No abstract available.

No abstract available.
Suicide, Attempted*

No abstract available.
Hospitals, General* ; Humans ; Outpatients*

OBJECTIVES: Patient insight is a very important factor in the management of schizophrenia. Manic symptoms can occasionally be identified by the patient, even in cases of schizophrenia. The aim of this study is to examine the relationship among patient insight, the psychotic and manic symptoms, and the demographic clinical variables.METHODS: Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities were evaluated according to the Korean version of the Scale to assess Unawareness of Mental Disorder (SUMD-K), the Korean version of Mood Disorder Questionnaire (K-MDQ), and the Brief Psychiatric Rating Scale (BPRS).RESULTS: The mean number of previous admissions was 3.85. The mean CGI-S score was 3.8 and a significant negative correlation (r=0.26) was shown with “awareness of mental disorder”. Thirty-five percent of subjects were K-MDQ positive (cutoff point=7 or more). Among the SUMD-K, “awareness of effect of medication” showed a significant negative correlation (r=−0.33) with the total K-MDQ score, but not with the total BPRS score. The negative correlation was more obvious in participants with negative K-MDQ (total K-MDQ score 6 or less, r=−0.31).CONCLUSION: A possible relationship was observed between these manic symptoms and patient insight. Identification of manic symptoms in schizophrenia would be considerable in a clinical setting.
Brief Psychiatric Rating Scale ; Female ; Humans ; Mental Disorders ; Mental Health ; Mood Disorders ; Schizophrenia

BACKGROUND: Progression note is a critical source in patient care. It is used to evaluate physician performance as well as the quality of clinical care. However, the majority of medical schools do not formally teach how to write progression notes. Therefore, the purpose of this research was to determine the impact of feedback education on the quality of the students' progression notes. METHODS: A static group-comparison design was used to determine the quality of progression notes written by 64 students. 31 students received feedback, but the other 33 students did not. 219 patients' progression notes were selected for this study. Progression notes were blindly reviewed by the 3 faculty members. RESULTS: Progression notes from students who received feedback showed significantly higher scores than those students who did not received feedback(p<0.05). CONCLUSIONS: Our findings suggest that feedback education in writing progression notes needs to be integrated to improve quality of the notes.
Education* ; Humans ; Patient Care ; Schools, Medical ; Students, Medical* ; Writing

PURPOSE: The purpose of this study is to search for factors which can help in deciding on proper treatment for patients who visit the Emergency department (ED) with symptoms of foreign body ingestion. METHODS: This study was a retrospective review of medical records of ED patients with primary symptoms of foreign body ingestion. The patients' demographic data, elapsed time since the ingestion, type of foreign body, symptoms, and the method of removal were analyzed. Receiver operating characteristic (ROC) curve was used for analysis of whether these factors can be used to decide on proper treatment. RESULTS: Among 321 patients, a foreign body was removed successfully in 285 patients and the foreign body was not found in the remaining 36 patients. Of the successfully treated cases, 76 were removed grossly, 133 were removed using a laryngoscope, 74 were removed with endoscopy, and 2 were removed spontaneously. Comparing the group in which a foreign body was found and the other group, there was a significant difference in elapsed time since the onset of symptoms (p=0.013) and the type of foreign body (p=0.001). There was no significant reliable factor which can predict the existence of a foreign body. CONCLUSION: There was no significant factor which can predict the existence of a foreign body. Considering that the foreign body was found in most suspected patients, and that numerous patients in which a foreign body was not found had shown signs of complications due to foreign body, constructive treatment should be advocated.
Adult* ; Eating* ; Emergencies* ; Emergency Service, Hospital* ; Endoscopes ; Endoscopy ; Foreign Bodies ; Gastrointestinal Tract* ; Humans ; Laryngoscopes ; Medical Records ; Retrospective Studies ; ROC Curve

