bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacy residency directors' concerns with implementing in‐training examinations in pharmacy residencies
Authors: Longyhore Daniel S. 
Published: April 2022

AbstractIntroductionThe use of in‐training examinations as formative assessment in graduate medical education is commonplace and performance has varying degrees of positive correlation with physician performance on future board certification examinations. Such a formative tool does not exist in graduate pharmacy education and may be a useful tool to consider developing and implementing into pharmacy residency programming.ObjectivesTo evaluate the concerns of residency program directors (RPDs) should they be faced with implementing an in‐training examination into their postgraduate year 1 (PGY1) pharmacy residency program.MethodsThe concerns‐based adoption model framework was used to conduct a mixed‐methods evaluation of RPDs' concerns about in‐training examinations in pharmacy residency training. RPDs from the eastern United States were invited to participate in a 35‐item survey, followed by a scripted interview to learn about their concerns with the idea of examination integration.ResultsTwenty‐four program directors completed the stages of concern (SOC) quantitative survey and seven continued on to complete the levels of use qualitative interview. Survey data identified that program directors were in the informational stage, requiring more information and understanding before implementing such an assessment tool. The qualification of their survey responses contained themes of equality and equity between participating programs, the difference between summative and formative assessment, and curriculum changes that would accompany such a programmatic change. All participants were in the early SOC and had not actively sought information about this practice before being part of this research.ConclusionSignificant efforts will be required to inform RPDs about in‐training examinations and formative assessment practices leading up to the implementation of such a practice in graduate pharmacy education.
Pursuing postgraduate pharmacy training in the United States for international pharmacy graduates: Approaches, current status, challenges, and future perspectives
Authors: Badreldin Hisham A. , Thabit Abrar K. , Almangour Thamer A. , Alessa Mohammed , Eljaaly Khalid , Fanikos John , Katz Michael 
Published: April 2022

AbstractAimsThis paper aims to describe the procedures and current status regarding the pursuit of postgraduate pharmacy training in the United States for international pharmacy graduates. Also, it highlights some of the challenges those individuals may face throughout their journey and provides future perspectives.MethodsTo describe the procedures regarding the pursuit of postgraduate pharmacy training in the United States, we searched and summarized the information in public online platforms, such as the National Matching System, National Association of Boards of Pharmacy, and many others. To describe the current status, we searched the publicly available American Society of Health‐System Pharmacists residency online directory and the American College of Clinical Pharmacy fellowship online directory for programs offered to international pharmacy graduates.ResultsTwo main pathways were identified to pursue postgraduate pharmacy training in the United States for international pharmacy graduates. Of the currently available residency training programs, we identified 16 programs that offer postgraduate year one and eight programs that offer postgraduate year two positions for international pharmacy graduates. We identified 64 fellowship programs in the American College of Clinical Pharmacy fellowship directory. However, the directory does not provide information on whether or not these fellowship programs will accept international pharmacy graduates.ConclusionIn order to pursue postgraduate training in the United States, international pharmacy graduates face several logistical, administrative, and immigration obstacles. This is the first article to describe the current status, provide guidance on the approaches to pursue postgraduate pharmacy training in the United States, address some of the challenges, and provide several recommendations to be considered in the future.
Scalability of a remote advanced pharmacy practice experience with post‐graduate year one pharmacy resident preceptors
Authors: Smithburger Pamela L. , Kobulinsky Lawrence R. , Kreider Madeline , Yourich Bryan E. , Seybert Amy L. 
Published: April 2022

