Yodogawa Christian Hospital

要旨 【目的】 メディカルラリーはチーム医療や多職種連携を体験的に学ぶシミュレーション教育である。本研究では，メディカルラリー参加前後でのアンケートを通じて，医療系学生における救急医療への興味や多職種連携への理解に及ぼす教育的効果を検証した。 【方法】 参加学生110名のうち，事前・事後アンケートに回答した45名を対象とした。アンケートでは，「救急医療への興味」，「他職種の役割や知識・技術の理解」，「他職種との連携の必要性」を5段階リッカート尺度で調査し，参加前後の変化を評価した。 【結果】 「他職種の役割や知識・技術の理解」では，肯定的回答が34%から51%に増加し，否定的回答は42%から7%に減少した。一方，「救急医療への興味」および「多職種連携の必要性」については，有意な変化を認めなかった。 【結語】 メディカルラリーは，多職種連携の理解を深める有効な教育手法であることが示唆された。一方で，救急医療に対する興味の変化は限定的であり，その教育効果をより正確に評価するためには，対象層や募集方法を考慮した検討が必要である。

<title>Abstract</title> Purpose This study was conducted to confirm the actual opioid conversion ratios (CRs) and opioid rotation ratios (ORRs) in clinical practice in Japan. Methods A cross-sectional survey was conducted between March 7th to 20th, 2024, targeting palliative care physicians and pharmacists in the following three societies: Japanese Society for Palliative Medicine, Japanese Society for Pharmaceutical Palliative Care and Sciences, and Japanese Association of Supportive Care in Cancer. The primary endpoint was to determine the CRs and ORRs used by participants, which were measured in the survey. Results 433 responses (68.1% physicians and 31.9% pharmacists) were received. 30.3% conducted &gt; 30 opioid rotations in the past 6 months. For most CRs and ORRs obtained from all the participants, values for the median, first quartile, third quartile, and mode were consistent. Among groups of professions and number of opioid rotations frequency, there were no differences in the median opioid ratios involving morphine, hydromorphone and oxycodone. However, there were significant differences in the ORRs involving intravenous (IV) fentanyl, specifically in the rotation ratios between IV fentanyl and IV morphine. Conclusion There was great consistency in the CRs and ORRs used by physicians and pharmacists in palliative care in Japan. This would suggest that education on the ratios is well established for medical professionals in Japan.

To compare the efficacy and safety of rituximab (RTX) to those of intravenous cyclophosphamide (IVCY) as remission induction therapy in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and severe renal impairment. Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of <30 mL/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models. In the weighted population, the hazard ratio (HR) for RTX versus IVCY was 0.73 (95% confidence interval: 0.31-1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the HRs for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant. RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.

To investigate whether higher-order aberrations (HOAs) in the anterior and posterior corneal surfaces and the entire eye vary with age. A prospective, cross-sectional study. One hundred eyes from 100 participants, with 20 eyes per decade group (20s to 60s+), were assessed. Participants had no ocular diseases except refractive errors and mild cataracts, and no abnormalities on the anterior corneal surface, as assessed by Placido-based corneal topography. Corneal and ocular wavefront aberrations were measured with an integrated Scheimpflug tomographer/Hartmann-Shack wavefront aberrometer and analyzed over a 4-mm pupil. The root mean square values for total HOAs, spherical aberrations (SAs), and coma were calculated from the Zernike coefficients up to the 6th order. The total HOAs, SAs, and comas from the anterior corneal surface, posterior corneal surface, total cornea, and whole eye were compared across the age groups. The correlations between HOAs and age were also evaluated. Significant positive correlations with age were observed for the total HOAs and SAs in the anterior cornea (R=0.27, 0.29; P<0.01), total cornea (R=0.31, 0.34; P<0.01), and whole eye (R=0.48, 0.39; P<0.01). No significant correlations were found for coma in any region. Similarly, no significant correlations were observed for the total HOAs, SAs, or coma in the posterior cornea. Total HOAs and SAs in the anterior cornea, total cornea, and whole eye were significantly positively correlated with age, whereas coma exhibited no age-related changes. These findings underscore the importance of considering age-related optical changes in clinical evaluations.

