Search

Introduction: Previous studies have revealed that vascular access resistance is constant during hemodialysis, but differs according to vascular access type. It is possible that intra-access flow volume (Qac) variation during hemodialysis may also differ according to vascular access type. We conducted this study to investigate whether there are differences in Qac according to vascular access type during hemodialysis. Methods: A total of 58 lower-arm arteriovenous fistula, 14 lower-arm arteriovenous graft, 27 upper-arm arteriovenous fistula, and 45 upper-arm arteriovenous graft cases were studied. Three consecutive Qac values (at 30, 120, and 240 min after the start of hemodialysis) were measured in each patient by the ultrasound dilution technique. Variations in Qac over time were analyzed using repeated measures analysis of variance and multivariate regression analyses, to assess the impact of different factors on Qac variation. Results: The repeated measures analysis of variance revealed that a significant interaction exists between time and vascular access type (p Conclusion: This study showed that there is a significant difference in Qac variation according to vascular access type during hemodialysis and that arteriovenous graft (vs arteriovenous fistula) and the lower-arm location (vs upper arm) were associated with a decrease in Qac during hemodialysis. This suggests that consideration of vascular access type is required to minimize Qac variation during hemodialysis.

Summary Background CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults. Methods We did this pragmatic, multicentre, randomi s ed controlled non-inferiority trial at 20 South Korean teaching hospitals with little experience with low-dose CT. Patients aged 15–44 years with suspected appendicitis were randomly assigned (1:1), via computer-generated random assignments (permuted block sizes of two, four, six, and eight) concealed in sequentially numbered envelopes, to receive low-dose CT (2 mSv) or standard-dose CT (≤8 mSv). Randomisation was stratified by site. Group allocation was concealed from patients, outcome assessors, and adverse event adjudicators; care providers, site pathologists, and data collectors were aware of allocation. The primary endpoint was the negative (unnecessary) appendectomy rate among all appendectomies, with a non-interiority margin of 4·5% for low-dose versus standard-dose CT. Primary analy s is was by modified intention to treat, which included all patients who received an appendectomy in the group to which they were assigned. This trial is registered with ClinicalTrials.gov, number NCT01925014. Findings Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group. Interpretation Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future. Funding Korea Health Industry Development Institute, Seoul National University Bundang Hospital, Dasol Life Science, and Bracco Imaging Korea.

Many universities have started to adopt online programming tools to support students’ programming practice, yet the services currently offered by the existing tools are somewhat passive with respect to considering a student’s programming skill level and providing appropriate code questions. To enhance students’ learning experience and improve their programming skills, it would be helpful to examine students’ programming abilities and provide them with the most suitable code questions and guidelines. Machine learning can play a role in modeling the level of students’ programming skills as well as the difficulty of questions by taking the students’ programming experience and code submissions into account. This paper presents a study on the development of machine learning models to classify the levels of students’ programming skills and those of programming questions, based on the data of students’ code submissions. We extracted a total of 197 features of code quality, code readability and system time. We used those features to build classification models. The model for the student level (four classes) and the question level (five classes) yielded 0.60 and 0.82 F1-scores, respectively, showing reasonable classification performance. We discuss our study highlights and their implications, such as group and question matching based on code submissions and user experience improvement.

Background/Aims The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Methods Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. Results We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Conclusions Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

Professional female free divers (Haenyeo) in Korea have been exposed to breathing in the water without any respiratory equipment and are increasingly aging. However, data on their general health status are scarce. A total of 733 electronic medical records of 480 professional female free divers who visited the emergency department from July 2012 to June 2013 were analyzed. Their mean age was 74.3 years, and 87.4% were 65 years or older. Most women had one or more comorbid conditions and were taking medication. The most common discharge diagnosis based on the International Classification of Disease-10 was symptomsand abnormal clinical and laboratory findings. Furthermore, 12.3% had a discharge diagnosis related to injury, and almost half of the injuries were caused by slip down. Older professional female free divers were more likely to have comorbid conditions and take medication, and have discharge diagnoses related to slipdown injury, and digestive, respiratory, and circulatory conditions more frequently. Therefore, specific symptoms related to diving and various age-related aspects such as injury prevention and chronic disease management should be considered in developing a health program for professional female free divers.

