• Title/Summary/Keyword: 일과

Search Result 46,735, Processing Time 0.073 seconds

Off Pump Total Arterial Myocardial Revascularization (동맥 도관만을 이용하여 체외심폐순환 없이 시행한 관상동맥우회술)

  • Youn Young Nam;Lee Kyo Joon;Lee Gy Jong;Joo Hyun Chul;Lim Sang Hyun;Kim Seung Ho;Kwak Young Lan;Yoo Kyung Jong
    • Journal of Chest Surgery
    • /
    • v.38 no.5 s.250
    • /
    • pp.349-356
    • /
    • 2005
  • Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of $59.3\pm11.9$ years ($36\~83$). Mean ejection fraction was $55.4\pm14.0\%\;(15\~86).$ Angiography showed left main disease or triple-vessel disease in $81.9\%$ of the patients. Indications of using arterial conduits was stenosis $\ge50\%$ of left anterior descending artery, stenosis $\ge80\%$ of branches of left circumflex artery, and stenosis $\ge90\%$ of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were $2.86\pm0.78$. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients ($1.8\%$), renal failure in 4 patients ($1.2\%$), perioperative myocardial infarction in 3 patients ($0.9\%$), reoperation for bleeding in 3 patients ($0.9\%$). There was no postoperative stroke. Patency rate of arterial conduits was $99.3\%$ (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.

Minimally Invasive Coronary Artery Bypass Grafting (소침습적 관상동맥우회술)

  • Na, Chan-Young;Lee, Young-Tak;Park. Joong-Won;Chung, Do-Hyun;Jung, Ill-Sang;Jung, Yoon-Seup;Kim, Ok-Sung;Bang, Jung-Hyun;Lee, Sub;Chung, Chul-Hyun;KIM, Woong-Han;Park, Young-Kwan;Kim, Chong-Whan;Hong, Sung-Nok;Han, Jae-Jin;Lee, Gun
    • Journal of Chest Surgery
    • /
    • v.31 no.2
    • /
    • pp.118-124
    • /
    • 1998
  • Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.

  • PDF

Inhibition of Neointima Formation and Migration of Vascular Smooth Muscle Cells by Anti-vascular Endothelial Growth Factor Receptor-1 (Flt-4) Peptide in Diabetic Rats (당뇨병 쥐에서 혈관내피 성장인자 수용체-1 차단 펩타이드를 이용한 신내막 형성과 혈관평활근세포 이동의 억제)

  • Jo, Min-Seop;Yoo, Ki-Dong;Park, Chan-Beom;Cho, Deog-Gon;Cho, Kue-Do;Jin, Ung;Moon, Kun-Woong;Kim, Chul-Min;Wang, Young-Pil;Lee, Sun-Hee
    • Journal of Chest Surgery
    • /
    • v.40 no.4 s.273
    • /
    • pp.264-272
    • /
    • 2007
  • Background: Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis, including stimulating the proliferation and migration of vascular smooth muscle cells (VSMCs). It has been known that diabetes is associated with accelerated cellular proliferation via VEGF, as compared to that under a normal glucose concentration. We investigated the effects of selective blockade of a VEGF receptor by using anti-Flt-1 peptide on the formation and hyperplasia of the neointima in balloon injured-carotid arteries of OLETF rats and also on the in vitro VSMCS' migration under high glucose conditions. Material and Method: The balloon-injury method was employed to induce neointima formation by VEGF. For f4 days beginning 2 days before the ballon injury, placebo or vascular endothelial growth factor receptor-1 (VEGFR-1) specific peptide (anti-Flt-1 peptide), was injected at a dose of 0.5mg/kg daily into the OLETF rats. At 14 days after balloon injury, the neointimal proliferation and vascular luminal stenosis were measured, and cellular proliferation was assessed by counting the proliferative cell nuclear antigen (PCNA) stained cells. To analyze the effect of VEGF and anti-Flt-1 peptide on the migration of VSMCs under a high glucose condition, transwell assay with a matrigel filter was performed. And finally, to determine the underlying mechanism of the effect of anti-Flt-1 peptide on the VEGF-induced VSMC migration in vitro, the expression of matrix metalloproteinase (MMP) was observed by performing reverse transcription-polymerase chain reaction (RT-PCR). Result: Both the neointimal area and luminal stenosis associated with neointimal proliferation were significantly decreased in the anti-Flt-1 peptide injected rats, ($0.15{\pm}0.04 mm^2$ and $ 36.03{\pm}3.78%$ compared to $0.24{\pm}0.03mm^2\;and\;61.85{\pm}5.11%$, respectively, in the placebo-injected rats (p<0.01, respectively). The ratio of PCNA(+) cells to the entire neointimal cells was also significantly decreased from $52.82{\pm}4.20%\;to\;38.11{\pm}6.89%$, by the injected anti-Flt-1 peptide (p<0.05). On the VSMC migration assay, anti-Flt-1 peptide significantly reduced the VEGF-induced VMSC migration by about 40% (p<0.01). Consistent with the effect of anti-Flt-1 peptide on VSMC migration, it also obviously attenuated the induction of the MMP-3 and MMP-9 mRNA expressions via VEGF in the VSMCS. Conclusion: Anti-Flt-1 peptide inhibits the formation and hyperplasia of the neointima in a balloon-injured carotid artery model of OLETF rats. Anti-Flt-1 peptide also inhibits the VSMCs' migration and the expressions of MMP-3 and MMP-9 mRNA induced by VEGF under a high glucose condition. Therefore, these results suggest that specific blockade of VEGFR-1 by anti-Flt-1 peptide may have therapeutic potential against the arterial stenosis of diabetes mellitus patients or that occurring under a high glucose condition.

