Determining the correlation between outdoor heatstroke incidence and climate elements in Daegu metropolitan city.

Background: Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS). Methods: We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression. Results: Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102-3.017). The most suitable cutoff point for MHI by Youden's index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%). Conclusion: Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.

Evaluation of reliability of traditional and computerized neurobehavioral tests.

Most Korean blue-collar workers are taking government-mandated medical screening periodically. The periodic neurobehavioral test provides a great chance to evaluate the functional change of the central nervous system. To utilize periodic neurobehavioral tests effectively, the reliability of currently used neurobehavioral tests needs to be evaluated. Test-retest of neurobehavioral tests were conducted to evaluate the reliability of neurobehavioral tests that are commonly used for Korean workers. The test-retest of five computerized tests, simple reaction time, additions, symbol digit, digit span, and finger tapping speed, and five traditional tests, Benton visual retention, digit symbol, digit span, pursuit aiming, and pegboard, were administered to 85 college students and 35 hospital workers over a 1 month interval. Computerized additions was found to have the highest test-retest reliability coefficient (r=0.90), followed by finger tapping speed (nondominant hand, r=0.89; dominant hand, r=0.85), symbol digit (r=0.82), and digit span (r=0.74). However, only two traditional tests, digit symbol (r=0.86) and pursuit aiming (r=0.72), showed a reliability coefficient greater than 0.70. These results suggest that the computerized additions, symbol digit, finger tapping speed, and traditional digit symbol are more satisfactory for periodical evaluation of the central nervous system of workers exposed to neurotoxic substances in Korea.

Splenic artery aneurysm with the double-rupture phenomenon.

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient's situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.

[Team dynamics and clinical performance of medical students in web-based and high-fidelity simulations].

PURPOSE: The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students. METHODS: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team's clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.). RESULTS: The teamwork scores on case 2 (22.67 ± 6.58) were higher than for case 1 in the HS (20.47 ± 7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS. CONCLUSION: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.

Remission of intestinal Behçet's disease treated with anti-tumor necrosis factor alpha monoclonal antibody (Infliximab).

Behçet's disease (BD) is a chronic relapsing multisystem disease characterized by oral ulceration, genital ulceration and ocular lesions. Gastrointestinal involvement is rare, often difficult to treat and associated with a high mortality rate. We treated a 47-year-old Korean man with BD who had a recurrent intestinal ulcer with tumor necrosis factor alpha antibody (infliximab); he initially underwent right hemicolectomy due to uncontrolled intestinal bleeding. For patients with intestinal BD who fail to respond to conventional treatment, infliximab may be a safe and effective new therapeutic option.