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김종근 ( Jong Kun Kim ), 김윤정 ( Yun Jeong Kim ), 서강석 ( Kang Suk Seo ), 류현욱 ( Hyun Wook Ryoo ), 감신 ( Sin Kam ), 박재용 ( Jae Yong Park ), 이성국 ( Sung Kuk Lee ), 이원기 ( Won Kee Lee ), 강윤식 ( Yun Sik Kang ), 박기수 ( Kee Sue ) 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.2
Purpose: Recent reports suggest that many professionals, including emergency physicians, suffer from job stress and psychosocial stress. Emergency physicians also report a high premature attrition rate. Our goal was to investigate the levels of job and psychosocial stress and the relationship between these stresses and abandonment of their own specialty. Methods: Data was collected using a cross-sectional mail survey with a self-administered questionnaire. The questionnaire included 49 questions in scales relating to job stress, job satisfaction and plans for their remaining years in their specialty. Three hundred and forty-two emergency physicians participated in this study and completed the questionnaire Results: Among the 342 questionnaires, 132(48.4%) were returned. Multivariate analysis of variance revealed statistically significant differences in job stress and psychosocial stress between academic emergency physicians and clinical emergency physicians. The average scores for job stress, job satisfaction and psychosocial stress among emergency physicians were, respectively, 3.35±0.57, 2.93±0.50 and 2.33±0.78. Mean levels of job stress and psychosocial stress were higher among academic emergency physicians. Job satisfaction and occupational commitment were also higher among academic emergency physicians. Variables such as patient load, working hours per week, and night shifts proved unimportant. Of clinical emergency physicians, 54% planned on leaving their specialty within ten years. Conclusion: Job stress and psycosocial stress of academic emergency physicians were higher, but job satisfaction and occupational commitment were higher. Job stress and psycosocial stress of clinical emergency physicians were lower, but premature attrition rate were higher.
최근들어 급속한 산업화와 도시화에 의하여 하구와 연안 지역의 환경이 악화되었다. 한강하구와 경기만은 대조차의 넓은 조간대 지역이며, 산업단지와 농지확보, 신도시 건설을 위하여 매립과 둑이 만들어졌다. 다양한 개발에 대한 하구 환경을 파악하고 향후 개발에 대한 누적 효과를 검토할 필요성이 있다. 최근 들어 하구 보호에 대한 국민적 관심이 증가에 따라 하구 환경 개선을 위한 연구가 시작되었다. 본 연구에서는 한강 하구와 경기만에서 계절별로 표층수의 연속 수질 조사를 통하여 그 분포 특성을 파악하였다. With the rapid industrialization and urbanization in recent, the estuarine and coastal regions aorund have been sevely damaged. Han River estuary and Gyeonggi Bay are characterized by high-tidal range and wide tidal flats, a series of reclamation of tidal flat regions and a series of bank construction of inlet regions have been made for industrial, agricultural and new-town building objects. It is necessary to estimate the effect of the past human activities and to assess the cumulative environment change to the future development in the Han river estuary and Gyeonggi bay. As increase of public concern on environmental conservation, the project on restoration technologies for estuaries and coastal seas was started. This study investigated spatial-temporal distribution of water quality in the Han River estuary and Gyeonggi Bay.
Purpose: For the differential diagnosis of acute abdomen, abdominal computed tomography (CT) is commonly performed in the emergency department (ED). Rapid and accurate interpretation after CT is essential; however, final interpretation of the images by a board-certified radiologist for 24 hours a day is nearly impossible. Therefore, a preliminary interpretation is mainly made by emergency physicians in the ED, which may result in some discrepancy with the interpretations of board-certified radiologists. This study was conducted to determine the discrepancy rate of emergency medicine (EM) residents'preliminary interpretation and any reduction in discrepancy through feedback imaging education programs by attending radiologists. Methods: This was a before-and-after study, including 540 cases of abdominal CT scans performed in the ED between November 1, 2014 and April 30, 2015. Residents first documented their preliminary interpretation of 300 cases for 3 months. Board-certified radiologists then provided feedback image education to EM residents for these cases for 1 month. After feedback education, preliminary interpretations of 240 cases were documented for 2 months. Discrepancy rates before and after feedback education were then analyzed. Results: Total and major discrepancy rates before feedback image education were 28% and 11.7%, respectively, which declined to 14.6% and 4.6%, respectively, after feedback image education (p<0.05). Conclusion: Feedback image education was effective in reducing the discrepancy rate of the interpretation of abdominal CT scans by EM residents.
