医学生が必要と実感した多職種連携教育

＜背景＞多様化する医療ニーズに対応するため，多職種連携教育（Interprofessional Education，IPE）が求められている。＜目的＞現役医師がIPEに対してどのように考えているかを明らかにする。＜対象＞規模や地域の異なる医療機関に従事する医師（医師免許取得後５年以上）３名と川崎医科大学附属病院に勤務する初期研修医30名＜方法＞経験年数，職場環境の異なる医師３名に対し，IPEに関する面接調査を行った。初期研修医に対し，IPEに関するアンケート調査を行った。＜結果＞医師３名に対する面接調査では，初期研修医終了以降に多職種連携の必要性を認識するようになっていた。さらに，多職種連携を行うため，高いコミュニケーション能力や多職種への理解が必要で，卒前に多職種連携教育を行うべきだと認識していた。初期研修医へのアンケート調査では，初期研修医は卒前多職種連携教育の機会が不足していると感じていた。さらに，医師以外の医療スタッフの業務内容を十分に理解していなかったと感じていた。＜結語＞医学生低学年時からIPEは必要である。Background: With diversified medical needs, there is a growing need for interprofessional education (IPE).Objective: The present study aims to investigate the perspectives of medical doctors concerning IPE.Research participants: Research participants include three medical doctors from three different institutions of different areas and sizes, who have at least five years of working experience, and 30 junior residents from the Kawasaki Medical School Hospital.Methods: Three medical doctors with different years of experience and working environments were interviewed and junior residents were given a questionnaire concerning IPE.Results: The interview with three doctors revealed that they became aware of the importance of IPE after completing the junior residency. They stressed the need for IPE for medical students in order to acquire strong communicational skills and sufficient understanding of diverse medical professions that are required for team medical care. The results of the questionnaire survey showed that they found the opportunity for medical students to receive IPE inadequate. The survey also indicated that they did not have sufficient understanding of other medical staff\u27s roles and responsibilities.Conclusion: IPE for medical students should begin in their early years

An Accidental Ingestion Of A Hearing Aid Including A Litium-Ion Rechargeable Battery Which Resulted In Spontaneous Excretion

　認知機能障害がある高齢者は，異物誤飲を生じるリスクとなりうる．これは認知症の併存によって誤飲の事実を患者本人が認知していないことや異物誤飲による症状が非特異的，もしくは無症候性であることが多いことと関係している．このため認知機能障害のある高齢者において異物誤飲は発見が遅れる可能性がある．リチウムイオン充電式電池を内蔵した補聴器の誤飲が MRI の撮像を契機に発覚し，その後合併症なく自然排泄が得られた症例を経験したので報告する．症例は 82歳女性，尿路感染の診断で入院となった．入院時から不穏行動があり，感染症によるせん妄が疑われた．入院２日目に補聴器を紛失したと訴え捜索を行ったが発見できなかった．入院４日目に腰椎圧迫骨折の精査目的で行った MRI 検査において腹腔内に強いアーチファクトを認め，補聴器の誤飲が疑われた．腹部 CT 検査を行い，補聴器であることを確認した．補聴器が充電式であることやトライツ靭帯を超え横行結腸に存在していることから外科的摘出を行わず自然排泄を待つこととした．その後，異物・電池誤飲に伴う腸管症状をきたすことなく経過し，入院５日目に補聴器が自然排泄された．精神疾患患者や高齢患者など，誤飲を生じうる患者が嚥下可能なサイズの装着物を紛失した際には，Ｘ線検査を行うことで発見できる可能性がある．異物誤飲に伴う腸閉塞や腸管損傷に加え，補聴器に使用されている電池がボタン型電池であるのか内蔵型の充電式電池であるのかによって，誤飲に伴う合併症の有無を評価し，対応する必要がある .　Delirium during hospitalization in elderly patients is a risk factor for accidental foreign body ingestion. The patient may not be aware of the fact that he or she has ingested foreign bodies due to coexisting dementia, and the symptoms of foreign body ingestion are often nonspecific or asymptomatic, which may delay the detection of the accidental ingestion. We report a case in which an accidental ingestion of a hearing aid containing a rechargeable battery was detected with the opportunity of MRI imaging, and the patient underwent spontaneous elimination without complications. An 82-year-old woman was admitted to the hospital with a diagnosis of urinary tract infection and was suspected to have delirium due to the infection because of her disturbing behavior from the time of her arrival. On day 2 of admission, she reported that she had lost her hearing aid, and a search was conducted but failed to find it. On day 4, an MRI scan performed to investigate complications revealed strong artifacts in the abdominal cavity, which led us to suspect that the patient had swallowed a hearing aid by mistake. An abdominal CT scan was performed and confirmed to be a hearing aid. The patient did not have any intestinal symptoms associated with ingestion of a foreign body or battery, and spontaneous excretion of the battery was obtained on day 5. When patients with psychiatric disorders or elderly patients who is at risk of accidental ingestion lose a swallowable size equipment, radiographic examination may help detect in such cases. In addition to intestinal obstruction and damage to the intestinal tract associated with ingestion of foreign objects, the presence or absence of complications associated with ingestion of batteries due to button batteries or rechargeable batteries in hearing aids should be evaluated and discussed with each department regarding the appropriate response

