BACKGROUND: The purpose of this study was to find out what factors affect revisits by elderly patients to the emergency department (ED) with the same symptoms within 72 hours and hospitalization after a revisit. Delineating these factors can reduce unnecessary revisits to the ED and minimize problems with diagnosing and treating, improving the quality of treatment provided and of discharge decisions. METHODS: This is a retrospective study involving 3790 elderly patients who presented initially to a general hospital ED between May 1, 2007 to June 30, 2009. Of these, 176 cases revisited the ED within 72 hours with the same symptoms. Their medical records were reviewed. A comparative analysis was conducted of the early revisit group by classifying them into 'discharge' and 'admission' considering age, gender, insurance status, means of arrival, chief complaint, diagnosis, length of stay, time of arrival, comorbidity disease, time lapse, and day of the week. RESULTS: The factors affecting revisits were age (< or =79 years), insurance status (medical aid), means of arrival (walk-in), and chief complaint (dysuria.flank pain, skin rash). The factors affecting hospitalization after a revisit were age (> or =80 years), means of arrival (by ambulance), increasing length of stay, and high comorbidity index (> or =2). CONCLUSION: The factors affecting revisits to the ED or hospitalization after a revisit were age, insurance status, means of arrival, chief complaint, length of stay, and comorbidity index. Physicians should be more careful when deciding discharge for elderly patients, especially those with the above factors.
Aged ; Comorbidity ; Emergencies ; Hospitalization ; Hospitals, General ; Humans ; Insurance Coverage ; Length of Stay ; Medical Records ; Retrospective Studies ; Skin

BACKGROUND: The purpose of this study was to compare the quality of simulated resuscitation between the conventional simulation training group and the script based training group. METHODS: This was a retrospective analysis of video clips from a previous study of cardiopulmonary resuscitation (CPR) team simulation training. A total of eighty-four video clips were analyzed. Each video clip belonged to either the conventional group or the script group, of either pre-training or post-training. One of the authors analyzed all the video clips. The qualities of resuscitation team plays were compared in terms of the hands-on compression time, the interval to meaningful measures and the number of utterances of the team leader and members. RESULTS: The hands-on time of the conventional group improved after training whereas that of the script group deteriorated (22.2 vs -7.0 sec, p = 0.009). The time to defibrillation also improved in the conventional group whereas that of the script group deteriorated (-24.0 vs 33.0 sec, p = 0.002). There were no differences in the utterances of team leaders and members between groups and between pre- and post-training. CONCLUSIONS: This study suggested that the effect of script-based training on quality of CPR was less useful than that of conventional training using simulation and debriefing. Therefore, CPR team training using a script alone should not be recommended.
Cardiopulmonary Resuscitation ; Heart Arrest ; Leadership ; Patient Care Team ; Resuscitation ; Retrospective Studies

PURPOSE: The incidence and severity of injuries differs between each region of Korea due to socioeconomic differences. The comparative analysis between national injury data and the evaluation of regional epidemiologic characteristics is useful in establishing an injury prevention strategy for a regional community. This study was conducted in order to provide basic data for the establishment of an injury prevention strategy by priority through comparison between national injury data collected by National Emergency Department Information System (NEDIS) and injury data from regional emergency centers located in small cities, in Korea. METHODS: The study subjects were the injury patients who visited a total of 117 regional, specialized and local emergency centers from April 2009 to March 2010, as well as those who visited Konkuk University Chungju Hospital during the same period. We collected national data from the Injury Surveillance Report published by Korea Centers for Disease Control and Prevention and compared these with study hospital data collected by our own injury registration system to include gender, ratio, age, and mechanism and severity of patient injury. RESULTS: Of 3,931,573 patients who visited 117 emergency centers and 23,671 patients who visited the study hospital during the study year, the number of injury patients was 786,006 (20.0%) versus 6,177 (26.1%), respectively. 485,521 (62.0%) of the nation-wide subjects versus 4,046 (65.5%) of the study hospital subjects were male, and 298,197 (38.0%) of the nation-wide subjects versus 2,128 (34.5%) of the study hospital subjects were female. The comparison by age of the injury subjects was as follows: below 9 years (22.4% versus 16.8%), twenties (14.5% versus 16.3%) and forties (14.5% versus 15.2%). In the comparison of injury mechanism, blunt injury was higher (20.4%) in nation-wide subjects followed by slip injury (20.0%) and transport accident (19.0%). Transport accidents produced the highest cause of injury (26.0%) in the study subjects followed by slip injury (20.1%) and bunt injury (16.1%). In the severity comparison, 641,344(81.6%) versus 4797(77.8%) were mild injury patients, 139,260(17.7%) versus 1299(21.1%) were severely injured, and 3114 (0.4%) versus 69(1.1%) were fatal injuries. The causes of severe injury nation-wide included intoxication (46.3%), falls (34.8%) and machine accidents (33.3%) versus machine (46.0%), asphyxia (44.4%), intoxication (39.3%) in the study hospital, and the causes of fatal injuries nation-wide were intoxication (5.2%), drowning (4.3%), and asphyxia (4.2%), versus drowning (11.1%), asphyxia (5.6%) and intoxication (4.9%) in the study hospital. CONCLUSION: Through the comparison between study hospital with national injury data, we found that the percentage of severe and fatally injured patients was higher in the nationally with transportation related accidents being highest in terms of mechanism. The construction of a regional injury data system with ongoing comparison with national injury data may be useful in the establishment of a regional injury intervention strategy by priority.
Accident Prevention ; Asphyxia ; Centers for Disease Control and Prevention (U.S.) ; Drowning ; Emergencies ; Female ; Humans ; Incidence ; Information Systems ; Korea ; Male ; Population Surveillance ; Transportation ; Wounds, Nonpenetrating

Objective: To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD). Methods: From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG. Results: The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality. Conclusions Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.

Objective: To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). Methods: This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (n=102) and ASA group (n=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Results: Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (P<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(P<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (P<0.001), NYHA classification was also remarkably improved (P<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),P=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (P=0.231). Survival free of HCM-related mortality was similar between the two groups (P=0.397). Conclusions: Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.
Atrial Fibrillation/drug therapy* ; Cardiomyopathy, Hypertrophic/therapy* ; Ethanol/therapeutic use* ; Heart Septum/surgery* ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

Humans ; Asthma/drug therapy* ; Biological Therapy