Analysis of the factors associated with survival to hospital discharge in adult patients with cardiac arrest in the emergency department

Objective@#There is limited data on the outcomes of cardiac arrest occurring in emergency departments (ED). The objective of this study was to identify the factors associated with these outcomes, primarily the survival to hospital discharge and the neurological status at discharge in emergency department cardiac arrest (EDCA) patients. @*Methods@#A retrospective study was conducted in a tertiary hospital. Adult patients aged over 18 years who had suffered an in-hospital cardiac arrest in the ED between July 2018 to June 2021 were included. The primary outcome was the survival to hospital discharge. Descriptive statistics and logistic regression analyses were performed. @*Results@#We identified 157 ED arrests. Among these, 57.9% of the patients died in the emergency room. A total of 24.1% obtained survival discharge. The combined existing illnesses, such as renal insufficiency or malignancy were directly related to the survival of the patients. A cardiac and respiratory cause of arrest increased the probability of survival (P<0.001). The shorter the time spent on cardiopulmonary resuscitation (CPR), the higher the chances of survival (odds ratio of 0.84). The subjects in both the survivor and deceased groups were classified as Korean Triage and Acuity Scale 2 (KTAS 2: emergency) or higher (P=0.719). There was no difference in the ED occupancy, which is an emergency room overcrowding indicator. @*Conclusion@#EDCA patients are already in a clinically deteriorated condition. The underlying clinical conditions, the cause of cardiac arrest, the initial rhythm, and the CPR duration time are directly related to the patient’s chances of survival and prognoses. Therefore, it is possible to identify these factors at an early stage and take the appropriate management measures.

Characteristics of patients transferred from long-term care hospital to emergency department

Objective@#This study was undertaken to assess the appropriateness of transfer of patients from a long-term care hospital to the emergency department (ED). @*Methods@#We conducted a retrospective study in a Wide Regional Emergency Center in Gyeongsangnam-do between January 2019 and December 2019. The patients were divided into groups (direct visit, transferred from other hospitals, and transferred from long-term care hospitals [LTCHs]). The baseline characteristics, Korean Triage and Acuity Scale (KTAS), vital signs, length of stay, ED disposition, cost, clinical outcome, and instances of application of the “Act on decisions on life-sustaining treatment” were collected. @*Results@#A total of 30,142 patients were enrolled during the study period. Twenty-one thousand, nine hundred and sixty-five patients were in the direct visit group, 7,057 patients were transferred from other hospitals, and 1,120 patients were transferred from LTCHs. Hospital admission was higher in cases of transfer from other hospitals and LTCHs (LTCHs, 63.8%; transferred from other hospitals, 64.1%, direct visit, 30.1%; P<0.001). Re-transfer and mortality in the ED were much higher (re-transfer: LTCHs, 11.0%; transferred from other hospitals 3.8%, direct visit 1.9%; P<0.001 and mortality in ED: 2.9%, 0.8%, 1.4%; respectively P<0.001). In the LCTH group after admission, mortality was higher (mortality: 16.2%, 5.4%, 7.1% for LTCH transfers and direct respectively; P<0.001). The implementation rate of the “Act on decisions on life-sustaining treatment”, the well-dying law, was higher in the LTCHs (26.6%, 12.5%, and 11.4% LTCH transfers, and direct respectively; P<0.001). @*Conclusion@#In the LTCH group, re-transfer, mortality, and the implementation rate of the “Act on decisions on life-sustaining treatment” were higher than in the other groups.

