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Purpose: This study aimed to examine the differences in scores of the Attitude to Patient Safety Questionnaire (APSQ) by medical students before and after the outbreak of COVID-19.Methods: In total, 97 and 118 medical students completed patient safety courses at Yonsei University Wonju College of Medicine in 2019 and 2020, respectively. In 2019, the course was conducted using traditional learning in the classroom, whereas, in 2020, most of the classes were conducted using non-face-to-face learning methods.Results: In 2019 and 2020, 49 and 53 students responded to the APSQ. Only one item “Patients are not really aware of how safe their care is” had a lower score in 2020 than in 2019.Conclusion: Although the total APSQ score did not differ between 2019 and 2020, the students in 2020 might have a poor understanding of the role of patients in medical errors.

This study analyzed the effect of lower back exercise using Web for each age group to use it as nursing intervention. We conducted a randomized experiment with 54 patients with low back pain, composed of 26 middle-aged and 28 older adult people with low back pain who visited a joint center. The participants were instructed to perform the exercise at least twice a day, four times a week. Pain, muscle strength, disability, and quality of life were measured before the exercise intervention, and data were collected again 8 weeks after. The data were analyzed using independent t tests, χ2test, Fisher's exact tests, repeated measures analysis of variance, and paired t tests. The middle-aged and older groups showed differences in pain, muscle strength, disability, and quality of life before and after exercise. In particular, the older group showed statistically significantly larger differences in quality of life compared with the middle-aged group. The results indicated that the effects of the lower back exercises, performed using the Web-based videos, were the same for both the middle-aged and older groups, whereas quality of life showed better improvement in the latter than in the former group. For elderly patients, exercise intervention is an appropriate nursing care to improve the quality of life.

Background This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. Methods We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents’ sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. Results Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. Conclusion For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered., Graphical Abstract

Purpose Brain swelling post-cardiac arrest may affect cerebrospinal fluid volume. We aimed to investigate the prognostic performance of the proportion of cerebrospinal fluid volume (pCSFV) using brain computed tomography (CT) in cardiac arrest survivors. Materials and Methods This retrospective multicentre study included adult comatose cardiac arrest survivors who underwent brain CT scan prior to target temperature management (TTM) from 2015 to 2016. Grey-to-white matter ratio (GWR) and pCSFV values were calculated. pCSFV analysis was performed using automated quantitative analysis programming. The primary outcome was a 6-month neurological outcome. Results Of 251 patients (median age, 57 years), 173 (68.9%) were male, 87 (34.7%) had a shockable rhythm, and 160 (63.7%) had unfavourable neurological outcomes. GWR but not pCSFV was significantly higher in terms of favourable neurological outcomes (p = .015). pCSFV prognostic performances were similar to GWR, and were poor overall, (0.521; 95% confidence interval [CI], 0.446–0.694 vs. 0.515; 95% CI, 0.441–0.589). After adjusting for covariates, pCSFV but not GWR was independently associated with neurological outcome 6 months following cardiac arrest (p = .049). Conclusion pCSFV was independently associated with neurological outcome 6 months following cardiac arrest, however prognostic performance was not good.

Background: In Korea, a new law was enacted in January 2016 allowing life-sustaining treatment (LST) of patients in end-of-life to be stopped, popularly known as the LST Decision Act. It came into effect in February 2018. Since then, brain death organ tissue donation affiliated with emergency physicians has decreased. This study aimed to explore emergency physicians’ experiences of and perspectives toward the impact of the LST Decision Act on brain death in Korea. Methods: A qualitative study was conducted using thematic analysis methods. Ten emergency physicians with experience in brain death, organ tissue donation, and LST were interviewed. Data analysis was performed following the six steps proposed by Braun and Clarke. Results: Data analysis revealed 14 subthemes and 5 themes: 1) The LST Decision Act is a legitimate way to stop LST, but it is not enough; 2) Many family members stop LST first, often more quickly and actively than physicians expect them to; 3) Stopping LST makes the patient more comfortable; thus, caregivers do not wish to opt for organ tissue donation, which is seen as distressing; 4) Not all patients experience brain death, and LST is stopped before brain death; and 5) Since the LST Decision Act, brain death organ tissue donation has decreased. Conclusion: Emergency physicians generally welcomed the LST Decision Act. However, family members seemed to perceive stopping LST as the means to making the patients comfortable, resulting in the loss of potential organ tissue donors. There is a need for a supplementary policy that connects stopping LST to brain death organ tissue donation.

