Adult ; Female ; Humans ; Interviews as Topic ; Kidney ; surgery ; Kidney Transplantation ; statistics & numerical data ; Living Donors ; statistics & numerical data ; Male ; Middle Aged

BACKGROUND: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. METHODS: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. RESULTS: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). CONCLUSIONS: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.
Dexamethasone ; Drug-Related Side Effects and Adverse Reactions ; Epidural Space ; Fluoroscopy ; Flushing ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Low Back Pain ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Spine ; Steroids ; Urticaria

PURPOSE: Amendment to the Act on Decisions on Life-sustaining Treatment was recently enacted to designate long-term care hospitals as providers of hospice and palliative care. Despite its benefit of providing improved accessibility to end-of-life care, the amendment has raised concerns about its effect on quality of service. This study aimed to use information obtained from an expert group interview and previous studies to compare how cancer patients, family caregivers, physicians, and the general Korean population perceive the potential benefits and risks of this amendment.METHODS: We conducted a multicenter cross-sectional study from July to October 2016. The included participants answered a structured questionnaire regarding the extent to which they agree or disagree with the questionnaire items indicating the potential benefits and risks of the amendment. Chi-square tests and univariate and multivariate logistic regression analyses were performed.RESULTS: Compared with the general population, physicians agreed more that long-term care hospitals are currently not adequately equipped to provide quality hospice and palliative care. Family caregivers found improved access to long-term care hospitals more favorable but were more likely to agree that these hospitals might prioritize profits, thereby threatening the philosophy of hospice care, and that families might cease to fulfill filial responsibilities. Compared with the general population, cancer patients were more concerned about the potentially decreased service quality in this setting.CONCLUSION: Although potential service beneficiaries and providers expected improved accessibility of hospice and palliative care services, they were also concerned whether the system can provide adequate quality of end-of-life care.
Caregivers ; Cross-Sectional Studies ; Health Personnel ; Hospice Care ; Hospices ; Humans ; Interviews as Topic ; Logistic Models ; Long-Term Care ; Palliative Care ; Philosophy ; Risk Assessment ; Terminal Care

PURPOSE: The aim of this study was to analyze an injury scene during fly fish boat riding (FBR).METHODS: We conducted survey on 12 patients who had humerus shaft fractures during FBR between 2011 and 2016 at three university-based emergency rooms. Individual information, injury mechanism, classification of humerus shaft fracture, and combined injury were recorded from medical document and telephone interview.RESULTS: The injury happened when the kite was turned over and fall into the water in 10 patients (82%); the kite was turned over in the air in one patient (9%), and a leash between kite and boat was broken in one patient (9%). All patients showed 12-B1 or 12-B3 type distal humerus shaft fracture. And there were combined contralateral distal humeral shaft fractures in two patients, vertebral compression fracture in one patient, and radial nerve injury in four patients.CONCLUSION: Riding position and injury mechanism such as turning over may affect distal humerus shaft fractures with butterfly fragment during FBR.
Butterflies ; Classification ; Diptera ; Emergency Service, Hospital ; Fractures, Compression ; Humans ; Humeral Fractures ; Humerus ; Interviews as Topic ; Radial Nerve ; Ships ; Water

This paper offers a selective overview of the increasingly popular paradigm of qualitative research. We consider the nature of qualitative research questions, describe common methodologies, discuss data collection and analysis methods, highlight recent innovations and outline principles of rigour. Examples are provided from our own and other authors' published qualitative medical education research. Our aim is to provide both an introduction to some qualitative essentials for readers who are new to this research paradigm and a resource for more experienced readers, such as those who are currently engaged in a qualitative research project and would like a better sense of where their work sits within the broader paradigm.
Anthropology, Cultural ; Data Collection ; Education, Medical ; Grounded Theory ; Humans ; Interviews as Topic ; Qualitative Research ; Research Design

OBJECTIVE: The risk of developing endometrial cancer (EC) and/or survival following a diagnosis of EC might differ by tumor DNA mismatch repair (MMR) status. We assessed the association between tumor MMR status (classified as MMR-proficient, somatic MMR-deficient, germline MMR-deficient) and the risk of developing EC and survival following a diagnosis of EC. METHODS: We analyzed data from women who participated in the Australian National Endometrial Cancer Study (ANECS) conducted between 2005 and 2007. Risk analyses (698 cases/691 population controls) utilized sociodemographic and lifestyle information obtained from telephone interviews at recruitment. For survival analyses (728 cases), patients' clinical data was abstracted from medical records, and survival data were obtained via linkage with the Australian National Death Index. We used logistic regression analysis to evaluate the associations between tumor MMR status and EC risk, and proportional hazards models to perform survival analyses with adjustment of known prognostic factors. RESULTS: Established risk factors for EC did not differ significantly by tumor MMR status. In analyses including all EC subtypes, overall and EC-specific survival did not differ by tumor MMR status. Among women with the most common endometrioid subtype, EC-specific survival was worse for women with somatic MMR-deficient EC compared to women with MMR-proficient EC (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.19–4.01). CONCLUSION: The risk of EC is not associated with MMR status. Accurate separation of germline from somatic causes of MMR deficiency suggests that patients with endometrioid subtype somatic MMR-deficient tumors have poorer EC-specific survival than those with MMR-proficient tumors, after accounting for other prognostic factors.
Diagnosis ; DNA Mismatch Repair ; Endometrial Neoplasms* ; Female ; Humans ; Interviews as Topic ; Life Style ; Logistic Models ; Medical Records ; Proportional Hazards Models ; Risk Factors

