論文 - 小松 弘幸
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増大号 AKI･CKDの診断･治療に臨床検査を活かせ 4章 腎疾患を知る-臨床検査ができること 臨床検査で迫る腎疾患 IgA腎症･IgA血管炎の診断および活動性･重症度の評価 招待あり
小松 弘幸
臨床検査 68 ( 4 ) 514 - 518 2024年4月
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COVID-19パンデミックの地域医療代替実習として実施したケアプラン作成実習 査読あり
舩元 太郎, 安倍 弘生, 宮内 俊一, 齋藤 勝俊, 黒木 純, 中村 佳菜子, 小松 弘幸
医学教育 54 ( 6 ) 607 - 609 2023年12月
担当区分：最終著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本医学教育学会
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Toida T., Sato Y., Komatsu H., Fujimoto S.
Nutrients 15 ( 21 ) 2023年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Nutrients
Iron deficiency/excess may be associated with worse prognosis in patients undergoing hemodialysis. This study ascertained the association of the estimated total body iron (TBI) with mortality in patients receiving hemodialysis. Multicenter clinical data collected in the Miyazaki Dialysis Cohort Study from 943 patients receiving hemodialysis were analyzed after stratification into tertile categories by baseline TBI—estimated as the heme iron plus iron storage from ferritin levels. The primary outcome was a 5-year all-cause mortality; hazard ratios of the TBI–all-cause mortality association were estimated using Cox models adjusted for potential confounders, including clinical characteristics, laboratory, and drug data, wherein patients with high TBI were the reference category. The receiver operating characteristic (ROC) curve analyses of TBI, serum ferritin levels, and transferrin saturation were performed to predict all-cause mortality; a total of 232 patients died during the follow-up. The low TBI group (<1.6 g) had significantly higher hazard ratios of mortality than the high TBI group (≥2.0 g). As ROC curve analyses showed, TBI predicted mortality more accurately than either levels of serum ferritin or transferrin saturation. Lower TBI increases the mortality risk of Japanese hemodialysis patients, and further studies should examine whether iron supplementation therapy that avoids low TBI improves prognosis.
DOI： 10.3390/nu15214658
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腎生検が有用であったMPO-ANCA陽性糖尿病患者の1例 査読あり
河野真菜、落合彰子、古郷博紀、岩切太幹志、馬場明子、稲垣浩子、菊池正雄、小松弘幸、海北幸一、藤元昭一
宮崎県医師会医学会誌 47 ( 2 ) 191 - 195 2023年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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新研修医オリエンテーションにおける実技主体の実習と動画視聴主体の実習への研修医評価の比較 査読あり
宮内俊一、森林耕平、小田康晴、鈴木翔、谷口智明、樋口和宏、木許恭宏、大平洋明、日髙康太郎、後藤智子、小松弘幸
日本シミュレーション医療教育学会誌 11 77 - 88 2023年8月
担当区分：最終著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
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5. 医学教育モデル・コア・カリキュラム (令和4年度改訂版) と共用試験公的化/診療参加型臨床実習 査読あり
高橋 誠, 松島 加代子, 高村 昭輝, 蓮沼 直子, 小松 弘幸, 守屋 利佳, 磯部 真倫, 近藤 猛, 田中 淳一, 山本 憲
医学教育 54 ( 2 ) 164 - 170 2023年4月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本医学教育学会
医学教育モデル・コア・カリキュラムがよりアウトカム基盤型に改訂されたことと, 医学生が臨床実習で行う医業が法的に位置付けられたことに対応して, 診療参加型臨床実習実施ガイドラインを改訂した. 診療参加型臨床実習の充実を図る意義, 医学生が臨床実習で行う医業の範囲, 守秘義務, 患者同意, 患者相談対応窓口, 臨床実習の目標, シミュレーション教育, 臨床実習を行う診療科等, 実習現場での評価, CC-EPOC, 学生を信頼し任せられる役割などを, 改訂あるいは新規に記述した. シームレスな卒前・卒後教育を推進する基盤ができたが, 臨床実習修了時に期待される具体的な到達度や診療科特異的な臨床実習の目標および方略の検討が今後の課題と考える.
