1
|
Lovasi O, Gaál P, Frank K, Lám J. Acute Pain Services and pain-related patient-reported outcomes in Hungarian hospitals. Perioper Med (Lond) 2024; 13:18. [PMID: 38475942 DOI: 10.1186/s13741-024-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Postoperative pain management is an important part of surgical care, where Acute Pain Service offers added value in terms of patient outcomes and costs. The technology, however, has hardly been adopted in Hungary, with only two hospitals operating Acute Pain Service and whose performance has not been evaluated yet. This research compared pain management outcomes of surgical, orthopedic, and traumatology patients in Hungarian hospitals with and without Acute Pain Service. METHODS We recruited 348 patients, 120 in the APS group and 228 in the control group, whose experience was surveyed with an adapted version of the American Pain Society Patient Outcome Questionnaire. The questionnaire covered pain intensity, pain interference with physical and emotional functions, side effects, patient satisfaction, information received, and participation in treatment decisions. The differences were analyzed by Fisher's exact test and Mann-Whitney U test. RESULTS The APS group showed better results with lower pain intensity scores regarding worst postoperative pain (χ2 = 18.919, p = 0.0043). They reported less pain interference with activities in bed (χ2 = 21.978, p = 0.0006) and out of bed (χ2 = 14.341, p = 0.0129). Furthermore, patients in the APS group experienced fewer pain-management-related side effects, like nausea (χ2 = 15.240, p = 0.0101), drowsiness (χ2 = 26.965, p = 0.0001), and dizziness (χ2 = 13.980, p = 0.0124). However, patient information (χ2 = 3.480, p = 0.0945) and patient satisfaction (χ2 = 5.781, p = 0.2127) did not differ significantly between the two groups. CONCLUSIONS Our findings confirm earlier international evidence on the benefits of Acute Pain Service in postoperative pain management and support the wider adoption of the technology in Hungarian hospitals. Nevertheless, close attention should be paid to patient information and involvement as better outcomes alone do not necessarily increase patient satisfaction.
Collapse
Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary.
| | - Péter Gaál
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Targu Mures, Romania
| | - Krisztián Frank
- Szekszárd District Office of the Government Office of Tolna County, Szekszárd, Hungary
| | - Judit Lám
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- NEVES Society for Patient Safety, Budapest, Hungary
| |
Collapse
|
2
|
Lovasi O, Lám J, Frank K, Schutzmann R, Gaál P. The First Comprehensive Survey of the Practice of Postoperative Pain Management in Hungarian Hospitals - a Descriptive Study. Pain Manag Nurs 2023; 24:342-349. [PMID: 36642581 DOI: 10.1016/j.pmn.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/20/2022] [Accepted: 12/10/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pain management is a key issue in health care. Providers adopt promising technological developments, like Acute Pain Service, at differing speeds, with countries, such as the USA and Germany taking the lead. Where Hungary stands is unknown, as the practice of pain management has not yet been comprehensively reviewed in that country. AIM To explore the practice of postoperative pain management in Hungarian hospitals by addressing the questions of who is responsible for it, who measures pain and how, what kind of pain relief technologies are used, and who takes care of patients during duty hours. METHODS We carried out a survey covering Hungarian hospitals with operational license for surgery, traumatology, orthopedics and anesthesiology between December 2019 and March 2020. The response rate was 72%, and we analyzed 135 questionnaires. RESULTS We identified only 2 hospitals with an Acute Pain Service. In the majority of hospitals, the attending physician orders pain relief therapy. During duty hours the surgeon on duty takes care of pain management in 52.1% of the cases. Among pain relief therapies, intravenous infusions (74.1%) and oral medication (67.4%) are the most frequent. Ward nurses measure postoperative pain (77.8%) with unidimensional scales. According to 59.7% of the respondents, pain is not measured and documented at rest. Written protocols are available in 34.4% of the departments. CONCLUSIONS Compared with other countries, pain management in Hungary lags behind with significant room for improvement. Development and implementation of pain management protocols with appropriate education is the key intervention point.
