Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea Health Panel Data 2010 to 2012

Objective We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea. Methods This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable. Results A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year. Conclusion Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted

Use of smart glasses for ultrasound-guided peripheral venous access: a randomized controlled pilot study

Objective Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access. Methods In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty. Results No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P<0.01). No significant differences in the number of skin punctures or needle restrictions were observed between the groups. Conclusion Our results indicate that smart-glasses may aid in ensuring ultrasound-guided peripheral venous access by reducing head movements

Effect of transported hospital resources on neurologic outcome after out-of-hospital cardiac arrest

Objective. Appropriate regional transport protocol for out-of-hospital cardiac arrest (OHCA) patients is important for achieving favorable outcomes in a certain community. This study aimed to investigate the effect of transported hospital resources on the neurologic outcome after OHCA. Methods. We categorized cardiac receiving centers (CRC) in our community into two levels (primary [P-CRC] and definite CRC [D-CRC]) according to the hospital resources that were identified by the Hospital Assessment Survey in 2015. OHCA patients with presumed cardiac etiology resuscitated by emergency medical service providers between 2012 and 2014, were enrolled in the study. The main exposure was the level of CRC. The primary endpoint was discharge with good neurologic outcomes. We compared outcomes between CRCs after adjusting for potential confounders. Results. Among the 9,912 patients, 5,876 were transported to P-CRC and 4,036 to D-CRC from 2012 to 2014. Patients admitted to D-CRC showed better neurologic outcome than those admitted to P-CRC (6.2% vs 1.5%, p<0.001). With regard to patients who survived to admission, the neurologic outcome of patients in D-CRC was better than those in P-CRC (11.3% vs 3.3%, p<0.001). In the multivariable logistic model, the adjusted odds ratio for all OHCA patients was 2.10 (95% confidence interval, 1.51–2.95). Conclusion. Transportation of OHCA patients to the D-CRC resulted in significantly good neurologic outcome than those transported to P-CRC. Further research is needed to establish a regional OHCA transport protocol

Synergistic effects of gelatin and nanotopographical patterns on biomedical PCL patches for enhanced mechanical and adhesion properties

Biomedical patches have been known as important biomaterial-based medical devices for the clinical treatment of tissue and organ diseases. Inspired by the extracellular matrix-like aligned nanotopographical pattern as well as the unique physical and biocompatible properties of gelatin, we developed strength-enhanced biomedical patches by coating gelatin onto the nanopatterned surface of polycaprolactone (PCL). The relative contributions of the nanotopographical pattern (physical factor) and gelatin coating (chemical factor) in enhancing the mechanical and adhesive properties of PCL were quantitatively investigated. The nanotopographical pattern increased the surface area of PCL, allowing more gelatin to be coated on its surface. The biomedical patch made from gelatin-coated nanopatterned PCL showed strong mechanical and adhesive properties (tensile strength: ~14.5 MPa; Young&apos;s modulus: ~60.2 MPa; and normal and shear adhesive forces: ~1.81 N/cm2 and ~352.3 kPa) as well as good biocompatibility. Although the nanotopographical pattern or gelatin coating alone could enhance these physical properties of PCL in both dry and wet environmental conditions, both factors in combination further strengthened the properties, indicating the importance of synergistic cues in driving the mechanical behavior of biomedical materials. This strength-enhanced biomedical patch will be especially useful for the treatment of tissues such as cartilage, tendon, and bone

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar

The characteristics of pediatric emergency department visits in Korea: An observational study analyzing Korea Health Panel data.

OBJECTIVE:We investigated the characteristics of pediatric emergency department (ED) patients in Korea and determined factors associated with hospital admission after ED treatment. METHODS:Korea Health Panel data from 2008 through 2013 were analyzed retrospectively; we included patients under 18 years old who visited the ED at least once. We collected patient and household epidemiologic data such as sex, age group, region of residence, disability, chronic disease, household income quintile, national health insurance type, use of private insurance, and annual frequency of ED visits. We also examined data related to each ED visit, such as reason for visit, medical service provided, and hospital size/ownership. We then investigated which factors were correlated with case disposition (discharge home or hospital admission) after ED treatment. RESULTS:In total, 3,160 pediatric ED visits occurred during the six-year period. Males (57.5%) and children aged 0-5 years (47.7%) made more visits than females and older children, respectively. The proportion of ED visits for disease (67.7%) was much higher than for injury or poisoning (32.2%), and 452 cases (14.3%) required hospital admission. For hospital admission, the odds ratio (OR) of females was 0.73 compared to males, and the OR of children aged 6-11 was 0.68 compared to children aged 0-5. The OR of capital residents was 0.69 compared to province residents, and the OR of the highest income quintile was 0.51 compared to the lowest quintile. The OR of children with private insurance coverage was 0.49 compared to those lacking private insurance, and the OR of ED visits due to disease was 1.82 compared to visits due to injury/poisoning. CONCLUSION:This analysis of clinical and demographic characteristics of pediatric ED visits and hospital admissions can serve as the foundation of future prospective studies required for establishing appropriate policies for the Korean pediatric emergency medical system

Factors associated with transfer/admission and their odds ratio.

<p>Factors associated with transfer/admission and their odds ratio.</p

KHPS survey response rates.

<p>KHPS survey response rates.</p

Case characteristics during study period.

<p>Case characteristics during study period.</p