The number of patients visiting the emergency room (ER) is increasing every year. The Korean Triage and Acuity Scale (KTAS) was developed in Korea in 2012 to help reduce the congestion of the ER at the hospital level and improve the safety of patients. From January 2016, KTAS has been implemented in emergency medical (EM) centers. KTAS evaluates patients who visit the ER by the following process: impression evaluation, infection confirmation, primary symptom selection, and primary/secondary considerations. KTAS prioritizes patients according to the level, and if necessary, sets a time for which the patient can wait safely with the aim to see a doctor within that time. KTAS has the characteristics of both severity and acuity, so there can be some discrepancy between the KTAS level and disposition. All EM centers conducted the KTAS classification from March to November, 2016. An analysis of the results of the KTAS classification showed no distortion in the classification from the beginning of KTAS introduction. In the near future, it is hoped to develop a KTAS-based transport protocol reflecting the regional medical resources and cultures at the pre-hospital stage, and establish an effective EM system, including medical basis and policy consideration.
Classification ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Estrogens, Conjugated (USP) ; Hope ; Humans ; Korea ; Patient Safety ; Triage*

PURPOSE: This study investigated the effects of shoulder protraction exercise according to weight by examining the surface electromyography (EMG) amplitude in the serratus anterior (SA), upper trapezius (UT), and pectoralis major (PM) as well as the activity ratio of each muscle. METHODS: Twenty three winging scapula subjects participated in the study. The subjects performed scapula protraction at shoulder 90° flexion and 60° horizontal abduction with up to four (none, 1kg, 1.5kg, and 2kg) dumbbells in the supine position. The EMG data were collected from the dominant side muscles during a shoulder protraction exercise according to weight in the supine position. One way repeated measures analysis of variance (ANOVA) was used to compare the normalized activities of the SA, UT, and PM and the ratios of PM/SA and UT/SA. RESULTS: The results showed that the activities of both the SA and UT were highest for the shoulder protraction exercise at 2kg in the supine position. The UT/SA ratio also was the lowest for exercise at 2kg. On the other hand, the activities of both the UT and PM/SA ratio were similar under all conditions. CONCLUSION: These results show that there is a need to selectively strengthen the SA muscle in the case of patients with the shoulder dysfunction. In particular, it is necessary to weigh 2kg when performing shoulder protraction exercises in the supine position to activate the SA muscle in patients with a winging scapula.
Electromyography ; Exercise ; Hand ; Humans ; Muscles ; Scapula ; Shoulder ; Superficial Back Muscles ; Supine Position

Purpose: In this study, based on the error augmentation, we performed walking training with increased rhythmic auditory stimulation speed on the affected side (IRAS) and walking training with decreased rhythmic auditory stimulation speed on the unaffected side (DRAS). The purpose of this study was to verify whether motor learning was effective in improving balance ability. Methods: Twenty-eight subjects with chronic stroke were recruited from a rehabilitation center. The subjects were divided into three groups: an IRAS group (10 subjects), a DRAS group (9 subjects), and control group (9 subjects). They received 30minutes of neuro-developmental therapy and walking training for 30minutes, five times a week for three weeks. Static and functional balance ability were measured before and after the training period. Static balance was measured by balancia software. Functional balance was measured by the timed up and go test (TUG) and the berg balance scale (BBS). Results: After the training periods, the IRAS group showed a significant improvement in TUG, BBS, area 95% COP, and weight distribution on the affected side when compared to both the DRAS group and control group (p<0.05). Conclusion Based on the results of this study, it is possible to consider error augmentation methods of motor learning if rhythmic auditory stimulation is applied to stroke patients in clinical practice. If the affected side is shorter than the unaffected side, the affected side should be adjusted to the increased rhythmic auditory stimulation speed, which is considered to be an effective intervention to improve balance ability.

