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Shigeaki Hinohara - One of the best experts on this subject based on the ideXlab platform.
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the tokyo subway sarin attack disaster Management Part 1 community emergency response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. Prior to the Tokyo subway sarin attack, there had never been such a large-scale disaster caused by nerve gas in peacetime history. This article provides details related to how the community emergency medical services (EMS) system responded from the viewpoint of disaster Management, the problems encountered, and how they were addressed. The authors' assessment was that if EMTs, under Japanese law, had been allowed to maintain an airway with an endotracheal tube or use a laryngeal mask airway without physician oversight, more patients might have been saved during this chemical exposure disaster. Given current legal restrictions, advanced airway control at the scene will require that doctors become more actively involved in out-of-hospital treatment. Other recommendations are: 1) that integration and cooperation of concerned organizations be established through disaster drills; 2) that poison information centers act as regional mediators of all toxicologic information; 3) that a real-time, multidirectional communication system be established; 4) that multiple channels of communication be available for disaster care; 5) that public organizations have access to mobile decontamination facilities; and 6) that respiratory protection and chemical-resistant suits with gloves and boots be available for out-of-hospital providers during chemical disasters.
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the tokyo subway sarin attack disaster Management Part 3 national and international responses
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The authors report the national and international responses to the disaster produced by the Tokyo subway sarin attack. From a worldwide historical perspective, there had never been such a large-scale disaster caused by nerve gas during peacetime. Therefore, this event should be studied from various viewpoints in cooperation with members of the international community. To this end, the Japanese government should help coordinate a large-scale and detailed investigation of the Tokyo subway sarin attack, including the long-term effects of sarin. The authors also recommend that the Japanese Self Defense Forces should be used more effectively in large-scale disasters. The system of direct control of disaster Management by the Japanese government could be useful in a large-scale disaster. Language: en
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the tokyo subway sarin attack disaster Management Part 2 hospital response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:Abstract. The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The authors report how St. Luke's Hospital dealt with this disaster from the viewpoint of disaster Management. Recommendations derived from the experience include the following: Each hospital in Japan should prepare an emergent decontamination area and have available chemical-resistant suits and masks. Ventilation in the ED and main treatment areas should be well planned at the time a hospital is designed. Hospital disaster planning must include guidance in mass casualties, an emergency staff call-up system, and an efficient emergency medical chart system. Hospitals should establish an information network during routine practice so that it can be called upon at the time of a disaster. The long-term effects of sarin should be monitored, with such investigation ideally organized and integrated by the Japanese government.
Laxmaiah Manchikanti - One of the best experts on this subject based on the ideXlab platform.
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evidence based medicine systematic reviews and guidelines in interventional pain Management Part 6 systematic reviews and meta analyses of observational studies
Pain Physician, 2009Co-Authors: Laxmaiah Manchikanti, S. Datta, Howard S Smith, Joshua A HirschAbstract:: Observational studies provide an important source of information when randomized controlled trials (RCTs) cannot or should not be undertaken, provided that the data are analyzed and interpreted with special attention to bias. Evidence-based medicine (EBM) stresses the examination of evidence from clinical research and describes it as a shift in medical paradigm, in contrast to intuition, unsystematic clinical experience, and pathophysiologic rationale. While the importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy, much of the medical research is observational. The reporting of observational research is often not detailed and clear enough with insufficient quality and poor reporting, which hampers the assessment of strengths and weaknesses of the study and the generalizability of the mixed results. Thus, in recent years, progress and innovations in health care are measured by systematic reviews and meta-analyses. A systematic review is defined as, "the application of scientific strategies that limit bias by the systematic assembly, clinical appraisal, and synthesis of all relevant studies on a specific topic." Meta-analysis usually is the final step in a systematic review. Systematic reviews and meta-analyses are labor intensive, requiring expertise in both the subject matter and review methodology, and also must follow the rules of EBM which suggests that a formal set of rules must complement medical training and common sense for clinicians to integrate the results of clinical research effectively. While expertise in the review methods is important, the expertise in the subject matter and technical components is also crucial. Even though, systematic reviews and meta-analyses, specifically of RCTs, have exploded, the quality of the systematic reviews is highly variable and consequently, the opinions reached of the same studies are quite divergent. Numerous deficiencies have been described in methodologic assessment of the quality of the individual articles. Consequently, observational studies can provide an important complementary source of information, provided that the data are analyzed and interpreted in the context of confounding bias to which they are prone. Appropriate systematic reviews of observational studies, in conjunction with RCTs, may provide the basis for elimination of a dangerous discrepancy between the experts and the evidence. Steps in conducting systematic reviews of observational studies include planning, conducting, reporting, and disseminating the results. MOOSE, or Meta-analysis of Observational Studies in Epidemiology, a proposal for reporting contains specifications including background, search strategy, methods, results, discussion, and conclusion. Use of the MOOSE checklist should improve the usefulness of meta-analysis for authors, reviewers, editors, readers, and decision-makers. This manuscript describes systematic reviews and meta-analyses of observational studies. Authors frequently utilize RCTs and observational studies in one systematic review; thus, they should also follow the reporting standards of the Quality of Reporting of Meta-analysis (QUOROM) statement, which also provides a checklist. A combined approach of QUOROM and MOOSE will improve reporting of systematic reviews and lead to progress and innovations in health care.
