論文 - 河添　仁

病院実務実習における多職種間を想定したコミュニケーション・スキルアップ実習プログラムの導入と評価

河添　仁, 田中亮裕, 田中　守, 末丸克矢, 荒木博陽

医療薬学 （(一社)日本医療薬学会）  39 （ 12 ） 733 - 740 2013年12月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

　概要を見る

There is a lack of opportunities in Japan to engage in communication skills education about effective interactions between pharmacists and medical staff. This is despite the fact that current pharmacy education programs should be producing clinical experts in this area. Because of this, we delivered an educational program relating to building communication skills when working in a multidisciplinary team; 29 pharmacy students took part between May and November 2011. The program was based on two components: a lecture about communication skills by a facilitator (including “active listening”, “assertiveness” and “conflict management”), and a small group discussion (SGD) relating to decisions about opioid increases/rotation using a cancer pain case as an alternative opioid treatment. After the students finished the SGD, we distributed questionnaires to them and assessed outcomes using a five-grade Likert scale. As a result of the questionnaires, their mean understanding about opioid increasing and opioid rotation were 4.59 ± 0.68 and 4.48 ± 0.69, respectively. The mean implementation score of communication skills relating to “assertiveness” was 3.62 ± 0.94, which was significantly worse when compared with that of “active listening” (4.31 ± 0.60, P = 0.003). In addition, the mean satisfaction levels of the SGD group work and the overall educational program were 4.31 ± 0.81 and 4.38 ± 0.62, respectively. Care is required when interpreting the results given the study was limited to a single institution. However, these results suggest that this type of program may be useful for supporting pharmacy students to learn about communication skills. Improved skills should result in more effective communication, when pharmacists interact with medical staff.

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外来化学療法における薬学的管理の業務展開と医療安全への質的貢献の評価

河添　仁, 井門敬子, 田中亮裕, 末丸克矢, 荒木博陽

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  49 （ 9 ） 981 - 985 2013年09月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

オキサリプラチン投与時の血管痛に対する加温ならびに温罨法の試み

宮嶋理沙, 河添　仁, 恒岡菊江, 藤原光子, 児島　洋, 薬師神芳洋

癌と化学療法 （癌と化学療法社）  40 （ 4 ） 537 - 540 2013年04月

研究論文（学術雑誌）, 共著, 査読有り

タクロリムス眼軟膏の製剤学的安定性の検討

公平恵崇, 渡邉真一, 河添　仁, 原　祐子, 末丸克矢, 荒木博陽

愛媛県病薬会誌 （(一社)愛媛県病院薬剤師会）  110   3 - 7 2012年04月

研究論文（学術雑誌）, 共著, 査読有り

Comparison of antiemetic efficacy between single and repeat treatment with dexamethasone in patients receiving carboplatin-based combination chemotherapy

Kawazoe H, Motoki Y, Takechi Y, Shishino Y, Ido K, Suemaru K, Araki H

Methods and Findings in Experimental and Clinical Pharmacology （THOMSON REUTERS）  32 （ 7 ） 499 - 505 2010年09月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

A retrospective study was carried out to compare the preventive effects of single and repeat treatment with dexamethasone (DEX) on delayed nausea and emesis in patients who had received carboplatin (CBDCA)-based combination chemotherapy. Sixty-four patients were evaluated. Efficacy was assessed using the nausea and emesis score, food intake score and the requirement for antiemetic medication. These forward scores were categorized as three-grade during the first 5 days after chemotherapy. Acute nausea and emesis were well controlled in both groups on day 1. Mean values of the nausea and emesis score on day 3 evening and the food intake score on day 4 morning in the repeat-treatment group was 1.31 ± 0.93 and 3.46 ± 1.03, respectively, which were significantly better when compared with the singletreatment group (2.00 ± 1.52; P = 0.028 and 2.79 ± 1.12; P = 0.018, respectively). Multivariate logistic regression analysis revealed that less frequent dispensing of antiemetic medication was significantly associated with the repeat-treatment group (adjusted odds ratio, 0.153; 95% confidence interval, 0.026-0.734; P = 0.018). These results suggest that repeat-dose DEX may be more effective than single-dose DEX for the prevention of delayed nausea and emesis after CBDCA-based combination chemotherapy.

