• 한국응급구조학회지
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• 제17권1호
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• pp.21-39
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• 2013

Purpose : The purpose of this study is to provide the basic data to improve pre-hospital phase emergency care for acute myocardial infarction (AMI) patients by analyzing AMI patients' clinical characteristics and emergency care situations. Methods : Data were collected through medical records of 385 AMI patients including ambulance records of 107 AMI patients transferred to the emergency medical center for three and a half years. Results : Regarding emergency care for AMI patients in pre-hospital phase, 47% of the care revealed moderate level or higher, and appropriateness of pre-hospital phase emergency care for cardiopulmonary complaints practiced by paramedics showed statistically significant improvement in recent years (p<.001). The time from onset of symptom to ballooning intervention by 119 emergency services was shorter than that in other cases. However, emergency care by paramedic was mainly basic life support. Conclusion : Since prognosis of AMI shows vast differences depending on prompt detection and medical intervention, cooperation between pre-hospital and in-hospital phase is highly required. 119 paramedics should be trained focusing on the accurate assessment and emergency care, and medical direction should be activated. In addition, regulation on 12-lead EKG, cardiac enzyme analysis, use of analgesics and thrombolytic agents should be legally implemented.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제6권10호
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• pp.77-94
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• 2000

The purpose of this thesis is to lay groundwork for the development of emergency care system in metropolitan area. It compares the performance and outcome of the current system with foreign counterparts and investigates the changing aspects of future medical environment. Emergency medical system can be divided into two parts of both pre-hospital care, which refers to the emergency measures taken before arriving at a hospital, and hospital care that is given within a hospital. Pre-hospital care includes on-the-spot expedients, information system and delivery system, whereas hospital care is related to the classification and specialization of medical care facilities. This research focuses on the evaluation of the performance of a rescue party, which is part of pre-historical care system. As a result, it provides valuable material for the development of the emergency medical system in Seoul.

• Korean Circulation Journal
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• 제53권9호
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• pp.594-605
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• 2023

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.

• 한국병원경영학회지
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• 제24권1호
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• pp.11-20
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• 2019

The purpose of this study was to identify the factors affecting the use of superior general hospitals on public holidays by using the medical use model (Dutton's medical use model) with the medical panel data. The study found that 34.2% of superior general hospital emergency rooms were used on public holidays and the factors which made statistically significant influences on the use of superior general hospital emergency rooms on public holidays were whether patients were operated or emergency care and inspection etc. Also, there was a difference depending on whether the type of establishment of the medical insititution is national or private. In other words, patients who received emergency care and examinations were found to make more frequent visit to hospital emergency room on pubic holiday, compared to patients who underwent surgery and those who visited emergency rooms in the private superior general hospital did so, compared to those who visited emergency room in the national general hospital(OR, 4.4, 3.386, respectively). Therefore, it is necessary to consider the introduction of integrated care of health and social care medical service that focuses on primary care in Denmark, which focuses on patients, and pre-The Canadian Triage and Acuity Scale(pre-CTAS) in the UK.

• Tuberculosis and Respiratory Diseases
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• 제80권3호
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• pp.296-303
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• 2017

Background: Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM). Methods: We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission. Results: Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted ${\beta}-coefficient$, -0.19; 95% confidence interval, -1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results. Conclusion: Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.

• 한국응급구조학회지
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• 제26권3호
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• pp.71-91
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• 2022

Purpose: This study aimed to provide baseline data for implementing advanced life-support for 119EMTs. This is done with an in-depth examination of the emergency care experiences of the 119EMTs on-site and during transportation. Methods: Interviews were conducted with twelve 119EMTs, and the data were analyzed using the phenomenological method. Results: The 34 topics had 19 sub-components and were analyzed according to seven categories: 'A work environment where you cannot focus only on emergency care on-site and during transportation', '119EMTs struggling with manpower shortage', 'Current status of education blocking the upward standardization of 119EMT', 'Implementation of professional emergency care was held back due to the limited legal scope of 119EMT', 'Medical oversight makes it difficult to implement emergency care due to low flexibility', '119EMTs who cannot choose hospital selection and find it difficult to receive help', 'An evaluation system not reflecting reality at all that only leaves high scores'. Conclusion: This study was undertaken to implement specialized emergency care for 119EMTs; not only the necessity of reviewing the expansion of the work scope of 119EMTs but also the necessity of effective 'Medical Oversight system' reorganization raised as well.

