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Background In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We herein report the outcomes of the HOPE at 2 years after commencement.Methods A total 125 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2014 and December 2018 at the Department of Surgery in Hamamatsu University School of Medicine. The patients were divided into the pre-HOPE group including 62 patients who underwent esophagectomy before the introduction of the HOPE and the HOPE group including 63 patients who underwent esophagectomy after the introduction of the HOPE. The outcomes of surgery were compared between the two groups.Results There were no significant differences in the clinicopathological characteristics between the two groups. The incidence rates of atrial fibrillation and pneumonia were significantly lower in the HOPE group than in the pre-HOPE group (6% vs. 19%, p=0.027 and 14% vs. 29%, p=0.037, respectively). The estimated calorie doses at the time of discharge were approximately 750 and 1500 kcal/day in the pre-HOPE group and the HOPE group, respectively. The body weight loss was significantly less in the HOPE group than the pre-HOPE group at 1, 3, 6, and 12 months postoperatively than that before the surgery (p, doctoral, 医学系研究科, 甲第869号

Objectives: To identify facilitators and barriers to the work carried out by multidisciplinary and interdisciplinary teams to stroke patients in hospitals and to identify the health professionals involved. Method: An integrative review was carried out with the search for bases: Virtual Health Library, CINAHL, Cochrane, Embase, PEDro, ProQuest, PubMed, Scopus and Web of Science. Including primary studies published between 2014 and 2020, in English, Portuguese and Spanish, you have a complete report that will answer the guiding question of the review. Results: Selected primary study forums, whose results show a diversity of work carried out by the teams, due to the high demand for care needed by the population with stroke. There is a wide range of professionals in the teams, with only nurses present in all of them. Barriers and facilitators for or teamwork were identified, related to the specific needs of patients. Collaboration and communication appeared as facilitators. The barriers found were insufficient time and lack of involvement of team members. Conclusions: It is important to understand how the different professionals of the teams work together with stroke patients, as it is so crucial to comprehensively assess the context of their personalities and plan chronic care, in a holistic way. Objetivos: Identificar factores facilitadores y barreras al trabajo de los equipos multidisciplinares e interdisciplinares en pacientes con accidente cerebrovascular en hospitales e identificar a los profesionales sanitarios involucrados. Método: Se realizó una revisión integradora con búsqueda en las siguientes bases de datos: Virtual Health Library, CINAHL, Cochrane, Embase, PEDro, ProQuest, PubMed, Scopus y Web of Science. Se incluyeron los estudios primarios publicados entre 2014 y 2020, en inglés, portugués y español, disponibles en su totalidad y que respondieron a la pregunta orientadora de la revisión. Resultados: Se seleccionaron ocho estudios primarios, cuyos resultados evidenciaron una diversidad de trabajos desarrollados por los equipos, debido a la gran demanda de cuidados que necesita la población con accidente cerebrovascular. Hubo una amplia variación de profesionales en los equipos, con solo enfermeras presentes en todos ellos. Se identificaron barreras y facilitadores para el trabajo en equipo, relacionados con las necesidades específicas de estos pacientes. Como facilitadores surgieron la colaboración y la mejora de la comunicación. Como barreras se encontraron falta de tiempo y falta de participación de los miembros del equipo. Conclusiones: Es importante comprender como los distintos profesionales de los equipos trabajan juntos cuando se trabaja con pacientes con accidente cerebrovascular, ya que esto es crucial para evaluar completamente el contexto de estas personas con esta enfermedad crónica y planear la atención de manera integral. Objetivos: Identificar fatores facilitadores e barreiras ao trabalho realizado por equipes multidisciplinares e interdisciplinares nos pacientes com AVC em hospitais e identificar os profissionais de saúde envolvidos. Método: Realizou-se uma revisão integrativa com busca nas bases: Biblioteca Virtual em Saúde, CINAHL, Cochrane, Embase, PEDro, ProQuest, PubMed, Scopus e Web of Science. Foram incluídos estudos primários publicados entre 2014 e 2020, em inglês, português e espanhol, disponíveis na íntegra e que responderam à questão norteadora da revisão. Resultados: Foram selecionados oito estudos primários, cujos resultados mostraram uma diversidade de trabalhos desenvolvidos pelas equipes, por conta da grande demanda de cuidados necessários para a população com AVC. Houve grande variação de profissionais nas equipes, sendo que apenas enfermeiros estiveram presentes em todas. Foram identificados barreiras e facilitadores ao trabalho em equipe, relacionados às necessidades específicas desses pacientes. Como facilitadores apareceram a colaboração e a comunicação aprimorada. Como barreiras foram encontradas falta de tempo e falta de envolvimento de membros da equipe. Conclusões: É importante entender como os diferentes profissionais das equipes atuam juntos no trabalho com pacientes de AVC, pois, isso é crucial para avaliar integralmente o contexto dessas pessoas com essa doença crônica e planejar o cuidado, de maneira holística.