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注射用抗がん剤調製の知識・手技の均てん化を目指した多施設共同研修

河添　仁, 刀根潤一, 吉田陽子, 木村博史, 村上　朋, 亀岡春菜, 武智宣佳, 小暮友毅, 村上通康, 浅川隆重, 井上智喜, 江口久恵, 末丸克矢, 荒木博陽

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  46 （ 8 ） 1086 - 1090 2010年08月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

Nephrotoxicity Induced by Repeated Cycles of Oxaliplatin in a Japanese Colorectal Cancer Patient with Moderate Renal Impairment

Kawazoe H, Sugishita H, Watanabe S, Tanaka A, Morioka J, Suemaru K, Watanabe Y, Kawachi K, Araki H

Japanese Journal of Cancer and Chemotherapy 37 （ 6 ） 1153 - 1157 2010年06月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

　概要を見る

There have so far been few reports of the pharmacokinetics of oxaliplatin in patients with renal impairment. This report describes the nephrotoxicity induced by repeated cycles of oxaliplatin in a Japanese colorectal cancer patient with moderate renal impairment(creatinine clearance(Ccr): 20-30mL/min). The patient was a 77-year-old male who had chronic renal impairment and received the modified FOLFOX6 repeated every 2 weeks. In cycle 8, the blood concentration of oxaliplatin(66 mg/m2)was measured as the platinum level to confirm the patient's safety. The serum ultrafiltrate concentrations of platinum were 800, 1, 000, 300, <200, and <200 ng/mLat 1, 2, 3 hr, 1 week, and 2 weeks after the start of infusion, respectively, which were closely comparable with the population pharmacokinetic data in Japanese patients with normal renal function. On the other hand, the serum creatinine value was gradually increased after cycle 6, resulting in a decrease of Ccr. The mean Ccr during day 1-59 and day 240-299were significantly different at 26. 5+/-2. 8(mean+/-SD)and 9. 6+/-1. 9mL/min, respectively. Consequently, the chemotherapy showed a complete response after 10 cycles, but the patient got dialysis on day 311. In conclusion, the repeated cycles of oxaliplatin cumulatively damaged the renal function in a Japanese patient with a moderate renal impairment.

カルボプラチン併用化学療法による骨髄抑制の危険因子の探索～多変量解析を用いた症例対照研究～

河添　仁, 元木雄己, 飛鷹範明, 井門敬子, 末丸克矢, 荒木博陽

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  46 （ 6 ） 792 - 796 2010年06月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

注射用抗がん剤取扱い時における薬剤師の被曝認識―愛媛県下10施設におけるアンケート調査―

小暮友毅, 河添　仁*, 井門敬子, 村上通康, 浅川隆重, 井上智喜, 末丸克矢, 荒木博陽, 江口久恵

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  46 （ 5 ） 651 - 655 2010年05月

研究論文（学術雑誌）, 共著, 責任著者, 査読有り

Problems associated with prophylactic use of erythromycin in 1566 staff to prevent hospital infection during the outbreak of pertussis

Tanaka H, Kaji M, Higuchi K, Shinohara N, Norimatsu M, Kawazoe H, Ninomiya M, Fukuoka N, Ishii N, Fujita J, Okabe A, Houchi H

Journal of Clinical Pharmacy and Therapeutics （WILEY）  34 （ 6 ） 719 - 722 2009年11月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0269-4727

　概要を見る

Background and objective: Pertussis developed in Kagawa University Medical School and University Hospital in May 2007. To control the outbreak and prevent the infection of hospital inpatients, the Infection Control Team (ICT) carried out the prophylactic administration of erythromycin (EM) to hospital staff (1566 staff) who might be exposed to Bordetella pertussis.
Methods: An oral dose of 1000 mg/day EM was given for 10 days. To assess compliance and estimate the frequency of adverse effect, the ICT conducted a questionnaire survey.
Results and discussion: Of 942 respondents (response rate: 60.2%), 264 (28.0%) experienced some form of EM adverse effects, of which the most commonly reported involved digestive organ symptoms, e.g. diarrhoea (15.6%), stomachache (7.5%), nausea (3.6%), epigastric distress (2.1%) and abdominal distention (1.8%). More importantly, 246 participants (26.1%) stopped taking the EM before completing 10 days because of perceived adverse effects.
Conclusion: These results indicate that EM appears to cause adverse effects more frequently than reported in the package insert in Japan. The prophylactic use of EM for pertussis infection is recognized in the guideline of the Centers for Disease Control and Prevention. However, this study suggests that attention should be paid to EM non-compliance during a pertussis outbreak, which could extend the duration of the outbreak and increase the number of affected patients.

