BACKGROUND: The elderly ex-smokers are not free from the effect of previously exposed smoking, and have a tendency to participate in health promoting behavior eagerly. This study was designed to evaluate factors that affect pulmonary function in the elderly ex-smokers. METHODS: The ex-smokers with normal chest radiological findings who visited Seoul National University Hospital Health Promotion Center were analyzed. The effect of various factors including age, height, smoking amount, and duration of smoking cessation on pulmonary function indices were analyzed with bivariate correlation analysis. Multiple regression analysis was performed using factors indentified significant in bivariate correlation tests. RESULTS: Multiple regression analyses were done for the all age group and the elderly group. Factors significantly affecting Forced vital capacity(FVC) were height,age and duration of smoking cessation for both grroups. Smoking amount was not significant. Forced expiratory volume in 1 second(FEV1) was significantly influenced by height, age, duration of smoking cessation, and smoking amount for both group. In the all age group, peak expiratory flow(PEF) was siginificantly influenced by age, regular exercise, and duration of smoking cessation. In the elderly group, PEF was significantly affected by height, age, regular exercise, and duration of smoking cessation. The factors significantly affectiong FEV1/FVC were age, smoking amount in the all age group, and regular exercise, smoking amount in the elderly group. CONCLUSION: Smoking amount was a significant factor decreasing FEV1 in the elderly ex-smoker. Duration of smoking cessation was significant in normalization of pulmonary function indices in both the all age group and the elderly group. It is inferred that smoking cessation is beneficial in reversing the adver sely affected pulmonary function indices even in the elderly.
Aged* ; Forced Expiratory Volume ; Health Promotion ; Humans ; Seoul ; Smoke ; Smoking ; Smoking Cessation ; Thorax

Background: The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). Methods: We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. Results: The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50–59 years), 10.81° ± 9.14° (60–69 years), 12.38° ± 8.55° (70–79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50–59 years), 6.09° ± 9.95° (60–69 years), 6.57° ± 9.51° (70–79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50–59 years), 20.30° ± 6.25° (60–69 years), 22.38° ± 7.36° (70–79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50–59 years), 17.54° ± 5.93° (60–69 years), 18.68° ± 6.62° (70–79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50–59 years), 31.11° ± 11.52° (60–69 years), 34.76° ± 10.86° (70–79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50–59 years), 23.63° ± 11.77° (60–69 years), 25.25° ± 12.02° (70–79 years), and 23.72° ± 11.88° (≥ 80 years). Conclusions Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.

Purpose: This study examined the difference in bone union time according to the fracture gap after minimally invasive plate osteosynthesis (MIPO) for simple distal femoral fractures in elderly patients. Materials and Methods: From January 2010 to December 2019, patients aged 60 years or older who underwent surgical treatment for distal femoral fractures due to a low-energy injury were investigated retrospectively. Forty patients were enrolled in the study. The patients were divided into two groups according to the fracture gap after reduction: no more than 2 mm (Group A) and more than 2 mm (Group B) in the anteroposterior and lateral plane. The demographic, operation time, presence or absence of cerclage wiring, plate screw density, plate span ratio, plate length, bone union period, non-union, and complications were evaluated. Results: No statistical differences in operation time, cerclage wiring, plate screw density, plate span ratio, and plate length were observed between the two groups, and the bone union was achieved in all patients without complication. The bone union period was 17.24±1.48 weeks in Group A and 24.53± 5.20 weeks in Group B, which was statistically significant (p<0.001). Conclusion The bone union time in treating geriatric simple distal femur fractures using the MIPO tech-nique was significantly shorter in the 2 mm or less fracture gap than in the greater than 2 mm group.

BACKGROUND: Functional status is important in the elderly and stress is highly related with functional status. This study was designed to evaluate the factors related with stress amount of the elderly. METHODS: The questionnaires for stress amount and health related factors were asked to the elderly who visited Health promotion center of Seoul national university hospital before health examination. Chi square-test, analysis of covariance were constructed to explore the factors related to stress amount. RESULTS: Mean age is 65.2+/-4.0 years and the proportion of the male is 54.9%. The frequency of severe stress is 10.4%, frequency of moderate is 26.5% and frequency of mild is 63.1%. The variables related to the stress are sex, marriage status, education status, average income, exercise, smoking, alcohol, subjective health cognition, satisfaction on life, disaster and personal loss and disease (anemia, hyperthyroidism). CONCLUSION: We conclude that sociodemographic characters, family factors, health behaviors, psychologic factors and biomedical factors are all related to the stress amount.
Aged* ; Cognition ; Disasters ; Education ; Health Behavior ; Health Promotion ; Humans ; Male ; Marriage ; Surveys and Questionnaires ; Seoul ; Smoke ; Smoking

