1
|
Esumi R, Ito-Masui A, Kawamoto E, Ito M, Hayashi T, Shinkai T, Hane A, Okuno F, Park EJ, Kaku R, Shimaoka M. Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study. Interact J Med Res 2023; 12:e50148. [PMID: 37935050 PMCID: PMC10719822 DOI: 10.2196/50148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. OBJECTIVE We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP's importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. METHODS Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies-Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. RESULTS Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=-0.318; P=.01). In 2018, the degree (r=-0.280; P=.01) and eigenvector (r=-0.284; P=.01) centralities were negatively correlated with CES-D scores. CONCLUSIONS Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211.
Collapse
Affiliation(s)
- Ryo Esumi
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Emergency Medicine, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Asami Ito-Masui
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, Japan
| | - Eiji Kawamoto
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Mami Ito
- Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, Japan
| | - Tomoyo Hayashi
- Department of Nursing, Mie University Hospital, Tsu, Japan
| | - Toru Shinkai
- Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, Japan
| | - Atsuya Hane
- Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, Japan
| | - Fumito Okuno
- Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, Japan
- Department of Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Eun Jeong Park
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryuji Kaku
- Department of Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
2
|
Suzuki K, Yoshida H, Esumi R, Ieki Y, Yamamoto A, Ohi M, Kaneko T, Imai H. Esophageal Perforation Accompanying Mediastinitis in Blunt Trauma in a Patient with Thoracic Osteophytes. Intern Med 2022; 61:2601-2605. [PMID: 35135923 PMCID: PMC9492484 DOI: 10.2169/internalmedicine.8930-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We herein report a 61-year-old man who sustained injury after a 2-m fall and developed mediastinitis. He presented to another hospital two days after the fall and was transferred to our hospital four days after the fall with a fever and dysphagia. Computed tomography revealed osteophytes on the second and third thoracic vertebrae and free air in the mediastinum, indicating esophageal perforation. Emergent surgery was performed. Intraoperatively, a longitudinal esophageal tear was identified. We stress the importance of being aware of the possibility of osteophyte-related esophageal perforation in patients with a history of a fall. A delayed diagnosis affects the prognosis.
Collapse
Affiliation(s)
- Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Japan
- Department of Infectious Diseases, Mie University Hospital, Japan
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Japan
| | - Haruna Yoshida
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Ryo Esumi
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yohei Ieki
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Akira Yamamoto
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Japan
| | - Masaki Ohi
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Japan
| |
Collapse
|
3
|
Esumi R, Kaneko T, Ito A, Ieki Y, Yamamoto Y, Nakajima A, Imai H. Anticoagulant-free venovenous extracorporeal membrane oxygenation for diffuse alveolar hemorrhage with bowel bleeding caused by antineutrophil cytoplasmic antibody-associated vasculitis: A case report. Respir Med Case Rep 2021; 34:101513. [PMID: 34540581 PMCID: PMC8441063 DOI: 10.1016/j.rmcr.2021.101513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is sometimes complicated by diffuse alveolar hemorrhage (DAH), which may cause respiratory failure. Venovenous extracorporeal membrane oxygenation (VV-ECMO) without an anticoagulant because of hemorrhagic status, showed the effectiveness for severe respiratory failure by DAH with AAV. A 44-year-old woman developed DAH with bowel bleeding following the onset of AAV, with positive anti-proteinase-3 (PR3) antibodies. Although ventilator management could not support her respiratory status, VV-ECMO was performed. The patient was given immunosuppressive therapy comprising a steroid pulse, plasma exchange, and cyclophosphamide. After about 10 days of VV-ECMO and immunosuppressive therapy, VV-ECMO was withdrawn, and on day 12, ventilator support was stopped. Although a thrombus developed within the inferior vena cava (IVC), which required IVC filtration, the patient was discharged on day 51. VV-ECMO support was effective for treating DAH in this patient with new-onset AAV, which takes some time to achieve remission with immunosuppressive therapy.
Collapse
Affiliation(s)
- Ryo Esumi
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Japan
- Corresponding author. Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie, 514-8507, Japan.
| | - Asami Ito
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yohei Ieki
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yoshiki Yamamoto
- Department of Rheumatology, Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Ayako Nakajima
- Department of Rheumatology, Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Japan
| |
Collapse
|
4
|
Esumi R, Kaneko T, Akama Y, Shinkai T, Ieki Y, Bessho S, Shomura Y, Imai H. Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report. Trauma Case Rep 2021; 35:100515. [PMID: 34401440 PMCID: PMC8353503 DOI: 10.1016/j.tcr.2021.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/02/2022] Open
Abstract
Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. Learning objectives To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax. To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.
