Hyperkalemia Detection in Emergency Departments Using Initial ECGs:A Smartphone AI ECG Analyzer vs. Board-Certified Physicians

Background@#Hyperkalemia is a potentially fatal condition that mandates rapid identification in emergency departments (EDs). Although a 12-lead electrocardiogram (ECG) can indicate hyperkalemia, subtle changes in the ECG often pose detection challenges. An artificial intelligence application that accurately assesses hyperkalemia risk from ECGs could revolutionize patient screening and treatment. We aimed to evaluate the efficacy and reliability of a smartphone application, which utilizes camera-captured ECG images, in quantifying hyperkalemia risk compared to human experts. @*Methods@#We performed a retrospective analysis of ED hyperkalemic patients (serum potassium ≥ 6 mmol/L) and their age- and sex-matched non-hyperkalemic controls. The application was tested by five users and its performance was compared to five board-certified emergency physicians (EPs). @*Results@#Our study included 125 patients. The area under the curve (AUC)-receiver operating characteristic of the application’s output was nearly identical among the users, ranging from 0.898 to 0.904 (median: 0.902), indicating almost perfect interrater agreement (Fleiss’ kappa 0.948). The application demonstrated high sensitivity (0.797), specificity (0.934), negative predictive value (NPV) (0.815), and positive predictive value (PPV) (0.927). In contrast, the EPs showed moderate interrater agreement (Fleiss’ kappa 0.551), and their consensus score had a significantly lower AUC of 0.662. The physicians’ consensus demonstrated a sensitivity of 0.203, specificity of 0.934, NPV of 0.527, and PPV of 0.765. Notably, this performance difference remained significant regardless of patients’ sex and age (P < 0.001 for both). @*Conclusion@#Our findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.

Analyses of Confirmed COVID-19 Cases Among Korean Military Personnel After Mass Vaccination

Background@#The military was one of the first groups in Korea to complete mass vaccination against the coronavirus disease 2019 (COVID-19) due to their high vulnerability to COVID-19.To confirm the effect of mass vaccination, this study analyzed the patterns of confirmed cases within Korean military units. @*Methods@#From August 1 to September 15, 2021, all epidemiological data regarding confirmed COVID-19 cases in military units were reviewed. The number of confirmed cases in the units that were believed to have achieved herd immunity (i.e., ≥ 70% vaccination) was compared with the number of cases in the units that were not believed to have reached herd immunity (< 70% vaccination). Additionally, trends in the incidence rates of COVID-19 in the military and the entire Korean population were compared. @*Results@#By August 2021, 85.60% of military personnel were fully vaccinated. During the study period, a total of 174 COVID-19 cases were confirmed in the 39 units. More local transmission (herd immunity group vs. non-herd immunity group [%], 1 [0.91] vs. 39 [60.94]) and hospitalizations (12 [11.01] vs. 13 [27.08]) occurred in the units that were not believed to have achieved herd immunity. The percentage of fully vaccinated individuals among the confirmed COVID-19 cases increased over time, possibly due to the prevalence of the delta variant. Nevertheless, the incidence rate remained lower in military units than in the general Korean population. @*Conclusion@#After completing mass vaccination, the incidence rates of COVID-19 infection in the military were lower than those in the national population. New cluster infections did not occur in vaccinated units, thereby suggesting that herd immunity has been achieved in these military units. Further research is needed to determine the extent to which levels of nonpharmacological intervention can be reduced in the future.

Ongoing outbreak of human adenovirus-associated acute respiratory illness in the Republic of Korea military, 2013 to 2018

