OBJECTIVES: Although ambulance-based telemedicine has been reported to be safe and feasible, its clinical usefulness has not been well documented, and different prehospital management systems would yield different results. The authors evaluated the feasibility and usefulness of telemedicine-assisted direct medical control in the Korean emergency medical service system. METHODS: Twenty ambulances in the Busan area were equipped with a telemedicine system. Three-lead electrocardiogram, blood pressure, and pulse oximetry data from the patient and audiovisual input from the scene were transferred to a server. Consulting physicians used desktop computers and the internet to connect to the server. Both requesting emergency medical service (EMS) providers and consulting physicians were asked to fill out report forms and submit them for analysis. RESULTS: In the 41 cases in which telemedicine equipment was used, cellular phones were concomitantly used in 28 cases (68.35%) to compensate for the poor audio quality provided by the equipment. The EMS providers rated the video transmission quality with a 4-point average score (interquartile range [IQR] 2-5) on a 5-point scale, and they rated the biosignal transmission quality as 4 (IQR 3-5). The consulting physicians rated the video quality as 4 (IQR 2.5-4) and the biosignal quality as 4 (IQR 3-4). The physicians' ratings for usefulness for making diagnosis or treatment decisions did not differ significantly in relation to the method of communication used. CONCLUSIONS: Our study did not find any significant advantage of implementing telemedicine over the use of voice calls in delivering on-line medical control. More user-friendly, smaller devices with clear advantages over voice communication would be required before telemedicine can be successfully implemented in prehospital patient care.
Ambulances ; Blood Pressure ; Busan ; Cellular Phone ; Diagnosis ; Electrocardiography ; Emergency Medical Services ; Humans ; Internet ; Oximetry ; Patient Care ; Remote Consultation ; Telemedicine* ; Telemetry ; Voice

BACKGROUND: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. METHODS: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. RESULTS: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). CONCLUSIONS: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.
Anti-Infective Agents ; Humans ; Critical Care ; Intensive Care Units* ; Korea ; Nutritional Support ; Observational Study ; Pharmacists* ; Pharmacokinetics ; Retrospective Studies

OBJECTIVE: The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA). The objective of this study was to evaluate the performance of the CDSS with respect to system quality, information quality, and user satisfaction in reducing prescription errors. METHODS: The study was based on survey data from 38 hospitals that were using the CDSS for drug prescriptions. To identify factors influencing the performance of CDSS, multiple linear regression and chi-square analyses were performed. RESULTS: Regression analysis showed that the variables for system quality and information quality significantly influenced the overall system performance. Specifically, ease of understanding the results and terminology assystem quality measures significantly influenced user satisfaction. Furthermore, based on chi-square analysis, two independent variables (ease of understanding results and decision support functions) were statistically significant with respect to all four dependent variables (information satisfaction, system satisfaction, willingness to recommend to other hospitals, and drug safety). CONCLUSION: Based on this study, users should be educated to improve their understanding of the system,and system and information quality should be continuously monitored to improve user satisfaction.
Drug Prescriptions ; Humans ; Insurance, Health ; Linear Models ; Pharmacists ; Prescriptions

Objective: To evaluate the antibacterial activity of Cinnamomum verum (C. verum) from 32 different essential oils against cariogenic bacteria, Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus). Methods: The antibacterial activities of each essential oil were individually investigated against S. mutans and S. sobrinus. The essential oil of C. verum was selected for further evaluation against S. mutans and S. sobrinus. Gas chromatography mass spectrometry was used to determine the major constituents of C. verum essential oil. In addition, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration of the most effective constituent was investigated. Results: The essential oil from C. verum exhibited the greatest antibacterial activity. Gas chromatography mass spectrometry analysis revealed that the major components of C. verum essential oil were cinnamaldehyde (56.3%), cinnamyl acetate (7.1%) and β-phellandrene (6.3%). The MIC of cinnamaldehyde was measured using broth dilution assays. The MIC of cinnamaldehyde was 0.02% (v/v) against both bacterial strains tested. The minimum bactericidal concentration of cinnamaldehyde against S. mutans and S. sobrinus were 0.2% and 0.1% (v/v), respectively. Conclusions: The essential oil of C. verum and its major component cinnamaldehyde possessed considerable in vitro antibacterial activities against cariogenic bacteria, S. mutans and S. sobrinus strains. These results showed that the essential oil of C. verum and its bioactive component, cinnamaldehyde, have potential for application as natural agents for the prevention and treatment of dental caries.

