基本情報
研究分野
1経歴
7-
2020年10月 - 現在
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2020年4月 - 2021年9月
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2016年4月 - 2020年3月
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2014年4月 - 2016年3月
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2013年4月 - 2014年3月
学歴
3-
2015年4月 - 2019年3月
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2000年4月 - 2006年3月
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1997年4月 - 2000年3月
論文
109-
Journal of Pediatric Surgery 60(3) 162106-162106 2025年3月
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QJM : monthly journal of the Association of Physicians 2024年10月21日
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Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2024年7月4日OBJECTIVES: We aim to assess the early use of contrast-enhanced computed tomography (CECT) of patients with severe acute pancreatitis (SAP) using the computed tomography severity index (CTSI) in prognosis prediction. The CTSI combines quantification of pancreatic and extrapancreatic inflammation with the extent of pancreatic necrosis. METHODS: Post-hoc retrospective analysis of a large, multicentric database (44 institutions) of SAP patients in Japan. The area under the curve (AUC) of the CTSI for predicting mortality and the odds ratio (OR) of the extent of pancreatic inflammation and necrosis were calculated using multivariable analysis. RESULTS: In total, 1097 patients were included. The AUC of the CTSI for mortality was 0.65 (95 % confidence interval [CI:] [0.59-0.70]; p < 0.001). In multivariable analysis, necrosis 30-50 % and >50 % in low-enhanced pancreatic parenchyma (LEPP) was independently associated with a significant increase in mortality, with OR 2.04 and 95 % CI 1.01-4.12 (P < 0.05) and OR 3.88 and 95 % CI 2.04-7.40 (P < 0.001), respectively. However, the extent of pancreatic inflammation was not associated with mortality, regardless of severity. CONCLUSIONS: The degree of necrosis in LEPP assessed using early CECT of SAP was a better predictor of mortality than the extent of pancreatic inflammation.
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Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) 10(3) 213-221 2024年7月AIM OF THE STUDY: Peripheral intravascular catheter (PIVC) insertion is frequently performed in the emergency room (ER) and many failures of initial PIVC insertion occur. To reduce the failures, new needles were developed. This study aimed to investigate whether the use of the newly developed needle reduced the failure of initial PIVC insertion in the ER compared with the use of the existing needle. MATERIAL AND METHODS: This single-centre, prospective observational study was conducted in Japan between April 1, 2022, and February 2, 2023. We included consecutive patients who visited our hospital by ambulance as a secondary emergency on a weekday during the day shift (from 8:00 AM to 5:00 PM). The practitioners for PIVC insertion and assessors were independent. The primary and secondary outcomes were the failure of initial PIVC insertion and number of procedures, respectively. We defined the difficulty of titrating, leakage, and hematoma within 30 s after insertion as failures. To evaluate the association between the outcomes and the use of newly developed needles, we performed multivariate logistic regression and multiple regression analyses by adjusting for covariates. RESULTS: In total, 522 patients without missing data were analysed, and 81 (15.5%) patients showed failure of initial PIVC insertion. The median number of procedures (interquartile range) was 1 (1-1). Multivariate logistic regression analysis revealed no significant association between the use of newly developed PIVCs and the failure of initial PIVC insertion (odds ratio, 0.79; 95% confidence interval, [0.48-1.31]; p = 0.36). Moreover, multiple regression analysis revealed no significant association between the use of newly developed PIVCs and the number of procedures (regression coefficient, -0.0042; 95% confidence interval, [-0.065-0.056]; p = 0.89). CONCLUSIONS: Our study did not show a difference between the two types of needles with respect to the failure of initial PIVC insertion and the number of procedures.
