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Purpose: Keywords describe the medical concepts of articles in the medical literature. They provide many benefits to those creating databases, to indexers who are cross-indexing scientific articles, and to users by providing easy access to sources. Hence, it is important for authors to choose keywords that are accurate and that correspond to Medical Subject Headings (MeSH). The objectives of this study were to investigate whether English keywords used in the Journal of the Korean Society of Emergency Medicine (KJEM) coincide with MeSH terms, and to understand the major errors in MeSH term selection. Methods: To analyze how accurately authors of KJEM use MeSH terms, keywords provided by authors (author terms) were compared with terms listed in the corresponding MeSH browser. We analyzed keywords from 356 articles of the KJEM that were published between 2005 and 2006 and between 2008 and 2009. We investigated frequently used keywords and what percentage of keywords agree with MeSH terms using the MeSH browser. Results: A total of 1,153 author terms were used as keywords in the 356 KJEM articles. There were on average 5.91 authors and 3.24 keywords per article. The keywords that appeared most frequently (in descending order) were cardiac arrest, emergency medical services, ultrasonography, emergency department (medicine), and cardiopulmonary resuscitation. The number of terms in precise agreement with MeSH headings was 584 (50.7%); 260 terms (22.5%) were not found in the MeSH browser;60 terms (5.2%) had only a trivial difference from MeSH terms; 203 terms (17.6%) including entry terms, and 46 terms (4.0%) matched MeSH subheadings. Conclusion: Many keywords used in the KJEM did not agree with MeSH terms. We conclude that medical authors should be educated in the proper use of MeSH terms in their research and subsequent publication.
A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury, which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients` entity, because urgent intervention may improve outcome.
저자들은 반복적인 구토와 복통이 발생한 후 토혈을 주소로 내원한 3세 된 남아에서 상부소화관 내시경으로 진단된 위식도 탈출증 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Prolapse gastropathy is not uncommon in adult, but is not reported yet in previously healthy children. A 3-year-old child came to our emergency room after a 1-day history of emesis episodes with coffee-ground hematemesis. During the endoscopic procedure, and the process of retching and vomiting was observed and a tense knuckle of gastric mucosa was seen to be forcefully and repeated prolapsed into the distal esophageal mucosa, and mucosal hematoma was found in the gastric fundus. Upper gastrointestinal study revealed no abnormality and 24 hour pH monitoring revealed no pathologic gastroesophageal reflux. Retching is thought to cause the forceful prolapse and induce subsequent trauma of gastric mucosa. This case illustrates that the episodes of vigorous retching and resultant gastric mucosa are now considered to be the cause of the hematemesis and epigastric pain in children.
Purpose: To investigate the present situation of emergency medical services (EMS) education and to develop an EMS education curriculum for medical students, emergency medicine residents and fellows in Korea. Methods: The objectives and curricula of the American and Canadian EMS training programs were used in the development of a questionnaire to investigate the actual situation of EMS education in Korea. The Delphi method was used to obtain the consensus of experts regarding which specific objectives should be included and how many hours would be needed in each training level. Results: For medical students, the didactic component of EMS education was 57.6% (median; 60 min, IQR: 50~60 min) and the experiential component was 12.1%. For residents, the didactic component was 57.6% (median; 120 min, IQR; 75~180 min) and the experiential component was 18.2% (median; 450 minutes, IQR; 135~1720 min). Only two hospitals had EMS fellowship programs. The consensus of experts for core objectives and the proper number of hours of EMS education for different levels of training were: 9 core topics and 8 hours for medical students, 16 core topics and 40 hours for medical residents, and 21 core topics and 30 hours for Fellows. The response rate was 42.9% for the first round and 71.4% for the second round. Conclusion: The authors propose the core content of EMS education for each training level from a consensus of experts.
조진성 ( Jin Seong Cho ), 임혁기 ( Hyuk Kee Lim ), 이근 ( Keun Lee ), 양혁준 ( Hyuk Jun Yang ), 이승철 ( Seung Chul Lee ), 염석란 ( Suk Ran Yeum ), 박주옥 ( Ju Ok Park ), 이경원 ( Kyung Won Lee ) 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.1
Purpose: We investigated current dispatcher education requirements and proposed how to further improve and develop the EMD education curriculum in Korea. Methods: The contents of EMD training programs from the US were used in the development of the questionnaire used to investigate the status of EMD education in Korea. The Delphi method was used to obtain expert consensus on which specific training objectives to include, how many hours would be required, who was qualified to receive the training, and how to confirm their successful qualification. Results: A consensus of the experts was made for core educational objectives, the appropriate number of education hours, qualifications for trainers, passing marks for the exams, and the format of re-education as follows: The didactic education time requirement was 18 hours and the experiential education time requirement was 10 hours. The target qualification requirement for trainees was EMT level 1, and they were required to have an experience of firstaid as a prerequisite. The minimum annual re-education time was 8 hours (61.1%). The passing mark for examinations was 70.0 (median, IQR: 65.0 - 70.0) for the didactic test and 70.0 (median, Interguatile range [IQR]: 60.0 - 80.0) for the experiential test. The format of the required re-education included both comprehensive and individual forms. Conclusion: We propose the core contents of EMD education should be based on the results of the expert consensus.
