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Background Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS. Methods We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS. Results Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected. Conclusions MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Coronavirus disease 2019 (COVID-19) can lead to acute organ dysfunction, and delirium is associated with long-term cognitive impairment and a prolonged hospital stay. This retrospective single-center study aimed to investigate the risk factors for delirium in patients with COVID-19 infection receiving treatment in an intensive care unit (ICU). A total of 111 patients aged >18 years with COVID-19 pneumonia who required oxygen therapy from February 2021 to April 2022 were included. Data on patient demographics, past medical history, disease severity, delirium, and treatment strategies during hospitalization were obtained from electronic health records. Patient characteristics and risk factors for delirium were analyzed. Old age (P < 0.001), hypertension (P < 0.001), disease severity (Sequential Organ Failure Assessment score) (P < 0.001), mechanical ventilator support (P < 0.001), neuromuscular blocker use (P < 0.001), and length of stay in the ICU (P < 0.001) showed statistically significant differences on the univariable analysis. Multivariable analysis with backward selection revealed that old age (odds ratio, 1.149; 95% confidence interval, 1.037-1.273; P = 0.008), hypertension (odds ratio, 8.651; 95% confidence interval, 1.322-56.163; P = 0.024), mechanical ventilator support (odds ratio, 226.215; 95% confidence interval, 15.780-3243.330; P < 0.001), and length of stay in the ICU (odds ratio, 30.295; 95% confidence interval, 2.539-361.406; P = 0.007) were significant risk factors for delirium. In conclusion, old age, ICU stay, hypertension, mechanical ventilator support, and neuromuscular blocker use were predictive factors for delirium in COVID-19 patients in the ICU. The study findings suggest the need for predicting the occurrence of delirium in advance and preventing and treating delirium.

Purpose Intraoperative cardiac arrest (IOCA) is rare, unpredictable, and may result in a poor outcome. The features of IOCA during cancer surgery and factors related to survival following an IOCA were examined. Methods This was a retrospective study of patients who had cancer surgery under general anesthesia between March 2009 and March 2021 (n = 84,615) to determine the number of patients who had an IOCA. Patients’ clinical information, cause of IOCA, hypoxemia during anesthesia, and the duration of hypotension and CPR were analyzed. Results A total of 22 cases of IOCA occurred during cancer surgery (overall incidence: 2.6 per 10,000 surgeries). Return of spontaneous circulation was achieved in 17 patients, but only 13 survived until discharge. There were statistically significant differences between the deceased and the survival cancer patient groups in; (1) duration of hypoxemia (survival group: 5 minutes, range: 2–18 minutes; deceased group: 60 minutes, range, 22.5–120 minutes; p = 0.019); (2) duration of hypotension (survival group: 35 minutes, range, 15–55 minutes; deceased group 160 minutes, range, 140–185 minutes; p = 0.007); and (3) total duration of CPR (survival group: 3 minutes, range: 1–15 minutes; deceased group: 40 minutes, range: 19–149 minutes; p = 0.005). Conclusion The duration of hypoxemia and hypotension prior to the onset of IOCA, as well as the duration of CPR were associated with the prognosis of IOCA, highlighting the need to reduce multi-organ damage caused by hypoxemia and hypotension during surgery in high-risk patients.

Abstract Little is known about the effects of parenchymal or vascular amyloid β peptide (Aβ) deposition in the brain. We hypothesized that Aβ strain-specific information defines whether Aβ deposits on the brain parenchyma or blood vessels. We investigated 12 autopsied patients with different severities of Aβ plaques and cerebral amyloid angiopathy (CAA), and performed a seeding study using an Alzheimer’s disease (AD) mouse model in which brain homogenates derived from the autopsied patients were injected intracerebrally. Based on the predominant pathological features, we classified the autopsied patients into four groups: AD, CAA, AD + CAA, and less Aβ. One year after the injection, the pathological and biochemical features of Aβ in the autopsied human brains were not preserved in the human brain extract-injected mice. The CAA counts in the mice injected with all four types of human brain extracts were significantly higher than those in mice injected with PBS. Interestingly, parenchymal and vascular Aβ depositions were observed in the mice that were injected with the human brain homogenate from the less Aβ group. The Aβ and CAA seeding activities, which had significant positive correlations with the Aβ oligomer ratio in the human brain extracts, were significantly higher in the human brain homogenate from the less Aβ group than in the other three groups. These results indicate that exogenous Aβ seeds from different Aβ pathologies induced Aβ deposition in the blood vessels rather than the brain parenchyma without being influenced by Aβ strain-specific information, which might be why CAA is a predominant feature of Aβ pathology in iatrogenic transmission cases. Furthermore, our results suggest that iatrogenic transmission of Aβ pathology might occur due to contamination of brain tissues from patients with little Aβ pathology, and the development of inactivation methods for Aβ seeding activity to prevent iatrogenic transmission is urgently required.

