Teletriage for patients with traumatic finger injury directing emergency medical transportation services to appropriate hospitals: a pilot project in Nagoya City, Japan

INTRODUCTION

Emergency medical technicians in Japan have experienced difficulties in identifying hospitals that will accept patients with severe finger injuries. We developed and managed a system named Interactive Teletriage using mobile phone photos to aid efficient patient transportation. The aim of this study was to investigate features related to the transportation of patients with severe finger injuries and to evaluate the feasibility of this system.

MATERIALS AND METHODS

We prospectively analysed data from the medical association of Aichi Prefecture and the Nagoya City Fire Department in Japan. We investigated features related to the transportation of 474 patients with severe finger injuries in Nagoya from 2010 to 2013: 100 in 2010, 134 in 2011, 125 in 2012, and 115 in 2013. We began using Teletriage in August 2011 and compared the periods before and after its implementation.

RESULTS

The time of injury showed two different peaks from 09:00 to 11:00h and at 13:00h. The number of patients injured during each weekday was generally the same, while cases on Saturdays and Sundays reflected 70% and 47% of the weekday average, respectively. Of the 474 patients, 395 (83%) were accepted to hospitals after 3 or fewer requests for admission: 160 of 202 (79.2%) before and 235 of 272 (86.4%) after Teletriage, constituting a significant increase (p=0.039). Furthermore, the number of patients who required 4 or more requests significantly decreased after implementation of Teletriage (p=0.039): 42 patients (20.8%) before and 37 (13.6%) after Teletriage. Our data showed that as the number of requests until final determination increased, the transportation period increased. Furthermore, the mean transportation period significantly decreased from 22.3min before to 18.1min after Teletriage (p=0.021). As the number of requests until final determination increased, the proportion of patients transported to Level I and II hospitals decreased; conversely, the proportion of patients transported to Level III, IV, and V hospitals increased.

CONCLUSIONS

Our results indicated that the implementation of Teletriage has the potential to ease the problem of emergency medical transportation for those with severe finger injuries.

Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain

The purpose of this study was to evaluate treatment results following arthroscopic triangular fibrocartilage complex (TFCC) debridement for recalcitrant ulnar wrist pain. According to the treatment algorithm, 66 patients (36 men and 30 women with a mean age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain were allocated to undergo ulnar shortening osteotomy (USO; n = 24), arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement (n = 14) or prolonged conservative treatment (n = 13). The mean follow-up was 36.0 months (15 to 54). Significant differences in Hand20 score at 18 months were evident between the USO group and TFCC debridement group (p = 0.003), and between the TFCC repair group and TFCC debridement group (p = 0.029). Within-group comparisons showed that Hand20 score at five months or later and pain score at two months or later were significantly decreased in the USO/TFCC repair groups. In contrast, scores in the TFCC debridement/conservative groups did not decrease significantly. Grip strength at 18 months was significantly improved in the USO/TFCC repair groups, but not in the TFCC debridement/conservative groups. TFCC debridement shows little benefit on the clinical course of recalcitrant ulnar wrist pain even after excluding patients with ulnocarpal abutment or TFCC detachment from the fovea from the indications for arthroscopic TFCC debridement.

Selective deoxygenation and O-methylation of benanomicin A: synthesis of 9-deoxy-, 9-O-methyl- and 14-O-methylbenanomicin A

The selective modifications of phenolic hydroxy groups in the chromophore of benanomicin A are described. Hydride reduction of 9-O-tosylate with sodium borohydride/nickel chloride led to 9-deoxybenanomicin A. Methylation of 1-O-diphenylmethylbenanomicin A diphenylmethyl ester with sodium hydride/iodomethane gave 9-O-methyl derivative and with Hünig's base/diazotrimethylsilylmethane afforded the 14-O-methyl derivative. These compounds showed the diminished activity against fungi.

A synthetic approach to benanomicin A. 2. Synthesis of the substituted 5,6-dihydrobenzo[a]naphthacenequinone

The key intermediate tri-substituted alpha-tetralone (8) has been synthesized, either via tandem Michael addition-Dieckmann condensation reaction between dienolate and methyl crotonate in a low yield or via Barton's radical decarboxylation of diester (9) without 4-dimethylaminopyridine in 75% yield, and applied to the synthesis of the substituted 5,6-dihydrobenzo[a]naphthacenequinone.

A synthetic approach to benanomicin A. 1. Synthesis of 5,6-dihydrobenzo[a]naphthacenequinone

5,6-Dihydrobenzo[a]naphthacenequinone has been constructed by Diels-Alder reaction of an outer-ring diene with a naphthoquinone regioselectively. Similarly, the 14-hydroxy-5,6-dihydrobenzo[a]naphthacenequinone (13) has also been synthesized via the reaction of vinylketene acetal (11) with naphthoquinone.

Amino acid analogs of benanomicin A through desalaninebenanomicin A

Desalaninebenanomicin A has been synthesized in good yield by the cleavage of the amido bond of benanomicin A using MEERWEIN's reagent. This is a useful intermediate to prepare amino acid analogs of benanomicin A. MEERWEIN's reagent reacts with totally protected benanomicin A to give a stable imino ether. After deprotection, the imino ether is treated with aqueous acetone at reflux to afford a methyl ester of desalaninebenanomicin A. Desalaninebenanomicin A was coupled with a variety of amino acids by the active ester method to afford new benanomicin analogs.