The purpose of this study was to investigate the recognition of medical direction in emergency medical service personnel in Jeju. The survey, which contained basic characteristics and 10 questions on medical direction using a five-point Likert scale, was conducted in 180 subjects. The sample included 156 men (86.7%), and the mean age was 37.1 ± 6.1 years. On comparing qualification license according to gender, it was found that most men were first responders (48.1%), while most women were nurses (62.5%), showing a significant difference (p

Farmers' injuries are more frequent and severe than those in the other job groups. To identify the characteristics of agricultural injuries in Jeju, 119 first aid records and emergency department based injury surveillance system data for four years were analyzed retrospectively. Farmers' injuries in 119 first aid records were 1,947 cases, and mean age of injured patients was 63.9±11.8 years. The proportion of major trauma was 27.4%. The more frequent months of farmers' injuries were from August to October. In comparison between farmers' and non-farmers' injuries, farmers' injuries showed more male proportion (70%), mean age (54.0±17.0 years), and old age proportion (29%) than non-farmers' injuries did, with significance(p

Proper transportation of patients within the golden time is essential in emergency medical service system. Awareness of transportation in 178 paramedics was surveyed with questionnaire. The subjects included 155 men (87.1%), and the mean age was 37.1±6.1 years. In comparison according to gender, women paramedics showed significantly higher scores in decision of destination depending on patients' severity (p=0.018), whereas men paramedics in going to the nearest hospital under emergent situation (p=0.014). In comparison according to qualification licenses, first responders revealed significantly lower scores in decision of destination on patients' claim (p=0.033) and going to the nearest hospital under emergent situation (p=0.023), whereas significantly higher in decision of destination depending on patients' severity (p

Jung Eun Lee,1,2 In Young Jo,3 Song Mi Lee,3 Woo Jeong Kim,3 Hoon Young Choi,2,4 Sung Kyu Ha,4 Hyung Jong Kim,5 Hyeong Cheon Park2,4 1Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 2Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, 3Department of Nutrition Services, Gangnam Severance Hospital, 4Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 5Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea Background: The number of elderly people on dialysis is increasing rapidly. Fluid overload and malnutrition status are serious problems in elderly dialysis patients. We aimed to compare the hydration and nutritional status through bioimpedance analysis (BIA) between young and elderly hemodialysis (HD) patients and to analyze risk factors related to fluid overload and malnutrition status in these patients.Method: We conducted a cross-sectional study, in which 82 HD (males 42, mean age 58.7±12.9years) patients were enrolled. We collected different types of data: laboratory data, such as serum creatinine, albumin, total iron-binding capacity, hemoglobin, total cholesterol; anthropometric data, such as hand grip strength (HGS); BIA data, such as intracellular water, skeletal muscle mass, body cell mass, bone mineral content, phase angle (PhA), extra cellular water (ECW)/total body water (TBW) ratio; and malnutrition-inflammation score (MIS), which is a traditional nutritional parameter for dialysis patients. All patients were stratified into two groups according to their age: young (

This study set out to evaluate the impact of personalized nutritional counseling (PNC) on the nutritional status of hemodialysis (HD) patients. This was an intervention study for 10 months at 2 hospitals. Anthropometric, biochemical, dietary, and body composition parameters were measured at baseline and after 3 and 6 months of PNC. A total of 42 patients (23 men and 19 women) were included. Intake of dietary protein, serum albumin, and cholesterol levels had increased significantly from baseline to month 6 (p < 0.05). Among the bioelectrical impedance analysis (BIA) parameters, both the body cell mass (BCM) and the fat free mass (FFM) had significantly reduced at month 3 compared to baseline (p < 0.05). However, there was no difference between baseline and month 6. We assessed the nutritional status of the subjects using the malnutrition inflammation score (MIS), and divided them into an adequately nourished (AN) and a malnourished (MN) group at baseline. In the subgroup analysis, serum levels of albumin and cholesterol had increased significantly, particularly from baseline to month 6 in the MN group (p < 0.05). This study suggests that consecutive PNC contributed to the improvement of the protein intake, serum levels of albumin, cholesterol and to the delay of muscle wasting, which could also have a positive impact on the nutritional status, particularly in malnourished patients receiving HD treatment.