AbstractIntroductionDue to suspension of onsite clinical instruction due to the coronavirus disease 2019 (COVID‐19) pandemic, a remote acute care rotation was created to provide students with an Advanced Pharmacy Practice Experience (APPE) and post graduate year one (PGY‐1) pharmacy residents with an opportunity to gain experience in precepting roles.ObjectiveThe objectives of this study were to evaluate student knowledge, clinical skills, communication, student satisfaction, and PGY‐1 pharmacy resident acceptance of this remote rotation and fulfillment of residency precepting objectives.MethodsA five‐week remote acute care APPE rotation was created with pharmacy residents serving as co‐preceptors. A written evaluation and intermittent clinical examination (ICE) were deployed at baseline and conclusion to assess student knowledge, clinical skills, and communication. Student surveys assessed perceived skill improvement, satisfaction, and assessment of rotation and resident preceptors. Surveys were also utilized to evaluate resident perceived attainment of precepting objectives and residency program fulfillment of precepting requirements.ResultsThirty‐four students and 10 residents participated in the rotation. Student knowledge and clinical skills increased from baseline (41 out of 60 [31‐52] vs 50 [43‐55]; P < .001) and the ICE (36 out of 70 [18‐55] vs 59.5 [43‐70]; P < .001). There was a statistically significant increase at rotation conclusion in resident rating of extreme competence or extreme comfort in 45% of domains assessed.ConclusionA remote APPE rotation is an effective approach to deliver an APPE rotation and can be successfully used to further student knowledge and provide PGY‐1 pharmacy residents a precepting opportunity to advance their precepting skills when onsite experiences are limited.
Impact of a health‐system longitudinal advanced pharmacy practice experience on student growth and postgraduate career placement
Authors: Triboletti Jessica S. , Jung Carolyn M. , Seither Amy L. , Walroth Todd A. 
Published: April 2022

AbstractWhile most longitudinal advanced pharmacy practice experiences (LAPPEs) include sequential core rotations, programs vary regarding additional elements offered. Pharmacy residency programs have become increasingly competitive with applicants outnumbering available positions. LAPPEs can help students improve their candidacy for postgraduate training while also benefiting health systems.ObjectiveTo describe the health‐system perspective of a LAPPE designed to build professional skills in students to best prepare them for subsequent career pursuits.MethodsStudents enrolled in the Eskenazi Health (EH) LAPPE were asked to complete pre‐ and postprogram assessments regarding career interests, strengths, areas for improvement, and goals. Students were also asked to rank their comfort level with 27 clinical skills in four categories. Additionally, a survey was distributed to all program alumni to gather demographic and qualitative data.ResultsIn the 9 years since inception, 52 students have enrolled in the EH LAPPE. Of the 44 program graduates surveyed, 41 responded (93%). Of these, 95% completed postgraduate training in 18 different states and two obtained jobs directly following graduation. The majority (54%) applied for a postgraduate year one (PGY1) residency at our institution, of which 11 (27%) matched for at least 1 year of residency training. A total of 32 students completed the pre‐ and postprogram skills assessments which demonstrated a statistically significant increase in comfort level in all 27 skills, with a median increase of 1.5 on a 4‐point scale. Clinical research, mentors, and mock interviews were identified as most helpful to program alumni.ConclusionsThe EH LAPPE can serve as an example for health‐systems wishing to institute a similar program. Students experienced perceived growth and increased confidence in various patient care activities, and successful career placement suggests that students benefited from career preparation elements of the LAPPE. LAPPEs can provide benefits to health systems through student contributions and should be considered by sites looking for growth and unique precepting opportunities.
Measuring health care quality: Implications, threats, and opportunities for clinical pharmacists
Authors: Ramachandran Sujith , Galdo John A. , Urick Benjamin Y. , Farley Joel F. 
Published: April 2022

AbstractThe Patient Protection and Affordable Care Act of 2010 has helped usher in an era of focus on health care quality and quality improvement. Since then, a variety of programs has driven quality improvement throughout the health care system using a combination of incentives and penalties. Many studies have demonstrated the value of integrating clinical pharmacist services into interdisciplinary models of care for the purpose of moving the needle on performance measures. The implementation of quality‐linked reimbursement programs has the greatest potential to meaningfully improve quality of care and reduce costs. However, the benefits of quality measures are dependent on their implementation into measurement systems and their application into clinical practice. Common threats to quality measurement in pharmacy practice may arise due to misapplication of health plan‐related measures to evaluate pharmacy services. Additionally, the core concepts related to novel reimbursement models have not adequately percolated into the formal education of practicing pharmacists. Therefore, the goal of this article is to help educate and raise awareness about the current quality landscape and present opportunities and directions for pharmacists to demonstrate their value in interdisciplinary health care teams. This article is broadly divided into four sections—first, we provide an introduction to quality measurement and its application to clinical pharmacists. Second, we elaborate on the development and endorsement of quality measures and measurement systems. Third, we present clinical scenarios of patient care—set in inpatient, ambulatory care, and community practice settings—that engage pharmacists in the context of quality measurement and evaluate the implications, threats, and opportunities for clinical pharmacists in each of these scenarios. Finally, we present recommendations for future advocacy, measurement, and leadership for pharmacist involvement in the quality landscape.
Endocrine pharmacotherapy education in United States colleges and schools of pharmacy
Authors: Shealy Kayce M. , Phillips Cynthia M. , Bzowyckyj Andrew S. , Gupta Vasudha , Guyton Justinne , Westberg Sarah M. , Cai Chao , Trujillo Jennifer , Goldman Jennifer D. 
Published: April 2022

