Bilateral Iliopsoas Hematomas under Sedation:A Complication of Postoperative Therapy after Coronary Artery Bypass Grafting

We report a case of bilateral iliopsoas hematomas that occurred during postoperative therapy after coronary artery bypass grafting (CABG). An 81-year-old woman receiving anticoagulant and antiplatelet therapies under sedation after CABG developed sudden anemia and went into shock. Abdominal ultrasonography showed a right retroperitoneal hematoma. She improved gradually with conservative treatment. Many patients with an iliopsoas hematoma complain of low-abdominal pain or femoral neuropathy, but such local signs may be absent under sedation. In anticoagulant and antiplatelet therapies under sedation, when the cause of anemia and shock is not clear, we should suspect peritoneal hematoma and examine the peritoneal space.</p

A Train-the-Trainers (TtT) Program for Engineers for Hosting Multiparty International Clinical Teleconferences

Background: International clinical teleconferencing connecting hospitals contributes to the standardisation of medical care. Introduction: The perception that participating in international teleconferences is easy while hosting and coordinating them is difficult has limited the expansion of these kinds of programmes. We evaluated the effectiveness of a Train-the-Trainer (TtT) programme on hosting international multiparty teleconferences targeted at hospital engineers. Methods: From 2015 to 2017, 20 engineers and physicians from 17 institutions in 10 countries participated in Kyushu University Hospital’s TtT programme. Hands-on training and hosting a Training Report Conference (TRC) were conducted. The impact of the programme was assessed using questionnaires about the participants’ confidence, perception of barriers, and teleconference activity before and one year after the training period. Results: The mean training period was 16.7 days (median, 19 days). Twelve TRCs were hosted by trainees connecting 56 institutions in 11 countries. All participants gave positive evaluations of the overall programme, 19 (95%) "very good" and 1 (5%) "good", and the trainers 9 (90%) "very good" and 1 (10%) "good"). Following the TtT programme, the mean number of trainee-hosted events increased significantly (0.8 to 1.3, p&lt;0.001), and more respondents (12/17, 71%) reported barriers to hosting a programme than participating in one (5/17, 29%, p&lt;0.001). Trainee confidence in both hosting and participating in international teleconferences was significantly higher after TtT. Conclusion: There are more barriers to hosting than participating in international clinical teleconferences. This TtT programmes for engineers could contribute to more active hosting engagement

Severe Acute Respiratory Distress Syndrome Using Electrical Activity of the Diaphragm on Weaning from Extracorporeal Membrane Oxygenation

The electrical activity of the diaphragm (EAdi) shows global diaphragmatic activation and power output from the central nervous system. We measured the EAdi as an indicator of breathing workload in a 40-year-old man suffering from severe acute respiratory distress syndrome (ARDS) secondary to influenza pneumonia in the process of weaning from extracorporeal membrane oxygenation (ECMO). Turning off the sweep gas flow immediately led to EAdi elevation, followed by hypoxia. The patient was successfully weaned from ECMO by reference to EAdi. This is the first case report to suggest that EAdi monitoring might be useful for ARDS patients during ECMO weaning

Five-Year Technological Changes of Distant Medical Education in Asia

All physicians would benefit from more comprehensive distance learning. However, the technology is often difficult to use because technological infrastructure is limited in many hospitals in Asia. Since 2003, we have worked to advance international distant medical education implemented through the Internet in Asia. This paper presents an analysis of our activities over the past five years to evaluate the technical transition and its effects on modes of distant medical education. Methods: We analysed distant medical education programmes that we conducted from 2011 to 2015. We used a Digital Video Transport System (DVTS), H.323 and Vidyo, along with commercial and research and education networks (REN) installed in the subject hospitals. Questionnaires were randomly distributed to the audience to evaluate image resolution, image movement, sound quality, and programme content. Results: The number of programmes increased to over 90 per year in 2014–2015. The main system gradually changed from DVTS (58%, 30/52 in 2011) to Vidyo (64%, 67/104 in 2015). The number of new institutions increased to 149 in 2014–2015. Over 92% of the ratings for image resolution and movement were positive. Sound quality was somewhat lower at 83%. Ultimately, 98% of respondents rated the programmes “very good” or “good.” Conclusions: Continuous technical development was observed with increasing numbers of sites for each programme. This resulted in expansion of activity involving non-university hospitals. Practical distant medical education, satisfies physicians’ need for quality and inclusiveness could be expanded to normal hospitals in Asia and beyond

How to Prevent Technical Issues in Large Multiparty Medical Videoconferencing

Introduction: Videoconferencing (VC) is useful for physicians who need to learn about many cases without moving from one institution to another. However, this advantage can be hampered by technical issues. This study aims to analyse the factors relating technical support that cause technical issues in regular multiparty medical VC to provide high-quality VC to meet participants’ demands. Methods: The study includes large multiparty VC between the Kyushu University Hospital Department of Paediatric Surgery and different institutions within Japan that were held from September 2014 to January 2017. Technical tests, a “previous-week test” and a “last-hour test,” were conducted for checking conditions prior to the VC. The chi-square test was used for factors: participation for previous-week and last-hour test, and attendance by an engineer VCs in each participating institution. A questionnaire survey was distributed among the participants to collect feedback on the quality of VC, ease of preparation and necessity of previous-week testing. Results: Participation in the last-hour test (P=0.002) and the presence of an engineer (P=0.049) significantly decreased overall technical issues. The last-hour tests significantly decreased disconnection (P=0.015) and audio (P=0.019) issues. The engineer’s attendance decreased content-sharing issues (P=0.027). Participants reporting “very good” and “good” audio and visual quality were 92% (109/118) and 96% (105/110). Eighty-three percent of participants (82/99) found the preparation “very easy” or “easy”; while 61% (63/103) found the previous-week test, “unnecessary.” Conclusions: Based on our study, “engineers’ attendance” and “last-hour” technical testing significantly reduced technical problems; these factors help provide high-quality output VC and meet the needs of the participants

Event style preferences in medical education and research meetings in Japan

Purpose: With the spread of COVID-19, medical education and research events have either been cancelled or shifted to online or hybrid mode. However, there are no accurate records containing the exact number of these events in new modes. This study explores trends in event modes of medical education and research in Japan using registered event data from a web service. Methods: We collected event data from January 2019 to December 2021. Text mining was used to extract and classify data into categories such as on-site and online events. Then, the annual and monthly numbers of categories were counted. Results: The total number of events in March 2020 was drastically reduced, but it recovered in November 2021 to a level equivalent to that of the peak month in 2019. The majority of the events were online by December 2020, increasing in number from March 2020. Hybrid events that integrate on-site and online modes later outnumbered online events and accounted for approximately 20% of the total in June, October, and November 2021. Conclusions: The online and hybrid modes ensured the continuation of medical education and research events during the pandemic. Though online events may reduce after COVID-19, the hybrid mode could become a popular mode that offers diversity