Opioids are commonly used for postoperative pain control in cancer patients. In addition to pain control, an association between opioid use and long-term oncologic outcomes, such as recurrence or overall survival, has been postulated. The aim of this study was to determine whether postoperative opioid use in patients with non-small cell lung cancer is associated with long-term oncologic outcomes, including recurrence and death. Data obtained from 1009 medical records of patients who underwent curative resection at the National Cancer Center, Korea between January 2006 and December 2010 were retrospectively analyzed. Seven-day opioid use was divided into four quartiles to analyze probability of recurrence and death. Multivariate regression analyses of recurrence and death was conducted, including the calculation of odds ratios. A total of 871 patients were analyzed. When opioid dosage was examined by quartiles, the probability of death and recurrence increased gradually with increasing opioid use. However, in the multivariate regression analysis, the amount of opioid usage did not affect the risk of recurrence or death of lung cancer (P = 0.520 for recurrence; P = 0.659 for death). Opioid use was correlated with outcome when stratified by lung cancer stage (P = 0.004 for recurrence; P = 0.049 for death); however, the odds ratios only slightly increased (1.001 for stage IA-IIIA) for both outcomes. In non-small cell lung cancer patients, the amount of opioid usage does not affect the risk of recurrence and death of lung cancer. There was an association with stage (IA-IIIA), but the effect was negligible. A well-designed prospective study is needed.

Purpose: The purpose of this study was to evaluate the clinical usefulness of the Critical Patient Severity Classification System (CPSCS) and Glasgow Coma Scale (GCS) for critically ill neurological patients and to determine the applicability of CPSCS and GCS in predicting their mortality. Methods: Data were collected from the medical records of 187 neurological patients who were admitted to the intensive care unit of C university hospital. The data were analyzed through chi-square test, t test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and receiver operating characteristic curve. Results: In accordance with patients' general and clinical characteristics, patient mortality turned out to be significantly different depending on intensive care unit stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Hosmer-Lemeshow goodness-of-fit tests were applied to CPSCS and GCS. The results of the discrimination test using the receiver operating characteristic curve were CPSCS0, .743, GCS0 .583, CPSCS24, .734, GCS24 .612, CPSCS48, .591, GCS48 .646, CPSCS72, .622, and GCS72 .623. Logistic regression analysis showed that each point on the CPSCS score signifies a 1.034 higher likelihood of dying. Conclusion: Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.

Background/Objectives: This study is to confirm the accuracy of various blood pressure measurement methods by 119 paramedics. Methods/Statistical analysis: This study evaluated the accuracy of blood pressure measurement and the confidence of blood pressure measurement in stable, stable and noisy, driving, and driving noise situations for 40 119 paramedics. The collected data were analysed with SPSS 22.0 using frequency, descriptive statistics, and paired t-test. Findings: The confidence of blood pressure measurement was significantly higher in four situations after education. In blood pressure measurement accuracy, there was the significant difference in the following situations: Stable noisy and driving noisy in normal blood pressure(t=-2.823, p=.007).Stable driving, stable noisy(t=-2.191, p=.034), and driving noisy(t=-2.421, p=.020)in hypertension. Stable driving, stable noisy(t=-3.674, p=.001), and driving noisy(t=-2.095, p=.043) in hypotension. In the accuracy of blood pressure measurement by palpation, there was the significant difference in stable and driving situation under hypotension(t=-2.211, p=.033). Improvements/Applications: The education on blood pressure measurement in various environments is necessary to improve the measurement accuracy of 119 emergency personnel. [ABSTRACT FROM AUTHOR]