AbstractBackgroundAs Doctor of Pharmacy (Pharm.D.) curricula are revised, it is important to identify what to retain and prioritize; previous studies have not evaluated the endocrine content within curricula at United States (U.S.) schools and colleges of pharmacy.ObjectiveTo determine the breadth of endocrine instruction and assessment within preadvanced pharmacy practice experience (pre‐APPE) coursework in the clinical sciences across U.S. Pharm.D. programs.MethodsA cross‐sectional survey‐based study of U.S. schools and colleges of pharmacy was completed evaluating the 2018 to 19 academic year. Data were summarized using descriptive statistics. Categorical variables were assessed using Chi‐square or Fisher's exact tests and ordinal variables were evaluated using Mann‐Whitney U and Kruskal‐Wallis tests, with a priori significance set at .05. The study was approved by the Presbyterian College Institutional Review Board with exempt status.ResultsFifty‐eight of 142 (40.8%) programs participated. Contact hours for required endocrine content varied, with 57% responding with more than 30 hours. Among 15 topics, only types 1 and 2 diabetes and thyroid disorders were required at all programs. For two‐thirds of the topics, the perception of topic importance differed between programs that cover and those that do not cover the topic (P <.05). The most common assessment strategies included case studies (100%), multiple choice questions (97%), SOAP note writing, and skills demonstrations (72% each). The most common diabetes‐related Entrustable Professional Activities (EPAs) were: evaluating drug therapy, following guidelines, and educating patients (98% each). The most commonly cited barrier to including more endocrine topics was lack of curricular time (88%).ConclusionsInconsistency in endocrine content within curricula at U.S. PharmD programs includes topics covered, contact hours, and perception of topic importance. Respondents consistently noted their methods appropriately educated student pharmacists to develop diabetes‐related EPAs. Development of a standardized endocrine curricula could establish minimal competencies for APPE‐readiness.
Implementation of defined criteria for clinical pharmacists in a pediatric cardiac transplant ambulatory clinic
Authors: Kiskaddon Amy L. , Brown Brian K. , Carapellucci Jennifer , Wisotzkey Bethany L. , Asante‐Korang Alfred 
Published: April 2022

AbstractIntroductionThe United Network of Organ Sharing (UNOS) bylaws and Centers for Medicare and Medicaid Services (CMS) accreditation standards require that transplant centers have a pharmacist. However, there are no established guidelines and there is a paucity of literature describing pharmacists in the pediatric ambulatory setting.ObjectiveThis project aims to describe the activities of pediatric clinical pharmacists in an ambulatory pediatric cardiac transplant clinic.MethodsThis is a single‐center pilot project describing pediatric clinical pharmacist interventions before (phase I) and after (phase II) implementation of comprehensive and standardized clinical activities. The list of defined key clinical activities was developed using UNOS and CMS accreditation standards, an evaluation of the literature, and cardiac transplant team feedback.ResultsPrior to a defined list of clinical activities, pediatric clinical pharmacists saw 74 unique patients during 174 patient encounters and recorded 240 interventions (phase I). Following implementation of standard activities, pediatric clinical pharmacists saw 81 unique patients during 225 patient encounters and recorded 510 interventions (phase II). The development of defined key activities led to a 129.4% increase in documented interventions per patient encounter. Interventions with the greatest increase included: medication schedule (phase I, 13.2%; phase II, 37.3%; P < .001), medication dose adjustment (phase I, 5.7%; phase II, 22.2%; P < .001), outpatient pharmacy coordination (phase I, 1.1%; phase II, 15.6%; P < .001), medication discontinuation (phase I, 0.6%; phase II, 9.3%; P < .001), and medication adherence education (phase I, 0%; phase II, 6.2%; P < .001).ConclusionThere was a significant increase in the number and variety of medication‐related interventions after the development and implementation of defined key clinical activities for pediatric clinical pharmacists in a pediatric cardiac transplant ambulatory care clinic.
The light‐dependent daily cycle of ovulation in the oviparous medaka fish, Oryzias latipes (Atherinomorpha: Beloniformes: Adrianichthyidae) artificially pregnant with developing embryos
Authors: Iwamatsu Takashi , Oda Shoji , Kobayashi Hirokuni , Parenti Lynne R. , Fluck Richard A. , Yasuda Takako , Nakane Kouzo 
Published: April 2022