Background: Distal radius fractures are the most common fractures in the upper extremity. Volar plate fixation is a commonly performed surgical procedure for this fracture. Flexor tendon rupture is a serious postoperative complication due to attrition between the plate and tendon. This study aimed to analyse the factors associated with the time from surgery to tendon rupture, classify plate position and determine the incidence of flexor tendon rupture in relation to plate position. Methods: This multicentre retrospective study included 28 patients (24 women) with flexor tendon rupture following volar plate surgery for distal radius fractures. Plate positions were classified into four types based on plain radiographs. They were distal position (DP), dorsal angulation (DA), screw protrusion (SP) and proximal position (PP). The associations between the time to rupture and factors, including patient backgrounds and radiological parameters, were examined. Results: Thirty-five flexor tendons ruptured. All cases included Soong grade 1 or 2 plate prominence. The average time to tendon rupture was 101.5 months (SD 60.2, range: 1.1-202.1). No factors were significantly associated with time to rupture. Flexor tendon ruptures were associated with DA in 17 ruptures, DP in 11, SP in 6 and PP in 2. SP was observed in the non-locking system only. Conclusions: Attention must be paid to the possibility of tendon rupture in patients with Soong grade 1 or 2. The risk of flexor tendon rupture was highest in patients with prominent plates due to DA. Level of Evidence: Level IV (Therapeutic).

This study aimed to evaluate the efficacy of romosozumab in older Japanese patients with osteoporosis. Bone mineral density (BMD) was measured at 0, 4, 6, and 12months after romosozumab treatment. Of 125 patients with osteoporosis (mean age: 77.6 ± 7.5years), 115 completed BMD measurements at the lumbar spine, total hip, and femoral neck. The BMD at the lumbar spine (11.5%, P < .01), total hip (3.0%, P < .01), and femoral neck (3.7%, P < .01) increased 12months after treatment. There were no differences in the improvement ratio of BMD after 12months of treatment at the lumbar spine, total hip, and femoral neck among 76 patients aged ≥75years and 39 aged <75years (11.0% vs. 12.5%: P = .48, 3.0% vs. 3.0%: P = .83, 3.6% vs. 4.1%: P = .92), 48 with prior treatment of osteoporosis and 67 without prior treatment of osteoporosis (10.8% vs. 12.1%: P = .56, 2.1% vs. 3.7%: P = .25, 2.8% vs. 4.5%: P = .61), and 55 patients with a history of fragility fracture and 60 without a history of fragility fracture (11.8% vs. 11.3%: P = .88, 2.4% vs. 3.5%: P = .51, 2.0% vs. 5.3: P = .11). Romosozumab improved BMD at the lumbar spine, total hip, and femoral neck in older adults with osteoporosis.

Film-specific uniformity variations in packages are known to significantly diminish the effectiveness of the one-scan protocol, a commonly used film dosimetry method. This method universally adopts the reference dose-response with rescaling linearly from the relationship of the known dose and the unexposed state. This study aims to visualize and quantify the variation in unexposed film-specific uniformity in a package to evaluate the suitability of the reference dose response using machine-learning method. Fourteen EBT4 films (#00-#13) were selected from two lot packages. Nine grid-spaced 100 × 100 pixel (72 dpi) patches were obtained from the color images of EBT4 film sheet using a single scanner with landscape (scan A) and portrait (scan B) scan orientations. The reference patch was set at the center of film #00. For this study, multidimensional scaling (MDS) and Lie derivative image analysis (LDIA) were applied to the patch data with respect to the red (R)/green (G)/blue (B) channels. MDS is a suitable method for analyzing non-linear data with similarity, which provides a map of data objects according to a distance metric. LDIA directly detects the deviation vector field between image gradients. The film-specific uniformity was measured at 1/10000 scaled pixel value as a scalar distribution. The image flow field was obtained as a negative gradient of the scalar distribution. Two similarity metrics were defined for comparison with the reference patch: (1) MDSr (the distance parameter in the MDS map from the origin) and (2) Stot (summed S-value in each patch, where S-value represents the vorticity of the deviation vector field obtained via the Lie derivative). MDSr highly correlated with the absolute pixel value difference from the reference patch except for the blue channel in which a favorable package was detected for the reference dose response. Stot quantified the film-uniformity variation from the reference, independent of the dataset, and detected the unfavorable film state as Stot < 0.8 in the blue channel. We visualized and quantified the variation in film-specific uniformity in a lot package using MDS and LDIA, thereby quantitatively determining the unfavorable condition for applying the reference dose-response.

