Journal of Yeungnam Medical Science

Original article

Determining the correlation between outdoor heatstroke incidence and climate elements in Daegu metropolitan city: Jung Ho Kim, Hyun Wook Ryoo, Sungbae Moon, Tae Chang Jang, Sang Chan Jin, You Ho Mun, Byung Soo Do, Sam Beom Lee, Jong-yeon Kim; Yeungnam Univ J Med. 2019;36(3):241-248. Published online July 2, 2019; DOI: https://doi.org/10.12701/yujm.2019.00248

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Background
Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS).
Methods
We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression.
Results
Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102–3.017). The most suitable cutoff point for MHI by Youden’s index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%).
Conclusion
Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.

Citations

Citations to this article as recorded by

Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial
Zhiyan Zhang, Hiddo J L Heerspink, Glenn M Chertow, Ricardo Correa-Rotter, Antonio Gasparrini, Niels Jongs, Anna Maria Langkilde, John J V McMurray, Malcolm N Mistry, Peter Rossing, Robert D Toto, Priya Vart, Dorothea Nitsch, David C Wheeler, Ben Caplin
The Lancet Planetary Health.2024; 8(4): e225. CrossRef

Original Articles

Two Year Experiences of the International Elective Clerkship for Medical Students.: Sam Beom Lee, Jae Beum Bang, Young Hwan Lee; Yeungnam Univ J Med. 2009;26(1):24-29. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.24

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Abstract PDF: BACKGROUND
The aims of medical education have recently been changing in Korea, which has been accompanied by efforts to modify the rotating clerkship courses, improve the quality of clinical education, and make global doctors. We report the experiences of medical students going through an international elective clerkship for during past two years. MATERIALS AND METHODS: Third year medical students could apply to the international elective clerkship course during a 4 week period after their third-year rotating clerkship at a university hospital. This was done twice-in 2008 and in 2009. Applicant students were allowed to select hospitals anywhere in the world. We analyzed their choices including data on nation, state or city, hospital or institute, contacted hospitals by medical college, differences of two years, etc. RESULTS: Twelve students (10.9%) of a total of 75 third-year students applied to 3 nations and 4 hospitals in 2008. Nine students applied to the Tampa General Hospital at the University of South Florida (USF) in the USA, which was arranged by their medical college. In 2009, a total of five (4.2%) of 77 students applied to 2 nations and 3 hospitals, including three at the University of South Florida, one in another city in the USA, and one in another nation because of the increased financial burden due to a higher exchange rate. CONCLUSION: Medical students started their first international elective clerkship courses during the past two years. Experiences were interesting and meaningful to the students and the medical college. Greater effort and support to developing a new paradigm and to enlarge the scope of the program for making global doctors are required in the future.

Introduction of Medical Simulation and the Experience of Computerized Simulation Program Used by MicroSim(R).: Sam Beom Lee, Jae Beum Bang, Joon Sakong; Yeungnam Univ J Med. 2007;24(2):148-153. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.148

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Abstract PDF: BACKGROUND
Computer- and web-based simulation methods help students develop problem solving and decision making skills. In addition, they provide reality based learning to the student clinical experience with immediate medical feedback as well as repetitive training, on-site reviews and case closure. MATERIALS AND METHODS: Seventy-five third-year medical students participated in a two-week simulation program. The students selected four modules from eight modules as follows: airway and breathing 1, cardiac arrest 1, cardiac arrhythmia 1, and chest pain 1, and then selected the first case within each of the modules. After 2 weeks, a pass score was obtained and the data analyzed. The average pass score of over 70% was considered a passing grade for each module. If the student did not pass each module, there was no score (i.e., pass score was zero). In addition, when at least one of the four modules was zero, the student was not included in this study. RESULTS: Seventy-five students participated in the simulation program. Nineteen students were excluded based on their performance. The final number of students studied was 56 students (74.7%). The average scores for each module 1 to 4 were 86.7%, 85.3%, 84.0%, and 84.0%, and the average obtained pass score was 88.6 for the four modules in all 56 students. CONCLUSION: Medical simulation enabled students to experience realistic patient situations as part of medical learning. However, it has not been incorporated into traditional educational methodology. Here we describe the introduction and the development of various simulation modules and technologies for medical education.

