BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.
Absorption* ; Area Under Curve ; Body Weight ; Creatinine ; Cyclosporine* ; Drug Monitoring* ; Female ; Humans ; Kidney Transplantation ; Transplantation*

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

Objective: The chest compression depth recommended in the current guidelines for average adult cardiopulmonary resuscitation is approximately 1/4-1/5 depth of the external chest anteroposterior (AP) diameter and at least 50 mm but less than 60 mm. The purpose of this study was to determine the proper compression depth in patients with amyotrophic lateral sclerosis (ALS). Methods: A retrospective analysis of the chest computed tomography scans obtained between January 2014 and December 2018 was performed, and the chest anatomical parameters, such as external, internal chest, and heart AP diameters, were measured. The primary outcomes were a 1/4 and 1/5 depth of an external chest AP diameter. Based on the values of these parameters, the heart compression fractures (HCF) and over compression depth (OCD) from 40 to 60 mm depths with every 5 mm interval were calculated. All outcomes in the two groups were compared. Results: Ninety three of 108 ALS and 93 of 17,150 healthy individuals were selected randomly from a database and analyzed. The mean±standard deviations of 1/4 and 1/5 depth of the external chest AP diameter in ALS were significantly lower than in healthy individuals (48.57±4.60 mm vs. 53.43±4.93 mm, 38.86±3.68 mm vs. 42.75±3.94 mm, respectively, all P<0.001). The HCF values were similar in the two groups. The number of OCD with 55 and 60 mm in the ALS group were increased (all P<0.05, univariate analysis) Conclusion An approximately 50 mm depth of chest compression could be appropriate, but an excessive depth greater than 55 mm is more likely to cause complications for ALS patients.

Purpose: It is known that the most common cause of gas poisoning in Korea is suicide attempts by burning ignition coals. Ignition coals are made from waste wood, and studies have been reported that heavy metals are emitted when this coal is burned. However, there was no study on how much heavy metal poisoning occurs in the human body through this, so this study was planned to find out whether the concentration of heavy metals in the blood increased in patients exposed to ignition coal combustion. Methods: From April 2020 to April 2021, blood lead, mercury, and cadmium concentrations were investigated in carbon monoxide poisoning patients who visited one regional emergency medical center in Seoul, and their association with exposure time, source of poisoning, and rhabdomyolysis were investigated. Results: During the study period, a total of 136 carbon monoxide poisoning patients were tested for heavy metals, and 81 cases of poisoning by ignition coal were reported. When comparing poisoning caused by combustion of ignition coal and other substances, there was no difference in the concentrations of lead, mercury, and cadmium in the blood, and there was no difference in the number of patients above the reference range. However, the patients exposed to more than 5 hours of ignition coal gas exposure are more frequent than those in the group less than 5 hours in lead (51.4% vs. 23.9%, p=0.012). Conclusion Compared to poisoning with other combustible substances, the blood concentration of lead, mercury, and cadmium does not increase further in patients with gas poisoning by ignition coal. However, prolonged exposure may result in elevated levels of lead.

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Background: Aortic dissection (AD) is one of the most catastrophic diseases and is associated with high morbidity and mortality. The aim of this study is to investigate the hospital incidence and mortality rates of thoracic AD in Korea using a nationwide database. Methods: We conducted a nationwide population-based study using the health claims data of the National Health Insurance Service in Korea. From 2005 to 2016, adult patients newly diagnosed with AD were included. All patients were divided into the following four subgroups by treatment: type A surgical repair (TASR), type B surgical repair (TBSR), thoracic endovascular aortic repair (TEVAR), and medical management (MM). The incidence rate, mortality rate, and risk factors of in-hospital mortality were evaluated. Results: In total, 18,565 patients were newly diagnosed with AD (TASR, n = 4,319 [23.3%];TBSR, n = 186 [1.0%]; TEVAR, n = 697 [3.8%]; MM, n = 13,363 [72.0%]). The overall AD incidence rate was 3.76 per 100,000 person-years and exhibited a gradual increase during the study period (3.29 to 4.82, P < 0.001). The overall in-hospital mortality rate was 10.84% and remained consistent (P = 0.57). However, the in-hospital mortality rate decreased in the TASR subgroup (18.23 to 11.27%, P = 0.046). An older age, the female sex, hypertension, and chronic kidney disease were independent risk factors for in-hospital mortality. Conclusion The incidence of thoracic AD has gradually increased in Korea. The in-hospital mortality in the TASR subgroup decreased over the decade, although the overall mortality of AD patients did not change.

Objective: With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods: This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results: A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.

Objective: With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods: This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results: A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.