AbstractIn the oviparous medaka fish, Oryzias latipes, mature spermatozoa that were artificially introduced into the ovarian cavity retaining ovulated eggs could internally fertilize these eggs. This enabled us to examine the effect of ovarian gestation on the ovulation cycle. Most freshly ovulated eggs could be internally fertilized in the ovarian cavity. Yet eggs ovulated 24 h after single insemination remained unfertilized in the ovarian cavity. Artificially pregnant females persisted in a daily cycle of ovulation, which occurred shortly before the onset of light under the present reproductive conditions. Females continuously ovulated a certain number of eggs despite ovarian gestation, that is, the presence of embryos within the ovarian cavity. Repeated cycles of ovulation led to crowding in the ovarian cavity because the group of fertilized eggs, with their hardened egg envelope (chorion or zona radiata), plugged the genital orifice. The development of fertilized eggs was retarded and ceased around the initiation stage of blood circulation, but when they were transferred from the ovarian cavity into regular saline, they regained their ability to develop normally up to hatching. These results show that in oviparous female medaka, ovarian gestation exerted little effect on the time of ovulation and the number of ovulated eggs.
急激な経過を辿った重症熱性血小板減少症候群（severe fever with thrombocytopenia syndrome: SFTS）の1例(A fatal case of severe fever with thrombocytopenia syndrome (SFTS))
Authors: (Hironori Matsumoto) 松本 紘典 , (Kensuke Umakoshi) 馬越 健介 , (Naoki Moriyama) 森山 直紀 , (Suguru Annen) 安念 優 , (Satoshi Kikuchi) 菊池 聡 , (Jun Takeba) 竹葉 淳 , (Mayuki Aibiki) 相引 眞幸 
Published: April 2022

要旨2013年に日本国内において重症熱性血小板減少症候群（severe fever with thrombocytopenia syndrome: SFTS）の発生が確認されて以来，その発生報告は増えている。今回，急激な多臓器不全の進行から短期間で死亡に至った重症のSFTSの1例を経験したので，病理解剖結果を加え報告する。症例は85歳の女性で，山中での農作業の3日目に，嘔吐症状にて発症した。速やかに対症療法が開始されたが，全身状態は悪化した。併発した播種性血管内凝固症候群に対する抗凝固療法や，血球貪食症候群に対するステロイド投与を含め集中治療を行ったが，改善せず，受傷から12日目に死亡した。病理解剖では，リンパ節や肝臓などのリンパ球に高コピーのSFTSウイルスが認められ，重症度が高いことが示唆された。また，末梢血の異型リンパ球やリンパ節でみられた多数のリンパ球はB細胞リンパ球であり，重篤なSFTSの病勢との関連が示唆された。今後，さらなる症例集積による病態の解明が必要である。
高齢敗血症患者における炎症と免疫抑制の病態生理(Pathophysiology of inflammation and immunosuppression in the elderly after sepsis)
Authors: (Shigeaki Inoue) 井上 茂亮 , (Nobuo Watanabe) 渡邊 伸央 , (Nanami Mizushima) 水嶋 七実 , (Sadaki Inokuchi) 猪口 貞樹 
Published: April 2022

