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成橋和正[著]
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成橋, 和正 ; 松下, 良 ; 清水, 栄 ; 山田, 清文 ; 宮本, 謙一 ; 木村, 和子 ; Naruhashi, Kazumasa ; Matsushita, Ryo ; Shimizu, Sakae ; Yamada, Kiyofumi ; Miyamoto, Ken-ichi ; Kimura, Kazuko
概要:
医薬保健研究域薬学系<br />We conducted a prospective investigation using the visual analog scale (VAS) method to evaluate the phar
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macy experience and lectures of the Division of Pharmacy and Health Sciences, Graduate School of Natural Science and Technology, Kanazawa University. The students were instructed to evaluate their understanding and attainment of the pharmacy experience and lectures. The preceptors then evaluated the students in their charge based on their understanding and attainment of the pharmacy experience. Comparisons before and after the pharmacy experience and for each student-preceptor pair were performed with the aim of solving problems encountered, if any, for improvement. For most of the cases, scores of, self-evaluation by the students for after the pharmacy experience were higher than those for before, indicating that the pharmacy practice had been effective. The student-preceptor comparison showed that the students gave themselves higher scores for understanding and the preceptors gave their students higher scores for skills. This shows that the students felt that they had gained much knowledge of pharmacy but thought that they needed further training to improve their practical skills. In the self-evaluations after the course of lectures but prior to the pharmacy practice, the overall degree of understanding was 60%, however, this decreased after the pharmacy experience. Thus, the students were not able to retain the knowledge gained during the lectures until the end of the pharmacy experience, suggesting a need to review the content of the lectures and to rearrange schedules.
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Naruhashi, Kazumasa ; Asahi, Mariko ; Higuchi, Yasuko ; Matsushita, Ryo ; Shimizu, Sakae ; Kimura, Kazuko ; Suzuki, Nagao ; Yokogawa, Koichi ; Fujita, Shin-ichi ; Miyamoto, Ken-ichi ; 成橋, 和正 ; 松下, 良 ; 清水, 栄 ; 木村, 和子 ; 鈴木, 永雄 ; 横川, 弘一 ; 宮本, 謙一
概要:
医薬保健研究域薬学系<br />To explore appropriate antimicrobial usage in Kanazawa University Hospital, the surveillance of antimicr
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obial use on an individual patient basis was conducted and analyses of outstanding cases were made in detail. All data of inpatients between August 1st and November 30th 1999, who were prescribed at least one of the 11 antimicrobial injections that are frequently used at our hospital were collected by utilizing a computer database support system of the hospital. The overall usage seemed appropriate in terms of the period of use based on an antimicrobial analysis. However, an analysis on an individual-patient basis suggested some inappropriate usage/misuse in certain cases. Imipenem was prescribed from the ophthalmology ward in more than 50% of all cases. This was found to be used as a postoperative prophylactic antibiotic. Since no antibiotic was prescribed to these patients thereafter, this usage cannot be defined as inappropriate although alternative antibiotics may be considered. Vancomycin was prescribed to some methicillin-resistant Staphylococcus aureus-negative patients. We also found some extensively prolonged usage of antimicrobials. All of these were considered to be inappropriate in regard to usage specified for insurance. After investigations of medical charts and consultations with attending physicians, these antimicorobials had been empirically prescribed. In one case, imipenem was prescribed to an imipenem-insensitive patient. A different effective antimicrobial drug should have been prescribed. In conclusion, we were able to uncover some inappropriate usage of antimicrobials in a patient-by-patient investigation. Our findings suggest that further surveillance and on-time suggestions to prescribers should result in a more appropriate administration of antimicrobials.
