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Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department
Sakong Dal,최승필,노우영,Park Chang Won 대한응급의학회 2023 Clinical and Experimental Emergency Medicine Vol.10 No.1
Objective: Acute gallbladder disease (AGD) is frequent in the emergency department (ED) and usually requires emergency surgery. However, only a few studies have reported the impact of COVID-19 on AGD. The goal of this study was to evaluate the time between symptom onset and surgery and the perioperative severity of AGD during the COVID-19 pandemic compared to before the era of COVID-19. Methods: This retrospective, single-center cohort study included patients who presented to the ED with suspected AGD and who underwent emergency cholecystectomy. We designed a before-after comparative study, and the intervention was the COVID-19 outbreak. The 6-month period after the COVID-19 outbreak was defined as the post-COVID group, whereas the pre-COVID group consisted of the same period in the previous year. The primary outcome was the time from symptoms to surgery. We evaluated the time intervals between symptom onset and ED arrival and between ED arrival and surgery. The secondary outcomes were preoperative and postoperative severity indexes. Results: A total of 316 patients was analyzed. The post-COVID group showed longer duration from symptom onset to ED arrival (34.0 hours vs. 15.0 hours, P<0.001) and longer time interval from ED arrival to surgery (16.2 hours vs. 10.2 hours, P<0.001) than the pre-COVID group. The overall time interval between symptom onset to surgery was longer in the post-COVID group than the pre-COVID group (71.5 hours vs. 33.5 hours, P<0.001). The post-COVID group showed higher preoperative Simplified Acute Physiology Score II scores than the pre-COVID group (20.1 vs. 18.2, P=0.045). The proportion of moderate or severe disease increased in the post-COVID group (78% vs. 65%, P=0.017). The durations of hospital stay (7.0 days vs. 5.0 days, P<0.001) and intensive care unit stay (27.1 hours vs. 10.8 hours, P=0.008) were longer in the post-COVID group than in the pre-COVID group. Conclusion: During the pandemic, the time interval between symptom onset to surgery was significantly increased among patients with AGD. Concomitantly, higher preoperative severity indexes and longer hospital stay were reported with a delay in emergency surgery.
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헌혈자와 비헌혈자의 헌혈에 대한 지식, 태도 및 동기에 대한 비교
신재학,사공준,김석범,김창윤,강복수,정종학,송달효 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.2
일부 가두 및 단체 헌혈자와 헌혈 미경험자들의 헌혈에 대한 태도, 지식 및 동기 등을 비교조사하기 위해 1989년 3월1일부터 3월 31일까지 대구적십자 혈액원 소속 가두헌혈차를 방문하여 헌혈한 사람과 동기관에서 실시한 단체헌혈캠페인의 헌혈자 622명과 가두 헌혈차를 방문하여 헌혈을 거부하였거나 단체헌혈캠페인에서 거부한 322명을 대상으로 자기기입식 설문서를 이용하여 조사분석하여 다음과 같은 결과를 얻었다. 헌혈자군은 남자가 84.1%, 여자 15.9%였고 비헌혈자군은 남자 73.6%, 여자 26.4%였고 16-24세군이 헌혈자군 63.2%, 비헌혈자군 72.7%를 차지하였다. 그외 교육정도, 직업분포, 종교, 가구당 월수입, 결혼상태 및 건강상태의 분포도 헌혈자군과 비헌혈자군이 유사하였다. 헌혈에 관한 정보습득 매체는 TV가 헌혈자군 75.2%, 비헌혈자군 78.9%로 가장 많았고, 헌혈차직원, 라디오, 신문 순이었다. 잡지를 통한 정보습득이 헌혈자군에서 유의하게 많았다(p<0.05). 헌혈자군의 70.6%, 비헌혈자군의 58.1%가 헌혈을 권유받은 적이 있다고 대답했으며(p<0.01), 권유의 근원은 두군 모두에서 친구가 가장 많았고 헌혈차직원이 그 다음이었다. 헌혈 및 혈액에 관한 지식측정 문항 중 정답률이 가장 높은 것은 "혈액의 생성 및 소멸"에 관한 것이었으며 오답률이 가장 높았던 문항은 "수혈을 통한 암전파 가능"이었다. 헌혈자군의 평균정답률은 62.6%였고 비헌혈자군은 54.1%로 뚜렷한 차이가 있었다(p<0.01). 그리고 교육수준이 높을수록 정답률도 높아지는 경향이었다. 헌혈에 대한 태도측정 문항중에서 "혈액에 대한 느낌", "수혈을 가정한 혈액선택" 및 "혈액부족상황에 대한 견해"가 헌혈자군과 비헌혈자군 사이에 태도의 차이가 있었다(p<0.05) 헌혈자군과 비헌혈자군에서 헌혈의 가장 큰 동기는 "예치성 동기"였고 그 다음이 "인도주의적 이유"이었다. 헌혈에 응하지 않은 이유의 분포는 헌혈자군과 비헌혈자군 모두에서 "주사침공포", "헌혈차나 혈액원 방문이 두렵다" 그리고 " 현혈이 건강이나 활동에 지장" 등의 순으로 중요한 이유였다. 이상의 소견으로 보아 헌혈에 대한 홍보 및 계몽활동시 잡지를 이용하는 방안이 더욱 고려 되어야겠으며 홍보내용은 위의 지식측정문항중 오답률이 높은 것과 헌혈에 응하지 않은 이유중 잘못 인식하고 있는 부분에 대해 중점적으로 다뤄져야겠으며 각종 두려움에 관한 문제를 해결하기 위해서 다회 헌혈자의 비중을 높여야겠다. This study was conducted to compare the date on knowledge, attitude and motivation toward blood donation between donors and nondonors. The study population included 622 donors and 322 nondonors who visited the mobile blood donation car of Taegu Red Cross Blood Center and participated the group appointed blood donation campaign managed by the center from March 1 to March 31, 1989. The donors and nondonors were questioned above mentioned items with a formulated questionnaire. Among the general characteristics of the subjects in the study, male predominace (84.1% in donors and 73.6% in nondonors) in young age group(16-24 years)was the outstanding feature. As a medium of information about blood donation, "television" was playing a dominant role(donors ; 75.2%, nondonors ; 78.9%), while "magazine" played more important roles among donors. Of the donors, 70.6% and ofthe nondonors, 58.1% replieb that they had ever been induced to donate blood(p<0.01). Major inducers were friend and personnel of mobile blood donation vehicle. On the measuring of knowledge level, the average rates of correct answer was higher in donors(62.6%) than in nondonors(54.1%) (p<0.01). Higher the education level was presented, higher the knowledge level(p<0.05). There have been noticeable difference between donors and nondonors in blood replying the questionnaire set to measure their attitude toward blood donation, especially in the items such as "impression toward blood", "selection of transfusion blood source" and "view on the situation of blood shortage." The major motivation toward blood donation of the groups were "possible future need" and "altruism or humanitarian interest." The major reasons for not donation blood in both groups were " fear of the needle" and "dread to visit to mobile car or center."
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