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イトラコナゾール内用液がシクロスポリンの薬物動態に及ぼす影響

山口佳津騎, 河添　仁, 井上達也, 田中裕章, 二宮昌樹, 福岡憲泰, 芳地 一

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  45 （ 11 ） 1494 - 1496 2009年11月

研究論文（学術雑誌）, 共著, 査読有り

Comparison of Antibacterial Activity of Fluoroquinolones with Their Sucralfate-complexes against Clinically-isolated Bacteria

Kawazoe H, Takaoka K, Shibata H, Arakaki N, Higuti T, Negayama K, Houchi H, Tsuchiya K, Takiguchi Y

Journal of Health Science （The Pharmaceutical Society of Japan）  55 （ 5 ） 790 - 795 2009年10月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

　概要を見る

Oral fluoroquinolones are widely known to form chelate complexes with metal-containing drugs, resulting in inhibition of their intestinal absorption. However, for intestinal sterilization, the concomitant regimen may be a selective and effective strategy due to decreased absorption of fluoroquinolones result in the retainment of antibiotics at the intestine if the mixture still perpetuated antibacterial activity. Therefore, to clarify whether the mixture of fluoroquinolones and sucralfate affects their antibacterial activity or not, we conducted in vitro study. According from the checkerboard study using a microdilution method with Mueller-Hinton broth, the antibacterial activity of these fluoroquinolones-sucralfate mixtures equaled to the parent fluoroquinolones even in the presence of sucralfate at the molar ratio of [sucralfate: fluoroquinolone] was less than 166, and the minimal inhibitory concentrations for clinical isolated Escherichia coli and Pseudomonas aeruginosa strains were independent of the existence of sucralfate. These data imply that the chelated forms of each fluoroquinolone retain antibacterial activity even in the presence of the recommended therapeutic doses of sucralfate in clinical practice.

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薬学生の満足度調査から見えてきた薬剤師教育の不足項目 -実務実習事前教育の現状-

河添　仁, 福岡憲泰, 辻　繁子, 合田哲子, 安西英明, 芳地　一

医療薬学 （(一社)日本医療薬学会）  35 （ 7 ） 501 - 508 2009年07月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

Little information is available on the level of satisfaction of pharmacy students with pharmacist education before clinical pharmacy practice,although the current pharmacy education is rapidly changing to place more importance on nurturing clinical experts.In view of this,we performed a questionnaire survey to investigate deficiencies in pharmacist education that affected the satisfaction level of pharmacy students.A questionnaire was given to 59 pharmacy students between February 2007 and July 2008 and the responses were analyzed using categorical regression in order to objectively reflect the results in future pharmacist education.The survey revealed that pharmacist jobs that reduced the satisfaction level of pharmacy students included“making in-hospital pharmaceutical preparations”,“compliance management”,“clinical research coordination”,“drug purchasing management and stock control”,and“payment for injection drugs”,etc.,listed in order of degree of deficiency.Other items that influenced the satisfaction level were“nurturing medical professionals”,“team approach to medical treatment”,and“communication”.In this regard,75.4% of the pharmacy students responded that communication education between pharmacists and other medical staff was insufficient.The findings of our survey suggest that satisfaction level is a useful index to target in improving pharmacist education.