Collapse
Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Budapest, Hungary.
| | - Judit Lám
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Krisztián Frank
- Szekszárd District Office of the Government Office of Tolna County, Szekszárd, Hungary
| | - Réka Schutzmann
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Péter Gaál
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary; Sapientia Hungarian University of Transylvania, Faculty of Technical and Human Sciences, Department of Applied Social Sciences, Targu Mures, Romania
| |
Collapse
|
3
|
Németh O, Simon F, Benhamida A, Kivovics M, Gaál P. eHealth, teledentistry and health workforce challenges: results of a pilot project. BMC Oral Health 2022; 22:552. [PMID: 36456948 PMCID: PMC9713149 DOI: 10.1186/s12903-022-02603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the twenty-first century, health systems have to cope with the challenges posed by their rapidly changing environment. Among these changes, the emergence of digital health solutions is an opportunity to make health systems better, but also a compelling force to change. Community dentistry is one area of health care, where the rapid technological development has the potential for substantial performance improvement benefitting dental patients in terms of access to care and conveniance. METHODS This study is based on a survey of the dental care provided by three units (Oral Medicine, Periodontology, Orthodontics) of the Department of Community Dentistry, Semmelweis University, Budapest. During a period of 12 weeks, we have collected time balance data on 1131 patients, 539 in the traditional and 592 in a pilot teledentistry setting, in order to estimate how much time could be spared by monitoring patients through videoconferencing instead of face-to-face visits. RESULTS According to our findings, teledentistry has the potential to shorten the visit with an average of 5-10 min per patient, which adds up to 58-116 work hours in a year. If the pilot was rolled out to all the 13 chairs of the surveyed 3 specialties (orthodontics, periodontology and oral medicine) the time saving would sum up to 186 workdays in one shift alone, which would translate to close to 4500 additional patients per year, considering remote patient monitoring cases alone. Further, if inactive doctors and highly qualified dental hygienists were involved in delivering telecare, 2.67 times as many workdays could be spared, which would allow about 12,000 more patients treated per year. CONCLUSIONS The rapid development of digital health technologies coupled with the evolving task distribution between health professionals have a great potential to improve health system performance in pursuit of population health. Unfortunately, the adaptation to these technological changes is uneven, and without a national strategy, the poor will unlikely benefit from these opportunities in public dental care.
Collapse
Affiliation(s)
- Orsolya Németh
- grid.11804.3c0000 0001 0942 9821Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, 1088 Hungary
| | - Fanni Simon
- grid.11804.3c0000 0001 0942 9821Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, 1088 Hungary
| | - Abdallah Benhamida
- grid.440535.30000 0001 1092 7422Abdallah Benhamida BioTech Research Center, Óbuda University, Bécsi Út 96/B, Budapest, 1034 Hungary
| | - Márton Kivovics
- grid.11804.3c0000 0001 0942 9821Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, 1088 Hungary
| | - Péter Gaál
- grid.11804.3c0000 0001 0942 9821Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, Budapest, 1125 Hungary ,grid.5120.60000 0001 2159 8361Department of Applied Social Sciences, Faculty of Technical and Human Sciences, Târgu-Mureș, Hungarian University of Transylvania, Transylvania, Romania
| |
Collapse
|
4
|
Marcisz-Dyla E, Dąbek J, Irzyniec T, Marcisz C. Personality Traits, Strategies of Coping with Stress and Psychophysical Wellbeing of Surgical and Non-Surgical Doctors in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031646. [PMID: 35162668 PMCID: PMC8835265 DOI: 10.3390/ijerph19031646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
The aim of the study was to determine the personality traits, strategies of coping with stress and psychophysical wellbeing of surgical and non-surgical Polish doctors. The study used the following questionnaires and scales: the Resiliency Assessment Scale, the Type D Personality Scale, the Framingham Type A Scale, the Mini COPE—Coping Inventory and the Wellbeing Scale. Doctors performing surgical specialties were characterized by a significantly higher level of resilience components, a more frequent occurrence of the type B behaviour pattern and less frequent type D personality than doctors performing non-surgical specializations. The Mini COPE point values were comparable between surgical and non-surgical physicians. The sense of psychological wellbeing was higher in surgical specialists. The higher the values of the Optimistic approach to life and the ability to mobilize oneself in difficult situations, the lower the values of the Turning to religion domain and the higher the values of the Denial