Background Many health care workers around the world tackled with COVID-19, however sadly, the infection of many medical care workers were reported. To reduce the risk of infection, we launched selected team (Team COVID) of non-specialists and brought in active telemedicine method and computed tomography (CT)-first protocol. We describe our actual practice and the health status of medical doctors dealing with COVID-19 patients. Methods Between April 17, 2020 and May 24, 2020, 10 doctors worked with COVID-19 patients as part of Team COVID. The Team COVID doctors used a CT-first triage protocol for outpatients and telemedicine for inpatients and outpatients. We evaluated paired serum-specific antibodies for SARS-CoV-2 at the initial and end of the study duration and PCR results for SARS-CoV-2 at the end of the study duration. Furthermore, 36-item short-form of the Medical Outcome Study Questionnaire (SF-36) at the beginning and end of the study period were evaluated. Results Ten doctors worked as Team COVID: seven internal medicine doctors and three surgeons. During the study period, Team COVID treated 165 individuals in the outpatient clinic and isolated hospitalized patients for 315 person-days. There were no positive results of serum-specific antibody testing and PCR testing for SARS-CoV-2 in Team COVID doctors. Furthermore, the SF-36 showed no deterioration in physical and mental QOL status. No in-hospital infection occurred during the study period. Conclusions The Team COVID fulfilled the treatment using the active telemedicine and CT-first triage protocol without in hospital infection and excess stress. The combination strategy seems acceptable for both the protection and stress relief among the medical staff.

Background This work explores the opinions and expectations of ultramarathon runners about medical services and their perceived quality during ultramarathons. Methods Focused questions related to medical services at ultramarathons were included in the 2018 survey of Ultrarunners Longitudinal TRAcking (ULTRA) Study enrollees. Results Among the 1,156 respondents, 83.2% agreed that ultramarathons should provide at least a minimum level of medical support with basic first aid and emergency transport services rated as the most important medical services, and individuals with basic first aid training rated as the most important medical providers at ultramarathons. Participant safety was felt to largely be the responsibility of each runner as well as the race and/or medical director. Among 832 respondents having completed an ultramarathon in 2016-2018, their impression of medical services at 4,853 ultramarathons was generally favorable. Of the four percent of times in which medical support was needed, it met expectations 74% of the time. Of the total of 240 different medical issues for which medical support was needed, blister management was the most common, accounting for 26.7% of issues. Conclusions Even though medical services receive minimal utilization during ultramarathons, ultramarathon runners largely believe that these events should provide at least a minimum level of medical support. Ultramarathon runners place a high onus for safety during ultramarathons on themselves, but they also place a high level of responsibility on race and medical directors, so it is prudent for the race and medical directors to consider this information and avoid a mismatch between runner expectations and the medical services actually provided.

