<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Wheth...<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>展开更多
Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in...Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.展开更多
Effective Medical Creation (EMC) is a kind of campaign to implement a team healthcare that can provide the most efficient and effective intensive care units (ICUs) by improving hospital room environment for not only p...Effective Medical Creation (EMC) is a kind of campaign to implement a team healthcare that can provide the most efficient and effective intensive care units (ICUs) by improving hospital room environment for not only patients and their family but also healthcare providers. This campaign was based on the concept of the “Art of Medicine”, which provides everyone a comfortable ICU environment of meditation and feeling with the five senses of sight, hearing, touch, smell, and taste. EMC can provide a healthcare environment that is not restricted by existing and traditional verse rules or style and aims to always provide better healthcare by working on the five senses. Provision of facilities for aromatherapy massage at an ornamental hospital room and landscape through a false window has been the ongoing activity of the EMC at Nara Medical University. These seemed effective in reducing a patient’s stress response in the ICU. However, the effect of EMC on the outcomes of critical<span style="font-family:Verdana;">ly</span><span style="font-family:Verdana;"> ill patients has not been determined. EMC might be one of the promising measures to create environments that positively affect both patients and healthcare providers. In this review article, the concept of EMC and practice of EMC at Nara Medical University Hospital are presented.</span>展开更多
Heating and humidification control during mechanical ventilation is important. Water condensation can occur due to insufficient humidification. Condensation in the breathing circuit can cause various adverse events. I...Heating and humidification control during mechanical ventilation is important. Water condensation can occur due to insufficient humidification. Condensation in the breathing circuit can cause various adverse events. In this study, we investigated whether the occurrence of tubing condensation in the breathing circuit could be affected by room temperature using a simulated respiratory circuit with a humidifier. The room temperature was set at 23°C, 25°C, and 27°C, and mechanical ventilation was performed for 8 h. The inspired gas was appropriately heated and humidified according to the manufacturer’s instructions. The weight of the circuit was measured every 2 h at room temperature to estimate the amount of condensation. During the mechanical ventilation, condensation continued to increase at a room temperature of 23°C, but only for the first 2 h at 25°C, and did not occur at 27°C. The room temperature of the indoor environment was one of the factors generating water condensation in the breathing circuit with a humidifier even when a heater wire in the breathing circuit was appropriately operated.展开更多
文摘<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>
文摘Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.
文摘Effective Medical Creation (EMC) is a kind of campaign to implement a team healthcare that can provide the most efficient and effective intensive care units (ICUs) by improving hospital room environment for not only patients and their family but also healthcare providers. This campaign was based on the concept of the “Art of Medicine”, which provides everyone a comfortable ICU environment of meditation and feeling with the five senses of sight, hearing, touch, smell, and taste. EMC can provide a healthcare environment that is not restricted by existing and traditional verse rules or style and aims to always provide better healthcare by working on the five senses. Provision of facilities for aromatherapy massage at an ornamental hospital room and landscape through a false window has been the ongoing activity of the EMC at Nara Medical University. These seemed effective in reducing a patient’s stress response in the ICU. However, the effect of EMC on the outcomes of critical<span style="font-family:Verdana;">ly</span><span style="font-family:Verdana;"> ill patients has not been determined. EMC might be one of the promising measures to create environments that positively affect both patients and healthcare providers. In this review article, the concept of EMC and practice of EMC at Nara Medical University Hospital are presented.</span>
文摘Heating and humidification control during mechanical ventilation is important. Water condensation can occur due to insufficient humidification. Condensation in the breathing circuit can cause various adverse events. In this study, we investigated whether the occurrence of tubing condensation in the breathing circuit could be affected by room temperature using a simulated respiratory circuit with a humidifier. The room temperature was set at 23°C, 25°C, and 27°C, and mechanical ventilation was performed for 8 h. The inspired gas was appropriately heated and humidified according to the manufacturer’s instructions. The weight of the circuit was measured every 2 h at room temperature to estimate the amount of condensation. During the mechanical ventilation, condensation continued to increase at a room temperature of 23°C, but only for the first 2 h at 25°C, and did not occur at 27°C. The room temperature of the indoor environment was one of the factors generating water condensation in the breathing circuit with a humidifier even when a heater wire in the breathing circuit was appropriately operated.
