Correlation between Systolic Blood Pressure and Triglyceride Level in the Uzbekistan Population / 이화의대지

Objectives@#: This study aimed to characteristic the systolic blood pressure (SBP), diastolic pressure, pulse pressure, glucose, creatine, and lipid profile. This study also aimed to investigate the prevalence of hypertension and the relationship between hypertension and the lipid profile in Uzbekistan. @*Methods@#The subjects consisted of 58 Uzbekistan subjects recruited from Ewha Medical Care patients. Blood samples were collected from the patients for the lipid profile and random glucose and creatinine levels. Paired t tests were used for the group means and a chi-square or Fisher’s exact test for categorical variables. A multiple logistic regression analysis was performed. @*Results@#Among the 58 patients constituting the baseline population, hypertension developed in 42 patients. Among them, the triglyceride (TG) level was significantly higher in the hypertension group than normal group (173.19 vs. 127.06 mg/dL, P=0.014). The SBP had a positive correlation with the TG (r=0.979, P<0.01) and creatinine (r=0.002, P<0.05) levels and also, the pulse pressure had a positive correlation with the cholesterol level (r=0.539, P<0.05). A multivariate analysis (adjusted for age and sex) indicated that there was a positive correlation between the SBP and TG level (r=0.941, P<0.05). @*Conclusion@#There was a positive correlation between the SBP and TG level in the Uzbekistan population according to this study.

Correlation between Systolic Blood Pressure and Triglyceride Level in the Uzbekistan Population / 이화의대지

Objectives@#: This study aimed to characteristic the systolic blood pressure (SBP), diastolic pressure, pulse pressure, glucose, creatine, and lipid profile. This study also aimed to investigate the prevalence of hypertension and the relationship between hypertension and the lipid profile in Uzbekistan. @*Methods@#The subjects consisted of 58 Uzbekistan subjects recruited from Ewha Medical Care patients. Blood samples were collected from the patients for the lipid profile and random glucose and creatinine levels. Paired t tests were used for the group means and a chi-square or Fisher’s exact test for categorical variables. A multiple logistic regression analysis was performed. @*Results@#Among the 58 patients constituting the baseline population, hypertension developed in 42 patients. Among them, the triglyceride (TG) level was significantly higher in the hypertension group than normal group (173.19 vs. 127.06 mg/dL, P=0.014). The SBP had a positive correlation with the TG (r=0.979, P<0.01) and creatinine (r=0.002, P<0.05) levels and also, the pulse pressure had a positive correlation with the cholesterol level (r=0.539, P<0.05). A multivariate analysis (adjusted for age and sex) indicated that there was a positive correlation between the SBP and TG level (r=0.941, P<0.05). @*Conclusion@#There was a positive correlation between the SBP and TG level in the Uzbekistan population according to this study.

A Delphi study for the application of Korean Triage and Acuity Scale to children

OBJECTIVE: We investigated the opinions of experts to identify problems and prepare an improvement plan when applying the Korean Triage and Acuity Scale (KTAS) to pediatric patients in the emergency department. METHODS: The experts comprised 15 researchers at a pediatric emergency center designated by the Ministry of Health and Welfare and research team members of the Korean Society of Pediatric Emergency Medicine. The first survey was an open-ended question about the problems, application results, and remedies of applying KTAS to children through e-mail. The problems were categorized by topic, and degree of agreement was presented using a 9-point Likert scale. RESULTS: In the first survey, 67% of experts participated and 18 problems were identified. In the second survey, 73% of experts participated and eight problems were identified in four categories, validity, reliability, feasibility and other opinions. All experts pointed out that resources were not considered during pediatric triage in the KTAS. Ninety-one percent of experts said that peak expiratory flow rate measurement and Glasgow Coma Scale evaluation were unlikely to be feasible. Moreover, 91% experts were concerned that the triage level could be distorted if KTAS was interlocked with medical costs. Eighty-two percent of the respondents pointed to the high triage result of febrile children and the difference in pain score between the evaluators, etc. CONCLUSION: Based on the problems pointed out by experts and the reality of Korea's emergency departments, it is necessary to consider revision of KTAS for children.

