Comparison of Clinical Outcomes between Arthroscopic Anterior Compartment Debridement with Posterior Compartment Mini-Open Debridement and Arthroscopic Both Compartments Debridement of the Primary Elbow Osteoarthritis / 대한정형외과학회잡지

Purpose@#This study analyzed the effectiveness of arthroscopic anterior compartment debridement with posterior mini-open debridement in patients with mild or moderate primary elbow osteoarthritis (OA). The clinical results of arthroscopic anterior compartment debridement with posterior mini-open debridement were compared with that of arthroscopic both compartments debridement. @*Materials and Methods@#Between January 2010 and December 2016, 46 patients diagnosed with elbow OA underwent arthroscopic anterior compartment debridement with posterior mini-open debridement or arthroscopic anterior and posterior compartments debridement arthroscopic surgery. Of these, 27 patients were finally included in this study. The data were collected retrospectively from the medical records. The subjects were divided into two groups according to the surgical procedure: group 1 (n=16) received arthroscopic anterior compartment debridement with posterior mini-open debridement surgery, and group 2 (n=11) received arthroscopic anterior and posterior compartments debridement surgery. The elbow flexion-extension range of motion (ROM), visual analog scale (VAS), Mayo Elbow Performance Score (MEPS) were analyzed for the clinical outcome before surgery and the last follow-up visit after surgery. @*Results@#The average follow-up period was 21 months (15–32 months). All clinical outcomes (ROM, VAS, and MEPS) were improved after surgery compared to those before surgery (p<0.05) in both groups. Group 1 showed further improvement in flexion (p=0.001) and total ROM (p=0.011) than group 2. On the other hand, there was no significant difference in extension, VAS, and MEPS between the two groups. @*Conclusion@#In patients with primary elbow OA, arthroscopic anterior compartment debridement with posterior compartment mini-open technique produced an excellent clinical outcome after surgery and was particularly helpful in increasing flexion and the total ROM.

The Correlation between Stool Exams and Abdominal Computed Tomography (CT) Findings in the Patients with Acute Diarrhea Visiting Emergency Department (ED)

PURPOSE: Stool exams are a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the Emergency Department (ED). CT scans are often used to increase the physician's level of certainty and to facilitate patient triage by identifying the source of pain in most patients with an acute abdomen in the ED. This study was designed to investigate the correlation between stool exams and abdominal CT in patients with acute diarrhea visiting the ED. METHODS: We conducted a retrospective study in the emergency department of a national university hospital from January 1, 2012 to June 30, 2013. The subjects consisted of 156 patients with acute diarrhea and abdominal pain who had stool exam results and abdominal CT findings. We divided the patients into three groups according to the stool exam results. Simultaneously, we evaluated their CT findings of the bowel and adjacent structures. RESULTS: A total of 156 patients were enrolled. Frequency of abnormal CT findings showed statistically significant correlation with stool exams (p-value <0.001). Abnormal CT findings increased as WBCs and RBCs in stool increased (p-value <0.001). CONCLUSION: The stool exam was a statistically significant predictive variable in indirectly determining the severity of acute diarrhea and it showed correlation with the frequency of abnormal CT findings. It is suggested that stool exams can be used as a susceptible marker for predicting the probability of severe infectious colitis, and for making an early decision regarding close medical attention.

Usefulness of Immediate W-plasty in the Emergency Department for Minimizing Scar Formation: Results from a Short-term Follow-up

PURPOSE: Facial scars are a main complaint of patients who had undergone suture in the emergency department. Therefore, effective techniques for minimizing scar formation are required. W-plasty, a widely used method of scar correction, has been performed to change the scar direction or divide it into multiple segmented scars. This method can be applied in the initial stage of wound repair in the emergency department. The aim of this study was to investigate the effectiveness of direct application of W-plasty to the wound in simultaneously accomplishing the aforementioned objectives. METHODS: This was a prospective study, from June 2012 to June 2014. Either simple debridement or W-plasty for facial laceration was performed in 31 patients. In patients in the simple debridement group, the excision was made along the laceration margin. In patients in the W-plasty group, the excision was made within the W-form predesigned margin of the laceration. The prognosis was evaluated using the Stony Brook scar evaluation scale (SBSES). RESULTS: Among 31 patients, 15 underwent simple debridement and 16 underwent W-plasty. In procedure time, there was no significant difference between the two groups. No complications were observed in either group. The median SBSES score was 4 (IQR, 3-4) in the simple debridement group and 5 (IQR, 5-5) in the W-plasty group, indicating a significant difference between the two groups (p<0.001). CONCLUSION: We achieved good results of direct W-plasty application to wound lacerations in terms of minimal scar formation. Thus, for patients with facial lacerations, we suggest that application of W-plasty to the wound debridement is more effective than the classic simple debridement.