要旨本邦では急激な高齢化の進行に伴い，高齢者の敗血症患者が激増している。一般に高齢者の敗血症は予後不良と言われているものの，その病態生理・機序は十分解明されていない。加齢に伴う免疫機能変化は「免疫老化（immunosenescence）」と呼ばれ，主に抗原特異的な応答を担う獲得免疫機能の低下を引き起こす。一方，高齢者では自己免疫性疾患の罹患率が上昇し，慢性炎症素因も指摘されている。高齢者では過剰炎症と免疫抑制が密接に関わっていることが指摘されているものの，敗血症患者におけるその病態生理は十分解明されていない。筆者らの検討では，65歳未満の成人敗血症患者と比較して65歳以上の高齢敗血症患者のT細胞は疲弊しており，活性抑制受容体の増加，IL–2の産生障害，活性化や増殖障害が明らかになった。また成人と比較して，高齢敗血症患者では血清IL–6値が第1～6病日まで有意に高値を示した（p<0.01）。さらに，高齢敗血症患者ではICU入室後2～4週間後の細菌培養陽性率が有意に増加し，Acinetobactor属やS. Maltophiliaの喀痰培養における陽性率が増加していた。また成人と比較して，高齢敗血症患者の90日後生存率は有意に低下していた。以上より，高齢者における敗血症後90日後死亡率は約4倍であり，その原因の一つとして敗血症直後からの過剰な炎症と免疫抑制による亜急性期の二次感染率の増加が関係している可能性がある。免疫機能が破綻した高齢敗血症患者では感染や炎症が遷延し重症化しやすいため，速やかかつ正確な敗血症診断と集学的な治療をドラスティックに展開することが望ましい。
高度救命救急センターの位置づけと客観的評価方法に関する調査報告(Questionnaire–based survey: the role of the advanced tertiary emergency centers in Japan)
Authors: (Yoichi Katayama) 片山 洋一 , (Katsutoshi Tanno) 丹野 克俊 , (Shuji Uemura) 上村 修二 , (Seizan Tanabe) 田邉 晴山 , (Yasufumi Asai) 浅井 康文 , (Yasuhiro Yamamoto) 山本 保博 
Published: April 2022

要旨【背景】平成5年から高度救命救急センター（以下，「高度」）が整備された。当初の位置づけが現在の医療情勢に即しておらず，要件を見直すべきとの指摘がある。本研究の目的は，現状での「高度」の位置づけを把握し，その客観的評価方法について検討することである。【方法】「高度」，一般の救命救急センター（以下，「一般」），都道府県庁に対してアンケートを行い，現状における「高度」の位置づけと客観的評価方法について調査した。【結果】「高度」28施設のうち27施設から，「一般」219施設のうち170施設から，都道府県庁22箇所のうち18箇所から回答を得た。「高度」の位置づけとして，「総合的な高度医療機関」と回答したのは「高度」，「一般」，都道府県庁で，それぞれ15（55.6%），82（50.0%），2（11.1%），「特殊疾病患者（広範囲熱傷，指肢切断，急性中毒）を特に受け入れる施設」と回答したのは「高度」，「一般」，都道府県庁で，それぞれ5（18.5%），31（18.9%），14（77.8%）であった。「高度」に対する客観的評価方法については，疾病分類や処置・手術の症例数を用いた数値などが挙げられたが，それらは「一般」でも実施可能なものであった。「高度」のみに対する客観的評価方法と考えられる，「MC会議開催，MCへの関与」を挙げたのは「一般」が6（3.5%），都道府県庁が1（5.6%）のみであった。【結語】元々の要件である特殊疾病診療によって「高度」を位置づけることが困難であると明らかになった。本研究から得られた「高度」に対する客観的評価方法の多くは診療機能に関するものであった。（平成24年度厚生労働科学研究費補助金分担研究）
脊椎・大動脈弓部間の食道狭窄から口側食道の拡張を来して気道閉塞を起こした1例(Airway obstruction caused by esophageal stricture due to compression between the spine and the aortic arch)
Authors: (Kota Hoshino) 星野 耕大 , (Junichi Tanaka) 田中 潤一 , (Takeshi Nishida) 西田 武司 , (Mariko Mizunuma) 水沼 真理子 , (Daiki Ohta) 大田 大樹 , (Norihiko Matsumoto) 松本 德彦 , (Hiroyasu Ishikura) 石倉 宏恭 
Published: April 2022

