Objectives: This study aims to determine the healthcare workers’ (HCWs) attitudes, perceptions, and practices regarding Antimicrobial Stewardship (AMS) at the Philippine Children's Medical Center (PCMC). Materials and Methods: This cross-sectional study employed a validated online survey. Results: The study included 288 healthcare workers, predominantly female (77.35% ) and aged 31-40 years (47.74%), with physicians being the largest professional group (57.14%). HCWs had positive attitudes toward AMS. They perceived moderate to high antimicrobial resistance (AMR) levels in different contexts but believed the hospital had lower AMR levels than the country. HCWs agreed that AMR impacts antimicrobial choices, patient outcomes, and safety. Contributors to AMR were prescribing inappropriate antimicrobials, unnecessary prescriptions, poor patient adherence, and inadequate infection control measures. HCWs, except medical technologists, were aware of the Antimicrobial Stewardship Program (ASP) and its interventions. Only nurses and pharmacists were aware of the hospital policies against AMR. Barriers to AMS implementation include inadequate training in antimicrobial use, lack of infectious disease/ microbiology services, lack of electronic medication management services, and personnel shortages. HCWs had high self-reported AMS practices, but a practice gap in single-dose surgical antibiotic prophylaxis was identified, with low physician adherence (50.6%). Conclusion This study revealed positive attitudes and high self-reported AMS practices among HCWs. They also perceived moderate to high AMR in different contexts but believed that the hospital has lower AMR levels than the country. Addressing the identified barriers to implementation and practice gaps is crucial for achieving antimicrobial stewardship goals.
Antimicrobial Stewardship ; Viperidae ; Health Personnel

PURPOSE: The standardized patient (SP) is a person carefully trained to represent a real patient case for consistent and accurate use in student performance evaluation and/or training, has added a very important dimension in OSCE. The purpose of this study is compared a well-trained professional SP (PSP) and a amateur SP (ASP) in OSCE. METHODS: We surveyed 378 students apprentices and staffs involving OSCE of Daegu-Kyungbuk Consortium and analysed the validity between the PSP and ASP after OSCE. RESULTS: Of 92 total stations in which students were evaluated by staff evaluator, SP were used in 47 stations (48%). Of the 47 stations, professional SP 7 stations (16%). The questionnaires were made to know the effectiveness and realistics of SP. The results were different between station used PSP and ASP. Moreover, it was significantly different between the staffs and the students. The SP can offer advantages such as availability, adaptability and effectivity. If trained well, they also can provide positive effects to the students and the staffs. The PSP provides efficient and reliable opportunity to assess clinical skills in a safe situation without any harm to the real patients. CONCLUSION: It is suggested that the use of SP is stimulating and challenging way of evaluating the OSCE. Also, It appeared to be financially and availably feasible if it commonly owned in the boundary of the land such Daegu-Kyungbuk Consortium.
Clinical Competence ; Humans ; Viperidae ; Surveys and Questionnaires

PURPOSE: Though web-based tests have many advantages, they do not become the main test form in medical education because of their many technical or operational limitations. We have developed a new web-based test system to overcome these limitations and, ultimately, to replace conventional paper and pencil tests. METHODS: We developed a web-based test system using a windows 2000 server, mySQL, visual basic 6.0 and ASP script as developing tools. We applied this system to formal examinations. The system was modified and optimized based on users' demands and problems identified during testing. RESULTS: Since web-based testing was first administered in 2003 to the third-year students during their clinical practice examinations, it has been used in 51 examinations at the College of Medicine in Chungbuk National University. In 2004, it was used in more than a half of the regular examinations at our medical college. At the beginning, lecturers were reluctant to adopt a new test system because of unfamiliarity and fear of additional workload. Shortly, however, they found that they were able to handle the multimedia contents more easily and obtain much information from results analysis without additional work. Examinees also favored web-based tests in presenting multimedia data but had some difficulties in focusing on the test. Overall, examinees' preference for web.based tests was comparable to conventional tests. According to user demand, we improved this test system by verifying question formats and making test analysis. CONCLUSION: Web-based tests can replace paper and pencil tests in medical education. Improvement of this testing system is expected with serious and continuous concerns from examiners.
Chungcheongbuk-do ; Education, Medical* ; Humans ; Multimedia ; Viperidae