Background: Reduced or delayed access to medical resources on weekends could lead to worsening outcomes, in critically ill infected patients requiring intensive care unit (ICU) admission. Objective: To investigate the “weekend effect,” on critically ill infected patients in Japanese ICUs for the first time. Design: Multicenter retrospective cohort study. Methods: We examined data from Japanese ICU patients participating in the DIANA study, a multicenter international observational cohort study. This prospective investigation enrolled critically ill patients with infections admitted to the ICU. The primary endpoint was successful discharge from the ICU within 28 days of admission. Outcome measures were evaluated through both univariate and covariate Cox regression analyses, providing hazard ratios (HRs) along with estimated 95% confidence intervals (CIs). Results: Out of the 276 patients enrolled in the DIANA study across 31 facilities, 208 patients (75.4%) meeting the inclusion criteria were included in the analysis. The weekday ICU admission group comprised 156 patients (75.0%), while the weekend ICU admission group comprised 52 patients (25.0%). In the multivariate Cox regression analysis, there were no statistically significant differences observed in the rates of ICU discharge alive within 28 days and 14 days (28 days, HR: 0.94, 95% CI: 0.63–1.40; 14 days, HR: 0.97, 95% CI: 0.64–1.48). Furthermore, the overall ICU mortality rates at 28 days and 14 days after ICU admission did not show statistical significance between patients admitted on weekends and those admitted on weekdays (ICU mortality, 28 days: 13.5% vs 11.5%, p = 0.806; 14 days: 7.7% vs 10.9%, p = 0.604). Conclusion: The rates of ICU discharge alive within 28 days after ICU admission did not differ significantly between weekday and weekend admissions, both in the unadjusted and adjusted analyses. Moreover, further well-designed studies are warranted to thoroughly assess this effect.

Background/Introduction:The WHO EMTCC coordinated responses to Cyclone Idai in Mozambique (2019), the refugee crisis in Moldova (2022), the earthquake in Türkiye (2023), and the humanitarian crisis in Cairo (2024). Each event presented unique Information Management (IM) challenges.Objectives:Analyze and compare WHO EMTCC Information Management practices across these crises, identifying specific challenges and implemented solutions.Method/Description: 2019 MozambiqueDisaster: Cyclone IdaiImpact: Infrastructure destruction, numerous casualtiesInformation Management: Diverse data collection, weak real-time updates, lack of unified management, poor communication infrastructure2022 MoldovaDisaster: Refugee crisis from Ukraine invasionImpact: Overburdened medical systemInformation Management: Fragmented EMT management, information overlaps, language barriers, stable communication infrastructure2023 TürkiyeDisaster: Major earthquakeImpact: Building collapses, numerous injuriesInformation Management: Improved use of tools like MDS, rapid data collection, multi-national team coordination challenges, real-time sharing needs, lack of domestic EMT data2024 CairoDisaster: Palestine Humanitarian CrisisImpact: Numerous casualties, infrastructure damageInformation Management: Secretive management, high-security needs, limited internal sharing, independent coordinator decisionsResults/Outcomes:Mozambique highlighted the need for digitalization and unified data systems. Moldova emphasized unified platforms and pre-registration processes. Türkiye showed progress in data tools but needed better real-time systems and domestic coordination. Cairo underlined secure and efficient information sharing in high-security contexts.Conclusion:WHO EMTCC’s IM practices varied across disasters. Common challenges included unified data management, real-time sharing, and multi-national team coordination. Future efforts should standardize protocols, improve communication infrastructure, and enhance WHO EMT Initiative training. The Japan Disaster Relief team’s contributions provided valuable insights for future improvements.

We report a rare case of a 25-year-old man with paraplegia and hemodialysis dependency due to traumatic spinal cord injury and renal infarction. Ischial and severe sacral pressure ulcers complicated by an urethrocutaneous fistula developed in the patient. A multidisciplinary approach was implemented, including percutaneous cystostomy, negative pressure wound therapy, and musculocutaneous flap surgery. This strategy successfully preserved urethral integrity, a significant achievement in such complex cases. After complete ulcer closure and meticulous follow-up, the patient successfully underwent living donor kidney transplantation with preserved urethral function. This case highlights the efficacy of a multidisciplinary approach in managing severe pressure ulcers with a urethrocutaneous fistula while maintaining urethral integrity. It also underscores the importance of achieving complete ulcer healing and preventing recurrence before kidney transplantation. Long-term follow-up and development of standardized treatment protocols for such complex cases are warranted, particularly focusing on urethral preservation strategies.