1
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Fergie R, Maxwell AP, Cunningham EL. Latest advances in frailty in kidney transplantation: A narrative review. Transplant Rev (Orlando) 2024; 38:100833. [PMID: 38309184 DOI: 10.1016/j.trre.2024.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
Frailty is a clinical syndrome that is characterised by decline in multiple systems with associated decreased physiological reserve and ability to respond to stressor events. It is associated with greater healthcare burden. It is common in patients with end-stage renal disease (ESRD). Kidney transplantation is considered the optimal form of renal replacement therapy for suitable patients with ESRD. However, surgery and immunosuppression are physiological stresses that can disproportionately affect frail individuals. Frailty is emerging as a potentially important risk factor in patients waitlisted for kidney transplantation. Most of the published research to date in this area comes from a single transplant centre in the USA. Frailty, as measured using the Physical Frailty Phenotype (FP), is prevalent in waitlisted patients and has been associated with early hospital re-admission, prolonged length of stay, delayed graft function and increased mortality after kidney transplantation. However, although kidney transplantation is a substantial physiological stress to a patient's reserve, by restoring kidney function, kidney transplantation has also been shown to improve a patient's frailty status. The FP is the most studied tool in patients waitlisted for transplantation, but it has not been able to distinguish those whose frailty is improved by kidney transplantation. In summary, there remain significant gaps in knowledge and uncertainties as to how to effectively use existing frailty measures to inform decision-making around kidney transplantation. Further research is needed to address these important gaps in the literature.
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Affiliation(s)
- Ruth Fergie
- Centre for Public Health, Queen's University of Belfast, Belfast BT12 6AB, UK; Regional Nephrology Unit, Belfast City Hospital, Lisburn Road, BT9 7BA Belfast, UK.
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University of Belfast, Belfast BT12 6AB, UK.
| | - Emma L Cunningham
- Centre for Public Health, Queen's University of Belfast, Belfast BT12 6AB, UK.
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2
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Furtado GE, Reis ASLDS, Braga-Pereira R, Caldo-Silva A, Teques P, Sampaio AR, dos Santos CAF, Bachi ALL, Campos F, Borges GF, Brito-Costa S. Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews. Healthcare (Basel) 2023; 11:3160. [PMID: 38132050 PMCID: PMC10742503 DOI: 10.3390/healthcare11243160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Centre for Natural Resources Environment and Society (CERNAS), Polytechnic Institute of Coimbra, Bencanta, 3045-601 Coimbra, Portugal
| | - Anne Sulivan Lopes da Silva Reis
- Postgraduate Program in Physical Education, University of Southwest Bahia and the State University of Santa Cruz (PPGEF/UESB/UESC), Ilhéus 45650-000, Brazil;
| | - Ricardo Braga-Pereira
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Adriana Caldo-Silva
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, 3040-248 Coimbra, Portugal;
| | - Pedro Teques
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
- CIPER, Interdisciplinary Center for the Study of Human Performance, 1499-002 Lisbon, Portugal
| | - António Rodrigues Sampaio
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - André Luís Lacerda Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Francisco Campos
- Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal;
| | - Grasiely Faccin Borges
- Center for Public Policies and Social Technologies, Federal University of Southern Bahia, Praça José Bastos, s/n, Centro, Itabuna 45600-923, Brazil;
| | - Sónia Brito-Costa
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Group in Social and Human Sciences (NICSH), Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal
- Human Potential Development Center (CDPH), Polytechnic of Coimbra, 3030-329 Coimbra, Portugal
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3
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Passarelli JL, Al Hamad H. Geriatric frailty determinants in India. Aging Med (Milton) 2023; 6:450-451. [PMID: 38239712 PMCID: PMC10792337 DOI: 10.1002/agm2.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Jorge Luis Passarelli
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
| | - Hanadi Al Hamad
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
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4
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Murdaca G, Banchero S, Casciaro M, Paladin F, Tafuro M, Monacelli F, Nencioni A, Bruschetta R, Pioggia G, Tartarisco G, Gangemi S. Multiparametric Evaluation of Geriatric Patients Admitted to Intermediate Care: Impact on Geriatric Rehabilitation. Diagnostics (Basel) 2023; 13:2906. [PMID: 37761272 PMCID: PMC10529473 DOI: 10.3390/diagnostics13182906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Optimizing the functional status of patients of any age is a major global public health goal. Rehabilitation is a process in which a person with disabilities is accompanied to achieve the best possible physical, functional, social, intellectual, and relational outcomes. The Intermediate Care Unit within the O.U. of Geriatrics and Gerontology of the San Martino Hospital in Genoa is focused on the treatment and motor reactivation of patients with geriatric pathologies. The objective of this study was to identify which factor, among the characteristics related to the patient and those identified by the geriatric evaluation, had the greatest impact on rehabilitation outcomes. Our findings revealed significant correlations between the Barthel Index delta, the 4AT Screening Test, and the number of drugs taken. This association highlights the potential benefits of medication management in enhancing the overall well-being and functional abilities of frail older adults, despite the literature suggesting that polypharmacotherapy is associated with a reduction in functional status and an increase in mortality. These findings underscore the significance of a multidimensional geriatric assessment. Refining and optimising these multidisciplinary approaches is the objective of a more effective geriatric rehabilitation strategy.