Background/Aims@#Human adenovirus type 55 (HAdV-55), an emerging epidemic strain, has caused several large outbreaks in the Korean military since 2014, and HAdV-associated acute respiratory illness (HAdV-ARI) has been continuously reported thereafter. @*Methods@#To evaluate the epidemiologic characteristics of HAdV-ARI in the Korean military, we analyzed respiratory virus polymerase chain reaction (RV-PCR) results, pneumonia surveillance results, and severe HAdV cases from all 14 Korean military hospitals from January 2013 to May 2018 and compared these data with nationwide RV surveillance data for the civilian population. @*Results@#A total of 14,630 RV-PCRs was performed at military hospitals. HAdV (45.4%) was the most frequently detected RV, followed by human rhinovirus (12.3%) and influenza virus (6.3%). The percentage of the military positive for HAdV was significantly greater than the percentage of civilians positive for HAdV throughout the study period, with a large outbreak occurring during the winter to spring of 2014 to 2015. The outbreak continued until the end of the study, and non-seasonal detections increased over time. The reported number of pneumonia patients also increased during the outbreak. Case fatality rate was 0.075% overall but 15.6% in patients with respiratory failure. The proportion of severe patients did not change significantly during the study period. @*Conclusions@#A large HAdV outbreak is currently ongoing in the Korean military, with a trend away from seasonality, and HAdV-55 is likely the predominant strain. Persistent efforts to control the outbreak, HAdV type-specific surveillance, and vaccine development are required.

Does delta neutrophil index predict 30-day mortality in patients admitted tointensive care unit via emergency department?

Objective@#A retrospective study was performed to evaluate the usefulness of the delta neutrophil index as a prognosticfactor for mortality in intensive care unit patients admitted via the emergency department. @*Methods@#Patients, who presented to the emergency department and were admitted to the intensive care unit fromJanuary 2018 to August 2018, were reviewed retrospectively. The clinical features, inflammatory marker levels, such asC-reactive protein, lactate, simplified acute physiology score 3, length of stay, and in-hospital mortality were obtainedfrom the medical records. Patients, who visited the emergency department because of trauma or suicidal attempts,arrived after out-hospital cardiac arrest, or were diagnosed with cerebrovascular disease, were excluded. @*Results@#Of the 310 patients included, 65 died during their admission, and 245 patients were discharged after treatment.The receiver operating characteristic curve showed that the delta neutrophil index (area under curve [AUC], 0.72), Creactiveprotein (AUC, 0.70), lactate (AUC, 0.64), and simplified acute physiology score 3 (AUC, 0.79) indicated a lowpredictive power for in-hospital mortality. Whole patients were divided into four subgroups (infectious diseases, cardiovasculardiseases, gastrointestinal bleeding diseases, and others). The receiver operating curve of delta neutrophil indexrevealed infectious diseases (AUC, 0.65), in cardiovascular diseases (AUC, 0.70), and gastrointestinal bleeding diseases(AUC, 0.79). @*Conclusion@#The role of the delta neutrophil index for predicting the prognosis of in-hospital mortality showed equally lowpredictive power for critically ill patients with the C-reactive protein and lactate.

Validation of Glasgow-Blatchford score, Pre-Rockall score, and AIMS65 score to predict active bleeding in patients with upper gastrointestinal bleeding in normotensive patients and suggestion for developing new predictors

OBJECTIVE: The aim of this study was to validate the Glasgow-Blatchford score (GBS), Pre-Rockall score (PRS), and AIMS65 score to predict active bleeding in patients with normotension and upper gastrointestinal bleeding (UGIB), and analyze the variables that can predict active bleeding to help develop new predictive factors. METHODS: Data were collected retrospectively from January 2015 to December 2017. A systolic blood pressure ≥90 mmHg were defined as normotension, and the patients were divided into active bleeding and not-active bleeding groups based on an esophagogastroduodenoscopy and levin-tube irrigation. The GBS, PRS, and AIMS65 of each group were calculated. The receiver operator characteristic (ROC) curve and area under the curve (AUC) were also calculated to obtain the predictive power for active bleeding. Furthermore, the factors that can predict active bleeding were analyzed by multivariate logistic regression. The ROC curve and AUC were calculated using the variables that were adopted as useful factors. RESULTS: Of the 250 patients included, 85 were active bleeding and 165 were not-active bleeding. The ROC curve showed GBS (AUC, 0.54; 95% confidence interval [CI], 0.47–0.61), PRS (AUC, 0.58; 95% CI, 0.50–0.65), and AIMS65 (AUC, 0.51; 95% CI, 0.43–0.59) to have low predictive power for active bleeding. Multivariate logistic regression revealed the lactate (odds ratio [OR], 1.10; 95% CI, 1.01–1.20) and shock indices (OR, 4.15; 95% CI, 1.12–15.40) to be significant predictors of active bleeding. When calculating the probability of predicting active bleeding through these variables, AUC 0.64 (95% CI, 0.57–0.71) showed higher prediction power than the previous scores. CONCLUSION: The conventional scoring systems that predict the prognosis of UGIB showed low predictability in predicting active bleeding in UGIB patients with a systolic blood pressure ≥90 mmHg. Further study suggests the development of new score using factors, such as the lactate and shock indices.

