u-Health is a good alternative in providing health care service under special situations where access to health care is limited. With the expansion of life space and the increase of travel, people are being put in danger across various situations on the sea, in the sky, disasters, and so on. It is not easy to provide health care in those situations, while people may still have high expectation to heath care. This gap can be narrowed by using u-Health, which is based on advanced information and communication technologies. The special situation for u-Health is where normal health care cannot be performed because of physical limitation and danger, which can be further broken down to five situations. The first is a situation on means of transportation such as ship and airplane. The second situation is when medical facilities are far away from life space, in places like backwoods. The third situation occurs on the place where it is difficult for patients to receive treatment due to restrained freedom, for example, a prison. The forth is the situation where the medical team is unable to approach easily, such as war zone and disaster area. The last special situation is the extreme environments like polar region. In order to make the u-health system more helpful for patients under special situations, there is a need for a research development and investment on sensors to measure accurate bio-signals, the network to transmit the data, and the technologies to analyze the data and to provide feedback. Therefore, institutional supports for technology development are required for further development of u-Health for people in great needs.
Aircraft ; Cold Climate ; Delivery of Health Care ; Disasters ; Freedom ; Health Services Accessibility ; Humans ; Hypogonadism ; Investments ; Mitochondrial Diseases ; Ophthalmoplegia ; Prisons ; Ships ; Telemedicine ; Transportation

A ruptured brain arteriovenous malformation (bAVM) presenting with a hematoma may have unseen parts of the shunts in diagnostic angiography in the acute phase, which may lead to innate incomplete evaluation for the whole angioarchitecture of the bAVM. Even though it is generally accepted that the nidus of a ruptured bAVM may be underestimated in angiography during the acute phase due to hematoma compression, documentation of the underestimated parts has not been described in the literature. The authors report 2 cases of ruptured bAVMs in which the obscured segments were cast with liquid embolic material, which suggests a potential presence of obscured segments in bAVMs.

OBJECTIVE: A system for reinforcing the patient safety has been established based on RFID (Radio Frequency Identification) technology in order to minimize a variety of potential medical errors which can take place in hospitals. The system is intended to prevent simple errors or misunderstandings attributed to manifold surgery, transfusion, and medication errors. METHODS: The RFID system was developed and established in one general hospital. The system was applied to managing the patient in the run-up to surgery during anesthesia preparation, transfusion, and anticancer medications, of which procedure information and the patient information are rechecked for assurance, respectively. RESULTS: With regard to the technological aspects, the system used 13.56 MHz of spectrum bandwidth and tags complying with ISO 15693 standard. The tag readers varied with the work, PDAs in the intensive care unit, and laptop computers in the anesthesiology department and on the general wards. After applying the system, we surveyed user's usage and satisfaction. CONCLUSION: The results of our survey indicated a high level of satisfaction with the RFID system in terms of reinforcing the patient's safety in medical environments. Respondents stated that patients were likely to wear an electronic bracelet, even if inconvenient, with their information revealed on the wrist and while going through extended medical procedures. Nurses had intentions to utilize the RFID system for managing hospital assets and tracking patients. A revitalization of the RFID system would be network stability, including the network environment, as well as quantitative effectiveness analysis.
Anesthesia ; Anesthesiology ; Surveys and Questionnaires ; Electronics ; Electrons ; Hospitals, General ; Humans ; Hypogonadism ; Intensive Care Units ; Intention ; Medical Errors ; Medication Errors ; Mitochondrial Diseases ; Ophthalmoplegia ; Patient Safety ; Patients' Rooms ; Radio Frequency Identification Device ; Track and Field ; Wrist

Purpose: The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods: Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results: The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

Purpose: The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods: Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results: The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

