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1.
Am J Emerg Med ; 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32165069

RESUMEN

INTRODUCTION: The primary goal of treating patients with carbon monoxide (CO) poisoning is preventing delayed neuropsychiatric sequelae (DNS). It is difficult to predict DNS because there is no precise diagnostic method in the early phase of CO poisoning. In this study, we aimed to investigate the optimal cut-off value for creatine kinase level to predict DNS. METHODS: This retrospective observational study included patients with CO poisoning visiting a single tertiary center from January to July 2018. They were divided into two groups according to the presence of DNS. We compared baseline characteristics with variables that could affect the presence of DNS. The optimal cut-off value of initial creatine kinase concentration for DNS was calculated. Additionally, multivariate analysis was performed to confirm whether creatine kinase could be an independent predictor of DNS. RESULTS: Of the 138 patients, 12 patients developed DNS. Univariate analysis showed significant differences in the Glasgow Coma Scale, duration of exposure, laboratory tests, abnormal finding on MRI in acute phase, the number of hyperbaric oxygen therapy sessions, and duration of hospitalization. Receiver operating characteristic analyses of creatine kinase were performed (AUC = 0.92; 95% CI, 0.86-0.96) with a cut-off value of 1603 U/L; DNS was predicted with a sensitivity of 91.7% and specificity of 88.1%. In multivariate analysis, the adjusted odds ratio of creatine kinase was 51.516. CONCLUSION: In patients with CO poisoning, initial creatine kinase concentrations of >1603 U/L can be used as an independent predictor of DNS.

2.
Medicine (Baltimore) ; 99(10): e19032, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150050

RESUMEN

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.


Asunto(s)
Paro Cardíaco/prevención & control , Equipo Hospitalario de Respuesta Rápida/normas , Evaluación de Resultado en la Atención de Salud , Adulto , China , Femenino , Paro Cardíaco/mortalidad , Mortalidad Hospitalaria , Hospitalización , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Habitaciones de Pacientes , Estudios Prospectivos , Mejoramiento de la Calidad
3.
Ann Emerg Med ; 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31759754

RESUMEN

STUDY OBJECTIVE: Few studies have investigated the association between carbon monoxide (CO) poisoning and risk of venous thromboembolism. We aim to identify the risk of pulmonary embolism and deep venous thrombosis after CO poisoning. METHODS: We conducted a nationwide cohort-crossover study using administrative claims data in Korea. We compared the risk of venous thromboembolism (pulmonary embolism or deep venous thrombosis) in the cohort period after CO poisoning to that of the same period 1 year later (crossover period), using conditional logistic regression analysis. RESULTS: We included 22,699 patients with a diagnosis of CO poisoning during the study period between 2004 and 2015. The risk of venous thromboembolism was significantly elevated during days 0 to 90 after CO poisoning (odds ratio 3.96; 95% confidence interval 2.50 to 6.25). However, this risk was not significantly elevated during subsequent postexposure periods through 360 days. During days 0 to 30 after CO poisoning, the risks of pulmonary embolism (odds ratio 22.00; 95% confidence interval 5.33 to 90.75) and deep venous thrombosis (odds ratio 10.33; 95% confidence interval 3.16 to 33.80) were significantly elevated. CONCLUSION: We found that the risk of venous thromboembolism persisted for up to 90 days after CO poisoning. The risk was increased 22-fold for pulmonary embolism and 10-fold for deep venous thrombosis, especially in the first month after CO poisoning. Patients should be monitored for venous thromboembolism risk after CO poisoning.

