PURPOSE: The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital. METHODS: A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members. RESULTS: Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108+/-75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224+/-67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively. CONCLUSION: The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.
Adult ; Attitude of Health Personnel ; *Cardiopulmonary Resuscitation ; Clinical Competence ; Communication ; Defibrillators ; Female ; Heart Arrest/*therapy ; Hospitals, University ; Humans ; Leadership ; Male ; Nursing Staff, Hospital ; Patient Care Team ; *Patient Simulation ; Quality of Health Care ; Time Factors

This study aimed to analyze trends in research on depression among medical students in Korea and to conduct a meta-analysis to determine the average correlation coefficients between depression and related variables. In total, 38 quantitative studies (four theses and 34 journal articles) published between January 1995 and February 2023 were analyzed according to publication year, subjects, analysis methods, and measurement tools. Among them, 15 studies that provided numerical information on the relationships between depression and variables such as self-esteem, social support, grade point average (GPA), stress, and academic stress were selected for meta-analysis. The main findings of this study were as follows. First, quantitative research on depression among medical students began in earnest in 2009, and cross-sectional studies targeting first-year and second-year medical students were the most prevalent. Furthermore, the most commonly used analysis method was difference testing, and the Beck Depression Inventory was the most frequently used measurement tool. Second, the mean correlation coefficients between depression and stress, self-esteem, social support, academic stress, and GPA were 0.534, 0.532, 0.465, 0.390, and 0.102, respectively. The results for self-esteem, stress, and academic stress showed substantial heterogeneity, while those for social support and GPA showed little heterogeneity. These findings suggest that educational interventions, such as social support improvement programs, are necessary to prevent depression among medical students.

PURPOSE: Right heart failure (RHF) is not a infrequant disease entitiy, but it is difficult to diagnose and mortality rate increases with worsening right heart failure. The utility of Nterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department for differentiating right heart failure from left heart failure (LHF), and optimal cut-off points for its use, are not well established. METHODS: One hundred thirty-six consecutive patients with acute dyspnea, who visited our emergency medical center from August 2005 to August 2006 were recruited prospectively. Patients with acute coronary syndrome and chronic renal failure were excluded. The diagnosis of RHF was based on echocardiographic evidence of right ventricular dysfunction. The diagnostic accuracy of NT-proBNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean patient age was 68+/-13 years, and 64% were women. The median NT-proBNP level among 68 patients (50%) who had LHF and 29 patients (21%) who had RHF were 2524 1572 pg/ml, respectively, versus 520 pg/ml for 39 patients (29%) who did not have heart failure (HF) (p = 0.01). NT-proBNP levels correlated well with right ventricular systolic pressure. However, although patients with RHF exhibited significantly higher NT-proBNP levels than did patients without HF, NT-proBNP levels did not differentiate left from right heart failure. The area under the receiver operating characteristic curve was 0.71 (95% CI 0.63~0.85). At a cutoff of 700 pg/ml, NT-proBNP had a sensitivity of 68%, a specificity of 35%, an overall accuracy of 58%, a false negative rate of 32%, a false positive rate of 66% in differentiating between LHF from RHF (p = 0.03). CONCLUSION: NT-proBNP is elevated in majority of cases of right heart failure, but NT-proBNP could not differentiate RHF from LHF. Therefore, this underscores that NTproBNP is not a stand-alone test and that correct clinical evaluation and echocardiography is still of highest importance.
Acute Coronary Syndrome ; Blood Pressure ; Diagnosis ; Diagnosis, Differential* ; Dyspnea* ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Failure* ; Heart* ; Humans ; Kidney Failure, Chronic ; Mortality ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ventricular Dysfunction, Right

PURPOSE: N-terminal probrain natriuretic peptide (NT-pro-BNP) is elevated in congestive heart failure and myocardial infarction similarly to brain natriuretic peptide (BNP). Serum brain natriuretic peptide (BNP) is elevated after sub-arachnoid hemorrhage (SAH). The aims of this study were to prospectively demonstrate whether NT-pro-BNP is elevated after SAH and to quantify the relationship between NT-pro-BNP levels and patient outcome after SAH. METHODS: Forty-six consecutive patients with aneurysmal SAH who visited our emergency medical center from March 2006 to August 2006 were prospectively recruited. Patients with histories of myocardial infarction, congestive heart failure and chronic renal failure were excluded from study enrollment. Plasma was collected for NT-pro-BNP and troponin I measurements as soon as possible after enrollment. The accuracy of prediction of outcome was assessed by inhospital mortality. RESULTS: The mean patient age was 52+/-13 years, and 59% of the patients were women. Troponin I was elevated in 8 (17.4%) patients and NT-pro-BNP was elevated in 14 (30.4%) patients. The NT-pro-BNP level was associated with the Hunt-Hess grade (p=0.00). The median NT-pro-BNP level was 543.8+/-406.3 pg/ml in in-hospital death patients and 131.4+/-91.1 pg/ml in surviving patients (p=0.00). At a cutoff of 300 pg/ml, the sensitivity and specificity of NT-pro-BNP for the prediction of outcome were 66.7% and 92.9%, respectively. By multivariate logistic regression analysis, the NT-pro-BNP was determined to be an independent predictor of in-hospital mortality (odds ratio 26, 95% CI 4.6-148.2, p=0.00). CONCLUSION: Early after SAH, elevated NT-pro-BNP levels are a strong independent predictor of in-hospital mortality.
Aneurysm ; Emergencies ; Fatal Outcome ; Female ; Heart Failure ; Hemorrhage ; Hospital Mortality ; Humans ; Kidney Failure, Chronic ; Logistic Models ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Plasma ; Prospective Studies ; Sensitivity and Specificity ; Subarachnoid Hemorrhage* ; Troponin I