Objective. Excessive daytime sleepiness (EDS) in emergency medicine (EM) residents is associated with patient safety. However, studies regarding EDS in EM residents are limited. The objective of this study was to identify the prevalence of EDS and its associated factors among EM residents. Methods. Epworth sleepiness scale scores, working hours per week (WHW), night working days per month, working environment, and depression were analyzed using data from the 2019 Korean Emergency Medicine Resident Survey. Results. The survey response rate was 63.8% (384/601). Among 241 respondents, the prevalence rate of EDS was 32.4%. Multivariable logistic regression analysis demonstrated that WHW (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01–1.06) and depression (OR = 3.64, 95% CI = 1.91–6.96) had increased ORs for EDS. Conclusions. Approximately one-third of EM residents had EDS. Depression and WHW were the associated factors.

On-demand music streaming has grown remarkably driving the growth in digital to compensate for the decline in downloads. Additionally, Technology and innovation has donated immensely to the Internet architecture and applications of audio streaming services. More recently, the rise in paid music streaming service companies such as Apple Music, MelOn, YouTube Music, Spotify, and SoundCloud was responsible for the increase of the on-demand music streaming services revenue. The rapid birth of these new audio streaming services relied on not only the mobile or online applications but also on the market penetration strategy of companies from different industries motivated to take part of the Music Industry. This comparative study of major music streaming services illustrates the significant impact of on-demand music streaming services on the global growth of the Recorded Music Industry. Additionally, the study underlines Internet technology advancement, connectivity including Wireless, and dynamic and diverse markets as the driving forces behind the rapid growth of on-demand music streaming services. From a practical perspective, this research study provides insights on the current state of the Music Industry and its future direction that can be valuable to new entrants, current market players, investors, stakeholders, and R & D.

The purpose of this study was to investigate grayanotoxin (GTX) levels in the blood of patients with GTX intoxication and in the consumed Rhododendron liqueur, and to determine whether there was an association between blood GTX level and the patient's clinical status.In September 2015, six patients were concurrently presented to the emergency department with various toxicity symptoms, which occurred after the consumption of Rhododendron liqueur at the same toxin concentration. Liquid chromatography-tandem mass spectrometry analysis was conducted on blood samples obtained from six cases of GTX intoxication treated in our emergency department.At the initial evaluation in the emergency department, the mean arterial pressure of the patients ranged from 36.7 to 76.7 mm Hg. The concentrations of GTX-I and GTX-III in Rhododendron liqueur were 1.436 and 16.907 ng/mL, respectively. The initial blood GTX-III and GTX-I levels ranged from 2.9 to 58.0 ng/mL and the lower limit of quantification (LLOQ) to 8.33 ng/mL, respectively. After 20 h, the mean arterial pressure ranged from 76.7 to 93.3 mm Hg, while the blood GTX-III and GTX-I levels ranged from the LLOQ to 17.8 and 2.52 ng/mL, respectively.We estimated that the minimum blood GTX-III and GTX-I levels that caused hypotension were between 17.83 and 27.3 ng/mL, and 2.52 and 4.55 ng/mL, respectively.

The purpose of this study was to develop a Web video designed to promote regular shoulder joint exercise on a continuous basis among patients with shoulder joint disease. This is a methodological research. A shoulder joint exercise video was developed through the five stages of the ADDIE model: analysis, design, development, implementation, and evaluation. The video demonstrates exercises that stretch and strengthen the joints and muscles of the shoulders. Stretching exercises include the pendulum, forward elevation, outer rotation, crossover arm stretch, inner rotation, and the sleeper; strengthening exercises include dumbbell exercises, a chair exercise, wall push-ups, and rowing. This Web exercise video can be used as an educational resource for preventing shoulder joint diseases by middle-aged and elderly people and those seeking to restore shoulder joint function damaged by shoulder joint diseases.

Background No study comparing short message service (SMS) texts and telephone counseling for patients undergoing total knee replacement (TKR) has been reported. Purpose The purpose of the study was to provide postdischarge telephone counseling and SMS texts to TKR patients and to analyze the effects of these services on their knee function (KF), activities of daily living (ADL), and life satisfaction (LS). Methods This study used a randomized clinical trial design. This study was conducted with 40 patients (counseling group: 21; SMS group: 19). In the telephone counseling group and the SMS group, KF, ADL, and LS were assessed before surgery and 1 and 3 months after TKR. Results Telephone counseling and SMS texts have the same effects on KF, ADL, and LS of TKR patients. Conclusion Future research is needed to determine optimal frequency and duration of post-TKR SMS to support patients who have undergone TKR.