Comparison of the Accuracy of the CPR Methods According to Change of the Ratio between Compression and Ventilation : Using a Training Mannikin: Sung Hoon Lee, Sam Beom Lee, Byung Soo Do; Yeungnam Univ J Med. 2007;24(2 Suppl):S544-548. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S544

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Abstract PDF: Background
：Newly revised cardiopulmonary resuscitation (CPR) guideline in 2005 recommends 30 chest compressions and 2 rescue breaths during CPR for all rescuers to use for all adult victims. We would compare the accuracy of the CPR methods by revised CPR guideline in 2005 and previous guideline in 2000. Materials and Methods：Fifty medical students during the introduction to clinical medicine (ICM) were investigated after 30 minutes lecture and brief education of CPR methods. Each students performed twice both CPR methods, the one by guideline 2005 (method A), 4 cycles of 30 compressions every 2 breaths, and the other by guideline 2000 (method B), 10 cycles of 15 compressions every 2 breaths. Resci® Anne mannekin and Laerdal® skillmeter were used and paper reports were printed after each tests. After then, we compared the technical accuracy of the results between method A (30:2) and method B (15:2).
Results
：Total fifty students (37 males, 13 females) were tested, their mean age was 25.1, mean body weight was 63.5 kg. The technical accuracy on chest compression was not different between two methods and also the technical accuracy on ventilation was not different between two methods except total ventilation number (p>0.05).
Conclusion
：We could not find significant differences of technical accuracy between both CPR methods. So we don’t think new guideline 2005 is superior to previous guideline 2000 by technical efforts although it’s hemodynamic responses and other clinical benefits is excluded in this study.

Prehospital Status of the Patients with Ischemic Chest Pain before Admitting in the Emergency Department.: Hye Hwa Jin, Sam Beom Lee, Byung Soo Do, Byung Yeol Chun; Yeungnam Univ J Med. 2007;24(1):41-54. Published online June 30, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.1.41

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Abstract PDF: BACKGROUND
The causes of chest pain vary but the leading cause of chest pain is ischemic heart disease. Mortality from ischemic chest pain has increased more than two fold over the last ten years. The purpose of this study was to determine the data necessary for rapid treatment of patients with signs and symptoms of ischemic chest pain in the emergency department (ED). MATERIALS AND METHODS: We interviewed 170 patients who had ischemic chest pain in the emergency department of Yeungnam University Hospital over 6 months with a protocol developed for the evaluation. The protocol used included gender, age, arriving time, prior hospital visits, methods of transportation to the hospital, past medical history, final diagnosis, and outcome information from follow up. RESULTS: Among 170 patients, there were 118 men (69.4%) and the mean age was 63 years. The patients diagnosed with acute myocardial infarction (AMI) were 106 (62.4%) and with angina pectoris (AP) were 64 (37.6%). The patients who had visited another hospital were 68.8%, twice the number that came directly to this hospital (p<0.05). The ratio of patients who visited another hospital were higher for the AMI (75.5%) than the AP (59.4%) patients (p<0.05). The median time spent deciding whether to go to hospital was 521 minutes and for transportation was 40 minutes. With regard to patients that visited another hospital first, the median time spent at the other hospital was 40 minutes. The total median time spent before arriving at our hospital was 600 minutes (p>0.05). The patients who had a total time delay of over 6 hours was similar 54.8% in the AMI group and 57.9% in the AP group (p>0.05). As a result, only 12.2% of the patients with an AMI received thrombolytics, and 48.8% of them had a simultaneous percutaneous coronary intervention (PCI). In the emergency department 8.5% of the patients with an AMI died. CONCLUSION: Timing is an extremely important factor for the treatment of ischemic heart disease. Most patients arrive at the hospital after a long time lapse from the onset of chest pain. In addition, most patients present to a different hospital before they arrive at the final hospital for treatment. Therefore, important time is lost and opportunities for treatment with thrombolytics and/or PCI are diminished leading to poor outcomes for many patients in the ED. The emergency room treatment must improve for the identification and treatment of ischemic heart disease so that patients can present earlier and treatment can be started as soon as they present to an emergency room.

