BACKGROUND: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time-dependent. The purpose of this study is to investigate the factors that influence the time from symptom onset to hospital arrival and the total arrival delay time for patients with acute stroke. METHODS: A prospective registry of patients presenting to the ED with signs or symptoms of acute stroke was established at Ewha Womans University Mokdong and Dongdaeumn hospitals from March to December 1999. We analyzed the prehospital delay time(reaction interval and total arrival delay) and factors associated with delayed arrival at the hospital. RESULTS: The study included 256 patients(49% were women) with a mean age of 62+/-13 years. 50.9% of the patients arrived within 3 hours, and 94.9% patients arrived within 24 hours after onset of symptoms of acute stroke. The total arrival delay time was 180 minutes(median time), and the reaction interval was 60 minutes(median time). Transportation by 119 or 129 ambulances was linked to shorter delay(47 minutes). Age, mental status, and degree of disability were statistically significant factors associated with delayed arrival at the hospital. CONCLUSION: Age, mental status, and degree of disability were significant factors associated with delayed arrival at the hospital. For effective treatment of acute stroke patients, increased public awareness to use an ambulance with direct transport to the acute-care hospital required.
Ambulances ; Female ; Humans ; Prospective Studies ; Stroke* ; Transportation

BACKGROUND: The objective of this study was to determine the sensitivity, specificity of the ultrasound examination performed by emergency physicians in patients with altered mental state due to trauma. METHODS: From July 1998 until June 2000, a total number of 59 patients showing altered mental state were examined using emergency ultrasound at the time of primary survey. Their medical records were reviewed, and the interpretations of the emergency ultrasound were compared with the abdominal CT scan or clinical results. RESULTS: Of the 59 patients, 3 were excluded due to incomplete records. Among the 56 remaining patients, 9 patients had intra-abdominal problems. The sensitivity and specificity were 77% and 95.7%, respectively. Abdominal CT was not required in 41 (73.2%) patients. CONCLUSION: Emergency ultrasonography can serve as a useful screening tool in detecting free fluid in trauma victims who are not mentally alert.
Emergencies* ; Humans ; Mass Screening ; Medical Records ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonography*

PURPOSE: In order to elicit efficient and effective operation of the Korean Emergency Medical Service System, we observed patients brought in by way of the Emergency Center by 119 ambulances and analyzed the appropriateness of the transport and the level of emergency care provided. METHODS: For the month of August 2002, patients who visited a university hospital emergency unit in Seoul were separated and evaluated according to the study protocols. The appropriateness of the 119 transport was based on a patient questionnaire and an evaluation of medical records and was categorized as follows; 1) need for emergency care or urgency/emergency transport by 119 ambulance, 2) need for emergency care or urgency/emergency transport by non 119 ambulance, 3) no need for emergency care or subemergency/nonemergency transport by 119 ambulance, 4) no needs for emergency care or subemergency/ nonemergency transport by non 119 ambulance. Of these, category 1 is viewed as the appropriate level of transport to the hospital emergency unit by 119 rescuers whereas category 3 is considered inappropriate transportation by 119 rescuers. The analysis of the appropriateness of the level of emergency care was based on sorting patients into 5 service categories; 1) emergency care required - appropriate operation, 2) emergency care required - no operation, 3)emergency care required - inappropriate operation, 4) no emergency care required - operation, 5) no emergency care required - no operation. Within these, categories 1 and 5 are considered appropriate and categories 2, 3 and 4 as inappropriate. RESULTS: Over the course of the study, 1,376 out of 1,451 patients transported to the hospital emergency unit qualified to be included under study protocols. Among them, the proportion of patients who needed emergency care or urgency/emergency transport was 22.8% (314 patients), and the proportion of those who received appropriate transport by the 119 emergency team was 62.6% (196 patients). Among the 282 patients who were transported by 119 emergency teams, in 195 patients (69.1%), emergency care was indicated while only 81 of the 195 patients (41.5%) received operations with an emergency or critical level of care. Of these 81, 47 patients (58.0%) received the appropriate operation. Therefore, the overall appropriateness of emergency care was 45.0% (127 patients), including emergency care required - appropriate operation (47 patients) and no emergency care required - no operation (80 patients). CONCLUSION: From this study, the appropriateness of transport by 119 rescuers is 62.6% but if subemergency cases are included, the appropriateness of transport increases to 95.2%. However, the appropriateness of care is only 45.0%, implying a need for continuing training for 119 emergency medical technicians and further organization of the medical control system.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Emergency Service, Hospital ; Humans ; Medical Records ; Surveys and Questionnaires ; Seoul ; Transportation

