九州大学 研究者情報
総説一覧
永田 高志(ながた たかし) データ更新日:2020.06.23

助教 /  医学研究院 先端医療医学部門 先端医療医学


総説, 論評, 解説, 書評, 報告書等
1. Akihito Hagihara, Daisuke Onozuka, Hidetoshi Shibuta, Manabu Hasegawa, Takashi Nagata, Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest, International Journal of Cardiology, 10.1016/j.ijcard.2018.04.067, 2018.04, [URL], INTRODUCTION: Bystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA.
METHODS: This is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18-100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event.
RESULTS: During the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78-0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65-1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43-0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased.
CONCLUSIONS: Survival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit..
2. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Shogo Miyazaki, Takashi Nagata, Grand Sumo Tournaments and Out-of-Hospital Cardiac Arrests in Tokyo, Journal of the American Heart Association, 10.1161/JAHA.118.009163, 2018.07, [URL], BACKGROUND: Sumo wrestling is a demanding sport. Although watching sumo wrestling may have cardiovascular effects, no studies of this relationship have been performed. Thus, we aimed to evaluate the association between sumo wrestling tournaments and the rate of out-of-hospital cardiac arrests.
METHODS AND RESULTS: We counted the daily number of patients aged 18 to 110 years who had an out-of-hospital cardiac arrest of presumed-cardiac origin in the Tokyo metropolis between 2005 and 2014. A Poisson regression was used to model out-of-hospital cardiac arrests of presumed-cardiac origin per day. Exposure days were the days on which a sumo tournament was held and broadcast, whereas control days were all other days. Events that occurred on exposure days were compared with those that occurred on control days. Risk ratios for out-of-hospital cardiac arrests on Grand Sumo tournaments days compared with control days were estimated. In total, 71 882 out-of-hospital cardiac arrests met the inclusion criteria. We recorded a 9% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days. In patients aged 75 to 110 years, we found a 13% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days.
CONCLUSIONS: We found a significant increase in the occurrence of out-of-hospital cardiac arrests on the days of sumo tournaments compared with control days in the Tokyo metropolis between 2005 and 2014. Further studies are needed to verify these initial findings on sumo tournaments and cardiovascular events..
3. Yuri Hosokawa, Takashi Nagata, Manabu Hasegawa, Inconsistency in the standard of care-toward evidence-based management of exertional heat stroke, Frontiers in Physiology, 10.3389/fphys.2019.00108, 2019.01, [URL], Tokyo 2020 Summer Olympics are projected to experience environmental heat stress that surpasses the environmental conditions observed in the Atlanta (1996), Athens (2004), Beijing (2008), and Rio (2016) Summer Olympics. This raises particular concerns for athletes who will likely to be exposed to extreme heat during the competitions. Therefore, in mass-participation event during warm season, it is vital for the hosting organization to build preparedness and resilience against heat, including appropriate treatment, and management strategies for exertional heat stroke (EHS). However, despite the existing literature regarding the evidence-based management of EHS, rectal thermometry and whole-body cold-water immersion are not readily accepted by medical professionals outside of the sports, and military medicine professionals. Current Japanese medical standard is no exception in falling behind on evidence-based management of EHS. Therefore, the first aim of this paper is to elucidate the inconsistency between the standard of care provided in Japan for EHS and what has been accepted as the gold standard by the scientific literature. The second aim of this paper is to provide optimal EHS management strategies that should be implemented at the Tokyo 2020 Summer Olympics from organizational level to maximize the safety of athletes and to improve organizational resilience to heat. The risk of extreme heat is often neglected until a catastrophic incidence occurs. It is vital for the Japanese medical leadership and athletic communities to reexamine the current EHS management strategies and implement evidence-based countermeasure for EHS to expand the application of scientific knowledge..
4. Akihito Hagihara, Daisuke Onozuka, Hidetoshi Shibuta, Manabu Hasegawa, Takashi Nagata, Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest, International Journal of Cardiology, 10.1016/j.ijcard.2018.04.067, 2018.04, [URL], INTRODUCTION: Bystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA.
