• Journal of Yeungnam Medical Science
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• v.24 no.1
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• pp.41-54
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• 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.

• Journal of the Korean Geographical Society
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• v.29 no.1
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• pp.16-38
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• 1994

The spatial structure of Korea has been changed drastically during the second half of this century. The events such as the Korean War and the resultant division of the Korean Peninsular into two Koreas, rapid industrialization and urbanization are the major causes among others for the spatial changes of the nation. The changes in turn have spawned a number of spatial problems. It is time, we argue, to diagnose how much the nation is now ill-structured, and to discuss of which directions the long-term spatial management be reoriented. A delphi survey was conducted during the early 1993 to fulfill such research needs. Questionnaires were distributed among geographers, planners, and high governmental officials throughout the nation. These 'experts of spatial problems' were requested to evaluate the past spatial policies and strategies, and to identify spatial and environmental problems at the national, regional and local levels. The survey included questions with regard to the spatial problems in North Korea too. A complementary literature survey in the fields of spatial sciences was accomplished as well in order to identify the major research interests and issues with regard to the nations's spatial structure. The delphi survey results indicatee that the present spatial structure: in relation to consumption, housing and economic activities is satisfactory in overall, while rather poor in terms of education, leisure and community activities. Most of the experts consider infrastructural improvements are urgent in the areas of roads, waste disposal facilitles, railroads, harbors, water supply and drainage systems. The over-concentration of economic, social and political function in the Seoul Metropolitan Region is perceived to be the most serious spatial problem in Korea. The long-term solutions suggested are strategies toward a more balanced regional development as well as toward a cleaner environment. The concensus among the experts for the short-term solution is the redistribution of population and industries from the Seoul Metropolitan Region to the intermediate and small cities. The land use policies and concurrent large-scale infrastructural projects are evaluated largely pertinent and desirable in general. It is, however, suggested that development projects be conducted in a more harmonious way with environment. The survey respondents suggest that the present environmental management policies should be reexamined critically. With regard to regional and local problems, transportation and pollutions are thought to be most serious in the Seoul Metropolitan Region, while employment opportunities, and information, education and health care services are most deprived in small cities and rural areas. The majority of the experts consider a city size of 250, 000-500, 000 population is desirable to live within. Respondents beileve that North Korea's physical environment is still not aggravated much whereas its infrastructural provisions are largely pool. The co-authors of this research figure a "environmentaly sound and spatially balanced Korean Penninsular" as the ideal type of spatial structure in Korea. The basic guidelines toward this ideal prototype are suggested: the recovery of spetial integrity, progressive restructuring of the nation, land uses geared to public welfare rather than private interests, and eco-humanistic approach in spatial policies.