Diagnosis and treatment of patients with heat-related illnesses

Heat stress disorders or heat-related illnesses are a kind of physiological damage that occurs when the body cannot dissipate enough heat due to its thermoregulatory dysfunction. This paper aims to summarize the latest information on the diagnosis and treatment of heat-related illnesses. Heat stress disorders come in a variety of forms including heat edema, heat rash, heat cramps, heat syncope, heat tetany, severe heat exhaustion, and life-threatening heatstroke. Major risk factors may include excessive exercise, continuous exposure to high temperatures or humid environments, lack of acclimation, excessive clothing or protective equipment, obesity, and dehydration. Additional risk factors may include the patientʼs existing medical condition, environmental and personal factors, and the use of various drugs. Mild heat-related illnesses can be treated only by supportive care such as moving patients to a cool place and laying them in a supine position while elevating their legs and loosening their clothes. However, in the case of heatstroke, quickly lowering the body temperature is an essential in reducing the mortality rate. The most effective cooling method is to immerse the entire body in ice cold water.

The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea

Background@#Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea. @*Methods@#This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients. @*Results@#A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00–24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5–10] vs. 8 [6–11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592–0.995) for survival at admission and 0.693 (95% CI, 0.446–1.077) for survival to discharge were found. @*Conclusion@#During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.

Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea / 보건의료교육평가

Purpose@#Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. @*Methods@#This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. @*Results@#The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. @*Conclusion@#Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

Diagnosis and treatment of patients with heat-related illnesses

Heat stress disorders or heat-related illnesses are a kind of physiological damage that occurs when the body cannot dissipate enough heat due to its thermoregulatory dysfunction. This paper aims to summarize the latest information on the diagnosis and treatment of heat-related illnesses. Heat stress disorders come in a variety of forms including heat edema, heat rash, heat cramps, heat syncope, heat tetany, severe heat exhaustion, and life-threatening heatstroke. Major risk factors may include excessive exercise, continuous exposure to high temperatures or humid environments, lack of acclimation, excessive clothing or protective equipment, obesity, and dehydration. Additional risk factors may include the patientʼs existing medical condition, environmental and personal factors, and the use of various drugs. Mild heat-related illnesses can be treated only by supportive care such as moving patients to a cool place and laying them in a supine position while elevating their legs and loosening their clothes. However, in the case of heatstroke, quickly lowering the body temperature is an essential in reducing the mortality rate. The most effective cooling method is to immerse the entire body in ice cold water.

The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea

Background@#Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea. @*Methods@#This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients. @*Results@#A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00–24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5–10] vs. 8 [6–11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592–0.995) for survival at admission and 0.693 (95% CI, 0.446–1.077) for survival to discharge were found. @*Conclusion@#During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.

Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea / 보건의료교육평가

Purpose@#Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. @*Methods@#This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. @*Results@#The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. @*Conclusion@#Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

Appropriateness of Korean Triage and Acuity Scale-based triage system for dizziness without neurologic symptoms

Objective@#This study aimed to identify the appropriateness of the Korean Triage and Acuity Scale (KTAS) for dizziness without neurological symptoms, which was level 3. @*Methods@#Using the registry of the National Emergency Department Information System (NEDIS), data regarding consecutive emergency patients from January 2016 to July 2018, who were aged 15 years and older, were reviewed retrospectively. The data were classified using KTAS and Dizziness KTAS level 3 were compared with non-dizziness KTAS level 3 including age, total admission rate, intensive care unit (ICU) admission rate, discharge rate, hospital cost, and length of stay in the emergency department (length of stay [LOS]). @*Results@#Of the 76,153 emergency patients, 345 (0.5%) had a KTAS level 1, 4,593 (6.0%) had a KTAS level 2, 21,561 (28.3%) had a KTAS level 3, 45,390 (59.6%) had a KTAS level 4, and 4,264 (5.6%) had a KTAS level 5. As the patient’s triage score decreased, the total admission rate, ICU admission rate, hospital cost, and LOS decreased. Patients discharged to home also had the same result. Dizziness KTAS level 3 had a significantly lower rate of total admission (23% vs. 56.2%, P<0.001) and ICU admission (0.9% vs. 6.2%, P<0.001) compared with non-dizziness KTAS level 3. On the other hand, the hospital cost and LOS were higher when patients were discharged to their home. The predictors of the admission rate of dizziness KTAS level 3 were the transportation method using a private ambulance service and older age, but older age was only slightly associated. @*Conclusion@#This study showed that KTAS level 3 for dizziness needs to be adjusted because of lower severity than other level 3. Old age and the transportation method should be considered factors.