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Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) 10(3) 232-244 2024年7月INTRODUCTION: Early and accurate identification of high-risk patients with peripheral intravascular catheter (PIVC)-related phlebitis is vital to prevent medical device-related complications. AIM OF THE STUDY: This study aimed to develop and validate a machine learning-based model for predicting the incidence of PIVC-related phlebitis in critically ill patients. MATERIALS AND METHODS: Four machine learning models were created using data from patients ≥ 18 years with a newly inserted PIVC during intensive care unit admission. Models were developed and validated using a 7:3 split. Random survival forest (RSF) was used to create predictive models for time-to-event outcomes. Logistic regression with least absolute reduction and selection operator (LASSO), random forest (RF), and gradient boosting decision tree were used to develop predictive models that treat outcome as a binary variable. Cox proportional hazards (COX) and logistic regression (LR) were used as comparators for time-to-event and binary outcomes, respectively. RESULTS: The final cohort had 3429 PIVCs, which were divided into the development cohort (2400 PIVCs) and validation cohort (1029 PIVCs). The c-statistic (95% confidence interval) of the models in the validation cohort for discrimination were as follows: RSF, 0.689 (0.627-0.750); LASSO, 0.664 (0.610-0.717); RF, 0.699 (0.645-0.753); gradient boosting tree, 0.699 (0.647-0.750); COX, 0.516 (0.454-0.578); and LR, 0.633 (0.575-0.691). No significant difference was observed among the c-statistic of the four models for binary outcome. However, RSF had a higher c-statistic than COX. The important predictive factors in RSF included inserted site, catheter material, age, and nicardipine, whereas those in RF included catheter dwell duration, nicardipine, and age. CONCLUSIONS: The RSF model for the survival time analysis of phlebitis occurrence showed relatively high prediction performance compared with the COX model. No significant differences in prediction performance were observed among the models with phlebitis occurrence as the binary outcome.
MISC
449-
日本集中治療医学会雑誌 20(Supplement) 293 2013年1月25日
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救急・集中治療 24(11-12) 1449-1458 2012年12月<Point>CRBSIの診断はとても難しく、ある程度の臨床診断が必要である。動脈圧ラインも中心静脈カテーテルと同様に扱おう。CRBSI治療のfirst choiceは、やはりバンコマイシンが妥当。CRBSIは予防が大事。CRBSIバンドルを活用しよう。(著者抄録)
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Intensivist 4(4) 639-652 2012年10月人工呼吸は,ICU入室患者の約30%に必要であり,ICUにおける患者管理に必要不可欠である。人工呼吸中の人工呼吸器関連肺炎ventilator associated pneumonia(VAP),人工呼吸器関連肺損傷ventilator associated lung injury(VALI)などは,ある一定の割合で発生する合併症であり,ICU滞在日数や死亡率に大きな影響を及ぼす。人工呼吸器装着時間は,患者予後に関連する独立の危険因子であることから,これを可能なかぎり短くすることは,人工呼吸器管理を行う医療従事者にとっての責務といってもよいだろう。米国では,ICU専従の呼吸療法士が中心となって人工呼吸器管理を行い,人工呼吸開始,日々の微調整,離脱に大きな力を発揮している。呼吸器離脱プロトコルを取り入れることにより,医師主体の人工呼吸器管理よりも早期に離脱が可能であったという報告も多い。一方,本邦では医師以外が主体となって人工呼吸器管理を行っている施設は少なく,プロトコルを利用している施設も少ないことが予想される。このような本邦の現状をふまえて,本稿では,自発呼吸トライアルspontaneous breathing trial(SBT)の具体的な適応,方法などについて実践的知識を提供し,その知識を臨床に活用したり,プロトコルの作成ができるようになることを意図した。(著者抄録)
書籍等出版物
6講演・口頭発表等
39所属学協会
5-
2012年8月 - 現在
共同研究・競争的資金等の研究課題
3-
日本学術振興会 科学研究費助成事業 基盤研究(C) 2021年4月 - 2026年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2019年4月 - 2024年3月
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日本学術振興会 科学研究費助成事業 2017年4月 - 2019年3月