Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

Background: Characteristics of coronary vasospasm-related sudden cardiac death are not well understood. We aimed to compare the characteristics and clinical outcomes between coronary vasospasm and stenosis, in out-of-hospital cardiac arrest (OHCA) survivors, who underwent coronary angiogram (CAG). Methods: We conducted a multicenter retrospective observational registry-based study at 8 Korean tertiary care centers. Data of OHCA survivors undergoing CAG between 2010 and 2015 were extracted. Patients were divided into vasospasm and stenosis (stenosis > 50%) groups based on CAG findings. The primary and the secondary outcomes were survival and a good neurologic outcome at 30 days after OHCA. Patients in the vasospasm and stenosis groups were propensity score matched. Results: Of the 413 included patients, vasospasm and stenosis groups comprised 87 and 326 patients, respectively. There were 279 (66.7%) survivors and 206 (49.3%) patients with good neurologic outcomes. The vasospasm group had better clinical characteristics for outcome (younger age, less diabetes and hypertension, more prehospital restoration of spontaneous circulation, higher Glasgow Coma Scale, less ST segment elevation, and less requirement of circulatory support). The vasospasm group had better survival (75/87 vs. 204/326, P < 0.001) and good neurologic outcomes (62/87 vs. 144/326, P < 0.001). However, vasospasm was not independently associated with survival (odds ratio [OR], 0.980; 95% confidence interval [CI], 0.400–2.406) or neurologic outcomes (OR, 0.870; 95% CI, 0.359–2.108) after adjustment and vasospasm was not associated with survival and neurologic outcome in propensity score-matched cohorts. Conclusion Our analysis of propensity score-matched cohorts finds that vasospasm OHCA survivors have survival and neurologic outcomes comparable with those of stenotic OHCA survivors.

BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.95), mortality (HR, 0.41; 95% CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.
Angiotensins ; Cohort Studies ; Heart Failure ; Heart ; Humans ; Mortality ; Receptors, Mineralocorticoid

BACKGROUND: Most studies on the incidence rate (IR) and post-exposure reporting rate (RR) of needle-stick injuries (NSIs) were performed using retrospective surveillance, which is vulnerable to recall bias. This study aimed to identify the agreement between IRs and RRs obtained from prospective and retrospective surveillance. METHODS: The prospective surveillance was performed with 716 nurses working at 3 hospitals from August to September in 2012. They prospectively reported when they experienced the NSIs, and the investigator retrospectively calculated the RR from records in the infection control unit or health care unit during the same periods when they reported the number of NSIs. The retrospective surveillance was carried out with 312 nurses who participated in the prospective surveillance. They retrospectively answered the question on the number of NSIs and post-exposure reporting after recalling the experienced NSI from August to September in 2012. RESULTS: The IR of NSIs was 9.8 per 100 nurses by the prospective surveillance and 36.4 per 100 nurses by the retrospective surveillance, which was statistically significantly different (P<0.001). The RR of NSIs was 14.3% by the prospective surveillance and 8.5% by the retrospective surveillance, which was not statistically significantly different. CONCLUSION: We recommend using a prospective approach for calculating the IR of NSIs to reduce the risk of recall bias. However, the RR of NSIs can be calculated using both prospective and retrospective approaches.
Bias (Epidemiology) ; Delivery of Health Care ; Humans ; Incidence* ; Infection Control ; Memory ; Needlestick Injuries* ; Prospective Studies* ; Research Personnel ; Retrospective Studies*

PURPOSE: The purpose of this study was to investigate the influence of communication competence and burnout on nursing performance in intensive care units (ICU). METHOD: The participants were 209 nurses from four university hospitals. Measurements included a socio-demographic and job related survey, communication competence inventory, the Maslach burnout inventory and a nursing performance scale. Data were collected from February 6 to 24, 2012, with a self-report questionnaire. The statistical analyses were performed with SPSS 18.0 software. RESULTS: The mean scores for communication competence, burnout and nursing performance were 50.49, 84.72, and 62.18, respectively. Communication competence (r=.44, p<.001) and burn out (r=-.32, p<.001) were significantly correlated with nursing performance. In the multiple linear regression, factors influencing nursing performance were communication competence, age and burnout. These variables explained about 46% of the total variance of nursing performance. Communication competence (beta=.34, p%.001) was the most influential factor. CONCLUSION: Nurses' poor communication skills and burnout can influence the occurrences of medical errors in ICU nursing performance. The results suggest that good communication and burnout resolution skills programs should be implemented to improve nursing performance efficiency.
Burns ; Hospitals, University ; Critical Care ; Intensive Care Units ; Linear Models ; Medical Errors ; Mental Competency ; Surveys and Questionnaires