Utilization Pattern of Complementary Therapy in Hypertension, Diabetes and Chronic Arthritis Patients Visited to Local Health Center (일개 보건소를 방문하는 고혈압, 당뇨 및 관절염환자의 보완요법 이용실태)

  • Park, Ae-Ju;Park, Jae-Yong;Han, Chang-Hyun
    • Journal of agricultural medicine and community health
    • /
    • v.28 no.2
    • /
    • pp.107-122
    • /
    • 2003
  • Objectives: The objective of this study is to investigate the use rate and some aspect of complementary therapies used by patients with chronic illness(hypertension, diabetic mellitus and chronic arthritis). Methods: 600 patients visiting the health center for one month(Jan. 2001) were interviewed on their complementary therapies used by the subjects for the previous year. Results: About fourteen-eight percent of the respondents used therapies; 35% of patients with hypertension, 44.6% of patients with diabetic mellitus and 62.9% of patients with chronic arthritis, which shows the highest rate among patients with three chronic disease. The use rate of complementary therapies indicates few meaningful differences according to the general characteristics of the interviewees. Hypertension patients used herb medication(31.0%) acupuncture(29.6%) and most of all the other therapies. Diabetic patients used dietary therapy(57.5%) and herb medication(35.1%). Chronic arthritis patients used acupuncture(85%) and herb medication(34.7%). 36.8% of all the patients who used complementary therapies tried more than two therapies. 18.3% of hypertension patients, 24.1% of diabetic patients and 55.9% of chronic arthritis patients used more than two therapies. Acupuncture(47%) was used most frequently, followed by herb medications(26.3%), health assistance utensils(21.8%). oriental therapy(21.8%), physical therapy(9.5%), health assistance food(8.4%), herb(7.7%), Korea hand acupuncture(3.2%), abdomen respiration(1.1%), and pore therapy(0.7%) Oriental clinic was visited most frequently(42.8%), which was used to cure diseases(61.8%), and to relieve symptoms(26.0%). (p<0.001) The cost spent on complementary therapies last year was 90,000 won(40.3%) and there are some cases of more than 500,000 won(31.2%). Most of the patients(56.1%) were satisfied with the complementary therapies, with 6% of them having side effects. 74% of the patients used complementary therapies answered that they would continue them and 56.1% of them also answered that they would continue them and 56.1% of them also answered that they would advise other patients to do them. Advantages(compared with those of orthodox medical treatment) are psychological comfort(28.1%), body protection(26.0%), effectiveness(20.0%). 34% of the patients using complementary therapies wanted to have informational orientation on complementary therapies. These findings reveal that a considerable number of patients with chronic illness(47.5%) tried a variety of complementary therapies. Though 6% of the patients using therapies had side effects, most of the subjects seemed satisfied with them and they are supposed to continue them. Conclusions: In conclusion, health center personnels and medical doctors should pay more attention to the complementary therapies used by patients with chronic illness. They also have to try their best to advise more scientific and informative complementary programs with less side effects and more help to improve their conditions.