Background/Objective: This study aimed to verify the quality and the appropriateness of pediatric CPR chest compressions according to 2015 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Method/Statistical Analysis: The participants of this study were 64 EMT and nursing students who were quailified as BLS providers. Four sets of 5 CPR cycles were performed with one hand and two hands at the ratio of chest compression (30 times) to respiration (2 times), and fatigue was confirmed by NRS(numeral rating scale). Collected data were analyzed using frequency, descriptive statistics, paired t-test, and repeated measure ANOVA by SPSS 22.0. Findings: While the total number of chest compressions (629.6 times vs. 618.3 times, p=.016) and hands-off time (6.6 sec vs. 6.9 sec, p=.006) were effective for one-handed chest compression, average pressure depth (42.2mm vs. 43.8mm, p<.001), sufficient chest compression depth rate (83.0% vs. 89.1%, p=.038) and fatigue (7.0 points vs. 6.2 points, p=.040) were more effective in two-handed chest compressions. In addition, there were significant differences in the average chest compression depth over time(p=.003) and the total elapsed time (p=.332), but no significant difference in inappropriate chest compression. Improvements/Applications: Performing pediatric CPR according to the 2015 Guidelines for Pediatric Cardiopulmonary resuscitation is acceptable, but it is necessary to consider two-hand chest compression more than one hand compression. [ABSTRACT FROM AUTHOR]

Background/Objectives: As the field activity of the fire fighter is increased increasing the exposure to the traumatic event, the development of effective program to reduce the job stress is needed. Methods/Statistical analysis: The present study investigated levels of emotional intelligence, self-efficacy, and job stress by personal characteristics, working environment of ambulance workers, and grasped their correlations. A survey of ambulance workers in service at fire stations in the northern Gyeonggi province was conducted from Feb. 22 to Mar. 31, 2019 and 160 questionnaires were analyzed. Collected data were subjected to frequency analysis, t-test, and ANOVA using SPSS software 12.0 program. Findings: Emotional intelligence showed a score of 63 out of 80 points. Emotional intelligence of females was higher than that of males. That of workers not younger than 35 years was higher than that of workers younger than 30 years. That of fire engineers or fire lieutenants was shown to be higher than that of firefighters. Job stress of females was higher than that of males. That of EMT level 2 qualification holders or workers who took the training course was shown to be higher than that of EMT level 1 qualification holders. That when less than three workers were mobilized was shown to be higher than that when three workers and more were mobilized. Self-efficacy showed a positive correlation with emotional intelligence but a negative correlation with job stress. Emotional intelligence showed a negative correlation with job stress. The higher the emotional intelligence, the higher the self-efficacy. The higher the emotional intelligence and self-efficacy, the lower the job stress. Improvements/Applications: To reduce the job stress, the health should be improved and the field response capability should be enhanced by establishing the strategy to enhance the emotional intelligence. [ABSTRACT FROM AUTHOR]

Background/Objectives: It is convenient to apply C-E technique during ventilation using bag-valve mask in the moving ambulance. Purpose of the study is to investigate the effective ventilation volume and airway pressure. Methods/Statistical analysis: The National Fire Service Academy conducted Virtual Reality ("VR") based ambulance simulations from April 17, 2018 to April 28, 2018. The mean and standard deviations of mean ventilation and airway pressure were analyzed using descriptive statistics and ANOVA and SPSS software 12.0 (SPSS Ins., Chicago, IL, USA) program. Findings: When VR-based intubation was performed, the ventilation volumes were 375 ml (±30.71), 225 ml (±8.48), 324 ml (±6.56), 244 ml (±7.79), and 427 ml (±10.42) when using bag-valve mask, laryngeal mask, laryngeal tube, I-gel, and intubation, respectively. Airway pressure was 17.48 cmH2O (±0.28) from endotracheal intubation, 14.79 cmH2O (±1.51) from bag-valve mask, 13.49 cmH2O (±0.78) from laryngeal tube, 8.66 cmH2O (±0.80) from I-gel, 6.73 cmH2O (±0.53) from laryngeal mask showed airway pressure. Improvements/Applications: The present study has significance in that basic data for the method of using a professional airway are provided by adequate ventilation for each professional airway in transit. [ABSTRACT FROM AUTHOR]