Aim The purpose of this study was to analyze the effect of an exercise programme that uses text messages on knee function after arthroscopic knee surgery. Methods This was a quasi-experimental study that used the nonequivalent control group non-synchronized design. A total of 52 adult patients (25 in the experimental group and 24 in the control group). scheduled for arthroscopic knee surgery for meniscal tears were included in the study. The knee injury and osteoarthritis outcome score was used to confirm the effect. The collected data were statistically analyzed using SPSS version 23.0. Repeated-measures analysis of covariance was used to analyze symptoms, activities of daily living (ADL), and knee-related quality of life (QOL). Repeated-measures analysis of variance was used to analyze pain and sports and recreation function. Results Significant differences in symptoms, ADL, sports and recreation function, and knee-related QOL were found according to time and group. Conclusion The use of text messages was effective as a way of promoting exercise after arthroscopic knee surgery.

Autologous fat injection is a common procedure used for skin augmentation. It is known to be safe and simple, but severe complications have been reported at times. The authors observed a patient with acute large cerebral infarction including the territories of the anterior and middle cerebral arteries and optic nerve infarction developing after autologous fat transplantation. A 32-year-old woman was referred to the emergency room of our hospital due to sudden stupor. Thirty minutes earlier, she was undergoing cosmetic autologous fat injection into the glabella area by a plastic surgeon at a private clinic. The cause was confirmed to be anterior and middle cerebral arteries infarction on brain imaging studies. When a patient presents abrupt mental change, hemiplegia, ocular pain, or blindness after autologous fat particle injection, physicians must consider cerebral infarction and combined retinal artery occlusion.

Purpose Organophosphates, commonly used in agricultural pesticides, pose high risks and incidences of poisoning. In the present study, we investigated the relative risk and clinical severity, including laboratory results, of non-oral route poisoning (NORP) patients, compared to oral route poisoning (ORP) patients. Materials and methods A single institutional toxicology database registry was utilized to gain information on clinical laboratory results on organophosphate poisoning patients who visited the emergency department (ED) between January 2000 and October 2016. Clinical outcomes, such as mortality and complication rates, were compared using 1:2 propensity score matching in the total cohort. Results Among a total of 273 patients in our study, 34 experienced NORP. After 1:2 propensity score matching, rates of respiratory complications and mortality were higher in the ORP group than in the NORP group. However, there was no difference in hospitalization time and time spent in the intensive care unit between the two groups. Compared with ORP patients after matching, the relative risk of mortality in NORP patients was 0.34, and the risk of respiratory distress was 0.47. The mean level of pseudocholinesterase was significantly higher in the NORP group than in the ORP group, while recovery rates were similar between the two groups. Conclusion Although the majority of NORP patients were admitted to the ED with unintentional poisoning and the relative risk of NORP was lower than that for ORP, we concluded that NORP is as critical as ORP. Considerable medical observation and intensive therapeutic approaches are also needed for NORP patients.

The purpose of this study to understand collaborative process and the capabilities of the firm impact on innovation performance in convergence environment. To achieve the purpose, research model was empirically tested with a survey from 162 employees from 4 Korea manufacturing companies and 1 USA company. The data obtained from the survey were analyzed using Partial Least Squares (PLS). As a result, collaboration process, learning capability and operation capability have significant and positive impact on innovation performance. It is a meaningful result that the collaboration process improve the innovation performance of firms through the operation capability and the learning capability.

South Korean Government confirmed the creation of competency-centered society as a key national issue and announced development and utilization plan of NCS(National Competency Standards) On May 21, 2013. As a part of the government's plans, they had been developed NCS about 833 jobs by 2014. But Big Data related job, as an emerging job, cannot be seen as a reliable form of job yet. As, at the major industrialized countries and the domestic, education and job competency models of knowledge and skills to take advantage of various types of Big Data have coming, it is a situation that is certainly not settled and more or less in confusion. In this study, for the purpose to present the Big Data Competency reference model for companies and organizations to effectively leverage Big Data, we have presented this reference model and summarized competency elements units such as 20 knowledges and 15 skills of Big Data competency. Key Words : Big Data Competency, NCS(National Competency Standards), Reference Model, Competency Unit Element, Knowledge and Skill