4.
J Am Heart Assoc ; 8(23): e013948, 2019 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-31766971

RESUMEN

Background This study aimed to investigate the relationship between body mass index (BMI) and sufficient chest compression depth (CCD) in obese patients by a mathematical model. Methods and Results This retrospective analysis was performed with chest computed tomography images conducted between 2006 and 2018. We classified the selected individuals into underweight (<18.5), normal weight (≥18.5, <25), overweight (≥25, <30), and obese (≥30) groups according to BMI (kg/m2). We defined heart compression fraction (HCF) as [Formula: see text] and estimated under-HCF (the value of HCF <20%), and over-HCF (the residual depth <2 cm after simulation with chest compression depth 5 and 6 cm). We compared these outcomes between BMI groups. Of 30 342 individuals, 8856 were selected and classified into 4 BMI groups from a database. We randomly selected 100 individuals in each group and analyzed a total of 400 individuals' cases. Higher BMI groups had a significantly decreased HCF with both 5 and 6 cm depth (P<0.001). The proportion of under-HCF with both depths increased according to BMI group, whereas the proportion of over-HCF decreased except for the 5 cm depth (P<0.001). The adjusted odds ratio of under-HCF, according to BMI group after adjustment of age and sex, was 7.325 (95% CI, 3.412-15.726; P<0.001), with 5 cm and 10.517 (95% CI, 2.353-47.001; P=0.002) with 6 cm depth, respectively. Conclusions The recommended chest compression depth of 5 to 6 cm in the current international guideline is unlikely to provide sufficient ejection fraction during cardiopulmonary resuscitation in obese patients.

5.
Medicine (Baltimore) ; 98(45): e17853, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702646

RESUMEN

BACKGROUND: The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS: Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION: This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Paro Cardíaco/terapia , Femenino , Dedos , Humanos , Lactante , Masculino , Maniquíes , Ensayos Clínicos Controlados Aleatorios como Asunto
6.
Am J Med ; 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31622578

RESUMEN

BACKGROUND: Current sepsis guidelines recommend administration of antibiotics within 1 hour of emergency department (ED) triage. However, the quality of the supporting evidence is moderate, and studies have shown mixed results regarding the association between antibiotic administration timing and outcomes in septic shock. We investigated to evaluate the association between antibiotic administration timing and in-hospital mortality in septic shock patients in the ED, using propensity score analysis. METHODS: An observational study using a prospective, multicenter registry of septic shock, comprising data collected from 10 EDs, was conducted. Septic shock patients were included, and patients were divided into 4 groups by the interval from triage to first antibiotic administration: group 1 (≤1 hour; reference), 2 (1-2 hours), 3 (2-3 hours), and 4 (>3 hours). The primary endpoint was in-hospital mortality. After inverse probability of treatment weighting, the outcomes of the groups were compared. RESULTS: A total of 2250 septic shock patients were included, and the median time to first antibiotic administration was 2.29 hours. The in-hospital mortality of groups 2 and 4 were significantly higher than those of group 1 (odds ratio [OR] 1.248; 95% confidence interval [CI], 1.053-1.478; P = .011; OR 1.419; 95% CI, 1.203-1.675; P < .001, respectively), but those of group 3 was not (OR 1.186; 95% CI, 0.999-1.408; P = .052). Subgroup analyses of patients (n = 2043) with appropriate antibiotics presented similar results. CONCLUSIONS: In patients with septic shock, rapid administration of antibiotics was generally associated with a decrease in in-hospital mortality, but no "every hour delay" was seen.

8.
J Psychosom Res ; 121: 14-23, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30712815

RESUMEN

OBJECTIVES: To evaluate the separate and combined associations of socioeconomic status (SES) and depression with the incidences of acute myocardial infarction (AMI) and stroke. METHODS: We conducted a population-based cohort study using nationwide health insurance claims data collected from 2002 to 2016 in South Korea. A total of 2,705,090 subjects aged 20 years or older for whom had health screening data were collected between 2004 and 2005 were analyzed. The hazard ratios (HRs) for the incidences of AMI and stroke were calculated using Cox proportional regression analyses. RESULTS: After adjusting for cardiovascular risk factors, a low SES was associated with increased risks of AMI (HR, 1.16; 95% confidence interval (CI), 1.14-1.19) and stroke (HR, 1.13; 95% CI, 1.11-1.14) incidence. Depression was also associated with an increased incidence of AMI (HR, 1.26; 95% CI, 1.21-1.31) and stroke (HR, 1.24; 95% CI, 1.21-1.27). Patients with depression who had a low SES exhibited significantly increased risks of AMI (HR, 1.47; 95% CI, 1.36-1.60) and stroke (HR, 1.37; 95% CI, 1.30-1.44) compared to patients with a high SES who were not diagnosed with depression. Depression showed a positive effect modification of low and medium SES compared to high SES on the association with AMI but not with stroke. CONCLUSIONS: Subjects with both a low SES and depression displayed the highest risk. Both SES and depression should be considered in cardiovascular risk assessments, particularly in individuals with depression who have a low SES.