  • PDF

The Effect of the Use of Concept Mapping on Science Achievement and the Scientific Attitude in Ocean Units of Earth Science (해양단원 개념도 활용 수업이 과학성취도 및 태도에 미치는 효과)

  • Han, Jung-Hwa;Kim, Kwang-Hui;Park, Soo-Kyong
    • Journal of the Korean earth science society
    • /
    • v.23 no.6
    • /
    • pp.461-473
    • /
    • 2002
  • Concept mapping is a device for representing the conceptual structure of a subject discipline in a two dimensional form which is analogous to a road map. In the teaching and learning of earth science, each concept depends on its relationships to many others for meaning. Using concept mapping in teaching helps teachers and students to be more aware of the key concepts and relationships among them. The purpose of this study is to investigate the effect of the use of concept mapping on science achievement and the scientific attitude in ocean units of earth science. The results of this study are as follows; first, the science achievement of a group of concept mapping teaching is significantly higher than that of the group of traditional teaching. Also, when the achievement levels are compared among different cognitive ability groups, the effect is more significant in mid or lower level student groups than in high level groups. The use of concept mapping is more effective when the concepts have a distinct concept hierarchy. Second, the scores of the test of ‘attitude toward scientific inquiry’ and ‘application of scientific attitude’ of the group of concept mapping teaching are significantly higher than those of the group of traditional teaching, whereas the scores of the test of ‘interest in science learning’ of concept mapping teaching is not different from those of group of traditional teaching. Third, the survey on the use of concept mapping shows a positive response across the tested groups. The use of concept mapping is more beneficial in fostering the comprehension of the topic. A concept map of student's own construction facilitates the assessment of learning, thus promising the usefulness of concept mapping as a means of evaluation. In regard to retention aspect, concept mapping is considered to be more effective in confirming and remembering the topic, while less effective in the aspects of activity and interest. In conclusion, the use of concept maps makes learning an active meaningful process and improves student's academic achievement and scientific attitude. If the concept mapping is more effectively as an active teaching strategy, more meaningful learning will be attained.

Effect of Dietary Inclusion of Various Sources of Green Tea on Immune System and Challenging Test of Juvenile Olive Flounder Paralichthys olivaceus (사료내 녹차 첨가가 넙치 유어기의 면역성 및 세균 공격성에 미치는 영향)

  • Cho Sung-Hwoan;Lee Sang-Mok;Park Byum-Hee;Ji Sung-Choon;Kwon Mun-Gyeong;Kim Yi-Cheong;Lee Jong-Ha;Park Sagn-Eun;Han Hyoung-Kyun
    • Journal of Aquaculture
    • /
    • v.19 no.2
    • /
    • pp.84-89
    • /
    • 2006
  • Effect of dietary inclusion of various sources of green tea on growth, immune system and challenging test of juvenile olive flounder Paralichthys olivaceus was investigated. Five experimental diets with triplicates were prepared: control, raw leaves, dry leaves, by-product and extract. Twenty five (an initial body weight of 52.5 g) were randomly distributed into 15 of 180 L flow-through tanks. Nutrient requirements of the experimental diets satisfied growth of juvenile olive flounder. The feeding trial lasted for 7 weeks. After 7-week feeding trial, blood were sampled from three randomly chosen fish for serum analysis of Iysozyme and bactericidal activity, and ten fish were infected with Edwardsiella tarda for challenging test from each tank. Weight gain (g/fish) of fish fed the diet containing extract and control diet was significantly higher than that of fish fed the other diets. Feed efficiency ratio for fish fed the diet containing extract and control diet was significantly higher than that for fish fed the diets containing raw leaves and by-product, but not significantly different from that for fish fed the diet containing dry leaves. Serum Iysozyme activity (units/ml) of fish fed the diets containing dry leaves and extract was significantly higher than that of fish fed the diets containing raw leaves and by-product, but not significantly different from that of fish fed the control diet. Serum bactericidal activity (${\times}10^6$ bacteria/ml) of fish fed the diet containing dry leaves and extract was significantly lower than that of fish fed the diets containing raw leaves, by-product and control diet in 3 hour. However, serum bactericidal activity of fish fed the diet containing extract was significantly lower than that of fish fed the other diets in 6 hour. And serum bacterial activity was low in fish fed the diets containing dry and raw leaves, by-product, and control in 6 hour in order. Accumulative mortality (%) of fish fed the control diet was low compared to that of fish fed the diets containing raw leaves and by-product, but high compared to that of fish fed the diets containing dry leaves and extract although no significant difference was found among treatments. In considering above results, dietary inclusion of extract and dry leaves of green tea seemed to be highly effective to improve immune system and endurance against E. tarda infection of juvenile olive flounder.

