BACKGROUND: Red blood cell (RBC) transfusion is an essential practice during surgery to accommodate for bleeding. As such, there are efforts being made to allow for a safe and appropriate transfusion due to shortages of blood components and to minimize transfusion-related adverse reactions. However, a conventional transfusion decision with relatively high hemoglobin (Hb) threshold is still performed in clinical setting. In this study, we investigated the threshold of Hblevel and appropriateness of RBC transfusion in patients receiving perioperative RBC transfusion in surgical departments. METHODS: We investigated the pre-transfusion Hb level of 1,379 patients (2,170 episodes) receiving perioperative RBC transfusion in five surgical departments, including cardiothoracic surgery (CS), general surgery (GS), neurosurgery (NS), obstetrics and gynecology (OBGY), and orthopedics (OS), between June 2017 and March 2018. The appropriateness of transfusion was evaluated with two criteria: 1) pretransfusion Hb level ≤10 g/dL and 2) posttransfusion Hb level ≤10 g/dL. RESULTS: The median pretransfusion Hb level was 8.5 g/dL (interquartile range 7.7~9.4); that of each department was as follows: 8.6 g/dL (7.9~9.2) in CS, 7.9 g/dL (7.3~8.6) in GS, 9.1 g/dL (8.5~9.8) in NS, 8.5 g/dL (7.7~9.8) in OBGY, and 8.7 g/dL (7.9~9.7) in OS. With a criteria of pretransfusion of Hb level ≤10 g/dL, 85.4% of total episodes were appropriate. With criteria of post-transfusion of Hb level ≤10 g/dL, 44.7% were appropriate. CONCLUSION: This study presents a fundamental data observing the trend of RBC transfusion in a single institution. A significant proportion of inappropriate RBC transfusion are still being conducted in surgical setting. Continuous and effective education of clinicians and implementation of monitoring systems to assess the appropriateness of RBC transfusion may be necessary.
Education ; Erythrocyte Transfusion ; Erythrocytes ; Gynecology ; Hemorrhage ; Humans ; Neurosurgery ; Obstetrics ; Orthopedics

PURPOSE: Non-blood transfusion is of increasing interest as more patients are refusing a blood transfusion because of religious belief, infection, or fear of a blood-transmitted disease such as AIDS. This study analyzed clinical findings to help the treatment and management of patients who want a non-blood transfusion. METHODS: Of the 83 patients who visited the non-blood transfusion center in Chosun University Hospital from June 2001 to December 2003, 59 patients had a sufficient clinical record, and these were reviewed retrospectively. We investigated sex, age, the reason for the visit, the reason for refusing a blood transfusion, the degree of anemia, the necessity of the blood transfusion, the histories of transfusion and attempted non-blood transfusion, and the histories of visits to emergency departments and the outcomes. RESULTS: The male-to-female ratio was 1:2.93, and the most prevalent ages of the patients were in the forties (26 patients) and thirties (10 patients). The reasons for refusing a blood transfusion were religion (48 patients, 81.4%), risk of infection (1 patients, 1.7%), and other (10 patients, 16.9%). Among the specialty departments, the proportions of patients from the departments of obstetrics and gynecology, internal medicine, general surgery and orthopedics were 40.7% (24 patients), 25.4%, 11.9%, and 6.8%, respectively. Of the patients, 28 patients (47.5%) were admitted directly to the emergency department, and 39 patients (66.1%) were operated on. A blood transfusion was considered to be necessary for 16 patients (27.1%), but only a 2 patients (3.4%) actually received a blood transfusion. Of those 14 patients, 3patients (21.4%) died. After admission, 17 patients (29.8%) received a non-blood transfusion. CONCLUSIONS: Most of the patients visited the non-blood transfusion center for religious reasons, and the majority of the patients were admitted from the Department of Obstetrics and Gynecology. Many of the patients medically should have received blood transfusion, but only a few actually did.
Anemia ; Blood Transfusion* ; Emergency Service, Hospital ; Gynecology ; Humans ; Internal Medicine ; Obstetrics ; Orthopedics ; Religion ; Retrospective Studies

