1.Change in Physicians’ Attitude on Clinical Practice after Joining Palliative Care Workshop Using the PEACE Program: Nation-wide Palliative Emphasis Program on Symptom Management and Assessment for Continuous Medical Education
Yumi Hayashi ; Makoto Kobayakawa ; Hitoshi Okamura ; Shigeto Yamawaki
Palliative Care Research 2016;11(4):234-240
Few studies have been performed to examine the effects of educational intervention for oncologists in Japan, to update their knowledge and skills regarding palliative care. This study is aimed to evaluate not only the improvement in trainees’ knowledge and self-complacency, but also to focus on the factors associated with the actual clinical practices of trainees. In one year, 323 trainees from the Hiroshima prefecture joined palliative care workshop using the Palliative Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE), and they were included as subjects in the present study. Referring to the contents of the program, a questionnaire was developed to estimate the extent of change in the trainees’ attitude towards clinical practice. Each of the 26 items included a five point Likert scale ranging from “mostly take responsibility for symptom management” to “depends mostly on the experts for direct intervention”. The questionnaire survey was conducted before and after the implementation of the PEACE program. From the 206 valid responses, most of the data items showed a significant and positive shift in the trainees’ attitude toward palliative care in a clinical setting. Items that did not show this change pertained to adjustment of antidepressants and tranquilizers for delirium and depression. These results suggest that the PEACE program may be effective in improving physicians’ attitudes regarding palliative care.
2.The Comparison Survey between TDM Guideline and TDM Analysis Software Related to Setting the Initial Dose of Vancomycin Aimed to Utilize the TDM Guideline
Makoto Nakashima ; Yuka Nakakihara ; Takeshi Takahashi ; Hiroshi Nomaguchi ; Morihiko Terashi ; Hideki Hayashi ; Tadashi Sugiyama
Japanese Journal of Drug Informatics 2016;18(1):13-21
Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital. In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012. We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%. The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group. Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group. The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software. In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.
3.Incidence of Injection Site Reactions Induced by Vinorelbine and Prevention with Hot Compresses
Makoto Hayashi ; Chie Ohnishi ; Hayato Sugimura ; Kenji Miyazawa ; Akimasa Yamatani ; Hiromu Funaki ; Kenichi Miyamoto
Japanese Journal of Drug Informatics 2013;15(1):8-12
Objective: Patients treated with vinorelbine(VNR)-containing chemotherapy often suffer from injection site reactions. VNR is a moderate vesicant that is well known to cause local venous damage. We conducted this study to identify clinical risk factors related to the incidence of injection site reactions caused by VNR, and whether applying a hot compress was effective for preventing such reactions.
Methods: Medical records were retrospectively investigated for 48 patients treated with chemotherapy regimens containing VNR. Injection site reactions were evaluated for every course and were graded according to the National Cancer Institute Common Toxicity Criteria (version 4.0). Gender, age, body mass index, chemotherapy regimen, dose of VNR, and volume of fluid for flushing the vein were assessed as clinical variables. A hot compress was applied to the vein proximal to the injection site during VNR injection.
Results: The injection site reactions occurred in 29 (60%) among 48 patients received intravenous VNR injection. According to multivariate analysis, use of gemcitabine (GEM) in combination with VNR showed a significant independent correlation with an increased risk of injection site reactions (p=0.019). When hot compress was applied to 21 patients, who experienced phlebitis of VNR, the injection site reaction was occurred to only three patients (p<0.001).
Conclusion: In this study, the risk factor of the injection site reaction by VNR seems to be combination of GEM. Application of hot compresses was effective for preventing injection site reactions by VNR.
4.Studies of Takotsubo-type Myocardioparthy-Centering on Our Cases
Makoto NAKANO ; Toshiaki TAKAHASHI ; Etsuko FUSHIMI ; Masaharu TAKEUCHI ; Nobuya SEKIGUCHI ; Keiji KIMURA ; Masato HAYASHI
Journal of the Japanese Association of Rural Medicine 2005;54(2):91-96
During the period of two years from 2001 to 2003, we treated nine cases of takotsubo-type myocardiopathy. In this paper, the clinical characteristics and patients' conditions are described, and the mechanisms leading to dyskinesia of the muscular walls of the heart are discussed. All the cases were female. The mean age was 73 years. Physiological as well as psychological stress was implicated as a major cause of the disease, with onset occurring when some members of their family were suddenly taken ill or when they started quarreling with others. Echocardiograms revealed sigmoid septa in almost half of the nine patients. The prognosis was good. Only one patient had cardiac insufficiency as a sequela, but her condition improved. No one died.Eight patients got over dyskinesia of the left ventricular walls in two weeks. From our experience and studies of literature, we ruled out the possibility of the involvement of circulatory disorder and myocarditis in the onset of the disease. Women of advanced age are apt to have sigmoid septa and left ventricular walls thinning. When the old patient in this condition suffer psychosomatic stress, catecholamines will be released, causing the hypercontraction of the left ventricle, the pressure difference in the chamber, and the collapse of the apical of the heart. We concluded that these physiopathological states may be responsible for the abnormal movements of the muscular walls of the heart peculiar to the disease taken up in this study.