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8. 学修評価とGood Practice (2) 査読あり
伊藤 彰一, 岡崎 仁昭, 小松 弘幸, 錦織 宏, 松山 泰, 山脇 正永, 菊川 誠, 清水 郁夫, 中村 真理子, 三谷 昌平
医学教育 54 ( 2 ) 182 - 186 2023年4月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本医学教育学会
医学教育モデル・コア・カリキュラム (令和4年度改訂版) で新たに記載された「第3章 学修方略・評価」の「II. 学修評価」は, 1. 学修評価の考え方, 2. 学修評価の方法, 3. 学修評価の問いの三部構成となっている. 3. 学修評価の問いでは, 「評価の在り方は教育機関によって異なる」という基本的な考え方にもとづいて, あえて「問い」に対する回答が記載されていない. カリキュラム開発において学修評価を計画する際には, 「 II . 学修評価」の記載を参考にしつつ, カリキュラムの背景や文脈をふまえて検討を重ねていただきたい.
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新研修医オリエンテーションにおける実技主体の実習と動画視聴主体の実習への研修医評価の比較 査読あり
宮内 俊一, 森林 耕平, 小田 康晴, 鈴木 翔, 谷口 智明, 樋口 和宏, 木許 恭宏, 大平 洋明, 日髙 康太郎, 後藤 智子, 小松 弘幸
日本シミュレーション医療教育学会雑誌 11 ( 0 ) 77 - 83 2023年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本シミュレーション医療教育学会
新規採用研修医に対して行った入職時の基本手技実習と救急蘇生実習について、実技を伴う実習を経験した研修医（実技群、n = 33）と動画視聴主体の実習を経験した研修医（動画群、n = 26）とを対象にアンケート調査を行い、回答内容を比較した。実施した８項目全体では、実技群の方が動画群よりもその後の臨床研修に役立つと回答した割合が有意に高かった（91% vs. 75%、p = 0.001）。手技の頻度や難易度、利用できる教材の内容、卒前教育で何をどこまで経験しているかといった要因を考慮した上で、実技演習を上手に取り入れ、より指導効率が良く、より学習効果が高い実習内容を模索していく必要がある。
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Yamamoto R., Imai E., Maruyama S., Yokoyama H., Sugiyama H., Takeda A., Uchida S., Tsukamoto T., Tsuruya K., Akai Y., Nitta K., Fukunaga M., Hayashi H., Masutani K., Wada T., Konta T., Katafuchi R., Nishio S., Goto S., Tamai H., Shirasaki A., Shoji T., Nagai K., Nishino T., Yamagata K., Kazama J.J., Hiromura K., Yasuda H., Mizutani M., Naruse T., Hiramatsu T., Morozumi K., Sobajima H., Saka Y., Ishimura E., Ichikawa D., Shigematsu T., Sofue T., Fujimoto S., Ito T., Sato H., Narita I., Isaka Y., Nishio S., Ishikawa Y., Nakazawa D., Nakagaki T., Sato T., Sato M., Sanada S., Sato H., Miyazaki M., Nakamichi T., Yamamoto T., Narumi K., Yamada G., Ichikawa K., Watanabe T., Asahi K., Kusano Y., Watanabe K., Yamagata K., Usui J., Kaneko S., Kawamura T., Maeshima A., Kaneko Y., Ikeuchi H., Sakairi T., Nakasatomi M., Hasegawa H., Iwashita T., Shimizu T., Kanozawa K., Ogawa T., Takayanagi K., Mitarai T., Okada H., Inoue T., Suzuki H., Tomori K., Nitta K., Moriyama T., Ino A., Sato M., Uchida S., Nakajima H., Homma H., Nagura N., Tamura Y., Shibata S., Fujigaki Y., Suzuki Y., Takeda Y., Osawa I., Hidaka T.