BACKGROUND Early identification of patients with acute diverticulitis who require emergent surgical intervention in the emergency department (ED) is important to the physician. Although computed tomography (CT) has an important role in evaluating the severity of diverticulitis, its findings alone may not predict the need for emergent surgical intervention in all patients with acute diverticulitis in the ED. Serum inflammation markers may help to differentiate severity of acute diverticulitis and predict the need for surgical intervention in clinical practice. No information is currently available on the clinical usefulness of the delta neutrophil index (DNI), with respect to the prediction of emergent surgical intervention in patients with acute diverticulitis at the ED. METHODS This was a retrospective observational study of consecutive adult patients with acute diverticulitis confirmed by CT in the ED, between January 2014 and December 2016. Recruited patients were divided into two groups: emergent surgical intervention and no surgical intervention. The following laboratory serum parameters were examined in the ED: DNI value, C-reactive protein (CRP) levels, white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). The patients were also examined for the presence or absence of complications by CT. RESULTS A total of 132 patients were finally included in the study, with the emergent surgical intervention group constituting 52 patients. The median DNI value, CRP levels, neutrophil count, and NLR were significantly higher in the emergent surgical intervention group than in the no surgical intervention group. The area under the curve for predicting emergent surgical intervention, using the DNI was significantly higher than that of CRP levels, neutrophil count, or NLR. Moreover, the combination of initial DNI and CT was most powerful diagnostic modality. CONCLUSIONS DNI values measured at the ED combined with CT were good predictors for emergent surgical intervention in acute diverticulitis. If the DNI value is greater than 0.7% and complications in CT are suspected in patients suspected to have acute diverticulitis, the need for emergent surgical intervention should be considered carefully in the ED.

Whether coronary artery changes are a main mechanism in the development of carbon monoxide (CO)-induced cardiomyopathy remains unknown. We investigated the effects of coronary artery stenosis on the presence or patterns of cardiomyopathy in CO-poisoned patients with myocardial injury defined as elevation of troponin I.This prospective observational study collected data from consecutive patients who were diagnosed with CO poisoning and myocardial injury during the 24-month study period. Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CCTA) were performed to evaluate cardiac function and coronary artery status.TTE and CCTA were performed in 32 consecutive patients. The observed echocardiographic patterns included non-cardiomyopathy (59.4%), left ventricular global dysfunction (25%), Takotsubo cardiomyopathy (6.3%), and cardiomyopathy matching the distribution of the left anterior descending (LAD) artery (9.4%). Four patients had more than moderate stenosis, while stenoses of the LAD, left circumflex, and right coronary arteries were observed in two (6.3%), three (9.4%), and zero patients, respectively. Patients with coronary artery stenosis did not develop cardiomyopathy except for one patient; this patient also did not have regional wall motion abnormalities (RWMA) matched with the stenosis territory.Because there was no difference in coronary artery stenosis according to the presence or patterns of CO-induced cardiomyopathy, coronary artery stenosis is not the main mechanism for the development of CO-induced cardiomyopathy. Thus, the evaluation of coronary arteries is not necessary in all patients with CO-induced cardiomyopathy unless there is RWMA consistent with ischemic changes in electrocardiograms and elevated troponin I levels.

Aim We previously reported that diffusion-weighted magnetic resonance imaging (DW-MRI) could be used to predict neurologic outcomes before targeted temperature management (TTM) after return of spontaneous circulation (ROSC) from cardiac arrest (CA). We compared the efficacy of brain computed tomography (CT) and DW-MRI to predict neurologic outcome before TTM in comatose cardiac arrest survivors. Methods We performed a retrospective study of CA patients treated with TTM. The brain CT and DW-MRI were both obtained before TTM. We analysed the grey matter to white matter ratio (GWR) on the brain CT and the presence of high signal intensity on DW-MRI, alone or in combination, to predict poor neurologic outcome (CPC 3–5). Results Of 47 comatose CA patients treated with TTM, 39 patients with brain CT and DW-MRI data were included. Median time from the ROSC to the brain CT and DW-MRI was 90 min (52–150) and 175 min (118–240), respectively. There was no significant difference in predicting poor neurologic outcome between average GWR (area under the curve [AUC] 0.891, sensitivity/specificity 78.8%/100%) and DW-MRI (AUC 0.894, sensitivity/specificity 75.8%/100%) (p = 0.963). The combination of average GWR and DW-MRI (AUC 0.939, sensitivity/specificity 87.9%/100%) improved the prediction of poor neurologic outcome rather than each one alone and in other combinations. Conclusion Our preliminary finding suggests that DW-MRI is potentially useful for early prediction of neurologic outcome (i.e., before TTM) in CA patients. The combination of GWR on brain CT and that on DW-MRI, rather than on each modality alone, appears to improve the sensitivity for predicting neurologic outcome after ROSC from CA. Large prospective multicenter studies should be conducted to confirm these results.

