論文 - 上村　修二

Prediction of the future number of fall-related emergency medical services calls in older individuals.

Shuji Uemura, Ryuichi Nakayama, Masayuki Koyama, Yukiko Taguchi, Naofumi Bunya, Keigo Sawamoto, Hirofumi Ohnishi, Eichi Narimatsu

International journal of emergency medicine   17 ( 1 ) 72 - 72  2024年06月  [国際誌]

　概要を見る

BACKGROUND: Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the projected number and percentage of fall-related emergency medical service (EMS) calls. METHODS: We examined the sex, age group, and location of falls among patients aged ≥ 65 years who contacted emergency services in Sapporo City from 2013 to 2021. Annual fall-related calls per population subgroup were calculated, and trends were analyzed. Four models were used to estimate the future number of fall-related calls from the 2025-2060 projected population: (1) based on the 2022 data, estimates from the 2013-2022 data using (2) Poisson progression, (3) neural network, (4) estimates from the 2013-2019 data using neural network. The number of all EMS calls was also determined using the same method to obtain the ratio of all EMS calls. RESULTS: During 2013-2022, 70,262 fall-related calls were made for those aged ≥ 65 years. The rate was higher indoors among females and outdoor among males in most age groups and generally increased with age. After adjusting for age, the rate increased by year. Future estimates of the number of fall calls are approximately double the number in 2022 in 2040 and three times in 2060, with falls accounting for approximately 11% and 13% of all EMS calls in 2040 and 2060, respectively. CONCLUSION: The number of fall-related EMS calls among older people is expected to increase in the future, and the percentage of EMS calls will also increase; therefore, countermeasures are urgently needed.

DOI PubMed

Prehospital advanced airway management and ventilation for out-of-hospital cardiac arrest with prehospital return of spontaneous circulation: a prospective observational cohort study in Japan.

Ryuichi Nakayama, Naofumi Bunya, Shuji Uemura, Keigo Sawamoto, Eichi Narimatsu

Prehospital emergency care     1 - 12  2023年09月  [国際誌]

　概要を見る

BackgroundThe relationship among advanced airway management (AAM), ventilation, and oxygenation in patients with out-of-hospital cardiac arrest (OHCA) who achieve prehospital return of spontaneous circulation (ROSC) has not been validated. This study was designed to evaluate ventilation and oxygenation for each AAM technique (supraglottic devices [SGA] or endotracheal intubation [ETI]) using arterial blood gas (ABG) results immediately after hospital arrival.MethodsThis observational cohort study, using data from the Japanese Association for Acute Medicine OHCA Registry, included patients with OHCA with prehospital and hospital arrival ROSC between July 1, 2014, and December 31, 2019. The primary outcomes were the partial pressure of carbon dioxide in the arterial blood (PaCO2) and partial pressure of oxygen in the arterial blood (PaO2) in the initial ABG at the hospital for each AAM technique (SGA or ETI) performed by paramedics. The secondary outcome was favorable neurological outcome (cerebral performance category [CPC] 1 or 2) for specific PaCO2 levels, which were defined as good ventilation (PaCO2 ≤45 mmHg) and insufficient ventilation (PaCO2 >45 mmHg).ResultsThis study included 1,527 patients. Regarding AAM, 1,114 and 413 patients were ventilated using SGA and ETI, respectively. The median PaCO2 and PaO2 levels were 74.50 mmHg and 151.35 mmHg in the SGA group, while 66.30 mmHg and 173.50 mmHg in the ETI group. PaCO2 was significantly lower in the ETI group than in the SGA group (12.55 mmHg; 95% CI 15.27 to 8.20, P-value < 0.001), while no significant difference was found in PaO2 by multivariate linear regression analysis. After stabilizing inverse probability of weighting (IPW), the adjusted odds ratio for favorable neurological outcome at 1 month was significant in the good ventilation group compared to the insufficient ventilation cohort (adjusted odds ratio = 2.12, 95%CI: 1.40 to 3.19, P value < 0.001).ConclusionThe study showed that in OHCA patients with prehospital ROSC, the PaCO2 levels in the initial ABG were lower in the group with AAM by ETI than in the SGA group. Furthermore, patients with prehospital ROSC and PaCO2 ≤45 mmHg on arrival had an increased odds of favorable neurological outcome after stabilized IPW adjustment.