9.
Medicine (Baltimore) ; 98(6): e14250, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30732139

RESUMEN

INTRODUCTION: N95 or higher filtering respirators have been recommended in healthcare settings, although there is still a risk of infection due to the improper selection and wearing of respirators. We aimed to assess the effects of training with N95 or higher filter respirators on the protection performance of respirators among healthcare providers in the emergency medical center (EMC). METHODS: This randomized crossover study evaluated 23 healthcare providers. Quantitative fit tests (QNFTs) were performed before and after training using three types of N95 or higher filter respirators (cup-type, fold-type, valve-type). Training was performed by lecture, real-time feedback, and fit check. The primary outcome was the fit factor, and the secondary outcomes were overall fit factor, adequate protection rate, and respiratory preference. RESULTS: Fit factors, overall fit factor, and adequate protection rate were higher after training than before training for the 3 types of respirators (all P < .05). For normal breathing, fit factors before and after training were 121 (10-185) vs 192 (161-200) for cup-type, 200 (39-200) vs 200 (200-200) for fold-type, and 85 (18-157) vs 173 (117-200) for valve-type. For normal breathing, the adequate protection rates before and after training were 62 (0-100) vs 100 (90-100) for cup-type, 100 (0-100) vs 100 (100-100) for fold-type, and 19 (0-100) vs 100 (44-100) for valve-type (all P < .05). The most preferred respirator type was the valve-type (10 persons, 45.5%). CONCLUSIONS: Training on wearing an N95 or higher respirator improved the protection performance of respirators among healthcare providers working in the EMC. The selection of proper respirators and training would be beneficial to the safety of healthcare providers.


Asunto(s)
Servicio de Urgencia en Hospital , Personal de Salud/educación , Exposición Profesional/prevención & control , Dispositivos de Protección Respiratoria/estadística & datos numéricos , Estudios Cruzados , Humanos , Capacitación en Servicio , Estudios Prospectivos
10.
Eur J Emerg Med ; 26(4): 266-271, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29369843

RESUMEN

OBJECTIVE: According to the guidelines, rescuers should provide chest compressions (CC) ~1.5 inches (40 mm) for infants. Feedback devices could help rescuers perform CC with adequate rates (CCR) and depths (CCD). However, there is no CC feedback device for infant cardiopulmonary resuscitation (CPR). We suggest a smartwatch-based CC feedback application for infant CPR. PARTICIPANTS AND METHODS: We created a smartwatch-based CC feedback application. This application provides feedback on CCD and CCR by colour and text for infant CPR. To evaluate the application, 30 participants were divided randomly into two groups on the basis of whether CC was performed with or without the assistance of the smartwatch application. Both groups performed continuous CC-only CPR for 2 min on an infant mannequin placed on a firm table. We collected CC parameters from the mannequin, including the proportion of correct depth, CCR, CCD and the proportion of correct decompression depth. RESULTS: Demographics between the two groups were not significantly different. The median (interquartile range) proportion of correct depth was 99 (97-100) with feedback compared with 83 (58-97) without feedback (P = 0.002). The CCR and proportion of correct decompression depth were not significantly different between the two groups (P = 0.482 and 0.089). The CCD of the feedback group was significantly deeper than that of the control group [feedback vs. control: 41.2 (39.8-41.7) mm vs. 38.6 (36.1-39.6) mm; P=0.004]. CONCLUSION: Rescuers who receive feedback of CC parameters from a smartwatch could perform adequate CC during infant CPR.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Retroalimentación , Paro Cardíaco/terapia , Entrenamiento Simulado/métodos , Humanos , Lactante , Corea (Geográfico) , Maniquíes , Presión , Estudios Prospectivos , Teléfono Inteligente , Estadísticas no Paramétricas
11.
Am J Emerg Med ; 36(9): 1717.e3-1717.e7, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29866416