Patient-physician interaction in clinical performance examination is one of essential components and assessed by standardized patients on the basis of five checklists. In this paper, medical students self-assessment was compared to standardized patients assessment on patient-physician interaction in clinical performance examination of one university. There were no significant correlations between them in two scenarios including breast pain and acute abdomen. However, there were tendencies that students underestimated their patient-physician interaction and orders of higher scores were regular independent of scenarios.

The purpose of this study was to identify the correlations between medical students’ self-assessment of communicationskills and patient-physician interaction. A total of 36 fourth-year medical students were enrolled in this study and weresurveyed concerning communication skills during clinical performance examination. The survey included 20 items in fourcategories: beginning an interview (greeting, identification, introduction, attention, and chief complaint), gathering information(open question, reflection, facilitation, clarification, and summarizing), giving information (discovering the patient’sunderstanding, empathy, easy terms, checking of understanding, and giving opportunities), and non-verbal communication(neat features, listening, eye contact, nodding, and silence). 20 items of communication skills were modulated to five patientphysicianinteraction items, and compared with patient-physician interaction scores by self-assessment. There were nocorrelations between communication skills and patient-physician interaction scores except one item, making an efforts tounderstand patient’s situation. This study demonstrated that medical education of communication skills could not betransferred to improvement of patient-physician interaction in clinical skills assessment.

The purpose of this study was to identify the correlation between medical students’ communication skills awareness and performance in clinical education and to determine means to improve communication. A total of 36 fourth-year medical students were enrolled in this study and were surveyed concerning communication skills during two clinical performance examinations. The survey included 20 items in four categories: beginning an interview (greeting, identification, introduction, attention, and chief complaint), gathering information (open question, reflection, facilitation, clarification, and summarizing), giving information (discovering the patient’s understanding, empathy, easy terms, checking of understanding, and giving opportunities), and non-verbal communication (neat features, listening, eye contact, nodding, and silence). The students were educated repeatedly about their communication skills for 8 months in a clinical clerkship between two examinations. All items showed the significant correlations between communication skills awareness and performance, except for greeting and summarizing in the first examination and neat feature and silence in the second. Communication skills awareness and performance were significantly improved in terms of attention, reflection, summarizing, discovering the patient’s understanding, empathy, checking understanding, and silence. This study demonstrated that medical students’ awareness of communication skills was mostly correlated with performance and communication awareness and performance were improved following clinical education.

The coating of silicide or nitride layers on U–7 wt%Mo or U–7 wt%Mo–1 wt%Ti particles has been proposed for the minimization of the interaction phase growth in U–Mo/Al dispersion fuel during irradiation. Out-of-pile annealing tests show reduced inter-diffusion by forming silicide or nitride protective layers on U–Mo and U–Mo–Ti particles. To characterize the constituent phases of the coated layers on U–Mo and U–Mo–Ti particles and the interaction phases of coated U–Mo and U–Mo–Ti particle dispersed Al matrix fuel, synchrotron X-ray diffraction experiments have been performed. It was identified that silicide coating layers consisted mainly of U 3 Si 5 and U 4 Mo(Mo x Si 1− x )Si 2 , and nitride coating layers were composed of mainly UN and U 4 N 7 . The interaction phases obtained after annealing of coated U–Mo and U–Mo–Ti particle dispersion samples were identical to those found in U–Mo/Al–Si and U–Mo/Al systems. Nitride-coated particles showed less interaction formation than silicide-coated particles after annealing at 580 °C for 1 h owing to the higher susceptibility to breakage of the silicide coating layers during hot extrusion.

