Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.ope

sH 하이드레이트 시스템에서 이산화탄소와 천연가스의 맞교환 현상에 대한 열역학 및 분광학적 해석

학위논문(석사) - 한국과학기술원 : 생명화학공학과, 2007.2, [ ix, 64 p. ]$^{13}C$ NMR spectra were obtained for sH isopentane + $CH_4$ hydrate and MCH + $CH_4$ hydrate and compared with liquid isopentane and MCH spectra in order to analyze the conformation of acyclic large guest molecules. For isopentane + $CH_4$ hydrate, the resonance line shifting was detected between isopentane in hydrate and liquid isopentane, in the other hand, any shifting was not detected between MCH in hydrate and liquid MCH. The differences in the chemical shifts between sH hydrate and liquid isopentane was checked through the use of a hydrogen-hydrogen steric perturbation model. In addition $^{13}C$ NMR spectra were also obtained for the replacement processes of $CH_4$ sH hydrates using pure $CO_2$ and $N_2$ + $CO_2$ mixture. Structure transitions were observed while the replacement processes proceeded, and the effect of $N_2$ for attacking sI-S was also found. Additionally, GC data and Raman spectroscopy for $N_2$ + $CO_2$ replacement processes were obtained, and no Raman peaks for $N_2$ and $CO_2$ in sH-M were detected. From the overall results, we concluded that one of the smallest acyclic guest molecules, isopentane, participating in the formation of a structure-H clathrate hydrate is encaged, confirming the gauche conformation in large cavities, and that the overall replacement of sH hydrate proceeds slowly, but that the lattice structure of the replaced hydrate changes into sI very rapidly.한국과학기술원 : 생명화학공학과