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and used widely in clinical settings. This paper provides evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining the cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, the cut-off value of at-risk drinking proposed by the World Health Organization was applied and the study sample was divided into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for the AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and the optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under the receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions was increased from one to four. The differences in the AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four, the AUROC increased to a statistically significant level. The cut-off values for the abbreviated versions of AUDIT were similar in South Korea to other countries.

Past, Present, and Future of Ewha Medical Care / 이화의대지

Historically, Ewha University Medical Center roots from Boguyeogwan, which was founded by missionaries in 1887 as the first women's hospital. Inheriting the spirit of missions, Ewha Medical Care (EMC) is an official missionary activity of Ewha Womans University that provide regular mission trips to offer medical services in underdeveloped countries. The first EMC trip was to Nepal in 1989 at the request of Nepalese Sakura Rajbhandary, a graduate of Ewha Womans University Medical School. Mission trips continued to Nepal from 1989 to 2001, and since 2003 mission fields were changed to Cambodia, Vietnam, and Uzbekistan. Since 2014, EMC has sent 3 mission teams to each countries, Cambodia, Vietnam, and Uzbekistan, every year. The final mission of EMC in the future is to establish a missionary hospital in the third world where medical service is in need as Boguyeogwan was established by missionaries to protect and save poor Korean women in the past.

Status and Analysis of the Accidental Out-of-Hospital Deliveries Transferred by Emergency Medical Service Providers

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.

Relationship between Gingival Biotype and Underlying Crestal Bone Morphology

PURPOSE: The purpose of this study was to assess the relationship between gingival biotype and underlying crestal bone morphology in the maxillary anterior region. MATERIALS AND METHODS: The maxillary anterior teeth from 40 subjects (20 thin biotype, 20 thick biotype) with ages from 20 to 50 years were included in this study. All subjects had healthy gingiva in the maxillary anterior region and had no history of orthodontic treatment, periodontal treatment, or hyperplastic medication. Using the probe transparency method, the scalloped distance (SCD) between the contact point-bone crest and the midface-bone crest was measured for each maxillary anterior teeth of two groups. RESULT: The mean SCD was 3.00±0.21 mm in thin biotype and 2.81±0.20 mm in thick biotype. The SCD value in the thin biotype was statistically significantly greater than in the thick biotype (t=2.982, P<0.01). Comparing the degree of crestal bone scallop in each maxillary anterior teeth in the two groups, all six teeth in the thin biotype showed higher bone scallop than in the thick biotype. CONCLUSION: A simple procedure using a probe could to determine gingival biotype and to predict the underlying crestal bone morphology was introduced. This may be useful for effective treatment planning.

Characteristics of Patients Who Visit the Emergency Department with Self-Inflicted Injury

During visits to emergency medical facilities, the primary care of and risk identification for individuals who have attempted suicide is considered an important element in suicide prevention. With the ultimate goal of helping to prevent suicide, the aim of the present study was to determine the characteristics of patients with self-inflicted injuries who presented in the emergency department. Patients with self-inflicted injuries who visited 1 of 3 sentinel emergency medical centers from 2007 through 2009 were included in the study. The characteristics, methods, and reasons for suicide attempts were evaluated. Moreover, predictors of severe outcomes were evaluated. A total of 2,996 patients with self-inflicted injuries visited the three centers during a period of 3 yr. The male-to-female suicide ratio was 1:1.38 (P or = 50 age group. The reasons for attempting suicide varied among the age groups. The predictors of severe outcome are male gender, older age, and not having consumed alcohol.

Changes in Preventable Death Rates and Traumatic Care Systems in Korea

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.