Purpose A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. Methods From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. Results Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. Conclusion We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.

Due to recent climate changes that accompany drastic changes in water recycle process, extreme floods and droughts are occurring frequently throughout the world. In response to these events, Smart Water Management that refers to implement intelligent water information systems by IT convergence is considered as a new paradigm. In this study, we seek to explore the Smart Water Management, especially the adoption of Smart Water Grid Technology. We aim to review previous studies to identify factors that influence the adoption of the Smart Water Grid and to analyze the importance and priority of the factors affecting Smart Water Grid adoption, thereby presenting the successful adoption measures for Smart Water Grid in Korea. This study set a research model with the influencing factors in relation to the adoption of new IT technologies that were identified through the literature reviews of previous studies based on the TOE framework. This study also conducted empirical analysis of the findings and found out that the issue of privacy protection and security due to hacker’s attack would be emerged as a significant risk factor.

Objectives This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated. Methods Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers. Results Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 ± 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference. Conclusions We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.

Benign pulmonary tumors are rare, composing less than 1% of pulmonary tumors; of these, hamartomas are the most common. Endobronchial hamartomas are rarer still, composing 1.4% of all pulmonary hamartomas. As therapeutic bronchoscopy has improved, it has replaced conventional operations for resection of endobronchial benign tumors, although there are limitations to the procedure in the case of large tumors causing complete obstruction. The present report describes a case of a large endobronchial hamartoma inducing total lung atelectasis, which was successfully resected using an electrosurgical snare through flexible bronchoscopy. This could be a useful option in select endobronchial tumors.

This study was conducted in order to identify the characteristics of total knee replacement patients and analyze their knee life satisfaction. It surveyed the characteristics and life satisfaction of 60 patients diagnosed with osteoarthritis and waiting for TKR at the Joint Center of a university hospital during April and May in 2015. Collected data were statistically analyzed using SPSS 23.0. 90.4% were female, and the largest age group consisted of people in their 60s. BMI was over 25.0 in 58.3% of the patients. The mean score of life satisfaction was 1.94 out of 3, and it was significantly different according to age. Intensive care of the knee is required for people in their 60s, women, and those with high BMI.

Dapsone is used as an antibiotic for leprosy and for dermatological disorders and may cause methemoglobinemia. The aims of this study are to analyze the clinical characteristics of patients presenting to the emergency department (ED) with dapsone ingestion to identify risk factors associated with mortality.We conducted a retrospective observational study of adult ED patients with methemoglobinemia because of dapsone intoxication admitted to a tertiary care hospital from September 2003 to December 2008. Data collected included demographic, clinical, and laboratory characteristics, as well as survival to discharge. Characteristics of young (less than or equal to 55 years) and older (greater than age 55) patients were compared. The main outcome was in-hospital mortality.There were 46 patients included in the study. The minimum intoxication dose was two 100 mg tablets and the maximum was 100 tablets. Changes in mental status were more common in the older patients. Methemoglobin levels were slightly higher in the younger patients, but both groups were treated with similar doses of methylene blue. Shock and death were more common in the older patients.Late presentation to medical care and an altered mental status at the time of presentation were predictive of death after dapsone intoxication. Methemoglobin levels tended to be higher in those who died.

We investigated the use of ulinastatin in association with the suppression of polymorphonuclear leukocyte elastase (PMNE), tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), and its effects on the prognosis of patients with traumatic hemorrhagic shock. Nineteen patients who visited the emergency department for traumatic hemorrhagic shock were enrolled. Eleven patients were randomly selected to receive a total of 300,000 IU of ulinastatin. Measurements of serum PMNE, TNF-alpha and IL-6 were taken before ulinastatin treatment at 24 hr, two days, three days, and seven days after admission. We compared the Systemic Inflammatory Response Syndrome scores, Multiple Organ Dysfunction Syndrome scores and Acute Physiology, age, Chronic Health Evaluation III scores of the control and ulinastatin groups. There were no significant differences in baseline values, laboratory data, treatment or mortality between the two groups. The serum PMNE levels in the ulinastatin group were lower than in the control group on the second hospitalized day. Serum TNF-alpha and IL-6 levels in the ulinastatin group decreased 24 hr after admission but had no significance. It is suggested that ulinastatin treatment could decrease the serum PMNE levels in trauma patients with hemorrhagic shock at 48 hr after treatment.