Scientific Reports 12 ( 1 ) 2022年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Scientific Reports
Previous studies reported conflicting results regarding an association between serum albumin concentration and the cumulative incidence of remission of proteinuria in adult patients with minimal change disease (MCD). The present study aimed to clarify the clinical impact of serum albumin concentration and the cumulative incidence of remission and relapse of proteinuria in 108 adult patients with MCD at 40 hospitals in Japan, who were enrolled in a 5-year prospective cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study (JNSCS). The association between serum albumin concentration before initiation of immunosuppressive treatment (IST) and the cumulative incidence of remission and relapse were assessed using multivariable-adjusted Cox proportional hazards models. Remission defined as urinary protein < 0.3 g/day (or g/gCr) was observed in 104 (96.3%) patients. Of 97 patients with remission within 6 month of IST, 42 (43.3%) developed relapse defined as ≥ 1.0 g/day (or g/gCr) or dipstick urinary protein of ≥ 2+. Serum albumin concentration was significantly associated with remission (multivariable-adjusted hazard ratio [95% confidence interval] per 1.0 g/dL, 0.57 [0.37, 0.87]), along with eGFR (per 30 mL/min/1.73 m2: 1.43 [1.08, 1.90]), whereas they were not associated with relapse. A multivariable-adjusted model showed that patients with high eGFR level (≥ 60 mL/min/1.73 m2) and low albumin concentration (≤ 1.5 g/dL) achieved significantly early remission, whereas those with low eGFR (< 60 mL/min/1.73 m2) and high albumin concentration (> 1.5 g/dL) showed significantly slow remission. In conclusion, lower serum albumin concentration and higher eGFR were associated with earlier remission in MCD, but not with relapse.
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宮崎県の臨床研修医数に影響を及ぼす要因の検討 査読あり
小松弘幸、宮内俊一、安倍弘生、舩元太郎、中村仁彦、黒木純、中村佳菜子、舟橋美保子、桑津あゆみ、菱川善隆
宮崎県医師会医学会誌 46 ( 2 ) 197 - 202 2022年9月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Yamamoto R., Imai E., Maruyama S., Yokoyama H., Sugiyama H., Takeda A., Tsukamoto T., Uchida S., Tsuruya K., Shoji T., Hayashi H., Akai Y., Fukunaga M., Konta T., Nishio S., Goto S., Tamai H., Nagai K., Katafuchi R., Masutani K., Wada T., Nishino T., Shirasaki A., Sobajima H., Nitta K., Yamagata K., Kazama J.J., Hiromura K., Yasuda H., Mizutani M., Akahori T., Naruse T., Hiramatsu T., Morozumi K., Mimura T., Saka Y., Ishimura E., Hasegawa H., Ichikawa D., Shigematsu T., Sato H., Narita I., Isaka Y., Komatsu H., Iwakiri T., Nishizono R., Kikuchi M., Sato Y., Fujimoto S., Obata Y., Uramatsu T., Abe K., Matsueda S., Nagae H., Nakamura N., Kurokawa Y., Yoshida C., Yano J., Fukami K., Ito K., Yasuno T., Hamauchi A., Abe Y., Matsukuma Y., Tsuchimoto A., Yamada S., Haruyama N., Yoshida H., Matsumoto T., Shimamura Y., Inoue K., Taniguchi Y., Horino T., Terada Y., Minamino T., Kushida Y., Nishijima Y., Hara T., Moriwaki K., Kiyomoto H., Sofue T., Doi T., Nagasu H., Fujimoto S., Sasaki T., Kashihara N., Mise K., Onishi A., Kitagawa M., Yamanari T., Tanaka K., Ito T., Mima T., Negi S., Ohya M., Tsushima H., Tanabe K., Tagawa M., Matsui M., Samejima K.I.