Selective intestinal decontamination (SID) with norfloxacin has been widely used for the prophylaxis of spontaneous bacterial peritonitis (SBP) because of a high recurrence rate and preventive effect of SID for SBP. However, it does select resistant gut flora and may lead to SBP caused by unusual pathogens such as quinolone-resistant gram-negative bacilli or gram-positive cocci. Enterococcus hirae is known to cause infections mainly in animals, but is rarely encountered in humans. We report the first case of SBP by E. hirae in a cirrhotic patient who have previously received an oral administration of norfloxacin against SBP caused by Klebsiella pneumoniae and presented in septic shock.
Administration, Oral ; Ampicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/microbiology ; Enterococcus/*isolation & purification ; Gram-Positive Bacterial Infections/complications/drug therapy/*microbiology ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Peritonitis/*diagnosis/drug therapy/microbiology ; Sepsis/*etiology

Acute respiratory failure from mycoplasma pneumonia is uncommon, because community-acquired pneumonia from mycoplasma pneumonia is typically not severe in patients without underlying disease. In addition, alveolar hemorrhage is a rare manifestation in these cases. We describe a case of acute respiratory failure that required mechanical ventilation due to diffuse alveolar hemorrhage in an immunocompetent patient with mycoplasma pneumonia.
Hemorrhage ; Humans ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Insufficiency

A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.
Arrhythmias, Cardiac ; Breath Holding ; Carcinoma, Non-Small-Cell Lung ; Central Nervous System ; Chlorpromazine ; Contracts ; Deglutition ; Dehydration ; Diaphragm ; Glottis ; Hiccup ; Humans ; Intercostal Muscles ; Lung Neoplasms ; Malnutrition ; Phrenic Nerve ; Reflex ; Sleep Initiation and Maintenance Disorders ; Water

PURPOSE: To compare the MR findings of a sequestered disc with an extruded disc. MATERIALS AND METHODS: MR images of 28 patients with a sequestered disc and 18 patients with an extruded disc were retrospectively reviewed. Patients with sequestered discs were divided into two groups whether definite separation from the parent disc was or was not seen. In the latter group (definite separation not seen) and the extruded disc group of patients, the signal intensities of the herniated discs were compared with the signal intensities of the parent discs and were evaluated on T1- and T2-weighted images. We also assessed the presence of a notch within the herniated disc. RESULTS: In the sequestered disc group of patients (28 discs), only 5 discs (18%) showed obvious separation from the parent disc. Among the remaining 23 discs with indefinite separation, the notch was visible in 14 discs (61%) and 9 discs (39%) had no notch. In the extruded disc group (18 discs), the notch was visible in 2 (11%) discs and the difference between the two groups was statistically significant (p = 0.0002). The signal intensities of the herniated discs on T1-weighted images were isointense in both the sequestered and extruded discs. The difference of incidence of high signal intensities on T2-weighted images was not statistically significant (p = 0.125). CONCLUSION: It is necessary to consider the possibility of the presence of a sequestered disc when a herniated disc material shows a notch.
Humans ; Incidence ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging* ; Parents ; Retrospective Studies ; Spine*

This study was aimed to elucidate the effects of K(ATP) activation during IPC on the PKC-epsilon, NF-kappaB and AP-1 in ischemia-reperfused rat hearts. SD male rats weighting from 300 to 350 g were split into 9 groups, such as sham control (S), IPC, 3 cycles of 5 min ischemia and 5 min reperfusion, continuous preconditioning (CP), 8 cycles of 5 min ischemia and 5 min reperfusion, K(ATP) opening (KO) with pinacidil (1.0 mg/kg), K(ATP) blocking with glibenclamide (1.0 mg/kg) injection, ischemia (IS), 30 min ischemia, IPC followed by IS, 8) K(ATP) blocking and IPC followed by IS (KB+IPC+IS), IS and K(ATP) opening (KO+IS). Heart were subjected to ligation of left descending coronary artery and reperfusion in groups of IPC, CP, IS with or without IPC. Immunohistochemistry and Western blotting for PKC-epsilon, NF-kappaB and AP-1 were performed at 3, 6, 24 hours after reperfusion or treatment. Immunoreactivities against PKC-epsilon antibody were observed stronger in the groups of IPC, KO, IPC+IS and KO+IS than groups of KB, IS and KB+IPC+IS. NF-kappaB activation and translocation were only observed in the groups of including 30 min ischemia and reperfusion. AP-1 activation and translocation were opposite to the results of PKC-epsilon activation. In the group of CP, KB, IS and KB+IPC+IS, reactivities of AP-1 antibody were stronger than IPC+IS, KO+IS, and weaker in the groups of S, IPC and KO. These results suggest that K(ATP) opening with IPC or pharmacological methods may direct effect on the PKC-epsilon activation and that K(ATP) blocking has effect on the AP-1 activation and translocation in the heart of ischemiareperfused of rats.
Animals ; Blotting, Western ; Coronary Vessels ; Glyburide ; Heart* ; Humans ; Immunohistochemistry ; Ischemia ; Ischemic Preconditioning* ; Ligation ; Male ; NF-kappa B* ; Pinacidil ; Rats* ; Reperfusion ; Transcription Factor AP-1*