Purpose: Assuming that attitude education for basic cardiopulmonary resuscitation contributes to delaying the declining period, the purpose of this study was to determine retention of knowledge and performance after cardiopulmonary resuscitation (CPR) training. Method: Total 90-minute training consisting of a 30-minute lecture, a 30-minute practice by non-feedback mannequin (Actar 911 Squadron™; Vital Signs, New Jersey, USA), and a 30-minute attitude education (such as prevention of brain damage progression; confidence in ability to perform correct compression; understanding of damage caused by compression; ability to overcome the patient's appearance of distress; awareness of exemption from liability; confidence in the subject's physical capacity; low probability of infection) was conducted with 256 undergraduate students at Eulji University in accordance with 2015 AHA guidelines for layperson adult CPR. A self-assessing Likert scale (1, not at all; 2, not really; 3, undecided; 4, somewhat; 5, very much) was used before and after basic CPR training in three-month intervals (total of five times: March, May and September 2015, and December 2015, February and June 2016) to assess knowledge (how much you know about CPR) and performance (how much you can do CPR). Repeated measures ANOVA were used at α=.05 (2-side) of type I error rate to determine change in knowledge and performance scores over time. Findings: Statistically significant difference in knowledge (epsilon, .891) was found (p<.001), in which the Bonferroni method was applied as post hoc analysis. There was a difference in knowledge score between before-training and months three, six, and nine. However, no difference in knowledge scores between months three, six, and nine, implying that knowledge had been retained at least for nine months. Statistically significant difference in performance (epsilon, .831) was found (p<.001), in which the Bonferroni method was applied as post hoc analysis. There was difference in performance score between before-training and months three, six, and nine. However, no difference in performance score was found between months three, six, and nine, implying that performance had been retained at least for nine months. Applications: It was determined that knowledge and performance have been retained at least for nine month after basic CPR training combined with attitude education. Knowledge and performance scores that have improved compared to that before training were consistently maintained after training. Results of this study show lengthier retention than other studies, suggesting that attitude education added to basic CPR training delays decline of knowledge and performance. [ABSTRACT FROM AUTHOR]

Background/Objectives: When chest compression is performed with two hands in a situation where the movement of the vehicle cannot be predicted, the hands-off time increased resulting in inadequate chest recoil. Method/Statistical Method: VR-based ambulance simulation experiments were conducted from February 19 to 28, 2018 in the National Fire Service Academy. The mean and standard deviation of chest compression and artificial respiration were analyzed by descriptive statistics and t-test. The results were analyzed using SPSS software 12.0 (SPSS Ins., Chicago, IL, USA). Findings: The results of Lucas (LUCASTM) and manual cardiopulmonary resuscitation of VR-based state showed better chest compression and less incomplete chest relaxation rate than the standard CPR of Lucas™ 2. In the VR-based condition, the respiration rate was better when the bag-valve mask was applied at a ratio of 30: 2 than in the case of continuous chest compression under the condition of special airway intubation. Therefore, chest compression using machine was more effective than cardiopulmonary resuscitation in transferring cardiac arrest patients, and it was more efficient to use bag-valve mask at 30: 2 in volume delivery. Improvements/Applications: This study suggests to use automatic external defibrillator as an alternative to chest compression in transit ambulances. [ABSTRACT FROM AUTHOR]

