BackgroundChronic kidney disease (CKD) is associated with a high risk of cardiovascular disease complications. Therefore, medical institutions conduct educational hospitalization for early treatment and education of CKD patients. However, patients who have been discharged after achieving educational targets can end up showing poor symptoms at home. There also have been several cases of rehospitalization or disease aggravation. In this study, we analyzed rehospitalized patients who were discharged from the hospital after CKD educational hospitalization and investigated the purpose of analyzing rehospitalization factors.Materials and methodsThis was an observational case-control study conducted at Yokosuka Kyousai Hospital. We performed univariate analysis using patient background features and laboratory data between a rehospitalization group and a no-rehospitalization group. Next, we performed multiple logistic regression analysis using the results of the univariate analysis.ResultsFrom the results of this study, we identified independent risk factors, such as serum albumin level, heart-failure complications, and estimated glomerular filtration rate (eGFR). Moreover, the serum Alb level was identified as the most important risk factor for rehospitalization. Therefore, we considered that it is important to live a life that makes it possible to maintain CKD stage G3b for a long time after discharge, because the cutoff level of eGFR is 31 mL/minute/1.73 m2.ConclusionWe believe that it is important to educate patients, their families, and medical staff on the importance of early detection and treatment, and we consider that this approach is important to inclusively protect the kidney.

Hyperuricemia and hyperlipidemia have attracted attention as progression factors for chronic kidney disease (CKD). In the drug treatment of hyperuricemia and hyperlipidemia complications, Atorvastatin (ATV), which inhibits urinary protein, increases glomerular filtration rate (GFR) and has renal protective effects, and Rosuvastatin (ROS) were found be suitable because they promote serum uric acid (SUA) excretion. However, these drugs were administered at very high doses in previous studies. In this study, we have investigated the effects of ATV or ROS on renal protective effects and their SUA levels before and three months after each drug administration in CKD patients. We retrospectively investigated outpatients presenting with CKD (stages 3) on the basis of their electronic medical records as subjects. Estimated GFR (eGFR) was significantly increased after ATV administration, whereas no change in eGFR was observed following ROS administration. Furthermore, SUA levels significantly decreased after ATV administration, whereas no changes were observed following ROS administration. Therefore, it may be not necessary to administer drugs that lower the SUA levels to patients presenting with hyperuricemia and hyperlipidemia complications associated with moderate renal failure, such as patients with at least stage 3 CKD. We consider that, by selecting ATV, the renal protective effects and SUA-lowering effect would be sufficient.

Background/Aims Our previous study showed that time in therapeutic range (TTR) control of warfarin therapy was negatively affected in non -valvular atrial fibrillation (NVAF) patients with heart failure. This study assesses the effect of intervention byhospital pharmacists on TTR control in Japanese NVAF patients with heart failure. Method This retrospective cohort study included NVAF patients with heart failure admitted and discharged from the cardiovascular internal medicine ward between March 2011 and July 2013. Participants were classified into two groups according to the instructions by hospital pharmacists and physicians (Intervention group) and by physicians only (Usual care group). The primary outcome was TTR. Secondary outcomes were major bleeding and minor bleeding. Results In total, 57 participants (35 males, 22 females ; mean age : 69.7 years) were classified into the Intervention (n = 25) and Usual care (n = 32) groups. TTR within-therapeutic range was significantly higher and within sub-therapeutic range was significantly lower in the Intervention than the Usual care group. Major bleeding and minor bleeding were not significantly different between the two groups. Conclusion The intervention of hospital pharmacists with anticoagulation therapy can lead to proper use of warfarin, which can be useful when physicians prescribe warfarin.

BackgroundIt is well-documented that chronic kidney disease (CKD) often results in end-stage renal failure and puts patients at extremely high risk for developing cardiovascular disease. Educational hospitalization at medical institutions in Japan is important for patients with CKD because it facilitates treatment in earlier stages of CKD when subjective symptoms are not apparent. However, some patients who have achieved their educational targets tend to have poor compliance at home after discharge from the hospital, resulting in rehospitalization shortly. In this study, we examined the factors for early rehospitalization of patients after initial CKD educational hospitalization compared with non-rehospitalized patients.MethodsOne hundred thirty-seven patients after discharge from CKD educational hospitalization in Japan between March 2011 and December 2012 were included in the analyses. The subjects were classified into two groups: the early rehospitalization group and control group. We adjusted for confounding variables and performed multiple logistic regression analysis with the presence or absence of early rehospitalization as a dependent variable to investigate the association of early rehospitalization with patient background features, laboratory data, vital signs, instruction-related items, and home environment.ResultsStudy subjects included 22 patients in the early hospitalization group and 115 patients in control group. Multivariable analysis for early rehospitalization indicated that insufficient instruction by physician, pharmacist, and dietitians was independent explanatory variable. Analyzing by Kaplan–Meier method, the probability of non-rehospitalization in the instruction group was significantly higher than that in the non-instruction group. Therefore, we believe it is necessary to involve a competent, multidisciplinary medical team (consisting of physicians, pharmacists, and dietitians) in addressing the early rehospitalization issue in patients with CKD.ConclusionThese findings confirm the importance of care by a multidisciplinary medical team in patients with CKD. Therefore, we suggest that care by a multidisciplinary medical team reduces the increase of early rehospitalization in patients with CKD.