RESUMEN

OBJECTIVE: Carbon monoxide (CO) poisoning is known to increase thrombotic tendency, and the risk of deep vein thrombosis in individuals who have experienced CO poisoning is higher than in the general population. However, there are a few reports describing cases of pulmonary thromboembolisms (PTE) secondary to CO poisoning. DATA SOURCES: Retrospective data analysis. STUDY SELECTION: Seven hundred fifty bed tertiary university affiliated hospital. DATA EXTRACTION AND SYNTHESIS: Five patients with PTE after CO poisoning were observed. Two patients experienced cardiac arrest; they were treated successfully with tissue plasminogen activators and targeted temperature management. Their cerebral performance scores at discharge were both 1. Three patients had PTE and were treated with anticoagulation. CONCLUSIONS: To date, the causal relationship between PTE and CO poisoning is unclear. However, PTE should be considered in patients with CO poisoning as a differential diagnosis when unexplained hypoxemia or shock are observed. Further studies on the association between CO poisoning and PTE are warranted.


Asunto(s)
Intoxicación por Monóxido de Carbono/complicaciones , Embolia Pulmonar/etiología , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto Joven
12.
PLoS One ; 13(4): e0195745, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29672533

RESUMEN

Emergency physicians are at risk of infection during invasive procedures, and wearing a respirator can reduce this risk. The aim of this study was to determine whether the protection afforded by a respirator during intubation is affected by the type of airway device used. In this randomized crossover study, 26 emergency physicians underwent quantitative fit tests for a N95 respirator (cup-type or fold-type) before and during intubation with a direct laryngoscope, GlideScope®, or i-gel® airway device. The primary outcome was the fit factor value of the respirator and the secondary outcome was the level of acceptable protection provided (percentage of fit factor scores above 100). Compared with the GlideScope and i-gel device, the fit factor values and level of acceptable protection provided were lower when physicians wore the cup-type respirator while intubating using the direct laryngoscope (200 fit factor [152-200] and 200 fit factor [121.25-200] versus 166 fit factor [70-200], 100% and 100% versus 75%, respectively; all P < 0.001). There were no significant differences in the fit factor value or level of acceptable protection provided when the physicians wore the fold-type respirator while intubating using any of the three airway devices (all P > 0.05). The type of airway device used for endotracheal intubation may influence the protective performance of some types of respirators. Emergency physicians should consider the effects of airway device types on fit factor of N95 respirators, when they perform intubation at risk of infection.


Asunto(s)
Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Laringoscopios , Dispositivos de Protección Respiratoria , Ventiladores Mecánicos , Adulto , Servicios Médicos de Urgencia , Femenino , Hospitales Universitarios , Humanos , Intubación Intratraqueal/efectos adversos , Masculino , Evaluación del Resultado de la Atención al Paciente , Factores de Tiempo , Ventiladores Mecánicos/efectos adversos
13.
Resuscitation ; 128: 1-5, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29689353

RESUMEN

BACKGROUND: Abdominal fatty tissue deposition in obese individuals could alter the proper hand position for chest compression during cardiopulmonary resuscitation, similar to that in pregnant women. This study aimed to identify the difference in body mass index between obese and normal weight individuals by measuring the optimal point of maximal left ventricular diameter (OPLV), using computed tomography (CT). METHODS: We performed a retrospective analysis of chest CT scans between January 2012 and August 2016 and measured the sternal length and OPLV and estimated the ratio of OPLV to that individual sternal length. We also investigated whether OPLV was within the clinically relevant range of 20 mm to the position advised by the Guidelines 2015. We compared these outcomes between the two groups. RESULTS: We randomly selected and analysed 50 of 7229 normal weight and 50 of 394 obese individuals from a database. The mean ±â€¯standard deviation of the ratio of OPLV was 22.0 ±â€¯5.7% and 14.8 ±â€¯6.6% of the sternal length, as measured from its most caudal point, respectively, for the obese and normal weight groups (p < 0.001). Both are more caudal than at the middle point of "the lower half of the sternum" as currently recommended. Notably, 96% of the OPLV in the obese group was within ±20 mm of the guideline point versus 52% for normal weight group. CONCLUSION: OPLV on the sternum in obese individuals was more cranial than that in normal weight individuals. The optimal point for chest compression in obese individuals could be slightly more cranial than that in the others.