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.
Checklist ; Female ; Humans ; Schools, Medical ; Students, Medical ; Videotape Recording

Herpes simplex virus (HSV) is a common causative agent of genital ulceration and can lead to subsequent neurological disease in some cases. Here, using a genital infection model, we tested the efficacy of vinegar-processed flos of Daphne genkwa (vp-genkwa) to modulate vaginal inflammation caused by HSV-1 infection. Our data revealed that treatment with optimal doses of vp-genkwa after, but not before, HSV-1 infection provided enhanced resistance against HSV-1 infection, as corroborated by reduced mortality and clinical signs. Consistent with these results, treatment with vp-genkwa after HSV-1 infection reduced viral replication in the vaginal tract. Furthermore, somewhat intriguingly, treatment of vp-genkwa after HSV-1 infection increased the frequency and absolute number of CD3-NK1.1+NKp46+ natural killer (NK) cells producing interferon (IFN)-gamma and granyzme B, which indicates that vp-genkwa treatment induces the activation of NK cells. Supportively, secreted IFN-gamma was detected at an increased level in vaginal lavages of mice treated with vp-genkwa after HSV-1 infection. These results indicate that enhanced resistance to HSV-1 infection by treatment with vp-genkwa is associated with NK cell activation. Therefore, our data provide a valuable insight into the use of vp-genkwa to control clinical severity in HSV infection through NK cell activation.
Animals ; Daphne* ; Herpesvirus 1, Human ; Inflammation ; Interferons ; Killer Cells, Natural* ; Mice ; Mortality ; Simplexvirus ; Therapeutic Irrigation ; Ulcer

BACKGROUND/AIMS: The purpose of our study was to investigate the change in incidence of intestinal metaplasia (IM) in healthy, young adults over 10 years. MATERIALS AND METHODS: Urease test and histopathology by endoscopic biopsies were performed from volunteers between 1995 and 2005. Histopathological grade was assessed using the updated Sydney System. RESULTS: In total, 714 subjects with a median age of 22.4 years were enrolled. Helicobacter pylori was observed at the antrum and body in 44.5% and 35.1%, respectively. IM limited to the antrum was present in 1.1% of the subjects. The degree of IM correlated negatively with age (P=0.04) but there was no correlation with H. pylori levels or the degree of chronic or active gastritis. Compared to the beginning of the study period, the positivity rate at the end of the study period droped to 45%. IM incidence did not change over the 11-year study period, whereas H. pylori-positivity and the frequency of chronic and active gastritis in the antrum and body dropped significantly over this period (P<0.05). CONCLUSIONS: This result suggests that other factors, besides chronic H. pylori infection or degree of gastritis, may contribute to the progression of atrophy to IM in healthy, young adults.
Adolescent* ; Atrophy ; Biopsy ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Metaplasia* ; Urease ; Volunteers ; Young Adult

Background: The objective of this study was to examine changes in the prevalence of cytotoxic-associated gene A (CagA) positive Helicobacter pylori infection in Jinju, Korea, over the last 20 years. Methods: Three cross-sectional analyses were conducted concurrently. A total of 1,305 serum samples were collected from 1994–1995, 2004–2005, and 2014–2015, respectively. The presence of immunoglobulin (Ig) G, IgA, and IgM antibodies against H. pylori CagA protein was examined by western blotting. Results: Overall, seropositivity for anti-CagA IgG antibody was significantly decreased from 63.2% to 42.5% over the last 20 years (P < 0.001). Anti-CagA IgG seropositivities in children and young adults aged 10–29 years decreased from 1994 (60.0%–85.0%) to 2015 (12.5%– 28.9%). The age when plateau of increasing IgG seropositivity was reached in each study period shifted from the 15–19 year-old group in 1994–1995 (85.0%) to the 40–49 year-old group in 2014–2015 (82.5%). Overall seropositive rates of anti-CagA IgA and IgM antibodies did not change significantly either over the last 20 years. Conclusion H. pylori infection rate in children and young adults declined over 20 years in Jinju, probably due to improved sanitation, housing, or economy.

OBJECTIVES: This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. METHODS: Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. RESULTS: AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. CONCLUSIONS: AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.
Decision Support Systems, Clinical ; Delivery of Health Care ; Disasters ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Information Systems ; Monitoring, Physiologic ; Privacy ; Quality of Health Care