The Validity of the Triage Tool as a Method to Screen Severe Alcoholic Intoxication Patients in the Emergency Department

PURPOSE: Altered mental status is common to alcohol intoxicated patients, resulting in difficulties to perform detailed physical examination and history taking. With this condition, the development of appropriate tools for evaluation was required. This study was conducted to investigate a better method for predicting the prognosis among alcohol intoxicated patients in the emergency department by modifying the Korean Triage Acuity Scale (KTAS). METHODS: We retrospectively reviewed the medical records of 1,155 alcohol intoxicated patients who presented to the ED between January and December of 2013. The correlation between admission and demographical characteristics of patients was analyzed. We applied the clinical values to KTAS (overdose category) and modified KTAS (alcoholic intoxication category). The efficiency of two triage methods was compared by using the receiver operating characteristic (ROC) curve analysis. RESULTS: Among these 1,155 patients, 201 were admitted and 954 were discharged. The sensitivity and specificity of the overdose category were 0.736 and 0.623, respectively. Those of the alcoholic intoxication category were 0.647 and 0.979, respectively. The area under ROC curves for overdose category and alcoholic intoxication category were 0.679±0.020 and 0.813±0.021, respectively (95% confidence interval, p<0.001). CONCLUSION: This study showed that the sensitivities of the overdose category and the alcoholic intoxication category were similar. However, the specificity of the alcoholic intoxication category was higher than that of the overdose category. Therefore, the alcoholic intoxication category was superior to the overdose category in predicting the prognosis among alcohol intoxicated patients.

Comparative Study of Uses and Characteristics of Emergency Medical Service between Islands and Urban Areas

PURPOSE: Despite the development of transportation, accessibility of medical service on islands is still poor. Therefore, providing adequate emergency medical services is becoming more important. The purpose of this study is to measure and describe utilization patterns of emergency medical services for the residents of islands. METHODS: A retrospective cross-sectional observational study of transported patients who live on islands and in urban areas from January 1st, 2011 to December 31th, 2013 was conducted. Through review of emergency medical technician (EMT) transfer records, the demographic information of transferred patients, the frequency of emergency medical services (EMS) activation, and the characteristics of transfer were collected. RESULTS: A total of 31,690 people were included; 29,064 people of urban areas and 2,626 people of islands. The mean age was older in the residents of islands (66+/-19 years old vs. 50+/-24 years old, p<0.001). For the residents of islands, the landline phone is the most common means of EMS activation (36.4% vs 29.9%, p<0.001), and the highest frequency of EMS activation was June (10.9% vs. 9.0% in August, p<0.001). The distance of transfer was longer for islands (5 min, 2-12) compared with urban areas (3 min, 2-4) (p<0.001). CONCLUSION: The above is an important indicator of specificity and form of urban residents and island residents using the EMS. It is our purpose that efficient EMS service be provided depending on each specificity.

A study of Knowledge Modeling using abstract concepts in Traditional East Asian Medicine / 대한의료정보학회지

OBJECTIVE: This research is focused on modeling the diagnostic knowledge in traditional medicine. Unlike the previous studies which have dealt mainly with the standardized heuristic knowledge for diagnosis, we investigated the logical procedures and a set of source knowledge which the standardized diagnosis has been based on. These procedures and knowledge are related to Yin-Yang principle and their medical derivatives which are believed to interact with the heuristic knowledge for diagnosis through analogical reasoning. METHOD: we analyzed disorders which have been specified in traditional medicine and their signs and symptoms on the diagnostic criteria defined by Korean Institute of Oriental Medicine. Based on the conventional knowledge, all the symptoms were analyzed into elementary abstractive concepts so that we represented their properties by the principles mentioned above. And then we analyzed the procedures to link the disorders to their assigned sign and symptoms. RESULTS: Based on the proposed methodology, the diagnostic knowledge in traditional medicine was represented as rules in our ontology which was written by OpenCyc system. By applying these rules to the properties of the symptoms that have been derived from a patient, the patient's disorder can be determined. And this preliminary algorithm was implemented to be able to obtain a limited diagnostic result for individual patients. CONCLUSION: This research developed an analytic and consequently flexible diagnostic knowledge system for traditional medicine than the previous studies. These results will be extended to developing an analogical reasoning algorithm by the authors. It is also necessary, however, to improve them both by providing more practical diagnostic knowledge in such medicine and by carrying out clinical evaluations.

