考文献数

29

被引用文献数

1 12 2

---

Background: The current study aimed to investigate factors associated with the prognosis of activities of daily living (ADL) in elderly patients with pneumonia who had undergone rehabilitation during their hospitalization.Methods: The study included patients of age ≥65 years who were hospitalized due to pneumonia and had undergone rehabilitation for disuse syndrome at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL. The participants were divided into a high-recovery group (≥80%) and a low-recovery group (<80%) based on the FIM recovery rate score. Further, factors associated with the prognosis of ADL were evaluated using multivariate logistic regression analysis. Basic characteristics, consciousness, usual mode of transportation, FIM score, grip strength, range of motion, orthostatic hypotension, exercise tolerance (6-minutes walking distance), respiratory disorder (Hugh–Jones classification), constipation, malnutrition (mini-nutritional assessment), cognitive (mini-mental state examination), depression (geriatric depression scale), balance (functional balance scale), urinary incontinence, and pressure ulcers were included as the evaluation items.Results: Among the 51 elderly patients with pneumonia (average age ± SD; 82.0 ± 11.3), 34 patients were classified in the high-recovery group and 17 in the low-recovery group. In multivariate logistic regression analysis, it was revealed that the number of days from the onset until the initiation of rehabilitation (days of inactivity) and nutritional status were factors associated with a high-recovery FIM score.Conclusions: The study results suggest that days of inactivity and early management of nutritional status after hospitalization are important for elderly patients with pneumonia to return to their ADL.

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

Kentaro Iwata Tomoko Toma Akihiro Yachie Hideaki Oka Goh Ohji Wataru Igarashi Tatsuyoshi Kitamura Yuichiro Oba

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.1, pp.29-31, 2011 (Released:2011-07-05)

参考文献数

7

---

A 23-year old female was referred to our clinic for intermittent fever occurring over a period of eight years. Every time she developed fever, blood examination revealed elevated leukocytes and C-reactive protein (CRP). Antibiotics were always given based on elevated CRP with apparent improvement. However, the pattern of periodicity with absence of symptoms in between suggested periodic fever syndrome, particularly Familial Mediterranean Fever (FMF), which was later confirmed by mutation analysis. In Japan there is a tendency to use antibiotics solely based on "elevated CRP"; however, careful review of patient history is essential to identify FMF while avoiding the use of unnecessary antibiotics.

著者

Kenichiro Yaita Yohei Sakamoto Kazuhiko Nakaharai Yukihiro Yoshimura Natsuo Tachikawa

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.1, pp.68-71, 2014-06-20 (Released:2014-06-27)

参考文献数

12

被引用文献数

1 2

---

A 58-year-old female was admitted due to severe sepsis and multi-organ failure with a fulminant purpuric rash. Meropenem, vancomycin and levofloxacin were administered, although no focus of infection was detected. However, computed tomography revealed a profoundly hypoplastic spleen, and a blood smear detected Howell-Jolly bodies. Blood cultures grew Streptococcus pneumoniae (serotype 22F) three hours after admission. The patient was finally diagnosed as overwhelming pneumococcal sepsis with hyposplenism precipitated by splenic hypoplasia. Clinicians should pay attention to the splenic size and Howell-Jolly bodies in cases of sepsis of unknown origin.

著者

MIYAMOTO Akihiko WATANABE Shigeyuki

出版者

Japan Primary Care Association

雑誌

General medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.51-60, 2011-12-01

被引用文献数

2 10 9

---

<b>Background:</b> Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal "influenza follicles" in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.<br><b>Methods:</b> Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition⁹, and new exclusion criteria were developed.<br><b>Results:</b> Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.<br><b>Conclusion:</b> Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.

著者

Kentaro Iwata Wataru Igarashi Midori Honjo Takashi Nishimoto Kyoko Shinya Akiko Makino Kazuo Mitani Yoshiko Tatsumi Hiroyuki Ninomiya Kumi Higasa Seiichiro Usuki Hiroki Kagawa Daisuke Uchida Kohei Takimoto Rei Suganaga Hiroo Matsuo Yuichiro Oba Mami Horigome Hideaki Oka Goh Ohji Yasuhisa Abe Hiroyuki Yoshida Shohiro Kinoshita Midori Hirai

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.13-22, 2013 (Released:2013-07-05)

参考文献数

34

被引用文献数

3

---

Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.