Collapse
Affiliation(s)
- Ryo Esumi
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yuichi Akama
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Toru Shinkai
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yohei Ieki
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Saki Bessho
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, Japan
| | - Yu Shomura
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Japan
| |
Collapse
|
5
|
Ito-Masui A, Kawamoto E, Esumi R, Imai H, Shimaoka M. Sociometric wearable devices for studying human behavior in corporate and healthcare workplaces. Biotechniques 2021; 71:392-399. [PMID: 34164992 DOI: 10.2144/btn-2020-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Wearable sensor technology enables objective data collection of direct human interactions. The authors review sociometric wearable devices (SWD) and their application in healthcare. Human interactions captured by wearable sensors have been shown to correlate with social constructs such as teamwork and productivity in the office. Application of SWD in the field of healthcare requires special considerations: validation studies have shown technological disadvantages in acute medical settings. Application of SWD in healthcare should be considered based on the strengths and weaknesses of the methodology. SWD can also play an important role in investigation of human interaction and epidemic spread. When study designs and methodologies are carefully considered, incorporation of SWD in healthcare research has promising potential for new insights.
Collapse
Affiliation(s)
- Asami Ito-Masui
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Eiji Kawamoto
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Ryo Esumi
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Hiroshi Imai
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| |
Collapse
|
6
|
Ito-Masui A, Kawamoto E, Sakamoto R, Yu H, Sano A, Motomura E, Tanii H, Sakano S, Esumi R, Imai H, Shimaoka M. Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study. JMIR Res Protoc 2021; 10:e24799. [PMID: 33626497 PMCID: PMC8088862 DOI: 10.2196/24799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID) DERR1-10.2196/24799
Collapse
Affiliation(s)
- Asami Ito-Masui
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Eiji Kawamoto
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Ryota Sakamoto
- Department of Medical Informatics, Mie University Hospital, Tsu City, Mie, Japan
| | - Han Yu
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Akane Sano
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Eishi Motomura
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| | - Hisashi Tanii
- Center for Physical and Mental Health, Mie University, Tsu City, Mie, Japan
| | - Shoko Sakano
- Mie Prefectural Mental Medical Center, Tsu City, Mie, Japan
| | - Ryo Esumi
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Hiroshi Imai
- Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Motomu Shimaoka
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| |
Collapse
|
7
|
Esumi R, Suzuki K, Ishikura K, Imai H. Challenges in Diagnosing Comatose Patients with Ethylene Glycol Poisoning. Am J Med 2021; 134:e127-e128. [PMID: 32738197 DOI: 10.1016/j.amjmed.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ryo Esumi
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Japan; Department of Infectious Diseases, Mie University Hospital, Japan; Department of Hematology and Oncology, Mie University Graduate School of Medicine, Japan.
| | - Ken Ishikura
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Japan
| |
Collapse
|
8
|
Kawamoto E, Ito-Masui A, Esumi R, Ito M, Mizutani N, Hayashi T, Imai H, Shimaoka M. Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study. J Med Internet Res 2020; 22:e23184. [PMID: 33258785 PMCID: PMC7808885 DOI: 10.2196/23184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
Background Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals. Objective We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected. Methods We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors. Results We detail the spatiotemporal distributions of staff members’ inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery. Conclusions Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network.
Collapse
Affiliation(s)
- Eiji Kawamoto
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Asami Ito-Masui
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Ryo Esumi
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Mami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Noriko Mizutani
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Tomoyo Hayashi
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Hiroshi Imai
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| |
Collapse
|
9
|
Kawamoto E, Ito-Masui A, Esumi R, Imai H, Shimaoka M. How ICU Patient Severity Affects Communicative Interactions Between Healthcare Professionals: A Study Utilizing Wearable Sociometric Badges. Front Med (Lausanne) 2020; 7:606987. [PMID: 33344484 PMCID: PMC7744931 DOI: 10.3389/fmed.2020.606987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
Numerous factors affecting the interactions between healthcare professionals in the workplace demand a comprehensive understanding if the quality of patient healthcare is to be improved. Our previous cross-sectional analysis showed that patient severity scores [i.e., Acute Physiology and Chronic Health Evaluation (APACHE) II] in the 24 h following admission positively correlated with the length of the face-to-face interactions among ICU healthcare professionals. The present study aims to address how the relationships between patient severity and interaction lengths can change over a period of time during both admission and treatment in the ICU. We retrospectively analyzed data prospectively collected between 19 February to 17 March 2016 from an open ICU in a University Hospital in Japan. We used wearable sensors to collect a spatiotemporal distribution dataset documenting the face-to-face interactions between ICU healthcare professionals, which involved 76 ICU staff members, each of whom worked for 160 h, on average, during the 4-week period of data collection. We studied the longitudinal relationships among these interactions, which occurred at the patient bedside, vis-à-vis the severity of the patient's condition [i.e., the Sequential Organ Failure Assessment (SOFA) score] assessed every 24 h. On Day 1, during which a total of 117 patients stayed in the ICU, we found statistically significant positive associations between the interaction lengths and their SOFA scores, as shown by the Spearman's correlation coefficient value (R) of 0.447 (p < 0.01). During the course of our observation from Day 1 to Day 10, the number of patients (N) who stayed in the ICU gradually decreased (N = 117, Day1; N = 10, Day 10), as they either were discharged or died. The statistically significant positive associations of the interaction lengths with the SOFA scores disappeared from Days 2 to 6, but re-emerged on Day 7 (R = 0.620, p < 0.05) and Day 8 (R = 0.625, p < 0.05), then disappearing again on Days 9 and 10. Whereas all 6 SOFA sub-scores correlated well with the interaction lengths on Day 1, only a few of the sub-scores (coagulation, cardiovascular, and central nervous system scores) did so; specifically, those on Days 7 and 8. The results suggest that patient severity may play an important role in affecting the interactions between ICU healthcare professionals in a time-related manner on ICU Day 1 and on Days 7/8.
