Objective: This study was conducted to identify the needs assessment for education and training of emergency medicine (EM) residents. Methods: The results of a national survey of EM residents of the Korean Society of Emergency Medicine in 2019 were used. Education was one of the five categories in the survey. The preferred learning methods and their perceived importance and ability to perform in nine competencies were assessed. The Borich’s needs assessment model was used to analyze their needs. Results: Among 591 EM residents, 382 responded, and 371 responses were finally analyzed. Regarding the learning methods, junior residents preferred in-hospital conferences, staff lectures, internet resources, and textbooks. Overall, medical knowledge and procedural skills were the most important, and research was less important to recognize. Medical knowledge showed the highest rank in the needs assessment in all years, and ethics and professionalism showed the lowest ranks. The needs for procedural skills were higher in junior years but lower in senior years. Conclusion These results will form the basis for the design of training programs to meet the educational needs of EM residents for each grade. Furthermore, an analysis of the educational needs should be done periodically according to the changes and demands of the times.

Background: Few studies have investigated the association between Behçet disease (BD) and cardiovascular disease (CVD). The aim of this study was to investigate the risk of various CVDs in patients with BD. Objective: The aim of this study was to investigate the risk of various CVD in patients with BD. Methods: Between 2003 and 2015, we performed a retrospective cohort study involving patients with BD selected from Korea’s National Health Insurance Service-National Sample Cohort database and age- and sex-matched controls. Age- and sex-matched controls were selected randomly from the NHIS-NSC database at a frequency of 1:5. Results: Among the 998 patients with BD and the 4,990 controls studied, patients with BD showed significantly higher risk for angina pectoris (adjusted Hazard Ratio [HR] 1.522, 95% confidence interval [CI] 1.020∼2.273;p=0.04) and peripheral arterial disease (adjusted HR 2.939, 95% CI 1.296∼6.664; p=0.01) than the controls. The cumulative incidence rates of these diseases in patients with BD were also significantly higher than those in the controls. Conclusion Patients with BD showed independent risk for angina pectoris and peripheral arterial disease.

Three-dimensional (3D) printing technology, with additive manufacturing, can aid in the production of various kinds of patient-specific medical devices and implants in medical fields, which cannot be covered by mass production systems for producing conventional devices/implants. The simulator-based medical image demonstrates the anatomical structure of the disease, which can be used for education, diagnosis, preparation of treatment plan and preoperative surgical guide, etc. The surgical guide is used as a patient-specific medical device for guiding incision, resection, insertion, and marking. As 3D printers can output materials that can be inserted into the human body, the patient-specific implant device that reflects the patient's anatomy and surgical plan could be of relevance. In addition, patient-specific aids, including gibs, splints, prostheses, and epitheses, could be used for a better outcome. Finally, bio-printing is also used to cultivate cells to produce functional artificial tissues.

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/surgery/*therapy ; Death, Sudden, Cardiac/etiology ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Thrombosis/etiology

PURPOSE: To evaluate the follow-up result of 11 cases that were operated with internal fixation of scapular neck and internal fixation of clavicle or acromioclavicular dislocation for severely displaced floating shoulder which was high energy injury and unstable. MATERIALS AND METHODS: We examined the scapular neck fracture with clavicle fracture or acromioclavicular joint dislocation by multidisciplinary research from August 1997 to July 2004. The scapular neck fractures were operated in the case of translational displacement of more than 25 mm and angular displacement of more than 45 degrees with 3.5 mm reconstruction plate fixation and internal fixation for clavicle fracture or acromioclavicular joint perpormed simultaneously. And we evaluated 11 cases that can be followed up for more than 9 months. RESULTS: We achieved bony union in all cases. In ASES functional score, we got average 89.2 (75~95) points. In Rowe functional score, we got average 89.1 (75~100) points. In complication, there was external rotation weakness in 1 case. CONCLUSION: In severely displaced floating shoulder due to high energy injury, we got good clinical and functional result after internal fixation for scapular neck and clavicle or acromioclavicular joint.
Acromioclavicular Joint ; Clavicle ; Dislocations ; Follow-Up Studies ; Neck ; Shoulder*

