The purpose of this study is to evaluate the ventricular conduction abnormalities, especially RBBB, observed electrocardiographically after surgical closure of VSD. The present study population consists of 92 patients with VSD who were surgically corrected at the Hanyang University Hospital during 6 years period from Jan. 1985 to Dec. 1990. We reviewed their clinical records including surgical notes and EKG findings before and after operations. The results of the study were as follows: 1) Male to female ratio was 1.1:1 (48:44) 2) Out of a total of 92 cases of VSD, 65cases(70.7%)were perimembranous type and 27 cases (29.3%)were subarterial type. 3) The normal preoperative EKG findings were seen in 22 patients, LVH in 21 patients, BUH in 47patients, and RVH in 3 patiens. 4) A transatrial approach was performed in 55 cases, right ventriculotomy with or without resection of muscles in right ventricle in 13 cases, and pulmonary arteriotomy alone in 24 cases. 5) The right bundle branch block after operation developed in 33 patients out of the 65 patinets with perimembranous defect and 5 patients out of the 27 patients with subarterial defects. Postoperative RBBB developed more frequently in perimembranous defect than in subarterial defect. 6) Postoperative RBBB occured in 31.8% of the patients with normal preoperative EKG findings, 23.8% with preoperative LVH, 52.1% with BVH and 66.7% with RVH. Postoperative RBBB was more frequently observed in the patients group with preoperative BVH or RVH than the patients with normal or LVH. 7) Postoperative RBBB was observed in 84.6% after right wentriculotomy, in 43.6% after right atriotomy and in 12.5% with pulmonary arteriotomy alone.
Bundle-Branch Block* ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Muscles

BACKGROUND: Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types. METHODS: We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science. RESULTS: A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44–0.73], P < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44–1.45], P = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate. CONCLUSIONS: This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.
Anesthesia, Epidural ; Humans ; Injections, Epidural ; Needles ; Spinal Diseases

PURPOSE: This study was to present the process of web-based educational program (WEP) development and to identify factors affecting satisfaction with WEP for the certificate of healthcare managers working at the National Health Insurance Corporation (NHIC). METHODS: Subjects were healthcare managers and voluntary participants of WEP. A total of 1,449 respondents were surveyed through an online questionnaire about their satisfaction with the educational contents and system. RESULTS: The mean contents satisfaction was 3.75 (SD 0.54), and system satisfaction 4.68 (SD 0.54). According to statistical analysis, the type of certification, experience and professional career of health care management affected contents satisfaction. And factors affecting system satisfaction were the type of certification and gender. CONCLUSION: WEP was utilized as a pre-requisite course for the certificate program of healthcare managers. However, the development of advanced WEP is suggested to meet the educational needs of healthcare managers who have certificate or license and their job related to healthcare management.
Certification ; Surveys and Questionnaires ; Delivery of Health Care ; Health Education* ; Licensure ; National Health Programs

The purpose of this study is to develop the computerized health instruction system to manage the Health Management Members(HMM) of the Gangbook-ku Health center in Seoul who have registered for the life-time health promotion. The HMM have been checked up and classified into 3 groups - healthy, borderline and ill group - based on their health assessment data through the computerized management system. But the computerized supporting programs for intensive management have not been sufficient enough to offer clear health instructions to the HMM and more than one user in the health center have not been able to use the system at the same time. Therefore, we have developed some new health instruction programs and upgraded the system to be used concurrently. For that purposes, we have used Delphi, Microsoft Access, ActiveX Data Objects(ADO) technology as development tools. We expect thi system to be used for health management of other public health centers, schools, and occupational settings, furthermore for evaluation of health promotion services. Additionally, this new computerized health management system supplemented with health instruction programs should be integrated to the computerized health care system at health centers in near future.
Delivery of Health Care ; Health Promotion ; Humans ; Public Health ; Seoul

OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. RESULTS: Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). CONCLUSION: Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.
Animals ; Cadaver ; Chest Tubes ; Critical Care ; Education ; Emergency Medicine ; Humans ; Methods ; Simulation Training ; Thoracostomy*

Purpose: : This study investigated coronavirus disease-19 (COVID-19) related stress, resilience, and organizational commitment, and determined the factors influencing nurses’ organizational commitment at an infectious disease hospital of COVID-19. Methods: : A cross-sectional descriptive survey was conducted with 138 nurses. Data analysis, including descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlations, and multiple regression analysis, were performed using SPSS 26.0 program. Results: : Factors influencing organizational commitment included resilience (β=0.31, p<.001), position (β=0.31, p<.001), COVID-19 related stress (β=-0.26, p<.001), and COVID-19 nursing period (β=-0.19, p=.012). These variables explained 29.6% of the organizational commitment. Conclusion : In order to enhance the organizational commitment of nurses in infectious disease hospitals of COVID-19, active program development and intervention are required at the organizational level to improve nurses’ resilience and relieve stress related to nursing infectious disease patients.

