Rinsho byori. The Japanese journal of clinical pathology
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Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder classified with a type of thrombotic microangiopathy (TMA). TTP is caused by a deficiency of von Willebrand factor-cleaving protease called ADAMTS13 (a disintegrin-like and metalloprotease with a thrombospondin type1 motif 13). ⋯ Congenital TTP (Upshaw-Schulman syndrome: USS) is an inherited disorder of ADAMTS13, and the other more commonly is an acquired TTP caused by autoantibodies against ADAMTS13. This article reviews the progress of ADAMTS13 activity measurement and the resulting changes in the diagnosis and treatment of TTP.
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It is important to develop safer medical systems and follow manuals of medical procedures for patient safety. However, these approaches do not always result in satisfactory results because of many human factors. It is known that defects of nontechnical skills are more important than those of technical skills regarding medical accidents and incidents. ⋯ In TeamSTEPPS, leadership to share mental models among the team, continuous monitoring and awareness for team activities, mutual support for workload and knowledge, and approaches to complete communication are summarized to enhance teamwork and patient safety. Other than improving nontechnical skills and teamwork, TeamSTEPPS is also very important as a High Reliability Organization (HRO). TeamSTEPPS is worth implementing in every hospital to decrease medical errors and improve patient outcomes and satisfaction.
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Recently, musculoskeletal ultrasonography has been becoming more common for diagnosis and treatment by ultrasound-guided intervention in the field of orthopedics. Because musculoskeletal ultrasound technology has rapidly advanced in recent years, and has many advantages, including no exposure to radiation, non-invasive, wide availability, cost-effectiveness, and the ability to be used in real-time in the general outpatient clinic. Traditional radiography was not able to detect soft tissue injury, but musculoskeletal ultrasonography enables the diagnosis of not only musculoskeletal disorders including soft tissue injury, but also fractures by dynamic examination. The first choice of diagnostic imaging should begin to shift to musculoskeletal ultra-sound from traditional radiography.
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Echocardiography is a powerful noninvasive cardiovascular diagnostic tool. In the emergency room, an outpatient setting, and the intensive care unit, physician-performed point-of-care (POC) echocardiography is particularly important to understand the concurrent pathophysiology of unstable patients. In POC echocardiography, the purpose of examination should be clearly decided in advance by performing careful symptom assessment and physical examination, including heart and lung auscultation. ⋯ Papillary muscle rupture and ventricular septal perforation are both fatal complications of myocardial infarction, and they should be kept in mind and pan-systolic murmur should be detected before echocardiography. In acute pulmonary thromboembolism, the right heart size and characteristic wall motion abnormality should be focused on using echocardiography in addition to tricuspid regurgitant flow velocity measurement. Femoral vein ultrasonography with a compression test should be performed for all patients with acute pulmonary thromboembolism to search for potential embolic sources.
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The performance of ultrasound (US) devices is improving every year, and more advanced US is being conducted in laboratory settings with high-end machines. Meanwhile, portable US devices, which have become less expensive and of a higher quality, have come into widespread use at bedsides in emergency rooms, intensive care units, and general wards. ⋯ The findings are interpreted based on the vital signs, history, and physical examination during the scan, and the interpretations are rapidly applied for decision-making. In this article, we review the findings of lung US, which is one of the main fields in POCUS, as well as diagnoses and evaluations of pneumothorax and pulmonary edema in acute care settings.