In the present study, we retrospectively investigated consecutive patients who visited the Nephrology Medicine Department of Yokosuka Kyousai Hospital between September 2006 and October 2011. In total, our study included 104 participants with CKD (stage G3a-G5) who were diagnosed with hyperlipidemia and commenced on high potency statins. The average normal PP is 50 mmHg, and the risk of CVD increases when PP is ≥65 mmHg [11]. The participants were categorized on the basis of their PP: ≥65 mmHg was the High PP group, and PP <65 mmHg was the Low PP group. Investigation itemsData regarding the participants' basic information were collected from their medical records at baseline and 12 months later, as appropriate. This included their age, gender, body weight (BW), body mass index (BMI), smoking history, comorbidity (e.g., diabetes mellitus, hypertension). Laboratory data, including the levels of SBP, DBP, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum uric acid (SUA), blood urea nitrogen (BUN), serum

The substance bound to the pemphigus antibody (P‐Ab), pemphigus antigen, was removed from the surface of the keratinocytes of both human and guinea pigs with high concentrations of trypsin. When keratinocytes were cultured for more than 24 hours, the antigen reappeared on the surface. Furthermore, P‐Ab was recovered from the P‐Ab treated cultured cells by acid treatment. Cell membranes were prepared from human keratinocytes in order to determine whether or not the antigen was situated on their surface. The antigen was also detected on the surface of the cell membrane. As the membrane was found to be able to absorb P‐Ab, the antigen was extracted from the membrane by papain digestion and P‐Ab coated Sepharose column chromatography. The eluate from the column was also able to block P‐Ab activity. At the same time, the culture supernatant of both human and guinea pig keratinocytes was examined for its ability to block P‐Ab activity. The culture supernatant showed a slight ability to block P‐Ab. The origin and nature of the antigen was discussed.

1 2 3 【目的】 短時間作用型オピオイド (short-acting opioid: SAO) と即放性オピオイド (rapid-onset opioid: ROO) に関 する認識について検討した． 【方法】 自記式質問紙を用いて，がん突出痛の定義や ROO 製剤の使用方法，SAO 製剤 との相違に関する質問を医師・看護師・薬剤師に行った． 【結果】 回収率は 72.7％であり，医師 35 名，看護師 102 名，病院薬剤師 171 名から有効回答を得た．SAO 製剤と ROO 製剤の相違の認識の程度を 0-10 の 11 段階で評 価したところ，全体で平均 3.8 であった．また，ROO 製剤の使用方法で 「開始用量」 ， 「開始用量は定時投与している オピオイド鎮痛薬の 1 日量に依存しない」 は，回答者間で認知度がばらついている傾向がみられた． 【考察】 本研究結 果を基に，今後は各職種が ROO 製剤の使用方法に関する内容を再確認し，適正使用に努めていく必要があると考 える． Palliat Care Res 2019; 14 (2) : 53-60Objective: The present study was conducted to determine the level of awareness about the difference between short-acting opioid (SAO) and rapid-onset opioid (ROO) formulation. Methods: A questionnaire survey was conducted to evaluate levels of awareness regarding the definition of cancer breakthrough pain, how to use the ROO formulation, and the difference between SAO and ROO formulation among physicians, nurses, and pharmacists. The surveillance period is between December 1, 2017 and December 31, 2017. Results: We received responses from 35 physicians, 102 nurses, and 171 pharmacists. The awareness of the difference between SAO formulation and ROO formulation across all occupation groups was approximately 3.8 in 11 steps from 0 to 10. Regarding the appropriate use of the ROO formulation, there was a tendency for variation among respondents in awareness about items referring to "the starting dose" and "the starting dose does not depend on the daily dose of the opioid analgesic administered on time." Conclusion: The results of the present study suggest that it is necessary for each healthcare professional to reconfirm their knowledge of ROO formulation in the future and ensure appropriate administration.Palliat Care Res 2019; 14 (2) : 53-60

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