DOI PubMed

一般住宅と高齢者施設から救急要請された高齢者転倒患者の比較

上村 修二, 中山 龍一, 小山 雅之, 原 正浩, 田口 裕紀子, 大西 浩文, 成松 英智

日本転倒予防学会誌 ( 日本転倒予防学会 )  ( 第10回学術集会 ) 150 - 150  2023年09月

Extension of Selection Time for the Emergency Destination of Patients with a Fever Due to the Coronavirus Disease 2019 Pandemic: A Difference-in-differences Analysis.

Ryuichi Nakayama, Shuji Uemura, Masayuki Koyama, Masahiro Hara, Naofumi Bunya, Keigo Sawamoto, Hirofumi Ohnishi, Eichi Narimatsu

Internal medicine (Tokyo, Japan)    2023年06月  [国内誌]

　概要を見る

Background During the coronavirus disease 2019 (COVID-19) pandemic period, an extended total activity time (TAT) in emergency cases has been reported, especially in febrile patients. A brief selection time (ST) regarding the transport of patients to designated hospitals is vital to achieving a good outcome. However, to our knowledge, no studies have reported the impact of the COVID-19 pandemic on the ST. We therefore examined the impact of a fever on the ST for the transportation of emergency patients during the COVID-19 pandemic. Method We analyzed emergency medical services (EMS) data in Sapporo between January 2015 and December 2020. The primary outcome was the ST for the emergency destination of patients. The secondary outcomes were the number of inquiries, time from emergency call to arrival at the scene [call-to-scene time (CST)], time from arrival at the hospital to return base [arrival-to-return time (ART)], and TAT. We used a multivariable linear regression model to estimate the difference-in-differences effect. Results A total of 383,917 patients who were transported to the hospital were enrolled within the study period. The mean ST was 5.8 min in 2019 and 7.1 min in 2020. The difference-in-differences analyses showed that the mean ST increased by 2.52 min (p<0.001), the mean ART by 3.10 min (p<0.001), and the mean TAT by 7.27 min (p<0.001) for patients with a fever during the COVID-19 period. Conclusions This study showed that febrile patients had a longer ST, ART, and TAT during the 2020 COVID-19 period. Considering the COVID-19 pandemic and the threat of future pandemics, regional infection control and information-sharing should be conducted to reduce the EMS activity time.

DOI PubMed

Influence of work and family environments on burnout among emergency medical technicians.

Junpei Haruna, Shuji Uemura, Yukiko Taguchi, Saori Muranaka, Sachi Niiyama, Hirotoshi Inamura, Keigo Sawamoto, Hirotoshi Mizuno, Eichi Narimatsu

Clinical and experimental emergency medicine    2023年02月  [国際誌]

　概要を見る

OBJECTIVE: : Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability. METHODS: : A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory. Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire. Family-work negative spillover was measured using the Survey Work-Home Interaction-NijmeGen-Japanese. The cutoff value for burnout syndrome was defined as emotional exhaustion ≥ 27 and/or depersonalization ≥ 10. RESULTS: : A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis, and low supervisor support (OR,1.421; 95% CI:1.136-1.406, p < .001) and high family-work negative spillover (OR:1.264, 95% CI:1.285-1.571, p < .001) were independent factors that predicted higher probability of burnout. CONCLUSION: : This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.

DOI PubMed

Prehospital emergency care patient satisfaction scale [PECPSS] for care provided by emergency medical teams: Scale development and validation.

Junpei Haruna, Nobuyasu Hayasaka, Yukiko Taguchi, Saori Muranaka, Sachi Niiyama, Hirotoshi Inamura, Shuji Uemura, Keigo Sawamoto, Hirotoshi Mizuno, Nobuaki Himuro, Eichi Narimatsu

AIMS public health   10 ( 1 ) 129 - 144  2023年  [国際誌]

　概要を見る

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: "teamwork", "explanation and communication", "physical treatment and psychological support", "quickness of transport", and "environment in the ambulance". In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82-0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs.

