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안재윤 ( Jae Yun Ahn ), 서강석 ( Kang Suk Seo ), 박정배 ( Jung Bae Park ), 정제명 ( Jae Myung Chung ), 류현욱 ( Hyun Wook Ryoo ), 강성원 ( Sung Won Kang ), 최규일 ( Kyu Il Choi ), 김윤정 ( Yun Jeong Kim ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.5
Purpose: The following study was performed to compare basic life support (BLS) skills and knowledge over a 6 months interval in preclinical medical students. Methods: Upon initial instruction, 112 first-year medical students at a teaching hospital were given instructions in BLS, their knowledge performance was evaluated by written test and skills test via checklist designed by instructors and PC SkillReporting System(R) (Laerdal, Norway). Their performance was re-evaluated 6 months after initial BLS training in an identical fashion. Evaluation was performed on 103 out of 112 students who had taken initial BLS training. Results: The results of written test showed that the students evaluated right after taking initial BLS training have better knowledge of BLS compared to students evaluated 6 months after taking initial BLS training (p<0.001). Results of skills test evaluated by checklist showed decrease in adequate performance of students evaluated 6 months after BLS education in 12 out of 18 items compared to students who have just received initial BLS training. The decreases were statistically significant in 6 items. Total scores after 6 months were also lower compared with initial scores (p<.0.001). The results of the skills test using PC Skill Reporting System(R) demonstrated that the percentage of adequate ventilation volume, compression rate, hands-off time, and hand position were each 18.4%, 46.6%, 47.6%, 84.2% initially and 5.8%, 32.0%, 32.0%, 76.1% at 6 months after initial training. Students performed significantly worse 6 months post training in 4 out of 7 items (p<0.05). Conclusion: Knowledge and skills of preclinical medical students decreased significantly after a 6 month period compared to knowledge and skills after initial training. Therefore, retraining of BLS is required within 6 months, but more study is required to determine appropriate intervals and methods of retraining.
조재완 ( Jae Wan Cho ), 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 ), 김윤정 ( Yun Je) 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.4
Objective: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. Methods: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. Results: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Fortytwo (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979). Conclusion: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
류호완 ( Ho Wan Ryu ), 안재윤 ( Jae Yun Ahn ), 서강석 ( Kang Suk Seo ), 박정배 ( Jung Bae Park ), 김종근 ( Jong Kun Kim ), 이미진 ( Mi Jin Lee ), 류현욱 ( Hyun Wook Ryoo ), 김윤정 ( Yun Jeong Kim ), 김창호 ( Changho Kim ), 최재영 ( Jae You) 대한응급의학회 2020 大韓應急醫學會誌 Vol.31 No.6
Objective: This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. Methods: A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. Results: A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919- 0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). Conclusion: The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.
Purpose: The objective of this study was to develop a new scoring tool that is comprehensively applicable and predicts fatality within 24 h of intoxication. Methods: This was a cohort study conducted in two emergency medical centers from 2011 to 2012. We identified factors associated with severe/fatality. Through a discriminant analysis, we devised the aBIG (age, Base deficit, Infection, and Glasgow coma scale) score. To compare the ability of aBIG to predict intoxication severity with that of previous scoring systems such as APACHE II, MODS, SAPS IIe, and SOFA, we determined the receiver operating characteristic curves of each variable in predicting severe-to-fatal toxicity. Results: Compared with the mild/moderate toxicity group (n=211), the severe/fatal group (n=143) had higher incidences of metabolic acidosis, infection, serious mental change, QTc prolongation and hepato-renal failure. Age, base deficit, infection-WBC count, and Glasgow Coma Scale were independently associated with severe/fatal poisoning. These variables were combined into the poisoning “aBIG” score [0.28×Age group+0.38×WBC count/103+0.52×Base deficit+0.64×(15-GCS)], which were each calculated to have an area under the curve of 0.904 (95% confidence interval: 0.868-0.933). The aBIG poisoning score had an equivalent level of severity predictability as APACHE II and a superior than MODS, SOFA, and SAPS IIe. Conclusion: We developed a simplified scoring system using the four variables of age, base deficit, infected leukocytosis, and GCS. The poisoning aBIG score was a simple method that could be performed rapidly on admission to evaluate severity of illness and predict fatal severity in patients with acute intoxications.
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.