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Prospective Study to Assess the Optimal Blood Concentration of Tacrolimus in Japanese Patients with Rheumatoid Arthritis

Kawazoe H, Dobashi H, Kameda T, Susaki K, Kittaka K, Tokuda M, Fukuoka N, Ishida T, Takiguchi Y, Houchi H

Journal of Health Science （The Pharmaceutical Society of Japan）  55 （ 3 ） 435 - 440 2009年06月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

We performed a prospective study to assess the optimal blood concentration of tacrolimus in Japanese patients with rheumatoid arthritis (RA). The dose of tacrolimus (1-3mg/day) was administered orally once daily after the evening meal, and the blood concentration of tacrolimus 12 hr after administration was quantified. A total of 23 patients were enrolled. Clinical efficacy was assessed using the Disease Activity Score in 28 joints and European League Against Rheumatism (EULAR) response criteria at each outpatient visit during months 1-6. The ratio of patients who showed a moderate or good response was 47.8% (11/23). The mean blood concentrations of tacrolimus in EULAR responders and EULAR non-responders were 5.5±3.6 (mean±S.D.) and 3.1±1.9 ng/ml, respectively (p=0.069). Interestingly, although tacrolimus had lower mean blood concentrations (<5 ng/ml) compared with transplant fields (10-20 ng/ml), six (35.3%) of 17 patients showed sufficient response to tacrolimus. In addition, in five patients, tacrolimus was co-administered with methotrexate (MTX). On the other hand, the mean blood concentrations of tacrolimus in patients who did or did not develop adverse events were 4.8±4.4 (n=8) and 4.0±2.1 (n=15) ng/ml, respectively (p=0.624). We failed to clear the optimal blood concentration of tacrolimus in RA patients, but one of the most remarkable findings was the observation that patients in whom tacrolimus was combined with MTX reached a positive response at much lower tacrolimus concentrations compared to patients not co-treated with MTX.

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精神科病棟における薬剤師の役割―医師・看護師への認識調査の前後比較による検証と再評価―

篠原尚樹, 河添　仁, 田中裕章, 二宮昌樹, 福岡憲泰, 芳地　一

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  45 （ 4 ） 511 - 514 2009年04月

研究論文（学術雑誌）, 共著, 査読有り

同種造血幹細胞移植患者における多剤耐性緑膿菌による感染症治療

河添　仁, 滝口祥令, 井上達也, 山口佳津騎, 田中裕章, 加地雅人, 辻　繁子, 二宮昌樹, 福岡憲泰, 大西宏明, 石田俊彦, 芳地　一

Yakugaku Zasshi （(公社)日本薬学会）  128 （ 4 ） 657 - 661 2008年04月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

Infections caused by multiple-drug-resistant Pseudomonas aeruginosa (MDRP) are a clinically significant problem. We reported here the effective use of combination therapy in a patient with infection caused by MDRP according to an interventional treatment strategy suggested by a pharmacist. The patient was a 70-year-old male who underwent allogeneic hematopoietic stem cell transplantation. On day 45 after transplant, MDRP was newly isolated from urine, but the diagnosis at that time was colonization. On day 61, the patient developed a fever (≥38.0°C). In addition, laboratory data showed that C-reactive protein (CRP) was also increased. At the medical team conference, the pharmacist proposed the following treatment strategy for this infection. Aztreonam and amikacin were intravenously administered at doses of 2 g/day and 800 mg/day, respectively. The subsequent clinical course was well controlled, but the infection recurred and was aggravated. Aztreonam and ciprofloxacin were then intravenously administered at doses of 4 g/day and 600 mg/day, respectively, resulting in the alleviation of fever in the patient as well as a decrease in CRP and disappearance of MDRP isolates from urine on day 67; that is, MDRP infection was consequently well controlled. In conclusion, the combination therapy between aztreonam and amikacin, or ciprofloxacin may be clinically useful for severe infections of MDRP in compromised hosts.

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院内製剤抗生物質点眼液の安定性

田中裕章, 朝倉正登, 土居智明, 河添　仁, 福岡憲泰, 玉井栄治, 宮田　茂, 松下　治, 岡部昭延, 芳地　一

日本病院薬剤師会雑誌 （(一社)日本病院薬剤師会）  43 （ 10 ） 1369 - 1372 2007年10月

研究論文（学術雑誌）, 共著, 査読有り

同種造血幹細胞移植患者におけるニューキノロン系抗菌薬による内因性感染の予防効果 —骨髄移植，末梢血幹細胞移植，臍帯血移植の比較—

河添　仁, 滝口祥令, 田中裕章, 二宮昌樹, 福岡憲泰, 大西宏明, 石田俊彦, 芳地　一

Yakugaku Zasshi （(公社)日本薬学会）  127 （ 8 ） 1301 - 1307 2007年08月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