PURPOSE: Seafarers injured at sea need appropriate and prompt medical advice. Since 2002, the Busan emergency medical information center (BEMIC) has provided remote medical advice to vessels on the distant ocean via telephone, e-mail, facsimile and radio-transmission. METHODS: Seventy-four cases had requested remote medical advices to BEMIC from Jan 2005 to Jul 2005, and they were studied retrospectively. We analyzed patients' general characteristics, type of disease or injury, dispositions, and so forth. The cases were classified into three groups according to disposition. Class I was defined as a case which required simple treatment. Class II involved medical or surgical treatment with close observation. Class III required transfer to the nearest harbor instantly due to severe or uncertain condition. RESULTS:The nationalities of subjects were Korean (32.4%), Southeast Asians (35.1%), Chinese (24.3%) and others. The most common symptom was abdominal pain (24.3%). The patients'disease types were acute disease (53.4%), trauma (20.3%), burn (13.7%), chronic disease (8.2%) and others. There were 8 voluntary medication cases, which were performed by seamen before taking medical advice. The dispositions were class I (6.8%), class II (39.7%), and class III (53.5%), respectively. A cross-sectional study between the types and the dispositions was performed, revealing a statistical significance (p<0.001). CONCLUSION: Despite the lack of any kind of direct support from ship companies or governments, the remote medical advice service has performed. Enhancing educational programs based on this data is necessary in order to provide effective education of seafarers.
Abdominal Pain ; Acute Disease ; Asian Continental Ancestry Group ; Burns ; Busan ; Chronic Disease ; Cross-Sectional Studies ; Education ; Electronic Mail ; Emergencies* ; Ethnic Groups ; Humans ; Information Centers* ; Korea* ; Remote Consultation ; Retrospective Studies ; Ships ; Telemedicine ; Telephone

Background/Aims: There are concerns that the use of renin-angiotensin system (RAS) blockers may increase the risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or progressing to a severe clinical course after infection. This this study aimed to investigate the influence of RAS blockers on the risk and severity of SARS-CoV-2 infection. Methods: We conducted a retrospective cohort study analyzing nationwide claims data of 215,184 adults who underwent SARS-CoV-2 tests in South Korea. The SARS-CoV-2 positive rates and clinical outcomes were evaluated according to the use of RAS blockers in patients with hypertension (n = 64,243). Results: In total, 38,919 patients with hypertension were on RAS blockers. The SARS-CoV-2 positive rates were significantly higher in the RAS blocker group than in the control group after adjustments (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 1.10 to 1.36; p < 0.001), and matching by propensity score (adjusted OR, 1.16; 95% CI, 1.03 to 1.32; p = 0.017). Among the 1,609 SARS-CoV-2-positive patients with hypertension, the use of RAS blockers was not associated with poor outcomes, such as mortality (adjusted OR, 0.81; 95% CI, 0.56 to 1.17; p = 0.265), and a composite of admission to the intensive care unit and mortality (adjusted OR, 0.95; 95% CI, 0.73 to 1.22; p = 0.669). Analysis in the propensity scorematched population showed consistent results. Conclusions In this Korean nationwide claims dataset, the use of RAS blockers was associated with a higher risk to SARS-CoV-2 infection but not with higher mortality or other severe clinical courses.