Objectives: This prospective observational study was performed to investigate if the hand position used for external chest compressions is in an optimal position for compressing the ventricles during standard cardiopulmonary resuscitation (CPR). Methods: Transesophageal echocardiography (TEE) was performed during standard CPR in 34 patients with nontraumatic cardiac arrest (24 males, mean ± standard deviation [SD] age = 56 ± 12 years). On the recorded image of TEE, an area of maximal compression (AMC) was identified, and the degree of compression at the AMC and the left ventricular stroke volume was calculated. Results: A significant narrowing of the left ventricular outflow tract (LVOT) or the aorta was noted in all patients, with the degree of compression at the AMC ranging from 19% to 83% (mean ± SD = 49 ± 19%). The AMC was found at the aorta in 20 patients (59%) and at the LVOT in 14 patients (41%). A significant narrowing of more than 50% of the diameter at the end of the relaxation phase occurred in 15 patients (44%). On linear regression, the left ventricular stroke volume was correlated with the location of the AMC (R2 = 0.165, p = 0.017). Conclusions: The outflow of the left ventricle is affected during standard CPR, resulting in varying degrees of narrowing in the LVOT and/or the aortic root.

Smart water management is emerging as a new paradigm. Smart water management combines existing water management techniques with cutting-edge IT to enable more sustainable water management. Developed countries have incorporated IT in a broad range of policies governing areas of Social Overhead Capital (SOC), ranging from water management to electricity, transportation, and the environment. As an IT powerhouse, Korea has an advantage in promoting smart water management, but the technologies in this particular field have not kept pace with those in more advanced countries. The Korean government has made a number of attempts to incorporate state-of-the-art IT and establish smart SOC, which is expected to greatly enhance infrastructure efficiency and functions. Water management has been included in SOC initiatives, and the deployment of a "Smart Water Grid" is underway. As a next-generation intelligent water management system, the Smart Water Grid has been well received around the world due to its potential to address dire water shortage problems. However, in Korea, studies on a Smart Water Grid are still at a nascent stage. This study aimed to lay the groundwork for the successful introduction of a new Smart Water Grid system by identifying factors that promote or restrict the adoption of innovative technology, analyze how various factors affect the intention to adopt a Smart Water Grid, and attempt to find a causal relationship between the identified factors and the intention to adopt the new IT system.

PURPOSE Identifying patients' agendas is important; however, the extent of Korean medical students' agenda-setting abilities is unknown. The study aim was to investigate the patterns of Korean medical students' agenda solicitation. METHODS A total of 94 third-year medical students participated. One scenario involving a female patient with abdominal pain was created. Students were video-recorded as they interviewed the patient. To analyze whether students identify patients' reasons for visiting, a checklist was developed based on a modified version of the Calgary-Cambridge Guide to the Medical Interview: Communication Process checklist. The duration of the patient's initial statement of concerns was measured in seconds. The total number of patient concerns expressed before interruption and the types of interruption effected by the medical students were determined. RESULTS The medical students did not explore the patients' concerns and did not negotiate an agenda. Interruption of the patient's opening statement occurred in 4.62±2.20 seconds. The most common type of initial interruption was a recompleter (79.8%). Closed-ended questions were the most common question type in the second and third interruptions. CONCLUSION Agenda setting should be emphasized in the communication skills curriculum of medical students. The Korean Clinical Skills Exam must assess medical students' ability to set an agenda.

Background Understanding the basic qualities of communication between emergency physicians and patients could improve communication in the emergency department. Objective The objectives of this scoping review are to map the literature about the gaps in communication between emergency physicians and patients in the emergency department and make recommendations for further research. Methods A scoping review of literature published since 1980 and written in English was undertaken using the following databases: Pubmed, Scopus, and SocINDEX. The articles were searched for using two-keyword combinations of the following keywords joined by “AND”: “communication,” “patient,” “emergency physician,” “emergency department/emergency room/accident,” and “emergency room.” Seventeen articles were included in the final review. Results Five research issues were covered by the 17 papers: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians' perspectives on communication. Emergency physicians have several communication characteristics: doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients also have several communication characteristics: active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians' difficulties, and factors that contribute to understanding. Conclusions Several conclusions about emergency department communication between patients and emergency physicians were drawn. Additional research is required to consider diverse patient needs in the emergency department. Furthermore, training programs for emergency physicians to improve the quality of communication should be developed and implemented in line with our research findings.

