• Title/Summary/Keyword: pre-hospital

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Changes in bioimpedance analysis components before and after hemodialysis

  • Kim, Hyunsuk;Choi, Gwang Ho;Shim, Kwang Eon;Lee, Jung Hoon;Heo, Nam Ju;Joo, Kwon-Wook;Yoon, Jong-Woo;Oh, Yun Kyu
    • Kidney Research and Clinical Practice
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    • v.37 no.4
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    • pp.393-403
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    • 2018
  • Background: This study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD. Methods: This cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-week dialysis sessions. Results: Extracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation ($r^2=0.924$, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period. Conclusion: The estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible to predict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.

Altered expression of norepinephrine transporter and norepinephrine in human placenta cause pre-eclampsia through regulated trophoblast invasion

  • Na, Kyu-Hwan;Choi, Jong Ho;Kim, Chun-Hyung;Kim, Kwang-Soo;Kim, Gi Jin
    • Clinical and Experimental Reproductive Medicine
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    • v.40 no.1
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    • pp.12-22
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    • 2013
  • Objective: We investigated the norepinephrine transporter (NET) expression in normal and pre-eclamptic placentas and analyzed the invasion activity of trophoblastic cells based on norepinephrine (NE)-NET regulation. Methods: NET and NE expression levels were examined by western blot and enzyme-linked immunosorbent assay, respectively. Trophoblast invasion activity, depending on NE-NET regulation, was determined by NET-small interfering RNA (siRNA) and NET transfection into the human extravillous trophoblast cells with or without NE treatment and invasion rates were analyzed by zymography and an invasion assay. Results: NET mRNA was expressed at a low level in pre-eclamptic placentas compared with normal placentas and NE concentration in maternal plasma increased significantly in pre-eclamptic women compared to normal pregnant women (p<0.05). NET gene upregulation and NE treatment stimulated trophoblast cell invasion up to 2.5-fold (p<0.05) by stimulating matrix metalloproteinase-9 activity via the phosphoinositol-3-kinase/AKT signaling pathway, whereas NET-siRNA with NE treatment reduced invasion rates. Conclusion: NET expression is reduced by inadequate regulation of NE levels during placental development. This suggests that a complementary balance between NET and NE regulates trophoblast cell invasion activities during placental development.

Risk Factors for Endometrial Hyperplasia Concomitant Endometrial Polyps in Pre- and Post-menopausal Women

  • Topcu, Hasan Onur;Erkaya, Salim;Guzel, Ali Irfan;Kokanali, Mahmut Kuntay;Sarıkaya, Esma;Muftuoglu, Kamil Hakan;Doganay, Melike
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.13
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    • pp.5423-5425
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    • 2014
  • Purpose: To evaluate the risk factors for endometrial hyperplasia concomitant endometrial polyps in pre- and post-menopausal women. Materials and Methods: A total of 203 patients undergoing endometrial sampling before hysterectomy were evaluated in this retrospective study. Data recorded were age, gravidity, parity, body mass index (BMI: weight(kg)/$height(m)^2$), endometrial thickness (ET), menopausal status, presence of adenomyosis and diabetes mellitus. Results: Endometrial hyperplasia and polyps were detected in 13 patients. There were statistically significant differences in terms of age, menopausal status, morbid obesity and diabetes mellitus (p<0.005). Logistic regression demonstrated that menopausal status and presence of diabetes mellitus were independent risk factors. Conclusions: According to the current study; menopause and diabetes mellitus are strong risk factors for the presence of concomitant endometrial polyps and endometrial hyperplasia.

Psychosocial Pre-Transplant Assessment of Living Kidney Donors (생체 신장 이식 공여자에 대한 정신사회적 평가)

