Nihon rinsho. Japanese journal of clinical medicine
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Frailty is a predictor of functional decline, falls, hospitalization, and mortality. Fried et al. developed the frailty index, which include 5 simple items: weight loss, weakness, exhaustion, slowness, and low activity. ⋯ Both frailty and sarcopenia could be associated with mild cognitive impairment which leads to dementia. Thus, early initiation of a comprehensive geriatric health examination and a multidomain intervention such as diet, exercise, cognitive training, and vascular risk monitoring may be useful to prevent frailty and sarcopenia in community-dwelling older adults.
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Several promising tau imaging probes have been developed by Tohoku University ([18F]THK series), National Institute of Radiological Sciences([11C]PBB3), Eli Lilly ([18F]T807), and Hoffman-La Roche ([18F]R06958948). In this paper we discussed some of the criteria required for the tau imaging probe in Alzheimer's disease. It will be certain that tau imaging plays an important role in an accurate diagnosis and as companion diagnostics.
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There is no "complete safety" in the medical treatment. Unavoidable events or human errors may frighten the patients' safety. Because of its characteristics, emergency medicine is one of the medical fields where treating the patients under the vast safety is difficult. ⋯ The implementation of the safety measures, such as minimum encounter, minimum probability, multiple detections, and minimum damage is helpful to prevent unfortunate outcomes. Since the emergency medicine treats the severely injured or critical ill patients, its daily works are the picture of the crisis management, and the most suitable environment to train the crisis management competence. The person in charge of crisis management of the institution should put the emergency department to practical use of medical staffs' crisis management training.
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A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals. A pattern of collaborating function by generalists taking part in emergency care is categorized into four types.
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Extracorporeal membrane oxygenation therapy (ECMO) is an artificial life support for severe respiratory and/or cardiac failure, and refractory cardiac arrest. It consists of a hollow-fiber membrane that oxygenates the blood and removes carbon dioxide and a centrifugal pump that drain blood from central venous circulation, pump through membrane, and return to the patients. ⋯ Veno-arterial ECMO offers hemodynamic support in addition to gas change for cardiac failure or refractory cardiac arrest. We describe the physiological principles and the clinical evidence supporting the use of ECMO in critically ill adult patients.