著者

Yuji Nishizaki Shinichiro Yamagami Hitoshi Sasano Eiryu Sai Kazuhisa Takamura Toshiki Nakahara Yoshiaki Furukawa Hiroyuki Daida

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.41-44, 2015-03-20 (Released:2015-03-27)

参考文献数

6

---

A 91 year-old male who was orally receiving dabigatran and digitalis for chronic arterial fibrillation was hospitalized for cerebral infarction (CI). The complications of anemia due to gastrointestinal bleeding and the development of renal failure were also found, which enhanced the effect of digitalis. This enhanced drug action induced bradycardia and hypotension. The hypotension was improved by implanting a temporary pacemaker, and the neurological abnormal findings also disappeared with the improved blood pressure. In many cases, dabigatran is efficient in preventing CI, but in our case it in fact triggered a CI hemodynamically due to bradycardia and hypotension with gastrointestinal bleeding.

著者

Toshio Naito Keiko Kume Kazunori Mitsuhashi Tetsu Okumura Hiroshi Isonuma Takashi Dambara Koichi Suda Yasuo Hayashida

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.7, no.1, pp.21-24, 2006 (Released:2010-06-08)

参考文献数

16

被引用文献数

1

---

We recently encountered a case of fatal pneumococcal infection in a previously healthy 19-year-old female. She had no history of splenectomy, but on autopsy she was found to have hyposplenism. It has been widely reported that life-threatening pneumococcal infection can occur after splenectomy, though cases of hyposplenic or asplenic adults, without a history of splenectomy, are very rare. We report this case and review the literature dealing with 6 similar cases.

著者

Masayuki Amano Taro Shimizu

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.63-67, 2015-06-20 (Released:2015-06-22)

参考文献数

11

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

---

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

Satoshi Kutsuna

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.148-149, 2014-12-20 (Released:2014-12-24)

参考文献数

3

著者

Howard B Abrams

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.1, pp.5-13, 2014-06-20 (Released:2014-06-27)

被引用文献数

1 1

---

Our Health Care Systems, especially our hospitals, were designed primarily to provide episodic care for acute occurrences of single diseases. With our aging population and the predominance of chronic diseases, highly integrated and coordinated care is required. This demands a “systems re-design”, not just making the old system better. Additionally, higher expectations of patients and families to be involved in and co-direct their care, and the advent of rapidly evolving mobile information technology (mHealth), requires an innovative and “agile” approach to this re-design process. To be sustainable, innovation must improve the experience of care for both patients and health care providers, as well as produce clinical and financial outcomes that are at least as good as or better than current care. Health Systems Centres of Innovation can be provide “new ways of thinking” about health care, and the creativity to sustainably re-design our Health Care Systems.

著者

Mikio Wada Hiromi Ueda Akiko Watanabe Natsuko Yuki Sadao Yamashita

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.1, pp.47-51, 2014-06-20 (Released:2014-06-27)

参考文献数

7

---

A 31-year-old healthy mother of twins developed Guillain-Barré syndrome in her fourth gestational week of pregnancy. Impaired motor coordination, sensation, and joint position sense were observed. Immunoglobulin therapy was not performed given the early stage of pregnancy. She received rehabilitation to accommodate changes in her body shape and movements necessary for pregnancy, childbirth, and childcare. The patient delivered a healthy baby by cesarean section. By 42 weeks postpartum, she was capable of almost all housework activities and childcare. Family support was important in this case. Patient-oriented intervention, which included periodic confirmation and establishment of goals in each phase and continuity of intervention, was also essential.

著者

Azeem H. Tajani

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.2, pp.140-141, 2013-12-20 (Released:2013-12-27)

著者

Kazuhiro Murata Shizukiyo Ishikawa Takashi Sugioka

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.32-39, 2013 (Released:2013-07-05)

参考文献数

11

被引用文献数

2

---

Objective: With the recent aging trend in the Japanese population, dysphagia appears to be increasing. However, few epidemiologic surveys have been conducted to determine the prevalence of dysphagia in local inhabitants. Ohkuma et al. prepared a highly reliable questionnaire using a simple test and safe examination method. We investigated the presence/absence of symptoms of dysphagia in local inhabitants, evaluated their association with subjective symptoms, and examined whether the inhabitants were following a particular diet, which is the most important factor in management of dysphagia.Methods: A cross-sectional study involving 743 inhabitants (age: over 20) of an isolated island was performed. Each subject was asked basic questions (awareness about the presence/absence of dysphagia and dietary habits), and the data was analyzed by chi-square test. Based on their responses, dysphagia incidence was determined and rated on a 3-category scale (severe, mild, and no dysphagia).Results: Responses were recollected from 368 subjects (response rate, 49.5%). The percentage of subjects aware of dysphagia in the severe, mild, and no dysphagia groups was 13.8%, 3.2%, and 0%, respectively and the percentage of subjects who changed their dietary habits was 17.2%, 2.6%, and 0%. These percentages were significantly higher in the severe group than in the mild and no dysphagia groups, though the value was less than 20% in the 3 groups.Conclusion: Most subjects in the present study were unaware of dysphagia, suggesting that patients with dysphagia tend to be unaware of the key symptoms of dysphagia.

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

---

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.