総合診療科

大杉 泰弘

オオスギ ヤスヒロ  (osugi yasuhiro)

基本情報

所属
藤田医科大学 医学部 医学科 総合診療科 准教授

J-GLOBAL ID
201501014570586642
researchmap会員ID
7000013209

研究キーワード

 1

論文

 22
  • Makoto Hasegawa, Yasuhiro Osugi, Yoshifumi Moriwaki, Yohei Doi
    Fujita medical journal 10(1) 24-29 2024年2月  
    OBJECTIVES: Multidrug-resistant (MDR) bacterial infections are highly prevalent among long-term care facility (LTCF) residents, and are thus important targets for antimicrobial stewardship. Diagnoses of urinary tract infections (UTIs), which are associated with antimicrobial use in these facilities, are not always made by physicians. Past epidemiologic studies have included asymptomatic bacteriuria together with UTIs. The National Healthcare Safety Network has initiated a surveillance program to identify the causative organisms of UTIs in LTCF residents. In Japan, medical care for these residents is provided through in-person physician visits; however, limited related data are available. Therefore, we investigated the organisms causing UTIs and their drug susceptibility among LTCF residents in central Japan, and examined the prevalence of multidrug resistance, its risk factors, and correlations with clinical outcomes. METHODS: We retrospectively evaluated clinical and urine culture data of LTCF residents with physician-diagnosed UTIs between April 1, 2019, and April 30, 2022. RESULTS: The detection rate of multidrug-resistant organisms was high, with Escherichia coli being the most prevalent. Ceftriaxone was frequently used for initial therapy. The initial antimicrobial agents were significantly less active against MDR pathogens than non-MDR pathogens. Most residents continued to receive the initial agents regardless of culture results. Nonetheless, differences in the therapy duration, relapse and hospitalization rates, and death rate within 28 days between the multidrug-resistant and non-multidrug-resistant groups were not significant. CONCLUSIONS: Antimicrobial stewardship is essential for reducing antimicrobial use and selective pressure in LTCFs in Japan; however, more specific data are needed for its effective implementation.
  • Haruhiro Uematsu, Yoshinori Noguchi, Yasuhiro Osugi
    BMJ case reports 16(4) 2023年4月7日  
  • Makoto Hasegawa, Yuji Ito, Yasuhiro Osugi, Masahiro Hashimoto, Nanako Hashimoto, Kunio Yano
    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 120 65-67 2022年7月  
    Pneumocystis jirovecii is a common opportunistic fungal pathogen that commonly affects immunocompromised individuals and can cause P. jirovecii pneumonia. Extrapulmonary P. jirovecii infections are extremely rare. Herein, we present a case of an HIV-positive, antiretroviral therapy-naïve patient who had extrapulmonary pneumocystosis (EPC). He presented with complaints of decreased appetite, abdominal fullness, and weight loss. Computed tomography (CT) revealed multiple low-attenuation masses in the spleen, liver, and both adrenal glands but no pulmonary involvement. A core-needle biopsy of a splenic lesion confirmed the diagnosis of EPC. The patient was initiated on intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and CT-guided percutaneous catheter drainage of the splenic lesion was performed. Intravenous TMP-SMX therapy was completed in 3 weeks and intravenous pentamidine (250 mg daily) therapy was commenced. Pentamidine was completed after 3 weeks, and antiretroviral treatment (ART) was initiated with dolutegravir 50 mg and Descovy HT (emtricitabine [200 mg] and tenofovir alafenamide fumarate [25 mg]). After starting ART, the patient's clinical condition improved, and the abscesses gradually reduced. TMP-SMX is commonly used to treat EPC; however, there is no standard method of treatment. ART may become the key to EPC treatment in individuals with HIV infection.
  • Yasuhiro Osugi, Hitoshi Iwata, Yasushi Imai, Daiki Kobayashi, Ryutaro Hirashima
    Cureus 14(2) e21882 2022年2月  
    AIM: This study aimed to report clinical courses of patients who had mild coronavirus disease 2019 (COVID-19), defined as SpO2 of 96 or higher, and treated with/without casirivimab/imdevimab in Japan, where mortality and number of severe patients were very limited compared to other resource-rich countries. METHODS: We conducted a retrospective cohort study in Toyota Regional Medical Center, Toyota, Japan, from August 31, 2021, to September 27, 2021. We included all patients with COVID-19 who were diagnosed at the hospital's family medicine department. Our primary outcome was admission to the hospital due to COVID-19 and secondary outcome was mortality due to COVID-19. We compared those who received casirivimab/imdevimab and those who did not. RESULTS: A total of 104 patients were included, of whom 30 received casirivimab/imdevimab and 74 did not receive casirivimab/imdevimab. The mean age of the patients was 47.8 ± 15.6 (standard deviation {SD}) years, 57 (54.8%) patients were male. During a median follow-up period of 12 days (interquartile range: 10-16 days), 19 (18.3%) patients were admitted to the hospital and none died. Patients who received casirivimab/imdevimab had similar rate to admission (p = 0.87). The hazard ratio (HR) of admission tended to be lower for those who received casirivimab/imdevimab (HR: 0.76, 95% confidence interval {CI}: 0.23-2.49, p-value = 0.65), but not statistically significant compared to those who did not, after adjusting for age, gender, risk factors, including obesity. CONCLUSIONS:  Our study demonstrated that patients with COVID-19 had similar disease progression rates regardless of casirivimab/imdevimab administration.
  • Masahiko Ogasawara, Haruhiro Uematsu, Kuniyoshi Hayashi, Yasuhiro Osugi
    Nagoya journal of medical science 84(1) 42-59 2022年2月  
    COVID-19 is indirectly associated with various mental disorders such as anxiety, insomnia, and depression, and healthcare professionals who treat COVID-19 patients are particularly prone to severe anxiety. However, neither the anxiety of healthcare workers in non-epicenter areas nor the effects of knowledge support have been examined thus far. Participants were 458 staff working at the Toyota Regional Medical Center who completed a preliminary questionnaire of their knowledge and anxiety regarding COVID-19. Based on text mining of the questionnaire responses, participants were offered an online lecture. The effect of the lecture was analyzed using a pre- and post-lecture rating of anxiety and knowledge confidence, and quantitative text mining. The response rates were 45.6% pre- and 62.9% post-lecture. Open-ended responses regarding anxiety and knowledge were classified into seven clusters using a co-occurrence network. Before the lecture, 28.2%, 27.2%, and 20.3% of participants were interested in and anxious about "infection prevention and our hospital's response," "infection and impact on myself, family, and neighbors," and "general knowledge of COVID-19," respectively. As a result of the lecture, Likert-scale ratings for anxiety of COVID-19 decreased significantly and knowledge confidence increased significantly. These changes were confirmed by analyses of open-ended responses about anxiety, lifestyle changes, and knowledge. Positive changes were strongly linked to the topics focused on in the lecture, especially infection prevention. The anxieties about COVID-19 of healthcare workers in non-epicenter areas can be effectively reduced through questionnaire surveys and online lectures using text mining.