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evidence based medicine systematic reviews and guidelines in interventional pain Management Part 4 observational studies
Pain Physician, 2009Co-Authors: Laxmaiah Manchikanti, Howard S Smith, Joshua A HirschAbstract:: Evidence-based medicine (EBM) stresses the examination of evidence from clinical research and describes it as a shift in medical paradigms, in contrast to intuition, unsystematic clinical experience, and pathophysiologic rationale. While the importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy, much of the medical research is observational. There is competition, contrast, and a feeling of inferiority and uselessness for observational studies, created by a lack of understanding of medical research. However, observational studies and randomized clinical trials (RCTs) can be viewed as the steps of observation and experimentation that form the basis of the scientific methodology. Further, rational healthcare practices require knowledge about the etiology and pathogenesis, diagnosis, prognosis, and treatment of disorders. The reporting of observational research is often not detailed and clear enough with insufficient quality and poor reporting, which hampers the assessment of strengths and weaknesses of the study and the generalizability of the mixed results. Thus, design, implementation, and reporting of observational studies is crucial. The biased interpretation of results from observational studies, either in favor of or opposed to a treatment, and lack of proper understanding of observational studies, leads to a poor appraisal of the quality. Similar to the Consolidated Standards of Reporting Trials (CONSORT) statement for the reporting of randomized trials, the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement was developed with recommendations to improve the quality of reporting observational studies. The STROBE statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Multiple types of observational studies are conducted; however, 3 types have been highlighted in the STROBE document and also in the present review, which include cohort studies, case-controlled studies, and cross-sectional studies. This comprehensive review provides an introduction and rationale, types, design, and reporting of observational studies; outcomes assessment and data presentation and analysis; statistical analysis, results, and a discussion of observational studies.
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evidence based medicine systematic reviews and guidelines in interventional pain Management Part 2 randomized controlled trials
Pain Physician, 2008Co-Authors: Laxmaiah Manchikanti, Joshua A Hirsch, Howard S SmithAbstract:: Evidence-based medicine (EBM) is a shift in medical paradigms and about solving clinical problems, acknowledging that intuition, unsystematic clinical experience, and pathophysiologic rationale are insufficient grounds for clinical decision-making. The importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy. Even though the concept of hierarchy of evidence is not absolute, in modern medicine, most researchers synthesizing the evidence may or may not follow the principles of EBM, which requires that a formal set of rules must complement medical training and common sense for clinicians to interpret the results of clinical research. N of 1 randomized controlled trials (RCTs) has been positioned as the top of the hierarchy followed by systematic reviews of randomized trials, single randomized trial, systematic review of observational studies, single observational study, physiologic studies, and unsystematic clinical observations. However, some have criticized that the hierarchy of evidence has done nothing more than glorify the results of imperfect experimental designs on unrepresentative populations in controlled research environments above all other sources of evidence that may be equally valid or far more applicable in given clinical circumstances. Design, implementation, and reporting of randomized trials is crucial. The biased interpretation of results from randomized trials, either in favor of or opposed to a treatment, and lack of proper understanding of randomized trials, leads to a poor appraisal of the quality. Multiple types of controlled trials include placebo-controlled and pragmatic trials. Placebo controlled RCTs have multiple shortcomings such as cost and length, which limit the availability for studying certain outcomes, and may suffer from problems of faulty implementation or poor generalizability, despite the study design which ultimately may not be the prime consideration when weighing evidence for treatment alternatives. However, in practical clinical trials, interventions compared in the trial are clinically relevant alternatives, Participants reflect the underlying affected population with the disease, Participants come from a heterogeneous group of practice settings and geographic locations, and endpoints of the trial reflect a broad range of meaningful clinical outcomes.
