• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.11
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• pp.626-634
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• 2018

This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.3-12
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• 2018

Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2031-2033
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• 2016

Background: Symptomatic multiple myeloma (MM) is an acquired B-cell malignant proliferation of antibody secreting plasma cells, characterized by end organ damage due to monoclonal immunoglobulin secretion. The aim of this study wa to determine the stage stratification according to an international scoring system in adult Pakistani MM patients at presentation. Materials and Methods: This single centre retrospective study extendedfrom January 2012 to December 2015. Data were retrieved from the departmental maintained records. Results: A total of 39 patients were diagnosed at our center with MM during the period of the study, 25 males and 14 females. Age ranged between 36 and 81 with a mean of $54.5{\pm}14.8$ and a median of 57 years. Common presenting complaints included fatigue (80.9%), backache (79.3%) and bone pain (66.2%). Overall, 9 patients were in ISS stage I (23%), 12 were in stage II (30.7%) and 18 were in stage III (46.1%). Out of the total, 29 (74.3%) had kappa immunoglobulin andthe remaining 10 (25.6%) had lambda type myelomas. IgG myeloma was commonest, seen in 26 (66.6%) followed by IgA in 11 (28.2%) with non secretory myeloma in one (2.5%) and light chain disease also in one patient (2.5%). Conclusions: MM in Pakistani patients is seen in a relatively young population with male predominance. Primarily patients are symptomatic and risk stratification revealed a predominance of advanced stage III disease in our setting.

• Journal of Community Nutrition
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• v.6 no.1
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• pp.35-41
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• 2004

Cardiovascular disease has the highest mortality rate in South Korea. Previous studies have reported that serum cholesterol level relates to intake of dietary fat and cholesterol. Therefore, in this study we developed a semiquantitative food frequency questionnaire (FFQ) for Koreans with a high-risk of hypercholesterolemia and to validate the FFQ. Semiquantitative FFQ, which includes 160 food items, reflects intakes of energy, fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUPA), polyunsaturated fatty acid (PUPA) and cholesterol. We chose food items from the previous study of our research group (Suh 1999) which reported a nutritional status of Korean adults with normocholesterolemia, borderline and hypercholesterolemia. To validate the FFQ, we compared the results of the FFQ with those of a 3-day food record using a paired t-test. In addition, we calculated Pearson's and Spearmen's correlation coefficients. Intakes assessed by the FFQ and a 3-day food record were classified into quartile and the degree of agreement was obtained. Fifty-five participants responded for the validation study by completing both the FFQ and a 3-day food record. Pearson's correlation coefficients between estimated intakes by respective methods for energy, fat, SF A, MUPA, PUPA and cholesterol were 0.32,0.41,0.37,0.41,0.37 and 0.21, respectively. Spearman's correlation coefficients of energy, fat, SF A, MUPA, PUPA, cholesterol were 0.31, 0.44, 0.39, 0.46, 0.46, and 0.37, respectively. Nutrient densities in 1000kcal were compared. Pearson's correlation coefficient of cholesterol density increased and other values were similar with original values. The average degree of agreement was 67％ that intakes of energy, fat, SF A, MUPA, PUPA and cholesterol assessed by the FFQ and 3-day food records were classified within the same and the adjacent quartile. On the average, 8％ were misclassified into the extreme opposite quartile. The average of weighted kappa was 0.46. In conclusion, the FFQ developed in this study is considered to be a reliable tool to assess nutrient intakes for Koreans with a risk of hypercholesterolemia because the FFQ reflects the intakes of energy, fat, SFA, MUFA, PUPA, and cholesterol.

• Health Policy and Management
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• v.11 no.1
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• pp.1-18
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• 2001