Studies on the Early Growth of Rockfish, Sebastes schlegeli (조피볼락, Sebastes schlegeli의 초기성장에 관한 연구)

  • Hyun Choung-Hun;Rho Sum
    • Journal of Aquaculture
    • /
    • v.9 no.1
    • /
    • pp.25-42
    • /
    • 1996
  • The study has been conducted to know an appropriate feeding strategy and effects of the rearing density on larval growth of the rockfish, Sebastes schlegeli. The results obtained are as fellowed ; 1. Thirty-day-old larvae reached at $25.25{\pm}3.76$ mm in total length and $0.23{\pm}0.07$ g in body weight in experiment A, at which rotifer was provided from the beginning to the end of 30-day experiment, Anemia from 3th to 18th day, and artificial feed from 13th to 30th day after hatching. When rotifer was provided for 30 days, Artemia from 6th to 18th day, and artificial feed from 18th to 30th day after hatching (experiment B), these larvae grew up to $27.52{\pm}2.50$ mm in total length and $0.26{\pm}0.06$ g in body weight. On the other hand, when rotifer and artificial feed were supplied with the same time schedule as shown in experiment B, and Artemia was feed from 6th to 30th day after hatching (experiment C), the total length and body weight of those larvae were $23.22{\pm}3.44$ mm and $0.15{\pm}0.05$ g, respectively. The best result for larval growth was obtained from experiment B. The survival rates estimated were $57.6\%$ in experiment A, $66.4\%$ in experiment B, and $44.4\%$ in experiment C. 2. The growth in total length of the larvae according to their rearing days could be represented by the following equations : Experiment A : Y=4.350+0.116X+$1.887X^2$ (r=0.993) Experiment B : Y=4.500+8.931X+$2.221X^2$ (r=0.994) Experiment C : Y=4.478+5.734X+$1.881X^2$(r=0.990) The average number of Artemia nauplius intaken by the larvae was rapidly increased between 15th and 20th day afer hatching, and 9, 212, 242, 750, and 1,171 nauplius were found in the different sizes of larvae, whose total length were 5.65, 6.81, 9.45, 14.96, and 24.52 mm, respectively. 3. Larval growth in total length and body weight reared at four different densites (A: 1.8 $kg/m^3$, B; 4.0 $kg/m^3$, C; 5.0 $kg/m^3$, D; 6.2 $kg/m^3$) indicated that the best growth was found in experiment A, at which the larval were reared at the lower density and the final survival rates extimated were $92.9\%$ in exp. A, $99.5\%$ in exp. C, $89.0\%$ in exp. B, and $88.2\%$ in exp. D. The amount of production per cubic meter turned out to be 30.45 kg in exp. D, 25.89 kg in exp. C, 20.75 kg in exp. B and 10.48 kg in exp. A. therefore, considering both larval growth and survival rate, higher yields seemed to be attainable at the relatively high-rearing density.