domain correlated with the performance of surgical specialization. Men performing surgical specializations were more often optimistic and inclined to consume alcohol, while women with non-surgical specialization more often coped with stress by turning to religion. We conclude that the personality traits of Polish doctors vary depending on their specialization. Physicians’ coping strategies do not differ depending on their specialization. The sense of mental wellbeing is higher in surgical specialists compared to non-surgical specialists. An optimistic approach to life and the ability to mobilize oneself in difficult situations, as well as coping with stress by denial are associated with the surgical specialization. Men performing surgical specialties more often declare optimism and a tendency to cope with stress by consuming alcohol or psychoactive substances, while women who perform non-surgical specializations more often cope with stress by turning to religion. Psychological screening tests and appropriate training, taking into account medical specialization, could be one way of improving resilience and coping with stress among doctors.
Collapse
Affiliation(s)
- Ewa Marcisz-Dyla
- Faculty of Management, Psychology, Katowice Business University, 40-659 Katowice, Poland
- Correspondence:
| | - Józefa Dąbek
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Tomasz Irzyniec
- Department of Health Promotion and Community Nursing, Faculty of Health Sciences, Medical University of Silesia, ul. Medyków 12, 40-752 Katowice, Poland;
| | - Czesław Marcisz
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland;
| |
Collapse
|
5
|
Mohos A, Frese T, Kolozsvári L, Rinfel J, Varga A, Hargittay C, Csatlós D, Torzsa P. Earning opportunities and informal payment as influencing factors in medical students' speciality choice. BMC FAMILY PRACTICE 2021; 22:258. [PMID: 34969365 PMCID: PMC8716841 DOI: 10.1186/s12875-021-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment. Methods A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. Results Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. Conclusions Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.
Collapse
Affiliation(s)
- András Mohos
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary.
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle/Saale, Germany
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4028 Kassai út 26, Debrecen, Hungary
| | - József Rinfel
- Institute of Primary Care, University of Pécs, 7623 Rákoczi St. 2, Pécs, Hungary
| | - Albert Varga
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Dalma Csatlós
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| |
Collapse
|
6
|
Sepúlveda-Vildósola AC, González HM, López-Sepúlveda MF, Martínez-Escobar CB. Trends in Medical Specialization and Employability in Mexico According to Gender. Arch Med Res 2021; 53:205-214. [DOI: 10.1016/j.arcmed.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/02/2022]
|
7
|
Lovasi O, Lám J, Schutzmann R, Gaál P. Acute Pain Service in Hungarian hospitals. PLoS One 2021; 16:e0257585. [PMID: 34550982 PMCID: PMC8457450 DOI: 10.1371/journal.pone.0257585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Surgical procedures play an increasing role among health technologies to treat diseases. Pain often accompanies such diseases, both as a result of their pathology, but also as the side-effect of the intervention itself, and it is not only a burdensome subjective feeling, but adversely affects the recovery process, can induce complications and increases treatment costs. Acute Pain Service Teams are becoming increasingly widespread in hospitals to address post-operative pain, yet we have so far no data on how many hospitals have actually adopted this technology in Hungary. Objectives The main objectives of our study were to assess the prevalence of Acute Pain Service Teams, map their structure and operation, as well as to understand the barriers and conducive factors of their establishment in Hungarian hospitals. Methods We carried out a survey among the 72 hospitals with surgical departments. The questionnaire was filled in by 52 providers, which gave us a response rate of 72.2%. Results Our results show, that only two of the responding hospitals have Acute Pain Service Teams albeit their structure and operation are in line with the literature. In the 50 hospitals without such teams, financing difficulties and human resources shortages are mentioned to be the most important obstacles of their establishment, but the lack of initiative and interest on the part of the specialities concerned are also an important barrier. Conclusions Lagging behind the more affluent EU member states, but similarly to other Central and Eastern European countries, Acute Pain Service has been hardly adopted by Hungarian hospitals. Hungarian health professionals know the technology and would support its wider introduction, if the technical feasibility barriers could be overcome. Health policy should play a more active role to facilitate change in this area, the investment in which promises a substantial return in terms of health gains and cost savings.
