Acute medicine and surgery 

About: Acute medicine and surgery is an academic journal published by Wiley. The journal publishes majorly in the area(s): Medicine & Internal medicine. It has an ISSN identifier of 2052-8817. It is also open access. Over the lifetime, 808 publications have been published receiving 4344 citations. The journal is also known as: AMS & Acute medicine and surgery.

Post-intensive care syndrome: its pathophysiology, prevention, and future directions

Abstract: Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

Strategies to improve cardiac arrest survival: a time to act.

Abstract: The Institute of Medicine (IOM) released a new report, Strategies to Improve Survival from Cardiac Arrest: A Time to Act, on June 30, 2015. The new report presents a comprehensive system-wide approach for improving cardiac arrest (CA) survival throughout the USA with eight evidencebased recommendations. In this communication, we wish to highlight this new report and briefly describe differences in approaches to improving survival for CA patients between Japan and the USA. In the weeks following the report, many organizations like the American Heart Association (AHA), American Red Cross, foundations, and others, have amplified many of the recommendations. For example, the AHA has committed $5million of funding to support the recommendations. By way of background for Japanese readers, the IOM/ National Academy of Medicine (NAM) is one of the most influential organizations in the promotion of new health care policy within the US. With a mission to “improve the health of the nation”, the IOM/NAM has been described by the New York Times as “The most esteemed and authoritative adviser on issues of health and medicine, and its reports can transform medical thinking around the world.” One of the most influential prior reports from the IOM is “To Err is Human”. As resuscitation experts, we have high hopes that this recently released IOM report will help elevate survival of CA both within the USA and globally because the system level recommendations call for tangible actions that could save thousands of lives. We particularly want to inform Japanese readers about the IOM report, and to provide a perspective from the Japan Resuscitation Council (JRC) and the Japanese Association of Acute Medicine (JAAM) in response to the recommendations. In addition, we highlight areas where the Japanese nation has been working actively (Table 1). Our most important message is to encourage everyone to read and consider the value of these recommendations. We agree that now is the “time to act”. 1. Establish a National Cardiac Arrest Registry: Because the USA does not have a national CA registry, as we have in Japan, the first recommendation addresses the need for this vital national data. The Japanese nation is proud of its existing national registry of out-of-hospital CA (OHCA) that was established in 2005 thanks to the broad support from the Japanese emergency medical system (EMS). According to the latest data, the 1-month survival rate of OHCA patients in 2013, whose arrest was witnessed, with presumed cardiac origin, and initially shockable rhythms, was 31.6%. Nichol et al. reported survival rates of shockable rhythms ranged from 7.7% to 39.9% in 10 communities in North America. These data tell us that Japan’s overall survival rates are increasing significantly but have not yet achieved the maximum possible. The AHA has the aspirational goal to double survival rates in the USA by the year 2020. 2. Foster a Culture of Action through Public Awareness and Training: CA demands immediate responses from laypersons, to rapidly begin bystander cardio pulmonary resuscitation (CPR) and bystander use of an automated external defibrillator (AED). The Fire and Disaster Management Agency has trained over 1.4 million people in more than 70,000 public training courses during the last two decades in Japan. The AHA is planning to increase the number of trained laypersons by 50%. Since Japan’s adoption of AEDs by the public, training courses for AED plus CPR have been widespread. Over 500,000 AEDs have been placed throughout the country. 3. Enhance the Capabilities and Performance of EMS Systems: Standardized training for EMS personnel promotes more rapid adoption of best practices and allows for better quality of CA care. Since Japanese CPR guidelines were released in 2010 by the JRC, progress in uniform adoption and quality assurance has been accelerated for all health care providers. 4. Set National Accreditation Standards Related to Cardiac Arrest for Hospitals and Health Care Systems: The AHA’s BLS, Heart saver, and ACLS provider courses have contributed to improve quality control for the provision of CPR in health care systems for the last several decades in Japan. These efforts were enhanced in 2007 with the establishment of the Japanese Circulation Society’s International Training Center, which was done in partnership with the AHA. The Japanese Circulation Society initiated CPR consensus for cardiologists in 2009. In the meantime, JAAM organized a new training course called Immediate Cardiac Life Support for non-cardiology residents and physicians. The course is typically attended by doctors, nurses, and

Local anesthetic toxicity: acute and chronic management.

Abstract: Local anesthetics are commonly used medicines in clinical settings. They are used for pain management during minor interventional treatments, and for postoperative care after major surgeries. Cocaine is the well-known origin of local anesthetics, and the drug and related derivatives have long history of clinical usage for more than several centuries. Although illegal use of cocaine and its abuse are social problem in some countries, other local anesthetics are safely and effectively used in clinics and hospitals all over the world. However, still this drug category has several side-effects and possibilities of rare but serious complications. Acute neurotoxicity and cardiac toxicity are derived from unexpected high serum concentration. Allergic reactions are observed in some cases, especially following the use of ester structure drugs. Chronic toxicity is provoked when nerve fibers are exposed to local anesthetics at a high concentration for a long duration. Adequate treatments for acute toxic reactions can secure complete recovery of patients, and careful use of drugs prevents long-lasting neurological complications. In addition to respiratory and circulatory management, effectiveness of lipid rescue in the acute toxicity treatment has been certified in many clinical guidelines. Prevention of the use of high concentration of local anesthetics is also validated to be effective to decrease the possibility of nerve fiber damage.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).

Abstract: Background and purpose The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. Methods Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (>66.6%) majority vote of each of the 19 committee members. Results A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs. Conclusions Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

The profile of Japanese Association for Acute Medicine - out-of-hospital cardiac arrest registry in 2014-2015.

Abstract: Aim To describe the registry design of the Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry as well as its profile on hospital information, patient and emergency medical service characteristics, and in-hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions. Methods The special committee aiming to improve the survival after OHCA by providing evidence-based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department. The primary outcome was a favorable neurological status 1 month after OHCA. Results Between June 2014 and December 2015, a total of 12,024 eligible patients with OHCA were registered in 73 participating institutions. The mean age of the patients was 69.2 years, and 61.0% of them were male. The first documented shockable rhythm on arrival of emergency medical services was 9.0%. After hospital arrival, 9.4% underwent defibrillation, 68.9% tracheal intubation, 3.7% extracorporeal cardiopulmonary resuscitation, 3.0% intra-aortic balloon pumping, 6.4% coronary angiography, 3.0% percutaneous coronary intervention, 6.4% targeted temperature management, and 81.1% adrenaline administration. The proportion of cerebral performance category 1 or 2 at 1 month after OHCA was 3.9% among adult patients and 5.5% among pediatric patients. Conclusions The special committee of the JAAM launched the JAAM-OHCA Registry in June 2014 and continuously gathers data on OHCA patients. This registry can provide valuable information to establish appropriate therapeutic strategies for OHCA patients in the near future.