<b>インフルエンザ診療における意思決定モデルの開発</b><b>現象と治療に立脚した診断方針の試案 </b>  [in Japanese] <b>Development of A Decision Making Model for the Management of Influenza. A Proposal of Diagnostic Policy </b><b>Based on Phenomena and Therapeutics. </b>  [in Japanese]

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Author(s)

    • 岩田 健太郎 IWATA Kentaro
    • 神戸大学大学院医学研究科微生物感染症学講座感染治療学分野 Division of Infectious Diseases Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine
    • 土井 朝子 DOI Asako
    • 神戸市立医療センター中央市民病院感染症科 Department of Infectious Diseases, Kobe City Medical Center General Hospital

Abstract

迅速診断検査(RIDT)とノイラミニダーゼ阻害薬(NI)が開発され,インフルエンザ診療の様相は激変した。しかし,RIDT の感度の低さ,副作用や薬剤耐性など NI の問題もあり,その診療は未だ最適とは言えない。そこで,インフルエンザをウイルスという「モノ」ではなく「現象」として認識し,漢方薬を治療選択に加えた診療意思決定モデルを開発した。まず患者の重症度を吟味し,重症・ハイリスク患者では RIDT に関係なく NI 点滴を基本とする。重症でもハイリスクでもない場合は,NI か漢方薬を患者に選択させ,前者の場合は検査前確率が50%未満で RIDT を用い,それ以上では事後確率への影響の低さから RIDT を行わない。漢方薬では「現象」を対象としているため,原則として RIDT は行わないものとした。本モデルでは RIDT を選択的に行うことで検査属性を活かし,かつ検査の乱用や誤解釈を回避することが可能になる。

The management of influenza has dramatically changed since the introduction of the rapid influenza diagnostic test, or RIDT, and neuraminidase inhibitors (NI). However, it is still far from optimal due to low RIDT sensitivity and problems involving NI such as side effects and the potential emergence of resistant virus.Therefore, we developed a decision-making model for the management of influenza, which includes Kampo medicines in its strategies. First, the severity of patients is evaluated. If a patient is judged at severe or high-risk, intravenous NI would be the main component of treatment. If a patient has neither a severe condition nor is at high-risk, the patient would be asked to choose either NI or Kampo medicine. In the former, RIDT would be used if pretest probability was less than 50%, but it would not be used if it was more than 50%, based on the lack of influence on the post-test probability. For the latter, RIDT would be not used in general as Kampo targets "phenomena", not the virus <i>per se</i>. This model enables us to optimize the use of RIDT by appropriately selecting patients based on the characteristics of RIDT, and by avoiding unnecessary tests and their misinterpretation.

Journal

  • Kampo Medicine

    Kampo Medicine 64(5), 289-302, 2013

    The Japan Society for Oriental Medicine

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