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成橋, 和正 ; Naruhashi, Kazumasa
概要:
取得学位：博士(薬学)，学位授与番号：博乙第253号，学位授与年月日：平成14年9月30日,学位授与年：2002
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成橋, 和正 ; 野村, 政明 ; 亀井, 浩行 ; 小野, 俊介 ; 松下, 良 ; 清水, 栄 ; 横川, 弘一 ; 山田, 清文 ; 鈴木, 永雄 ; 宮本, 謙一 ; 木村, 和子
概要:
金沢大学医薬保健研究域薬学系<br />従来の薬学教育における臨床教育の不足から,多くの薬学系大学院博士前期課程(修士課程)に薬剤師免許取得後の大学院生を対象とした臨床系の専攻やコースが設立されてきている.金沢大学でも,薬学研究科(現:自然
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科学研究科)に臨床薬学教育を主眼に置いた医療薬学専攻が平成8年に設立され,国立大学としては早期であった.本学医療薬学専攻では,薬剤師免許取得者を対象とし,臨床現場で指導的役割を果たす高度な薬剤師の養成および次世代の医療薬学教育研究に携わる人材の育成を教育理念としている.このため,医療薬学専攻の学生に対して医療現場の実習を通じて医療を担うものとしての自覚を深めさせるとともに,自然科学の素養を身に付けることを求めている.具体的な教育目標は,医療人としての倫理観の醸成,医療の専門家として健康と疾病に関する知識獲得,薬物治療に起因する問題の同定・評価・解決,ならびに,コミュニケーションに関する知識・技術の習得,さらには,関連分野における高い研究・開発能力を発展させることである.このため,発足当初は,入学初期の集中講義,1か月の市内保険薬局での薬局実習,6か月の本学医学部附属病院薬剤部での実務実習を行い,1年間を課題研究期間としていた.講義は学部教育に引き続き,基礎自然科学系科目が大半であり,臨床現場での実習との非関連性が学生からも指摘されていた.また,半年間の実習後に修士の学位論文の一部として病院実務実習篇の作成や口頭発表が要求されていたために,実質的な実務実習は,時間的に極めて限られていた.実務実習を終えたあとの課題研究は,医療薬学専攻ならびに生命薬学専攻に属する各研究室で行っていたことから,必ずしも臨床に近いものではなかった.さらに,学生が就職するのは実習終了後1年を経過した後であり,就職直前の学生から実務に対する不安がでたり,就職直後に修了生や雇用者から実習経験が薬剤師として十分に活かせていないとの声が聞かれた.このような問題点を踏まえて,平成13年度に医療薬学専攻のカリキュラムの改善を図った.医療薬学に対する幅広い知識を深めさせるため,臨床系講義科目を充実させた.この変更では,薬物治療の科学的基礎とともに,看護,倫理,心理,国際など,医療に関連する人文・社会系分野も開講し,受講する学生の講義科目数が増加した.また,実習に関しては,継続性や充実性を考慮し,実務実習期間を1年に延長した.最初の2か月間は薬剤師業務全般の集中的な導入実習として,6人ずつ4グループに分かれ,調剤部門(一般調剤・注射薬調剤,2週間),製剤部門(一般製剤・無菌調剤,1週間),薬剤管理指導部門(医薬品情報・医薬品管理・TDM,1週間:病棟業務,4週間)を行う.その後は学生1人に対し指導薬剤師1人というマンツーマン形式の個別指導とし,薬剤師職能の病棟の薬剤管理指導を中心の実習としている.これに対し,医療薬学専攻の各教官も3名程度の学生を担当し,面接などにより実習の進捗状況を把握するとともに,専門分野に応じた指導も担当している.しかしながら,実習(実務)の大部分は指導薬剤師により行われており,個別指導であるため学生全体としての質の評価や,問題点の抽出は行いにくい.そこで,この新カリキュラムによる講義の理解度や実習の達成度について,visual analog scale(VAS)を用いて,学生と指導薬剤師による評価を試みた.また,この評価結果から,新カリキュラムの問題点などについて考察することとした. We conducted an investigation to determine whether the visual analogue scale (VAS) method could be utilized in evaluating the lectures and pharmacy experience of the Division of Pharmacy and Health Sciences, Graduate School of Natural Science and Technology, Kanazawa University. Graduate students who had finished the 1-year pharmacy experience at the Kanazawa University Hospital were asked to make a self-evaluation of the understanding/attainment of lectures and experience in the course. Since the experience was carried out as a one-student-to-one-pharmacist system, the preceptors (pharmacists) were also asked to evaluate their corresponding students. When evaluating the necessity of the lectures, students tended to feel that the medical science- or pharmacotherapy-related subjects were important and those of social sciences were less important. These results suggest the need to review the contents of the lectures to enhance the interests of the students in the latter. By comparing the extent of understanding of each lecture before and after pharmacy experience, it was found that students had a better understanding of the lectures through their experience. In most results from the answers in pharmacy experience, students also scored themselves higher than their preceptors. Therefore comparisons of evaluation may provide more objective results in pharmacy experience. It was demonstrated that utilization of the VAS method and comparing the data are very useful in evaluating not only students' understanding/attainment but also the importance and usefulness of lectures and pharmacy experience in an objective way.
