- Low-dose Intravenous N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy in Emergency Patients Undergoing Computed Tomography
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Tae Wan Lee, Ji-Hoon Kim, Seung Pil Choi
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J Korean Soc Clin Toxicol. 2017;15(2):122-130. Published online December 31, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.2.122
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 Abstract
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- Purpose: To evaluate the effects of low-dose intravenous N-acetylcysteine on the prevention of contrast-induced nephropathy (CIN) in patients undergoing computed tomography (CT). Methods: All patients presenting to our emergency department and undergoing CT with intravenous contrast media between August 2014 and April 2016 were retrospectively enrolled. We included hospitalized patients with renal dysfunction [estimated glomerular filtration rate (GFR) between 30 and $89mL/min/1.73m^2$]. A 600-mg injection of N-acetylcysteine was given to patients once before and once immediately after CT, depending on the preference of physician. The primary outcome was CIN defined as an increase in creatinine level of ${geq}25%$ or ${geq}0.5mg/dL$ from the baseline within 48 to 72 hours after CT. A trained person blindly reviewed all medical records. Results: Of the 1903 admitted patients, CIN occurred in 9.8% of patients who received 1200 mg intravenous N-acetylcysteine (24/244) and 6.8% of patients who did not (113/1659, p=0.090). In a multivariable regression analysis, N-acetylcystine was not relevant to the prevention of CIN (odds ratio=1.42 [95% CI, 0.90-2.26]). Even in the stratified analysis using the propensity score matching, N-acetylcysteine was irrelevant (GFR 30-59: odds ratio=1.06 [95% CI, 0.43-2.60]; GFR 60-89: odds ratio=1.76 [95% CI, 0.75-4.14]). After adjustment, crystalloids were significantly associated with the reduction in CIN compared with dextrose water (odds ratio=0.60 [95% CI, 0.37-0.97]). Conclusion: No effect was found when low-dose intravenous N-acetylcysteine was used to prevent CIN. However, there seems to be an association between crystalloids and reduction in CIN.
- Development and Validation of a Virtual Patient Simulator for the Management of Acute Poisoning: An Assessment of Face and Content Validity
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Ki Yong Kwon, Ji-Hoon Kim, Hyo Joon Kim
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Received November 11, 2024 Accepted January 23, 2025 Published online April 23, 2025
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DOI: https://doi.org/10.22537/jksct.2024.00009
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Abstract
- Purpose: This study describes the development of a virtual reality simulator to train medical staff responsible for acute poisoning in early diagnosis and treatment and presents an evaluation of its face and content validity.
Methods
Five clinical toxicology experts identified calcium channel blocker poisoning, neuroleptic malignant syndrome, ethylene glycol poisoning, methemoglobinemia, and organophosphate poisoning as the focus of scenario development. A three-dimensional virtual reality environment was created using a video game engine, with interaction taking place via a head-mounted display and hand controllers. Emergency physicians assessed the simulator, and a questionnaire survey was conducted to evaluate its face and content validity using a 10-point scale. The collected data were descriptively analyzed.
Results
Eighteen emergency physicians with an average age of 43.9 years old with 11.3 years of experience, evaluated the simulator. Thirteen (72.2%) had no prior experience with immersive virtual reality. The simulator’s realism and ease of operation were highly rated, averaging 9 points. The initial diagnosis and treatment training effectiveness, educational content clarity, and feedback were given scores of 10 points in some scenarios. The simulator’s usefulness as a training tool was rated 9 points. The lowest score (8 points) was given for clarity of interaction in four scenarios. Positive feedback highlighted the value of experiencing rare poisoning cases and receiving feedback on treatment.
Conclusion
A virtual patient simulator with five scenarios was developed to train medical staff responsible for cases of acute poisoning in the initial diagnosis and treatment. Emergency physicians evaluated the simulator aa realistic and stated that it would be effective in education.
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KSCT
Korean Society of Clinical Toxicology