One of the major clinical issues encountered after lumbar spinal fusion is the development of adjacent segment pathology (ASP) caused by increased mechanical stress at adjacent segments, and resulting in various radiographic changes and clinical symptoms. This condition may require surgical intervention. The incidence of ASP varies with both the definition and methodology adopted in individual studies; various risk factors for this condition have been identified, although a significant controversy still exists regarding their significance. Motion-preserving devices have been developed, and some studies have shown their efficacy of preventing ASP. Surgeons should be aware of the risk factors of ASP when planning a surgery, and accordingly counsel their patients preoperatively.
Humans ; Incidence ; Pathology* ; Risk Factors ; Spinal Fusion* ; Stress, Mechanical ; Viperidae

BACKGROUND/AIMS: We evaluated the status of antibiotic stewardship programs (ASPs) for physicians. This survey was a follow-up study of data from 2006 and was performed with some new questions about ASPs. METHODS: The online survey collected information on infectious diseases from doctors in 84 hospitals. The questions included some about ASPs. The data were analyzed and compared with a previous report. RESULTS: Responses came from 40 hospitals. ASPs existed in 87.5% of these (95.5% in 2006), and a computerized preauthorization system was the most common method (85.0%, 59.1% in 2006). An antimicrobial management team existed in 33 hospitals (82.5%), and the preauthorization systems were mainly implemented by infectious disease doctors (72.5%). Incentives to set up ASPs existed in only 12.5% of hospitals (2.3% in 2006). CONCLUSIONS: Computerized preauthorization ASP systems are relatively more common. To improve the uptake of ASPs in each hospital a team approach from the medical institutions is required, along with the cooperation and willingness of those involved.
Anti-Bacterial Agents ; Communicable Diseases ; Follow-Up Studies ; Motivation ; Viperidae

Recently, Wireless internet market has reached to the induction and growth stage by rapid development of Mobile service by fusion of Internet and wireless technology of communications. This paper improved the problem of a result report system of the donation of blood inspection which is delivered to the mail currently. We can confirm the result of the blood inspection to the execution. The user uses cellular phone taking the security of the individual into account. We used ASP language with WML and developed in this paper, Database used MS-SQL2000 Servr and Web server used a host server which offers Mnuri.
Cellular Phone ; Internet ; Postal Service ; Viperidae ; Wireless Technology

BACKGROUND: Resistance of Mycobacterium tuberculosis to anti-tuberculosis (TB) drugs is almost exclusively due to spontaneous chromosomal mutations in target genes. Rapid detection of drug resistance to both first- and second-line anti-TB drugs has become a key component of TB control programs. Technologies that allow rapid, cost-effective, and high-throughput detection of specific nucleic acid sequences are needed. This study was to develop a high-throughput assay based on allele-specific primer extension (ASPE) and MagPlex-TAG microspheres to detect anti-TB drug resistance mutations. METHODS: DNA samples from 357 M. tuberculosis clinical isolates and H37Rv were amplified by multiplex PCR using four primer sets, followed by multiplex ASPE using 23 TAG-ASPE primers. The products were sorted on the TAG-ASPE array and detected by using the Luminex xMAP system. Genotypes were also determined by sequencing. RESULTS: Genetic drug susceptibility typing by the TAG-ASPE method was 100% concordant with those obtained by sequencing. Compared with phenotypic drug susceptibility testing (DST) as a reference method, the sensitivity and specificity of the TAG-ASPE method were 83% (95% confidence interval [CI], 79-88%) and 97% (95% CI, 90-100%) for isoniazid. For rifampin testing, the sensitivity and specificity were 90% (95% CI, 86-93%) and 100% (95% CI, 99-100%). Also, the sensitivity and specificity were 58% (95% CI, 51-65%) and 86% (95% CI, 79-93%) for ethambutol. CONCLUSIONS: This study demonstrated the TAG-ASPE method is suitable for highly reproducible, cost-effective, and high-throughput clinical genotyping applications.
DNA ; Drug Resistance* ; Ethambutol ; Genotype ; Isoniazid ; Microspheres ; Multiplex Polymerase Chain Reaction ; Mycobacterium tuberculosis ; Rifampin ; Tuberculosis ; Viperidae