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation

OBJECTIVES: The usability of clinical information systems (CISs) is known to be an essential consideration in ensuring patient safety as well as integrating clinical flow. This study aimed to determine how usability and safety guidelines of CIS consider clinical workflow through a systematic review in terms of the target systems, methodology, and guideline components of relevant articles. METHODS: A literature search was conducted for articles published from 2000 to 2015 in PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement method was employed. Articles containing recommendations, principles, and evaluation items for CIS usability and safety were included. The selected articles were classified according to article type, methodology, and target systems. Taking clinical workflow into consideration, the components of guidelines were extracted and classified. RESULTS: A total of 7,401 articles were identified by keyword search. From the 76 articles remaining after abstract screening, 15 were selected through full-text review. Literature review (n = 7) was the most common methodology, followed by expert opinions (n = 6). Computerized physician order entry (n = 6) was the most frequent system. Four articles considered the entire process of clinical tasks, and two articles considered the principles of the entire process of user interface affecting clinical workflow. Only two articles performed heuristic evaluations of CISs. CONCLUSIONS: The usability and safety guidelines of CISs need improvement in guideline development methodology and with consideration of clinical workflow.
Expert Testimony ; Heuristics ; Hospital Information Systems ; Information Systems* ; Mass Screening ; Medical Order Entry Systems ; Methods ; Patient Safety ; User-Computer Interface

Background and Objectives: This study investigated whether an artificial intelligence computer-assisted diagnosis (AI-CAD) software recently developed in our institution named the Severance Artificial intelligence program (SERA) could show similar diagnostic performance for thyroid cancers using ultrasonographic (US) images from a mobile phone (SERA_M) compared to using images directly downloaded from the pictures archive and communication system (PACS) (SERA_P). Materials and Methods: From October 2019 to December 2019, 259 thyroid nodules from 259 patients were included. SERA was run on original and mobile images to evaluate SERA_P and SERA_M. Nodules were categorized according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). To compare diagnostic performance, a logistic regression analysis was conducted using the Generalized Estimating Equation. The area under the curve (AUC) was calculated using the receiver operating characteristic (ROC) curve, and compared using the Delong Method. Results: There were 40 cancers (15.4%) and 219 benign lesions (84.6%). The AUC and sensitivity of SERA_M (0.82 and 85%, respectively) were not statistically different from SERA_P (0.8 and 75%, respectively) (p=0.526 and p=0.091, respectively). The AUC of radiologists (0.856) was not significantly different compared to SERA_P and SERA_M (p=0.163 and p=0.414, respectively). The sensitivity of radiologists (77.5%) was not statistically different compared to SERA_P and SERA_M (p=0.739 and p=0.361, respectively). Conclusion AI-CAD software using pictures taken by a mobile phone showed comparable diagnostic performance with the same software using images directly from PACS.

Objectives: In this paper, we aimed to investigate the evolving debate over border closure in Korea during the coronavirus disease 2019 (COVID-19) pandemic, to address the main themes associated with border closure, and to discuss the factors that need to be considered when making such decisions. Methods: We collated and reviewed previously conducted review studies on border closures during infectious disease outbreaks to derive relevant themes and factors. Results: According to our systematic review on border closures and travel restrictions, the effects of such containment efforts are limited. We suggest considering the following factors when determining whether to impose border closure measures: (1) disease characteristics, (2) timeliness of implementation, (3) transmission delay and the basic reproduction number, (4) globalization and pandemics, and (5) social and economic costs. Conclusions Our assessment indicates that the effects of border closures are at best temporary and limited. Alternative measures must be contemplated and implemented to suppress the spread of COVID-19 in particular and infectious diseases more broadly.

OBJECTIVE: To improve lower extremity function and balance in elderly persons, we developed a novel, three-dimensional interactive augmented reality system (3D ARS). In this feasibility study, we assessed clinical and kinematic improvements, user participation, and the side effects of our system. METHODS: Eighteen participants (age, 56-76 years) capable of walking independently and standing on one leg were recruited. The participants received 3D ARS training during 10 sessions (30-minute duration each) for 4 weeks. Berg Balance Scale (BBS) and the Timed Up and Go (TUG) scores were obtained before and after the exercises. Outcome performance variables, including response time and success rate, and kinematic variables, such as hip and knee joint angle, were evaluated after each session. RESULTS: Participants exhibited significant clinical improvements in lower extremity balance and mobility following the intervention, as shown by improved BBS and TUG scores (p<0.001). Consistent kinematic improvements in the maximum joint angles of the hip and knee were observed across sessions. Outcome performance variables, such as success rate and response time, improved gradually across sessions, for each exercise. The level of participant interest also increased across sessions (p<0.001). All participants completed the program without experiencing any adverse effects. CONCLUSION: Substantial clinical and kinematic improvements were observed after applying a novel 3D ARS training program, suggesting that this system can enhance lower extremity function and facilitate assessments of lower extremity kinematic capacity.
Aged* ; Education ; Exercise ; Feasibility Studies* ; Hip ; Humans ; Joints ; Knee ; Knee Joint ; Leg ; Lower Extremity ; Reaction Time ; Rehabilitation* ; Walking