Effect of vasopressin on prognosis in sepsis shock

Objective@#This study analyzed the relationship between the timing of vasopressin treatment and the prognosis ofpatients with septic shock. @*Methods@#Patients who were admitted to a university hospital for one year using vasopressin were studied retrospectively.All records were collected through the medical records; several factors were studied to determine the prognosis of thepatient. The 24-hour, 48-hour mortality, and hospital mortality were examined. The difference in the timing of vasopressinadministration between death and survival patients was analyzed to determine the effect of the vasopressor on the survivalrate using the receiver operating characteristic (ROC) curve. @*Results@#The general characteristics of the patients in the hospital and survivors were similar. Vasopressin infusion wasfaster in the surviving patients than in the death patients, but there was no significant difference (survival, 187.0 minutes;interquartile range [IQR], 95.0-548.0 minutes vs. death, 285.5 minutes; IQR, 92.7-739.2). To determine the effect of vasopressorinjection on the survival rate, the ROC curve was drawn, and the area under curve was not affected significantlyby norepinephrine (NE) 0.416 and vasopressin 0.529. In addition, the duration of the ventilator application was found toincrease with increasing NE injection period in survivors (period of application of ventilator: NE injection time, r=0.460,P=0.048; vasopressin, r=0.369, P=0.120). @*Conclusion@#The prognosis was similar regardless of the timing of vasopressin in patients with septic shock.

A survey of work status of a local emergency medical services (EMS) personnel and the perception between EMS personnel and medical directors about on-line medical oversight

Objective@#This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. @*Methods@#A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. @*Results@#The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). @*Conclusion@#There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

A survey of work status of a local emergency medical services (EMS) personnel and the perception between EMS personnel and medical directors about on-line medical oversight

Objective@#This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. @*Methods@#A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. @*Results@#The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). @*Conclusion@#There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

The influence of symptom to balloon time in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVE@#The current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommends early reperfusion with a door to balloon (DTB) time of 90 minutes or less in patients undergoing primary percutaneous coronary intervention (PPCI). Therefore, the focus of most studies has been the DTB time. On the other hand, the ischemic time is related to the symptom to balloon (STB) time rather than the DTB time. This study examined the clinical effects of the STB time as well as the social and clinical factors affecting the STB time in STEMI patients.@*METHODS@#This study analyzed 286 patients diagnosed with STEMI from December 2008 to December 2016. The STB time (≤4 hours and>4 hours, ≤12 hours, and >12 hours) in the groups was compared. The mortality and ejection fraction were investigated. In addition, the characteristics of patients and socioeconomic factors affecting STB were analyzed.@*RESULTS@#The SBT time is inversely associated with the ejection fraction (R=−0.126, P=0.033), and the ejection fraction of the ≤12 hours group was higher than that of the >12 hours group (54% vs. 50%, P=0.047). On the other hand, there was no significant difference in mortality between the two groups (3.26% vs. 4.84%, P=0.506). In multivariate analysis, the variable related to SBT was only typical chest pain (adjusted odd ratio, 1.931; 95% confidential interval, 1.014-3.792; P=0.045).@*CONCLUSION@#The results of the study support the prognostic value of SBT in STEMI undergoing PPCI. Therefore, efforts should be made to shorten the STB time.

Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study

BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.

