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Shin Young-Heun,Taerim Ko,John Hee Park,장원배 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.2
To overcome the shortage of donor grafts in kidney transplantation (KT), the use of marginal grafts has evolved. However, prolonged cold ischemic time (CIT) is especially critical when using marginal grafts. Recently, hypothermic machine perfusion (HMP) has been used to overcome the negative effects of prolonged CIT, and we report the first use of HMP in Korea. The donor was a 58-year-old man with severe hypoxia (PaO2 <60 mmHg, FiO2 100%) for 9 hours prior to procurement. The patient’s kidneys were the only organs accepted for transplantation, and both kidneys were assigned to Jeju National University Hospital. After procurement, the right kidney was preserved using HMP immediately, and the left kidney was directly transplanted into a patient with a CIT of 2 hours 31 minutes. The second operation was performed following the first, using the right kidney graft that had been preserved by HMP for 10 hours and 30 minutes. Although postoperative graft function gradually recovered in both patients, the serum creatinine level decreased faster in the HMP patient. Neither patient showed signs of delayed graft function, and both were discharged without significant complications. The short-term outcomes in this transplantation of mate kidney grafts demonstrated that graft function can be safely preserved using HMP, and that HMP is beneficial in overcoming the negative effects of prolonged CIT.
( Byungju Roh ),( Kwang Yul Jung ),( Taerim Kim ),( Hanzo Choi ),( Tae Gun Shin ),( Min Seob Sim ),( Ik Joon Jo ),( Won Chul Cha ) 대한응급의학회 2017 대한응급의학회지 Vol.28 No.5
Purpose: In this study, we aimed to measure the effects of emergency department (ED) expansion at a tertiary hospital on overall ED length of stay (LOS). Methods: This study was a before and after study using data from a tertiary medical center in Seoul, a large metropolis. We used electronic medical records and administrative databases obtained from the ED. The control period (before expansion) was defined as from January 1 to April 31, 2016. The study period (after expansion) was defined as from May 1 to August 31, 2016. The number of ED beds increased from 42 to 74 after the expansion. After adjusting individual characteristics and institutional characteristics, multivariate regression analysis was carried out to evaluate the effects of expansion on overall ED LOS. Results: A total of 45,632 patients visited the emergency medical center: 20,592 patients before and 25,040 after the expansion. Although the absolute number of patients increased, the portion of medical patients, portion of non-referral patients, and ambulatory patients decreased during the study period (all p<0.001). Average visit number increased from 170.2 (standard deviation [SD], 27.3) to 203.6 (SD, 21.3) (p<0.001). The overall ED LOS increased from 332.2 (SD, 473.4) to 391.0 minutes (SD, 649.5). After adjusting for potential confounders, we found that ED expansion was associated with an increase in ED LOS by 75.8 minutes (95% confidence interval, 63.5 to 88.2). Conclusion: We found that the ED expansion was associated with a significant increase in ED LOS.
Purpose, Procedure, and Contents of Counseling according to Tinnitus Interventions
Soon-Je Choi,Minseung Ku,TaeRim Lee,YeonWoo Sim,Jeeun Yoo,Nor Farawaheeda Ab Shukor,Yerim Shin,In-Ki Jin 한국청각언어재활학회 2021 Audiology and Speech Research Vol.17 No.2
Tinnitus refers to the perception of ringing sounds in the ear that are not heard by others. Counseling plays a vital role in tinnitus intervention. Counseling provides correct information about tinnitus and hearing loss, corrects any misunderstandings related to tinnitus, and suggests precise alternative interventions for tinnitus. In this review, we aimed to examine the counseling contents in Tinnitus Retraining Therapy (TRT), Cognitive Behavioral Therapy (CBT), and Tinnitus Activities Treatment (TAT) to identify information that could be useful for counseling approaches and contents for the various tinnitus intervention methods. We searched Web of Science, Embase, Science Direct, and PubMed for relevant articles. Of the 5,283 articles, 31 were included in the final review of counseling contents for TRT, CBT, and TAT. Based on our findings, we were able to summarize the main contents of counseling in TRT, CBT, and TAT. Although the contents of counseling may vary depending on the individuals with tinnitus, our review provided information that may help audiologists or hearing professionals further understand the fundamentals of counseling for each tinnitus intervention. Our review may serve as a guideline for tinnitus counseling according to tinnitus interventions.