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evidence based medicine systematic reviews and guidelines in interventional pain Management Part i introduction and general considerations
Pain Physician, 2008Co-Authors: Laxmaiah ManchikantiAbstract:: Evidence-based medicine, systematic reviews, and guidelines are Part of modern interventional pain Management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent, trustworthy information by systematically acquiring, analyzing, and transferring research findings into clinical, Management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care with practical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge that can be applied in clinical settings. Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitly defined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initially called "critical appraisal" to describe the application of basic rules of evidence as they evolve into application in daily practices. Evidence-based medicine is defined as a conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is defined based on 4 basic and important contingencies, which include recognition of the patient's problem and construction of a structured clinical question, thorough search of medical literature to retrieve the best available evidence to answer the question, critical appraisal of all available evidence, and integration of the evidence with all aspects and contexts of the clinical circumstances. Systematic reviews provide the application of scientific strategies that limit bias by the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and health technology assessments. Clinical practice guidelines are systematically developed statements that aim to help physicians and patients reach the best health care decisions. Appropriately developed guidelines incorporate validity, reliability, reproducibility, clinical applicability and flexibility, clarity, development through a multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinical practice guidelines represent statements developed to improve the quality of care, patient access, treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain Management provides an introduction and general considerations of these 3 aspects in interventional pain Management.
Tetsu Okumura - One of the best experts on this subject based on the ideXlab platform.
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the tokyo subway sarin attack disaster Management Part 1 community emergency response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. Prior to the Tokyo subway sarin attack, there had never been such a large-scale disaster caused by nerve gas in peacetime history. This article provides details related to how the community emergency medical services (EMS) system responded from the viewpoint of disaster Management, the problems encountered, and how they were addressed. The authors' assessment was that if EMTs, under Japanese law, had been allowed to maintain an airway with an endotracheal tube or use a laryngeal mask airway without physician oversight, more patients might have been saved during this chemical exposure disaster. Given current legal restrictions, advanced airway control at the scene will require that doctors become more actively involved in out-of-hospital treatment. Other recommendations are: 1) that integration and cooperation of concerned organizations be established through disaster drills; 2) that poison information centers act as regional mediators of all toxicologic information; 3) that a real-time, multidirectional communication system be established; 4) that multiple channels of communication be available for disaster care; 5) that public organizations have access to mobile decontamination facilities; and 6) that respiratory protection and chemical-resistant suits with gloves and boots be available for out-of-hospital providers during chemical disasters.
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the tokyo subway sarin attack disaster Management Part 3 national and international responses
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The authors report the national and international responses to the disaster produced by the Tokyo subway sarin attack. From a worldwide historical perspective, there had never been such a large-scale disaster caused by nerve gas during peacetime. Therefore, this event should be studied from various viewpoints in cooperation with members of the international community. To this end, the Japanese government should help coordinate a large-scale and detailed investigation of the Tokyo subway sarin attack, including the long-term effects of sarin. The authors also recommend that the Japanese Self Defense Forces should be used more effectively in large-scale disasters. The system of direct control of disaster Management by the Japanese government could be useful in a large-scale disaster. Language: en
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the tokyo subway sarin attack disaster Management Part 2 hospital response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:Abstract. The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The authors report how St. Luke's Hospital dealt with this disaster from the viewpoint of disaster Management. Recommendations derived from the experience include the following: Each hospital in Japan should prepare an emergent decontamination area and have available chemical-resistant suits and masks. Ventilation in the ED and main treatment areas should be well planned at the time a hospital is designed. Hospital disaster planning must include guidance in mass casualties, an emergency staff call-up system, and an efficient emergency medical chart system. Hospitals should establish an information network during routine practice so that it can be called upon at the time of a disaster. The long-term effects of sarin should be monitored, with such investigation ideally organized and integrated by the Japanese government.
Andy Spoerri - One of the best experts on this subject based on the ideXlab platform.
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transitions of municipal solid waste Management Part ii hybrid life cycle assessment of swiss glass packaging disposal
Resources Conservation and Recycling, 2014Co-Authors: Gregoire Meylan, Andy SpoerriAbstract:Abstract In policy support of municipal solid waste (MSW) Management, life cycle assessment (LCA) can serve to compare the environmental or economic impacts of two or more options for waste processing. The scope of waste Management LCAs generally focuses less attention on future developments, e.g., where will recycling take place, and more on the environmental performance of prototypes, e.g., the incineration of all waste compared to recycling. To provide more robust support for Swiss waste glass-packaging disposal, scenarios of Swiss waste glass-packaging are assessed from a life cycle perspective. The scenarios consist in schemes for the disposal of the total amount of Swiss waste glass-packaging, i.e., different combinations of recycling and downcycling in Switzerland or abroad developed in Part I, Meylan et al. (2013) . In this article (Part II), the disposal schemes are assessed with respect to eco-efficiency, an indicator that combines total environmental impacts and gross value added in Switzerland. Results show that no policy alternative guarantees environmental impact reductions and gross value added gains under all developments of exogenous constraints. Downcycling to foam glass in Switzerland is not only an environmentally sound disposal option, but it also buffers gross value added losses in case domestic recycling (and thus glass-packaging production in Switzerland) ceases in the future. The substitution of products based on raw materials other than Swiss cullet is the main responsible for change in environmental and economic impacts. Hence, an eco-efficiency maximizing policy should consider the products of disposal schemes. The combination of scenario analysis and eco-efficiency assessment as presented in this paper can be applied to other contexts (i.e., countries, waste fractions).