MISC

 168
  • 山田 智也, 平嶋 竜太郎, 岩田 仁志, 河口 あゆみ, 野口 善令, 大杉 泰弘
    日本病院総合診療医学会雑誌 20(3) 152-158 2024年5月31日  
    Refeeding 症候群による肝障害と飢餓状態による肝障害の鑑別に苦慮した症例を経験した。 Refeeding 症候群と考え栄養増量を控えた結果,肝不全に陥り,最終的に病態として飢餓状態に伴う肝障害が考えられた症例を経験したので報告する。 低栄養状態の患者の肝障害では,飢餓状態による肝障害と Refeeding 症候群に合併する肝障害を鑑別する必要がある。この2つの病態は全身状態・栄養投与後の肝酵素上昇のタイミングの差・肝臓の画像所見・肝組織像にて鑑別をすることができる。いずれの病態も致死的である。Refeeding 症候群による肝障害は投与カロリーを制限,漸増すべきであるのに対し,飢餓状態による肝障害は, 十分なカロリーを投与すべきである。治療方針が大きく異なるため低栄養状態に伴う肝障害ではこれらを鑑別することが重要である。
  • 大杉 泰弘
    病院 83(2) 106-110 2024年2月  
    <文献概要>Point 在宅医療の需要急増に対し,中小病院が在宅医療を提供することは,これまで見えにくかったケアミックス病院の価値を明確化するとともに病院経営の改善にもつながる.中小病院にとって医師確保は重要な課題であるが,プライマリ・ケア外来や在宅医療,地域包括ケア病棟での魅力的な総合診療専門研修プログラムを用意することにより,中小病院にも医師が集まり,将来の在宅医療を担う人材も輩出できる.
  • 山中健斗, 大杉泰弘, 橋川有里
    日本プライマリ・ケア連合学会学術大会(Web) 15th 2024年  
  • 大杉泰弘
    日本プライマリ・ケア連合学会学術大会(Web) 15th 2024年  
  • 服部瞭一, 服部瞭一, 加藤心良, 加藤心良, 野口善令, 大杉泰弘
    日本プライマリ・ケア連合学会学術大会(Web) 15th 2024年  

書籍等出版物

 1