이성주 ( Seong Ju Lee ), 박원빈 ( Won Bin Park ), 조진성 ( Jin Seong Cho ), 현성열 ( Sung Youl Hyun ), 임용수 ( Yong Su Lim ), 김진주 ( Jin Joo Kim ), 이수복 ( Su Bok Lee ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ) 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.1
Purpose: The purpose of this article was to evaluate the efficiency of an automated prescription program serving pediatric patients who visited our emergency department. We expected that the program would reduce pediatric patient prescription errors and shorten the length of stay in the emergency department. Methods: We developed the computerized physician order entry system to serve the pediatric patients visiting the emergency department and recommended that the emergency medicine residents use this program. We compared the rate of error as it affected prescription dosage and length of stay in the emergency department, before and after the program was deployed. We also performed a survey with 20 emergency medicine residents that have used the program. Results: Of the total number of prescriptions filled, the number of prescription dosing errors observed was 40(4.5%) before and 22(2.8%) after the program was deployed. The results of the survey revealed high system usability and satisfaction. However, the length of stay in the emergency department was not affected. Conclusion: The computerized physician order entry system for pediatric patients visiting the emergency department was effective in reducing prescription related medical errors.
Purpose: This study was conducted to compare demographic and characteristic differences in self-poisoned patients by age groups using a comprehensive trauma database. Methods: This study included 1,823 patients who were admitted to the emergency room following self-poisoning. Three age groups were defined: young patients (less than 19 years), adult patients (19 to 64 years) and elderly patients (65 years and old). From January 2011 to December 2015, data were obtained from in a single emergency medical center. We investigated the materials of poisoning, ingestion time, GCS, systolic blood pressure, heart rate, and outcomes of patients. Results: A total of 1,823 self-poisoned patients visited the hospital during 5 years. Among these, 130 (7.1%) were categorized as young, 1,460 (80.1%) were adults and 233 (12.8%) were elderly. The most common drug of self-poisoning substances was antipyretics (50.0%) for those in the young group, sedative drugs (45.0%) for adults, and pesticides (41.2%) for the elderly. Mortality was 2.7% in the adult group and 14.6% in the elderly group. After adjusting for all factors related to mortality, the odds ratio (OR) of mortality was 2.63 in the elderly group (95% confidence interval [CI]: 1.44-4.81). Conclusion: There were definite differences in the characteristics of three groups. The younger patients used drugs that could be easily obtained while older patients used more lethal drugs.
Purpose: This study was performed to evaluate the feasibility of the Gamma Knife Surgery on the symptomatic control of brain metastasis from breast carcinoma. Methods: We retrospectively reviewed patients with brain metastases from breast cancer who underwent Gamma Knife Surgery at our hospital, between May 2004 and November 2007. Total 82 metastases were treated with 26 cycles of Leksell gamma knife. Freedom from local recurrence and survival time were analyzed by the Kaplan-Meier method. Results: 17 patients with 82 metastases were treated over 26 Gamma Knife Surgery sessions. The mean time to brain metastases was 41.7 months (8∼84), median number was 2.0 (1∼10), and median volume was 7.4 ㎤ (0.6∼25.4). Radiologic response occurred in 84.6%, and the rate of symptom relief was 73.1%. Local brain tumor recurrences were observed in 15.3% and intracranial distant recurrence occurred in 57.7% that occurred within 3.2 months. The median length of survival for all patients was 9.3 months (95% confidence interval, 4.23∼9.37 months). Conclusion: Gamma Knife Surgery is an effective and feasible treatment for symptomatic control of brain metastases from breast cancer patients who have severe extracranial metastases and short life expectancy.
Purpose: The relationship between prognostic factors and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia was analyzed. Methods: We conducted a tertiary center retrospective study of post-cardiac arrest patients treated with therapeutic hypothermia between January 2008 and December 2012. We investigated the association of the following factors with outcomes: BMI, time to ROSC, number of vasoactive drugs, smoking, alcohol, and short time to therapeutic range in hypothermia. Results: A total of 251 patients were enrolled in this study. Large number of vasoactive drugs was a prognostic factor of 3-month mortality (adjusted OR 1.96, 95% CI:1.41-2.71, p<0.001). Obesity (BMI≥25 kg/m2) was not associated with delayed time to therapeutic range in hypothermia. Both univariate and multivariate analysis showed that high initial BT (β(SE)=63.64 (11.53), p<0.001) and a small number of vasoactive drugs (β(SE)=18.66(8.74), p=0.034) were independent predictors of delayed time to therapeutic range in hypothermia. Conclusion: In this study, a small number of vasoactive drugs showed a significant influence on delayed time to therapeutic range in patients receiving therapeutic hypothermia after return of spontaneous circulation after out-of-hospital cardiac arrest.
Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)≤8 (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above 40.5℃ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ≤8, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.