インターネットを活用した医療薬学系大学院教育カリキュラムの開発

金沢大学医薬保健研究域薬学系金沢大学薬学部および自然科学研究科医療薬学専攻では、これまでのソニー(株)との共同研究の経験をふまえ、社会人の薬剤師を対象として、インターネットを用いた遠隔地教育システムを構想した。今回の研究では、医療薬学という講義用コンテンツの効率的な作製、供給体制を確立するための問題点を抽出し、その解決策を探ること。医療薬学教育に必要な、教育講義内容をどういう電子媒体で提供することが効果的か、どういう通信システムを構築すれば良いか検討した。まず,平成15年度までに行った講義コンテンツの作製を継続し、さらなる充実をはかった。具体的には、以下に示す講師の講義コンテンツを医療従事者向け会員制サイト「メディカル・チャンネル(http://www.medch.tv)」でインターネットを通じて放映した.・米田幸雄(金沢大学大学院 教授)「骨芽細胞におけるグルタミン酸シグナリング」・木津良一(金沢大学大学院 助教授)「ディーゼル排気粉塵中の内分泌攪乱化学物質」・杉本八郎(京都大学大学院 客員教授)「創薬物語ドネペジル 開発に賭けた夢」・石橋弘行(金沢大学大学院 教授)「創薬物語ドネペジル 医薬品を有機化学の目で見よう」・辻 彰(金沢大学大学院 教授)「創薬物語ドネペジル 体内動態の特徴と脳内移行性」・山田清文(金沢大学大学院 教授)「創薬物語ドネペジル 薬効薬理」一方で,これまでメディカル・チャンネル用に作製した講義コンテンツを利用し,金沢大学自然科学研究科マルチメディア教育・研究システムとしてe-learning systemをハードおよびカリキュラムの面から整備した.そして,実際に大学院(博士前期課程)医療薬学専攻に入学した社会人薬剤師に対して,それらコンテンツを提供し運用した.その結果,通常の講義との整合性,著作権,受講管理,コンテンツのデータ変換等の問題点が浮き彫りになった.それらを改善し,日本初の医療薬学系大学院を,インターネットを活用して実施することが可能となった.研究課題/領域番号:15659035, 研究期間(年度):2003 – 2004出典：「インターネットを活用した医療薬学系大学院教育カリキュラムの開発」研究成果報告書　課題番号15659035（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-15659035/)を加工して作

A new method for maturity-dependent fractionation of neutrophil progenitors applicable for the study of myelodysplastic syndromes

We applied our new method, maturity-dependent fractionation of bone marrow-derived neutrophil progenitors, to a study of gene expression profiles during granulopoiesis in myelodysplastic syndromes. CD34(+) cells with low density [F1], CD11b(-)/CD16(-) [F2], CD11b(+)/CD16(-) [F3] and CD11b(+)/CD16(low) [F4] with intermediate density, CD11b(+)/CD16(int) [F5] and CD11b(+)/CD16(high) [F6] with high density were isolated from six patients. Although AML1 and C/EBP-ϵ mRNA peaked at F1 and F4, respectively, in healthy individuals, C/EBP-ϵ was maximized at F2/F3 in all patients, two of whom showed simultaneous peaks of AML1 at F2. Thus, this fractionation is useful to detect mistimed induction of granulopoiesis-regulating genes in myelodysplastic syndromes

Treatment of refractory acute leukemia with aclacinomycin-A.

Twelve patients with refractory acute leukemia (7 patients with acute myelocytic leukemia and 5 patients with acute lymphocytic leukemia) were treated with a new anthracycline antibiotic, aclacinomycin-A (ACM). ACM was administrated by intravenous drip infusion at a dose of 20 mg/day for 7 or 14 days and this was repeated after at least 7 days. Four of 12 patients (33.3%) achieved a complete remission; 3 of 7 acute myelocytic leukemia (42.8%) and 1 of 5 acute lymphocytic leukemia (20.0%). The days required for achieving the complete remission ranged from 23 to 78 days (median: 61) and the total doses of ACM used from 180 to 500 mg (median: 310), and the durations of complete remission from 11 to 28+ weeks (median: 21+). The untoward effects on digestive organs, such as nausea, vomiting and anorexia, and hematological toxicities were frequently seen; however, they were controlled by supportive treatment. Alopecia was not observed. Arrythmia was recognized in one patient at the initiation of ACM infusion with complete remission without withdrawal of ACM. These results suggest that ACM is a potentially effective anthracycline antibiotic in the clinical management of acute leukemia.</p

Treatment of refractory acute leukemia with aclacinomycin-A.