ミゾリビンによる急性尿酸性腎症とメソトレキサートによる骨髄抑制を併発した1例

症例は83歳,男性.近医で関節リウマチの診断で加療(プレドニゾロン2mg,メソトレキサート(MTX)4mg),他に高尿酸血症,高血圧で加療中であった.当院へ入院13日前にミゾリビン(MZ)150mg追加投与された.入院2日前に食欲不振と全身倦怠感で近医を受診,尿素窒素99.5mg/dl,クレアチニン7.8mg/dlと急性腎不全を認めたため当院へ紹介入院した.入院時の検査所見で尿酸26.5mg/dLと著明な高尿酸血症を認めMZによる急性尿酸性腎症と診断した.そのためMZ及び尿酸の除去を目的に緊急血液透析を施行した.尿酸値及び腎機能は速やかに改善した.しかし,入院後より血小板及び白血球数の減少を認めた.骨髄検査では骨髄異形成症候群様であり,MZに加えMTXの関与を推測された.その後汎血球減少も改善している.本症例はMZの血中濃度も高くMZの排泄遅延による高尿酸血症のため急性腎不全を合併し更に腎機能の増悪がMTXによる無効造血を発症した可能性が考えられた.MZと尿酸も血液透析により体外への除去が可能でありMZによる急性尿酸性腎症の場合は早急な血液透析が有効である.An 83-year-old man was diagnosed with rheumatoid arthritis at a nearby hospital for which he was administered methotrexate (MTX) and prednisolone. Thirteen days before admission, he had started mizoribine (MZ) 150mg. Two days before admission to our hospital, he was admitted to a nearby hospital for appetite loss and general fatigue. Laboratory tests showed renal dysfunction at nearby hospital, and he was consequently admitted to our hospital for further examination. On admission, we reasoned that renal dysfunction had resulted from hyperuricemia during MZ administration because the serum concentration of uric acid (26.5mg/dL) and MZ (trough level, 5.14μg/mL) were markedly elevated. Accordingly, MZ treatment was terminated, and hemodialysis was initiated. The patient subsequently showed an improvement in his condition and renal function recovered. However, pancytopenia developed soon after admission, and bone marrow aspiration showed myelodysplastic syndrome-like lesions. We suspected MTX and MZ to be the main cause of pancytopenia. Because the onset of acute renal failure had been attributed to MZ, it was conjectured that the dose of MTX was too high. Therefore, MTX administration was cancelled, and pancytopenia ameliorated. In cases of transient renal dysfunction with MZ, it is necessary to consider discontinuation of MZ and initiation of hemodialysis