김양헌 ( Yang Hun Kim ), 서강석 ( Kang Suk Seo ), 이미진 ( Mi Jin Lee ), 박정배 ( Jung Bae Park ), 김종근 ( Jong Kun Kim ), 안재윤 ( Jae Yun Ahn ), 하소영 ( So Young Ha ), 류현욱 ( Hyun Wook Ryoo ), 문유호 ( Yoo Ho Mun ), 최마이클승필 ( Micha) 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.4
Purpose: Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. The objective of this study is to apply novel trauma scoring systems; BIG score (Base deficit (B), International normalized ratio (I), Glasgow Coma Scale (G)), Emergency Trauma Score (EMTRAS), Probability of Survival score version 12 (PS12), and MGAP (Mechanism, GCS, Age, Arterial pressure) to adults with major trauma, and to compare their performance with traditional systems; Injury Severity System (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS). Methods: Retrospective data collected between January 2011 and June 2012 from a regional trauma center registry on adult major trauma patients (Age≥18, ISS≥16) were used to identify factors associated with death. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: A total of 298 adult major trauma patients were retrieved in order to validate new trauma scoring systems. The median ISS was 22 [interquartile range (IQR) 17~25], and the hospital mortality rate was 30.9%. Traditional trauma scoring systems were each calculated to have an area under the curve of ISS 0.72 [95% confidence interval (CI): 0.67- 0.77], TRISS 0.91 (95% CI: 0.88-0.94), and RTS 0.90 (95% CI: 0.86-0.93). New trauma scoring systems were calculatedto have an area under the curve of EMTRAS 0.91 (95% CI: 0.87-0.94), BIG score 0.90 (95% CI: 0.86-0.93), PS12 0.91 (95% CI: 0.87-0.94), and MGAP 0.89 (95% CI: 0.85-0.93). Conclusion: The new trauma scoring systems (EMTRAS, BIG, MGAP) were good predictors of mortality in adult major trauma patients on admission. They performed well compared to traditional trauma scoring systems (ISS, RTS, TRISS).
여인환 ( In Hwan Yeo ), 김종근 ( Jong Kun Kim ), 이미진 ( Mi Jin Lee ), 신수정 ( M. D. Su Jeong Shin ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ), 박신률 ( Sin Youl Park ), 양승준 ( Seung Joon Yang ), ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.4
Purpose: An internship is a very generally a stressful period during medical training in general. Working in the Emergency Department (ED) is especially difficult and stressful because of its unique clinical environment. Our goal was to determine the level of the depression, fatigue, sleep disorders and stress of interns in the ED. Methods: A questionnaire was distributed to 430 interns who are working or had worked in the ED. The questionnaire included questions about general characteristics and scales relating to symptoms of depression, fatigue, sleep disorder and stress. Results: Of the 430 questionnaires given out, 178(41.4%) were returned. The mean age of the participants was 28.4【 2.9, and 123(69.5%) were male. Also, 112(63.3%) participants were working at an alumni-affiliated hospital or at related hospital. The interns at an unrelated hospital experienced more discrimination than those working at an alumni-related hospital (21.5% vs. 9.8%, respectively, p=0.031). Also, female interns experienced more sexual harassment than male interns (16.7% vs. 2.4%, respectively, p=0.001). The average score for medical outcomes study MOS sleep scale, Beck Depression Inventory, Fatigue Severity Scale and Cohen Perceived Stress Scale were 16.2【4.0, 8.0【7.8, 4.3 【1.2 and 19.4【5.4, respectively. The degree of participation in treating patients first hand (OR 2.33, 95% CI=1.19- 4.57), experiencing discrimination (OR 3.17, 95% CI=1.15- 8.73) and long working hours (OR 2.02, 95% CI=1.05-3.86) had a significant effect on stress and depression. Conclusion: The interns who worked at an ED had higher fatigue and stress scores compared to ordinary person. Also, participation, discrimination and working hours may be good to mention. Therefore, more research and effort is required to improve the factors that cause fatigue, stress and depression of the interns in ED.