METHODS: This is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18-100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event.
RESULTS: During the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78-0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65-1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43-0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased.
CONCLUSIONS: Survival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit..
5. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Shogo Miyazaki, Takashi Nagata, Grand Sumo Tournaments and Out-of-Hospital Cardiac Arrests in Tokyo, Journal of the American Heart Association, 10.1161/JAHA.118.009163, 2018.07, [URL], BACKGROUND: Sumo wrestling is a demanding sport. Although watching sumo wrestling may have cardiovascular effects, no studies of this relationship have been performed. Thus, we aimed to evaluate the association between sumo wrestling tournaments and the rate of out-of-hospital cardiac arrests.
METHODS AND RESULTS: We counted the daily number of patients aged 18 to 110 years who had an out-of-hospital cardiac arrest of presumed-cardiac origin in the Tokyo metropolis between 2005 and 2014. A Poisson regression was used to model out-of-hospital cardiac arrests of presumed-cardiac origin per day. Exposure days were the days on which a sumo tournament was held and broadcast, whereas control days were all other days. Events that occurred on exposure days were compared with those that occurred on control days. Risk ratios for out-of-hospital cardiac arrests on Grand Sumo tournaments days compared with control days were estimated. In total, 71 882 out-of-hospital cardiac arrests met the inclusion criteria. We recorded a 9% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days. In patients aged 75 to 110 years, we found a 13% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days.
CONCLUSIONS: We found a significant increase in the occurrence of out-of-hospital cardiac arrests on the days of sumo tournaments compared with control days in the Tokyo metropolis between 2005 and 2014. Further studies are needed to verify these initial findings on sumo tournaments and cardiovascular events..
6. Yuri Hosokawa, Takashi Nagata, Manabu Hasegawa, Inconsistency in the standard of care-toward evidence-based management of exertional heat stroke, Frontiers in Physiology, 10.3389/fphys.2019.00108, 2019.01, [URL], Tokyo 2020 Summer Olympics are projected to experience environmental heat stress that surpasses the environmental conditions observed in the Atlanta (1996), Athens (2004), Beijing (2008), and Rio (2016) Summer Olympics. This raises particular concerns for athletes who will likely to be exposed to extreme heat during the competitions. Therefore, in mass-participation event during warm season, it is vital for the hosting organization to build preparedness and resilience against heat, including appropriate treatment, and management strategies for exertional heat stroke (EHS). However, despite the existing literature regarding the evidence-based management of EHS, rectal thermometry and whole-body cold-water immersion are not readily accepted by medical professionals outside of the sports, and military medicine professionals. Current Japanese medical standard is no exception in falling behind on evidence-based management of EHS. Therefore, the first aim of this paper is to elucidate the inconsistency between the standard of care provided in Japan for EHS and what has been accepted as the gold standard by the scientific literature. The second aim of this paper is to provide optimal EHS management strategies that should be implemented at the Tokyo 2020 Summer Olympics from organizational level to maximize the safety of athletes and to improve organizational resilience to heat. The risk of extreme heat is often neglected until a catastrophic incidence occurs. It is vital for the Japanese medical leadership and athletic communities to reexamine the current EHS management strategies and implement evidence-based countermeasure for EHS to expand the application of scientific knowledge..
7. 永田 高志, 胸部外傷, 救急医学 へるす出版, 2014.04.
8. 永田 高志, 外傷専門診療ガイドライン JETEC, へるす出版, 2014.08, 日本外傷学会では、2002年に外傷診療の初期診療に焦点を当てた「外傷初期診療ガイドラインJATEC」を上梓し、同時に研修コースとしてJATEC(Japan Advanced Trauma Evaluation and Care)コースを開催し、確実にその成果を収めてきた。本書は、JATEC で指導する初期診療を引き継ぎ,チームとして質の高い根本治療と患者管理が行えることを一般目標とした、外傷診療を専門とする医師のためのテキストである。外傷診療の専門性向上には診療の組み立てや管理能力を磨くことが重要であり、前者を「戦術」と表現すれば,後者は「戦略」といえる。手術や処置に関する「戦術」については,術式の創意工夫や新しいデバイスの開発など,状況に応じた多彩な手法が存在する。一方,「戦略」は人,物,技術の管理であり,限られた時間経過のなかでの意思決定も含まれる。「戦略」に標準化はなじまないが,その展開には一定の理論が存在する。外傷診療を専門とする者にはこの戦略立案の能力が求められる。したがって,本書JETEC では「外傷治療戦略」になにより力点を置いている。「JATEC の引き継ぎ」,「専門性」,「根本治療」,「意思決定」,「チーム医療」,「トータルマネージメント」――など、JETECの方向性を明確にした外傷診療を専門とする医師必携の一冊。.

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