Prescription Patterns of Antimicrobial Agents for Upper Respiratory Tract Infections in Patients Visiting the Emergency Department of Kawasaki Medical School Hospital: A Descriptive Study

　Antimicrobial resistance (AMR) has become a global threat. The need for the appropriate use of antimicrobial agents has been recognized, such as in upper respiratory tract infections. This study aimed to clarify the prescription of antimicrobial agents for upper respiratory tract infections in the Emergency Department of Kawasaki Medical School Hospital. Patients who visited the department from January 1, 2014, to December 31, 2016, and were diagnosed with upper respiratory tract infection (common cold, acute upper respiratory tract infection, acute pharyngitis, acute tonsillitis, acute bronchitis, acute sinusitis) were included. Excluded were patients who visited non-emergency departments, those under 15 years of age, those transported by ambulance (ambulance, doctor car, doctor helicopter), and those who visited during office hours (8:30-15:30 on weekdays or 8:30-11:00 on Saturdays). A total of 3,920 patients were included in the study, with a median age of 34 years (interquartile range: 25-51 years), and 2007 (51%) were male. Of these, 1,023 patients (26%) were prescribed antimicrobial agents for upper respiratory tract infections. Of the antimicrobial agents prescribed, thirdgeneration cephem antibiotics accounted for more than 40%. In terms of the appropriate use of antimicrobial agents, interventions against prescribing third-generation cephalosporins were considered

自然排泄したリチウムイオン充電式補聴器の誤飲

症例報告Case Reportjournal articl

Anionic Sublattices in Halide Solid Electrolytes: A Case Study with High‐Pressure Phase of Li3ScCl6

The Li3MX6 compounds (M = Sc, Y, In; X = Cl, Br) are known as promising ionic conductors due to their compatibility with typical metal oxide cathode materials. In this study, we have successfully synthesized γ-Li3ScCl6 using high pressure for the first time in this family. Structural analysis revealed that the high-pressure polymorph crystallizes in the polar and chiral space group P63mc with hexagonal close-packing (hcp) of anions, unlike the ambient-pressure a-Li3ScCl6 and its spinel analog with cubic closed packing (ccp) of anions. Investigation of the known Li3MX6 family further revealed that the cation/anion radius ratio, rM/rX, is the factor that determines which anion sublattice is formed and that in γ-Li3ScCl6, the difference in compressibility between Sc and Cl exceeds the rM/rX threshold under pressure, enabling the ccp-to-hcp conversion. Electrochemical tests of γ-Li3ScCl6 demonstrate improved electrochemical reduction stability. These findings open up new avenues and design principles for lithium solid electrolytes, enabling routes for materials exploration and tuning electrochemical stability without compositional changes or the use of coatings

Anionic Sublattices in Halide Solid Electrolytes: A Case Study with the High‐Pressure Phase of Li3ScCl6

Abstract: The Li3MX6 compounds (M=Sc, Y, In; X=Cl, Br) are known as promising ionic conductors due to their compatibility with typical metal oxide cathode materials. In this study, we have successfully synthesized γ‐Li3ScCl6 using high pressure for the first time in this family. Structural analysis revealed that the high‐pressure polymorph crystallizes in the polar and chiral space group P63mc with hexagonal close‐packing (hcp) of anions, unlike the ambient‐pressure α‐Li3ScCl6 and its spinel analog with cubic closed packing (ccp) of anions. Investigation of the known Li3MX6 family further revealed that the cation/anion radius ratio, rM/rX, is the factor that determines which anion sublattice is formed and that in γ‐Li3ScCl6, the difference in compressibility between Sc and Cl exceeds the ccp rM/rX threshold under pressure, enabling the ccp‐to‐hcp conversion. Electrochemical tests of γ‐Li3ScCl6 demonstrate improved electrochemical reduction stability. These findings open up new avenues and design principles for lithium solid electrolytes, enabling routes for materials exploration and tuning electrochemical stability without compositional changes or the use of coatings