This study was performed to investigate the recognition of medical students on the methods of education in clinical clerkship.Throughout the clinical clerkship of emergency medicine for 4th grade medical school, various methods of education such asclinical lecture, problem based learning, standardized patients practice, discussion on the patient-doctor-society relationship,bedside skill, and case presentation were applied for 2 weeks. The satisfaction on curriculum and recognition on the methodsof education were surveyed with questionnaire by Likert 5 step scales after clinical clerkship. Students responded positively andhad been motivated to bedside skill and standardized patients practice especially. They also evaluated that problem basedlearning and discussion on the patient-doctor-society relationship were helpful. To improve the abilities of medical students inclinical reasoning, self-directed learning, professionalism, problem solving and clinical skills, various methods of education thatmake students be interested, active, and satisfied should be considered based on the response of students.

Background In breast augmentation with implant, there is severe pain due to damage from expansion of breast tissue and the pectoralis major. Therefore, the authors conducted this study to analyze the effectiveness of postoperative intercostal nerve block (ICNB) in reducing postoperative pain after breast augmentation with implant. Method Forty-four female patients were enrolled in the study. Just before awaking from general anesthesia, 34 cases were injected with 0.2% ropivacaine to both third, fourth, fifth, and sixth intercostal spaces. We compared them (ICNB group) with the control group for VAS scores at the time of arrival in the recovery room, after 30, 60, and 120 min. Result The average VAS scores per time of the control group and ICNB group were 7.1 ± 0.74 and 3.50 ± 1.81 at arrival time in the recovery room, 7.00 ± 0.67 and 3.03 ± 1.47 after 30 min, 5.50 ± 0.71 and 2.68 ± 1.49 after 60 min, and 4.60 ± 0.84 and 2.00 ± 1.35 after 120 min. VAS scores of two groups were significantly different at each time and decreased overall. Also, time and group effect of the two groups were significantly different, especially between 30 and 60 min. Conclusion ICNB just before awaking from general anesthesia showed a statistically significant reduction in VAS score, and this means postoperative pain was reduced effectively and time to discharge could be shortened. Therefore, it can be a good way to reduce postoperative pain after augmentation mammoplasty with implant. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (doi:10.1007/s00266-017-0802-6) contains supplementary material, which is available to authorized users.

The purpose of this study was to analyze infection control and prevention of 119 rescuers in Jeju. We surveyed the level of recognition on infection control and hand sanitization of total 149 recuers. Hand sanitization of 119 rescuers during the process of first-aid treatment were 2.19±1.23 before first-aid treatment 2.68±1.49 before transfer to emergency room 3.30±1.50 after transfer to emergency room and 3.91±1.27 after return to 119 center. The appropriateness groups showed higher hand sanitization than the non-appropriateness groups in all first-aid treatments. To improve the infection control in prehospital treatments, more education would be needed.

This study was designed to compare clinical skill performances between the methods of education. In practice of cardiopulmonary resuscitation (CPR) during clerkship of emergency medicine, 50 medical students were randomized to three groups according to the methods of education. 1st groups were educated with video-based lecture, 2nd groups with slide lecture and instructor's demonstration, 3rd groups with practice while watching (PWW) program. After each education, general clinical skill performance was checked by international checklists for CPR and the variables on the accuracy of chest compression were measured by computer program such as skill reporter system. There was no difference between three groups in general clinical skill performance. But, 2nd group educated with slide lecture and instructor's demonstration showed the significant differences in the accuracy of chest compression compared with the other two groups. For more accurate performance of clinical skill, education including instructor's demonstration would be needed.

We aimed to share the experience of educating the clinical performance examination (CPX) using self video monitoring and to investigate the core contents for improvement of clinical performance of medical students. Forty forth-year medical students participated in this study in 2011. This course consisted of simple lecture one CPX practice and self video monitoring. They submitted two reports describing their opinions about this course and analyzing their CPX practice through video monitoring. In addition, their satisfaction score was investigated. Average satisfaction point was over 4.5 on a five-point scale. Common strengths and weaknesses were patient education, eye contact, sympathy expression, and gesture. Suggestion for improvement of this course was repeated CPX practice, and advantage of this course was that they realized their improper nonverbal communication using video monitoring and other students’ CPX. ln conclusion, video monitoring was effective CPX teaching method and patient education, eye contact, sympathy expression, and gesture were the core contents for improvement ofclinical performance of medical students.