Collapse
Affiliation(s)
- Eiji Kawamoto
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Asami Ito-Masui
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Esumi
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Imai
- Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Motomu Shimaoka
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
10
|
Esumi R, Yokochi A, Shimaoka M, Kawamoto E. Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report. J Med Case Rep 2020; 14:46. [PMID: 32290865 PMCID: PMC7158090 DOI: 10.1186/s13256-020-02370-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fasciotomy is a life-saving procedure to treat acute compartment syndrome, a surgical emergency. As fasciotomy dramatically improves wound pain, it should be performed as soon as possible. Moreover, delays in the use of fasciotomy can increase the rate of wound infections. Once the fasciotomy wound is infected, pain control is achieved via the long-term use of opioids or anti-inflammatory analgesics. However, the administration of high doses of opioids may cause complications, such as respiratory depression, over-sedation, and constipation. Therefore, treatment methods other than narcotic administration should be established to better manage the pain caused by fasciotomy wound infections. Virtual reality has recently been introduced in analgesic therapy as a replacement, or complement, to conventional pharmacological treatments. Its use has been extensively studied in the pain management of patients with burns. An increasing number of painful conditions are being successfully treated with virtual reality. Here, we report a case of acute compartment syndrome complicated by fasciotomy wound infection. CASE PRESENTATION A 40-year-old Japanese man suffering from acute compartment syndrome of his leg due to a car accident trauma was treated with a fasciotomy to decompress intra-compartmental pressure and restore tissue perfusion, and admitted to an intensive care unit. Unfortunately, as the open fasciotomy wound was complicated by infection, he complained of hyperalgesia and severe pain during wound debridement. He was therefore given acetaminophen and high-dose intravenous patient-controlled analgesic fentanyl (35 μg/kg per day) to reduce the pain. Despite these efforts, the pain was poorly controlled and opioid-induced side effects such as respiratory depression were observed. An immersive virtual reality analgesic therapy aimed at distraction and relaxation was used and effectively alleviated the pain. Three sessions of virtual reality analgesic therapy over 2 days produced sustainable analgesic effects, which led to a 25-75% dose reduction in fentanyl administration and the concomitant alleviation of respiratory depression. CONCLUSIONS This case suggests the feasibility of virtual reality analgesic therapy for pain management of fasciotomy wound complications in acute compartment syndromes. Virtual reality represents a treatment option that would reduce analgesic consumption and eliminate opioid-induced respiratory depression to treat fasciotomy wound infection.
Collapse
Affiliation(s)
- Ryo Esumi
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Ayumu Yokochi
- Department of Anesthesiology and Critical Care Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Eiji Kawamoto
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. .,Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| |
Collapse
|
11
|
Ito A, Iwashita Y, Esumi R, Sasaki K, Yukimitsu M, Kato T, Kawamoto E, Suzuki K, Imai H. Acquired factor XIII deficiency in two patients with bleeding events during veno-venous extracorporeal membrane oxygenation treatment. J Artif Organs 2019; 23:283-287. [PMID: 31834529 PMCID: PMC7458886 DOI: 10.1007/s10047-019-01148-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
We report two cases of acquired factor XIII deficiency with bleeding events during veno-venous extracorporeal membrane oxygenation (ECMO). Case 1: A 76-year-old man diagnosed with aspiration pneumonia after near-drowning was started on ECMO. Later, the patient presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 29%. Although the patient recovered after receiving 1200 International Units of factor XIII concentrate, the patient had another episode of decreased factor XIII activity and bloody stool and was treated again with factor XIII concentrate. Case 2: A 48-year-old female diagnosed with pneumonia was started on ECMO. Soon after, she presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 39%. The patient was treated with 720 IU of factor XIII concentrate with good recovery. Acquired factor XIII deficiency cannot be detected by routine coagulation tests, therefore it may be under-diagnosed in the ICU. Detection of acquired factor XIII deficiency is essential when treating a bleeding ECMO patient.
Collapse
Affiliation(s)
- Asami Ito
- Mie University Hospital, Tsu, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|