宮道 亮輔

The first coronavirus 2019 (COVID-19) patients were reported in China on December 12, 2019, and the first COVID-19 patients were reported in Japan on January 16, 2020. Here, we investigated the number of patients in Emergency Departments (EDs) in three major hospitals in Tokyo, and also briefly discussed about the relationship between the number of patients in EDs and health system's capacity. We compared the number of patients in 2020 to the average number of patients from 2016 to 2019. Numbers were compared in three periods: before the first COVID-19 patient was reported in Japan (January 1 to January 16), after the government encouraged social distancing (February 26 to March 10), and the interval between them (January 17 to February 25). The average number of daily patients in 2020 (n = 122) decreased by 17% compared to the average number of patients from 2016 to 2019 (n = 144) (Mann-Whitney test, p < 0.001). This phenomenon might be due to a fear of contracting the virus at hospitals, companies having their employees work remotely and postponing events, people following the Japanese Ministry of Health, Labour and Welfare's instructional guidelines for going to the hospital, prevention awareness becoming widespread, and a decreased number of tourists. The number of patients visiting Emergency Departments in Tokyo was decreased and the number of COVID-19 infections has remained within the health system's capacity during the early phase of COVID-19 first wave.

Gastrointestinal perforation with psoas sign was diagnosed by abdominal radiography. Although CT is most useful modality for diagnosing gastrointestinal perforation, clinic doctors need to also swim abdominal radiography.

Gastrointestinal perforation discovered in CT.

【目的】震災派遣医師のストレスマネジメントにおけるSignificant Event Analysis（SEA）の有効性を検討する。【対象と方法】自治医科大学同窓会東日本大震災支援プロジェクトにより被災地（東北地方）に派遣された医師67名である。SEA施行群（SEA群）と非施行群（対照群）に無作為に割り付け，SEA群には震災派遣から帰還4週間後に質問紙にてSEA調査を行った。【主要なアウトカム評価】改訂出来事インパクト尺度（IES-R），K6質問票を用いて，帰還4週間後（SEA調査前）と8週間後の改善度を調査した。【結果】IES-Rの改善度は，SEA群: 1.27&amp;plusmn;5.08［平均±標準偏差］，対照群: 2.43&amp;plusmn;4.05であり，p=0.30と有意な差を認めなかった。K6質問票の改善度は，SEA群: 1.83&amp;plusmn;2.68，対照群: 0.76&amp;plusmn;3.01であり，p=0.13と有意な差を認めなかった。【結語】ボランティアで被災地支援に行った医師にSEAを行うことは，ストレスの軽減につながらない。

BACKGROUND: Emergency departments deal with large patient loads on a day-to-day basis. The importance of patient self-assessment in the triage process has not been fully considered when determining the need for hospital admission. OBJECTIVE: To determine the validity of a series of self-administered triage questions in determining the need for hospitalisation in the emergency setting. DESIGN: Prospective cohort study. SETTING: Emergency department in a tertiary-care, municipal hospital in Japan. PARTICIPANTS: 5380 consecutive walk-in patients visiting the emergency department of Okazaki City Hospital were asked to self-evaluate the urgency and severity of their condition and their perceived need for hospital admission. These patients were then assessed by emergency physicians blinded to the results from each patient's self-assessment. MAIN OUTCOME MEASURES: Sensitivity, specificity and likelihood ratios were calculated for each self-assessment by comparing these with findings from assessments made by emergency physicians. RESULTS: Patient-perceived need for hospitalisation had a sensitivity of 0.79 (95% CI 0.76 to 0.82) and a specificity of 0.93 (95% CI 0.92 to 0.93) in determining hospital admission. The positive and negative likelihood ratios for self-assessments were 10.68 (95% CI 9.59 to 11.90) and 0.22 (95% CI 0.19 to 0.26), respectively, in the diagnosis of hospital admission (p<0.01). CONCLUSIONS: The patient self-triage questions concerning condition with five categories (medication only to life threatening) seem to supplement the triage process for hospital admission in emergency departments.