A dog (5.6 kg, 4-year-old, castrated male, Miniature pinscher) with diffuse symmetric alopecia on the chest and excessive scales was referred to Veterinary Medical Teaching Hospital of Chungnam National University, Korea. On physical examination, diffuse alopecia on ventral aspect of the neck and caudomedial thighs, and severe scales were presented. Dermatologic tests of lesions revealed bacterial infections. Histopathologically, atrophy of hair bulb was observed in the severely alopecic lesion of caudomedial thighs. ACTH stimulation test was performed to differentiate the endocrine disorder related to generalized alopecia. The pre-ACTH serum testosterone and progesterone concentrations were above normal ranges and the post-ACTH serum testosterone concentration was high. The pre- and post-ACTH serum estradiol and cortisol concentrations were within normal ranges. Canine pattern alopecia was diagnosed based on history, physical examination, hormonal assay and dermatohistopathologic examination. After 3 months of melatonin administration, multifocal alopecia on the trunk was improved and general hair regrowth was identified.
Adrenocorticotropic Hormone ; Alopecia ; Alopecia Areata ; Animals ; Atrophy ; Bacterial Infections ; Dogs ; Estradiol ; Hair ; Hospitals, Teaching ; Humans ; Hydrocortisone ; Korea ; Male ; Melatonin ; Neck ; Physical Examination ; Preschool Child ; Progesterone ; Reference Values ; Testosterone ; Thigh ; Thorax ; Weights and Measures

PURPOSE: This study identifies best practices for informed consent for emergent computed tomography (CT) scans and development of a new document used to explain the informed consent using an iPad in an emergency department (ED). METHODS: Literature review, semi-structured interviews, and observations of informed consent were used for development of a new process for informed consent. Participants were ED physicians, residents, and senior nurses. Interviews were conducted for identification of agreed best practice and to derive new structural documents for classification of the information into relevant sections. RESULTS: Interviews identified a variety of perceived current deficits in informed consent, including difficult contents and missing explanation of the possible adverse events, such as radiation hazards. Participants provided examples of poor informed consent that were thought to have led to patient dissatisfaction; these included delay for patients who do not agree to undergo CT scan due to brief or inaccurate explanation. The interviewers' responses were used to reach a unifying 'best practice' for the content of informed consent. Their opinions were also used in implementation of a new tool for informed consent using the iPad. CONCLUSION: A new informed consent was developed using an iPad in order to provide a more efficient and organized template, which includes visual information necessary to facilitate understanding. Additional video clips were also developed in order to provide adjuvant materials for detailed explanations.
Consent Forms ; Emergencies ; Humans ; Informed Consent ; Practice Guidelines as Topic

PURPOSE: As a first step towards reform of the emergency medical service system, we aimed to assess the current status of our emergency department triage systems and illustrated the current status and problems of the Korean emergency department triage system. METHODS: We conducted e-mail and telephone surveys of the triage officers of all 136 emergency medical centers in Korea. RESULTS: All 136 emergency departments responded to the survey. In Korea, a triage scale derived from the 'emergency symptoms based on the requirements of the Emergency Medical Service Act' is the most-used triage scale. We identified factors showing significant association with use of verified triage vs. unverified scales, including level of triage scale, type of hospital, type of emergency department, perception of problems regarding the triage scale, educational performance, and number of annual visits. CONCLUSION: Results of our survey showed that in Korea various kinds of triage scale are in use and the reliability and validity of more than half of them are unverified. Reform of the Korean national triage system is in progress and our survey findings should be helpful in guiding reorganization of the national triage systems of many countries.
Electronic Mail ; Emergencies ; Emergency Medical Services* ; Emergency Service, Hospital* ; Korea ; Patient Safety ; Reproducibility of Results ; Telephone ; Triage* ; Weights and Measures*

PURPOSE: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). METHODS: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. RESULTS: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. CONCLUSION: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.
Delivery of Health Care ; Education ; Emergencies ; Emergency Service, Hospital* ; Hospitals, Urban ; Humans ; Inpatients ; Insurance ; Logistic Models ; Marital Status ; Observational Study ; Prospective Studies ; Suicide