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Affiliation(s)
- Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
| | - Sara Banchero
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
| | - Marco Casciaro
- Department of Medical Sciences, University Hospital of Messina, 98125 Messina, Italy;
| | - Francesca Paladin
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Michele Tafuro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy;
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Yi Y, Lee Y, Kang S, Kwon YH, Seo YM, Baek JY, Jang IY, Lee E, Koh Y, Jung HW, Park CM. Unmet Needs and Barriers in Providing Hospital Care for Older Adults: A Qualitative Study Using the Age-Friendly Health System Framework. Clin Interv Aging 2023; 18:1321-1332. [PMID: 37588681 PMCID: PMC10426405 DOI: 10.2147/cia.s409348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose This study aims to identify unmet needs and barriers for improving inpatient care for older adults at an academic hospital in Korea by using a qualitative focus group design and the Age-Friendly Health Systems (AFHS) framework. Patients and Methods A total of 14 healthcare providers and employees participated in focus group interviews. Participants included medical doctors, registered nurses, a receptionist, a patient transporter, a pharmacist, a physical therapist, and a social worker. The data were analyzed qualitatively, as per the Consolidated Criteria for Reporting Qualitative Research guidelines. The analysis method encompassed a thematic framework analysis via the AFHS 4Ms framework, consisting of the four domains "What Matters", "Medication", "Mentation", and "Mobility". Results Multiple barriers and unmet needs were identified using the AFHS 4Ms framework in the provision of inpatient care for older adults at the hospital. The main barriers identified in the "What matters" domain are a lack of shared decision-making and individualized care plans, as well as economic and safety-conscious preferences among some older patients. In the "Medications" domain, the main barriers to providing adequate and safe pharmacotherapy include patient and caregiver-related factors, increased complexity of medication use, and lack of institutional support systems. In the "Mentation" domain, the main issues identified are communication barriers related to patients, caregiver factors, and insufficient delirium management due to a lack of adequate processes/environments such as delirium identification. In the "Mobility" domain, the main challenges include reduced mobility and geriatric complications, unnecessary mobility restrictions, and the increased risk of falls due to lack of resources and environmental factors. Conclusion The study highlighted the need for improvements in inpatient care for older adults at an academic hospital in Korea. Identified unmet needs and barriers can be used to guide a more patient-centered approaches for an age-friendly inpatient environment.