Twelve patients with refractory acute leukemia (7 patients with acute myelocytic leukemia and 5 patients with acute lymphocytic leukemia) were treated with a new anthracycline antibiotic, aclacinomycin-A (ACM). ACM was administrated by intravenous drip infusion at a dose of 20 mg/day for 7 or 14 days and this was repeated after at least 7 days. Four of 12 patients (33.3%) achieved a complete remission; 3 of 7 acute myelocytic leukemia (42.8%) and 1 of 5 acute lymphocytic leukemia (20.0%). The days required for achieving the complete remission ranged from 23 to 78 days (median: 61) and the total doses of ACM used from 180 to 500 mg (median: 310), and the durations of complete remission from 11 to 28+ weeks (median: 21+). The untoward effects on digestive organs, such as nausea, vomiting and anorexia, and hematological toxicities were frequently seen; however, they were controlled by supportive treatment. Alopecia was not observed. Arrythmia was recognized in one patient at the initiation of ACM infusion with complete remission without withdrawal of ACM. These results suggest that ACM is a potentially effective anthracycline antibiotic in the clinical management of acute leukemia.</p

Antibiotic utilization in a dental teaching hospital in Yogyakarta

医薬保健研究域薬学系Background: Various antibiotics are prescribed by dental practitioners to treat odontogenic infections. However, there has been no comprehensive study of antibiotics use in a dental teaching hospital in a developing country using World Health Organization (WHO) dose measurement units. Objective: This study was designed to evaluate the use of antibiotics among dental outpatients at a dental teaching hospital in Yogyakarta, Indonesia. Methods: A cross-sectional study of outpatients’ medical records was carried out in order to identify oral antibiotics administered during January-December 2011. Prescriptions that included antibiotics (N=2024) were separated from total prescriptions collected from medical records. The source and type of antibiotics prescribed and the diagnoses were recorded. Anatomical Therapeutic Chemical classification and Defined Daily Dosage (DDD) measurement units were assigned, and the information was compiled, coded, analyzed in accordance with WHO guidelines. Results: Thirteen different antibiotics were prescribed and all were administered to patients. Antibiotics were frequently prescribed contrary to generally accepted criteria and there was wide variation in prescribing. The most commonly prescribed antibiotic was amoxicillin (78.8%), followed by clindamycin (9.0%) and metronidazole (5.0%). The dental diagnosis most frequently reported was pulp gangrene (26.7%), followed by pulp necrosis (8.8%) and impaction-related problems (6.4%). There was a marked increase in total antibiotics use expressed in defined daily dose (DDD) per 1000 patient visit per month during September to November, which might have been associated with seasonal change or availability of student health insurance at the start of the academic year. Conclusion: Our findings show a high level of inappropriate antibiotics usage at a dental teaching hospital in Indonesia, and indicate that there is a need for educational initiatives and guidelines to promote best practice and appropriate use of antibiotics in this hospital

Superoxide anion (O2-) production by neutrophils in refractory anemia with excess of blasts.

The O2- production by neutrophils was examined in 4 cases of refractory anemia with excess of blasts (RAEB) in order to evaluate the possible causes of enhanced susceptibility to infection and to gain some informations on the differentiation of neutrophils in this hematological disorder. In three of the four RAEB cases there was little O2- production by neutrophils, in addition to there being morphological anomalies of the neutrophils such as a Pelger-Huet-like anomaly, granular deficiency and binucleated cells. These results suggest that the impairment of O2- production by neutrophils in RAEB is one of the possible causes of susceptibility to infection and also suggest that the differentiation of neutrophils in this hematological disorder is faulty. The estimation of O2- production by neutrophils may be a useful diagnostic method for preleukemia.</p

Investigation of Antibiotic Use at a Dental Teaching Hospital in Yogyakarta, Indonesia: A Review from Guidelines

医薬保健研究域薬学系Objective: To investigate prescription of antibiotics by dental practitioners at a dental teaching hospital in Yogyakarta, Indonesia, and to establish whether it conforms to major guidelines. Methods: A cross-sectional study of adult outpatients’ medical records was conducted in order to scrutinize antibiotic prescriptions. The results were compared with recommendations in four published guidelines. Results: Dental practitioners prescribed a wide range of antibiotics to treat 121 diagnoses. Amoxicillin (78.8%) was most commonly prescribed, followed by clindamycin (9.9%), metronidazole (5.0%), and lincomycin (2.1%). Among all prescriptions, 79.5% were for generic antibiotics. The most common diagnoses were dental pulp gangrene followed by dental pulp necrosis (26.7% and 8.8%, respectively). According to guidelines-1 through-4, the percentages of antibiotic prescriptions that were evaluated as appropriate for the reported diagnosis were 15.1%, 7.2%, 7.5%, and 16.3%, respectively. However, 9.9%, 84.0%, 83.7% and 67.8% of prescriptions could not be classified as appropriate or inappropriate because the respective guidelines neither listed the antibiotic nor gave statement regarding appropriate indications. Conclusion: Our results suggest that significant inappropriate antibiotic prescribing occurred at a dental teaching hospital in Yogyakarta, Indonesia, according to major antibiotics guidelines. However, the four guidelines failed to list some antibiotics, failed to list indications for prescription in some cases, and were inconsistent in their recommendations. There is a need to introduce specific institutional guidelines. Our findings should be helpful for developing public health policy guidelines to minimize inappropriate antibiotic prescribing at dental hospitals