  • Ah Rah Lee;Myungjae Baik;Sang Min Lee;Won Sub Kang;Jin Kyung Park
    • Korean Journal of Psychosomatic Medicine
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    • v.31 no.2
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    • pp.43-49
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    • 2023
  • In Korea, the dependence on living donations is high due to the shortage of organs available for donation compared to the number of people waiting for transplants and the number of living organ donations continues to increase. In particular, the number of living-donor transplantations is high worldwide, highlighting the importance of pre-transplant psychosocial evaluation of living kidney donors. According to previous studies, when evaluating living organ donors before transplantation, it is crucial to determine whether the donor can give informed consent and be aware of the risks after surgery. Pre-transplant evaluation tests such as ELPAT living organ donor Psychological Assessment Tool (EPAT), Live Donor Assessment Tool (LDAT), Living Donation Expectancies Questionnaire (LDEQ), Minnesota Multiphasic Personality Inventory-2 questionnaire (MMPI-2) and Temperament and Character Inventory (TCI) are conducted for donors. After reviewing the literature on these pre-transplant psychosocial assessment tools, we will also look at legal considerations for living kidney donors in Korea and suggest an effective and essential pre-transplant screening evaluation method for living kidney transplant donors.

Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital

  • Kim, Kyoung Hwan;Han, Sung Ho;Chon, Soon-Ho;Kim, Joongsuck;Kwon, Oh Sang;Lee, Min Koo;Lee, Hohyoung
    • Journal of Trauma and Injury
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    • v.32 no.1
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    • pp.1-7
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    • 2019
  • Purpose: The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region. Methods: We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups. Results: No significant differences were found in the annual patients' average age ($54.1{\pm}20.0$ vs. $52.8{\pm}18.2$, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: -0.358, -0.271 vs. post-trauma group: 1.071, 0.958). Conclusions: There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

A Study on the Scope of Practice of Nurses in the Prehospital Emergency Medical Service System (병원 전 응급의료체계에서 간호사의 업무범위에 대한 소고(小考))

  • Bae, Hyuna
    • The Korean Society of Law and Medicine
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    • v.20 no.2
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    • pp.141-171
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    • 2019
  • Nurses are medical personnels under the Medical Service Act and perform medical practice such as medical assistance at medical institutions. The nurse, a medical personnel, provides emergency medical service to emergency patients in the pre-hospital emergency medical system as a 119 rescuer based on the Act on 119 Rescue and Emergency Medical Services. The scope of practice of nurses is comprehensively defined in the Medical Service Act and specified through precedents. In contrast, The scope of work of emergency medical technician is listed in detail. It is understood that nurses in the pre-hospital emergency medical service system have a wider scope of practice than emergency medical technician. In particular, the scope of practice of nurses as emergency medical personnel in the pre-hospital emergency medical system should be interpreted differently within the medical institution, considering the urgency of the patient, being transferred to the emergency medical institution, and the specificity of medical direction through tele-communication.

Effect of pre-hospital BLS simulation training on the paramedic's competency

  • Jung, Jun-Ho;Cho, Byung-Jun
    • Journal of the Korea Society of Computer and Information
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    • v.23 no.1
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    • pp.103-109
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    • 2018
  • The purpose of the study is to investigate the effect of a simulation training of BLS in paramedics in pre-hospital situation. This a nonequivalence control quasi-experimental study. The study subjects were 8 paramedics of experimental group and 8 paramedics of control group in K fire department. An informed consent was written by the subjects after explaining of the purpose of the study. The study methods consisted of conventional education and practice training. The conventional education was done for 30 minutes and the practice training was taken by four trainees of one group and the instructor demonstrated Basic Iife Support (BLS) performance for three minutes. Each trainer peformed BLS for ten minutes. In the beginning of the course, two paramedics got off from the ambulance and performed BLS including 5 cycles of Cardiopulmonary Resuscitation (CPR). Soon after the BLS, another two paramedics performed pre-hospital BLS survey. The education was guided by two professors of emergency medical technology, two Basic Iife Support instructors, and two emergency rescue directors. Pre-hospital BLS was measured by a 5-point Likert scale. Higher score means higher performance skills. The data were analyzed using SPSS/WIN 22.0 program set at significance level of p<05. The effect of simulation education was much more significant than the conventional education in BLS. The simulation education is very important and effective in improving the clinical performance skills of paramedics than the conventional education. The simulation education can provide the virtual environment of cardiac arrest to the paramedics. In conclusion, the simulation education can provide the effective teaching methods for various practice performance skills and solution by critical thinking in the paramedics and healthcare providers in the future.