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transitions of municipal solid waste Management Part i scenarios of swiss waste glass packaging disposal
Resources Conservation and Recycling, 2013Co-Authors: Gregoire Meylan, Roman Seidl, Andy SpoerriAbstract:Abstract All municipal solid waste (MSW) Management systems—even “high quality systems” or those employing “best practices”—face multiple challenges, e.g., decreasing prices of secondary raw materials recovered by municipalities, increasing complexity of waste composition, technological lock-ins. Policy-making involves translating these challenges into goals that are generic in nature and implementing them on MSW fractions thanks to tailor-made policy tools, e.g., anticipated disposal fees. Anticipating the impacts of policies can provide valuable insights into the adequacy of policy tools with respect to economic, political, and social contexts of MSW. The goal of this paper is to construct consistent, future scenarios of Swiss waste glass-packaging disposal based on literature and stakeholder knowledge, including the allocation of waste to different disposal routes. These scenarios are future states to which the current system could transit to due to alternative policies in line with waste policy goals and varying societal constraints (e.g., commodity prices). Results of scenario construction show that policy has a limited effect on waste glass-packaging disposal because of economic constraints, preventing goals from consistently being achieved. For instance, increases in energy prices can impede a policy favoring recycling over downcycling to foam glass, an energy-saving product. The procedure applied to construct possible scenarios suits well the ambition of considering uncertain future developments affecting MSW Management as it integrates qualitative and quantitative knowledge of various sources and disciplines.
Kouichiro Suzuki - One of the best experts on this subject based on the ideXlab platform.
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the tokyo subway sarin attack disaster Management Part 1 community emergency response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. Prior to the Tokyo subway sarin attack, there had never been such a large-scale disaster caused by nerve gas in peacetime history. This article provides details related to how the community emergency medical services (EMS) system responded from the viewpoint of disaster Management, the problems encountered, and how they were addressed. The authors' assessment was that if EMTs, under Japanese law, had been allowed to maintain an airway with an endotracheal tube or use a laryngeal mask airway without physician oversight, more patients might have been saved during this chemical exposure disaster. Given current legal restrictions, advanced airway control at the scene will require that doctors become more actively involved in out-of-hospital treatment. Other recommendations are: 1) that integration and cooperation of concerned organizations be established through disaster drills; 2) that poison information centers act as regional mediators of all toxicologic information; 3) that a real-time, multidirectional communication system be established; 4) that multiple channels of communication be available for disaster care; 5) that public organizations have access to mobile decontamination facilities; and 6) that respiratory protection and chemical-resistant suits with gloves and boots be available for out-of-hospital providers during chemical disasters.
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the tokyo subway sarin attack disaster Management Part 3 national and international responses
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:The authors report the national and international responses to the disaster produced by the Tokyo subway sarin attack. From a worldwide historical perspective, there had never been such a large-scale disaster caused by nerve gas during peacetime. Therefore, this event should be studied from various viewpoints in cooperation with members of the international community. To this end, the Japanese government should help coordinate a large-scale and detailed investigation of the Tokyo subway sarin attack, including the long-term effects of sarin. The authors also recommend that the Japanese Self Defense Forces should be used more effectively in large-scale disasters. The system of direct control of disaster Management by the Japanese government could be useful in a large-scale disaster. Language: en
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the tokyo subway sarin attack disaster Management Part 2 hospital response
Academic Emergency Medicine, 1998Co-Authors: Tetsu Okumura, Kouichiro Suzuki, Atsuhiro Fukuda, Akitsugu Kohama, Nobukatsu Takasu, Shinichi Ishimatsu, Shigeaki HinoharaAbstract:Abstract. The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The authors report how St. Luke's Hospital dealt with this disaster from the viewpoint of disaster Management. Recommendations derived from the experience include the following: Each hospital in Japan should prepare an emergent decontamination area and have available chemical-resistant suits and masks. Ventilation in the ED and main treatment areas should be well planned at the time a hospital is designed. Hospital disaster planning must include guidance in mass casualties, an emergency staff call-up system, and an efficient emergency medical chart system. Hospitals should establish an information network during routine practice so that it can be called upon at the time of a disaster. The long-term effects of sarin should be monitored, with such investigation ideally organized and integrated by the Japanese government.