PURPOSE: In spite of preventive measures and excellent prognosis with immediate treatments, drowning and drowning- related injuries remain as one of the leading causes of accidental death in Korea. However, abundant statistical data for drowning has yet to be collected. Thus, this study aimed to describe the epidemiologic characteristics of drowning in terms of demographic characteristics, geopolitical factors and socio-economic status. METHODS: This study was conducted with drowning patients who either visited hospitals or died between January 2001 and December 2003. Of these patients, we enrolled individuals registered for such coverages as automobile insurance, national health service and work injury insurance and we reviewed death records reported to the Korea National Statistical office. NISS (New Injury Severity Scale) and EMR-ISS (the Excessive Mortality Ratio -adjusted Injury Severity Score) values were calculated for each patients and the results were classified 4-into four different severity groups. After analysis, we drew conclusions in terms of year, gender, age, region, insurance type, daily rate of incidences and severity. RESULTS: The incidences of drowning-related injury were 2,486 in 2001, 2,364 in 2002, and 2,595 in 2003 (average of 2,482). The average annual death were 1,954. Victims were more likely to be male and especially high incidence rates were found for two groups: (1) Children aged 5-9 years, (2) Adults aged 40 and older. Seoul and Gyeonggi had the largest total numbers of injury cases, while JeJu had the highest per capita incidence rate (106 per 1,000,000 population). The seasonal distribution of incidence rates showed that predictably, incidents were most frequent between the beginning of July and September. CONCLUSION: The average number of incidents was 55.73 per 1,000,000 population, which constitutes approximately 0.02% of all injuries. Based on this data, we recommand continuing studies and further evaluations in order to develop specific measures to combat drowning.
Adult ; Aged ; Automobiles ; Child ; Death Certificates ; Drowning ; Humans ; Incidence ; Insurance ; Korea ; Male ; National Health Programs ; Prognosis ; Seasons

PURPOSE: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. METHODS: We conducted a retrospective study over an 8-year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. RESULTS: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7+/-220.5 minutes in patients who died and 395.5+/-363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. CONCLUSION: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.
Brain Injuries ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Odds Ratio ; Retrospective Studies

BACKGROUND: Thalidomide has been reported to have antitumor activity for treating metastatic hepatocellular carcinoma (HCC). We evaluated the safety and efficacy of using thalidomide for treating selected patients with unresectable or metastatic HCC, and their disease was refractory to systemic chemotherapy. METHODS: Eight patients with measurable and metastatic HCC that had progressed with prior systemic chemotherapy and who desired further active therapy were enrolled in this study. Thalidomide was given orally at bedtime and it was started at 200 mg/day with no further dose escalation. The response was measured at 2-month intervals. RESULTS: The median age was 44 years (range: 34-52 years) and all the patients had received doxorubicin-based systemic chemotherapy prior to their enrollment. Each patient received thalidomide for a median of 152 days (range: 5-422 days). One partial response was observed (12.5%, 95% CI; 0-42%) along with 4 cases of stable diseases. The most commonly encountered toxicity was somnolence; grade 3 somnolence was noted for one patient, which led to treatment discontinuation. Skin rash was observed in one responding patient. CONCLUSIONS: The results indicate that thalidomide may feasibly offer disease stabilization to metastatic HCC patients. Further dose escalation of thalidomide, or its combination with other chemotherapeutic agents, may be of interest and this should be investigated for treating patients with metastatic HCC.
Treatment Outcome ; Thalidomide/*therapeutic use ; Retrospective Studies ; Pilot Projects ; Middle Aged ; Male ; Lymphatic Metastasis ; Lung Neoplasms/drug therapy/*secondary ; Liver Neoplasms/*drug therapy/pathology ; Immunosuppressive Agents/*therapeutic use ; Humans ; Follow-Up Studies ; Female ; Carcinoma, Hepatocellular/*drug therapy/secondary ; Bone Neoplasms/drug therapy/*secondary ; Adult

BACKGROUND: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). METHODS: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. RESULTS: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. CONCLUSION: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.
Anesthesia, General ; Anesthesia, Local ; Aneurysm ; Conscious Sedation ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Mortality ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage