Triage is a process to accurately assess and classify symptoms to identify and provide rapid treatment to patients. The Korean Triage and Acuity Scale (KTAS) is used as a triage instrument in all emergency centers. The aim of this study was to train and compare machine learning models to predict KTAS levels. This was a cross-sectional study using data from a single emergency department of a tertiary university hospital. Information collected during triage was used in the analysis. Logistic regression, random forest, and XGBoost were used to predict the KTAS level. The models with the highest area under the receiver operating characteristic curve (AUROC) were the random forest and XGBoost models trained on the entire dataset (AUROC = 0.922, 95% confidence interval 0.917-0.925 and AUROC = 0.922, 95% confidence interval 0.918-0.925, respectively). The AUROC of the models trained on the clinical data was higher than that of models trained on text data only, but the models trained on all variables had the highest AUROC among similar machine learning models. Machine learning can robustly predict the KTAS level at triage, which may have many possibilities for use, and the addition of text data improves the predictive performance compared to that achieved by using structured data alone.

Background: South Korea took preemptive action against coronavirus disease (COVID-19) by implementing extensive testing, thorough epidemiological investigation, strict social distancing, and rapid treatment of patients according to disease severity. The Korean government entrusted large-scale hospitals with the operation of living and treatment support centers (LTSCs) for the management for clinically healthy COVID-19 patients. Objective: The aim of this paper is to introduce our experience implementing information and communications technology (ICT)-based remote patient management systems at a COVID-19 LTSC. Methods: We adopted new electronic health record templates, hospital information system (HIS) dashboards, cloud-based medical image sharing, a mobile app, and smart vital sign monitoring devices. Results: Enhancements were made to the HIS to assist in the workflow and care of patients in the LTSC. A dashboard was created for the medical staff to view the vital signs and symptoms of all patients. Patients used a mobile app to consult with their physician or nurse, answer questionnaires, and input self-measured vital signs; the results were uploaded to the hospital information system in real time. Cloud-based image sharing enabled interoperability between medical institutions. Korea’s strategy of aggressive mitigation has “flattened the curve” of the rate of infection. A multidisciplinary approach was integral to develop systems supporting patient care and management at the living and treatment support center as quickly as possible. Conclusions: Faced with a novel infectious disease, we describe the implementation and experience of applying an ICT-based patient management system in the LTSC affiliated with Seoul National University Hospital. ICT-based tools and applications are increasingly important in health care, and we hope that our experience will provide insight into future technology-based infectious disease responses.

Background: A recently introduced tricuspid annuloplasty ring, the MC3 ring, has a 3-dimensional form that is designed to remodel the tricuspid valve annulus. The aim of this study was to investigate its clinical performance. Methods and Results: From December 2004 to April 2008, 103 patients underwent tricuspid annuloplasty using the MC3 ring (mean age, 52±13 years; 63.6% women). The average preoperative tricuspid regurgitation (TR) grade was 2.5±0.8, and the mean preoperative systolic pulmonary artery pressure was 48.4±15.0 (24-88) mmHg; the mean follow-up was 26.7±11.2 (0-52) months. One patient died after surgery (1.0%), because of cor pulmonale. No MC3 ring-related complications, such as, atrioventricular block, ring dehiscence or thromboembolism, were encountered. Predischarge echocardiography showed a significant decrease in the TR grade (2.5±0.8 to 0.8±0.8, respectively; P<0.001). After a median 15 months, the mean TR grade was stable (0.9±0.8). The mean systolic pulmonary artery pressure was also lower than its preoperative value (33.9±7.9 vs 48.4±15.0 mmHg, respectively; P<0.001). Conclusions: The MC3 ring provides good mid-term clinical and echocardiographic results for TR. However, long-term follow-up is mandatory to confirm the stability of this procedure. (Circ J 2010; 74: 278-283)

The benefits of concomitant tricuspid annuloplasty (TAP) for non-significant functional tricuspid regurgitation (TR) during mitral valve replacement (MVR) are controversial. We evaluated the long-term outcomes—particularly the long-term tricuspid valve (TV) functional outcomes—of MVR with or without tricuspid ring annuloplasty. From 2004 to 2014, 256 patients (56.4 ± 12.1 years) with trivial or mild functional TR who underwent MVR were enrolled. Eighty-two patients underwent concomitant tricuspid ring annuloplasty (TAP group), and 174 patients did not undergo the TV procedure (nTAP group). Propensity score-matched analysis was performed (n = 72 in each group). The follow-up duration was 77.4 ± 42.4 months. The early clinical outcomes were similar between the 2 groups before and after propensity score matching with an early mortality rate of 3.5% (9 of 256). No patients experienced ring-related complications during follow-up. Eleven (6.3%) patients developed significant TR (≥moderate) in the nTAP group, while no patients developed significant TR in the TAP group. There were no significant differences in overall survival between the 2 groups before or after matching. However, propensity score-matched analysis revealed that the freedom from significant TR aggravation and freedom from TV-related event rates were significantly higher in the TAP group than in the nTAP group (P = 0.047 and P = 0.043, respectively). Patients with untreated trivial or mild functional TR accompanied by mitral valve disease can develop significant TR during follow-up. TV ring annuloplasty can be performed without complications and can be beneficial for patients with trivial or mild functional TR who are undergoing MVR.