BACKGROUND: Inadequate preoperative evaluation leads to delay or cancellation of elective surgery. To minimize this problem, we launched an anesthesia preoperative evaluation clinic. We analyzed major causes of referral, requested departments and distribution of age to make guidelines of management and laboratory tests. METHODS: The data was collected based on 6,902 patients referred to the anesthesia preoperative evaluation clinic from August 1997 to February 2002. The number of patients each year, distribution of sex, age, requested departments and clinical causes of referral were analyzed retrospectively. RESULTS: The sex ratio (M/F) was 42:58. Twenty-three percent of the patients were in their 7th decade. Obstetrics and gynecology (24.3%), general surgery (20.7%), and orthopedic surgery (15.4%) were the main requested departments. Major causes of referral were cardiovascular problems (27.5%) and pulmonary problems (21.0%). Irrespective of age and department, the most common consultations were related to cardiovascular or pulmonary problems. Nineteen percent of patients had more than two problems that included diabetes mellitus and hypertension. CONCLUSIONS: We concluded that increases in the number of referral patients and making guidelines related to cardiovascular and pulmonary problems will contribute to reduce delay or cancellation of elective surgery.
Anesthesia* ; Diabetes Mellitus ; Gynecology ; Humans ; Hypertension ; Obstetrics ; Orthopedics ; Referral and Consultation ; Retrospective Studies ; Sex Ratio

PURPOSE: This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada's Qualifying Examination Part I (MCCQE1) clinical decision making cases (CDM). The outcomes of this study have important implications for a number of activities, including scoring and test development. METHODS: Candidates included all first-time Canadian medical graduates and international Medical graduates who completed either the spring or fall 2010 test form of the MCCQE1. The fit of one- to five-factor exploratory models was assessed for the 2010 CDM cases item response matrix. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program, Mplus(R) was used for all analyses. RESULTS: Out of five exploratory factor analytic models, a three-factor model provided the best fit. Factor 1 loaded on 3 medicine cases, 2 obstetrics and gynecology cases, and 2 orthopedic surgery cases. Factor 2 corresponded to a pediatrics factor whereas the third factor loads on psychiatry CDM cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five factor discipline models provided the best fit. CONCLUSION: Above results suggest that broad discipline domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using these two constraints i.e. discipline and age.
Decision Making* ; Educational Measurement ; Factor Analysis, Statistical* ; Gynecology ; Humans ; Licensure, Medical ; Obstetrics ; Orthopedics ; Pediatrics

The contribution of anesthesia has been one of the major factors in developing surgical procedures at present. Now anesthesia is an essential part for surgery. Understanding of anesthesia is necessary for the surgeon to do his uaual job and to solve anesthetic problems where the anesthesiologist is absent. Because of these necessities. several surgical departments have sent their residents for several months for rotation through anesthesiology although it is not long enough to learn and understand anesthesia practices. In 1975 we made a special form to evaluate the residents and have collected these from 1977 until 1985. Now we analyzed and evaluated these protocols. The number of residents rotating through our department in the last nine years were 174. Residents from obstetrics and gynecology were accounted for the greatest number and the decreasing order was general surgery, oral surgery(dental part), plastic surgery, orthopedic surgery, neurosurgery, and the urology department. The distribution of residents by their residential year of training numbered as follows: the 1st residential year numbered 122(70%), the 2nd 45(26%), the 3rd(4%), and there was none from the 4th residential grade. The number of anesthesias performed for the 9 years were 14,632 and the ratio between general and regional anesthesia was 10:l. All residents had thoughts that the rotation was very valuable(59%) and valuable(39%) totaling(98%). They wanted more chances to give regional anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesiology* ; Gynecology ; Neurosurgery ; Obstetrics ; Orthopedics ; Surgery, Plastic ; Urology

The cross-matching test, an essential pre-transfusion test, is usually performed using only a segment of a blood bag and a recipient's blood sample at a commercial laboratory. We analyzed cross-matching test results obtained at LabGenomics laboratory, client of which were mainly small- and medium-sized medical clinics. Data for a total of 12,902 cross-matching tests referred from January 2012 to December 2015 were analyzed for incompatibility in the results and trends based on the distribution of medical clinics. Medical clinics were categorized as nursing home, obstetrics and gynecology, plastic surgery, dental clinic, orthopedic surgery, and others. Incompatible results were observed for 35 cases (1.09%) in 2012, 22 cases (0.68%) in 2013, 31 cases (1.02%) in 2014, and 41 cases (1.20%) in 2015. Overall, 55.4% of referrals came from a nursing home, 6.4% from obstetrics and gynecology, 4.4% from plastic surgery, 20.0% from dental clinic, 5.9 % from orthopedic surgery, and 7.9% from others. Further studies are required to evaluate the efficacy of cross-matching test results and its relationship with transfusion requirements.
Dental Clinics ; Gynecology ; Nursing Homes ; Obstetrics ; Orthopedics ; Referral and Consultation ; Surgery, Plastic

BACKGROUND: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. METHODS: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. RESULTS: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. CONCLUSIONS: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement.
Anesthesia* ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Bupivacaine* ; Humans ; Incidence ; Obstetrics ; Orthopedics