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成橋, 和正 ; 松下, 良 ; 清水, 栄 ; 山田, 清文 ; 宮本, 謙一 ; 木村, 和子
概要:
We conducted a prospective investigation using the visual analog scale (VAS) method to evaluate the pharmacy experience and lectures of the Division of Pharmacy and Health Sciences, Graduate School of Natural Science and Technology,
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Kanazawa University. The students were instructed to evaluate their understanding and attainment of the pharmacy experience and lectures. The preceptors then evaluated the students in their charge based on their understanding and attainment of the pharmacy experience. Comparisons before and after the pharmacy experience and for each student-preceptor pair were performed with the aim of solving problems encountered, if any, for improvement. For most of the cases, scores of, self-evaluation by the students for after the pharmacy experience were higher than those for before, indicating that the pharmacy practice had been effective. The student-preceptor comparison showed that the students gave themselves higher scores for understanding and the preceptors gave their students higher scores for skills. This shows that the students felt that they had gained much knowledge of pharmacy but thought that they needed further training to improve their practical skills. In the self-evaluations after the course of lectures but prior to the pharmacy practice, the overall degree of understanding was 60%, however, this decreased after the pharmacy experience. Thus, the students were not able to retain the knowledge gained during the lectures until the end of the pharmacy experience, suggesting a need to review the content of the lectures and to rearrange schedules.
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大川, 浩子 ; 谷本, 明日香 ; 旭, 満里子 ; 成橋, 和正 ; 松下, 良 ; 坂尻, 顕一 ; 宮本, 謙一
概要:
The control of drug use for Parkinson's disease is very important for both the QOL and ADL of patients. Nowadays, patients with Parkinson's disease are treated with the concomitant use with L-dopa, dopamine receptor agonists and
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norepinephrine receptor agonists. However, these drugs elicit some adverse effects. Therefore, we tried to search for the effects and adverse effects, based on patient histories. As a result of our investigations, most patients broke out with tremors and were administered anticholinergic drugs, while a few patients were treated with L-dopa as the first drug of choice. Avoid the administration of L-dopa at first seemed to help prevent the onset of Wearing-off or On-off phenomenon. Gastric mucosal cytoprotective drugs appeared to be effective for preventing of gastric symptoms due to drugs for Parkinson's disease. Moreover, we found that mental symptoms only rarely occurred after the readministration of anticholinergic drugs. We must be careful to treat patients with brain infarction after the onset of mental symptoms. These results are valuable for helping to improve the treatment of Parkinson's disease, and may also help in performing further studies on the use of new drugs.
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成橋, 和正 ; 稲木, 正樹 ; 大谷, 嘉奈子 ; 古川, 裕之 ; 安田, 幸代 ; 清水, 栄 ; 鈴木, 永雄 ; 横川, 弘一 ; 小泉, 晶一 ; 宮本, 謙一
概要:
To elucidate the effect of the concomitant usage of other drugs on the occurrence of mucositis during and after chemotherapy, we investigated prescriptions for pediatric patients with hematological cancers at Kanazawa
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University Hospital, focusing particularly on drugs that have an adverse effect of xerostomia. The patients were divided into two groups consisting of methotrexate-treated (MTX group) and other-anticancer-drug-treated patients (non-MTX group). The occurrence of mucositis in the MTX group was significantly higher than in the non-MTX group. In the MTX-group, the number of concomitantly used drugs during a one-week period after chemotherapy was 6.18 in patients with mucositis and 2.95 in patients without mucositis. In the non-MTX group, there were 3.38 or 3.56 concomitantly used drugs in patients with or without mucositis, respectively. The concomitant drugs were divided into xerostomia-inducing and non-xerostomia-inducing drugs and there-after were classified into pharmacological groups. The occurrence of mucositis was higher among patients using xerostomia-inducing drugs than among those using non-xerostomia-inducing drugs with an exception of diuretics, and this tendency was more prominent in the MTX group than in the non-MTX group. It was recently documented that mucositis was significantly associated with xerostomia during 5-fluorouracil chemotherapy. Therefore, it is assumed that the concomitant usage of xerostomia-inducing drugs reduced the saliva flow, leading to mucositis. We conclude that the concomitant use of xerostomia-inducing drugs is one of the factors that influence the occurrence of mucositis during chemotherapy with MTX and other anticancer agents. It is recommended that the use of xerostomia-inducing drugs should thus be avoided as much as possible to decrease the occurrence of mucositis during chemotherapy.