Asunto(s)
Índice de Masa Corporal , Reanimación Cardiopulmonar/métodos , Masaje Cardíaco/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Obesidad/diagnóstico por imagen , Esternón/diagnóstico por imagen , Adulto , Humanos , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Retrospectivos , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/métodos
14.
Medicine (Baltimore) ; 96(42): e8308, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29049235

RESUMEN

OBJECTIVE: Healthcare providers in emergency departments should wear respirators for infection protection. However, the wearer's vigorous movements during cardiopulmonary resuscitation may affect the protective performance of the respirator. Herein, we aimed to assess the effects of chest compressions (CCs) on the protective performance of respirators. METHODS: This crossover study evaluated 30 healthcare providers from 1 emergency department who performed CC with real-time feedback. The first, second, and third groups started with a cup-type, fold-type, and valve-type respirator, respectively, after which the respirators were randomized for each group. The fit factors were measured using a quantitative fit testing device before and during the CC in each experiment. The protection rate was defined as the proportion of respirators achieving a fit factor ≥100. RESULTS: The fold-type respirator had a significantly greater protection rate at baseline (100.0% ±â€Š0.0%) compared to the cup-type (73.6% ±â€Š39.6%, P = .003) and valve-type respirators (87.5% ±â€Š30.3%, P = .012). During the CC, the fit factor values significantly decreased for the cup-type (44.9% ±â€Š42.8%, P < .001) and valve-type respirators (59.5% ±â€Š41.7%, P = .002), but not for the fold-type respirator (93.2% ±â€Š21.7%, P = .095). CONCLUSIONS: The protective performances of respirators may be influenced by CC. Healthcare providers should identify the respirator that provides the best fit for their intended tasks.


Asunto(s)
Reanimación Cardiopulmonar/efectos adversos , Diseño de Equipo , Personal de Salud , Exposición Profesional/prevención & control , Dispositivos de Protección Respiratoria , Adulto , Reanimación Cardiopulmonar/métodos , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
15.
Biomed Res Int ; 2017: 7565706, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28536701

RESUMEN

Purpose. Emergency physicians are at risk for infection during invasive procedures, and the respirators can reduce this risk. This study aimed to determine whether endotracheal intubation using direct laryngoscopes affected protection performances of respirators. Methods. A randomized crossover study of 24 emergency physicians was performed. We performed quantitative fit tests using respirators (cup type, fold type without a valve, and fold type with a valve) before and during intubation. The primary outcome was respirators' fit factors (FF), and secondary outcomes were acceptable protection (percentage of scores above 100 FF [FF%]). Results. 24 pieces of data were analyzed. Compared to fold-type respirator without a valve, FF and FF% values were lower when participants wore a cup-type respirator (200 FF [200-200] versus 200 FF [102.75-200], 100% [78.61-100] versus 74.16% [36.1-98.9]; all P < 0.05) or fold-type respirator with a valve (200 FF [200-200] versus 142.5 FF [63.50-200], 100% [76.10-100] versus 62.50% [8.13-100]; all P < 0.05). There were no significant differences in intubation time and success rate according to respirator types. Conclusions. Motion during endotracheal intubation using direct laryngoscopes influenced the protective performance of some respirators. Therefore, emergency physicians should identify and wear respirators that provide the best personalized fit for intended tasks.


