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박정호 ( Jeong Ho Park ), 박주옥 ( Ju Ok Park ), 정주 ( Joo Jeong ), 홍기정 ( Ki Jeong Hong ), 김태한 ( Tae Han Kim ), 송성욱 ( Sung Wook Song ), 김주현 ( Chu Hyun Kim ), 신상도 ( Sang Do Shin ) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.3
Purpose: The aim of this study was to evaluate the characteristics of Emergency Medical Service (EMS) provider responded chemical, biological, radiological, and nuclear (CBRN) incidents in Korea. Methods: Nationwide EMS rescue records from Jan 2012 to Dec 2014 were analyzed. All EMS rescue records were integrated according to the unique accident ID. Cases related to animal rescue, hive removal, and suicide-related were excluded. CBRN-associated keywords were extracted by literature review and pilot survey. In-depth review of cases containing CBRN-associated keywords in the activity summary were conducted by trained emergency medical technicians, and predefined information was abstracted. Descriptive analyses were performed to characterize the EMS provider responded CBRN incidents. Results: A total of 1,571,293 cases were included, and 1,335,205 cases had a unique accident ID; 515,417 cases were excluded because of their association with animal rescue, hive removal, and suicide attempts; 19,663 cases contained CBRN-associated keywords in the activity summary, and in-depth review identified 1,862 cases as CBRN incidents. Among them 1,856 cases were chemical incidents, and 6 cases were radiological incidents; 144 cases were resulted to victims. In chemical incidents, ammonia, hydrogen chloride, sulfuric acid, hydrogen fluoride, and nitric acid were the top 5 toxic substances. In chemical incidents with victims, the proportion of explosion/implosion, and suffocation in sealed space was more prevalent than chemical incidents without victims. Median scene time of all CBRN incidents was 41 minutes (interquartile range 18.0-57.0). Conclusion: We evaluated the characteristics of CBRN incidents responded by EMS in Korea.
Purpose: Measurement of pseudocholinesterase (PChE) is a simple test for evaluation of the severity of intoxication with organophosphate and carbamate insecticides, because they inhibit PChE; however, as demonstrated in several studies, PChE does not reflect severity and mortality. The basal level of PChE in patients who attempt suicide with insecticides could be low, because they are exposed to insecticides for a long period of time, as they are engaged in agriculture. This is part of the reason that PChE level does not reflect severity. No research on the basal level of PChE in the normal population in South Korea has been conducted. The authors of this study investigated the characteristics of residents of Jeju, Korea who have a low level of PChE. Methods: Residents of Jeju over 60 years of age were randomly enrolled. Level of PChE, demographic data, medical history, and occupation were investigated. Groups (higher level vs lower level) were divided on the basis of the median value of PChE. Mann-Whitney test, Pearson chi square, or Fisher`s exact test was used for comparison between the two groups. Logistic regression was used for evaluation of factors having an effect on low level of PChE. Results: Of a total of 353 residents, 28(7.9%) residents were engaged in agriculture, and had recently used insecticide. Sixteen (4.5%) residents had lower PChE levels out of normal range (5,400~13,200 U/L), and the lower group included 177 residents. Age of residents in the lower group was older, and the level of high-density lipoprotein (HDL) was lower, compared with those of the higher group. Older age and lower HDL levels indicated a risk of lower PChE in univariate logistic regression, however, the only risk factor in multivariate logistic regression was age. Conclusion: Many potential causes of lower PChE must be considered; genetics, chronic disease, hepatic failure, liver cirrhosis, malnutrition, tumor, infection, and pregnancy. In this study, the only risk factor was age. Future investigation of genetic factors and other risk factors contributing to lower PChE level in residents under 60 years of age will be necessary.
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본 연구에서는 특수재난 대응 통합 위해인자 탐지 장비를 고안하고, 제작하여 그 사용성을 평가하였다. 본 연구에서 개발된 장비는 화학 가스 탐지 및 분석, 방사선 탐지 및 분석, 생물학 위해 인자 탐지로 구성이 되었다. 화학 가스 탐지의 결과를 상황 위험도를 나타내는 acute exposure guideline levels (AEGLs)로 변환하여 제시하고 방사선 탐지의 결과는 노출량과 누적량만이 아니라 10mSv를 기준으로 최대 활동 시간으로 제시한다. 최종 사용성 평가에서 개발된 시제품은 탐지 분석 결과에 대한추가적인 정보를 제공하여 사용자가 결과 해석을 쉽게 할 수 있도록 한 특징이 잘 나타났다. 시제품은 여러 장비의 통합으로크기가 크고 운반의 용이성은 떨어졌지만, 전반적 사용성 및 버튼 조작의 편리성, 화면 구성 및 결과 제시 방식에 대한 사용자 만족도는 높은 것으로 나타났다. In this study, we developed a unified chemical, biological, radiological, and nuclear (CBRN) threat analyzer and performed user evaluation of the device. The proposed device is composed of sub-systems capable of analyzing common toxic industrial chemical(TIC) gases, gamma rays, and common non-gaseous biological agents. The threats are analyzed and presented in a user-friendly form; the results of gas analysis are presented in the form of acute exposure guideline levels (AEGLs), the results of radiation analysis are presented in the form of maximum exposure time, and the results of biological agents analyses are presented as present or absent. In the user evaluation, the developed device is compared against commercial devices. Due to the extra analyses on the CBRN threats in addition to chemical gas concentration and radiation levels, the subjects were better able to comprehend the degree of danger as compared to the commercial devices. The proposed device was also rated as bulky and less portable as compared to the commercial devies, but was rated higher in terms of ease of use and information display
김솔아 ( Sola Kim ), 박정호 ( Jeong Ho Park ), 박주옥 ( Ju Ok Park ), 홍기정 ( Ki Jeong Hong ), 최동선 ( Dong Sun Choi ), 김태한 ( Tae Han Kim ), 정정주 ( Joo Jeong ), 송성욱 ( Sung Wook Song ), 송경준 ( Kyoung Jun Song ), 신상도 ( Sang Do) 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.2
Objective: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. Methods: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. Results: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. Conclusion: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.
