• Journal of Hospice and Palliative Care
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• v.14 no.2
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• pp.101-109
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• 2011

Purpose: The Assessing Care Of Vulnerable Elders project has developed indicators for the quality of the end-of-life (EOL) care. However, family members of cancer patients may have a different view on the quality indicators (QIs) established by health care experts. We evaluated the QIs from the family members' perspective. Methods: The information used in this study was gathered by surveying family members of cancer patients who were admitted to the inpatient hospice ward in Korea. A cross-sectional anonymous questionnaire was distributed to 120 potential respondents from July to October 2009. We included 69 responses in this study (effective response rate, 57.5%). Statistical analysis was performed by using SPSS for Win ver. 14.0, with independent t-test and Pearson's chi-square test. Results: Among QIs for good hospice care, families agreed the most on "Medical examination by the palliative care team or specialist" (88.4%) and "Dying in the family's presence" (88.4%). They agreed the least on "Discussing cardiopulmonary resuscitation with patients" (15.9%). Among QIs for bad hospice care, "Occurrence of fall or pressure ulcer are undesirable" showed the highest agreement rate (94.2%). The lowest agreement rate was 11.6% on "Dying in the hospital is undesirable." In addition, women, patients who were aware of their prognoses, and people with a high socioeconomic status tended to agree more on the QIs. Conclusion: Patients' families did not agree on some of the QIs recommended by previous studies. Family members' characteristics were related to their opinions on QIs.

• Journal of the Korean Society of Surveying, Geodesy, Photogrammetry and Cartography
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• v.34 no.3
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• pp.263-271
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• 2016

On account of population aging and increasing cardiovascular disorders, acute cardiac arrest cases are escalating each year. In order to increase the survival rate of the patients, rapid cardiopulmonary resuscitation is necessary. For this reason, the government is expanding the supply of Automated External Defibrillators(AED). However, the AEDs cannot be effectively deployed to the incident cases that occur outdoors, for the installed AEDs are mostly located indoors. After analyzing the distribution of incident cases within the study area, about 11% of cardiac arrest incidents occurred in open spaces including sidewalks and residential areas. This study was conducted to increase the survival rate of the patients by allocating 41 additional AEDs in the study area using a GIS based location-allocation method. To conduct a feasibility study, the density of a senior floating population covered by the same number of AEDs placed at random and the density covered by the experiment were compared. In conclusion, having excluded outliers caused by geological and social factors, results showed that AEDs placed through GIS based location-allocation covered 5% more of the senior floating population density.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.57-64
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• 2009

Purpose: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. Methods: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. Results: Of the 50 patients (mean age : $45{\pm}18years$, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). Conclusion: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.

• Journal of Trauma and Injury
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• v.26 no.4
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• pp.255-260
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• 2013

Purpose: For the treat hypothermia patients, active warming might be needed. In most emergency departments, IV warm saline infusion is used for treatments. However, during IV warm saline infusion, heat loss from the warm saline may occur and aggravate hypothermia. Thus, in this study, we conducted an experiment on conserving heat loss from warm saline by using a simple method. Methods: Four insulation methods were used for this study. 1) wrapping the set tube for the administration of the IV fluid with a cotton bandage, 2) wrapping the set tube for the administration of the IV fluid with a cotton bandage with aluminum foil, 3) wrapping the warm saline bag and tube with a cotton bandage, and 4) wrapping the warm saline bag and tube with a cotton bandage with aluminum foil. Intravenous fluid was preheated to a temperature between $38-40^{\circ}C$. The temperatures of the saline bag temperature and the distal end of the IV administration set were measured every ten minutes for an hour. The infusion rate was 1000 cc/hr, and to obtain an accurate infusion rate, we used an infusion pump. Results: The mean initial temperature of the saline bag was $39.11^{\circ}C$. An hour later, the fluid temperature at the distal end of the fluid temperature ranged from $39.11^{\circ}C$ to $34.3^{\circ}C$. Without any insulation, the initial temperature of the pre-heated warm saline, $39^{\circ}$ had decreased to $34.8^{\circ}C$ after having been run through the 170-cm-long IV administration tube, and after 1-hour, the temperature was $29.63^{\circ}C$. As we expected, heat loss was prevented most by wrapping both the saline bag and the IV administration set with a cotton bandage and aluminum foil. Conclusion: Wrapping both the saline bag and the IV administration set with a cotton bandage and aluminum foil can prevent heat loss during IV infusion in Emergency departments.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.47 no.1
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• pp.56-61
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• 2010