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Affiliation(s)
- Youngseok Yi
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Selin Kang
- Department of Economics, The Graduate School, Yonsei University, Seoul, South Korea
| | - Young Hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Yeon Mi Seo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chan Mi Park
- Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA, USA
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6
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Lee JH, Park YS, Kim MJ, Shin HJ, Roh YH, Kim JH, Chung HS, Park I, Chung SP. Clinical Frailty Scale as a predictor of short-term mortality: A systematic review and meta-analysis of studies on diagnostic test accuracy. Acad Emerg Med 2022; 29:1347-1356. [PMID: 35349205 DOI: 10.1111/acem.14493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is a representative frailty assessment tool in medicine. This systematic review and meta-analysis aimed to examine whether frailty defined based on the CFS could adequately predict short-term mortality in emergency department (ED) patients. METHODS The PubMed, EMBASE, and Cochrane libraries were searched for eligible studies until December 23, 2021. We included studies in which frailty was measured by the CFS and short-term mortality was reported for ED patients. All studies were screened by two independent researchers. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) values were calculated based on the data extracted from each study. Additionally, the diagnostic odds ratio (DOR) was calculated for effect size analysis, and the area under the curve (AUC) of summary receiver operating characteristics was calculated. Outcomes were in-hospital and 1-month mortality rate for patients with the CFS scores of ≥5, ≥6, and ≥7. RESULTS Overall, 17 studies (n = 45,022) were included. Although there was no evidence of publication bias, a high degree of heterogeneity was observed. For the CFS score of ≥5, the PLR, NLR, and DOR values for in-hospital mortality were 1.446 (95% confidence interval [CI] 1.325-1.578), 0.563 (95% CI 0.355-0.893), and 2.728 (95% CI 1.872-3.976), respectively. In addition, the pooled statistics for 1-month mortality were 1.566 (95% CI 1.241-1.976), 0.582 (95% CI 0.430-0.789), and 2.696 (95% CI 1.673-4.345), respectively. Subgroup analysis of trauma patients revealed that the CFS score of ≥5 could adequately predict in-hospital mortality (PLR 1.641, 95% CI 1.242-2.170; NLR 0.580, 95% CI 0.461-0.729; DOR 2.883, 95% CI 1.994-4.168). The AUC values represented sufficient to good diagnostic accuracy. CONCLUSIONS Evidence that is published to date suggests that the CFS is an accurate and reliable tool for predicting short-term mortality in emergency patients.
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Affiliation(s)
- Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jung Shin
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Yun Ho Roh
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Takauji S, Hifumi T, Saijo Y, Yokobori S, Kanda J, Kondo Y, Hayashida K, Shimazaki J, Moriya T, Yagi M, Yamaguchi J, Okada Y, Okano Y, Kaneko H, Kobayashi T, Fujita M, Shimizu K, Yokota H, Yaguchi A. Association between frailty and mortality among patients with accidental hypothermia: a nationwide observational study in Japan. BMC Geriatr 2021; 21:507. [PMID: 34563118 PMCID: PMC8466946 DOI: 10.1186/s12877-021-02459-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Frailty has been associated with a risk of adverse outcomes, and mortality in patients with various conditions. However, there have been few studies on whether or not frailty is associated with mortality in patients with accidental hypothermia (AH). In this study, we aim to determine this association in patients with AH using Japan's nationwide registry data. METHODS The data from the Hypothermia STUDY 2018&19, which included patients of ≥18 years of age with a body temperature of ≤35 °C, were obtained from a multicenter registry for AH conducted at 120 institutions throughout Japan, collected from December 2018 to February 2019 and December 2019 to February 2020. The clinical frailty scale (CFS) score was used to determine the presence and degree of frailty. The primary outcome was the comparison of mortality between the frail and non-frail patient groups. RESULTS In total, 1363 patients were included in the study, of which 920 were eligible for the analysis. The 920 patients were divided into the frail patient group (N = 221) and non-frail patient group (N = 699). After 30-days of hospitalization, 32.6% of frail patients and 20.6% of non-frail patients had died (p < 0.001). Frail patients had a significantly higher risk of 90-day mortality (Hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.25-2.17; p < 0.001). Based on the Cox proportional hazards analysis using multiple imputation, after adjustment for age, potassium level, lactate level, pH value, sex, CPK level, heart rate, platelet count, location of hypothermia incidence, and rate of tracheal intubation, the HR was 1.69 (95% CI, 1.25-2.29; p < 0.001). CONCLUSIONS This study showed that frailty was associated with mortality in patients with AH. Preventive interventions for frailty may help to avoid death caused by AH.
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Affiliation(s)
- Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University Hospital, 2-1, Midorigaoka higashi, Asahikawa, 078-8510, Japan. .,Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.
| | - Toru Hifumi
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shoji Yokobori
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Kanda
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Yutaka Kondo
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kei Hayashida
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
| | - Junya Shimazaki
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Takashi Moriya
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Yagi
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency, Disaster and Critical Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Junko Yamaguchi
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yohei Okada
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Primary care and Emergency medicine, Graduate school of medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Okano
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hitoshi Kaneko
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tatsuho Kobayashi
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan
| | - Motoki Fujita
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Keiki Shimizu
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiroyuki Yokota
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Arino Yaguchi
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
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