PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon idiopathic, self-limiting disease characterized by cervical lymphadenopathy. Patients with KFD may present with a wide variety of nonspecific symptoms, including fever, night sweats, and weight loss. Although KFD can affect all lymph nodes of the body, involvement of the intrathoracic lymph nodes is relatively rare. In particular, isolated involvement of the intrapulmonary lymph nodes is extremely unusual. We herein report a case involving a 45-year-old man who presented with symptoms of myalgia, fatigue, and fever. Computed tomography performed during follow-up showed a slowly growing nodule in the upper lobe of the left lung. Results of laboratory tests did not reveal any evidence of infection or autoimmune disease, including systemic lupus erythematosus. Results of excisional biopsy by video-assisted thoracoscopic surgery revealed KFD in an intrapulmonary lymph node. His symptoms improved after a trial of nonsteroidal anti-inflammatory drugs.
Autoimmune Diseases ; Biopsy ; Fatigue ; Fever ; Follow-Up Studies ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Lymph Nodes* ; Lymphatic Diseases ; Middle Aged ; Myalgia ; Solitary Pulmonary Nodule ; Sweat ; Thoracic Surgery, Video-Assisted ; Weight Loss

BACKGROUND: It is well known that ergonomic risk factors and back pain are related. However, few studies have examined the relationship between simultaneous exposure to these risk factors and back pain in a Korean population. We aimed to investigate the relationship between simultaneous exposure to ergonomic risk factors and work-related lower back pain (LBP) based on the fourth Korean Working Conditions Survey (KWCS). METHOD: The fourth KWCS (2014) was used for this study. Chi-square tests and logistic regression were used to assess relationship between 5 ergonomic risk factors and work-related LBP. We also analyzed the relationship between simultaneous exposure to 2 risk factors and work-related LBP. RESULTS: All 5 ergonomic risk factors (fatigue-inducing and painful posture; lifting or moving people; dragging, pushing, or moving heavy objects; standing posture; and repetitive hand or arm movements) were significantly correlated with work-related LBP in the severe exposure group (adjusted odd ratios [aOR] 5.09, 95% confidence interval [CI] 4.46–5.83; aOR 1.98, 95% CI 1.62–2.42; aOR 2.09, 95% CI 1.82–2.40; aOR 1.79, 95% CI 1.60–2.01; aOR 2.04, 95% CI 1.82–2.30, respectively). When exposed to 2 risk factors simultaneously, the relationship between exposure and work-related LBP was not greater than exposure to only 1 risk factor in our study (usually exposed to ‘fatigue-inducing or painful posture’ aOR 2.17, 95% CI 2.02–2.34; high exposure to both ‘fatigue-inducing or painful posture’ and ‘dragging, pushing, or moving heavy objects’ aOR 2.00, 95% CI 1.82–2.20). CONCLUSIONS: There was a strong relationship between severe exposure to each ergonomic risk factor and work-related LBP. However, when exposed to 2 ergonomic risk factors simultaneously, the relationship between exposure and work-related LBP was not stronger than when exposed to only 1 risk factor in our study.
Arm ; Back Pain ; Cross-Sectional Studies ; Hand ; Lifting ; Logistic Models ; Low Back Pain ; Methods ; Posture ; Risk Factors

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found colocalized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206⁺ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68⁺ microglia/macrophages can therefore be used as a potential therapeutic target.
Brain ; Haplorhini ; Immunohistochemistry ; Infarction, Middle Cerebral Artery ; Inflammation ; Macaca mulatta ; Magnetic Resonance Imaging ; Microglia ; Middle Cerebral Artery ; Primates ; Stroke ; Transforming Growth Factor beta