응급실 근무자의 외상 후 스트레스장애 유병률 및 발생 기여 요인

고동률,김건배,이지환,Ko, Dong-Ryul,Kim, Gun-Bae,Lee, Ji-Hwan 한국의료질향상학회 2021 한국의료질향상학회지 Vol.27 No.1

Purpose: This study was designed to investigate that the prevalence of Post-traumatic stress disorder (PTSD) and occupational environmental factors that contribute to the developing of PTSD in workers who worked in emergency room in Korea. Methods: This study is a multicenter cross-sectional study that was conducted in three emergency rooms. Data was collected by self-response method through questionnaire. The Impact Event Scale-Revised was used to screen the high-risk group of PTSD. Univariate and multivariate regression analysis was used to identify the factors associated with the developing of high-risk group of PTSD. Results: Total 211 subjects responded to the questionnaire. Of these, 170 subjects experienced psychological trauma event (PTE) in the working environment. And 60 subjects classified as high risk group of PTSD, so a prevalence of high risk group for PTSD was 28.4%. Factors related to the high risk group of PTSD were the frequency of psychological trauma events experienced over the past 1 year and the high score of QIDS-SR16. Conclusion: The prevalence of high risk group for PTSD among emergency room workers in Korea is very high. This may adversely affect the safety of patients, so early screening and intervention are necessary.

MC/DC 100% Test case를 활용한 Back-to-Back Testing

고동률 ( Dong-ryul Ko ),유영민 ( Young-min You ),박인권 ( In-kuen Park ),한일영 ( Il-young Han ) 한국정보처리학회 2017 한국정보처리학회 학술대회논문집 Vol.24 No.2

차량 내 전장부품이 증가하고, 차량 OEM(Original Equipment Manufacturing)이 다양한 차종을 생산 판매함에 따라 다양한 SW(software) 형상이 개발되고 있다. 따라서, 기존에 개발된 SW 형상 과 변경된 SW 형상 간에 기능 일치성 검증에 대한 필요성이 증가하고 있다. 두 가지 SW 형상 간에 기능 일치성 확인을 위한 테스팅 방법으로 Back-to-Back Testing 이 있는데, 이는 각 SW 형상에 동일한 입력값을 주입하고 동일한 출력값이 산출되는 지 확인하는 테스팅 방법이다. Back-to- Back Testing 수행 시 Test case 설계가 필요한데, Test case 의 분량과 테스팅 종료기준에 대해서 아직 확립이 되어 있지 않다. 이제 본 논문에서는 MC/DC(Modified Condition /Decision Coverage) 개념을 이용하여 Test case 분량과 테스팅 종료 기준에 대해서 제시하고, 이를 적용한 사례를 설명한다. 본 논문에서 제시한 Test case 설계 기준을 적용하면, 제한적인 테스팅 일정과 인력을 만족하고, 기능 일치를 확인할 수 있는 충분한 테스팅이 가능할 것으로 판단한다.

Amatoxin 중독 환자에서 Silymarin, Penicillin, N-acetylcysteine의 효과 비교: 체계적 고찰

최민우,고동률,공태영,좌민홍,유제성,정성필,Choi, Min Woo,Ko, Dong Ryul,Kong, Taeyoung,Choa, Min Hong,You, Je Sung,Chung, Sung Phil 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.1

Purpose: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. Results: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. Conclusion: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.

급성 칼슘통로차단제 중독에서 고용량 인슐린/정상혈당치료의 효과: 체계적 고찰

양진모 ( Jinmo Yang ),고동률 ( Dong Ryul Ko ),공태영 ( Taeyoung Kong ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. Methods: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. Results: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. Conclusion: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.