Characteristics of Alcohol-related Injuries in Adolescents Visiting the Emergency Department

Alcohol is frequently a factor affecting emergency department patients, and alcohol consumption is more common among those who are injured. In Korea, the socioeconomic impact of alcohol has been enormous because of traditional permissive attitudes toward alcohol. Juvenile drinking has increased recently; consequently, an increase in alcohol-related injuries is likely in this population. Therefore, we compared the characteristics and severity of alcohol-related injuries in adolescents and adults. All injured patients seen at six EDs throughout 2007 were included. We obtained data from the 'Development of a model for an in-depth injury surveillance system based on the emergency department' surveillance. The proportion of adolescents who drank was 5.0%. No significant alcohol-related difference in injuries was found between male and female adolescents (P = 0.14), whereas in adults, being male was strongly related to alcohol consumption (P < 0.001). Among traffic accidents, motorcycle-related injuries were strongly associated with alcohol use in adolescents (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.09-5.83). Results also indicated that alcohol-related injuries in adolescents showed poor outcomes (OR 2.36, 95% CI 1.47-3.81) as compared with those in adults (OR 1.42, 95% CI 1.26-1.59). Preventive strategy on alcohol-related injuries in adolescents should focus on reducing motorcycle accidents.

A Case of Gastric Rupture after Cardiopulmonary Resuscitation by a Bystander

The presence of a bystander who can implement cardiopulmonary resuscitation would appear to increase chances of survival. However, there have been many reported complications associated with bystander CPR. Gastric rupture is a rare complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. The majority of reported cases have been associated with inappropriate airway management or esophageal intubation. Gastric rupture can occur during chest compressions when the stomach is overinflated due to difficult airway management or esophageal intubation. Here we present the case of a patient with sudden cardiac arrest who experienced gastric rupture and pneumoperitoneum after bystander cardiopulmonary resuscitation.

Fall-Down Injuries in children in Treated at the Emergency Department; Preventable Aspects

PURPOSE: This study was conducted in order to evaluate the epidemiological characteristics of children with fall-down injuries according to age groups and to analyze the major trauma groups that were treated at the emergency room (ER). METHODS: Among 1,222 children under age 6 who were treated at the ER from January 2008 to December 2009, a retrospective study was conducted through examination of medical records. The children were classified by age into 3 groups: infant, toddler, and pre-schooler. In each group, the differences between the causative factors that led to the fall-down injuries were analyzed. Also, ISS (Injury Severity Score) score above 4 was classified as major trauma, and an ISS score 0-1 was classified as a minor trauma. The relationship between major trauma and age group was also analyzed. RESULTS: Through an analysis of child fall-down injuries, men (56.6%), toddler (47.3%), head-related symptoms (72.9%), furniture-related traumas (80.2%), and falls from less than a 1-m height (69.9%) were found to be common factors. Furthermore, in radiological studies, fractures and brain hemorrhages accounted for 16.9% of major traumas, and simple skull fractures were the most common (21.4%). Distributed according to age group, the factors relevant to fall injuries were fall height and head-related symptoms for infants, accident site, fall height and head-related symptoms for toddlers, and accident site for pre-schoolers (p<0.05). Also, head-related symptoms and fall height were independent factors of major trauma in all age groups. However, major traumas (17.3%) were related to dumped trauma, fall height and accident site (p<0.05). CONCLUSION: This study was mainly about head-related injuries, and toddler were most common victims. The relevant factors for the major trauma were falling height for infants, accident site and falling height for toddlers, and accident site, falling height for pre-schoolers.

The Validity of the Quantity of Alcohol Drinking Questionnaire as a Method to Screen Alcohol Drinkers in the Emergency Department: Comparison with the Alcohol Use Disorder Identification Test (AUDIT)

