PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.
Allied Health Personnel ; Disasters* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Fires* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Retrospective Studies ; Triage

PURPOSE: Emergency physicians usually perform ultrasound exams for patients with multiple injuries. Extended focused assessment with sonography for trauma (eFAST) can reveal injuries from chest to the abdomen immediately. However, in Korea, the curriculums of medical schools do not currently include eFAST. We have devised a study to assess the feasibility of the eFAST exam in medical school students. METHODS: This study was conducted in students in their fifth year out of six years of medical school, over 11 weeks. Four Emergency Medicine specialists trained the students over 4 hours, tested the students, and conducted a questionnaire. RESULTS: Average age of students was 25.9+/-2.6 years, and 24 were male and 20 were female. Mean success rate of 17 components on the eFAST exam was 95.9% (94.6%-97.4%). The success rate of transverse view of aorta, transverse view of bladder, lung sliding sign, and sea-shore sign of both anterior chest walls was 100%, scanning the spleen and attaching the probe to a body surface were 75%, 86.3%. Total time consumption was 449.0+/-22.2 seconds. The questionnaires showed that the eFAST exam for the splenorenal recess, spleen, and left upper quadrant lung was difficult. CONCLUSION: We found that medical students in Korea could perform the eFAST exam by themselves after 4 hours education. In the future, these findings can be helpful in development of an eFAST education program for medical students.
Abdomen ; Aorta ; Curriculum ; Education ; Emergencies ; Emergency Medicine ; Female ; Humans ; Korea ; Lung ; Male ; Multiple Trauma ; Surveys and Questionnaires ; Schools, Medical* ; Specialization ; Spleen ; Students, Medical ; Thorax ; Ultrasonography ; Urinary Bladder

Ataxia is presented by various etiologies, including acquired, genetic and degenerative disorders. Although hereditary ataxia is suspected when typical symptom of ataxia with concurrent is identified, it is sometimes difficult to diagnose hereditary ataxia without genetic test. Clinically, next generation sequencing technology has been developed and widely used for diagnosis of hereditary disease. Hereby, we experienced cases of genetically confirmed OPA1 mutation, which are presented with various clinical manifestations including ataxic gait and decreased visual acuity.

The sacral spinal epidural space is an uncommon site for primary malignant lymphomas, presenting with symptoms associated with cauda equina compression. Especially, lumbo-sacral epidural lymphoma has been reported to be very rare. We present a rare case of 29-year-old male with sacral spinal epidural malignant lymphoma. The patient complained of tingling sensation in his buttocks that was radiating to his calf. The neurological examination was normal. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural mass lesion at the mid L5 to mid S2 level. The lesion was iso- to hypointense on T1 and T2 weighted images and showed homogenous enhancement and a focal enhancement in the L5 vertebral body on post-contrast images. The patient underwent a L5-S2 laminectomy and subtotal excision of the lesion. Intra-operatively, the lesion was extradural and not densely adherent to the dura; the lesion was friable, not firm, fleshy, brownish and hypervascular. The histologic diagnosis was grade 2 non-Hodgkin's follicular lymphoma. Even though the primary spinal epidural non-Hodgkin's lymphoma is a very rare disease, clinicians should take it into consideration in the differential diagnosis of patients with spinal epidural tumor.
Adult ; Buttocks ; Cauda Equina ; Diagnosis ; Diagnosis, Differential ; Epidural Neoplasms ; Epidural Space* ; Humans ; Laminectomy ; Lymphoma* ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Rare Diseases ; Sensation

OBJECTIVE: We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). METHODS: We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. RESULTS: Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. CONCLUSION: The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion.
Animals ; Arm ; Body Height ; Diskectomy* ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Retrospective Studies

The rapid aging trend in South Korea will cause a growing shortage of labor and decreasing quality of the labor force. The purpose of this commentary is to recommend a health care strategy to maintain and promote the work ability of employees in an aging Korea. Strategies to promote the work ability require the collaboration of governmental agencies at the central and local levels. First, the common goal should be the reinforcement of follow-up measure in general medical examinations and the promotion of healthy lifestyles for workers. Second, collaborating activities should be performed among the Worker’s Health Center, the Health Promotion Center, and community health centers. In conclusion, health care strategies for ensuring the work ability in an aging Korea require the collaboration of governmental agencies at the central and local levels.
Aging* ; Community Health Centers ; Cooperative Behavior ; Delivery of Health Care* ; Employment ; Follow-Up Studies ; Health Promotion ; Korea* ; Life Style