Journal of Nephrology 35 ( 4 ) 1135 - 1144 2022年5月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Nephrology
Background: Minimal change disease (MCD) is characterized by a nephrotic syndrome usually steroid-sensitive and a high incidence of relapse of proteinuria. Previous cohort studies have reported conflicting results regarding the association between the time to remission and incidence of relapse. Methods: This multicenter prospective cohort study included 102 adult patients with steroid-sensitive MCD or focal segmental glomerulosclerosis from a 5-year cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study, who achieved remission of proteinuria within 2 months of immunosuppressive therapy (IST). The association between the time to remission of proteinuria after immunosuppressive therapy and incidence of relapse was assessed using Cox proportional hazards models adjusted for clinically relevant factors. Results: Remission was observed at 3–7, 8–14, 15–21, 22–28, and 30–56 days after initiation of immunosuppressive therapy in 17 (16.7%), 37 (36.3%), 21 (20.6%), 13 (12.7%), and 14 (13.7%) patients, respectively. During a median observation period of 2.3 years after the end of the 2nd month after initiation of immunosuppressive therapy, 46 (45.1%) patients relapsed. The time to remission was associated with the incidence of relapse in an inverse U-shaped pattern (multivariable-adjusted hazard ratios [95% confidence intervals] of the time to remission of 3–7, 8–14, 15–21, 22–28, 30–56 days: 1.00 [reference], 1.76 [0.56, 5.51], 6.06 [1.85, 19.80], 5.46 [1.44, 20.64], and 2.19 [0.52, 9.30], respectively). Conclusion: The time to remission was identified as a significant predictor of relapse in steroid-sensitive patients.
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Toida R, Uezono S, Komatsu H, Toida T, Imamura A, Fujimoto S, Kaikita K
CEN case reports 11 ( 2 ) 220 - 224 2021年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：CEN case reports
Coronavirus disease-2019 (COVID-19) has affected more than 220 million individuals since the global pandemic began. There is an urgent need for safe and effective vaccines, and vaccinations, such as mRNA vaccines, have been initiated worldwide. However, the adverse effects of these vaccines remain unclear. We herein present a case of an 80-year-old female on maintenance hemodialysis who developed takotsubo cardiomyopathy 4 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. There was no obvious trigger for the onset of takotsubo cardiomyopathy other than the COVID-19 vaccination, which was the most significant event preceding her presentation. Echocardiograms obtained during her admission allowed us to monitor and show the recovery of left ventricular wall motion. We confirmed the diagnosis of takotsubo cardiomyopathy based on the findings, including transient left ventricular dysfunction, electrocardiographic abnormalities, an elevated troponin level, and the absence of occlusive coronary artery disease. In the present case, the vaccination may have triggered emotional or physical stress. Although difficulties are associated with proving the causal relationship in the present case, the temporal relationship between the vaccination and the onset of takotsubo cardiomyopathy is highly suggestive. The adverse effects associated with the vaccine are typical of COVID-19 vaccines administered to date, most of which are acceptable. Therefore, despite our experience of the present case, we still recommend the vaccination for COVID-19 because takotsubo cardiomyopathy induced by the COVID-19 vaccine is extremely rare and the prognosis of the patient was good. We herein present the first case of a patient on hemodialysis who developed takotsubo cardiomyopathy after receiving COVID-19 vaccination.
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Toida T., Toida R., Takahashi R., Uezono S., Komatsu H., Sato Y., Fujimoto S.
Clinical and Experimental Nephrology 25 ( 11 ) 1215 - 1223 2021年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Clinical and Experimental Nephrology
Background: Polypharmacy (PP) is common in end-stage chronic renal disease patients largely due to the presence of multiple comorbid conditions. Although PP is potentially harmful, its relationship with mortality and morbidity in hemodialysis patients currently remains unclear. Methods: Study design: cohort study. Setting: participants: one hundred and fifty-two initial hemodialysis patients (male, 88 patients; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: patients were divided into 2 groups according to PP (6 or more drug prescriptions or less) during admission and discharge for the initiation of hemodialysis. Outcomes: all-cause mortality and hospitalization during the mean 2.8-year follow-up. Measurements: hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and clinical outcomes and adjusted for potential confounders. The group with 5 or less drug prescriptions was set as a reference. Results: The number of prescribed drugs per patient averaged 7.4 at admission and 7.0 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During the follow-up, 20 patients died and 71 were hospitalized. PP at admission did not correlate with outcomes, whereas that at discharge correlated with all-cause hospitalization. Conclusions: PP at discharge may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of outcomes or is simply a marker for an increased risk of outcomes.