BACKGROUND: Several risk factors of atherosclerosis have been known. However, many patients have been experienced coronary heart disease without known risk factors of atherosclerosis, and it has been suggested that some kinds of infections may be associated with atherosclerosis as risk factors. Among many candidate infectious agents, Chlamydia pneumoniae (Cp) has been showing a positive relationship with atherosclerosis. Therefore, we investigated massive serologic study using a ELISA for detection of Cp to identify the relationship with atherosclerosis as a risk factor. METHODS: Serologic tests were done in patients who were performed coronary angiogram among patients with typical symptoms of angina and with positive results in non- invasive test (EKG, Treadmill) from May 1997 to September 1998. Among them, patients with luminal narrowing of more than 50% in at least one vessel were grouped into 'Case group (Group I)' and patients with normal coronary arteries or minimal lesion were grouped into 'Positive control group(Group II)'. We also studied healthy persons, as a 'Negative control group (Group III), who had not experienced any symptoms related with coronary heart disease and had normal EKG findings. Serologic tests for Cp-IgG and Cp-IgA were performed by ELISA. RESULTS: There was no statistical difference in seropositive rate between Group I and II, but seropositive rate of Group III was statistically lower than those of Group I or II for Cp-IgG, Cp-IgA, and both, respectively. But multivariate analysis by using logistic regression showed no statistcal differences between groups. Subgrouping by several traditional risk factors, seropositive rate for Cp-IgG and both IgG and IgA, was significantly different between Group I and III in patients without traditional risk factors of atherosclerosis, such as, females, non-smokers, normotension, non-diabetes, normal cholesterol level, and high HDL-cholesterol level. For Cp-IgA, however, the difference was observed in normotension, non-diabetes, and in normal cholesterol level. In multivariate analysis, seropositive rate for Cp-IgG and both IgG and IgA was significantly different between Group I and III in females and non-smokers, but not for the Cp-IgA. CONCLUSIONS: These results suggest that Cp infection might be an independent risk factor of atherosclerotic coronary disease, particularly in patients without traditional risk factors of atherosclerosis. Further study with coronary tissue should be continued.
Atherosclerosis* ; Chlamydia* ; Chlamydophila pneumoniae ; Cholesterol ; Coronary Disease ; Coronary Vessels ; Electrocardiography ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Logistic Models ; Multivariate Analysis ; Phenobarbital ; Risk Factors* ; Seroepidemiologic Studies* ; Serologic Tests

PURPOSE: To analyze the outcome of radiation therapy for patients with a metastatic carcinoma of cervical lymph nodes from an unknown primary (MUO), and identify the prognostic factors for these patients. MATERIALS AND METHODS: Between July 1981 and June 1999, 39 patients with MUO underwent radiation therapy with curative intent. Twelve patients were treated with radiation therapy alone (Group 1), 8 with neoadjuvant chemotherapy followed by radiation therapy (Group 2), and 19 with either an excision or neck dissection and postoperative radiation therapy (Group 3). There were 31 males and 8 females, with a median age of 55 years, ranging from 25 to 77 ears. The median duration of follow-up was 38 months, ranging from 3 to 249 months. RESULTS: The 5-year overall survival rate was 55%. According to the treatment modality, the 5-year disease-free survival rates of Groups 1, 2 and 3 were 48, 19 and 75%, respectively (p=0.0324). In addition to the treatment modality, the appearance of the primary site was a significant prognostic factor for disease-free survival (p=0.0085). CONCLUSION: Surgical resection and radiation therapy achieves a superior disease-free survival compared to radiation therapy alone, either with or without chemotherapy. Further investigation is needed to evaluate the role of chemotherapy in the treatment of MUO.
Disease-Free Survival ; Drug Therapy ; Ear ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Male ; Neck Dissection ; Survival Rate ; Treatment Outcome*

PURPOSE: To analyze the outcome of radiation therapy for patients with a metastatic carcinoma of cervical lymph nodes from an unknown primary (MUO), and identify the prognostic factors for these patients. MATERIALS AND METHODS: Between July 1981 and June 1999, 39 patients with MUO underwent radiation therapy with curative intent. Twelve patients were treated with radiation therapy alone (Group 1), 8 with neoadjuvant chemotherapy followed by radiation therapy (Group 2), and 19 with either an excision or neck dissection and postoperative radiation therapy (Group 3). There were 31 males and 8 females, with a median age of 55 years, ranging from 25 to 77 ears. The median duration of follow-up was 38 months, ranging from 3 to 249 months. RESULTS: The 5-year overall survival rate was 55%. According to the treatment modality, the 5-year disease-free survival rates of Groups 1, 2 and 3 were 48, 19 and 75%, respectively (p=0.0324). In addition to the treatment modality, the appearance of the primary site was a significant prognostic factor for disease-free survival (p=0.0085). CONCLUSION: Surgical resection and radiation therapy achieves a superior disease-free survival compared to radiation therapy alone, either with or without chemotherapy. Further investigation is needed to evaluate the role of chemotherapy in the treatment of MUO.
Disease-Free Survival ; Drug Therapy ; Ear ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Male ; Neck Dissection ; Survival Rate ; Treatment Outcome*

PURPOSE: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. METHODS: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. RESULTS: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. CONCLUSION: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.
Adult ; Amylases ; Anorexia ; Aspartate Aminotransferases ; Bilirubin ; Body Temperature ; Cholecystitis ; Cholecystitis, Acute* ; Creatinine ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Gangrene ; Humans ; Hypertension ; Leukocyte Count ; Lipase ; Logistic Models ; Male ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies