The effects of observation program of cadaver dissection for paramedical students were surveyed and obtained the following results. After observation of cadaver dissection, the students who will participate next time with their own will, who think this program is essential for anatomy study, who understand the orientation contents, and who think their anatomical knowledge elevated were increased. However, the number staffs of medical school who think this program is essential for paramedical students were about 1/3. The problems obtained in the observation program of cadaver dissection were discordance with teaching schedule, long orientation and observation time, and the 1/2 or above staffs leading this program were teaching assistants and medical students. Through this observation program of cadaver dissection, the paramedical students were aware of the meaning of cadaver donation and the noble will of donors certainly, and gained an opportunity feel the dignity of life.
Appointments and Schedules ; Cadaver ; Humans ; Orientation ; Schools, Medical ; Tissue Donors

BACKGROUND: All medical conduct should be practiced under the permission of patients or guardians. Because anesthetic procedures have high risk, every anesthesia practice is done under verbal and/or written consent. However, collecting anesthetic permission is not common in Korean medical anesthesiologists. The purpose of this article is to survey current anesthetic status and to provide some suggestions. METHODS: We had given questionnaire sheet to anesthesiologists participating in an annual meeting of the Korean Society of anesthesiologists. It included the percentage of receiving the anesthetic consent, the reasons why they received the informed consent or not, and the conditions to improve to receive it. RESULTS: The total number of responded anesthesiologists was 187. More than half of the responders had received the informed consents from less than 25% of their patients. And only thirty percent of them had taken the consents from more than 75% of their patients. To increase this rate, they replied, it is needed to strengthen the legal validity of the consent and to improve working conditions. CONCLUSIONS: The rate of receiving the informed consent is very low for the anesthesia practice in Korea. There are some procedures that are needed to improve the current situation so that anesthesiologists can provide better quality to the patients.
Anesthesia* ; Humans ; Informed Consent* ; Jurisprudence ; Korea* ; Patient Rights

BACKGROUND: Surgical patients should be provided adequate information on operation. The information on mortality is extremely important among them. The purposes of this study are to investigate the recent mortality associated with anesthesia and surgery, and to get a logistic regression model of mortality based on patient information. METHODS: We collected all of the anesthetic cases except local anesthesia during 5 years (between 2000 and 2004) in a hospital. All deaths within 7 days after anesthesia were retrieved. These data were analyzed in terms of age, gender, department in charge, time point after anesthesia, elective or emergency surgery, type of anesthesia, operation name, and diagnosis. The combined effects of the variables on the mortality were evaluated with logistic regression. The causes of death were also analyzed. RESULTS: There were 155 deaths among 74,458 patients under anesthesia. Age less than 1 year old or greater than 80 years old, male gender, department of thoracic surgery, emergency operation, cardiovascular surgery, and diseases for transplantation had higher mortality than their counterparts. Regression model was followed with assignment of '1' for the above mentioned categories. Other categories were designated by '0'. Log[p (death)/{1-p (death)}] = -9.15+1.03xage+0.66xsex+0.79xdepartment+2.77xemergency+2.52 xdiagnosis+0.89xoperation The leading cause of death was sepsis (21.9%). CONCLUSIONS: The average of mortality within 7 days after anesthesia was 21 per 10,000 anesthetic cases (0.21%). Estimated mortality based on logistic regression ranged from 0.01% to 10.25% depending on patient information.
Aged, 80 and over ; Anesthesia* ; Anesthesia, Local ; Cause of Death ; Diagnosis ; Emergencies ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Mortality* ; Sepsis ; Thoracic Surgery

Background: The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. Methods: We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. Results: The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, −5%; 95% CI, −13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, −8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, −2%; 95% CI, −3 to −1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). Conclusions In 2020, the incidence rate of hip fracture did not significantly decrease, and inhospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.

BACKGROUND: Psychological preparation to reduce preoperative anxiety is one of the main purposes of preoperative visits. However, there are only a few reports about the parental anxiety of pediatric patients. This study was performed to get some information to reduce parental anxiety of pediatric patients through an interview during the preanesthetic visit. METHODS: We collected data from the parents of the 122 preoperative children younger than 18 years old and scheduled for elective surgery. The questionnaire consisted of the demographic data, the severity of anxiety, the reason of anxiety, and the parental understanding level about anesthesia before and after hospitalization. RESULTS: The most common cause of anxiety was about fear "not to recover from anesthesia" (33.1%), which appears to be usually due to lack of medical knowledge about anesthesia (65.1%). After hospitalization, parental understanding level about anesthesia was increased. CONCLUSIONS: Anesthesiologists should explain anticipated events and the proposed anesthetic management, which would increase the understanding of parents about anesthesia. Therefore, anxiety and apprehension about anesthesia can be reduced.
Adolescent ; Anesthesia* ; Anxiety* ; Child ; Hospitalization ; Humans ; Parents*

Background: The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. Methods: We used the National Health Insurance Service-Senior cohort of South Korea.Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. Results: Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282). Conclusion There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Background: The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. Methods: We used the National Health Insurance Service-Senior cohort of South Korea.Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. Results: Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282). Conclusion There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

BACKGOUND: The accuracy of a disposable blood pressure transducer (DBPT) is determined by its physical properties: natural frequency (NF) and damping coefficient (DC). We planned this study to investigate whether the NF and DC of a DBPT are altered by attaching extended catheters and evaluated changes of these physical properties over time. METHODS: Fifteen DBPT sets were connected to a monitor and recorder set. These sets were divided into three groups; five sets had catheters of normal length (Group 1), five sets had 50 cm extended catheters (Group 2), and five sets had 100 cm extended catheters (Group 3). The NF and DC of each system were measured using the fast flush (FF) test. After the DBPT sets were installed, the FF test was performed for each group at five time intervals: 4, 24, 48, 72, and 96 hours. RESULTS: The NF of Groups 2 and 3 decreased and their DC increased compared to those of Group 1. Whereas the NF of Group 3 increased over time, those of Groups 1 and 2 did not. The DC of Groups 2 and 3 decreased over time, but remained unchanged over time for Group 1. When the FF test was done at intervals longer than 24 hours, it was found that the NF, but not the DC, increased for all groups. CONCLUSIONS: Attention should be paid to interpret blood pressure using DBPTs measured by extended catheters and using DBPTs for long periods of time without FFs.
Blood Pressure ; Catheters* ; Transducers ; Transducers, Pressure*

BACKGROUND:One of effective treatment methods for back pain and radiculopathy is epidural steroid injection (ESI). However, its effectiveness is hard to judge.So, it is strongly urged to develop a method to evaluate the proper injection of ESI. Photoplethysmogram (PPG) is known as a technique to measure blood oxygen saturation. We were intended to study the PPG for the evaluation of the ESI instantaneously. METHODS:All patients were explained for the study protocol to get informed consent.Twenty volunteers were recruited for this study and four of them were allocated in one of 5 ESI levels; L2-3, L3-4, L4-5, L5-S1 and caudal.They were in the lateral position with 4 PPG probes in their both 2nd fingers and 2nd toes.The PPG signals were collected to a device and converted digitally.PPG signal has two components, total absorbance (TA) and oscillating pulse component (OPC).We compared the both toe PPG signals before and after ESI based on the finger PPG. RESULTS:TA changed in 60% of ESI volunteers and L4-L5 and L5-S1 groups had high change rate compared to L2-L3 group.Also, the symptom relief rate of TA and OPC change volunteers of L4-L5 and L5-S1 were 100% but other level had variable relief rate. CONCLUSIONS:It is possible to use the PPG signal to predict ESI success based appropriate signal change.It is also needed to develop other level signal detection method and to modify appropriate guideline for the decision of change of PPG.
Back Pain ; Fingers ; Humans ; Oxygen ; Radiculopathy ; Toes

BACKGROUND: The chemical reaction of carbon dioxide absorbent and sevoflurane is known to produce compound A. However, carbon dioxide absorbents are not controlled by the Food and Drug Administration, but are treated as industrial products in some nations. Moreover, carbon dioxide absorbents differ in their capacities to produce compound A, because their chemical compositions differ. In this study, we compared the renal safety between carbon dioxide absorbent products in patients under sevoflurane anesthesia. METHODS: Eighty patients with no preexisting renal disease undergoing elective gynecologic surgery were randomly assigned to receive sevoflurane or isoflurane anesthesia with one of four carbon dioxide absorbent products (Sodasorblime(R), Sodalyme(R), Sodasorb(R), Spherasorb(R)) at the same fresh gas flow of 2 L/min. The renal safety was evaluated by changes of blood urea nitrogen (BUN), creatinine and urine N-acetyl-b-glucoseaminidase (NAG)-creatinine ratio at 24 hours and 72 hours after surgery from preoperative level. RESULTS: There was no significant difference in the renal safety indicators between carbon dioxide absorbents during sevoflurane anesthesia (P > 0.05). However, the BUN and urine NAG-creatinine ratios at 72 hours after surgery were higher in isoflurane anesthesia in some carbon dioxide absorbent groups (P = 0.03 and 0.04, respectively). CONCLUSIONS: We could not find significant differences of renal safety indicators with carbon dioxide absorbents. Although the adverse effect of carbon dioxide absorbents on renal function was not proved, consideration should be given to their contol by the regulation on their efficacy and safety because carbon dioxide absorbents can produce compound A.
Anesthesia ; Anesthetics ; Blood Urea Nitrogen ; Carbon ; Carbon Dioxide ; Creatinine ; Female ; Gynecologic Surgical Procedures ; Humans ; Inhalation ; Isoflurane ; Kidney ; Methyl Ethers ; Pilot Projects ; United States Food and Drug Administration