KEIO RESEARCHERS INFORMATION SYSTEM

Career 【 Display / hide 】

Career 【 Display / hide 】

• 2014.04

  -

  2024.09

  Hokkaido University Hospital, Department of Pharmacy, Pharmacist

• 2024.10

  -

  Present

  Keio University, Faculty of Pharmacy, Project Assistant Professor

Academic Background 【 Display / hide 】

Academic Background 【 Display / hide 】

• 2008.04

  -

  2014.03

  International University of Health and Welfare, School of Pharmacy, Department of Pharmaceutical Sciences

• 2019.04

  -

  2024.09

  Hokkaido University, Graduate School of Life Science, Division of Clinical Pharmacy

Research Areas 【 Display / hide 】

Research Areas 【 Display / hide 】

• Life Science / Clinical pharmacy

• Life Science / Surgical dentistry

Papers 【 Display / hide 】

Papers 【 Display / hide 】

• Validity and Utility of a Risk Prediction Model for Wound Infection After Lower Third Molar Surgery

  Akira Yamagami, Katsuya Narumi, Yoshitaka Saito, Ayako Furugen, Shungo Imai, Keisuke Okamoto, Yoshimasa Kitagawa, Yoichi Ohiro, Ryo Takagi, Yoh Takekuma, Mitsuru Sugawara, Masaki Kobayashi

  Oral Diseases (Wiley)   2025.01

  Accepted,  ISSN  1354-523X

  　View Summary

  ABSTRACT
  
  Objectives
  
  To externally validate a clinical prediction model for surgical site infection (SSI) after lower third molar (L3M) surgery and evaluate its clinical usefulness.
  
  Methods
  
  We conducted a retrospective cohort study of patients who underwent L3M surgery at Hokkaido University Hospital. The study was designed to evaluate the historical and methodological transportability. Clinical usefulness was evaluated using decision curve analysis on the data of the non‐antibiotic‐treated patients.
  
  Results
  
  We obtained 2543 validation cohorts from April 2020 to March 2023, and 640 non‐antibiotic cohorts from July 2010 to September 2023. The incidences of SSI after L3M surgery were 5.3% (135/2543) and 7.7% (49/640) in the validation and non‐antibiotic cohorts, respectively. The discrimination ability of the prediction model was acceptable for the external validation cohort (c‐statistic: 0.67; 95% CI: 0.62–0.71) and adequate for the non‐antibiotic cohort (c‐statistic: 0.72; 95% CI: 0.63–0.79). In both cohorts, the model showed excellent calibration between the observed and predicted probabilities. Decision curve analysis showed increased net benefit across a range of meaningful risk thresholds.
  
  Conclusion
  
  A simple risk prediction model for SSI after L3M surgery demonstrated clinical transportability and usefulness. This model may help surgeons/clinicians determine the appropriateness of prophylactic antibiotics administration for patients in L3M surgery.

  • Access to Document (DOI)

• Reply to Accurate Risk Prediction Model for Surgical Site Infection After Lower Third Molar Surgery.

  Akira Yamagami, Katsuya Narumi, Yoshitaka Saito, Ayako Furugen, Shungo Imai, Yoshimasa Kitagawa, Yoichi Ohiro, Ryo Takagi, Yoh Takekuma, Mitsuru Sugawara, Masaki Kobayashi

  Oral diseases  2024.11

  Lead author, Accepted,  ISSN  1354-523X

  • Access to Document (DOI)

• Development of a risk prediction model for surgical site infection after lower third molar surgery.

  Akira Yamagami, Katsuya Narumi, Yoshitaka Saito, Ayako Furugen, Shungo Imai, Yoshimasa Kitagawa, Yoichi Ohiro, Ryo Takagi, Yoh Takekuma, Mitsuru Sugawara, Masaki Kobayashi

  Oral diseases 30 ( 5 ) 3202 - 3211 2024.07

  Lead author, Accepted,  ISSN  1354523X

  　View Summary

  BACKGROUND: There is little evidence regarding risk prediction for surgical site infection (SSI) after lower third molar (L3M) surgery. METHODS: We conducted a nested case-control study to develop a multivariable logistic model for predicting the risk of SSI after L3M surgery. Data were obtained from Hokkaido University Hospital from April 2013 to March 2020. Multiple imputation was applied for the missing values. We conducted decision tree (DT) analysis to evaluate the combinations of factors affecting SSI risk. RESULTS: We identified 648 patients. The final model retained the available distal space (Pell & Gregory II [p = 0.05], Pell & Gregory III [p < 0.01]), depth (Pell & Gregory B [p < 0.01], Pell & Gregory C [p < 0.01]), surgeon's experience (3-10 years [p = 0.25], <3 years [p < 0.01]), and simultaneous extraction of both L3M [p < 0.01]; the concordance-statistic was 0.72. The DT analysis demonstrated that patients with Pell and Gregory B or C and simultaneous extraction of both L3M had the highest risk of SSI. CONCLUSIONS: We developed a model for predicting SSI after L3M surgery with adequate predictive metrics in a single center. This model will make the SSI risk prediction more accessible.