Background In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We herein report the outcomes of the HOPE at 2 years after commencement. Methods A total 125 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2014 and December 2018 at the Department of Surgery in Hamamatsu University School of Medicine. The patients were divided into the pre-HOPE group including 62 patients who underwent esophagectomy before the introduction of the HOPE and the HOPE group including 63 patients who underwent esophagectomy after the introduction of the HOPE. The outcomes of surgery were compared between the two groups. Results There were no significant differences in the clinicopathological characteristics between the two groups. The incidence rates of atrial fibrillation and pneumonia were significantly lower in the HOPE group than in the pre-HOPE group (6% vs. 19%, p = 0.027 and 14% vs. 29%, p = 0.037, respectively). The estimated calorie doses at the time of discharge were approximately 750 and 1500 kcal/day in the pre-HOPE group and the HOPE group, respectively. The body weight loss was significantly less in the HOPE group than the pre-HOPE group at 1, 3, 6, and 12 months postoperatively than that before the surgery (p Conclusions The introduction of the multidisciplinary HOPE was associated with a significant reduction in the incidence of postoperative pneumonia and significantly less weight loss.

Patients at risk of organ dysfunction or with established organ dysfunction should be referred to central or tertiary-level hospitals. However, even in central hospitals, intensive care unit (ICU) beds are often unavailable, which may contribute to maternal deaths. One pragmatic solution is to establish obstetric critical care units (OCCUs) in the labor wards of central hospitals; however, specific guidance on how to do this is limited. In addition, globally applicable standards of care are lacking, with uncertainty regarding who should lead obstetric critical care. In this article the specific OCCU infrastructure, equipment and human resources required to establish such units in central hospitals in low- and middle-income countries are described in sufficient detail for easy replication. Admission and discharge guidelines and operational recommendations that include quality indicators are also provided.

The concept of ‘obstetrical medicine’ was established in the late 19th century, but overshadowed during most of the 20th century by dramatic improvements in surgical, anesthetic, antimicrobial therapeutics, and obstetrical methods and practice. During the last quarter of the 20th century the causes of maternal morbidity and mortality increasingly became pre-existing hereditable and acquired medical disorders and treatable or preventable medical complications of pregnancy. The role of obstetric medicine re-emerged because of surgical, therapeutic, and medical success. New professional associations have been formed to support, through education and research, the growth in numbers of clinicians from many specialties concerned with the medical care of the pregnant patient (Rev Med Chile 2006; 134: 109-14). (Key-words: Medical care team; Obstetrics; Prenatal care; Pregnancy complications; Pregnant women)

The concept of 'obstetrical medicine' was established in the late 19th century, but overshadowed during most of the 20th century by dramatic improvements in surgical, anesthetic, antimicrobial therapeutics, and obstetrical methods and practice. During the last quarter of the 20th century the causes of maternal morbidity and mortality increasingly became pre-existing hereditable and acquired medical disorders and treatable or preventable medical complications of pregnancy. The role of obstetric medicine re-emerged because of surgical, therapeutic, and medical success. New professional associations have been formed to support, through education and research, the growth in numbers of clinicians from many specialties concerned with the medical care of the pregnant patient El concepto de «Medicina Obstétrica» se originó a fines del siglo 19, pero quedó sobrepasado durante la mayor parte del siglo 20 por los avances dramáticos en la terapéutica quirúrgica, en la anestesia, en la disponibilidad de antimicrobianos, y en los métodos y la práctica de la obstetricia. Durante las últimas décadas del siglo 20 las causas de morbilidad y mortalidad maternas cambiaron progresivamente hacia patologías médicas preexistentes, hereditarias o adquiridas, y a complicaciones médicas del embarazo que son prevenibles y tratables. El rol de la medicina obstétrica emergió nuevamente debido a los éxitos quirúrgicos, terapéuticos y médicos. Se han constituido nuevas sociedades profesionales que apoyan a través de la educación y la investigación al número creciente de clínicos de distintas especialidades que se involucran en la atención médica de las embarazadas

Background The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. Methods Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. Results Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. Conclusion Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team.