Case Reports

A Case of Subcutaneous Emphysema without Associated Injuries at Neck from Motorcycle Accident.: Jung Ho Kim, Sam Beom Lee, Byung Soo Do; Yeungnam Univ J Med. 2003;20(2):217-222. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.217

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Abstract PDF: Subcutaneous emphysema defines collection of air in subcutaneous spaces of body. It is usually originated from air in upper airway and lower respiratory tract such as larynx, trachea, bronchus and lungs. Air in subcutaneous spaces derives from leakage of air due to tearing or ruptures of airway structures, and also accompanies pneumothorax or pneumomediastinum and/or rib or sternal fractures or other major airway injuries. We experienced a case of subcutaneous emphysema caused by laryngeal injury without any associated airway injuries at neck from motorcycle accident, so we would report a case with the review of literatures.

A Case of Spontaneous Pneumomediastinum without Direct Cause.: Sam Beom Lee, Jung Ho Kim, Byung Soo Do; Yeungnam Univ J Med. 2003;20(2):212-216. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.212

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Abstract PDF: No abstract available.

Original Article

Multimarker Approach by Troponin T, C-Reactive Protein, and CK-MB to Assessment in AMI in the Emergency Department.: Sam Beom Lee, Jung Ho Kim, Byung Soo Do; Yeungnam Univ J Med. 2003;20(2):197-205. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.197

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Abstract PDF: No abstract available.

Review

What is Emergency Medicine and Its Agenda for Future.: Byung Soo Do, Sam Beom Lee; Yeungnam Univ J Med. 2002;19(2):92-98. Published online December 31, 2002; DOI: https://doi.org/10.12701/yujm.2002.19.2.92

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Abstract PDF: Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life or limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.

Original Articles

Clinical Presentation of th patients with Non-traumatic Chest Pain in Emergency Department.: Jun Young Chung, Sam Beom Lee, Byung Soo Do, Jong Seon Park, Dong Gu Shin, Young Jo Kim; Yeungnam Univ J Med. 1999;16(2):283-295. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.283

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Abstract PDF: BACKGROUND
Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were 1.1+/-0.9 in non-cardiac diseases, 1.4+/-1.1 in cardiac diseases and 1.7+/-1.1 in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. CONCLUSION: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

Analysis of Arrival Information and Status of the Patients in Emergency Department.: Sam Beom Lee, Byung Soo Do; Yeungnam Univ J Med. 1999;16(2):277-282. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.277

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Abstract PDF: BACKGROUND
For effective and systematic management of patients in the emergency department (ED), the data on patient arrival and status in DE of Yeungnam University Hospital were evaluated, MATERIALS AND METHODS: During the seven days form Apr. 1 to. 7 , 1998, the general patient information such as onset time and place, factors associated with transportation. causes of admission, cared department and patient disposition were recorded. RESULTS: Total of 464 patients visited the ED during the seven days, and the mean number of patients per day was 66.3 Male to female ratio was 1:0.71. Daily staying patients were 17.3 and 83.6 patients were cared totally each day. The methods of transportation and distribution of patients according to region and event were as follows: visit by walk (57.3%), transportation by car(58.0%),place of event in residence(85.3%), regional distribution in Taegu(81.5%), and direct visit(97.4%). Cause of admission due to diseases was 74.6%. The percentages of department which cared the patients were internal medicine 26.6%, pediatrics 16.8%, orthopedics 8.6%, neurology 8.2%, neurosurgery 7.8% and other department including emergency medicine 8.2%, respectively. Patient dispositions were admission 38.4%, discharge 61.0% and death on arrival(DOA) 0.6%, but referred-patient-to -another-hospital was zero. CONCLUSION: Improvements in several aspects of ED's caring system such as "fast tracking" system and reinforcement of disease and trauma caring system, would be helpful for effective management of emergency patients.

Status of the Use and Assessment of Order-Communicating System(OCS) in Emergency Care Center.: Sam Beom Lee, Jun Young Chung, Byung Soo Do; Yeungnam Univ J Med. 1997;14(1):85-93. Published online June 30, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.1.85

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Abstract PDF

Hospital information system has been widely used and increased recently for a variety of many aspects. And Order-Communication System(OCS), as like as hospital information system, has been used in many medical care facilities, which is simple and easily accessible, useful system. Also then the use of OCS in emergency care center in YUMC has been introduced sine 1996. 10, above 70% of availability is notice at present and increasing in the use rate, is considered that is very simple and accurate, time-saving, widely applicable system. So authors say that, after the use of OCS in emergency care center, interhospital exchange of the patient's information and also accomplishment of EMSS can be possible.