BACKGROUND: Combined spinal-epidural anesthesia is becoming popular especially in obstetrics and orthopedics, however few studies have been done involving abdominal operations METHODOLOGY: A randomized, blind study was conducted to compare the clinical outcome of combined spinal-epidural anesthesia (CSEA) with epidural anesthesia (EA) in abdominal surgery. CSEA was established using tetracaine 0.5 percent for the spinal component and bupivacaine 0.5 percent for the epidural component, whereas EA was established using bupivacaine 0.5 percent and fentanyl. Sixty patients were enrolled (Group CSEA, n=30; Group EA, n=30) RESULTS: The ease of doing the procedures were similar in both groups. Of the two techniques, CSEA was associated with earlier onset times (p0.05), more intense motor block (100 percent in the CSEA group achieved compete motor block compared to 10 percent in the EA group). Ephedrine use was similar in both groups. Pain scores were similar in both groups. Overall patient satisfactions were higher in the CSEA groups. The incidence of shivering was higher in the EA group (33 percent) compared to CSEA group (17 percent). Pruritus was present only in the EA group (10 percent). Nauses, vomiting, and headache were absent in both groups CONCLUSIONS: CSEA is a useful and safe technique that confers advantages over the EA technique for major abdominal surgery. CSEA has low failure rates, rapidly produces a reliable spinal blockade, provides good operating conditions, and offers high level of patient satisfaction.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA ; ANESTHESIA, EPIDURAL ; ANESTHESIA, SPINAL ; OBSTETRICS, ORTHOPEDICS

This study was conducted to investigate and to improve the actual condition of food service for patients in hospitals. For this purpose, were distributed to 283 patients admitted to a university hospital and three general hospitals between January 27 and February 15, 1997. The department participated in the study included internal medicine, surgery, obstetrics, orthopedics and so forth. For meal time, 61.1% of patients wanted to eat breakfast at 8 am, 55.8% lunch at noon, and 73.5% dinner at 6 pm. The patients complained about unsatisfactory hospital food itself by 37.8%, about insufficient food amount by 19.6%, about menu with no choice by 41.2% and about low variety of the meals by 32.7%. Sixty two point nine percent of the subjects enjoyed snacks between meals because of poor appetite at meal time(46.1%), delayed food service(39.9%) and others(11.2%). The types of diet were mainly regular ones(58.6%) with some high protein(12.4%) and diabetic sensitive ones(7.1%). As eating place, the patient's prefered bed(51.9%), room-table(27.2%) and dining room(17.7%). Fifty-five percent of them also wanted hospital foods available to their caring relatives.
Appetite ; Breakfast ; Diet ; Eating ; Food Services ; Hospitals, General* ; Humans ; Internal Medicine ; Lunch ; Meals ; Obstetrics ; Orthopedics ; Snacks ; Surveys and Questionnaires

PURPOSE: From June 20, 2000, to June 24, 2000, for five nationwide hospitals and clinics went on strike in opposition to the government 's policy on the separation of dispensaries from medical practice. The present study examined the present state of medical examination and treatment and the management system of the third medical institution to indicate a model for dealing with such strikes ahead in the future. METHODS: The present state of the medical examination and management system in eight hospitals of the nationwide emergency medical centers was examined. The term of strike, June 20, 2000, to June 24, 2000, for five days, was the subject term; Five weekdays of the week just prior to the strikes and two consecutive holidays, January 1, 2000, and January 2, 2000, were chosen as a contrast group. RESULTS: During the term of strike, the number of patients was larger than it was on the weekdays, but was less than it was on consecutive-holidays. In severity triage, the ratio of emergency patients increased but non-emergency and delayed patients decreased than consecutive-holidays, and the number of medical personnel decreased for all types of visits. The attending hospitals in cases of disease increased, and the ratio of internal medicine, general surgery, obstetrics, orthopedics patients increased than consecutive-holidays level, and the ratio of gynecology, phychiatry, opthalmology patients increased than consecutive-holidays and weekdays level. The ratio of cases in CPR decreased, and deliveries was at the same level as it was on the weekdays. Both radiation tests and emergency tests decreased. CONCLUSION: During a strike, carrying out severity triage and operating emergency outpatient care for non-emergency patients, such as outpatients, may be desirable. Adding emergency-treatment manpower to the areas where the number of patients increased, putting additional nursing and assistance manpower in emergency and operation rooms, providing for administration manning at the consecutive-holidays level, and resetting radiation and examination manpower at the consecutive-holidays level should be considered in managing effectively and emergency medical center.
Ambulatory Care ; Cardiopulmonary Resuscitation ; Emergencies* ; Emergency Service, Hospital* ; Gynecology ; Holidays ; Humans ; Internal Medicine ; Nursing ; Obstetrics ; Orthopedics ; Outpatients ; Strikes, Employee* ; Triage