PURPOSE: Diagnosis of congestive heart failure (CHF) is difficult in the emergency care setting using clinical diagnostic tests. Although echocardiography is important for making the diagnosis of left ventricular dysfunction, its cost and lack of availability limit its use as a routine screening test. The utility of N-terminal probrain natriuretic peptide (NT-proBNP) testing in the emergency department for differentiating between systolic (SHF) and diastolic heart failure (DHF) are not well established. METHODS: One-hundred-seven consecutive patients with acute dyspnea, who visited our emergency medical center from January 2006 to August 2006 were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of DHF was based on European study group guidelines on diastolic heart failure. The diagnostic accuracy of NT-proBNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-11 years, and 59% of the patients were women. The median NT-proBNP level among 41 patients (38%) who had SHF was 3817 and 26 patients (24%) who had DHF was 1781 pg/ml versus 550 pg/ml for those 40 patients (37%) who did not have acute CHF (p=0.01). The area under the receiver operating characteristic curve was 0.89 (95% CI of 0.82-0.96). At a cutoff of 700 pg/ml, NT-proBNP had a sensitivity of 87%, a specificity of 78%, and an overall accuracy of 84% for acute CHF (p<0.01). NT-proBNP levels were correlated well with left ventricular systolic and diastolic dysfunction. But, although SHF had significant higher NT-proBNP levels than those with DHF, NT-proBNP levels were unable to differentiate systolic versus diastolic heart failure. CONCLUSION: NT-proBNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department. Whereas NT-proBNP could not differentiate SHF from DHF, therefore, its clinical major role is still the separation of patients with CHF from those without CHF.
Acute Coronary Syndrome ; Diagnosis ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Heart Failure ; Heart Failure, Diastolic* ; Humans ; Kidney Failure, Chronic ; Mass Screening ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ventricular Dysfunction, Left

BACKGROUND: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. MATERIAL AND METHOD: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. RESULTS: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7~14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians, 35(4.9%) failed to adhere to the death certification guidelines. Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. CONCLUSION: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments. Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.
Cause of Death* ; Certification ; Classification ; Consensus ; Coroners and Medical Examiners ; Death Certificates* ; Emergencies ; Emergency Service, Hospital ; Hospitals, General ; Hospitals, Teaching ; Humans ; Medical Records ; Physical Examination ; Surveys and Questionnaires ; Specialization ; Vital Statistics

PURPOSE: Accurate determination of left ventricular ejection fraction (LVEF) is important in the emergency management of patients with cardiovascular disease. In 10% to 20% of patients, LVEF cannot be accurately determined by 2D echocardiography because of suboptimal endocardial definition on fundamental imaging. Measurement of mitral annular velocity is advantageous because it is not dependent on endocardial definition. METHODS: One hundred fifty-four consecutive patients with acute dyspnea who visited our emergency medical center from September 2005 to March 2007 were prospectively recruited. Patients with atrial fibrillation, valvular disease and regional wall motion abnormality were excluded. Mitral annular peak systolic velocity was obtained from the medial site with apical 4-chamber view by pulsed wave tissue Doppler imaging. LVEF was calculated by modified Simpson's method for apical 4- and 2-chamber views. RESULTS: The mean mitral annular peak systolic velocity was 7.2+/-1.8 cm/s (range 2.9 to 12.1), and the mean ejection fraction was 57.9+/-14.6% (range 17.9 to 83.9). The mitral annular peak systolic velocity correlated linearly with the ejection fraction (r=0.72, p<0.001): LVEF = 15+6 x mitral annular peak systolic velocity(%). The optimal cutoff value of mitral annular peak systolic velocity for identifyng LV systolic dysfunction (LVEF <55%) was 6.7 cm/s. At this cutoff value, the sensitivity, specificity, and accuracy were 84%, 85% and 85%, respectively. The area under the receiver operating characteristic curve was 0.91 (95% CI: 0.85-0.96). The intra-observer variability was +/-0.4 cm/s (3%) and the inter-observer variability was +/-0.6 cm/s (5%). CONCLUSION: Simple measurement of mitral annular systolic velocity by pulsed wave tissue Doppler imaging can be easily applied to patient care and can be used to quantify LVEF accurately and with a high level of reproducibility.
Atrial Fibrillation ; Cardiovascular Diseases ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Emergencies ; Humans ; Observer Variation ; Patient Care ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Ventricular Function

A 26-year-old man visited our emergency medical center with dyspnea, and he was diagnosed with pulmonary embolism. He did not have any specific risk factor. His job was a computer programming. Pulmonary embolism is rare at such young age. Predisposing risk factors in pulmonary embolism patients include a history of venous thromboembolism, history of malignancy, complicating infections, increasing age, thrombophilia, and obesity. Prolonged seated immobility at work is another risk factor for venous thromboembolism like economy class syndrome. We report a case of pulmonary embolism in a young patient who had no risk factor.
Adult ; Dyspnea ; Emergencies ; Humans ; Immobilization ; Obesity ; Pulmonary Embolism ; Risk Factors ; Software ; Thrombophilia ; Venous Thromboembolism

PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.
Acute Coronary Syndrome ; Diagnosis* ; Diagnostic Errors ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Kidney Failure, Chronic ; Male ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.
Acute Coronary Syndrome ; Diagnosis* ; Diagnostic Errors ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Kidney Failure, Chronic ; Male ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity