Therapeutic Research

一般財団法人 東京顕微鏡院と医療法人社団 こころとからだの元氣プラザによる健康セミナーが11 月24 日に開催された。今回は「100歳まで元気に健康長寿をどう生きるか」のテーマで3 年続くシリーズとなる。本年2022 年の第1 回目「骨粗しょう症とフレイルの予防と対策」について，寺本民生先生（帝京大学）および荒井秀典先生（国立長寿医療研究センター）の講演を紹介する。

近年の3Dマッピングシステムの進歩は目覚ましく，カテーテルアブレーションに不可欠な存在となっている。本稿では，わが国で使用可能な3Dマッピングシステムのうちで最も新しいRHYTHMIATMについて述べる。

息切れは加齢に伴って自覚される一般的な症状の一つであるが，その背景には生命にかかわる重大な疾患が潜んでいる可能性がある。息切れの原因は循環器疾患と呼吸器疾患が大半を占めており，高齢者では合併していることが多い。中でも心不全とCOPD は見過ごされやすく，発見や治療介入の遅れにより生活の質の悪化や健康寿命の短縮につながる恐れがある。そのため，可能なかぎり早急に対処し，疾患の進行を抑制することが非常に重要である。息切れへの対処としては，緊急度を判断したうえで原因疾患の鑑別とその治療を行い，専門的検査の必要性や増悪が生じた場合は適切な診療科専門医へ引き継ぐことが重要である。高齢者では複数の基礎疾患・病態を合併していることが多いため，一つの疾患のみならず他の疾患も見過ごさないよう注意が必要である。

Objective： The current study aimed to investigate the achievement rate of target blood pressure（BP）, and factors associated with nonachievement of target BP in patients with chronic kidney disease（CKD）on antithrombotic therapy. 　Methods： This cross‒sectional study was conducted at an outpatient clinic in 2018. Of 2427 outpatients who received antithrombotic therapy, patients without CKD, those with CKD stage 5 or on hemodialysis and those with missing data on body mass index, urinalysis results and estimated glomerular filtration rate were excluded from the study. Finally, 786 outpatients met the inclusion criteria. Clinical parameters were obtained from the center’s electronic database. The target office BP was set at＜130/80 mmHg in patients with CKD on antithrombotic therapy.　Results： Approximately 59％ of patients had a BP of＜140/90 mmHg, and only 30.3％ achieved the target BP of＜130/80 mmHg. Multivariable logistic regression analyses indicated that obesity and proteinuria were significantly correlated with nonachievement of target BP. Moreover, heart failure and cerebrovascular disease were negatively associated with nonachievement of target BP. 　Conclusions： Only a small proportion of patients with CKD on antithrombotic therapy achieved the target BP. Obesity and proteinuria were associated with nonachievement of the target BP in patients with CKD on antithrombotic therapy.

Background：In order to improve medication adherence, it is necessary to consider the degree of knowledge of patients and family members about the prescribed medications and provide detailed medication guidance. 　Object：The purpose of this study was to ascertain the degree of knowledge of patients who have been newly prescribed mirogabalin tablets, a drug for treatment of neuropathic pain, with regard to the therapeutic agent and to investigate the changes in their knowledge level as a result of receiving personalized medication guidance based on their current knowledge level.　Method：The patients were asked 6 questions about the purpose of treatment, type of side effects, timing of onset of effects and side effects of the drug during each medication guidance session. The patients’ degree of knowledge was evaluated by scoring their responses to the 6 questions（know：“1”；do not know：“0”）and summing these responses, with a total possible score of 6 detailed explanation were provided to questions the patient could not answer correctly, this was done using medication guidance materials to improve their understanding.　Results：Of the 513 target patients, the degree of knowledge was evaluated up to 4 times for 136 patients. As a result, the mean degree of understanding score was 2.14 the first time, 4.70 the second time, 5.05 the third time, and significantly increased up to 5.18 the fourth time（p＜0.01）. In addition, at the 90‒day point, the medication persistence rate of the 513 patients was 19.5％. The most common reason for discontinuation was “drowsiness,”followed by“dizziness.”　Conclusion：The results suggest that the practice of standard medication guidance in accordance with each individual patient’s level of understanding can contribute to improving patient knowledge. Demonstrating the outcome of medication guidance that is standardized to many drugs to improve medication adherence can be explored in future research.