PURPOSE Action learning is an educational method, whereby participants study their own actions and experiences to improve performance. We aimed to study the effects and share the experiences with action learning to teach clinical performance examination (CPX). METHODS Twenty-eight fourth-year medical students participated in this study in 2010. This course consisted of three mini-lectures, three CPX practice sessions, and an evaluation. Satisfaction and improved and deficient elements in the CPX practice session were investigated. Internal consistencies of peer evaluation and CPX scores were also investigated using Cronbach's alpha. RESULTS Average satisfaction was 4.5 on a 5-point scale. Low Cronbach's alpha was noted for the consistencies of peer evaluation and patient-physician interaction. The most common improved element was self-confidence, followed by accustoming themselves to conversation with the standard patient. Seven students stated that they were deficient in self-confidence; other deficiencies were sympathy expression, conversation, and physical examination. CONCLUSION CPX education using action learning by peer evaluation, generating CPX cases by themselves, repeated practices, and feedback, effected self-active learning. However, the educator and educatee must invest much time and effort. Allotting specific, scheduled times for this type of education would be more effective.

119 rescuer's ability in prehospital emergency medical system is very important for the better outcome of patients. The proper education program is needed to improve the appropriateness of prehospital emergency care by 119 rescue services. To establish the proper education plan, educational needs of 119 rescuers should be assessed first of all.

Purpose: The purpose of the present study was to investigate needs and satisfaction on the medical services of cancer patients in Jeju Special Self-Governing Province. Methods: Total 174 cancer patients, who visited at the clinic of Jeju National University Hospital, submitted informed consent and participated in this study from July 13 to July 30, 2009. Self questionnaire was used and data were analyzed with Kolmogorov-Smirnov test, Mann- Whitney U test, ANOVA, and Kruskal-Wallis test. Results: Participants expressed the needs of most economical support (3.38 out of 4), followed by counseling of treatment pl an (3.22), information of disease (3.07), and disease management except cancer (2.97). Participants were satisfied most with religious counseling (3.41), followed by nursing service support (3.39), employment counseling (3.26), and counseling for family or interpersonal relationships (3.26). The satisfaction of economical support was the lowest (1.98). Satisfaction of men was higher than women, and needs in patients who were living with children was the highest. Patients who were living alone or with children showed the lowest satisfaction about the medical services. There were no significant differences in the general characteristics, however, participants who were older than 60 years of age or had higher income showed lower needs and higher satisfaction. There were no significant differences in the medical characteristics, however, thyroid cancer patients and patients who were treated with radiation therapy or transarterial embolization showed low satisfaction. Conclusion: Cancer patients seemed to need more economical support, information of treatment or disease, and symptom management. Furthermore, ther e were various needs about the services, depending on family formation or economical support of patients. Therefore, it is certain that patients who were suffering from other cancers, except the 5 major cancers, needed more services. In conclusion, continuous and systemic policy to consider patient's characteristics and needs are needed in community as well as health care system. (Korean J Hosp Palliat Care 2010;13:153-160)Key Words: Neoplasms, Needs assessment, Patient satisfaction서론 2007년 암 발생자는 161,920명으로 2006년에 비해 5.6% 증가하였으며, 생활양식이 점차 서구화되어가고 있는 우리나라의 경우 서구처럼 대장암, 전립샘암, 유방암이 점차 증가할 것으로 예상하고 있다(1,2). 이러한 암환자의

Clinical performance examination(CPX) is a examination for comprehensive evaluation of clinical performance in medical education ，and was introduced to various medical examination including the national examination for certified Iicense of doctor Education and preparation for CPX became one of the most important courses in medical school，so it’s needed to know the correlation between conventional written examination and CPX. This study showed the correlations between written examination scores and some parts of CPX scores and suggested the points we should pay attention to for education of medical students.