Elastofibroma Dorsi in the Chest Wall: A case report / 대한흉부외과학회지

A 63 year-old woman visited our hospital with a palpable chest wall mass in the infrascapular region. We performed excision of the mass. The mass was histolocally diagnosed as elastofibroma. Elastofibroma is characterized by the proliferation of fibrous tissue with elastin. It is a relatively slow growing benign soft tissue tumor and it is most often found in the infrascapular region. We have experienced a cases of this rare disease and we report on it together with a review of the relevant literature.

Analysis of the Service Quality Provided by Foodserice Workers in Restaurants / 대한지역사회영양학회지

Consistently delivering good service quality is a complex and dynamic process. In this matter, service differs from tangible products and is highly dependent on the business and service provider. Therefore, efficiently managing the process of delivering service quality can contribute to profits for organization and satisfaction to customers. This study was performed to define service quality, and to investigate the personal and operational characteristics that impacts the service quality provided by foodservice provider. The responses from 278 foodservice providers and 427 customers in 82 fast-food and family restaurants were used in this analysis. Descriptive, Factor Analysis, T-test, ANOVA, and Correlation Analysis were used for statistical Analysis. The Results of this study were as follows : 1) The perception of foodservice provider was significantly higher than that of the customers in most of the 21 service quality attributes. 2) The 6 dimensions derived from Factor Analysis explained 56.8% for service quality. 3) Among the personal characteristics of the foodservice provider, the level of education and the position in the job led to a significant difference in some of the service qualities. 4) The type of restaurant played an important role in foodservice providers' perception of service quality. 5) Month since opening had a negative correlation with 'Atmosphere' and a positive correlation with 'Reputation', while the number of seats showed a positive correlation with 'Atmosphere' and a negative correlation with 'Food' and 'Convenience'. 6) In general, the characteristics of sales had a positive correlation with service quality. 7) The proportion of part-time employees showed a negative correlation with 'Atmosphere' and 'Food', and a positive correlation with 'Reputation'.

Examination of the Gap between Customer's Perception and Foodservice Provider's Perception of Service Quality in Restaurants / 대한지역사회영양학회지

A significant gap can exist between what customers expect in foodservice and what service providers deliver to customers. Reducing the gap and enhancing service quality plays a key role in increasing customer satisfaction and repurchase intentions. The purpose of this study was to investigate the personal and operational characteristics that affect the customer perceptions of service quality, to analyze the overall satisfaction and repurchase intention of customers, and to study the service quality gap between customer and foodservice provides. 427 customers and 278 foodservice providers in 82 fast food and family restaurants were surveyed. T-test, ANOVA, Correlation Analysis, and Multiple Regression were used for statistical analysis, The results of this study were as follows: 1) Among the personal characteristics of customers, sex affected the preception of 'General Management' and 'Reputation', and the expense per person showed a correlation with service quality. 2) Among the operational characteristics, the type of restaurant, months since opening, and the number of seats had a significant impact on service quality, while the seat turnover rate showed a negative correlation with service quality. 3) Among the human resource characteristics, the proportion of part-time employees had a negative correlation with service quality, and in general, the training program for full-time employees led to a higher degree of customer perception of service quality. 4) Six dimensions of service quality accounted for 38.39% of customer satisfaction in Multiple Regression. 5) The overall satisfaction of customers willing to repurchase was significantly higher than that of the non-repurchase customers. 6) The operational characteristics explained over 35% for the service quality gap among the customers and the service providers in Multiple Regression.