Impact of interhospital transfer on outcomes for trauma patients: impact of direct versus non-direct transfer

OBJECTIVE: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). METHODS: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. RESULTS: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. CONCLUSION: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

Alterations in Spontaneous Movement, Corticosterone, and Cytokines in Mice Exposed to 835 MHz Radiofrequency Radiation / 체질인류학회지

Although commercialization of mobile phones has raised much concerns about the effects of radiofrequency radiation on the human body, few experimental studies have been conducted on the effects of radiofrequency radiation on physiological homeostasis, immune and inflammatory responses. Therefore, we presently investigated the effect of 835 MHz radiofrequency radiation on spontaneous wheel exercise, hormone and cytokines levels in the plasm of mice. Mice were divided into 4 groups as control, exercise, radiofrequency radiation, radiofrequency radiation & exercise group. The body weight, corticosterone and blood cytokine levels were checked for 10 weeks. Followed by the exposure to radiofrequency radiation for 6 hours a day, the more increase in body weight was observed in the radiofrequency radiation & exercise group than in the spontaneous exercise group. When the amount of spontaneous exercise was measured for 10 weeks, the amount of exercise was increased in the both control and spontaneous exercise group, while the amount of exercise was decreased in the radiofrequency radiation group. To determine whether the homeostasis, immune and inflammatory responses are indirectly affected by radiofrequency radiation exposure, IL-1β, IL-6, IL-12 (p70), TNF-α, IFNγ, and GM-CSF were measured by ELISA kit, respectively. As a result, the blood levels of IL-6, IL-12 (p70) and TNF-α in the spontaneous exercise group were higher than that of control group, and each cytokine levels in the radiofrequency radiation & exercise group were lower than that of control group. However, the corticosterone, IL-1β, IFNγ and GM-CSF didn't show statistically significant differences in all groups. It has been confirmed that exposure to high frequency electromagnetic waves for a long time can affect the amount of exercise, body weight, and some inflammatory cytokines such as IL-6, IL-12 (p70) and TNF-α.

Usefulness of ultrasonography for the evaluation of catheter misplacement and complications after central venous catheterization

OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.

Factors affecting the urologist’s decision to administer ureteral stone therapy: a retrospective cohort study

OBJECTIVE: We aimed to evaluate the factors influencing treatment option selection among urologists for patients with ureteral stones, according to the stone diameter and location. METHODS: We retrospectively reviewed the records of 360 consecutive patients who, between January 2009 and June 2014, presented to the emergency department with renal colic and were eventually diagnosed with urinary stones via computed tomography. The maximal horizontal and longitudinal diameter and location of the stones were investigated. We compared parameters between patients who received urological intervention (group 1) and those who received medical treatment (group 2). RESULTS: Among the 360 patients, 179 (49.7%) had stones in the upper ureter and 181 (50.3%) had stones in the lower ureter. Urologic intervention was frequently performed in cases of upper ureteral stones (P<0.001). In groups 1 and 2, the stone horizontal diameters were 5.5 mm (4.8 to 6.8 mm) and 4.0 mm (3.0 to 4.6 mm), stone longitudinal diameters were 7.5 mm (6.0 to 9.5 mm) and 4.4 mm (3.0 to 5.5 mm), and ureter diameters were 6.4 mm (5.0 to 8.0 mm) and 4.7 mm (4.0 to 5.3 mm), respectively (P<0.001). The cut-off values for the horizontal and longitudinal stone diameters in the upper ureter were 4.45 and 6.25 mm, respectively (sensitivity 81.3%, specificity 91.4%); those of the lower ureter were 4.75 and 5.25 mm, respectively (sensitivity 79.4%, specificity 79.4%). CONCLUSION: The probability of a urologic intervention was higher for patients with upper ureteral stones and those with stone diameters exceeding 5 mm horizontally and 6 mm longitudinally.

Analysis of Prognostic Factors Affecting Admission in Acute Alcohol-intoxicated Patients with Traumatic Brain Injury Visiting Emergency Room

PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.

Comparison between an instructor-led course and training using a voice advisory manikin in initial cardiopulmonary resuscitation skill acquisition

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.