PURPOSE: Falling is one of the most common causes of injury for preschool children. Here, we aim to identify the characteristics and risk factors of injuries by falling-down in preschool children. METHODS: Between January 2010 and December 2011, we enrolled patients under the age of 7 years, who were injured by falling down and visited an urban regional emergency center. We retrospectively surveyed the medical record of these patients, including age, sex, place and height of fall, type of floor, guardian's witness, traumatic brain injury (TBI), and fracture of extremities. RESULTS: The odds ratios sex (male), age (under 2 years old), height of fall, type of floor (hard), and guardian's witness (presence) that resulted in TBI were 1.35 (95% confidence interval [Cl], 0.72?2.55; p=0.352), 3.83 (95% Cl, 1.78?8.65; p<0.05), 6.38 (95% Cl, 3.27–12.44;p<0.05), 3.58 (95% Cl, 0.47–27.30; p=0.218), and 1.47 (95% Cl, 0.63–3.43; p=0.377), respectively. The odds ratios sex (male), age (over 2 years old), height of fall, type of floor (soft), and guardian's witness (absence) that resulted in fractures were 1.19 (95% Cl, 0.78–1.81; p=0.433), 3.10 (95%Cl, 1.99–4.84; p<0.05), 1.98 (95%Cl, 1.19–3.29; p<0.05), 2.41 (95% Cl, 1.29–4.54; p<0.05), and 1.15 (95%Cl, 0.72–1.85, p=0.554), respectively. CONCLUSION: In preschool children who experienced an injury from falling down, TBI was increased with younger patients and higher height of fall, but it was not related with patient's sex, type of floor, and guardian's witness; conversely, fractures were increased with older patients, higher height of fall, and soft floor, but not related with patient's sex and guardian's witness.
Accidental Falls ; Brain Injuries ; Child* ; Child, Preschool ; Emergencies ; Extremities ; Humans ; Medical Records ; Odds Ratio ; Retrospective Studies ; Risk Factors*

Objective: We aimed to explore whether nursing professionals’ psychological states affect their grief response for a patient’s death in the coronavirus disease-2019 (COVID-19) inpatients’ ward. Methods: Survey was conducted among frontline nursing professionals working in COVID-19 inpatients wards at three tertiary-level affiliated hospitals of the University of Ulsan during April 7–26, 2022. Participants’ information such as age, years of employment, or marital status were collected, and their responses to rating scales including Pandemic Grief Scale (PGS) for healthcare workers, Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Patient Health Questionnaire-9 (PHQ-9), Loneliness and Social Isolation Scale, and Insomnia Severity Scale (ISI) were collected. Results: All 251 responses were analyzed. We observed that 34% reportedly suffered from depression. The linear regression analysis showed that a high PGS score was expected by high SAVE-9 (β=0.12, p=0.040), high PHQ-9 (β=0.25, p<0.001), high loneliness (β=0.17, p=0.006), and high ISI score (β=0.16, p=0.006, F=20.05, p<0.001). The mediation analysis showed that the depression of nursing professionals directly influenced their pandemic grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. Conclusion We confirm that frontline nursing professionals’ depression directly influenced their grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. We hope to establish a psychological and social support system for the mental health of nurses working in the COVID-19 wards.

Objective: The aim of this study was to explore the psychometric properties of the Insomnia Severity Index (ISI) based on modern test theory, such as item response theory (IRT) and Rasch analysis, with shortened versions of the ISI among the general population. Methods: We conducted two studies to evaluate the reliability and validity of the shortened versions of the ISI in a Korean population. In Study I, conducted via online survey, we performed an exploratory factor analysis (n=400). In Study II, confirmatory factor analysis (CFA) was conducted (n=400). IRT and Rasch analysis were performed on all samples. Participants symptoms were rated using the ISI, Dysfunctional Beliefs and Attitudes about Sleep–16 items, Dysfunctional Beliefs about Sleep–2 items, Patient Health Questionnaire–9 items, and discrepancy between desired time in bed and desired total sleep time. Results: CFA showed a good fit for the 2-factor model of the ISI (comparative fit index=0.994, Tucker–Lewis index=0.990, root-meansquare-error of approximation=0.039, and standardized root-mean-square residual=0.046). The 3-item versions also showed a good fit for the model. All scales showed good internal consistency reliability. The scale information curve of the 2-item scale was similar to that of the full-scale ISI. The Rasch analysis outputs suggested a good model fit. Conclusion The shortened 2-factor ISI is a reliable and valid model for assessing the severity of insomnia in the Korean population. The results are needed to be explored further among the clinical sample of insomnia.

Proteinuria is associated with poor allograft and patient survival in kidney transplant recipients. However, the clinical relevance of spot urine protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) as predictors of renal outcomes during the early postoperative period following kidney transplantation (KT) has not been determined. Methods: This single-center retrospective cohort study included 353 kidney transplant recipients who underwent KT between 2014 and 2017 and were followed up for more than 3 years. Among them, 186 and 167 recipients underwent living donor KT and deceased donor KT, respectively. The PCR and ACR were measured during the immediate postoperative period (within 7 days postoperatively), before discharge (2–3 weeks postoperatively), and 3–6 months postoperatively. Results: The median age of the patients was 51 years (interquartile range, 43–59 years), and 62.9% were male. An immediate postoperative PCR of ≥1 mg/mg was associated with old age, diabetes mellitus, high systolic blood pressure, delayed graft function, and donor factors (deceased donor KT, old age, and high serum creatinine concentrations). The PCR and ACR 3 to 6 months posttransplant were inversely associated with the estimated glomerular filtration rate at 1 year posttransplant. Deceased donor KT recipients with immediate postoperative PCR of ≥3 mg/mg showed a greater incidence of delayed graft function and lower estimated glomerular filtration rate before discharge than those with immediate postoperative PCR of <3 mg/mg. Conclusion: Early postoperative proteinuria is a useful biomarker to predict early renal outcomes after KT.