PURPOSE: Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety. MATERIALS AND METHODS: This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital-wide high risk patient care improvement program. RESULTS: The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain. CONCLUSION: A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated.
Academic Medical Centers ; Cardiopulmonary Resuscitation ; Cohort Studies ; Death, Sudden, Cardiac ; Delivery of Health Care* ; Health Personnel* ; Humans ; Methods ; Patient Care* ; Patient Safety ; Prospective Studies ; Quality Improvement ; Questionnaires ; Resuscitation

PURPOSE: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. METHODS: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. RESULTS: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the pre- and post-score difference between the training and control groups was not statistically significant. CONCLUSION: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the ED.
Cooperative Behavior ; Delivery of Health Care ; Emergencies ; Humans ; Medical Staff ; Patient Care ; Patient Satisfaction ; Quality Improvement ; Role Playing

PURPOSE: The purpose of this study was to identify the changes in the characteristics of patients with carbon monoxide (CO) poisoning, as well as the distinctive differences in intentionally exposed patients. METHODS: The medical records of CO poisoning patients, who visited nine emergency departments between January 2010 and December 2011, were reviewed retrospectively. The clinical information including age, gender, hospitalization, type of discharge, cause and location of exposure, site of onset, concentration of initial blood carboxyhemoglobin (COHb), methods of treatment and presence of neurological complications was examined. The subjects were divided into an intentional and non-intentional group and the differences between them was compared. RESULTS: A total 209 subjects were recruited. The median age was 38 years (29~49.5 years). They frequently complained of nausea and vomiting, and the most common exposures occurred in winter, normally in the home. The cause of exposure was usually fire, followed by incomplete combustion of fuels. The median initial blood COHb was 13.15%. The proportion of intentionally exposed patients was 21%. They were significantly younger, more frequently discharged against medical advice, and showed a higher initial blood COHb level (22.85%) than the non-intentional group. CONCLUSION: This study suggests that those with intentional CO poisoning are normally discharged against medical advice even when they have a higher initial COHb level. An adequate explanation of the delayed neurologic sequelae and short term follow-up observation is recommended for those patients with intentional exposure.
Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Emergencies ; Fires ; Follow-Up Studies ; Hospitalization ; Humans ; Intention ; Medical Records ; Nausea ; Retrospective Studies ; Suicide ; Vomiting

Radiation-induced osteosarcoma is a very rare complication of radiation therapy, with a poor prognosis. We experienced a case of radiation-induced osteosarcoma of the sternum, in a patient who had had breast cancer treated with surgery, adjuvant chemotherapy, and adjuvant radiation therapy 6 years earlier. A 53-year-old woman complained of a painful anterior chest wall mass. The mass was diagnosed as osteosarcoma on biopsy. The radiation-induced osteosarcoma had an aggressive nature.
Biopsy ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Female ; Humans ; Middle Aged ; Osteosarcoma ; Prognosis ; Sternum ; Thoracic Wall

PURPOSE: This study was designed to evaluate the educational effects of cardiopulmonary resuscitation (CPR) instruction to elementary school children and the perspectives of students and teachers about such instruction. METHODS: A total of 34,232 5th and 6th grade students from 998 elementary schools were instructed using a two-hour CPR lesson from each school teacher using CPR Anytime(R). The school teachers also were instructed by the same lesson from BLS instructors. Survey questionnaires were distributed to students involved. CPR skills were tested using a checklist during the class. We calculated the multiply effect that how many people were instructed CPR secondarily by student after the lesson and analyzed results by grade and gender. RESULTS: Most students (82%) said that CPR was easy to learn; 81% indicated a willingness to do CPR on a stranger. CPR skills were tested in 11,529 students (34%), and 10,269 (89%) passed. Assessment of respiration was the most commonly omitted procedure. The multiply effect was 1.54, and was higher in the 5th grade and among girls. CONCLUSION: This study suggests that the CPR instruction to 5th or 6th grade students in an elementary school setting is feasible and effective. Although the quality of instruction may be low, the children performed CPR on their family and friends.
Cardiopulmonary Resuscitation ; Checklist ; Child ; Friends ; Health Education ; Heart Arrest ; Humans ; Manikins ; Surveys and Questionnaires ; Respiration

PURPOSE: CPR Anytime(R), a self-instructional video program, has gained popularity amongst CPR instructors for training non-healthcare providers. This instructional kit enables second-tier instruction. The purpose of this study is to determine the status of second-tier instruction CPR by CPR Anytime(R) trainees. METHODS: Questionnaires were sent to 606 CPR Anytime(R) trainees from 12 BLS training sites. The training period was from October 2006 to July 2007. Questionnaires included provider's basic information, post-course self exercise, amount of second-tier instruction, and multiplier status. RESULTS: The response rate of the questionnaire was 53.6%(325). The mean age was 20.4+/-10.3 years old. The professions of respondents were as follows: students (76.3%), office workers(13.2%), teachers(4.4%), and service providers(1.9%). The post-course self exercise rate was 49% with three fourths of those completing the exercises using both the DVD and MiniAnne(R). Second-tier instruction tools use rates(48%) were as follows: DVD and manikin(35%), manikin only(9%), verbal only(2%), and DVD only(1%). The total multiplier effect was 1.77(575/ 325) with the multiplier effect of teachers significantly higher than others. CONCLUSION: This study found that 48% of CPR Anytime(R) providers perform second-tier instruction to family and friends. Amongst them, the total multiplier effect was 1.77 (575/325).
Cardiopulmonary Resuscitation ; Surveys and Questionnaires ; Exercise ; Friends ; Humans ; Manikins