Structural characterization of Laves-phase MgZn2 precipitated in Mg-6 wt.%Zn-1 wt.%Y alloy was performed using a high-resolution transmission electron microscope (HRTEM). Plate- and rod-shaped precipitates with the Laves structure were observed in an aged sample at 200 °C. An individual rod of the β2′ phase precipitated in the matrix contained several domains with various orientations. Numerous antiphase boundaries (APBs) and stacking faults (SFs) were observed in the β2′ precipitates. The stacking sequence of the 14C structure partially changed to that of the C15 structure due to the presence of a stacking fault. The orientation relationship between the C14 structure and the C15 structure in the β2′ precipitates was [11–20]C14‖[1–10]C15 and (0001)C14‖(111)C15. Modification of the stacking sequence based on the synchroshear mechanism was discussed.

Cancer patients is being increased annually, and reached up to 464, 857 in 2008. Many cancer patients suffer from the progression of their diseases and various complications that follow the treatmenl such as operation. chemotherapy, and radiotherapy. so visit emergency medical center to solve their problems. From April 2009 to June 2009, totally 104 cancer patients visited emergency medical center of Jeju National University Hospital, and the mean age was 54.38±19.05 years old. Male patients were 67.3%. and most symptoms presented were pain(25.0%), gastrointestinal symptoms(20.2%). and respiratory symptoms( 13.5%), For total care of cancer patients. the comprehension of their visits to emergency medical center and the proper preparedness for the management are needed. based on the analysis on cancer patients in emergency medical center.

CPX(Clinical performance examination) is an examination for comprehensive evaluation of clinical performance in medical education, and has been used worldwide since Harden introduced OSCE(objective structured clinical examination) in 1975. To perform CPX, SP(standardized patient) is essential, who is a simulated and well-trained person for education and evaluation of medical student. In Korea. CPX is scheduled to be introduced into national examination in this year, so most medical school are paying close attention to CPX now Although evaluation results of SP have some debates for validity and reliability, CPX will be introduced to other medical examinations.

Problem-based learning(PBL) is a process of acquiring understanding, knowledge skills and attitudes in the context of an unfamiliar situation and applying such learning to the situation. PBL can make students thinking more efficiently than they can do in the traditional methods of medical education. PBL has the standardized structure composed of fact/problem, hypothesis, action plan/need to know and learning issue. After introduction of PBL to Korea in 1992, many colleges of medicine made efforts to settle the curriculum of PBL in medical education. Although a practice of PBL have some problems. PBL will advance gradually because of its effective results in medical education.

The purpose of this study was to investigate the awareness on direct medical control of Jeju 119 rescuers. Subjects were 180 rescuers and the survey which contained basic characteristics and ten questionnaires on medical control awareness was performed using Likert 5-point scale. Men were 156 people (86.7%), and mean age was 37.1 ± 6.1 years. Compared qualification kind according to gender, first aid training men were 48.1% as the most common, whereas women as a nurse were 62.5%, showing significant difference (p

Women divers have been exposed to breathing without any respiratory equipment for several decades and are becoming increasingly aging. However, there are few data about their health problems. In this study, 87.4% were 65 years or order. Most had one or more comorbidity and were taking medication. 12.3% had discharge diagnosis related to injury, and almost half of injuries were caused by slip down. Older women divers were likely to have comorbid disease and take medication, and use 119 to visit ED more. Also, older women divers were admitted to hospital more often, and had more discharge diagnoses related to slip-down injury, digestive, respiratory, and circulatory. Health management program included management of chronic illness as well as prevention of injury is needed for women divers.

ObjectiveTo determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.MethodsA prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.ResultsA total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).ConclusionsEarly pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.