5.Studies of Takotsubo-type Myocardioparthy
Makoto NAKANO ; Toshiaki TAKAHASHI ; Etsuko FUSHIMI ; Masaharu TAKEUCHI ; Nobuya SEKIGUCHI ; Keiji KIMURA ; Masato HAYASHI
Journal of the Japanese Association of Rural Medicine 2005;54(2):91-96
During the period of two years from 2001 to 2003, we treated nine cases of takotsubo-type myocardiopathy. In this paper, the clinical characteristics and patients' conditions are described, and the mechanisms leading to dyskinesia of the muscular walls of the heart are discussed. All the cases were female. The mean age was 73 years. Physiological as well as psychological stress was implicated as a major cause of the disease, with onset occurring when some members of their family were suddenly taken ill or when they started quarreling with others. Echocardiograms revealed sigmoid septa in almost half of the nine patients. The prognosis was good. Only one patient had cardiac insufficiency as a sequela, but her condition improved. No one died.Eight patients got over dyskinesia of the left ventricular walls in two weeks. From our experience and studies of literature, we ruled out the possibility of the involvement of circulatory disorder and myocarditis in the onset of the disease. Women of advanced age are apt to have sigmoid septa and left ventricular walls thinning. When the old patient in this condition suffer psychosomatic stress, catecholamines will be released, causing the hypercontraction of the left ventricle, the pressure difference in the chamber, and the collapse of the apical of the heart. We concluded that these physiopathological states may be responsible for the abnormal movements of the muscular walls of the heart peculiar to the disease taken up in this study.
Heart
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Patients
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Dyskinetic syndrome
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Age, NOS
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Heart insufficiency
6.Midterm Results of ePTFE Trileaflet Dacron Graft Conduit for Reconstruction of Right Ventricular Outflow Tract in Children
Hiroki Hayashi ; Yukihiro Takahashi ; Makoto Ando ; Masahito Yamashiro ; Keima Nagamachi ; Toshio Kikuchi ; Hitoshi Kasegawa
Japanese Journal of Cardiovascular Surgery 2005;34(2):88-92
Reconstruction of the right ventriclar outflow tract (RVOT) in congenital heart disease often requires implantation of a valved conduit. A hand-made expanded polytetrafluoroethylene (ePTFE) trileaflet Dacron graft conduit has been used at our center since 1997, and has been implanted in 31 patients. Midterm results of this conduit were investigated in 30 of the patients who have been followed at our outpatient clinic. There were 16 males and 14 females. The mean age and body weight were 16.4±7.2 (range, 3.4-33.4) years and 41.7±13.3 (range, 13.0-64.0)kg, respectively. Diagnoses were tetralogy of Fallot with pulmonary atresia in 14 patients, RVOT reconstruction associated with Ross procedure in 8, transposition with pulmonary stenosis in 3, pulmonary atresia with intact ventricular septum in 2, tetralogy with absent pulmonary valve syndrome in 1, pulmonary regurgitation developed after tetralogy repair in 1, and hemitruncus in 1. The median size of the graft was 22 (range, 20-26)mm. All patients were in NYHA functional class I at the time of the latest follow-up. The pressure gradient across the conduit was 11.0±5.8mmHg during the same hospitalization and 13.8±6.5mmHg on the latest echocardiogram (Interval, 2.4±1.5 years, p=0.85). The valve function was well maintained in all patients, with the regurgitation graded as non-trivial in 22 patients, mild in 7, and moderate in only 1. Midterm results of hand-made ePTFE trileaflet valved cunduit was satisfactory. A longer follow-up is mandatory to assess its actual durability.
7.Invention of Check Points Used in Pharmaceutical Management in Hospital Ward Utilizing PREAVOID
Makoto Nakashima ; Yoshihiro Yamamoto ; Akira Takahashi ; Takuya Goto ; Mie Kominami ; Tomomi Konishi ; Yukiko Shibata ; Hideki Hayashi ; Tadashi Sugiyama
Japanese Journal of Drug Informatics 2015;17(3):155-163
PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care. Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards. However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management. To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center. Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them. The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward. In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work. These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.