BACKGROUND: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. METHODS: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. RESULTS: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Pre-program attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. CONCLUSION: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
Capacity Building ; Delivery of Health Care* ; Education ; Female ; HIV* ; Humans* ; Infection Control ; Interviews as Topic ; Mentors ; Methods* ; Occupational Health* ; South Africa ; Tuberculosis*

OBJECTIVE: Delayed neuropsychiatric sequelae (DNS) following carbon monoxide (CO) poisoning, which may result from a demyelinating leukoencephalopathy, is a disease with a poor prognosis. This study examined the factors affecting the long-term prognosis of DNS and the efficacy of hyperbaric oxygen therapy (HBOT) in patients with DNS. METHODS: This retrospective study included 84 patients with DNS following CO poisoning from January 2013 to June 2016. HBOT was given to 24 patients. The patients were divided into an improvement group and non-improvement group based on their clinical condition on a telephone interview at intervals between 3 months and 3 years after the onset of DNS. The improvement group was defined as having Cerebral Performance Category (CPC) scores in their daily life that improve to 1 or 2 grade. RESULTS: Of the 594 patients, DNS were found in 18.2%, and 70.2% (59 of 84) of the patients with DNS improved. The prognostic factors for the improvement of DNS were an age of 45 years or less (odds ratio [OR], 12.068; 95% confidence interval [CI], 2.393–60.858; P < 0.005), CPC score of 1 or 2 group at the time of DNS onset (OR, 12.361; 95% CI, 3.161–48.330; P < 0.005), and a lucid interval longer than 20 days (OR, 5.164; 95% CI, 1.393–19.141; P < 0.01). HBOT was not associated with the improvement of DNS in CO poisoning (OR, 0.467; 95% CI, 0.172–1.269; P>0.1). CONCLUSION: Patients aged less than 45 years, low grade CPC score of 1 and 2, and lucid interval longer than 20 days are more likely to have a good prognosis. On the other hand, HBOT failed to produce a benefit for DNS patients.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Hand ; Humans ; Hyperbaric Oxygenation ; Interviews as Topic ; Leukoencephalopathies ; Poisoning ; Prognosis ; Retrospective Studies

OBJECTIVE: Mild cognitive impairment (MCI) has high conversion risk to dementia. However, it is not easy to detect amnestic MCI patient early in the community. This study aimed to evaluate the three-stage design for early detection of amnestic MCI in the community. METHODS: Overall 4,385 persons participated who were already registered with Mini Mental Status Examination (MMSE) evaluation. It was conducted in Nam-Gu district, one of the 5 districts of Gwangju, Korea from Jan 1, 2017 to May 31, 2017. We first screened them applying inclusion criteria of over 5-year education and age, gender, education adjusted norm based MMSE Z score between −1.5 and 0. Second stage assessments were done by telephone interviews with asking subjective memory complaints and 5 words list recall tests. And 3rd stage evaluation of neuropsychological tests and clinical interview with visit were performed. RESULTS: We screened 456 of the 4,385 persons and 2nd stage included 51 of the 211 participants telephone interview completed. Twenty-four individuals visited clinic center for 3rd stage evaluation. We finally diagnosed 17 MCI including 16 amnestic MCI and 1 non-amnestic MCI. CONCLUSION: Our three-stage evaluation detected 16 amnestic MCI patients of the 4,385 community dwelling persons with primary screening of MMSE. Our study suggests that this three-stage performance could be effective for early detection of amnestic MCI in large sample community.
Dementia ; Education ; Gwangju ; Humans ; Independent Living ; Interviews as Topic ; Korea ; Mass Screening ; Memory ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Program Development*

BACKGROUND: Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF. METHODS: During the years 2003–2012, 282 injured individuals aged 20–55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment. RESULTS: Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626–25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092–6.720) were identified as independent predictive factors of full RTW. CONCLUSION: PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.
Employment ; Greece ; Hospitalization ; Humans ; Informed Consent ; Interviews as Topic ; Logistic Models ; Occupational Health ; Quality of Life ; Retrospective Studies ; Return to Work* ; Sports ; Tertiary Care Centers