Citations

Citations to this article as recorded by

A CAOPI System Based on APACHE II for Predicting the Degree of Severity of Emergency Patients
Young-Ho Lee, Un-Gu Kang, Eun-Young Jung, Eun-Sil Yoon, Dong-Kyun Park
Journal of the Korea Society of Computer and Information.2011; 16(1): 175. CrossRef

Case Report

A Case of Idiopathic Hypereosinophihc Syndrome Assoclated with Pulmonary Infiltration.: Hun Mo Ryoo, Young Soo Kweon, Jin Hong Chung, Kwan Ho Lee, Hyun Woo Lee, Dong Sug Kim, Sam Beom Lee; Yeungnam Univ J Med. 1994;11(2):375-380. Published online December 31, 1994; DOI: https://doi.org/10.12701/yujm.1994.11.2.375

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Abstract PDF: The idiopathic hypereosinophilic syndrome consists of peripheral blood eosinophilia of 1500/mm3 or more without a known cause, plus signs and symptoms of organ eosinophilia. The prognosis of HES without treatment is poor. However, about one third of the patients with this syndrome may respond to corticosteroid thrapy. Morever, the majority of the remainder may have a favorable response to hydroxyurea. We present here a case of hypereosinophilic syndrome without any identifiable causes, involving bone marrow, liver, lungs and cervical lymph node. We tried corticosteroid as a treatment but it showed no response. However the hydroxyurea showed good response.

Original Articles

Isolation of Acid-fast bacilli from Tissues of Extrapulmonay Tuberculosis.: Jin Woo Rho, Hee Jin Choi, Hyeung Il Kim, Jin Hong Chung, Kwan Ho Lee, Hyun Woo Lee, Sam Beom Lee; Yeungnam Univ J Med. 1994;11(2):240-247. Published online December 31, 1994; DOI: https://doi.org/10.12701/yujm.1994.11.2.240

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Abstract PDF: To evaluate the isolation rate of acid-fast bacilli on Ziehl-Neelsen stain from biopsy specimens of extrapulmonary tuberculosis proven by chronic granulomatous inflammation, 286 cases of extrapulmonary tuberculosis were reviewed and the results are as follows : 1) Mean age was 27.3 years old and lymphatic tuberculosis was more prevalent in the female but others were more common in the male. 2) The most common site of extrapulmonary tuberculosis was pleura (103 cases ; 36%) followed by lymph nodes (87 cases ; 30.4%), gastrointestinal tract (27 cases ; 9.4%), skin and soft tissue (23 cases ; 8.0%), bone (19 cases ; 6.6%), urinary tract (14 cases ; 4.6%), larynx (9 cases ; 3.2%) and breast (5 cases ; 1.8%) in order of frequencies. 3) Of 286 cases, 30.4%, (87 cases) of the biopsy specimens showed acid fast bacilli on microscopy. The isolation rate according to the sites was slightly higher in breast and lymph nodes as 3 of 5 cases (60.0%) and 35 of 87 cases (40.2%) respectively, and followed by 3 of 9 cases (33.3%) in the larynx, 4 of 13 cases (30.8%) in the urinary tract, 5 of 19 cases (26.3%) in the bone, 7 of 27 cases (25.9%) in the gastrointestinal tract, 26 of 103 cases (25.2%) in the pleura, and 4 of 23 cases (17.4%) in the skin and soft tissue, in order of frequencies. 4) The prevalence of extrapulmonary tuberculosis associated with pulmonary tuberculosis on chest X-ray was 85 of 286 cases (29.7%).

Determinants of Successful Percutaneous Transluminal Coronary Angioplasty.: Kyo Won Choi, Jun Young Kweon, Yeung Jin Kim, Tae Il Lee, Dong Gu Shin, Young Jo Kim, Bong Sup Shim, Hyun Woo Lee, Sam Beom Lee; Yeungnam Univ J Med. 1994;11(2):230-239. Published online December 31, 1994; DOI: https://doi.org/10.12701/yujm.1994.11.2.230

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Abstract PDF: In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients(89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A(95.7%), type B (89.%). There was significantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bed >45° and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors, Stenosis severity, thrombus, lesion location at a bend >45°, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.

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