8.Survey of the Economic Effect of Prescription Questions Associated with Renal Function and the Antibiotics Treatment Completion Rate
Makoto NAKASHIMA ; Hideki HAYASHI
Japanese Journal of Drug Informatics 2022;24(2):88-97
Objective: Drugs that are excreted by the kidneys may require dose adjustments, depending on the patient’s renal function. The pharmacist must ask the prescribing physician about the prescription if a dose is deemed inappropriate. In the current study, we investigated the economic effects of prescription questions associated with renal function and the antibiotics treatment completion rate.Methods: The current study included inpatient prescription inquiries by pharmacists at our institution between January and December 2018. For all cases that were inquired prescription, the economic effects were estimated as follows; the drug costs were calculated based on drug prices at April 2018 edition, and the reduced medical care costs associated with avoiding adverse reactions due to prescription questions were calculated based on the number of benefits and the total cost of benefits in the Relief System for Sufferers from Adverse Drug Reactions. The antibiotics treatment completion rates were calculated based on the number of cases in which drug and dose maintained after prescription questions.Results: The study included 279 cases, 266 of which involved inappropriate doses due to deteriorated renal function. Most prescriptions were for antibiotics. The drug costs were reduced due to the prescription question in 213 cases; the total reduced cost was 699,483 Japanese yen. The economic effects associated with avoiding adverse reactions due to prescription questions were worth approximately 11,481,056 Japanese yen. The completion rate of antibiotic treatment in cases where doses were reduced due to prescription questions was 63.0% (treatment of 75 cases completed/all cases were 119), compared with 63.6% (7 cases/11 cases) in cases in which doses were not changed. Thus, dose reduction due to questions regarding the prescription did not lead to reduced completion rates of antibiotics treatment (p=0.621).Conclusion: Dose adjustments due to prescription questions about drugs excreted by the kidneys led to reduced drug costs and adverse reactions, and did not result in negative effects during infectious disease therapy.
9.Diet, microbiota, and inflammatory bowel disease: lessons from Japanese foods.
Takanori KANAI ; Katsuyoshi MATSUOKA ; Makoto NAGANUMA ; Atsushi HAYASHI ; Tadakazu HISAMATSU
The Korean Journal of Internal Medicine 2014;29(4):409-415
The incidence and prevalence of inflammatory bowel diseases (IBDs) including ulcerative colitis and Crohn disease are rapidly increasing in Western countries and in developed Asian countries. Although biologic agents targeting the immune system have been effective in patients with IBD, cessation of treatment leads to relapse in the majority of patients, suggesting that intrinsic immune dysregulation is an effect, not a cause, of IBD. Dramatic changes in the environment, resulting in the dysregulated composition of intestinal microbiota or dysbiosis, may be associated with the fundamental causes of IBD. Japan now has upgraded water supply and sewerage systems, as well as dietary habits and antibiotic overuse that are similar to such features found in developed Western countries. The purpose of this review article was to describe the association of diet, particularly Japanese food and microbiota, with IBD.
Animals
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*Asian Continental Ancestry Group
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Diet/*ethnology
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Evidence-Based Medicine
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Food Habits/ethnology
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Humans
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Incidence
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Inflammatory Bowel Diseases/diagnosis/diet therapy/*ethnology/immunology/*microbiology
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Intestines/immunology/*microbiology
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Japan/epidemiology
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*Microbiota
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Prevalence
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Probiotics/therapeutic use
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Prognosis
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Risk Factors
10.Timing of Use of the Term “Palliative Care” for Cancer Patients by Physicians and Nurses in Japan
Yumi Hayashi ; Makoto Kobayakawa ; Yoshie Makino ; Mineko Shirakawa ; Chie Shigeyama ; Kazuko Yamanaka ; Satoru Izumitani ; Kyouko Oshita ; Ryuichi Nakanuno ; Hitoshi Okamura ; Shigeto Yamawaki
Palliative Care Research 2016;11(3):209-216
Palliative care is sometimes difficult for medical staff to say to patients with cancer and their families. The late of using the term “palliative care” decrease the opportunity to know about palliative care for the patients and their families. The primary aims of this study were to reveal physicians’ and nurses’ usage of the term “palliative care”, time to use the term for the first time, and a synonym. We conducted a questionnaire survey to 387 physicians and 518 floor nurses at Hiroshima University Hospital in February, 2010. We analyzed the results of physicians and nurses separately. Two hundred and seventy-two physicians (response rate 70.3%) and 284 nurses (54.8%) answered the questionnaire. Many physicians (77.2%) and the majority of nurses (56.0%) explain with the term “palliative care”. the majority of physicians use the term when cancer cause any symptoms and at early stage. Some nurses (31.4%) couldn’t use the term “palliative care” before physicians explained the term. Nurses having longer experience tend to use the term regardless of physicians’ use. Many physicians use the term “palliative care” at early stage of cancer. Many nurses also use the term at early stage of cancer, but some nurses couldn’t use before physicians’ use.