Background/Objectives: The purpose of the study is to investigate the effective ventilation delivery that affects the rate of resuscitation. Method/Statistical Analysis: The National Fire Service Academy conducted Virtual Reality ("VR") based ambulance simulations from April 17, 2018 to April 28, 2018. The mean and standard deviations of mean ventilation and airway pressure were analyzed using descriptive statistics and ANOVA and SPSS software 12.0 (SPSS Ins., Chicago, IL, USA) program. Findings: When VR-based intubation was performed, the ventilation was 427 ml from Oxylator EM-100, 458 ml from MicroVenT CSI-3000 and 305 ml from OXY-LIFE II. For the airway pressure, Oxylator EM- 100 showed 10.623 cmH2O, MicroVenT CSI-3000 showed 11.291 cmH2O and OXY-LIFE II showed 6.965 cmH2O. When tracheal intubation was performed on the VR base, Oxylator EM-100 and MicroVenT CSI- 3000 showed adequate ventilation and airway pressure. Improvements/Applications: This study suggests to use an oxygenator as an efficient ventilation method after intubation in ambulance during transport. Skilled practice and the method of use of rescuer is very important. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the first response, rescue, and transport of emergency patients in Korea coast guard center workers. A self-administered questionnaire was carried out by 333 maritime police workers working at Korea coast guard center from March-June, 2016. The questionnaire consisted of 25 question items. Data were analyzed using SPSS WIN 21.0. Majority of the study subjects worked at the Korea Coast Guard Center and of them, 96.7% were composed of staff who did not possess emergency medical technician certificate, followed by 2.7% possessing level 2 emergency medical technician certificate, and 0.6% possessing level 1 emergency medical technician certificate. And in terms of the possession of lifeguard certificate, 60.1% of the staff possessed lifeguard certificate which was higher percentage than the staff who did not possess lifeguard certificate at 39.9%. In the case of lifeguard certificate, staff who possess lifeguard certificate had better knowledge about the usage instructions for Automated External Defibrillator, than the staff who did not possess the certificate, and meaningful difference was seen in accordance with the possession of the lifeguard certificate(t=4.31, p<.001).Paramedics, also referred to as prehospital emergency personnel, must also be recognized as expert manpower and accordingly, there is a need for a system to allow them to receive corresponding reward. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand the significance of clinical practice of nursing students by using a phenomenological method, and to provide a basic set of data for clinical practice and training programs for nursing students. The analysis method presented by Van Kaam for phenomenological studies were used as the basis. The number of research participants is reached when no further content comes out in interviewing, namely, repetitive statements on a phenomenon. The result was that of the total of 260 meaningful statements, 32 sub-themes and 5 themes, as well as 2 categories were determined. The results of this study can be summarized as follows: First, it is expected that nursing students will be able to use the experiences of the nursing practitioners and the experiences of patients who have been given medication practice. While reading repeatedly the original data that describes the nursing students' experience of clinical practice, meaningless statements were abandoned. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate correlation between self-evaluation factors and academic achievement of medical students according to introduction of explanation meeting in cadaveric dissection. The students explained cadaveric structure to health allied sciences students and discussed with each other. Just after the meeting, 102 medical students filled out a self-reported questionnaire on impact of self-evaluation factors and communication. The data were analyzed by frequency analysis, t-test and analysis of variance. Regardless of their gender, age, previous experience, the majority of the students gave high scores in all of self-evaluation factors. Among them, linkage with major and verbal communication factor were closely related to their academic achievement(p<0.05). The verbal and non-verbal communication factors also had a high correlation of 0.580(p<0.01). The explanation meeting provided a chance to learn further with positive attitude to medical students and motivated them academically. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify relationships between compassion fatigue, burnout, and turnover intention in Korean hospital nurses. Methods: In total, 142 hospital nurses were surveyed as part of data collection. Data related to compassion fatigue, burnout, and turnover intention were collected using a questionnaire between May 2011 and September 2011. The data analysis was performed using PASW 19.0 program, which included one-way ANOVA, independent t-tests, Pearson's correlation coefficient, and hierarchical regression analysis. Results: This study detected a positive correlation between compassion fatigue and burnout(r=.37, p<.001), and turnover intention(r=.55, p<.001). Compassion fatigue accounted for 29.6% of the variance for turnover intention among Korean hospital nurses. Conclusion: The results indicate that it is necessary to reduce compassion fatigue, and turnover intention among Korean hospital nurses. [ABSTRACT FROM AUTHOR]