Task and Time Analysis of Intern Physicians in the Emergency Department: Multicenter Cross-sectional Study

PURPOSE: This study was conducted in order to describe how intern physicians in the emergency department (ED) spent their time, and the frequency of tasks performed by them. METHODS: This was an observational, time-motion study for 15 intern physicians in 15 emergency centers. Observers in each hospital shadowed interns for a 60-minute period, two times, both day and night shift. They recorded time spent on various activities, type and number of activities. The proportion of activity that can be replaced by other staff members was calculated. RESULTS: Average number of duty hours of interns was 80.9 hours (63~87.8) per week. A total of 662 activities were observed during 30 hours. Interns' activities were classified as direct patient care 28.2%, personal time 24.2%, documentation 17.0%, procedures 16.7%, communication 8.1%, transportation 2.6%, indirect patient care 2.0%, learning activity 0.8%, and administrative work 0.4%. The proportion of procedural task showed negative correlation with the number of emergency medical technicians (r=-0.710, p=0.003). The proportion of activity that can be replaced by staff members other than doctors was 24.3% (0~47%) of time, except personal or learning activity. CONCLUSION: Results of this study showed that only 24.3% of interns' activity in the emergency department could be replaced by staff members other than doctors. Because the proportion of activities that could be replaced was variable among hospitals, each hospital should perform task analysis of interns' activity in order to forecast alternative manpower.

A Comparative Study of Tissue Injury Grades, with Clinical Factors, in Patients with Hydrofluoric Acid Burns who Received Intra-arterial Infusion of Calcium Gluconate

PURPOSE: Hydrofluoric acid (HFA) causes injury via tissue penetration by the free fluoride ion. Methods for treatment of HFA burns include continuous intra-arterial infusion of calcium gluconate, which is especially useful for patients with dermal burns of the digits caused by HFA. However, no comparative study of tissue injury grade with clinical factors among patients with HFA burns treated with continuous intra-arterial infusion of calcium gluconate has been conducted in Korea. METHODS: We conducted a prospective study at the emergency department of a university teaching hospital between January 2011 and June 2013. The subjects enrolled in this study consisted of 33 patients with HFA burns. After completion of treatment, we divided the patients into three groups according to the type of skin lesions. Patients requiring a skin graft or surgical flap were included in the poor outcome group, those who had to undergo incision and drainage in the moderate outcome group, and those who did not require further treatment in the good outcome group. RESULTS: After completion of all treatments, 22 of the 33 patients were included in the good outcome group and seven in the moderate outcome group; the remaining four patients were included in the poor outcome group, as they met the above-mentioned criteria, experienced longer-lasting pain, and were more frequently treated with injection in comparison with the other patients. CONCLUSION: Patients with HFA burns with long-term pain who need frequent arterial injections despite undergoing intra-arterial calcium gluconate treatment are likely to have poor outcome; therefore, they require more proactive interventions.

A Case of Chemical Pneumonitis with Gastrointestinal Disturbance Caused by Nitric Acid Inhalation

Nitric acid is a typical strong acid that is colorless, corrosive, and flammable. It is often used for industrial purposes, such as refining, metal cleaning, and electroplating. In Korea, some cases of chemical pneumonitis from nitric acid poisoning have been reported, but to our knowledge, there have been no reports of diarrhea caused by nitric acid poisoning. A 42-year-old man visited a nearby hospital because of continuous diarrhea, coughing, and dyspnea after inhaling nitric acid fumes at his workplace the previous day. He was transferred to our hospital and admitted to the intensive care unit. He showed tachypnea and hypoxemia in our emergency department. Initial chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient showed improvements in clinical symptoms and on chest radiographs after receiving oxygen and mechanical ventilation, antibiotics, and systemic glucocorticoid therapy. After 20 days he was discharged and showed no symptoms and sequelae on his 1-year follow-up.

The Influence of Rotation Order on Medical Students' BLS Performance during the OSCE Examination

PURPOSE: An objective structured clinical examination (OSCE) is an examination made up of a series of stations through which the candidate rotates to test clinical skill performance. This study was conducted to evaluate whether the testing ability changed and the basic life support (BLS) performance was influenced during the OSCE as a function of the time elapsed during the rotations. METHODS: Candidates rotated around the 10 stations in 6 groups lasting 6 minutes each, for a total examination period of approximately 1 hour. For our analysis, 58 third-year medical students were divided into four groups by testing order; early, early-middle, late-middle, and latter. BLS performance scoring consisted of 50 points with 13 question items. We also analysed their objective BLS performance by Resusci(R) Anne Skill Report TM scoring results. RESULTS: The total OSCE scores of each group were 404.8 +/-28.5, 395.8+/-18.7, 386.0+/-20.9, and 386.3+/-39.5 (p=0.187), respectively. The station scores were as follows: 40.8+/-5.4, 36.6+/-7.2, 34.2+/-6.1, and 33.7+/-6.2 for total BLS examination score (p=0.008), respectively; 2.5+/-2.6, 5.0+/-0.0, 4.7+/-1.2, and 5.0+/-0.0 for performance of sequence (p=0.000), respectively; 43.0+/-23.7%, 47.2+/- 17.6%, 12.7+/-2 2.0%, and 16.8+/-21.4% for adequate ventilation (p=0.000), respectively; and 77.3+/-21.5%, 62.8+/- 46.1%, 52.4+/-22.4%, and 31.3+/-36.1% (p=0.003) for adequate compressions, respectively. The general performance- related variables were lesser points in the early group. As the test progressed, accuracy decreased conspicuously in the middle groups. However, accuracy rose again, but fatigue-related scores were deteriorated in the latter group. CONCLUSION: According to our study, the rotating order has exerted a strong influence on medical students' BLS performance and examination scores. Therefore, we should consider score distribution in the performance evaluation and accuracy of items to according to the rotation order during the OSCE examination.