Riding a bicycle under the influence of alcohol is illegal in Japan. Nevertheless, intoxicated bicyclists are frequently treated at hospital emergency departments for bicycle-related injuries. This patient population usually requires more hospital resources, even for relatively minor injuries. Therefore, we hypothesized that bicycle-related crashes involving bicyclists under the influence of alcohol cost more to treat than those that do not involve alcohol intoxication. The aim of the present study was to examine the costs associated with bicycle-related minor injuries and alcohol intoxication of the bicyclist. The study was conducted at the Tokyo Bay Urayasu Ichikawa Medical Center Emergency Department, Japan. All minor bicycle crashes involving 217 individuals aged ≥20 years treated from September 1, 2012 to August 31, 2013 were included in the analysis of data obtained from medical records. Variables included alcohol intoxication, sex, age, collision with a motor vehicle, Glasgow Coma Scale, injury severity score (ISS), laboratory tests, treatment of wounds, number of X-ray images, number of computed tomography scans, and medical costs. Multiple linear regression analysis was performed to evaluate the association between alcohol intoxication and medical costs. Seventy (32%) patients consumed alcohol, and the median medical cost was 253 USD (interquartile range [IQR], 164–330). Multivariable analysis showed that alcohol intoxication was independently associated with higher medical costs (p = 0.030, adjusted R-square value = 0.55). These findings support our hypothesis and should encourage authorities to implement comprehensive measures to prohibit bicycling under the influence of alcohol to prevent injuries and to reduce medical costs.

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Introduction/Background: At this time, simulators are available for the trainings of central venous catheter (CVC) insertion and lumbar puncture (LP). Both interns and medical students can utilize these simulators in preparation for the clinical trainings. Since these two procedures do not require special experiences, we made the following hypothesis that success rates of those who first attempt the CVC insertion and LP procedure does not vary among medical students and interns or with academic experience levels. To prove this hypothesis, we compared the CVC insertion and LP procedural competencies between medical students and interns, none of whom are yet to perform actual procedures to patients.Methods: This is a prospective observational study of simulation-based competency assessment of the two groups, medical students (undergraduate year 1 to 6) and interns (postgraduate year 1, considered as undergraduate year 7). After a brief lecture on each procedure, participants are assigned to perform both CVC insertion and LP on the simulators. Assessment for CVC insertion was based on ultrasound (US) guided internal jugular venous catheter insertion on a simulator. Results are recorded as "successful" or "unsuccessful". The success is defined as the confirmation of the back flow of simulated body fluid through the inserted catheter or needle. The primary outcome was the differences in success rates in each procedure between the two groups. We used Fisher's exact test and logistic regression for univariate analysis.Results: Of 61 participants, 32 were medical students and 29 were interns. There were 37 males (60.7%) and no significant difference in gender was seen (p=0.20). The success rates in CVC insertion and LP between the two groups (medical students vs. interns) were 90.9% vs. 100% and 57.6% vs. 93.1%, respectively. For CVC insertion success rates, no significant difference was seen between the two groups (p=0.49). Further more, there was no statistical correlation between success rates and academic experience levels (odds ratio [OR] 1.39, 95% confidence interval [CI] 0.74-2.62, p = 0.31). For LP procedure, we found statistically significant difference in success rates between the two groups (p< 0.01) and the success rates were associated with participants' academic experience levels (OR 1.37, 95% CI 1.06-1.77, p= 0.02). No difference was observed in success rates between male and female in both procedures.Conclusion: Contrary to our hypothesis, interns performed better than medical students for the LP procedure. The higher success rate in LP is correlated with academic years. Our hypothesis for the Results is that, unlike directly visible US-guided CVC insertion, LP is a blind procedure that is performed only with the help of anatomical landmarks and tactile sensation, which requires detailed anatomical knowledge and skills to apply experiences all together. For achieving better success rate in LP procedure, our study suggests the need of tailored lecture in advance, according to participant's knowledge and ex...