Purpose: The rate of volunteering by emergency residents is currently low in Korea because of the relatively high job stress. We aimed to investigate the job stress and job satisfaction of emergency residents and we wanted to identify the related factors. Methods: Data was collected by conducting a cross-sectional mail survey. This mail was sent to 397 emergency residents in Korea. Among them, 226 persons answered the questionnaire and 220 responses were analyzed, with excluding 6 incomplete answers. Results: Age, gender, the marriage status and the type of training hospital showed no statistically significant differences in relation to job stress and job satisfaction. XXXXBut the grade of the residents, satisfaction as emergency residents, thoughts of changing their job, thoughts of leaving the emergency department, their social and economic positions and the type of work-shift showed significant differences for job stress and job satisfaction. XXX Among the job stresses, the mean scores of the job factor, the environmental factor and the reward factor were 3.45±0.90, 3.63±0.67 and 3.55±0, respectively. Among job satisfaction, the mean scores of the job factor, the relationship factor and the reward factor were 3.59±0.67, 2.46±0.74 and 2.53±0.80, respectively Conclusion: The job stress of emergency residents is excessive, and especially for the environmental and reward factors, and the degree of job satisfaction is low. Management of crowding, improving the environment by changing the type of work-shift type, eradicating violence in the emergency department and adequate rewards are needed to reduce this job stress. Efforts to increase the treatment capability and positively improve the relationship of residents with other medical specialists should be made to enhance emergency residents` job satisfaction.
김인혁 ( In Hyuk Kim ), 서강석 ( Kang Suk Seo ), 이미진 ( Mi Jin Lee ), 박정배 ( Jung Bae Park ), 김종근 ( Jong Kun Kim ), 류현욱 ( Hyun Wook Ryoo ), 안재윤 ( Jae Yun Ahn ), 문성배 ( Sungbae Moon ), 이동언 ( Dong Eun Lee ), 박용석 ( Yong S) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: The terminology that represented major trauma was vague, inconsistent, and lacked validation. The objective of this study is to investigate the new definition of polytrauma in adult patients of major trauma. Methods: A retrospective data of adult major trauma patients [Age≥15, 16≤Injury Severity Score (ISS)<75] from a regional trauma center were collected in period between July 2011 and December 2013 and divided into two groups: polytrauma and non-polytrauma. We compared the demographic, laboratory characteristics, and outcomes in patients with major trauma, polytrauma and non-polytrauma. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine the parameters associated with in-hospital mortality and early death. Results: A total of 662 patients met the inclusion criteria for major trauma. Of these, 150 (22.7%) met the new polytrauma definition. In the major trauma group, the mean ISS was 22, in-hospital mortality rate was 23.4%, and early death rate was 20.7%. In the polytrauma group, ISS was 27, in-hospital mortality rate was 44.7%, and early death rate was 38.7%. In the non-polytrauma group, ISS was 20, in-hospital mortality rate was 17.2%, and early death rate was 15.4%. Of the five physiologic parameters (systolic blood pressure≥90 mmHg, Glasgow Coma Scale≥8, base deficit≥6, international normalized ratio≥1.4/activated partial thromboplastin time≥40 seconds, age≥70 years), the lowest in-hospital mortality was found when one parameter was involved (2.5%), and the highest mortality was found when all parameters were involved (100%). Conclusion: Based on “The new Berlin definition”, polytrauma was associated more with in-hospital mortality and early death than non-polytrauma in adults. The five physiologic parameters were correlated with in-hospital mortality.