InfiniBand technology is being accepted as the future system interconnect to serve as the high-end enterprise fabric for cluster computing. This paper presents the design and implementation of the InfiniBand system interconnect, focusing on an InfiniBand host channel adapter (HCA) based on dual ARM9 processor cores The HCA is an SoC tailed KinCA which connects a host node onto the InfiniBand network both in hardware and in software. Since the ARM9 processor core does not provide necessary features for multiprocessor configuration, novel inter-processor communication and interrupt mechanisms between the two processors were designed and embedded within the KinCA chip. Kinch was fabricated as a 564-pin enhanced BGA (Bail Grid Array) device using 0.18 CMOS technology Mounted on host nodes, it provides 10 Gbps outbound and inbound channels for transmit and receive, respectively, resulting in a high-performance cluster system.

Aim of the study To develop a clinically relevant and qualitative brain magnetic resonance imaging (MRI) scoring system for acute stage comatose cardiac arrest patients. Methods Consecutive comatose post-cardiopulmonary arrest patients were prospectively enrolled. Routine brain MRI sequences were scored by two independent and blinded experts. Predefined brain regions were qualitatively scored on diffusion-weighted imaging (DWI) sequences according to the severity of the abnormality on a scale from 0 to 4. The mean score provided by the raters determined poor outcome defined under the Cerebral Performance Categories 3, 4, or 5. DWI scans were repeated after therapeutic hypothermia (TH). The same qualitative scoring system was applied and results were compared to the initial scores. Results Out of 24 recruited patients, 19 with brain MRI scans were included. Of the 19 included patients, seven showed a good outcome at hospital discharge and 12 patients showed poor neurologic outcome. Median time from the arrest to the initial DWI was 166 min (IQR 114–240 min). At 100% specificity, the overall, cortex, and cortex plus deep grey nuclei scores predicted poor patient outcome with a sensitivity of 91.7–100% (95% CI). Follow-up DWI scans after TH showed worse results than initial scans. Conclusion A qualitative MRI scoring system effectively assessed the severity of hypoxic-ischaemic brain injury following cardiopulmonary arrest. The scoring system may provide useful prognostic information in comatose cardiopulmonary arrest patients.

The term “virtual enterprise” has been used in articulating the 21 st century global manufacturing enterprise strategy. One of the key requirements is to develop an Information Technology (IT) infrastructure to control the interoperability of the distributed, heterogeneous and concurrent systems of the participating organizations. After describing organizational aspects of virtual enterprises, this article presents an IT infrastructure to help organizing global support for this kind of inter-organizational enterprises with the background of modem information and communication technology. A brief comparison with other works for having referential infrastructure are made.

Lung injury is the main cause of death in acute paraquat (PQ) intoxication. Sivelestat (SV), a neutrophil elastase inhibitor, is effective in reducing inflammation in acute lung injury. The aim of this study was to examine the effect of SV on acute lung injury in PQ-intoxicated rats. Seven-week-old male Sprague-Dawley rats were randomly assigned to four groups: (1) control group (group N; n = 5); (2) PQ + normal saline (group P; n = 6); (3) normal saline + SV (group S; n = 6) and (4) PQ + SV (group PS; n = 6). SV treatment (intraperitoneally [i.p.], 20 mg/kg) was performed 30 minutes after PQ injection (i.p., 100 mg/kg), and injections were continued every hour for a total of five doses. One hour after the last treatment, blood samples were obtained for analysis of interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α). Lung sections were stained with hematoxylin--eosin for light microscopic analysis. Neutrophil infiltration score of group PS was significantly lower than that of group P (p 0.05). But, other scores and total score had no significant differences. IL-6 of group PS did not differ, compared to group P. In addition, there were no differences among the four groups. TNF-α of group PS was reduced, in comparison to the level of group P. SV attenuated neutrophil infiltration in PQ-induced acute lung injury in rats. In addition, systemic inflammation was partially suppressed with SV treatment, suppressing TNF-α production. These results suggest that SV reduces paraquat-induced lung injury, at least partially, by inhibiting neutrophil infiltration and TNF-α secretion.