The Immediate Effects of Static Stretching with Talus Stability Taping on Ankle Dorsiflexion and Balance (목말뼈 안정화 테이핑을 동반한 정적 장딴지근 스트레칭이 발목 관절의 발등굽힘과 균형에 미치는 즉각적인 효과)

  • An, Da-In;Jung, Jong-Chul;Park, Won-Young;Kim, Soo-Yong
    • PNF and Movement
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    • v.19 no.1
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    • pp.87-95
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    • 2021
  • Purpose: The purpose of this study was to determine the effects of talus stability taping during gastrocnemius stretching on ankle passive dorsiflexion, talus posterior glide, and balance in subjects with limited ankle dorsiflexion. Methods: Fifteen subjects (eight males and seven females) with limited ankle dorsiflexion participated in this study. Ankle passive dorsiflexion range of motion (ROM), talus posterior glide, and the lower quarter Y-balance test (YBT-LQ) were measured pre-stretching, after applying gastrocnemius stretching (GS), and after applying gastrocnemius stretching with talus stability taping (GSTST). The two types of stretching were performed at random. Results: Ankle passive dorsiflexion ROM was significantly increased by both types of stretching (p < 0.05), and ROM was significantly more increased post-GSTST than post-GS (p < 0.05). In addition, talus posterior glide was significantly increased post-GSTST than pre-stretching and post-GS (p < 0.05). However, there was no significant difference between post-GS and pre-stretching (p > 0.05). YBT-LQ score was significantly increased post-GSTST than pre-stretching (p < 0.05). Conclusion: Gastrocnemius stretching with talus stability taping is an effective method for subjects with limited ankle dorsiflexion to improve ankle passive dorsiflexion, talus posterior gliding, and balance.

Pap Smear Combined with HPV Testing: A Reasonable Tool for Women with High-grade Cervical Intraepithelial Neoplasia Treated by LEEP

  • Mo, Ling-Zhao;Song, Hong-Lin;Wang, Jian-Li;He, Qing;Qiu, Zhang-Can;Li, Fei
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.10
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    • pp.4297-4302
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    • 2015
  • Background: To evaluate HPV testing by Hybrid Capture II (HCII) in conjunction with cytology in detecting the residual/recurrence disease after treatment of high-grade cervical intraepithelial neoplasia (CIN II-III) with loop electrosurgical excision procedure (LEEP). Materials and Methods: A retrospective review of 158 patients with histologically confirmed CIN II-III who underwent LEEP between January 2011 and October 2012 was conducted. Post-treatment control was scheduled at the 3rd, 6th, 12th and 18th month. All patients were followed up by Pap smear and HR-HPV genotype and viral load testing. Results: Pre-treatment, HR-HPV DNA, was detected in all specimens of the patients. At follow-up, 25 patients were diagnosed as the residual/recurrent disease during the FU visit, among whom, 16 patients with positive margin: 13 patients (52%) with HR-HPV DNA+/cytology+, 2 patients (8%) with HR-HPV DNA+/cytology-, 1 patient (4%) with cytology+/HR-HPV DNA-; 9 patients with clean margin - 5 patients (55.6%) with HR-HPV DNA+/cytology+; 2 patients (22.2%) with HRHPV DNA+/cytology-, 2 patients (22.2%) with cytology+/HR-HPV DNA-. None of them persisting HR-HPV DNA-/cytology-with positive or negative margin was identified as the residual/recurrent disease. The majority of residual/recurrent disease was detected at the 12th and 18th month FU, and there was almost no difference in the sensitivity and negative predictive value (NPV) between at the 3rd month and the 6th month FU visits. 14 residual/recurrence disease (14/46:30.4%) had pre-treatment high viral load (>5 000 RUL/PC) and 11 (11/112, 9.8%) with pre-treatment low viral load, P<0.05. Conclusions: (1) The persistence HR-HPV DNA is the root cause of the residual/recurrent disease for the women treated for high-grade CIN; the pre-treatment viral load and margin can be seen as the predictor. (2) The FU visit beginning at the 6th month post-treatment and lasting at least 24 months with the combination of cytology and HPV testing. (3) Patients with high pre-treatment HPV load, which is considered as one risk of developing the residual/recurrent disease, should be paid more attention (especially above 500RUL/PC) to by clinicians.