An electrolytic tilt sensor has been designed and fabricated using micro electro mechanical systems (MEMS) technique. The anisotropic KOH etching is used to form a deep Si cavity where conductive electrolyte solution is filled in. Au/NiCr electrodes are simultaneously deposited and patterned using e-beam evaporator with an aligned shadow mask, which is fabricated by through-wafer via etching on a 400-µm-thick Si wafer. A composite electrolyte of 4.8 µL in the volume is filled in the anisotropically-etched cavity that has a volume of 7.3 µL. The electrolyte solution is comprised of variable amount of KCl and a mixture of deionized (DI) water, ethanol and methanol (50, 25, and 25 vol %, respectively). When the electrolyte is injected into the cavity, a cover glass is bonded to seal the electrolyte solution. The fabricated electrolytic tilt sensor is excited by an alternating current to prevent electrolysis in the electrolyte-filled cavity and measured by Wheatstone bridge setup that reads the variation of resistance with respect to an incoming inclination. The measured output characteristic of the MEMS-based electrolytic tilt sensor is as good as that of a conventional electrolytic tilt sensor. Moreover, MEMS-based sensor prevails in its small size, low cost and possible mass production.

Purpose : Drowning is a process resulting in primary respiratory impairment from submersion in a liquid medium and one of leading cause of accidental death. The purpose of this study was to investigate the clinieal characterisitcs of submersion injury in Jeju and to find the prognostic factors in the treatment of submersion injury.Methods : A total 46 patients who were treated for submersion injury in Cheju National University Hospital from May 2003 to February 2006 were reviewed retrospectively. DOA(death on arrival) group and the other group wecompared according to the outcome in ED(emergency department) and ED discharge group and admission group were compared according to the disposition in ED. Also, death group and survival group were compared according to the final outcome in admission group.Results : Among 46 submerged patients, there were 30 males and 16 females, and their mean age was 29.7±21.1 years. The most common age group, season, and type of water were childhood, summer, salt water respectively and the mean duration of submersion was 7.0±8.4 minutes. DOA group showed significantly longer duration of submersion, higher K and PCO2. and lower pH. PO2. SaO2 compared to the other group. Admission group showed significantly higher Na and PCO2 and lower PO2, SaO2 compared to ED discharge group. Death group showed significantly longer duration of submersion and higher Cr compared to survival group in final outcome.Conclusion : Prognosis of submerged patients could be predicted by some factors such as K. PCO2. pH. PO2.SaO2, and Cr.

Purpose: Poison information system plays many roles in managing acute intoxication. The purpose of this study was to find the characteristics of acute intoxication in Jeju by comparing data of acute intoxication in Jeju with nationwide data.Methods: A total 68 cases that were treated for acute intoxication in Cheju National University Hospital from June 2004 to May 2005 were reviewed according to toxic exposure surveillance system retrospectively. Then, data in Jeju and nationwide data were compared for each item in toxic exposure surveillance system.Results: In acute intoxication in Jeju, proportion of men was larger, and sixties among age groups had largest proportion. In toxic substances in jeju, domestic article such as caustics had larger proportion relatively, and analgesics and antidepressants had larger proportion relatively in medical drugs. In emergent treatment in Jeju, use of antidotes had larger proportion relatively.Conclusion: Serial investigations were needed for continuous poison information system.

Purpose: Decompression sickness (DCS) is a spectrum of clinical illness that result from the formation of small bubbles of nitrogen gas in the blood and tissue. The purpose of this study was to find the characteristics of DCS in Jeju.Methods: A total of 44 cases that were treated with recompression therapy for DCS in Cheju National University Hospital from February 2002 to May 2005 were reviewed retrospectively. According to professional diving, professional group (n=27) and non-professional group (n=17) were compared. Also, according to DCS type, DCS type I group (n=21) and DCS type II group (n=17) were compared.Results: Non-professional group showed a higher incidence of male, younger mean age, shorter time from symptom to treatment, and fewer No. of recompression therapy than did the professional group. There were no significant differences between DCS type I group and DCS type II group.Conclusion: For proper diagnosis and treatment for DCS, more support of authorities and researches were needed.