DOI PubMed

人工鼻除去による死腔の減少が換気を改善したCOVID-19によるARDSの1例

岩元 悠輔, 中山 龍一, 文屋 尚史, 後藤 祐也, 渡辺 梨花, 和田 健志郎, 宮下 龍, 沢本 圭悟, 上村 修二, 成松 英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 )  29 ( Suppl.1 ) 631 - 631  2022年11月

新型コロナウイルス感染症の自宅療養者に対する健康観察アプリケーションのユーザビリティ

中山 龍一, 小山 雅之, 高塚 伸太朗, 向原 強, 谷川 琢海, 藤本 直樹, 福田 潤, 小澤 秀弘, 大西 浩文, 上村 修二

医療情報学連合大会論文集 ( (一社)日本医療情報学会 )  42回   539 - 541  2022年11月

新型コロナウイルス感染症の自宅療養者に対する健康観察アプリケーションのユーザビリティ

中山 龍一, 小山 雅之, 高塚 伸太朗, 向原 強, 谷川 琢海, 藤本 直樹, 福田 潤, 小澤 秀弘, 大西 浩文, 上村 修二

医療情報学連合大会論文集 ( (一社)日本医療情報学会 )  42回   539 - 541  2022年11月

COVID-19肺炎によるARDSに続発した二次性器質化肺炎に対してステロイドが有効であった3例

萩原 詢哉, 中山 龍一, 柿崎 隆一郎, 和田 健志郎, 文屋 尚史, 沢本 圭悟, 上村 修二, 原田 敬介, 成松 英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 )  29 ( Suppl.1 ) 611 - 611  2022年11月

保健所での入院調整

石川 幸司, 上村 修二, 水野 浩利, 田口 裕紀子

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 )  29 ( Suppl.1 ) 410 - 410  2022年11月

HFNCによる呼吸管理の有用性 人工呼吸管理前HFNC期間は重症COVID-19の予後予測因子である

宮下 龍, 文屋 尚史, 中山 龍一, 柿崎 隆一郎, 沢本 圭悟, 原田 敬介, 上村 修二, 成松 英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 )  29 ( Suppl.1 ) 288 - 288  2022年11月

札幌市における救急搬送となった運動競技中のアキレス腱損傷の実際調査

萩原 詢哉, 上村 修二, 青柳 有沙, 中山 龍一, 成松 英智

日本救急医学会雑誌 ( (一社)日本救急医学会 )  33 ( 10 ) 854 - 854  2022年10月

札幌市における雪下ろし作業関連外傷についての検討

青柳 有沙, 上村 修二, 中山 龍一, 萩原 詢哉, 成松 英智

日本救急医学会雑誌 ( (一社)日本救急医学会 )  33 ( 10 ) 784 - 784  2022年10月

Dexmedetomidine improves excessive extracellular glutamate-induced synaptic depression (BRAINRES-D-21-00941)

Eichi Narimatsu, Ryuichiro Kakizaki, Kazuhito Nomura, Keigo Sawamoto, Kazunobu Takahashi, Shuji Uemura, Masanori Ishiguro

BRAIN RESEARCH ( ELSEVIER )  1789  2022年08月

　概要を見る

We investigated the effects of dexmedetomidine, a selective alpha 2-adrenergic agonist and a sedative, on excessive glutamate-induced depressions of central excitatory synaptic transmissions in vitro. From the CA1 in rat hippocampal slices, orthodromically elicited population spikes (PSs) and field excitatory postsynaptic potentials (fEPSPs) at 0.1 Hz were simultaneously recorded. ANOVA was used for statistics, and p < 0.05 was accepted as significant. Glutamate (10 mM for 10 min) completely depressed PSs and fEPSPs, which were partially recovered by the following washout for 40 min (57.4 & PLUSMN; 10.2% and 59.9 & PLUSMN; 9.8% of the control, respectively, p < 0.01, n = 6). The recoveries in PSs and fEPSPs were improved by pre-treatment and simultaneous treatment with dexmedetomidine (p < 0.01, n = 6) but were not altered by post-treatment. Dexmedetomidine alone did not alter PSs and fEPSPs. Simultaneous treatment with isoproterenol or dobutamine exacerbated the recoveries in PSs and fEPSPs (p < 0.01, n = 6), but simultaneous treatment with salbutamol, propranolol, phenylephrine or phentramine did not influence the recoveries. Simultaneous treatment with AP5 improved the recoveries in PSs and fEPSPs that were depressed by glutamate alone and by glutamate with dexmedetomidine, isoproterenol or dobutamine (p < 0.01, n = 6). Excessive glutamate depresses glutamatergic excitatory synaptic transmissions by mainly mediating NMDA receptors, and the depressed transmissions are improved by alpha 2-adrenoceptor stimulation but are exacerbated by beta 1-adrenoceptor stimulation. Dexmedetomidine has a protective effect on neuronal dysfunctions induced by excessive glutamate, which is one of the main mechanisms of the secondary damage in the central nervous system.