PURPOSE: Many the trauma patients in the emergency department (ED) are associated with drinking alcohol. These patients' alcohol behavior is changed by screening and intervention. Although there are several kinds of screening tools, they are difficult to apply in the ED. The aim of this study to determine whether a brief questionnaire about the quantity of drinking can screen hazardous drinkers in the ED. METHODS: A prospective study was performed in a local emergency medical center from September 2008 to December 2008. We included the trauma patients who were 18 years or older and who were injured less than 6 hours before being admitted to the ED. We compared the results of AUDIT with a brief questionnaire about the quantity of drinking. We were analyzed the difference between patients who were AUDIT positive and heavy drinkers (group 1) and the patients who were AUDIT positive, but they were non heavy drinkers (group 2). RESULTS: A total 516 patients agreed to take the questionnaire. There were 91 AUDIT positive patients and 104 heavy drinkers. There were 71 patients (81.3%) in group 1. The group 2 included 17 patients, including 1 alcohol abusing patient and 2 alcohol dependent patients. Group 1 and group 2 had statistically significant differences for the quantity of drinking and the AUDIT score. CONCLUSION: We could screen hazardous drinkers using the brief questionnaire about the quantity and frequency of drinking compared with the AUDIT in a crowded ED. If we perform brief motivational intervention for these heavy drinkers, it will be effective and reduce the alcohol related problems.

Characteristics of elderly patients with acute poisoning

PURPOSE: Poisoning is a major health problem for the elderly, and poisoning can cause fatal side effects. However, the characteristics and clinical features of elderly patients with acute poisoning have not been well studied in the previous domestic research. So, we tried to analyze the clinical characteristics and toxic substances of the patients who were 65 years old or older and who were admitted to the regional emergency medical center due to acute poisoning. METHODS: We retrospectively reviewed the medical records and poisoning protocols of the patients who were 65 years of age or older and who had with acute poisoning and who visited the ED in our emergency center from January 2005 to December 2009. We collected the demographic information, the gender, the underlying diseases, the causes and toxic substances, the initial presentation, the treatment and the outcomes. RESULTS: A total of 2179 poisoned patients visited the hospital during 5 years, and among them 244 were 65 years of age or older (11.2%). The mean age was 75.6+/-6.9 years and the male:female ratio was 1:1.7. The most common cause of poisoning was suicide (73.4%) and the most common source of poisonous substances was their own drugs. Of the substances used for poisoning, benzodiazepine was the most common drug (25.8%), followed by sedatives other than benzodiazepine (25.4%), insecticide (12.7%), chemical agents (12.3%) and herbicides (8.2%). The most common initial presentation was mental change (64.8%). CONCLUSION: In this Korean study, unlike the foreign studies, the most common cause of poisoning in elderly patients was intentional poisoning. The admission rate was 68.8% and mortality rate was 10.2%.

The Epidemiology of Bicycle Injury in Korea: Patients Who Visited 55 Emergency Rooms

PURPOSE: Bicycle riding is a healthy and cheap form of transportation and a popular form of recreation. This study aims to evaluate the epidemiology and the factors affecting the severity of bicycle-related injuries and to find effective methods for preventing injuries. METHODS: This is a retrospective study of the patients' characteristics, the injury severity, the injury location, the effect of safety equipment on the bicycle injury based on information collected through the NEDIS (National Emergency Department Information System) from 1,284,429 patients who visited 55 emergency rooms nationwide. RESULTS: During the research period throughout 55 emergency rooms 5,671 patients were seen because of bicycle injuries. The male-to-female ratio was 3.1:1, the median age 28 years old, and 42.6% of the patients were younger than 20 years old. Injury sites were mostly in the extremities(46.7%), the head(32.4%), and the face(14%), and 70.3% of severely injured patients had accompanying head trauma. Males aged 65 and older was possibly associated with severe head trauma. Of the patients who provided helmet information 4.8%(71 patients) used helmets, and 95.2%(1392 patients) did not. In this group of patients providing helmet information, none of those wearing helmets died, but 0.4% of those not wearing helmets died. CONCLUSION: In this study, most bicycle injuries occurred in young adult men. From now, there seems to be a need for more effort on publicity activities on bicycle injuries and on the education of children and teenagers, who show a high incidence rate, and of senior citizens (over 65 years old) who show a high severity rate, about using a safety helmet to reduce the severity of injury.