要旨今回，拡張した食道が気管を圧迫して気道閉塞を来した症例を経験したので報告する。症例は出生直後の脳性麻痺による精神発達遅滞，ならびに高度の脊椎側弯のある53歳の女性。食事中にチアノーゼが出現したため救急要請となり，救急隊により半座位の状態から臥位へと変更しバッグバルブマスク換気を行ったところチアノーゼは消失し，当センターに搬入となった。搬入時，呼吸状態は安定しており，胸部CT検査で食道は大動脈弓部と弯曲した脊椎で挟まれ，口側の食道は拡張し，内容物で充満していた。また，気管は拡張した食道により背側から圧排されていた。内視鏡的に貯留した食物残渣を吸引除去した。第4病日に水溶性造影剤を服用し，造影剤の胃への移行を認め，経口摂取は可能であると判断した。その後は食事内容のコントロールで呼吸困難の再発なく，良好に経過した。本症例では，食道が弯曲した脊椎と大動脈弓部に挟まれ，食物の通過障害を来し，食道は慢性的に拡張していたと考えられた。食道は完全閉塞の状態ではなかったことから，ある程度の食道内圧で食物は通過していたと思われる。しかし，何らかの理由（固形物の大量摂取など）を契機に口側食道の内圧が高まり，それにより背側から気管を圧排し，気道閉塞の症状が出現したと推測された。我々が検索した限り類似の病態は散見されるが，本病態は過去に報告例がなく，非常に稀な症例であった。脊椎側弯症に合併する呼吸不全の鑑別診断として，食道拡張による気道閉塞も念頭に置くべきである。
救急外来の腹部CT検査で偶然発見された病変（偶発病変）の検討(Incidental findings on abdominal computed tomography scans in the emergency room)
Authors: (Kota Hoshino) 星野 耕大 , (Norihiko Matsumoto) 松本 德彦 , (Kentaro Muranishi) 村西 謙太郎 , (Shinichi Morimoto) 森本 紳一 , (Hironari Kaneyama) 金山 博成 , (Yoshito Izutani) 泉谷 義人 , (Hiroyasu Ishikura) 石倉 宏恭 
Published: April 2022

要旨【目的】救急外来（以下，ER）に来院した患者を撮影したCT所見に，主訴と関連せず偶然発見される病変（以下，偶発病変）がある。沖縄県立宮古病院のERにおいて腹部造影CT検査で発見した偶発病変の特徴と，そのフォローアップの現状を検討した。【対象】2014年1月から6月の間に当院ERで消化器症状を主訴として，腹部造影CT検査が撮影された症例を対象とした。対象患者の性別，偶発病変を認めた頻度，一人当たりの偶発病変数，偶発病変に対してフォローアップとなった頻度を，65歳以上の高齢群と65歳未満の非高齢群に分類し，比較した。【結果】対象患者は151例であり，高齢群72例，非高齢群79例であった。性別は両群において差を認めなかった（p=0.65）。偶発病変を認めた症例は64%であり，その頻度は高齢群が有意に高く（p<0.01），一人当たりの偶発病変数も高齢群が有意に高値であった（p<0.01）。偶発病変発見後にフォローアップとなった症例の頻度は両群において差を認めなかった（p=0.88）。偶発病変のうち腫瘤性病変と血管性病変の計17例はフォローアップが必要と考えられたが，実際にフォローアップされたのは8例のみであった。【結語】ERで撮影された腹部造影CTで発見された偶発病変の頻度は，高齢者が非高齢者よりも有意に高かった。また，偶発病変をフォローアップするシステム構築が求められる。
心室細動発症を契機に診断された筋強直性ジストロフィーの1例(Manifestation of sudden–onset ventricular fibrillation along with myotonic dystrophy type 1: a case report)
Authors: (Takahiro Yukawa) 湯川 高寛 , (Masahiro Kashiura) 柏浦 正広 , (Kazuya Tateishi) 立石 和也 , (Mutsufusa Watanabe) 渡邊 睦房 , (Yuichi Hamabe) 濱邊 祐一 
Published: April 2022