Staphylococcus aureus (S. aureus ) is known to induce apoptosis of host immune cells and impair phagocytic clearance, thereby being pivotal in the pathogenesis of atopic dermatitis (AD). Adipose-derived stem cells (ASCs) exert therapeutic effects against inflammatory and immune diseases. In the present study, we investigated whether systemic administration of ASCs restores the phagocytic activity of peripheral blood mononuclear cells (PBMCs) and decolonizes cutaneous S.aureus under AD conditions. AD was induced by injecting capsaicin into neonatal rat pups. ASCs were extracted from the subcutaneous adipose tissues of naïve rats and administered to AD rats once a week for a month. Systemic administration of ASCs ameliorated AD-like symptoms, such as dermatitis scores, serum IgE, IFN-γ+/IL-4+ cell ratio, and skin colonization by S. aureus in AD rats. Increased FasL mRNA and annexin V+/7-AAD+ cells in the PBMCs obtained from AD rats were drastically reversed when co-cultured with ASCs. In contrast, both PBMCs and CD163+ cells bearing fluorescent zymosan particles significantly increased in AD rats treated with ASCs. Additionally, the administration of ASCs led to an increase in the mRNA levels of antimicrobial peptides, such as cathelicidin and β-defensin, in the skin of AD rats. Our results demonstrate that systemic administration of ASCs led to decolonization of S. aureus by attenuating apoptosis of immune cells in addition to restoring phagocytic activity. This contributes to the improvement of skin conditions in AD rats. Therefore, administration of ASCs may be helpful in the treatment of patients with intractable AD.

Background and Objectives: Human mesenchymal stem cells (MSCs) are emerging as a treatment for atopic dermatitis (AD), a chronic inflammatory skin disorder that affects a large number of people across the world. Treatment of AD using human umbilical cord blood-derived MSCs (hUCB-MSCs) has recently been studied. However, the mechanism underlying their effect needs to be studied continuously. Thus, the objective of this study was to investigate the immunomodulatory effect of epidermal growth factor (EGF) secreted by hUCB-MSCs on AD. Methods: and Results: To explore the mechanism involved in the therapeutic effect of MSCs for AD, a secretome array was performed using culture medium of hUCB-MSCs. Among the list of genes common for epithelium development and skin diseases, we focused on the function of EGF. To elucidate the effect of EGF secreted by hUCB-MSCs, EGF was downregulated in hUCB-MSCs using EGF-targeting small interfering RNA. These cells were then co-cultured with keratinocytes, Th2 cells, and mast cells. Depletion of EGF disrupted immunomodulatory effects of hUCB-MSCs on these AD-related inflammatory cells. In a Dermatophagoides farinae-induced AD mouse model, subcutaneous injection of hUCB-MSCs ameliorated gross scoring, histopathologic damage, and mast cell infiltration. It also significantly reduced levels of inflammatory cytokines including interleukin (IL)-4, tumor necrosis factor (TNF)-α, thymus and activation-regulated chemokine (TARC), and IL-22, as well as IgE levels. These therapeutic effects were significantly attenuated at all evaluation points in mice injected with EGF-depleted hUCB-MSCs. Conclusions EGF secreted by hUCB-MSCs can improve AD by regulating inflammatory responses of keratinocytes, Th2 cells, and mast cells.

PURPOSE: The Korean Triage and Acuity Scale (KTAS), which was developed in 2012 due to the need for a single triage tool for emergency patients in Korea, has since become nationalized. Although five years has passed, there has been limited evidence of its validation. Therefore, this study was conducted to analyze the validity of the new triage system. METHODS: We conducted a multicenter prospective study. Data were collected from seven hospitals and 42,187 patients were classified using the KTAS from April 1, 2013 to July 6, 2014. We analyzed whether the indirect severity variables showed meaningful differences according to KTAS levels. The variables consisted of disposition from emergency room, length of stay, numbers of consultations, examination of computed tomography, emergency room costs, and performance of emergent interventions. RESULTS: From KTAS level 1 to 5, a decreasing trend in the length of stay in emergency room, frequency of consultation with other departments, admission, computed tomography rate, emergency intervention rate, and emergency room costs was observed. Upon binominal logistic regression, disposition from emergency room and emergent intervention rate showed the highest odds ratio with statistical significance. CONCLUSION: The results of this study demonstrated that KTAS is a valid emergency triage tool that reflects the severity of the patient with indirect indicators. The results of this study will be useful as a reference for quality control of KTAS.
Emergencies ; Emergency Service, Hospital ; Health Resources ; Humans ; Korea ; Length of Stay ; Logistic Models ; Odds Ratio ; Prospective Studies ; Quality Control ; Referral and Consultation ; Triage