The purpose of the present study was to assess the agreement of survival probability estimated by International Classification of Diseases l0th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with professional panel's judgment on preventable death. ICISS has a promise as an alternative to Trauma and Injury Severity Score(TRISS) which have served as a standard measure of trauma severity, but requires more validation studies. Furthermore as original version of ICISS was based ICD-9CM, it is necessary to test its performance employing ICD-10 which has been used in Korea and is expected to replace ICD-9 in many countries sooner or later. Methods : For 1997 and 1998 131 trauma deaths and 1,785 blunt trauma inpatients from 6 emergency medical centers were randomly sampled and reviewed. Trauma deaths were reviewed by professional panels with hospital records and survival probability of trauma inpatients was assessed using ICD-10 based ICISS. For trauma mortality degree of agreement between ICISS survival probability with judgment of professional panel on preventable death was assessed and correlation between W-score and preventable death rate by each emergency medical center was assessed. Results : Overall agreement rate of ICISS survival probability with preventable death judged by professional panel was 66.4%(kappa statistic 0.36). Spearman's correlation coefficient between W-score and preventable death rate by each emergency medical center was -0.77(p=0.07) and Pearson's correlation coefficient between them was -0.90(p=0.01). Conclusions : The agreement rate of ICD-10 based ICISS survival probability with of professional panel's judgment on preventable death was similar to TRISS. The W-scores of emergency medical centers derived from ICD-10 based ICISS were highly correlated with preventable death rates of them with marginal statistical significance.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.266-271
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• 2008

Background: Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea. Methods: We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records. Results: Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor ($\kappa$ coefficient=0.06). Conclusion: In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules.

• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.198-206
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• 2019

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward. Methods: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital. Results: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation. Conclusion: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.

• Pediatric Infection and Vaccine
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• v.30 no.3
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• pp.121-128
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• 2023

Purpose: This study aimed to investigate the recent age distribution of Mycoplasma pneumoniae in patients with respiratory infections and the differences in diagnostic usefulness according to the methods used in these patients. Methods: We retrospectively reviewed the medical records of patients aged ≤18 years with respiratory infectious diseases who underwent polymerase chain reaction (PCR) or a specific immunoglobulin M (IgM) test between July 2016 and February 2019. The diagnosis of M. pneumoniae infection was confirmed by a positive result in the PCR or IgM test. Results: Of the 2,721 patients tested for M. pneumoniae, 2,197 underwent IgM, and 1,144 underwent PCR, with positivity rates of 17% and 20%, respectively. Among the 620 patients tested for both IgM and PCR tests simultaneously, 35% had M. pneumoniae infection, with 14% under 1 year old and 13% under 1-2 years old. The positive rate increased with age in both tests. Higher positive rates were observed in the IgM test before 3 years of age and in the PCR test after 3 years of age. The agreement rate between the two tests was 77.9% (Cohen's kappa 0.402). Conclusions: As age increased, the rates of M. pneumoniae infection also increased. In patients under 2 years of age, 4¬-14% of infections were confirmed depending on the method used. The moderate agreement between the PCR and IgM tests suggests that the simultaneous use of PCR and the IgM test for the early diagnosis should be approached with caution.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.144-148
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• 2007

Purpose: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. Methods: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS ${\geq}$ 5. Results: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. Conclusion: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.

• The Journal of Korean Obstetrics and Gynecology
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• v.34 no.1
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• pp.1-14
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• 2021

Objectives: We studied for the adjustment of the patterns of 'The Diagnostic Tool for Climacteric and Postmenopausal Syndrome Pattern Identification (hereinafter CaPSPI)' (studyI) and the correlation between CaPSPI and Korean medicine doctors' diagnosis which was carried out without knowing the results of CaPSPI (studyII). Methods: The studyI followed the previous study method in 2018 (2018-3). The studyII was conducted from June 1, 2019 to July 10, 2020 with ◯◯ University Korean Medicine Hospital IRB's approval (2019-4). Doctors' diagnosis was conducted face-to-face with the subjects. Doctors' diagnosis was carried out based on the Kupperman's questionnaire, 'Diagnosis System of Oriental Medicine (hereinafter DSOM)' and four examinations (四診) records. The diagnosis was marked with 0 for 'no', 1 for 'somewhat', 2 for 'yes' and 3 for 'very yes'. The correlation between CaPSPI and the mean of doctors diagnostic scores were investigated statistically. Results: The studyI showed that heart-heat (心火) pattern was added. The Factor loading coefficient for heart-heat was 0.551 to 0.789, and the Cronbach's coefficient was 0.896. The studyII showed that the diagnosis (Kappa statistic) of two doctors showed statistically significant concordance (all eight patterns), with correlation of them were 0.3 or higher. And the correlation between the CaPSPI score and the mean of doctors' diagnostic score showed a statistically significant correlation, with liver qi depression (肝鬱) being the highest at 0.552 and dual deficiency of the heart-spleen (心脾兩虛) being the lowest at 0.301. Conclusions: Since the diagnosis results of CaPSPI showed a significant correlation with the diagnosis of Korean traditional medicine experts, it was believed that the CaPSPI results can be trusted and used for clinical purposes.