DOI

Disseminated mucormycosis in a patient with severe COVID-19 on venovenous extracorporeal membrane oxygenation: a case report.

Hazuki Ito, Ryuichiro Kakizaki, Keisuke Harada, Daisuke Kyuno, Terufumi Kubo, Naofumi Bunya, Takehiko Kasai, Shuji Uemura, Eichi Narimatsu

IDCases     e01578  2022年07月  [国際誌]

　概要を見る

Background: Since the global outbreak of coronavirus disease 2019 (COVID-19), there have been several reports of mucormycosis as a secondary complication. However, the disseminated type of mucormycosis is extremely rare. Case: A 58-year-old male patient with COVID-19 started receiving venovenous extracorporeal membrane oxygenation because of severe respiratory failure. During hospitalization, intra-abdominal hemorrhage occurred and an emergency laparotomy was performed. Subsequently, the patient suffered septic shock, and part of the small intestines and the abdominal wall became necrotic. Finally, the patient died. At autopsy, he was diagnosed with disseminated mucormycosis. Conclusion: Disseminated mucormycosis should be considered in patients with COVID-19 with refractory sepsis unresponsive to broad-spectrum antimicrobial therapy.

DOI PubMed

勇の探求:2020東京オリンピック・パラリンピック開催時の救急医療の実際 オリンピック・マラソン競技医療救護の経験から得たレガシー

上村 修二, 沢本 圭悟, 田口 裕紀子, 大西 昌亮

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 )  25 ( 2 ) 264 - 264  2022年05月

Pneumomediastinum as patient self-inflicted lung injury in patients with acute respiratory distress syndrome due to COVID-19: a case series.

Rika Watanabe, Ryuichi Nakayama, Naofumi Bunya, Naoya Yama, Yusuke Iwamoto, Yoichi Katayama, Takehiko Kasai, Keigo Sawamoto, Shuji Uemura, Eichi Narimatsu

Acute medicine & surgery   9 ( 1 ) e796  2022年  [国際誌]

　概要を見る

BACKGROUND: In patients with coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 infection, pneumomediastinum has been increasingly reported in cases of noninvasive oxygen therapy, including high-flow nasal cannula, and invasive mechanical ventilation. However, its pathogenesis is still not understood. CASE PRESENTATION: We report two cases of pneumomediastinum in acute respiratory distress syndrome (ARDS) caused by COVID-19. In both cases, control of spontaneous breathing with neuromuscular blocking agents resulted in resolution of pneumoperitoneum. CONCLUSION: The improvement of pneumomediastinum with control of spontaneous breathing suggested patient self-inflicted lung injury as a possible mechanism in this case series. In ARDS cases with pneumomediastinum, in addition to controlling plateau pressure with conventional lung protective ventilation, spontaneous breathing should be controlled if the patient's inspiratory effort is suspected to be strong.

DOI PubMed

【禍難を乗り越えて】COVID-19の病態を医学する COVID-19死亡原因の疫学とその特徴について J-RECOVER中間解析結果より

文屋 尚史, 中山 龍一, 上村 修二, 成松 英智, 早川 峰司, 田上 隆

日本救急医学会雑誌 ( (一社)日本救急医学会 )  32 ( 12 ) 1065 - 1065  2021年11月

コロナ禍における救急対応と今後の課題-臨床現場と保健所の協働による挑戦- 臨床と保健所が手をつないだ札幌の医療提供体制の確保

水野 浩利, 石川 幸司, 田口 裕紀子, 上村 修二, 成松 英智

日本救急看護学会雑誌 ( (一社)日本救急看護学会 )  23 ( Suppl. ) [SY2 - 04]  2021年10月