BACKGROUND AND OBJECTIVES: Compliance to a prescribed antihypertensive regimen influences the management of hypertension in various steps, but studies on this issue are very rare in Korea. The medication event monitoring system (MEMS) is the gold standard in measurement of compliance, which is a special pill container, designed to electronically monitor drug intake patterns. Here, the authors investigated the compliance to the antihypertensive regimen in the cardiology practice of a tertiary care hospital using the MEMS. SUBJECTS AND METHODS: Monitoring using the MEMS was performed in 80 hypertensive patients during monotherapy. Demographic, clinical and psychological profiles were collected through a standardized questionnaire. The parameters used for compliance were the percentage of doses taken (PDT) and the percentage of doses taken correctly (PDTc), according to the prescribed regimen. RESULTS: The mean age of the patients and duration of monitoring were 53+/-10 years and 60+/-26 days, respectively. The median and range for the PDT and PDTc were 97% (88-100%) and 92% (80-97%), respectively. About 16% of patients showed relatively poor compliance (PDT<80%). Predicting factors for poor compliance were a recent history of self-discontinuation of drug treatment, not currently being on medication and a young age (p<0.05). Agreement between intuitive prediction by the physician and the actual compliance was closer to what would be expected by chance (kappa coefficient=-0.11). CONCLUSION: Although average compliance to the single drug antihypertensive regimen was relatively high in the cardiology practice of the tertiary care hospital in this study, a significant proportion of patients show low compliance. Special consideration should be given to patients with factors predictive of poor compliance. Investigation of compliances in other clinical settings is also warranted.
Cardiology ; Compliance* ; Drug Therapy ; Humans ; Hypertension ; Korea ; Micro-Electrical-Mechanical Systems ; Patient Compliance ; Tertiary Healthcare ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Recent advances in trans-radial coronary intervention (TRI) have shown a reduction in patient's morbidity. However, the role of TRI for a chronic total occlusion (CTO) is not well established. The aim of this study was to assess the safety and feasibility of TRI for a CTO. SUBJECTS AND METHODS: Sixty-three successive CTO lesions of more than 2 months duration were prospectively included in this registry between April 2002 and November 2003. Guiding catheters with strong back-up, stiff guide wires and supportive infusion catheters were actively used. The angiographic and procedural characteristics were prospectively evaluated. RESULTS: There were 45 male and 18 female patients, with a mean age of 59.8+/-9.5 years. The most common clinical diagnosis was stable angina (95.2%). The mean duration of the occlusions was 10.3+/-1.6 months. Procedural success was achieved in 53 lesions (84.1%). No cases were crossed over to transfemoral procedure. The most common cause of procedural failure was guide wire passage failure (7 lesions). The mean duration of occlusions was significantly longer in the failure group (7.5+/-1.1 versus 24.8+/-6.5 months, p<0.001). Bridging collateral vessels, long occlusions, calcification at lesion sites, a side branch at the occlusion site and blunt entry morphology were also statistically significant predictors for procedural failure. Procedure-related complications were noted in 6 patients (9.8%), which included coronary perforations (3.3%), severe dissections (3.3%), arrhythmia (1.6%) and branch artery occlusion (1.6%). No patients suffered from local complications, such as hematoma or radial artery occlusion. CONCLUSION: TRI for a CTO seems to be safe and feasible, with acceptable success and complication rates.
Angina, Stable ; Angioplasty ; Arrhythmias, Cardiac ; Arteries ; Catheters ; Coronary Disease ; Diagnosis ; Female ; Hematoma ; Humans ; Male ; Prospective Studies ; Radial Artery

BACKGROUND: Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly-developed collagen-based arterial closure device, angioseal(R) after transfemoral percuatenous coronary intervention. METHODS: This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; angioseal(R) group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after the procedure by telephone. RESULTS: The baseline clinical characteristics, clinical diagnosis, cardiovascular risk factors, types of procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3 0.3 hours, group B: 13.7 0.8 hours, p=0.004) and the time to ambulation (group A: 6.8 0.5 hours, group B: 18.8 2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A: 12%, group B: 3%, p=0.001) The duration of hospital stay was similar between two groups. During 7 days of follow-up period, the incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. CONCLUSION: The angioseal(R) may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.
Angioplasty, Balloon, Coronary ; Anticoagulants ; Blood Pressure ; Diagnosis ; Ecchymosis ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Incidence ; Length of Stay ; Percutaneous Coronary Intervention* ; Prospective Studies ; Punctures ; Risk Factors ; Telephone ; Walking

BACKGROUND: Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention (TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation. The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admission program for PCI. METHODS: Total 230 consecutive patients underwent TRI on the day of admission, according to pre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical and angiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day and seven days after discharge to assess late complications and the patients' satisfaction. RESULTS: The mean age of the subjects was 59+/-9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) had unstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients (89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The average hospital stay for them was 9.4+/-1.4 hours. Two subjects reported hematoma near the puncture site within 24 hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there were no cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. No deaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority of the patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. CONCLUSIONS: Same day admission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Chest Pain ; Coronary Disease ; Follow-Up Studies ; Hematoma ; Humans ; Length of Stay ; Male ; Myocardial Infarction ; Patient Satisfaction ; Percutaneous Coronary Intervention ; Punctures ; Radial Artery ; Stents ; Walking

BACKGROUND: In this study, we performed one-lung ventilation (OLV) in rabbits to assess the effects of OLV on the VA/Q ratio and the respiratory physiological changes using MIGET. METHODS: Ten male New Zealand white rabbits, weighing 3-4 kg were selected. To perform MIGET, six inactive gases (SF6, krypton, desflurane, enflurane, diethyl ether, acetone) in 500 ml normal saline were injected intravenously. During two-lung ventilation (TLV), and after OLV for 30 minutes, blood was sampled for blood gas analysis and MIGET, hemodynamic variables were measured. For MIGET, the concentrations of the injected inert gases were measured and converted to retention/excretion data; the VA/Q distribution curve was obtained using a computer. RESULTS: Systolic, mean, and diastolic pulmonary pressures were elevated significantly and pulmonary resistance was doubled (P<0.05) in OLV compared to TLV. Blood pH decreased in OLV. The calculated intrapulmonary shunt was 19% and 52%, TLV and OLV, respectively. The analysis of VA/Q using MIGET showed that the VA/Q distribution curve was wider and that the VA/Q area was larger in normal rabbits. And, that intrapulmonary shunt approximated to 11%. In the case of OLV, a significant increase in shunt was observed but no change in the amount of dead space at distribution area, (log SDQ, log SDV) remained the same, whereas the VA/Q distribution curve shifted toward the right. CONCLUSIONS: OLV in rabbits showed severe hypercapnia and hypoxemia leading to a considerable increase in shunt. Because of the wide range of VA/Q distribution in TLV, no significant changes in respiratory variables were observed during OLV.
Anoxia ; Blood Gas Analysis ; Enflurane ; Ether ; Gases ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypercapnia ; Krypton ; Lung* ; Male ; Noble Gases ; One-Lung Ventilation ; Rabbits ; Ventilation ; Ventilation-Perfusion Ratio*