Although an inverse relationship between abdominal adiposity and pulmonary function has been suggested, direct measurement of abdominal adipose tissue has rarely been attempted. Our object is to determine the impact of abdominal adiposity on pulmonary function by directly measuring abdominal adipose tissue with abdominal computed tomography (CT). In this cross-sectional study, we included never-smokers between the ages of 18 and 85 yr, who had undergone spirometry and abdominal adipose tissue analysis with CT scans during November 1, 2005 to October 31, 2009 as part of the comprehensive health examination. Among a total of 3,469 participants, 890 (25.7%) were male. The mean body mass index and waist circumference among males and females were 24.6 kg/m2 and 87.8 cm and 23.0 kg/m2 and 83.0 cm, respectively. Although total adipose tissue (TAT) of the abdomen in males (269.1 cm2) was similar to that in females (273.6 cm2), the ratio of visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) was different; 0.99 in males and 0.50 in females. In males, TAT, SAT, and VAT were inversely associated with the absolute value of forced vital capacity (FVC), and TAT and VAT were inversely associated with forced expiratory volume in one second (FEV1). However, in females, TAT and VAT, but not SAT, were inversely associated with absolute FVC and FEV1 values. In conclusion, the amount of abdominal adipose tissue directly measured using CT is inversely associated with lung function.
*Adiposity ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Humans ; Intra-Abdominal Fat/*radiography ; Lung/*physiology ; Male ; Middle Aged ; Radiography, Abdominal ; Smoking ; Tomography, X-Ray Computed

PURPOSE: This study investigated the compliance of the general public to the guidance conveyed by hospital emergency medical information centers. METHODS: This study included the incidences of inquiry on hospitals and clinics to Busan Emergency Medical Information Center by the general public for a 2-week period from January 4-17, 2009. Information obtained included general characteristics, time of hospital arrival and departure, length of hospitalization, hospitals visited, and treatment outcome. RESULTS: A total of 939 incidences of hospital guidance to the general public were examined. The degree of compliance was 71.2%, the ratio of the primary and secondary facility that the participants visited were 88.6% and 93.5% of the participants in this study were discharged from hospitals after their visit. Patients who complied with the information received displayed a shorter period of hospitalization than non-compliant patients. CONCLUSION: Emergency medical information centers may help ease the unnecessary use of emergency rooms by providing information on diseases to the general public and effectively distributing medical resources with guidance to proper hospitals according to the degree of symptoms.
Access to Information ; Compliance ; Emergencies ; Emergency Medical Services ; Hospitalization ; Humans ; Incidence ; Information Centers

PURPOSE: This study investigated the compliance of the general public to the guidance conveyed by hospital emergency medical information centers. METHODS: This study included the incidences of inquiry on hospitals and clinics to Busan Emergency Medical Information Center by the general public for a 2-week period from January 4-17, 2009. Information obtained included general characteristics, time of hospital arrival and departure, length of hospitalization, hospitals visited, and treatment outcome. RESULTS: A total of 939 incidences of hospital guidance to the general public were examined. The degree of compliance was 71.2%, the ratio of the primary and secondary facility that the participants visited were 88.6% and 93.5% of the participants in this study were discharged from hospitals after their visit. Patients who complied with the information received displayed a shorter period of hospitalization than non-compliant patients. CONCLUSION: Emergency medical information centers may help ease the unnecessary use of emergency rooms by providing information on diseases to the general public and effectively distributing medical resources with guidance to proper hospitals according to the degree of symptoms.
Access to Information ; Compliance ; Emergencies ; Emergency Medical Services ; Hospitalization ; Humans ; Incidence ; Information Centers

BACKGROUND: A number of questionnaires designed for analyzing family members' inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. METHODS: The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). RESULTS: In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman's r = 0.84, p < 0.001). Cronbach's αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). CONCLUSIONS: The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members' satisfaction about ICU care.
Atmosphere ; Critical Care* ; Decision Making ; Emergencies ; Humans ; Intensive Care Units* ; North America ; Tertiary Care Centers ; Visual Analog Scale