서현일 ( Hyun Il Seo ), 박용석 ( Yong Seok Park ), 이미진 ( Mi Jin Lee ), 안재윤 ( Jae Yun Ahn ), 김종근 ( Jong Kun Kim ), 문성배 ( Sungbae Moon ), 이동언 ( Dong Eun Lee ), 손유동 ( You Dong Sohn ), 이숙희 ( Suk Hee Lee ), 최재영 ( Jae You) 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.4
Purpose: This study aims to investigate how variability of bystander cardiopulmonary resuscitation (CPR) willingness may change depending on special situations and to find out factors that enhance CPR willingness in each situation and ways to increase the ratio of bystander CPR. Methods: A population-based, nationwide study using a structured questionnaire via telephone survey regarding CPR was done in 2015 (n=1,000). A stratified cluster sampling was conducted to assess the impact of age and gender on CPR willingness. The contents of the questionnaire consisted of basic characteristics, CPR training experience, and status. Additionally, respondents were presented with five hypothetical scenarios of cardiopulmonary arrest; family member, stranger, elderly person, preschool child, and pregnant woman. Results: Willingness to perform CPR was low for pregnant women (52.1%) or elders (59.3%), moderate for strangers (73.3%) or children (71.3%), but high for a family members (90.4%). Age, awareness of CPR, training experience of CPR, CPR training by manikin practice, recent CPR training (≤2 years), experience of bystander CPR, family history of severe illness, and awareness of Good Samaritan law all influenced the willingness to perform CPR on bystander in each scenario. Conclusion: The willingness of bystander CPR decreased in special situations, especially for elderly and pregnant woman. However, recent CPR training group were more willing in the elderly, and CPR experienced group also showed increased tendency in pregnant woman. It is expected that the rate of bystander CPR can be increased by emphasizing that performing bystander CPR for children, pregnant women, and elders is not different from the general population.
이숙희 ( Suk Hee Lee ), 류현욱 ( Hyun Wook Ryoo ), 안재윤 ( Jae Yun Ahn ), 서강석 ( Kang Suk Seo ), 박정배 ( Jung Bae Park ), 신상도 ( Sang Do Shin ), 송경준 ( Kyoung Jun Song ), 박창배 ( Chang Bae Park ), 이강현 ( Kang Hyun Lee ), 유인술 ) 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.5
Purpose: This study was conducted in order to determine the characteristics and risk factors of pediatric eye injury patients in the emergency department and to offer strategies for prevention of pediatric eye injury. Methods: This prospective study was conducted by use of a standardized eye injury survey of patients under the age of 16 years who were treated for ocular injury at nine emergency medical centers, from March to September of 2010. The following data were collected; general characteristics of the study population, type and location of injury, causative activities, and materials of injury. Risk factors associated with open-globe injury were analyzed by logistic regression. Results: A total of 1,151 patients were enrolled in the study; 75% were male. The highest incidence was observed between the age of 11 and 16 years (34.5%); 79.2% of patients had closed globe injury. The most common type of injury was contusion (65.4%) in closed globe injury and penetration (5.1%) in open-globe injury. Eye injury occurred most commonly at home (48.6%), followed by school/institution (19.4%). The most common causative activity and material were play (42.4%) and person/animal/plant (17%). Application of eye protective equipment (odds ratio: 24.33; 95% CI: 11.32~52.29) was found to be a statistically significant factor for occurrence of an open-globe injury. Conclusion: Establishment of safety measures considering gender and age is important since characteristics of pediatric eye injury differ based on such risk factors. The risk of open-globe eye injury increased with application of personal protective equipment, therefore, public education and promotion to use protective equipment of adequate level would be considered important.
임창덕 ( Chang Duk Lim ), 류현욱 ( Hyun Wook Ryoo ), 황양하 ( Yang Ha Hwang ), 이미진 ( Mi Jin Lee ), 신수정 ( Su Jeong Shin ), 안재윤 ( Jae Yun Ahn ), 김종근 ( Jong Kun Kim ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6
Purpose: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients. Methods: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term “acute” was defined as 24 hours from symptom recognized. The term “urban” was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system. Results: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas. Conclusion: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.
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.
박용석 ( Yong Seok Park ), 서강석 ( Kang Suk Seo ), 박정배 ( Jung Bae Park ), 이미진 ( Mi Jin Lee ), 류현욱 ( Hyun Wook Ryoo ), 문성배 ( Sungbae Moon ), 김종근 ( Jong Kun Kim ), 이동언 ( Dong Eun Lee ), 안재윤 ( Jae Yun Ahn ) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: This study investigated the association between the initial red cell distribution width (RDW) and mortality in patients with severe trauma. Methods: We conducted a retrospective analysis between January and December 2014. Severe adult trauma patients (age ≥18, Injury Severity Score≥16), who were treated in our emergency department, were included in this study. We classified patients into four groups in accordance with their RDW (group 1: RDW≤12.3%, group 2: 12.4%≤RDW≤12.6%, group 3: 12.7%≤RDW≤13.2%, group 4: 13.3%≤RDW). They were compared based on the characteristics of their groups. We also compared the baseline characteristics of patients who survived and did not survive. Univariate and multivariate Cox proportional hazard analyses were performed to determine the association between mortality and each variable. Results: We enrolled 364 severe trauma adult patients. The mortality rate was 8.9%, 16.2%, 12.6%, and 20.4% for RDW groups 1, 2, 3, and 4, respectively; there was no statistical significance. The RDW of patients who survived (n=311) and did not survive (n=53) were 12.7% (12.4-13.3%) and 12.9% (12.5-13.6%), respectively, but this was also not statistically significant (p=0.075). Univariate Cox proportional hazard analysis showed a significant difference between the mortality and initial RDW, but a multivariate analysis did not show an independent association between initial RDW and mortality (hazard ratio, 0.729; confidence interval, 0.508-1.047; p=0.087). Moreover, multivariate analysis did not also show a significant difference between RDW quartile groups according to route of hospital visit. Conclusion: There was no independent association between the initial RDW and mortality in patients with severe trauma.