( Minseok Song ),( Eun-jin Kang ),( Taerim Kim ),( Jong Eun Park ),( Gun Tak Lee ),( Hee Yoon ),( Sung Yeon Hwang ),( Won Chul Cha ),( Tae Gun Shin ),( Min Seob Sim ),( Ik Joon Jo ),( Jin-ho Choi ) 대한응급의학회 2021 대한응급의학회지 Vol.32 No.6
Objective: Elevated levels of cardiac troponin in chronic kidney disease (CKD) patients admitted to the emergency department (ED) is not well understood and is often ignored. This study aimed to investigate the impact of cardiac troponin I (TnI) levels on the clinical outcome of patients visiting the ED with or without CKD. Methods: In this retrospective single-center cohort study, we enrolled patients visiting the ED without a diagnosis of coronary artery disease (CAD). Elevated cardiac TnI was defined as being ≥99th percentile of the normal population (Siemens ADVIA Centaur TnI-Ultra≥0.040 ng/mL). The clinical outcomes of patients with CKD stage≤2 and CKD stage ≥3 were compared. The primary endpoint was the 180-day all-cause death, including cardiovascular and non-cardiovascular deaths. Results: Among a total of 30,472 patients (median age, 61 years; male sex, 54.3%), elevated TnI was found in 4,377 patients (14.4%). There were 3,634 deaths (11.9%) including 584 cardiovascular (1.9%) and 3,050 non-cardiovascular deaths (10.0%). The risk of all-cause death increased in patients with elevated TnI in both CKD stage≤2 (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.9-2.3) and CKD stage≥3 (HR, 1.5; 95% CI, 1.4-1.7), and so did the risks of cardiovascular and non-cardiovascular death (HR, 1.2-4.7) (P<0.05, all). The association of elevated TnI with death risk was consistent in multivariate analyses and in most clinical subgroup analyses. Conclusion: Elevated TnI was associated with higher 180-day mortality irrespective of renal function among patients visiting the ED without documented CAD. CKD patients visiting the ED with elevated TnI may warrant additional evaluation or careful follow-up even without the presence of CAD.
Yang Hyun Jun,Yoon Hee,Kang Soo Yeon,Lee Guntak,박종은,Kim Taerim,Lee Se Uk,Hwang Sung Yeon,Cha Won Chul,Shin Tae Gun,Jo Ik Joon 대한의학회 2021 Journal of Korean medical science Vol.36 No.28
Background: Ear-loop-type Korean Filter 94 masks (KF94 masks, equivalent to the N95 and FFP2) are broadly used in health care settings in Korea for the coronavirus disease 2019 pandemic. Methods: A prospective randomized open-label study was designed to identify differences in the fitting performance between mask wearing methods in three different types of KF94 mask with ear loops between January to March 2021. General-fitting involved wearing an earloop-type KF94 mask, and tight-fitting involved wearing a mask aided by a clip connecting the ear loops. Each of the 30 participants wore three types of masks according to a randomly assigned order in both methods and performed a total of six quantitative fit tests (QNFTs) according to the occupational safety and health administration protocol. Results: All fit factors (FFs) measured by the QNFT were significantly higher for tight-fitting method with the clip in all KF94 masks (P < 0.001). However, the total FFs were very low, with a median (interquartile range) of 6 (3–23) and 29 (9–116) for general-fitting and tight-fitting, respectively. When wearing tightly, the horizontal 3-fold type mask with adjustable ear-loop length had the highest FF, with a median of 125, and the QNFT pass rate (FF ≥ 100) increased significantly from 4 (13%) to 18 (60%). Conclusion: Even with sufficient filter efficiency, ear-loop-type-KF94 masks do not provide adequate protection. However, in relatively low-risk environments, wearing a face-seal adjustable KF94 mask and tight wearing with a clip can improve respiratory protection for healthcare workers.
Yoo Jonghoon,Kang Soo Yeon,Jo Ik Joon,Kim Taerim,Lee Guntak,박종은,Hwang Sung Yeon,Cha Won Chul,Shin Tae Gun,Yoon Hee 대한의학회 2021 Journal of Korean medical science Vol.36 No.21
Background: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine (EM). We aimed to investigate the current status and perception of POCUS use in emergency medical centers in Korea. Methods: A cross-sectional, nationwide survey was conducted using a mobile survey of physicians at emergency medical centers in Korea. The first message was sent on November 27, 2020, and the second message was sent on December 3, 2020 to the non-responders. The questionnaire comprised 6 categories and 24 questionnaires on demographics, current practice, education, perception, and barriers to the use of POCUS. Results: A total of 467 physicians participated in the survey (a response rate of 32% among 1,458 target physicians), of which 43% were residents and 57% were EM specialists. Most of the respondents (96%) answered that they use POCUS, of which 89% reported using it at least once a week. The most frequently used types of POCUS were focused assessment with sonography for trauma (68%) and echocardiography (66%). Musculoskeletal, male genital, and pediatric scans were rarely performed tests but ranked as of the scans physicians most wanted to learn. About 73% of the respondents received ultrasound education, and 41% received ultrasound education at their own institutions. Nevertheless, educationrelated barriers are still the biggest deterrent to POCUS use (60%). In addition, multivariate multinomial logistic regression analysis revealed that the greater the number of ultrasound devices and the total number of physicians in the emergency center, the more likely they were to use POCUS every day. Conclusion: This study found that most physicians currently working in emergency medical centers in Korea more frequently perform various types of ultrasound scans compared to those 10 years prior. To further promote the use of POCUS, it is important to have an appropriate number of ultrasound devices and physicians in the emergency center along with systematic POCUS education.