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寺町, ひとみ ; 畠山, 裕充 ; 立木, 智 ; 大塚, 守紀 ; 成橋, 和正 ; 松下, 良 ; 今井, 幸夫 ; 宮本, 謙一 ; 辻, 彰
概要:
We examined antibiotic use on an individual patient basis and investigated outstanding cases in detail to produce a guide for the activity of the Infection Control Committee of Kouseiren Chu-nou Hospital. The prescription data for 14
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frequently used antibiotic injections were collected by utilizing a computer database of hospital inpatients between March 1st and June 30th, 2001. Although the overall antibiotic usage seemed appropriate, some inappropriate usages were uncovered by investigations on an individual-patient basis, including a prolonged administration. Vancomycin (VCM) was prescribed to some methicillin-resistant Staphylococcus aureus-negative patients. VCM was prescribed more than 14 days consecutively to 34. 4 % patients. All of these were considered to be inappropriate in regard to the usage specified for insurance. Therapeutic drug monitoring (TDM) was not carried out in all the patients administered VCM. Cefazopran was prescribed to many patients with respiratory infections. In addition, cefazopran was used as a first line medicine for empiric therapy in the treatment of pneumonia of the aged with chronic respiratory diseases. In conclusion, we found antibiotic usage problems in our hospital. According to the results in this study, we made new guidelines for pharmacists to monitor antibiotic usage by inpatients. We also suggest that the coordination of infection control nurses with pharmacists remains an important next step in improving the appropriate use of antibiotics in our hospital.
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成橋, 和正 ; Naruhashi, Kazumasa
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同志社女子大学 / 金沢大学医薬保健研究域薬学系<br />本研究では,小腸における薬物トランスポーターの機能的変動および変動影響因子の解明を目的として,総胆管結紮ラットにおけるin situ, in vitro系での小腸タウロコール酸輸送
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変動の検討,およびヒト小腸モデルCaco-2細胞における内因性物質によるMRP2, ASBT mRNA発現変動の検討を行った。胆管結紮3日後のラット小腸において,apical sodium-dependent bile transporter (ASBT)のmRANの発現量が有意に増加した。しかし、小腸薬物輸送能の検討として、closed loop法およびUssing chamber法でタウロコール酸の吸収の吸収を測定したところ,コントロール群,胆管結紮ラット群間で小腸のどの部位においても有意な差がみられなかった。よって、ASBT mRNAの発現増加は小腸での吸収機能にまで影響するものではなかった。また,どちらの実験系においても上部,中部で分泌指向性がみられたことから,上部,中部では内因性胆汁酸を分泌方向に輸送する未知のトランスポーターが存在し,機能している可能性が示唆された。胆汁鬱滞の状態では血中ビリルビンに加え,胆汁酸,サイトカインが増加することを確認した。これら内因性物質のトランスポーター発現調節の検討では,タウロコール酸およびコール酸はmultidrug resistance-associated protein 2(MRP2),ASBT mRNA発現に影響を与えないことが明らかになった。一方,ビリルビンおよびTNF-α処理によってMRP2 mRNA発現量が減少した。また,TNF-αとIL-1βの同時処理によって,MRP2 mRNA発現量が減少した。この結果から,胆汁鬱滞により増加する血漿中内因性物質のうち,ビリルビンおよびサイトカインが,小腸MRP2 mRNA発現量の減少に関与している可能性が示唆された。<br />研究課題/領域番号:15790092, 研究期間(年度):2003 – 2005<br />出典：「病態時の薬物消化管吸収の変化におよぼす薬物トランスポーターの影響」研究成果報告書 課題番号1579009（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-15790092/)を加工して作成
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