Hemorrhagic shock is a common cause of death in the emergency department. The purpose of this study was to investigate the relationship between blood loss as a percent of the total estimated blood volume (% blood loss) and changes in several physiological parameters. The other goal was to achieve an accurate prediction of percent blood loss for hemorrhagic shock in rats using a linear regression model. We allocated 60 Sprague-Dawley rats into four groups: 0ml, 2ml, 2.5ml, 3 mL/100 g during 15 min. We analyzed the heart rate, systolic and diastolic blood pressure, respiration rate, and body temperature in relation to the percent blood loss. We generated a linear regression model predicting the percent blood loss using a randomly chosen 360 data set and the R-square value of the model was 0.80. Root mean square error of the tested 360 data set using the linear regression was 5.7%. Even though the linear regression model is not directly applicable to clinical situation, our method of predicting % blood loss could be helpful in determining the necessary fluid volume for resuscitation in the future.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.493-499
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• 2018

Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

• Journal of Internet of Things and Convergence
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• v.8 no.6
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• pp.115-122
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• 2022

Recently, the importance of CPR training for the layperson has been emphasized to improve the survival rate of out-of-hospital cardiac arrest patients. An accurate and realistic training strategy is required for the CPR training effect for laypersons. In this study, we develop an extended reality (XR) based CPR training system and evaluate its usability. The XR based CPR training system consisted of three applications. First, a 3D heart anatomy image registered to the manikin is transmitted to the smart glasses to guide the chest compression point. The second application provides visual and auditory information about the CPR process through smart glasses. At the same time, the smartwatch sends a vibration notification to guide the compression rate. The 'Add-on-kit' is a device that detects the depth and speed of chest compression via sensors installed on the manikin and sends immediate feedback to the smartphone. One hundred laypersons who participated in this study agreed that the XR based CPR training system has realism and effectiveness. XR based registration technology will contribute to improving the efficiency of CPR training by enhancing realism, immersion, and self-directed learning.

• Journal of Trauma and Injury
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• v.25 no.2
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• pp.49-56
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• 2012

Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.

• The Korean Journal of Emergency Medical Services
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• v.13 no.1
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• pp.87-96
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• 2009

Purpose : To grasp the mental burden for legal responsibility that rescue members have in the performance of job. Method : Questionnaire was presented to rescue members serving in 2 direct control safety centers of fire station located in Seoul, Daejon, Incheon, Kwangju, Busan, Daegu and Ulsan. Results : 1. Questioned whether they have mental burden for legal responsibility while performing job on the site, the rescue members responded : very burdensome in 38.0%, burdensome in 56.0%, moderate in 4.5%, not burdensome in 1.0%, no burden at all in 0.5%. 2. Questioned on the first aid treat for which they have the most mental burden, the rescue members responded : intubation into trachea laryngeal mask airway(LMA) in 40.4%, automatic external defibrillator in 16.3%, securing vein providing sap(medicine) in 10.8%, basic cardiopulmonary resuscitation in 7.2%, eliminating foreign matters inserted into body in 5.4%, stanching external bleeding and treating injury in 5.4%, fixing extremities and spine by using splint in 1.8%, measuring the symptom of vitality in 1.2%, providing oxygen in 0.0%. 3. Questioned whether experiencing legal problem or firm petition(complaint) raised by patient while serving as rescue members, they responded : experiencing a complaint in 41.6%, experiencing no complaint in 58.4%. Asked to indicate the stress level in the scale of which they suffered when lawsuit or firm petition was raised, 0(weak)-10(strong), they answered 8.8 in average. 4. Questioned whether 119 rescue members put the legal responsibility in case that they cause damage to patients intentionally in performing, they responded to the inquiry 3.66 in average(of 5.00). It represented meaningful differences (F=2.874, p=.024) whether they had license or not. 5. In future, legal action will raise against the rescue member by 99% because of people's rights improvement(63.1%), high expectations for the rescue system(29.5%), non-licensed rescue members(5.1%). Conclusion : It was found that the rescue members had severe mental burden for advanced life support which was investigated to have low enforcement rate in the preceding research, for instance, intubation into trachea securing vein management by using automatic external defibrillator. To improve the qualitative level of rescue service in the fire fighting, it may be required to construct the environment that eliminates the mental burden of rescue members for legal responsibility.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.277-284
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• 2020

Background: Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. Methods: Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. Results: All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01). The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia. Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. Conclusion: Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.