체외 생명유지술을 이용한 중독 환자의 치료: 체계적 고찰

이용희 ( Yong Hee Lee ),고동률 ( Dong Ryul Ko ),공태영 ( Taeyoung Kong ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.1

Purpose: Extracorporeal life support (ECLS) is a term used to describe a number of modalities including extracorporeal membrane oxygenation (ECMO) to support cardiac and/or pulmonary systems. The purpose of this study is to review the available evidence regarding the effect of ECLS in patients with acute poisoning. Methods: Electronic literature searches with PubMed, Embase, Cochrane library, and KoreaMed were conducted for identification of relevant studies addressing ECLS in treatment of acute poisoning. The literature search was conducted by two investigators in March, 2016 with publication language restricted to English and Korean. The toxic substance, technique of ECLS, and final outcome of each case were analyzed. Results: The final analysis included 64 articles including 55 case reports. There were no articles classified according to a high level of evidence such as randomized trial and prospective cohort study. ECLS treatment was used in the management of patients poisoned with 36 unique substances. Venovenous ECMO was performed in 4 cases. Among the reported cases, 10 patients died despite treatment with ECLS. Conclusion: Evidence supporting ECLS for patients with acute poisoning is inadequate. However, many case reports suggest that early consideration of ECLS in poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial.

급성 중독 환자에서 지질 유탁액 정맥투여의 효과: 체계적 고찰

명진우 ( Jinwoo Myung ),고동률 ( Dong Ryul Ko ),공태영 ( Taeyoung Kong ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.1

Purpose: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. Results: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. Conclusion: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.

급성 중독으로 응급실에 내원하여 사망한 환자의 원인물질 및 시간 분포

이현재 ( Hyeonjae Lee ),좌민홍 ( Minhong Choa ),한은아 ( Eunah Han ),고동률 ( Dong Ryul Ko ),고재욱 ( Jaiwoog Ko ),공태영 ( Taeyoung Kong ),조준호 ( Junho Cho ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.2

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (< 6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period ( >7 d) were 9.8%. Conclusion: This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

소아의 에틸렌글리콜 및 메탄올 중독에서 Fomepizole의 효과

민하나 ( Ha Na Min ),황윤정 ( Yoon Jung Hwang ),고동률 ( Dong Ryul Ko ),주영선 ( Young Seon Joo ),공태영 ( Tae Young Kong ),좌민홍 ( Min Hong Choa ),박인철 ( In Cheol Park ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2017 대한임상독성학회지 Vol.15 No.2

Purpose: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. Methods: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. Results: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. Conclusion: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.

중독관리센터의 경제적 효과에 대한 체계적 고찰

한은아 ( Eunah Han ),황현아 ( Hyuna Hwang ),유지나 ( Gina Yu ),고동률 ( Dong Ryul Ko ),공태영 ( Taeyoung Kong ),유제성 ( Je Sung You ),좌민홍 ( Minhong Choa ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.1

Purpose: The purpose of this study was to conduct a systematic review to investigate the socio-economic benefits of the poison control center (PCC) and to assess whether telephone counseling at the poison control center affects the frequency of emergency room visits, hospitalization, and length of stay of patients with acute poisoning. Methods: The authors conducted a medical literature search of the PubMed, EMBASE, and Cochrane Library databases. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. Key results such as the cost-benefit ratio, hospital stay days, unnecessary emergency room visits or hospitalizations, and reduced hospital charges were extracted from the studies. When meta-analysis was possible, it was performed using RevMan software (RevMan version 5.4). Results: Among 299 non-duplicated studies, 19 were relevant to the study questions. The cost-benefit ratios of PCC showed a wide range from 0.76 to 36 (average 6.8) according to the level of the medical expense of each country and whether the study included intentional poisoning. PCC reduced unnecessary visits to healthcare facilities. PCC consultation shortened the length of hospital stay by 1.82 (95% CI, 1.07-2.57) days. Conclusion: The systematic review and meta-analysis support the hypothesis that the PCC operation is cost-beneficial. However, when implementing the PCC concept in Korea in the future, it is necessary to prepare an institutional framework to ensure a cost-effective model.