OBJECTIVES: The purpose of this study was to evaluate the efficacy and tolerability of osmotic release oral systemmethylphenidate (OROS-MPH) in children with attention-deficit hyperactivity disorder (ADHD) and comorbid psychiatric disorders. METHODS: This was an 8-week open label study of OROS-MPH monotherapy. The subjects were 113 children with ADHD aged 6-12 years. Outcome measures were the Korean version of the parent ADHD Rating Scale (K-ARS), Korean version of the Conners Parent Rating Scale (K-CPRS), Clinical Global Impression-Severity and Clinical Global Impression-Improvement. Side effects were monitored using Barkley's Side Effect Rating Scale. We compared the change-over-time in the mean scores of the outcome measure according to the comorbidity of disruptive behavior disorder, depressive disorder, anxiety disorder, and tic disorder. RESULTS: The mean K-ARS and K-CPRS scores were significantly decreased, regardless of the comorbidity. The mean doses of OROS-MPH and dropout rate did not differ significantly according to comorbidity. The OROS-MPH was well tolerated, regardless of the comorbidity. However, children with tic disorder reported a higher frequency of tics or nervous movements between the 2nd and 8th week than those without tic disorder. CONCLUSION: The OROS-MPH is effective for decreasing the symptoms of ADHD, and it is well tolerated, even by patients with comorbid psychiatric disorders.
Aged ; Anxiety Disorders ; Attention Deficit and Disruptive Behavior Disorders ; Child ; Comorbidity ; Depressive Disorder ; Humans ; Outcome Assessment (Health Care) ; Parents ; Patient Dropouts ; Tic Disorders ; Tics

Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide's exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.
Adult ; Air Bags ; Automobiles ; Coma ; Crystallins ; Eating ; Emergencies ; Exanthema ; Eye ; Female ; Headache ; Heart Arrest ; Humans ; Indicators and Reagents ; Pharyngitis ; Pruritus ; Resuscitation ; Sodium ; Sodium Azide

PURPOSE: Current resuscitation guideline recommends not using the automated external defibrillator (AED) in a running ambulance, because artifact arising from movement of the ambulance can interfere with rhythm analysis of AED and can simulate ventricular fibrillation (VF). This study was conducted to determine whether the AED can be operated correctly in a running ambulance. METHODS: Five AEDs were tested for their sensitivity, specificity, positive/negative predictive value, and accuracy. Each AED was connected to a manikin randomly simulating coarse and fine VF, asystole, and normal sinus rhythm, and each rhythm was analyzed 5 times by AEDs on the highway. Data about the shock recommendation given and delivery time interval from analysis to shock were collected. ECGs were also downloaded during the analysis time for a normal volunteer to search for baseline artifacts. RESULTS: All AEDs recommended shock delivery correctly for the simulated rhythms whether the ambulance was stopped (0 km/h) or running on unpaved road (20 km/h). The sensitivity, specificity, positive/negative predictive value, and accuracy of AEDs on the highway (100 km/h) were similar to those obtained in previous studies on AED performance in pre-hospital settings. The recorded ECG rhythm of a volunteer in a running car showed no baseline artifacts. CONCLUSION: All AEDs recommended shock delivery correctly in a running ambulance. Therefore, the current recommendation of not using the AED on a running ambulance should be reconsidered.
Ambulances ; Artifacts ; Defibrillators ; Electrocardiography ; Heart Arrest ; Manikins ; Resuscitation ; Running ; Sensitivity and Specificity ; Shock ; Transportation ; Ventricular Fibrillation

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for schizophrenia to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Schizophrenia patients in clinical settings in Korea. METHODS: A total of 108 schizophrenia and schizophreniform disorder patients were enrolled at 19 centers and treated according to the algorithm. PANSS (Positive and Negative Symptom Scale) and CGI (Clinical Global Impression) were used to evaluate symptom severity. Also UKU (UKU side effect rating scale) and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale), DAI-10 (Drug Attitude Inventory-10), PPS (Patient Preference Scale), SWN (Subjective Well-Being under Neuroleptic treatment) and WHOQOL (World Health Organization Quality of Life) were used to evaluate tolerability and satisfaction of patient respectively. RESULTS: Overall ratings including symptom severity, compliance of medication, side effect of medication, quality of life were favorable. The treatment response (PANSS improvement > or = 20%) rate was 63%, 75% at the first Clinical decision point (CDP) and 4 month respectively. CONCLUSION: Symptom improvement, tolerability and quality of life were all favorable. These results suggest that this algorithm can be useful in clinical practices.
Compliance ; Humans ; Korea ; Psychotic Disorders ; Quality of Life ; Schizophrenia ; World Health Organization