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末期腎不全患者における血液透析導入時のバスキュラーアクセスと生命予後の関係（地域コホート研究） 査読あり
戸井田達典、戸井田玲子、海老原尚、高橋理沙、上園繁弘、小松弘幸、佐藤祐二、藤元昭一
日本腎臓学会誌 63 ( 5 ) 593 - 602 2021年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Takeuchi T, Matsuura Y, Yamamura Y, Ohkusu M, Koyama S, Kawaguchi T, Akaki Nagayasu M, Komatsu H, Okayama A, Ishikawa T, Atsumi T, Kitamura K
Clinical case reports 9 ( 9 ) e04805 2021年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Clinical Case Reports
Patients with immune thrombocytopenia have increased risks of bleeding and thrombosis. The acute-phase treatment for venous thromboembolism complicated with severe immune thrombocytopenia involves a “platelet dilemma” in therapeutic decision-making.
DOI： 10.1002/ccr3.4805
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臨床研修指導医講習会における “Myミニカリキュラム” 作成の試み 査読あり
小松 弘幸, 安倍 弘生, 長野 健彦, 吉田 和代, 江村 正
宮崎県医師会医学会誌 45 ( 2 ) 218 - 221 2021年9月
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成人・高齢紫斑病性腎炎（IgA血管炎に伴う腎炎）コホート研究 招待あり
小松弘幸
腎臓内科 13 ( 6 ) 750 - 758 2021年6月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
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宮崎県における若手医師の育成と確保を目指した宮崎県臨床研修・専門研修運営協議会ワーキンググループの取り組み 査読あり
小松弘幸、吉村学、坪内拡伸、長野健彦、姫路大輔、早川学、外山孝典、楠元寿典、松浦良樹、高田慎吾、梅村好郎、金丸吉昌
宮崎県医師会医学会誌 45 ( 1 ) 71 - 77 2021年3月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Toida T., Toida R., Ebihara S., Takahashi R., Komatsu H., Uezono S., Sato Y., Fujimoto S.
Nutrients 12 ( 10 ) 1 - 11 2020年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Nutrients
Background: The relationships between serum zinc levels and body composition or clinical outcomes of incident hemodialysis (HD) patients remain unclear. Methods: This prospective observational study examined the relationships between serum zinc levels and clinical indexes, including body composition, in 142 incident HD patients using a bioelectrical impedance analysis. Patients were divided into three groups according to baseline serum zinc levels: tertile, <45, 45–59, and ≥60 µg/dL. The reference group was set as ≥60 µg/dL. Cox’s regression analysis was performed to investigate the relationships between serum zinc categories and cardiovascular events and all-cause mortality after adjustments for potential confounders. Results: Serum zinc levels positively correlated with the nutritional index and negatively correlated with fluid volume markers. In a mean follow-up of 2.5 years, there were 20 cases of cardiovascular events and 15 of all-cause mortality. In the Cox’s regression analysis for cardiovascular events and all-cause mortality, the hazard ratio increased with a decrease in serum zinc levels, but was not significant. Conclusion: Serum zinc levels were associated with nutritional and fluid volume markers in incident HD patients. To clarify the relationship between serum zinc levels and cardiovascular events or mortality, further studies with a larger number of cases will be necessary.
DOI： 10.3390/nu12103187
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コロナ禍の渦中で思うこと…「過ぎたるは及ばざるが如し」 査読あり
小松 弘幸
医学教育 51 ( 3 ) 234 - 235 2020年7月
担当区分：筆頭著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本医学教育学会