The Impact of Early Hyperventilation on Outcome in Intubated Patients with Traumatic Brain Injuries

PURPOSE: We recommend early aggressive airway management with intubation in patients with severe traumatic brain injuries due to prevent hypoxia and aspiration. Reports exist about increased mortality after pre-hospital intubation, which is caused by hyperventilation. Therefore, we studied the impact of hyperventilation on outcome in patients with traumatic brain injuries. METHODS: This was a retrospective study conducted on 865 patients with traumatic brain injuries obtained from the trauma registry between January 2001 and June 2007. Patients >19 years of age with a GCS< or =13 were selected. We analyzed the impact of hyperventilation within 12 hours on outcome as a function of intubation. We also analyzed the predictors for mortality and poor outcome by logistic regression analysis. RESULTS: One hundred sixty-six patients were included with a mean age of 48.7+/-17.9 years. The mortality rate was 25.9%, and the poor outcome rate was 44.6%. In the hyperventilation group, the poor outcome and mortality rates were higher than in the non-hyperventilation group (66.1% vs 37.5%, p=0.012; 47.2% vs 20.0%, p=0.001). The predictors of mortality for intubated patients was hyperventilation within 12 hours (odds ratio [OR], 5.7; 95% of confidence interval [CI], 1.6~20.5). The predictors of poor outcome for intubated patients was a GCS <8 (OR, 3.9; 95% CI, 1.2~13.3). CONCLUSION: Early hyperventilation is a predictor for mortality in intubated patients with traumatic brain injuries. We should monitor and correct early hyperventilation in intubated patients with traumatic brain injuries.

The Effectiveness of Transvaginal Ultrasonography Performed by Emergency Physicians

PURPOSE: The aim of this study was to examine the diagnostic accuracy and effectiveness of transvaginal ultrasonography (TVUS) performed by emergency physicians (EPs') in the emergency department. METHODS: In this study, female patients with lower abdominal pain who had risks for obstetric and gynecologic diseases were assessed. The accuracy and effectiveness of TVUS performed by emergency physicians was determined by comparing EPs' interpretations of TVUS with the interpretations of TVUS by OGs CT findings, and surgical pathologic results. RESULTS: Forty-one patients were included in the study. The diagnosis was changed in 48.8% of the patients after the TVUS had been performed by an EPs'. When the accuracy of diagnosis was compared pre- and post-TVUS, the accuracy of post-TVUS (80.5%) was higher than the pre-TVUS (39.0%). The agreement between the sonographic findings of EPs' and OGs' was substantial (accuracy=81.3~93.8%; kappa=0.611~0.811; p<0.05). The accuracy of TVUS performed by EPs' in obstetric and gynecologic diseases was 90.6%. The sensitivity and specificity were 100% and 90.9%, respectively, and the positive and negative predictive values were 96.8% and 100%, respectively. CONCLUSION: TVUS performed by EPs' is of considerable help in establishing the correct diagnosis with a high degree of accuracy.

Clinical Characteristics of Acute Zolpidem Intoxication

PURPOSE: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. METHODS: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. RESULTS: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: 0.2~7.4 mg/L). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. CONCLUSION: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

Patients' Experiences in Using Emergency Department Services and Factors Influencing Willingness to Return

PURPOSE: The purpose of this study was to evaluate the experiences of patients who used emergency department services and to analyze the factors which influenced their willingness to use them again. METHODS: The survey was carried out at 17 emergency medical centers for one days, and 509 patients and caregivers answered the questions. The questionnaire was developed through literature review and consultation with professionals. The survey questions addressed the following: duration of residence in ED (emergency department), waiting times, fairness of waiting times, respectfulness from medical staff, explanation of treatment plan, explanation of medical test, explanation of drug prescription, explanation of discharge, ease of asking about treatment, response times to requests for help, respect for privacy, existence of threatening situations and cleanliness of ED. RESULTS: The major factors which influenced patients' willingness to return were duration of residence in ED, fairness of waiting times, respectfulness from medical staff, explanation of drug prescription, ease of asking about treatment, existence of threatening situations and cleanliness of ED. Only education among all demographic and socio-economic factors and clinical outcomes had a bearing on willingness to return. CONCLUSION: The evaluation of patients' experiences is a useful method for gauging the quality of emergency department services. Moreover, specifically focused questions about patients' experiences can greatly contribute to improving the quality of emergency department services.