要旨患者は43歳の女性。外出中に卒倒し救急要請された。救急隊接触時は心室細動による心停止状態であり，電気的除細動を含む心肺蘇生を実施しながら当院へ搬送となった。心室細動は持続しており，extracorporeal cardiopulmonary resuscitationを導入開始し，心停止から73分後に経皮的人工心肺補助装置を作動させた。入院後に集学的治療を施行し一命をとり留めた。心室細動の原因疾患を検索したが，心臓超音波検査や冠動脈造影検査を含む諸検査では器質的異常は認められず，また蘇生後に延長していたQTc時間は経時的に正常化した。一方で，患者は突然死の家族歴を有し，四肢の筋萎縮が目立つ痩身体型で，西洋斧様顔貌といった特徴的な身体所見を呈していた。筋強直性ジストロフィーを疑い，分子遺伝学的検査を施行した結果，1型筋強直性ジストロフィー（DM1）と確定診断された。今回の心室細動の原因はDM1に起因するものと推察された。若年者の心室細動症例では，その背景に遺伝性疾患が存在する可能性も考慮すべきである。逆に，遺伝性疾患を有する患者においては，突然死の原因となる致死性不整脈の発症リスクを評価し，予防的ペースメーカーまたは植込み型除細動器の植込みを考慮すべきである。
ラリンゲルチューブサクション（LTS）挿入における咽頭損傷の1例(A case of pharyngeal injury by Laryngeal Tube Suction insertion)
Authors: (Ryouji Iizuka) 飯塚 亮二 , (Wataru Ishii) 石井 亘 , (Makoto Kitamura) 北村 誠 , (Masahiko Nakano) 中野 昌彦 , (Yoshihiro Yamahata) 山畑 佳篤 , (Kenichiro Takashina) 高階 謙一郎 , (Nagahisa Unno) 海野 永久 
Published: April 2022

要旨気道確保器具であるLaryngeal Tube Suction（LTS）は，声門上気道デバイスとして使用される。その挿入に要する時間の短さ，挿入の簡便さなどの点で気管挿管と比べて優れている。70歳女性の心肺停止者に救急救命士が病院収容前にLTSを挿入し，病院搬入時頸部に皮下気腫を認めた事例があった。原因検索にて死亡宣告後，喉頭鏡にて咽頭部を観察すると，後咽頭部に約縦3cm，横5mm，深さ3mmの損傷を認めた。形状からLTS挿入時に生じた損傷と判断した。LTS挿入時に伴う咽頭後壁粘膜損傷の1例を経験した。LTSの適正使用についてメディカルコントロールに関わる医師に広く周知するために報告する。
血管攣縮像を経時的に捉えた典型的可逆性脳血管攣縮症候群の1例(Serial imaging of reversible cerebral vasoconstriction syndrome: a case report)
Authors: (Soh Sampei) 三瓶 想 , (Tomohiro Kawaguchi) 川口 奉洋 , (Atsuhiro Nakagawa) 中川 敦寛 , (Ryousuke Nomura) 野村 亮介 , (Teiji Tominaga) 冨永 悌二 , (Shigeki Kushimoto) 久志本 成樹 
Published: April 2022

要旨可逆性脳血管攣縮症候群（reversible cerebral vasoconstriction syndrome: RCVS）は雷鳴頭痛を主徴とし，画像上の脳血管攣縮を認める症候群である。本疾患に関する認識は救急医療の現場において十分とはいえず，早期診断に至らない場合も少なくない。今回我々は，血管攣縮の継時的変化を捉えられたRCVS症例を経験した。本症例を通じてRCVSの診断，治療および臨床上の問題点について報告する。症例は20歳の男性。運動中に激しい後頭部痛を認めた。第5病日に近医を受診し頭部MRIおよびMRAを施行されるも異常を指摘されなかった。症状が改善しないため第8病日にMRAを再度施行されるも異常を指摘されず，第16病日に当院へ救急搬送となった。神経脱落所見を認めなかったが，CTで右前頭葉円蓋部にくも膜下出血を認めた。MRAで動脈瘤や血管解離所見を認めず，両側中大脳動脈末梢に多発性の血管攣縮像を認めた。第5，8病日のMRAでも同部位の血管攣縮を後方視的に指摘し得た。RCVSと診断し保存的に加療した。第21病日のMRAで血管攣縮所見は正常化した。神経脱落所見を後遺せず第23病日に退院となった。本疾患の自然歴は不明であり標準的な治療法が確立されておらず，治療介入により重症化を回避し得るか否かは不明である。病態把握と治療法確立のために，さらなる症例の蓄積と統合的な検討が望まれる。