PURPOSE: The GlideScope video laryngoscope (GL) has been known to help inexperienced health care providers become able to manage even difficult airways. The purpose of this study was to compare foreign body removal efficacies between the Macintosh laryngoscope (ML) and the GL in a setting of airway obstruction. METHODS: Participants were asked to remove the simulated foreign body (2x2 cm rice cake) from the supraglottic area of a freshly embalmed cadaver. This simulated a normal airway and a difficult airway with cervical spine immobilization. Participants performed the removal maneuver 4 times in random order using a Magill forceps with both the ML and the GL. We measured the time to removal (sec) and preference of the participant (5-point scale) and compared results according to the type of laryngoscope. Successful removal was defined as a removal time that was less than 120 sec. RESULTS: Forty participants were enrolled in this simulation experiment. The success rate, time to removal and provider preference were not significantly different betweeh the two types of laryngoscope. In subgroup analysis for experienced providers, the time to removal was significantly shorter in the ML group than the GL group (14 vs 20 sec, p<0.05). The preference of experienced provider was also significantly higher for ML than GL. CONCLUSION: This study suggests that ML has comparable efficacy for foreign body removal to GL and is acceptable to experienced providers.
Airway Obstruction ; Cadaver ; Foreign Bodies ; Health Personnel ; Humans ; Immobilization ; Laryngoscopes ; Spine ; Surgical Instruments

PURPOSE: We aimed to evaluate whether the modified Alvarado score-which is currently being used to diagnose acute appendicitis-can be applicable in the diagnosis of diseases in pregnant women. METHODS: We retrospectively analyzed the medical records of 252 pregnant women who visited our emergency department (ED) with a chief complaint of abdominal pain and a suspicion of acute appendicitis, and ultimately underwent appendix ultrasonography or appendix magnetic resonance imaging (MRI). The modified Alvarado score was calculated for each pregnant woman. A receiver operating characteristic (ROC) curve was drawn for each subject, those in the first trimester, second trimester, and third trimester, from which the best cut-off value, sensitivity and specificity were induced. RESULTS: For all 252 pregnant women who visited our ED, the area under the curve was 0.742 (p<0.001), with sensitivity and specificity of 75.41% and 62.30%, respectively, when using the value of 5 as the cut-off point for the modified Alvarado score. The area under the curve was 0.811 (p<0.001) for those in their first trimester and 0.749 (p<0.001) for those in the second trimester, while it was 0.641, with the p-value of 0.109, for those in the third trimester. CONCLUSION: There is a limitation using the modified Alvarado score alone in pregnant woman, and if there is uncertainty in the diagnosis, other imaging studies, such as appendix ultrasonography or appendix MRI, should be considered.
Abdominal Pain ; Appendicitis* ; Appendix ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography ; Uncertainty

BACKGROUND/AIMS: Variceal hemorrhage is one of the major complications of cirrhosis and is associated with significant mortality and morbidity. The development of gastroesophageal varices and variceal hemorrhage is the most direct consequence of portal hypertension. Correlations between the hepatic venous pressure gradient (HVPG) and first variceal hemorrhage were examined. METHODS: Patients with cirrhosis who underwent HVPG measurement between July 2009 and September 2010 were enrolled (n=535). All patients underwent esophagogastroduodenoscopy to enable the evaluation of gastroesophageal varices. RESULTS: The HVPG for all patients was 16.46+/-7.05 mmHg (mean+/-SD), and was significantly higher among those with first variceal hemorrhage than in those without it. The HVPG was significantly correlated with both Child-Turcotte-Pugh (r=0.488, P<0.001) and Model for End-stage Liver Disease (r=0.478, P<0.001) scores. An HVPG value of 11 mmHg was predictive of first variceal hemorrhage with a sensitivity of 92.4% and a specificity of 27.7%. CONCLUSIONS: The HVPG was higher in patients with first variceal hemorrhage than in those without it.
Adult ; Catheters ; Esophageal and Gastric Varices/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Liver Cirrhosis/*complications/mortality ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; *Venous Pressure

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Dietary Supplements/adverse effects ; Drug-Induced Liver Injury/enzymology/*etiology/pathology ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy/adverse effects ; Plant Preparations/adverse effects ; Prescription Drugs/adverse effects ; Republic of Korea ; Retrospective Studies