Development Environment for Automatic Generation of Clinical Data Acquisition System / 대한의료정보학회지

OBJECTIVE: This paper discusses the development environment that automatically generates software intended to execute arbitrarily defined functions. Software that we develop can be regarded as a kind of development environment or development platform, and its purpose is the automatic generation of the clinical data acquisition system that supports arbitrary clinical researches. METHODS: Basically, the clinical data acquisition system consists of the interface, the data storage and the clinical research protocols. Our development environment generates these components automatically according to the ontology written by the end user, e.g. a clinical researcher. A clinical data acquisition system is then generated. RESULTS: Our development environment consists of the interface generation module, the database generation module, the temporary data storage generation module for CDA (clinical document architecture), and the ontologies. Ontology is a method of expressing structured information and can be regarded as a knowledge base serialized by XML format. These ontologies are constructed by domain experts who want a clinical research support system. Ontology describes clinical data items, the interface design and the database schema of a clinical data acquisition system. The development environment parses these ontologies and secures the information on how to generate a clinical data acquisition system. CONCLUSION: This study can be utilized to develop the clinical data acquisition system in oriental medicine.

Prognostic Value of Serum CA 125 Measurment during Chemotherapy for the Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

Serum CA 125 was measured during early chemotherapy in 34 patients from January, 1991 to December, 1994 with ovarian cancer to investigate if serial measurmemts of antigen level could be used as a prognostic parameter. Serum CA 125 was determined after the first, second, and third course of chemotherapy. There was significant correlation between high serum CA 125 levels(>35U/ml) after the third course of chemotherapy and advanced FIGO stage, large residual tumor volume after cytoreductive surgery, but there was no significant correlation with patient age, tumor differentiation, and hitologic type. And high serum level of CA 125 after the third course of chemotherapy was significantly correlate with poor response to chemotherapy(p35U/ml) after the third course had a 0% 5-year survival. This should be compared with a 89.5% 5-year survival in patients who had serum CA 125 level of 35U/ml or less(p<0.0001). As a consequence of this study, chemotherapy of patients with high CA 125 levels after the third course may be discontinued and replaced by other chemotherapy or palliative therapy.

A Case of Marfan Syndrome in Pregnancy with Aortic Root Dilatation / 대한산부인과학회잡지

The Marfan syndrome is a dominantly inherited disorder of connective tissue with multiple system involvement. The cardiac complications of Marfan syndrome in pregnancy which increases the maternal mortality. We experienced one case of Marfan syndrome in pregnancy with mild aortic dilatation, so we report the case and review of literature briefly.

Clinical Analysis of Glaucoma Triple Procedure of Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined with Trabeculectomy

Glaucoma triple procedure of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy which was undergone in 21 eyes(20 cases) since May 1984, were reviewed. The results as follows. 1. In the distribution of sex and age of 20 patients, 16 patients(75%) were male, and seventies, which were most common, were 9 patients(45.0%); fifties, 5; forties, 1; thirties, 1. The average age was 63.9 years old. 2. In type of glaucoma, chronic open angle glaucoma which was most common, were 14 eyes(66.7%); chronic angle closure glaucoma, 5 eyes(23.8%); aphakic glaucoma, 1 eye(4.8%); secondary glaucoma, 1 eye(4.8%). 3. Visual acuity improved in 20 eyes but unchanged in 1 eye, and 14 eyes(66.7%) achieved visual acuity 0.5 or better. 4. Preoperative mean intraocular pressure(IOP)was 20.9mmHg and postoperative mean IOP was 6.1, 4.5mmHg lower than preoperative level at 2 and 6 months res pectively. 5. 2.1 glaucoma medications was needed preoperatively and 0.7, 0.8 was needed at postoperative 2 and 6 months respectively. 6. There were no serious complications that affected the visual acuity. However minor complications were as follows. Hyphema were 4 eyes(19.0%); mydriasis, 3 eyes(14.3%); flat chamber, 1 eye(14.3%); flat chamber, 1 eye(4.8%); cystoid macular edema, 1 eye(4.8%).

A Case of Choroidal Malignant Melanoma

The patient, 54-year-old female, visited our department of ophthalmology because of decreased visual acuity of left eye. The light brown to gray colored mass was visible through clear ocular media, and extensive serous detaclunent of adjacent retina was noticed. Ultrasonograpy showed large smooth smooth ecogenic density extending into vitreous cavity and occupying most of vitreous cavity. Enucleation was performed. The histopatholgical examination revealed malignant choroidal melanoma composed of spindle B type cells and epithelioid cells. Extrascleral invasion was not found.

A Case of Orbital Cavernous Hemangioma

A 40 year-old female was admitted to our hospital because of proptosis for 4 years. Detecting a 2 cm-sized retrobulber mass on computerized tomography, we extracted well capsulated reddish brown mass, which confirmed as a cavernous hemangioma by histologic examination. One year postoperatively, her proptosis was gone, visual acuity was normal, and ocular motility was good.