  • PDF

A Comparative Study on Awareness of Middle School Students, School Parents, and Human Resources Directors in Industrial Institutions about Admission into Specialized High Schools and Career after Graduating from Specialized High Schools (특성화고 진학 및 졸업 후 진로에 대한 중학생, 학부모, 산업체 인사 담당자의 인식 비교 연구)

  • Lee, Byung-Wook;Ahn, Jae-Yeong;Lee, Chan-Joo;Lee, Sang-Hyun
    • 대한공업교육학회지
    • /
    • v.38 no.2
    • /
    • pp.48-67
    • /
    • 2013
  • This study tried to suggest implications about operation direction of specialized high schools (SHS) by researching awareness of middle school students (MSS), school parents (SP), human resources directors in industrial institutions (HRDII) who will be the main users of SHS education, about entering SHS and career after graduating from SHS. Seniors of middle school, SP and HRDII in Asan, Chungnam were the subject of this survey research. The summary of the result of this study is as follow: First, MSS and SP usually hoped to enter general high schools rather than vocational education schools such as SHS, meister high schools, and MSS considered school records and SP considered aptitude and talent for the factors to choose high school. Second, MSS, SP, and HRDII recognized purposes of SHS as improvement of talent and aptitude, and getting a job. As for positive images of SHS, they recognized it as applying talent and aptitude to life early, getting good jobs easily, fast independence after graduation, and learning excellent technologies, and as for negative images of SHS, they recognized it as social prejudices and discrimination, students with bad school records enter them, disadvantages about promotion and wages, and being unfavorable for entering universities. They also recognized education of SHS as being effective for improvement of basic and executive ability and key competency, development of creative human resources, and improvement of right personality and courteous manners. Third, many MSS and SP showed intention to enter SHS if it is established in Asan. They wished to enter SHS because they would like to apply their aptitude and talent to life early, learn excellent skill, and hope for early employment, on the other hand, they did not wish to enter SHS because it was not suited for their aptitude and talent, awareness about SHS is low, it is unfavorable to enter universities, and there were social prejudices and discrimination. They also similarly hoped for getting jobs and entering universities after graduating from SHS. And the reason they wanted to get a job was usually because they want to be successful by advancing into society early, or because it is still hard to get a job even after graduate from the university, on the other hand, the reason they want to enter university is because is usually in-depth education about major and social discrimination about level of education. The ability to perform duties forms the greatest part of the employment standard that MSS, SP, and HRDII aware. MSS and SP usually hoped for industrial, home economics and housework and commercial majors in SHS, and considered aptitude and talent, the promising future, and being favorable for employment for choosing major. The reason HRDII hire SHS student was to develop student into talent of industrial institution, ability of student, and need for manpower with high school graduation level, and there were also partial answer that they can hire SHS student if they have ability to perform duties. The proposals about operation direction of SHS according to the results above are as follow: SHS should diversify major and curriculum to meet various requirements of student and parents, establish SHS admission system based on career guidance, and improve student's ability to perform duties by establishing work-based learning. The Government should organize work-to-school policy to enable practical career development of students from SHS, and promote relevant policy to reinforcing SHS education rather than quantitative evaluation such as employment rate, and cooperative support from each government departments is required to make manpower with skill related to SHS to get proper evaluation and treatment.

Extension Method of Association Rules Using Social Network Analysis (사회연결망 분석을 활용한 연관규칙 확장기법)