Purpose: To evaluate patient satisfaction with emergency department (ED) services and to identify factors influencing dissatisfaction. Methods: Direct interviews with questionnaires were administered at 18 EDs during a 6-day period from July 26 to July 31, 2006. All patients and accompanying persons who visited the ED during the survey period were included. Questionnaires consisted of 14 questions regarding the patient`s characteristics (determinants), 9 questions about ED services (components) evaluated on a 5-point Likert scale, and 2 questions to gauge overall ED satisfaction rated on a 5-point Likert scale and a visual analogue scale (VAS). Overall dissatisfaction was modeled using logistic regression. Results: Of the 708 patients visiting ED during the survey period, 322 patients consented to an interview (response rate: 45.5%), including 286 who gave complete responses. Among the 286 complete responses, 177 indicated an overall satisfaction of ED service, rating it at 79.2% on the VAS. The determinant "number of ED visits >1 for last 1 year" and all questions in the components category were related to overall dissatisfaction. In logistic regression modeling, the determinants "age≥45 years" and "number of ED visits >1 for last 1 year" correlated with overall dissatisfaction. In the final model, dissatisfaction with the comfort of the waiting room (OR=2.6, 95% CI:1.3-5.0), care received from the physicians (OR=4.0, 95% CI:2.0-8.3), care received from the nurses (OR=3.6, 95% CI:1.6-7.7), and waiting time to receipt of treatment (OR=5.8, 95% CI:2.9-11.3) were all related to overall dissatisfaction. Conclusion: In order to reduce dissatisfaction with ED services, EMS policies should be formulated to improve care by physicians and nurses and to decrease the perceived waiting time.
Purpose: To develop consensus opinion for quality improvement in pre-hospital emergency care, the Delphi study was performed in Korea. Methods: Consensus was developed through several rounds of assessment between August, 2006 and October, 2006. Physicians in emergency center and the specialized emergency center were chosen as Delphi experts. The Delphi questionnaire collected data in the following categories; 1) Dispatcher, 2) Ambulance Station and Operation, 3) Advanced Life Support (ALS) for prehospital care, 4) Tiered response system, 5) Medical control, 6) Triage and transport, and 7) Desirable (Emergency medical system) EMS model. Respondents were asked to indicate their level of agreement with questionnaire statements on a scale from 0 to 9 (0 indicating total disagreement and 9 indicating total agreement). A score of 1-3 was classified as disagreement, 4-6 as medium agreement, and 7-9 as agreement. Consensus was considered to be defined when the respond rate was more than 2/3 in each section. Results: Response rate was 68.2% for the first round and 75.6% for the second round. Paramedics were the consensus choice as dispatchers and providers for prehospital ALS, and there were general desire for an increased number of physicians working rescue in order to improve the medical direction, triage, and transport. The rate of formation of consensus was fairly low (24.1%). Consensus was not achieved in recommending a desirable EMS model. Conclusion: Experts for EMS in Korea achieved consensus on certain aspect of pre-hospital emergency care design. The results were considered in planning for improved EMS services.
Objective: A method of early diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin-T (hs-TnT) has been introduced. This study was conducted to evaluate the accuracy of hs-TnT in patients with suspected AMI. Methods: Patients who were more than 20 years old with symptoms of AMI and who underwent hs-TnT and coronary angiography or echocardiography were included. Risk factors associated with AMI and basic characteristics were collected. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The effects of time from symptom onset to emergency department (ED) visit on test accuracy were analyzed. Results: The final analysis included 102 patients, of which 37 were AMI. The sensitivity and specificity of the hs-TnT was 59.5% (95% confidence interval [CI], 42.1% to 75.2%) and 67.7% (95% CI, 54.9% to 78.8%), respectively. In patients with typical chest pain, the sensitivity and specificity of the hs-TnT was 58.1% (95% CI, 39.1% to 75.5%) and 73.2% (95% CI, 57.1% to 85.8%), respectively. The NPV and sensitivity increased, and the PPV and specificity decreased as time from symptom onset to ED visit increased. Conclusion: The accuracy of the hs-TnT test was not as good in patients who visited the ED for symptoms suggestive of AMI. Therefore, to rule-in or rule-out AMI by using hs-TnT in ED, it is necessary to consider the electrocardiogram and clinical features, or to check variations by repeated measurement of hs-TnT.
Taser guns are considered less lethal weapon than pistols. However, several cases and animal experiments reported injuries associated with Taser guns. This report describes the case of a patient who suffered a penetrating eye injury after being shot by a Taser gun. It is important for the emergency physician to understand potential injuries that can be caused by Taser guns.