• Clinical and Experimental Pediatrics
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• 제54권12호
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• pp.477-480
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• 2011

In order to care for an ill or injured child, it is crucial that every emergency department (ED) has a minimum set of personnel and resources because the majority of children are brought to the geographically nearest ED. In addition to adequate preparation for basic pediatric emergency care, a comprehensive, specialized healthcare system should be in place for a critically-ill or injured victim. Regionalization of healthcare means a system providing high-quality and cost-effective care for victims who present with alow frequency, but critical condition, such as multiple trauma or cardiac arrest. Within the pediatric field, neonatal intensive care and pediatric trauma care are good examples of regionalization. For successful regionalized pediatric emergency care, all aspects of a pediatric emergency system, from pre-hospital field to hospital care, should be categorized and coordinated. Efforts to set up the pediatric emergency care regionalization program based on a nationwide healthcare system are urgently needed in Korea.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.42-52
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• 2019

Background: Transforming growth factor ${\beta}$ (TGF-${\beta}$), retinoic acid (RA), p38 mitogen-activated protein kinase (MAPK), and MEK signaling play critical roles in cell differentiation, proliferation, and apoptosis. We investigated the effect of RA and the role of these signaling molecules on the phosphorylation of Smad2/3 (p-Smad2/3) induced by TGF-${\beta}1$. Methods: A549 epithelial cells and CCD-11Lu fibroblasts were incubated and stimulated with or without all-trans RA (ATRA) and TGF-${\beta}1$ and with MAPK or MEK inhibitors. The levels of p-Smad2/3 were analyzed by western blotting. For animal models, we studied three experimental mouse groups: control, bleomycin, and bleomycin+ATRA group. Changes in histopathology, lung injury score, and levels of TGF-${\beta}1$ and Smad3 were evaluated at 1 and 3 weeks. Results: When A549 cells were pre-stimulated with TGF-${\beta}1$ prior to RA treatment, RA completely inhibited the p-Smad2/3. However, when A549 cells were pre-treated with RA prior to TGF-${\beta}1$ stimulation, RA did not completely suppress the p-Smad2/3. When A549 cells were pre-treated with MAPK inhibitor, TGF-${\beta}1$ failed to phosphorylate Smad2/3. In fibroblasts, p38 MAPK inhibitor suppressed TGF-${\beta}1$-induced p-Smad2. In a bleomycin-induced lung injury mouse model, RA decreased the expression of TGF-${\beta}1$ and Smad3 at 1 and 3 weeks. Conclusion: RA had inhibitory effects on the phosphorylation of Smad induced by TGF-${\beta}1$ in vitro, and RA also decreased the expression of TGF-${\beta}1$ at 1 and 3 weeks in vivo. Furthermore, pre-treatment with a MAPK inhibitor showed a preventative effect on TGF-${\beta}1$/Smad phosphorylation in epithelial cells. As a result, a combination of RA and MAPK inhibitors may suppress the TGF-${\beta}1$-induced lung injury and fibrosis.

• Tuberculosis and Respiratory Diseases
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• 제71권2호
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• pp.88-96
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• 2011

Background: It is known that cigarette smoke (CS) causes cell death. Apoptotic cell death is involved in the pathogenesis of CS-related lung diseases. Some members of the protein kinase C (PKC) family have roles in cigarette smoke extract (CSE)-induced apoptosis. This study was conducted to investigate the role of PKC epsilon in CSE-induced apoptosis in human lung fibroblast cell line, MRC-5. Methods: Lactate dehydrogenase release was measured using a cytotoxicity detection kit. The MTT assay was used to measure cell viability. Western immunoblot, Hoechst 33342 staining and flow cytometry were used to demonstrate the effect of $PKC{\varepsilon}$. Caspase-3 and caspase-8 activities were determined using a colorimetric assay. To examine $PKC{\varepsilon}$ activation, Western blotting was performed using both fractions of membrane and cytosol. Results: We showed that CSE activated $PKC{\varepsilon}$ by demonstrating increased expression of $PKC{\varepsilon}$ in the plasma membrane fraction. Pre-treatment of $PKC{\varepsilon}$ peptide inhibitor attenuated CSE-induced apoptotic cell death, as demonstrated by the MTT assay (13.03% of control, 85.66% of CSE-treatment, and 53.73% of $PKC{\varepsilon}$ peptide inhibitor-pre-treatment, respectively), Hoechst 33342 staining, and flow cytometry (85.64% of CSE-treatment, 53.73% of $PKC{\varepsilon}$ peptide inhibitor-pre-treatment). Pre-treatment of $PKC{\varepsilon}$ peptide inhibitor reduced caspase-3 expression and attenuated caspase-3, caspase-8 activity compared with CSE treatment alone. Conclusion: $PKC{\varepsilon}$ seem to have pro-apoptotic function and exerts its function through the extrinsic apoptotic pathway in CSE-exposed MRC-5 cells. This study suggests that $PKC{\varepsilon}$ inhibition may be a therapeutic strategy in CS-related lung disease such as chronic obstructive pulmonary disease.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.81-85
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• 2019

Background: Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. Methods: We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. Results: Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation ($SpO_2$) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air $SpO_2$ pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. Conclusion: This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.