PURPOSE: Cyanate, known as one of the uremic toxins and derived spontaneously from urea, has several effects on the biologic substances including erythropoietin, antioxidant and ceruloplasmin. To find out the protective materials from the hazardous effect of cyanate in osteoblast, we added twenty amino acids, albumin globulin and hemoglobin in the culture media containing osteoblastic cells with cyanate. METHODS: Osteoblastic ROS 17/2.8 cells, exposed to various concentrations of sodium cyanate, were used to analyze for the cytotoxicity. The cyanate-induced cytotoxicity was assessed by the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay by measuring the absorbance of the reaction solution at 570 nm. Viability of the treated cells was expressed as A570 of sample/A570 of control. The degree of the carbamylation was measured using trinitrobenzenesulphonic acid. The degree of the carbamylation in amino acid was about 50% in average. RESULTS: The degree of the carbamylation in albumin was increased depending on the incubation time with cyanate and the concentration of the cyanate. The degree of the carbamylation in globulin and hemoglobin was nearly zero. Asp, Glu, Leu, Trp and Tyr among the twenty amino acids revealed the protective effect against the damage induced by cyanate. And only albumin among the three proteins revealed the protective effect. CONCLUSION: On the basis of these results, Asp, Glu, Leu, Trp, Tyr and albumin are useful tools for the protection against damages by cyanate carbamylation.
Albumins ; Amino Acids* ; Ceruloplasmin ; Culture Media ; Cyanates ; Erythropoietin ; Osteoblasts* ; Sodium ; Urea ; Viperidae

An alveolar soft part sarcoma(ASPS) is a rare malignant soft tissue tumor, which metastasizes to the lung, bone and brain. Recently, we encountered an unusual case of a metastatic ASPS to the bilateral breasts in a 27-year-old woman. She had undergone surgery for an ASPS in her right thigh two years ago, which metastasized to the breast on three occasions, 15 months, 20 months and two years after surgery.
Adult ; Brain ; Breast ; Female ; Humans ; Immunohistochemistry ; Lung ; Neoplasm Metastasis* ; Sarcoma, Alveolar Soft Part* ; Thigh ; Viperidae

The purpose of this study was to investigate the fluoroquinolone resistance frequency of Enterococcus spp. from normal chicken feces and to analyse mutations of the gyrA and parC gene associated with fluoroquinolone resistance. Among 52 Enterococcus faecalis and 25 E. faecium isolates, 23 (44.2%) E. faecalis and 7 (28.0%) E. faecium were resistant to ciprofloxacin (CIP) by disc diffusion method. Genetic exchange in gyrA and parC gene among 2 CIP intermediate isolates and 15 CIP resistant isolates were found in the amino acid codon of Ser-83 and Asp-87, and Ser-80 and Glu-84, respectively. These mutants contained a change from Ser to Phe, Val, Tyr, Ile, Thr or Pro at codon 83 and from Glu to Gly or Leu at codon 87 in gyrA gene, and a change from Ser to Ile or Thr at codon 80 and from Glu to Asp or Lys at codon 84 in parC gene. The isolates with mutation in gyrA regardless of a mutation in parC showed high resistance (MIC > or =32 microgram/ml) to CIP, enrofloxacin, norfloxacin and ofloxacin. These results suggested that gyrA gene is the primary target for 4 fluoroquinolones resistance in Enterococcus spp.
Chickens* ; Ciprofloxacin ; Codon ; Diffusion ; Enterococcus faecalis ; Enterococcus* ; Feces* ; Fluoroquinolones ; Norfloxacin ; Ofloxacin ; Viperidae