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Sakong D, Choe MSP, Nho WY, Park CW. Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department. Clin Exp Emerg Med 2023; 10:84-91. [PMID: 37016736 PMCID: PMC10090734 DOI: 10.15441/ceem.22.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/16/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Acute gallbladder disease (AGD) is frequent in the emergency department (ED) and usually requires emergency surgery. However, only a few studies have reported the impact of COVID-19 on AGD. The goal of this study was to evaluate the time between symptom onset and surgery and the perioperative severity of AGD during the COVID-19 pandemic compared to before the era of COVID-19. METHODS This retrospective, single-center cohort study included patients who presented to the ED with suspected AGD and who underwent emergency cholecystectomy. We designed a before-after comparative study, and the intervention was the COVID-19 outbreak. The 6-month period after the COVID-19 outbreak was defined as the post-COVID group, whereas the pre-COVID group consisted of the same period in the previous year. The primary outcome was the time from symptoms to surgery. We evaluated the time intervals between symptom onset and ED arrival and between ED arrival and surgery. The secondary outcomes were preoperative and postoperative severity indexes. RESULTS A total of 316 patients was analyzed. The post-COVID group showed longer duration from symptom onset to ED arrival (34.0 hours vs. 15.0 hours, P<0.001) and longer time interval from ED arrival to surgery (16.2 hours vs. 10.2 hours, P<0.001) than the pre-COVID group. The overall time interval between symptom onset to surgery was longer in the post-COVID group than the pre-COVID group (71.5 hours vs. 33.5 hours, P<0.001). The post-COVID group showed higher preoperative Simplified Acute Physiology Score II scores than the pre-COVID group (20.1 vs. 18.2, P=0.045). The proportion of moderate or severe disease increased in the post-COVID group (78% vs. 65%, P=0.017). The durations of hospital stay (7.0 days vs. 5.0 days, P<0.001) and intensive care unit stay (27.1 hours vs. 10.8 hours, P=0.008) were longer in the post-COVID group than in the pre-COVID group. CONCLUSION During the pandemic, the time interval between symptom onset to surgery was significantly increased among patients with AGD. Concomitantly, higher preoperative severity indexes and longer hospital stay were reported with a delay in emergency surgery.
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Choe MSP, Lee MJ, Seo KS, Kam S, Kim KY, Je D, Kim SH, Nho WY, Park HI, Shin S, Ryoo HW. Application of calcium nebulization for mass exposure to an accidental hydrofluoric acid spill. Burns 2020; 46:1337-1346. [PMID: 32209280 DOI: 10.1016/j.burns.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF. METHODS This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals. RESULTS Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium-lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1-3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure. CONCLUSION Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.
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Affiliation(s)
- Michael Sung Pil Choe
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Kang Suk Seo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Sin Kam
- Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Keon Yeop Kim
- Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Dongwook Je
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Seong Hun Kim
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Woo Young Nho
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Hong In Park
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Sujeong Shin
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Lee MJ, Choe MSP, Park SJ, Seo HI. Public awareness and Internet search patterns on automated external defibrillator using web-search traffics and nationwide surveys. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kim SJ, Chung SP, Gil HW, Choi SC, Kim H, Kang C, Kim HJ, Park JS, Lee KW, Cho J, Yoon JC, Cho S, Choe MSP, Hwang TS, Hong DY, Lim H, Kim YW, Kim SW, Kang H, Kim WJ. The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea. J Korean Med Sci 2016; 31:1037-41. [PMID: 27365999 PMCID: PMC4900993 DOI: 10.3346/jkms.2016.31.7.1037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022] Open
Abstract
The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.
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Affiliation(s)
- Su Jin Kim
- Department of Emergency Medicine, Korea University Medical Center, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang-Cheon Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun Jin Kim
- Department of Emergency Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung Woo Lee
- Department of Emergency Medicine, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Chol Yoon
- Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Soohyung Cho
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | | | - Tae Sik Hwang
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Young Hong
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hoon Lim
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Yang-Weon Kim
- Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea
| | - Seung Whan Kim
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Woo Jeong Kim
- Department of Emergency Medicine, Jeju National University, Jeju, Korea
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Bae SG, Kam S, Park KS, Kim KY, Hong NS, Kim KS, Lee YM, Lee WK, Choe MSP. Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community. Patient Prefer Adherence 2016; 10:1979-1989. [PMID: 27729776 PMCID: PMC5047725 DOI: 10.2147/ppa.s114529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE We assessed medication nonadherence, categorized as intentional or unintentional, and related factors in elderly patients with hypertension, correlating the data with measurement of blood pressure as the final target of medication adherence and other possible influencing factors, such as lifestyle. PATIENTS AND METHODS Subjects were aged ≥65 years, resided in a rural area, and were taking antihypertensive drugs. The survey was conducted in July 2014. Participants were divided into the following three groups: "Adherence", "Unintentional nonadherence", and "Intentional nonadherence". Individual cognitive components, such as necessity and concern as well as self-efficacy and other related factors, were compared according to adherence groups. The interrelationships between those factors and nonadherence were tested using structural equation modeling analysis. RESULTS Of the 401 subjects, 182 (45.6%) were in the adherence group, 107 (26.7%) in the unintentional nonadherence group, and 112 (27.9%) in the intentional nonadherence group. Necessity and self-efficacy were found to have a significant direct influence on unintentional nonadherence behaviors (necessity β=-0.171, P=0.019; self-efficacy β=-0.433, P<0.001); concern was not statistically significant (β=-0.009, P=0.909). Necessity was found to have significant direct and indirect impact on intentional nonadherence (direct β=-0.275, P=0.002; indirect β=-0.113, P=0.036). Self-efficacy had no significant direct effect on intentional nonadherence though it had the only significant indirect effect on intentional nonadherence (direct β=-0.055, P=0.515; indirect β=-0.286, P<0.001). Concern had no significant influence on intentional or on unintentional nonadherence (direct β=0.132 0.132, P=0.151; indirect β=-0.006, P=0.909). CONCLUSION Unintentional nonadherence should be regularly monitored and managed because of its potential prognostic significance. Interventions addressing cognitive factors, such as beliefs about medicine or self-efficacy, are relatively difficult to implement, but are essential to improve medication adherence.
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Affiliation(s)
- Sang Geun Bae
- Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital
| | - Sin Kam
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Ki Soo Park
- Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine
- Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju
- Ki Soo Park, Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, 15 Jinju-daero, 816 Beon-gil, Jinju 52727, Korea, Tel +82 55 772 8095, Fax +82 55 772 8099, Email
| | - Keon-Yeop Kim
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Nam-Soo Hong
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Ki-Su Kim
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Yu-mi Lee
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Won Kee Lee
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu
| | - Michael Sung Pil Choe
- Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
- Correspondence: Michael Sung Pil Choe, Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, 10, Sinsi-ro, Gumi–si 39315, Korea, Tel +82 54 10 9707 0911, Fax +82 54 70 7817 0139, Email
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