Study of Practical Application of Medical Assistants in Burn Center

PURPOSE: Complications and mortality rate of burn injuries are recently decreasing owing to development of systematic and special burn therapy. Whereas we are suffering from the lack of the medical manpower in burn center. In the future we might need more medical assistants to compensate these shortages. In this study we tried to search the path through these difficulties by considering the practical application of medical assistants. METHODS: We compared Korea's current situation of burn treatment with other countries in various references. Also we studied and compared recent situation of medical assistants in Korea and U.S.A. We took special considerations for Korean emergency medical technician, physical therapist and occupational therapist. RESULTS: Our study showed that we are practically using emergency medical technician, physical therapist and occupational therapist as medical assistants in various fields including burn centers. Emergency medical technician, physical therapist and occupational therapist as medical assistants can be excellent medical substitutes for shortage of manpower in our burn centers. Compared with U.S.A's current situation we are quite lacking of certain certified programs for such medical assistants. Burn therapists can be promoted from medical assistants through certain certified educational programs. CONCLUSION: We think that emergency medical technician, physical therapist and occupational therapist, who have certification concerning certain medical experience, should undergo certified educational program for burn therapy and should be used as a actual burn therapists to overcome the shortage of manpower in our burn centers.

The Incidence and Risk Factors of Psychiatric Complications in Electrical Injury

PURPOSE: Electrical injuries may cause many psychiatric complications such as depression, acute stress disorder, post-traumatic stress disorder (PTSD), etc. The purpose is to search the incidence of psychiatric complications in electrical injury and to compare its associated risk factors with other burn and trauma. METHODS: We reviewed the medical records of 709 electrically injured patients who were admitted to Hanil General Hospital from 2002 to 2007. Psychiatric complications were defined as depression, acute stress disorder and PTSD according to DSM-IV. We sorted the medical records into demographics, hospitalization, electrical voltage, injured type, extent or site of burn and type of amputation. RESULTS: Total incidence of psychiatric complications was 27.5% (Depression; 15.8%, acute stress disorder or PTSD; 17.6%). High voltage injured patients had psychiatric complications 2.38 times higher than low voltage. Incidence of psychiatric complications were 1.83 times in 6~10% of BSA, 2.01 times in 11~20% and 2.41 times in 21~30% higher than in 0~5% of BSA. If the site of burn included face, psychiatric complications occurred 1.96 times more than other sites. Patients with history of minor and major amputation showed 2.39 and 7.70 times incidence of psychiatric complications, respectively. CONCLUSION: The risk factors of psychiatric complications were high voltage electrical injury, facial burn, extent of burn and history of amputation. If the patients have risk factors, earlier psychiatric consultation may help to manage the psychiatric complications of electrical injury.

Fibrinogen as Risk Factors for the Coronary Artery Disease

BACKGROUND: This prospective and cross-sectional study was conducted to assess the risk factors for coronary artery disease in the selected Korean Pateints. METHOD: We analyzed clinical parameters and biochemical parameters in 158 subjects; 98 subjects with significant coronary artery disease as proven by coronary angiography(stable angina pectoris : 55, unstable angina pectoris : 30, post-myocardial infarction angina pectoris : 13) and 58 normal subjects as proven by coronary angiography, from November 1993 to April 1994 in Seoul National University Hospital. RESULTS: 1) Old age, male gender, history of diabetes and smoking, high low density lipoprotein cholesterol level, high lipoprotein (a) level and high fibrinogen level were identified and risk factors for coronary artery disease on simple logistic regression analysis. 2) Lp(a) was positively related to fibrinogen(r=0.23), cholesterol(r=0.23) and low density lipoprotein cholesterol(r=0.28). 3) High fibrinogen level, old age, and male gender were independent risk factors of significant coronary artery disease in the selected Korean Population on multiple stepwise logistic regression analysis. CONCLUSION: High fibrinogen level, old age, and male gender six were independent risk factors of significant coronary artery disease in the selected Korean Population of multiple stepwise logistic regression analysis. These findings could not deny the role of cholesterol in coronary artery disease, but suggested that factors related to thrombosis and fibrinolysis, may play more important role in Korean patients coronary artery disease.

Fibrinogen as Risk Factors for the Coronary Artery Disease

BACKGROUND: This prospective and cross-sectional study was conducted to assess the risk factors for coronary artery disease in the selected Korean Pateints. METHOD: We analyzed clinical parameters and biochemical parameters in 158 subjects; 98 subjects with significant coronary artery disease as proven by coronary angiography(stable angina pectoris : 55, unstable angina pectoris : 30, post-myocardial infarction angina pectoris : 13) and 58 normal subjects as proven by coronary angiography, from November 1993 to April 1994 in Seoul National University Hospital. RESULTS: 1) Old age, male gender, history of diabetes and smoking, high low density lipoprotein cholesterol level, high lipoprotein (a) level and high fibrinogen level were identified and risk factors for coronary artery disease on simple logistic regression analysis. 2) Lp(a) was positively related to fibrinogen(r=0.23), cholesterol(r=0.23) and low density lipoprotein cholesterol(r=0.28). 3) High fibrinogen level, old age, and male gender were independent risk factors of significant coronary artery disease in the selected Korean Population on multiple stepwise logistic regression analysis. CONCLUSION: High fibrinogen level, old age, and male gender six were independent risk factors of significant coronary artery disease in the selected Korean Population of multiple stepwise logistic regression analysis. These findings could not deny the role of cholesterol in coronary artery disease, but suggested that factors related to thrombosis and fibrinolysis, may play more important role in Korean patients coronary artery disease.

Serum Creatine Kinase for Early Diagnosis and Evaluation of Reperfusion in Acute Myocardial Infarction

BACKGROUND: Acute myocardial infarction is one of major cardiovascular disease that increases according to the changes of diet and life style. Early diagnosis and treatment of acute myocardial infarction is critical for better prognosis and for reducing mortality. But early diagnosis of acute myocardial infarction is limited by several factors. Recently it was reported that measurements of several serum cardiac enzymes were useful for early diagnosis of acute mocardial infarction. This study was performed to investigate which method of serum creatine kinase measurement is the faster and accurate and whether serum creatine kinase is an early noninvasive predictor of coronary artery patency following thrombolysis in patients with acute myocardial infarction by means of analysis of serial changes in serum creatine kinase. METHODS: This study included 32 patients who had acute myocardial infarction. Serum CK-MB was measured by electrophoretic method and enzymatic immuoasssay method. and compared with EKG and total CK activity which measured by photoabsorbance method. Also we studied whether CK time-activity could be predictor for reperfusion. RESULTS: Immunoassay method accurately measures the serum CK-MB and correlates well with that of electrophoretic method in patients with acute mocardial infarction. Immunoassay method is more sensitive than EKG and has the similar sensitivity to electrophoretic method in diagnosis of acute myoardial infarction. Reperfusion of an occluded coronary artery results in early elevation of serum creatine kinase and CK-MB reflected by earlier appearance time, peak, and onset of clearance. CONCLUSION: Because immunoassay measurement of serum creatine kinase is faster than electrophoresis and requires less technical expertise, it is possible to make diagnosis in patients with acute myocardial infarction in a more timely and cost effective manner and creatine kinase is good predictor of recanalization of an occluded coronary artery after intravenous thrombolytic therapy.

The Association of the Lipoprotein(a) Levels with Age and Sex

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).

The Association of the Lipoprotein(a) Levels with Age and Sex

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).