Asunto(s)
Servicios Médicos de Urgencia/métodos , Intubación Intratraqueal/métodos , Laringoscopios , Ventiladores Mecánicos , Adulto , Femenino , Humanos , Intubación Intratraqueal/efectos adversos , Masculino
16.
Yonsei Med J ; 58(4): 859-866, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28541002

RESUMEN

PURPOSE: In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completely banned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-induced poisoning. MATERIALS AND METHODS: This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis. RESULTS: We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortality rates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independent predictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban. CONCLUSION: This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestation of regulatory measures outcomes.


Asunto(s)
Herbicidas/envenenamiento , Paraquat/envenenamiento , Envenenamiento/mortalidad , Teorema de Bayes , Demografía , Femenino , Geografía , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , República de Corea
17.
PLoS One ; 12(4): e0169046, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28369055

RESUMEN

Previous studies have demonstrated the potential for using smartwatches with a built-in accelerometer as feedback devices for high-quality chest compression during cardiopulmonary resuscitation. However, to the best of our knowledge, no previous study has reported the effects of this feedback on chest compressions in action. A randomized, parallel controlled study of 40 senior medical students was conducted to examine the effect of chest compression feedback via a smartwatch during cardiopulmonary resuscitation of manikins. A feedback application was developed for the smartwatch, in which visual feedback was provided for chest compression depth and rate. Vibrations from smartwatch were used to indicate the chest compression rate. The participants were randomly allocated to the intervention and control groups, and they performed chest compressions on manikins for 2 min continuously with or without feedback, respectively. The proportion of accurate chest compression depth (≥5 cm and ≤6 cm) was assessed as the primary outcome, and the chest compression depth, chest compression rate, and the proportion of complete chest decompression (≤1 cm of residual leaning) were recorded as secondary outcomes. The proportion of accurate chest compression depth in the intervention group was significantly higher than that in the control group (64.6±7.8% versus 43.1±28.3%; p = 0.02). The mean compression depth and rate and the proportion of complete chest decompressions did not differ significantly between the two groups (all p>0.05). Cardiopulmonary resuscitation-related feedback via a smartwatch could provide assistance with respect to the ideal range of chest compression depth, and this can easily be applied to patients with out-of-hospital arrest by rescuers who wear smartwatches.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Paro Cardíaco/terapia , Maniquíes , Microcomputadores , Adolescente , Adulto , Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/normas , Educación de Pregrado en Medicina , Retroalimentación Sensorial , Femenino , Humanos , Masculino , República de Corea , Teléfono Inteligente , Adulto Joven
18.
Clin Exp Emerg Med ; 4(1): 38-47, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28435901

RESUMEN

OBJECTIVE: We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. METHODS: This is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy. RESULTS: There were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy. CONCLUSION: We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.

20.
Biomed Res Int ; 2016: 6418710, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27668257

RESUMEN

Objective. There are many smartphone-based applications (apps) for cardiopulmonary resuscitation (CPR) training. We investigated the conformity and the learnability/usability of these apps for CPR training and real-life supports. Methods. We conducted a mixed-method, sequential explanatory study to assess CPR training apps downloaded on two apps stores in South Korea. Apps were collected with inclusion criteria as follows, Korean-language instruction, training features, and emergency supports for real-life incidents, and analyzed with two tests; 15 medical experts evaluated the apps' contents according to current Basic Life Support guidelines in conformity test, and 15 nonmedical individuals examined the apps using System Usability Scale (SUS) in the learnability/usability test. Results. Out of 79 selected apps, five apps were included and analyzed. For conformity (ICC, 0.95, p < 0.001), means of all apps were greater than 12 of 20 points, indicating that they were well designed according to current guidelines. Three of the five apps yielded acceptable level (greater than 68 of 100 points) for learnability/usability. Conclusion. All the included apps followed current BLS guidelines and a majority offered acceptable learnability/usability for layperson. Current and developmental smartphone-based CPR training apps should include accurate CPR information and be easy to use for laypersons that are potential rescuers in real-life incidents. For Clinical Trials. This is a clinical trial, registered at the Clinical Research Information Service (CRIS, cris.nih.go.kr), number KCT0001840.

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