  • Access to Document (DOI)

• Evaluation of the strategies to reduce third-generation oral cephalosporins in dentistry at a Japanese academic hospital: An interrupted time series analysis.

  Akira Yamagami, Katsuya Narumi, Yoshitaka Saito, Ayako Furugen, Shungo Imai, Yoshimasa Kitagawa, Yoichi Ohiro, Ryo Takagi, Yoh Takekuma, Mitsuru Sugawara, Masaki Kobayashi

  Journal of clinical pharmacy and therapeutics 47 ( 7 ) 1010 - 1019 2022.07

  Lead author, Accepted,  ISSN  02694727

  　View Summary

  <h4>What is known and objective</h4>Third-generation oral cephalosporins, especially cefcapene-pivoxil (CFPN-PI), have been used frequently in the Japanese dental field. In December 2014 and April 2016, the newly published clinical guidelines recommended the use of amoxicillin (AMPC). Thus, it is important to evaluate the impact of these guidelines on the prescription profiles of prophylactic antibiotics, clinical outcomes and cost-effectiveness of antibiotics.<h4>Methods</h4>We conducted a retrospective study to analyse an interrupted time series analysis from April 2013 to March 2020 at the Department of Dentistry of Hokkaido University Hospital. A segmented regression model was used to estimate the changes in the incidence of infectious complications following tooth extraction. Prescribed antibiotic data were evaluated via days of therapy (DOT). Antibiotic costs were calculated in terms of the Japanese yen (JPY).<h4>Results and discussion</h4>We identified 17,825 eligible patients. The incidence rates of infectious complications (SSI + dry socket) and SSI after tooth extraction were 3.2% and 2.2%, respectively, during the entire period. The extraction of impacted third molars corresponded to 5.0% and 3.4%, respectively. However, their incidence rates were not significantly different during this period. The use of prophylactic antibiotics and antibiotic cost showed consistent trends following the implementation of guidelines. The mean DOT of CFPN-PI decreased (ranging from 4893.6 DOTs/1000 patients [March 2013 to November 2014] to 3856.4 DOTs/1000 patients [December 2014 to March 2016]; p < 0.001, and from 3856.4 DOTs/1000 patients [December 2014 to March 2016] to 2293.9 DOTs/1000 patients [April 2016 to March 2020]; p < 0.001). In contrast, the mean DOT of AMPC was found to be increased (ranging from 1379.7 DOTs/1000 patients [March 2013 to November 2014] to 3236.3 DOTs/1000 patients [December 2014 to March 2016]; p < 0.001, and from 3236.3 DOTs/1000 patients [December 2014 to March 2016] to 4597.8 DOTs/1000 patients [April 2016 to March 2020]; p < 0.001). The mean monthly cost was decreased (ranging from 905.3 JPY [March 2013 to November 2014] to 788.7 JPY [December 2014 to March 2016]; p = 0.003, and from 788.7 JPY [December 2014 to March 2016] to 614.0 JPY [April 2016 to March 2020]; p < 0.001).<h4>What is new and conclusion</h4>After December 2014, prophylactic antibiotics were switched from CFPN-PI to AMPC, and the incidence rate of infectious complications was not significantly different over time. However, changing antibiotics is useful from a cost-effectiveness perspective.

  • Access to Document (DOI)

• 腎機能低下患者へのバンコマイシン初回負荷投与の安全性調査

  新沼 悠介, 今井 俊吾, 山田 武宏, 鏡 圭介, 山神 彰, 宮井 貴之, 笠師 久美子, 小林 正紀, 井関 健

  TDM研究 ((一社)日本TDM学会)  36 ( 3 ) 117 - 124 2019.09

  Accepted,  ISSN  0911-1026

  　View Summary

  腎機能低下患者におけるバンコマイシン(VCM)初回負荷投与の安全性は十分に検証されていない。そこで今回、腎機能低下患者に対するVCM初回負荷投与の安全性を明らかにするために、単施設(n=1489)後ろ向き観察研究を実施した。初回負荷投与実施群(n=86)と非実施群(n=206)では、腎機能障害発現割合に有意差は認めなかった。(初回負荷投与実施群:非実施群=6.98%:9.71%、P=0.46)ベースラインの腎機能別でも同様の結果であった。また、VCMの初回トラフ値(中央値)はいずれの群も推奨濃度範囲内であり、両群間に有意差はなかった。多変量ロジスティック回帰分析で腎機能障害発現の危険因子として、投与日数9日以上、フロセミド、ピペラシリン・タゾバクタムの併用、ICU入室、初回トラフ値12.2μg/mL以上が抽出され、初回負荷投与の実施は抽出されなかった。以上より、VCMの初回負荷投与は腎機能低下患者に対しても安全に行える可能性が示唆された。(著者抄録)