Background Acute coagulopathy, hypothermia, and acidosis are the lethal triad of conditions manifested by major trauma patients. Recent animal studies have reported that hypothermia improves survival in animals subjected to controlled haemorrhagic shock. The objective of this study was to investigate the effect of hypothermia on coagulation in rats subjected to uncontrolled haemorrhagic shock. Methods Thirty-two male Sprague–Dawley rats were randomly divided into four groups: normothermia (control, group N), hypothermia (group H), hypothermic haemorrhagic shock (group HS), and normothermic haemorrhagic shock (group NS). Haemorrhagic shock was induced by splenic laceration. Capacity for coagulation was measured by rotation thromboelastometry (ROTEM®), and was measured at baseline as well as the end of the shock and resuscitation periods. Survival was observed for 48 h post-trauma. Results Baseline parameters were not different amongst the groups. Rats exposed to hypothermia alone did not differ in coagulation capacity compared to the control group. Clot formation time (CFT) and maximal clot firmness (MCF) in group HS decreased as the experiment progressed. Maximal clot firmness time (MCFt) in groups H and HS was significantly prolonged during shock and resuscitation compared with that in group NS. In group NS, MCF did not change significantly, but MCFt was reduced compared with baseline. Group HS had poor survival when compared with normovolaemic groups. Conclusion Blood clotted less firmly in traumatic haemorrhagic shock, and hypothermia prolonged clotting. However, clot firmness maximised rapidly under normothermic haemorrhagic shock. Haemorrhage would continue for a longer time in hypothermic haemorrhagic shock. Survival of hypothermic shock was not significantly different compared to that of normothermic haemorrhagic shock.

Jeju Island is the most visited spot in South Korea; however, it had the highest death rate in the country due to injury in 2008. We investigated injured patients who presented to an emergency department (ED) in Jeju and compared patients who were visitors with those who were residents of Jeju.A retrospective study was conducted on injured patients visiting the ED at the Jeju National University Hospital from March 2008 to February 2010. The following factors were investigated: demographic data, new injury severity score (NISS), alcohol use, intention of injury, mechanism of injury, place of occurrence, activity when injured, patient outcome, and final mortality.A total of 9,226 injured patients visited the ED during the study: 8,392 residents and 834 visitors (9.04%). The sex ratio and NISS were not different between the two groups. The mean age was younger in visitors (33.96 ± 23.37 vs 30.83 ± 18.79, p0.001). More intentional injuries and alcohol-related injuries occurred in residents than visitors (p0.001 and p0.005, respectively). In both groups, the most common reasons for injury were falling, stumbling, jumping, and being pushed. Visitors had more transportation-related injuries and were injured more often during leisure or play or when traveling. Injuries to visitors occurred more often in commercial, countryside, recreational, and cultural areas. Forty-three deaths were reported, including two visitors who died from suffocation and drowning.To prevent accidents, safety information should be provided for visitors and injury prevention education should be provided for students on school trips and tour guides. Legislation should be passed on the use of protective equipment for motorcyclists and bicyclists. These results support taking measures to decrease the rate of injury among visitors on Jeju Island.

Copyright c 2014, the Korean Thyroid Association. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 메티마졸 복용 후 즉시 발생한 항갑상선제 관절염 증후군 1예

A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.

Background: The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED). Methods: This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves. Results: Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared. Conclusions: Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.

Purpose: The purpose of this study was to demonstrate effects of a critical pathway (CP) for stroke patients seen in emergency rooms (ER). Method: The CP developed by the CP committee consisted of 8 criteria: behavior of doctors a nd nurses, laboratory tests, Image testing, medication, treatment, activity, and nutrition. According to application of CP, a control group (n=17) and experimental group (n=17) were defined. Time was checked by the electronic medical records. Result: Use of CP for stroke patients in the ER, resulted in a decreased length of stay in ER (t=2.341, p=.026), and time required for image testing (t=2.623, p=.021), and an increased number of patients using rtPA (χ 2 =4.802, p=.049). Time required for neurology doctor contact, for neurology doctor to see patient in the ER, and for report of blood tests decreased, but there were no statistical significance. Conclusion: Quick responses are most important in the ER, so CP for these patients is a very effective patient manage ment tool. To reduce delay in stroke diagnosis, continuous education programs for similar symptoms are necessary. CPs for other patients in the ER should be developed, and studies on cost and satisfaction, as well as length of stay, should be done.