  • Lee, Dongwon
    • Journal of Intelligence and Information Systems
    • /
    • v.23 no.4
    • /
    • pp.111-126
    • /
    • 2017
  • Recommender systems based on association rule mining significantly contribute to seller's sales by reducing consumers' time to search for products that they want. Recommendations based on the frequency of transactions such as orders can effectively screen out the products that are statistically marketable among multiple products. A product with a high possibility of sales, however, can be omitted from the recommendation if it records insufficient number of transactions at the beginning of the sale. Products missing from the associated recommendations may lose the chance of exposure to consumers, which leads to a decline in the number of transactions. In turn, diminished transactions may create a vicious circle of lost opportunity to be recommended. Thus, initial sales are likely to remain stagnant for a certain period of time. Products that are susceptible to fashion or seasonality, such as clothing, may be greatly affected. This study was aimed at expanding association rules to include into the list of recommendations those products whose initial trading frequency of transactions is low despite the possibility of high sales. The particular purpose is to predict the strength of the direct connection of two unconnected items through the properties of the paths located between them. An association between two items revealed in transactions can be interpreted as the interaction between them, which can be expressed as a link in a social network whose nodes are items. The first step calculates the centralities of the nodes in the middle of the paths that indirectly connect the two nodes without direct connection. The next step identifies the number of the paths and the shortest among them. These extracts are used as independent variables in the regression analysis to predict future connection strength between the nodes. The strength of the connection between the two nodes of the model, which is defined by the number of nodes between the two nodes, is measured after a certain period of time. The regression analysis results confirm that the number of paths between the two products, the distance of the shortest path, and the number of neighboring items connected to the products are significantly related to their potential strength. This study used actual order transaction data collected for three months from February to April in 2016 from an online commerce company. To reduce the complexity of analytics as the scale of the network grows, the analysis was performed only on miscellaneous goods. Two consecutively purchased items were chosen from each customer's transactions to obtain a pair of antecedent and consequent, which secures a link needed for constituting a social network. The direction of the link was determined in the order in which the goods were purchased. Except for the last ten days of the data collection period, the social network of associated items was built for the extraction of independent variables. The model predicts the number of links to be connected in the next ten days from the explanatory variables. Of the 5,711 previously unconnected links, 611 were newly connected for the last ten days. Through experiments, the proposed model demonstrated excellent predictions. Of the 571 links that the proposed model predicts, 269 were confirmed to have been connected. This is 4.4 times more than the average of 61, which can be found without any prediction model. This study is expected to be useful regarding industries whose new products launch quickly with short life cycles, since their exposure time is critical. Also, it can be used to detect diseases that are rarely found in the early stages of medical treatment because of the low incidence of outbreaks. Since the complexity of the social networking analysis is sensitive to the number of nodes and links that make up the network, this study was conducted in a particular category of miscellaneous goods. Future research should consider that this condition may limit the opportunity to detect unexpected associations between products belonging to different categories of classification.

Prehospital Status of the Patients with Ischemic Chest Pain before Admitting in the Emergency Department (허혈성 흉통 환자의 응급의료센터 방문 전 상황)

  • Jin, Hye-Hwa;Lee, Sam-Beom;Do, Byung-Soo;Chun, Byung-Yeol
    • Journal of Yeungnam Medical Science
    • /
    • v.24 no.1
    • /
    • pp.41-54
    • /
    • 2007
  • Background : The causes of chest pain vary but the leading cause of chest pain is ischemic heart disease. Mortality from ischemic chest pain has increased more than two fold over the last ten years. The purpose of this study was to determine the data necessary for rapid treatment of patients with signs and symptoms of ischemic chest pain in the emergency department (ED). Materials and Methods : We interviewed 170 patients who had ischemic chest pain in the emergency department of Yeungnam University Hospital over 6 months with a protocol developed for the evaluation. The protocol used included gender, age, arriving time, prior hospital visits, methods of transportation to the hospital, past medical history, final diagnosis, and outcome information from follow up. Results : Among 170 patients, there were 118 men (69.4%) and the mean age was 63 years. The patients diagnosed with acute myocardial infarction (AMI) were 106 (62.4%) and with angina pectoris (AP) were 64 (37.6%). The patients who had visited another hospital were 68.8%, twice the number that came directly to this hospital (p<0.05). The ratio of patients who visited another hospital were higher for the AMI (75.5%) than the AP (59.4%) patients (p<0.05). The median time spent deciding whether to go to hospital was 521 minutes and for transportation was 40 minutes. With regard to patients that visited another hospital first, the median time spent at the other hospital was 40 minutes. The total median time spent before arriving at our hospital was 600 minutes (p>0.05). The patients who had a total time delay of over 6 hours was similar 54.8% in the AMI group and 57.9% in the AP group (p>0.05). As a result, only 12.2% of the patients with an AMI received thrombolytics, and 48.8% of them had a simultaneous percutaneous coronary intervention (PCI). In the emergency department 8.5% of the patients with an AMI died. Conclusion : Timing is an extremely important factor for the treatment of ischemic heart disease. Most patients arrive at the hospital after a long time lapse from the onset of chest pain. In addition, most patients present to a different hospital before they arrive at the final hospital for treatment. Therefore, important time is lost and opportunities for treatment with thrombolytics and/or PCI are diminished leading to poor outcomes for many patients in the ED. The emergency room treatment must improve for the identification and treatment of ischemic heart disease so that patients can present earlier and treatment can be started as soon as they present to an emergency room.

  • PDF