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Reviews, Commentaries, etc. 【 Display / hide 】

Reviews, Commentaries, etc. 【 Display / hide 】

• 【STOP!AMR 抗菌薬の適正使用を考える】歯科における最適な抗菌薬に関する考察

  山神 彰, 菅原 満

  DENTAL DIAMOND ((株)デンタルダイヤモンド社)  48 ( 3 ) 46 - 50 2023.02

  ISSN  0386-2305

• 歯科領域における経口第3世代セフェム系抗菌薬減少戦略の評価:中断時系列分析

  山神彰, 鳴海克哉, 齋藤佳敬, 古堅彩子, 今井俊吾, 北川善政, 大廣洋一, 高木諒, 武隈洋, 菅原満, 菅原満, 小林正紀, 小林正紀

  医療薬学フォーラム講演要旨集 30th 2022

  ISSN  1348-0863

• 下顎埋伏智歯抜歯術におけるセフカペンピボキシルとアモキシシリンの手術部位感染予防効果の比較

  山神 彰, 小林 正紀, 山田 武宏, 北川 善政, 大廣 洋一, 佐藤 淳, 石黒 信久, 今井 俊吾, 武隈 洋, 菅原 満, 井関 健

  日本薬学会年会要旨集 ((公社)日本薬学会)  140年会   28Z - am10S 2020.03

  ISSN  0918-9823

• 血液培養陽性患者におけるde-escalationの実施状況とその有用性調査

  新沼 悠介, 今井 俊吾, 冨山 直樹, 鏡 圭介, 山神 彰, 山田 武宏, 小林 正紀, 井関 健, 石黒 信久, 福元 達也

  北海道病院薬剤師会誌 ((一社)北海道病院薬剤師会)   ( 95 ) 9 - 12 2018.11

  ISSN  0917-0936

  　View Summary

  当院における血液培養陽性患者へのde-escalationの実施状況を調査し、その有用性(薬剤コスト削減効果)を明らかにした。菌種別のde-escalation実施率は、メチシリン感受性黄色ブドウ球菌(MSSA)が最も高く、次いで腸球菌属(Enterococcus spp.)が高かった。抗MRSA薬からの切り替えが最も多く、これはMSSAやEnterococcus spp.のde-escalation実施率の高さに反映されていると考えられた。de-escalation実施群と非実施群における治療失敗率の比較では、両群において有意差は認められなかった。治療失敗例は各群に1例ずつ認められ、その内訳はいずれも培養結果判明後30日以内の死亡であり、感染症の重篤度との関連が疑われた症例である。菌種はそれぞれMSSAとEnterococcus spp.であった。菌の持続的検出・菌血症の再発に関しては両群で認められなかった。治療期間と治療コストの比較については、de-escalation実施群に関して多剤で治療を行っていた症例が有意に多かったため、単剤で治療を行った症例を抽出し比較を行った。治療期間に関しては両群で差は認められなかった。一方、治療コストに関しては実施群で有意に低いという結果となった。

• L-NAMEによるマウスの血圧上昇および心肥大形成に対する防已の作用

  遠藤 恵, 鈴木 理奈, 鎌田 麻央, 山神 彰, 小貫 瑛大, 谷本 枝穂, 森田 翔平, 榊原 巌, 原 明義

  日本薬学会年会要旨集 ((公社)日本薬学会)  133年会 ( 3 ) 165 - 165 2013.03

  ISSN  0918-9823

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Presentations 【 Display / hide 】

Presentations 【 Display / hide 】

• 医療の現場で使える臨床予測モデル～口腔外科手術における予防的抗菌薬を例に～

  山神 彰

  国際医療福祉大学 薬学部講演会, 

  2024.10

• 抗菌薬適正使用に役立つ臨床予測モデル～口腔外科手術における予防的抗菌薬投与を例に～

  山神 彰

  札幌病院薬剤師会「感染制御専門薬剤師」セミナー, 

  2024.08

  , 

  Public lecture, seminar, tutorial, course, or other speech

• [臨床研究入門] 薬剤師スキルアップ講座 第5回 臨床研究プレゼンテーション(2)観察研究その他: 作成と発表

  山神 彰, 山田武宏

  北海道科学大学, 

  2024.05

  -

  2025.01

• [臨床研究入門] 薬剤師スキルアップ講座 第7回 臨床研究プレゼンテーション(2)観察研究その他: 作成と発表

  山神 彰, 山田武宏

  北海道科学大学, 

  2024.02

Memberships in Academic Societies 【 Display / hide 】

Memberships in Academic Societies 【 Display / hide 】

• Japanese Society of Pharmaceutical Health Care and Sciences, 

  2014.10

  -

  Present