Collapse
Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Judit Lám
- Semmelweis University Health Services Management Training Centre, Budapest, Hungary
| | - Réka Schutzmann
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Péter Gaál
- Semmelweis University Health Services Management Training Centre, Budapest, Hungary
| |
Collapse
|
8
|
Saito H, Tanimoto T, Kami M, Suzuki Y, Morita T, Morita M, Yamamoto K, Shimada Y, Tsubokura M, Endo M. New physician specialty training system impact on distribution of trainees in Japan. Public Health 2020; 182:143-150. [PMID: 32305513 DOI: 10.1016/j.puhe.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. STUDY DESIGN Retrospective observational study. METHODS The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. RESULTS In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. CONCLUSIONS After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.
Collapse
Affiliation(s)
- H Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
| | - T Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - M Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Suzuki
- Department of Obstetrics and Gynecology, Tone Central Hospital, Numata, Gunma, Japan
| | - T Morita
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Morita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - K Yamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
| | - M Tsubokura
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Endo
- Support Office for Medical Education and Trainings, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| |
Collapse
|
9
|
Nakayasu A, Kido M, Katoh K, Homma Y. Survey on Specialty Preference and Work-Life Balance among Residents of Japanese Red Cross Hospitals. JMA J 2020; 3:118-124. [PMID: 33150243 PMCID: PMC7590388 DOI: 10.31662/jmaj.2019-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/11/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction The paucity and maldistribution of physicians among various specialties are key issues facing the Japanese health care system. Studies have shown that young physicians place more emphasis on work-life balance while selecting their specialty and that they prefer controllable lifestyle (CL) specialties over noncontrollable lifestyle (NCL) specialties. As this may be a cause of maldistribution, we investigated the relationship between views on work-life balance and specialty selection among young physicians in Japan. Methods An online questionnaire was sent to 1451 residents (postgraduate years 1-5) at 60 Japanese Red Cross hospitals across Japan. Results In all, 226 physicians responded (response rate: 15%), with 21% in CL and 74% in NCL specialties. When compared with NCL specialties, CL specialties had less overtime (43% vs. 16%, p = 0.001), considered life to be more important than work (26% vs. 15%, p = 0.018), and were more likely to give precedence to work-life balance over medical interest while choosing their specialty (49% vs. 30%, p < 0.001). Furthermore, physicians were more likely to change their choice of specialty, contrary to their professional interest, because of social reasons (49% vs. 26%, p = 0.007). Conclusions Our study suggests that young physicians in CL specialties have better working hours and place more emphasis on work-life balance while choosing their specialty compared with those in NCL specialties. The increase in the number of physicians in CL specialties is likely attributable to the growing preference for an optimal work-life balance among young physicians; this seems to have increased the maldistribution of physicians among various specialties. Institutional mechanisms to support the lifestyle of physicians (especially in NCL specialties) are required to provide a balanced medical service in Japan.
Collapse
Affiliation(s)
- Anna Nakayasu
- Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Michiko Kido
- Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keiichi Katoh
- Department of Anesthesiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yukio Homma
- President, Japanese Red Cross Medical Center, Tokyo, Japan
| |
Collapse
|