著者

Abe Toshikazu Ishimatsu Shinichi Tokuda Yasuharu

出版者

Public Library of Science

雑誌

PLoS ONE (ISSN:19326203)

巻号頁・発行日

vol.8, no.3, pp.e59738, 2013-03

被引用文献数

3

---

IntroductionFew studies are available on the clinical characteristics of patients using emergency medical transports in Japan. In this study, we aimed to investigate reasons for emergency medical transports and their relation to clinical severity.MethodsWe conducted a 3-year population-based observational study of patients transported by ambulance to emergency departments (ED) in the capital of Japan, Tokyo, which has a population of about 13 million. Demographic data, reasons for transport, and the severity of initial assessment at ED were recorded. Logistic regression was used to determine the odds of the clinical severity of each reason for transport.ResultsThe number of emergency medical transports in the three-year study period was 1,832,637. Mean age was 53±26. Males were 976,142 (53%). Overall, 92% of all transported patients were in a mild or moderate medical state and patients with the 17 most frequent reasons for transport occupied 82% (1,506,017) of all transports. Pain was the most frequent reason for transport, followed by traffic accident. Considering all the patients and their reasons for transport, patients whose reason was pain or a traffic accident (29% of all patients) were in a relatively mild state compared with patients with other reasons for transport. Patients in an altered mental state in the prehospital setting (6.8% of all patients) were in a more severe medical state than other patients.ConclusionsIn Tokyo, Japan, 92% of transported patients were in a mild or moderate medical state. In particular, most patients from traffic accidents were in a mild state, even though traffic accidents were the second most frequent reason for transport. Patients in an altered mental state were most likely to be in a severe medical state.

著者

Kinoshita Kensuke Hattori Kazuya Ota Yoshio Kanai Takao Shimizu Miyuki Kobayashi Hiroyuki Tokuda Yasuharu

出版者

Elsevier Inc.

雑誌

Experimental gerontology (ISSN:05315565)

巻号頁・発行日

vol.48, no.2, pp.255-258, 2013-02

被引用文献数

14

---

PurposeDry axilla can sometimes be found among dehydrated older patients. In this study, we measured the axillary moisture and assessed it as possible marker for dehydration.MethodsTwenty-nine older patients admitted with acute medical conditions participated in this study. Dehydration was diagnosed by the calculated serum osmolality of greater than 295 mOsm/L. The moisture of axilla was measured by a skin moisture impedance meter which was applied at the center of axilla of patients.Results11 patients (7 males and 4 females) were diagnosed as dehydrated and 18 patients (10 males and 8 females) were diagnosed as non-dehydrated. The mean axillary moisture (33%) in the dehydrated group was significantly lower than that (42%) in the non-dehydrated group (p < 0.05). The axillary moisture ≥ 50% showed the sensitivity of 88%. The axillary moisture < 30% showed the specificity of 91%. Use of a single cutoff value of 40% moisture produced the sensitivity of 59% and the specificity of 9%. As for the physical signs, dry axilla had also moderate sensitivity and excellent specificity to detect dehydration.ConclusionsThe measurement of the axillary moisture could help assess dehydration. Dehydration could be ruled out when the axillary moisture ≥ 50%, while it could be ruled-in when the axillary moisture is < 30%.

著者

Tokuda Yasuharu Goto Eiji Otaki Junji Omata Fumio Shapiro Mina Soejima Kumiko Ishida Yasushi Ohde Sachiko Takahashi Osamu Fukui Tsuguya

出版者

Elsevier Inc.

雑誌

The Journal of emergency medicine (ISSN:07364679)

巻号頁・発行日

vol.43, no.3, pp.494-501, 2012-09

被引用文献数

4

---

BackgroundThe new postgraduate medical education (PGME) was recently introduced to improve quality of emergency care in Japan.ObjectivesTo compare the quality of care and confidence in provision of emergency medicine between physicians who completed the old and new PGME programs.MethodsA cross-sectional survey was sent to 279 physicians of postgraduate years 4–9, and 208 responses (75%) were received. Quality of care in emergency medicine was measured using 26 questions on treatment choices for various clinical conditions. Each question had six responses, including a single correct choice. Effect size was obtained by dividing the total difference in score by the standard deviation of the score distribution. Confidence in emergency medicine was rated using four self-reported items on the level of confidence in treating acute illnesses in various emergency medicine settings.ResultsThe mean score for quality of care was significantly higher in the new PGME group (15.3) compared to the old PGME group (12.8). The difference in scores was 2.5 (p < 0.01) and the effect size (0.47) indicated a moderate difference. Linear regression of total scores adjusted for physician covariates produced similar results of an adjusted score difference of 2.5 (p < 0.01) and an adjusted effect size of 0.47. The new PGME group also had significantly greater confidence in provision of emergency medicine based on significant differences between the groups for all four self-reported items (all p < 0.05).ConclusionsJapanese physicians who complete the new PGME program are likely to provide higher quality of care and have greater confidence in emergency medicine compared to those who completed the old PGME program.