Demand and supply of invasive and noninvasive ventilators at the peak of the COVID-19 outbreak in Okinawa.

While Okinawa has been facing outbreak of the coronavirus disease 2019 (COVID-19) pandemic, healthcare collapse should be prevented by sufficient supply of ventilators for caring the rapidly growing number of critically ill patients with COVID-19. We estimated the number of invasive and noninvasive ventilators that would be required in Okinawa at the peak of the COVID-19 outbreak based on recent data of COVID-19 cases in Okinawa and data on the proportion of patients with COVID-19 in the ICU requiring ventilation. Based on our results using the current supply of all ventilators, demand for ventilators could be prepared for patients with COVID-19 who would require it and demand for noninvasive ventilators could also be prepared for those with COVID-19 who would require it. The higher supply over the demand would be achieved by flattening the epidemic curve by implementing public health interventions to delay and suppress the epidemic peak in Okinawa.

Cardiac auscultation skills among junior doctors: effects of sound simulation lesson.

OBJECTIVES: To evaluate the effect of a sound simulation lesson to improve cardiac auscultation skills among junior doctors. METHODS: This study is based on the design of test comparison before and after educational intervention using a convenient sample. For 50 junior doctors in Japan, diagnostic accuracy before and after a sound simulation lesson for cardiac auscultation skills was compared. There were 15 doctors who experienced cardiology rotation. The lesson used seven abnormal cardiac recordings (third heart sound, double gallop, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, and pericardial friction rub). At tests before and after the lesson, the doctors listened to random sound outputs of the same seven recordings, chose diagnostic findings from multiple-choice items, and obtained individual diagnostic accuracy based on the total number of choosing correct findings. Top 10 doctors obtaining the greatest individual accuracy received a commendation. RESULTS: Pre-lesson diagnostic accuracy was not different between doctors with cardiology rotation training (total diagnostic accuracy of the group, 27/105 [26%]) and those without cardiology rotation (70/245 [29%]). Compared to pre-lesson, post-lesson total diagnostic accuracy significantly improved with about two-folds (97/350 [28%] vs 170/350 [61%]; McNemar Test, p<0.0001). The improvement was significant for double gallop (5/50 [10%] vs. 15/50 [30%]), mitral stenosis (0/50 [0%] vs. 6/50 [12%]), and pericardial friction rub (1/50 [2%] vs. 35/50 [70%]). CONCLUSIONS: The use of a simple sound simulation lesson may help junior doctors to learn cardiac auscultation skills. Clinician educators are encouraged to use this strategy in addition to cardiology rotation training.