We performed a retrospective study to examine the preventive effects of newquinolones for endogenous infection in patients receiving various allogeneic hematopoietic stem cell transplantation including bone marrow transplantation (BMT), peripheral blood stem cell transplantation (PBSCT), and cord blood transplantation (CBT). Forty-nine patients were enrolled. Ciprofloxacin or norfloxacin was orally administered for intestinal sterilization from day -14 until engraftment. As a result, the period from transplantation until engraftment was significantly longer in CBT group than in BMT group. The febrile index (the ratio of the febrile (≥38.0°C) period during neutropenia (≤500 cells/mm3) and C-reactive protein (CRP)-positive index (the ratio of CRP-positive (≥2.0 mg/dl) period during neutropenia) were comparable among the three groups. In addition, no gram-negative bacteria in stool was isolated in the three groups; that is, an endogenous infection of gram-negative bacteria, a potential pathogen, was well controlled by newquinolones. We should be careful when interpreting the results of this small study; however, newquinolones are clinically effective for endogenous infection of gram-negative bacteria in patients receiving not only BMT, but also PBSCT and CBT.

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個々の患者の副作用予測のために開発された婦人科がん化学療法モニタリングシート

土居智明, 飯原なおみ, 河添　仁, 福岡憲泰, 芳地　一, 黒崎勇二, 森田修之

Yakugaku Zasshi （(公社)日本薬学会）  127 （ 6 ） 1027 - 1033 2007年06月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

Monitoring the adverse reaction patterns specific to individual patients is important to avoid subsequent reactions. Gynecologic cancer chemotherapy is often implemented repeatedly with an altered protocol during prolonged terms. The purpose of this study was to develop and assess the efficacy of a worksheet that pharmacists can use to analyze adverse reaction patterns in individual patients with gynecologic chemotherapy. The worksheet which we developed consisted of multiple sections. One section is for necessary drug information for the proper use of antineoplastic agents. Another section is for the following items recorded by the pharmacists: a) patients' basic information such as stage of disease and protocol, b) state of implementation and break of chemotherapy and supportive therapy on calendar, and c) laboratory data and symptoms. We arranged the last item below the calendar and enabled pharmacists to easily assess individual adverse reactions coupled with the treatment course. Reviews of the developed worksheet indicated that the worksheet led to the convenient detection of individual adverse reaction patterns and effective prevention of additional adverse reactions. This monitoring sheet covering long-term chemotherapy which was designed to predict individual adverse reaction patterns will improve the individualization and safety of gynecologic chemotherapy.

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Preventive Effects of Low-dose Dexamethasone for Delayed Adverse Events Induced by Carboplatin-based Combination Chemotherapy

Kawazoe H, Takiguchi Y, Tanaka H, Doi C, Fukuoka N, Kanaji N, Bandoh S, Ishida T, Houchi H

Yakugaku Zasshi （(公社)日本薬学会）  127 （ 6 ） 1001 - 1006 2007年06月

研究論文（学術雑誌）, 共著, 筆頭著者, 責任著者, 査読有り

　概要を見る

We performed a retrospective study to examine the protective effect of low-dose dexamethasone (DEX) on delayed adverse events induced by carboplatin (CBDCA)-based combination chemotherapy in patients with thoracic tumors. Low-dose DEX (4-8 mg/day) was administered on day 1 and after, in addition to a serotonin 5-HT3 receptor antagonist. The acute adverse events (day 1) were well controlled in the patients with or without co-treatment of DEX. On the other hand, the delayed nausea, emesis, anorexia, and fatigue after day 2 failed to be controlled by 5-HT3 antagonist alone. Co-treatment with DEX significantly suppressed the grade of the delayed adverse events during days 2-10. The mean ratio of complete protection during days 2-10 were significantly higher in the DEX-treated group compared with the non-DEX-treated group. These results reveal that low-dose DEX is a clinically effective treatment for the prevention of delayed adverse events induced by CBDCA-based combination chemotherapy.

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