No abstract available.
Abscess* ; Thyroid Gland*

Pillows are known to contain significant levels of indoor allergens and endotoxin, that are of importance to house dust mite sensitized asthmatics. Buckwheat pillows are commonly used in Korea. We studied the levels of the house dust mite allergen, Der f 1, and endotoxin on new synthetic and buckwheat pillows and their accumulation over three months. Endotoxin levels were significantly higher on new buckwheat pillows compared to synthetic pillows; geometric mean levels (95% CI) were 60,950 EU/g (30,270-122,700) and 4,887 EU/g (2,570-9,311) respectively (p<0.001). No Der f 1 was detected on the new pillows. After three months Der f 1 levels were similar on buckwheat and synthetic pillows, geometric mean levels (95% CI) were 1.16 microgram/g (0.02-8.13) and 1.08 microgram/g (0.19-1.68) respectively. These results indicate that buckwheat pillows are a source of very high endotoxin levels that may be of relevance to asthma severity of atopic asthmatics.
Allergens/*immunology ; Animals ; Antigens, Dermatophagoides/*immunology ; Asthma/immunology ; *Bedding and Linens ; *Buckwheat ; Dermatophagoides farinae/immunology ; Endotoxins/*immunology ; Humans ; Korea ; Research Support, Non-U.S. Gov't

About a third of the patients with decompensated liver cirrhosis have reduced arterial oxygen saturation and are sometimes cyanosed in the absence of any apparent lung or heart disease; There is a reduction of diffusing capacity without a restrictive ventilatory defect. The aim of this study was to determine diffusing capacities in patients with chronic liver- diseases. The diffusing capacities and arterial oxygen saturations were measured in 25 patients with chronic active hepatitis(CAH), 9 early cirrhotics (early LC), 36 cirrhotics(Child's class A) and 11 cirrhotics(Child's class B). The anterior tibial area was observed for pitting edema, and Thallium-201 test per rectum(shunt index) was done. Hypoxemia was not observed in all subjects. The number of cases with decreased pulmonary diffusing capacity (DLco) is 3/25(12.0%) for CAH, 3/9(33.3%) for CAH with early liver cirrhosis(LC), 17/36(47.2%) for LC(Child's class A) and 6/11(54.5%) for LC(Child's class B). The mean+/-standard deviation of Dlco(% predicred) are 93.1+/-12.1 for CAH, 85.7+/-12.3 for CAH with early LC, 82.2+/-14.7 for LC(Child's class A) and 80.4+/-6.9 for LC(Child's class B), There is a significant difference between DLco in CAH and that in LC(Child's class A)(p<0.01). Patients with higher shunt index(>0.3) had significantly lower DLco than these with lower shunt index(<0.3)(76.4+/-9.7% vs. 89.3+/-13.3%)(p<0.01). The DLco was also lower in patients with pitting edema(77.3+/-10.2%) than in those without pitting edema(85.5+/-13.8%) (p<0.01). These results summarized that the DLco was low in patients with cirrhosis and with higher shunt index(>0.3) or pitting edema. This may be due to an increased systemic blood flow shunt and an increased generalized interstitial edema. Pulmonary function tests including diffusing capacity may be useful as prognostic parameters in patients with chronic liver disease, especially in those with CAH or early LC.
Anoxia ; Edema ; Fibrosis ; Heart Diseases ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Oxygen ; Pulmonary Diffusing Capacity* ; Respiratory Function Tests

Purpose: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data. Methods: The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling. Results: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint. Conclusion Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.

OBJECTIVE: To examine the association between hospital procedure volume and treatment outcomes following allogeneic bone marrow transplantation (allo-BMT). METHODS: Out of 1, 050 patients who received allo-BMTs between 1998 and 2000 in 21 Korean hospitals, 752 with first allo-BMT and complete data were included in this study. Study subjects were divided into the following three groups according to cumulative hospital experience of all-BMTs during the study period: low (< 30 cases), medium (30-49) and high (> or =50 cases) volume. Patient outcome was defined as early survival at day 100 and one-year survival. Multiple logistic regression analyses were performed to examine the association between hospital experience and survival at day 100 and one year. RESULTS: When the low volume group was defined as the reference group, the adjusted relative risks (RR) of survival at day 100 for the high volume group were 2.46 (95% CI, 1.13-5.36) for all patients, 2.61 (1.04-6.57) for those with leukemia, and 2.20 (0.47-10.32) for those with aplastic anemia. For one-year survival, adjusted RR for the high volume group were 2.52 (1.40-4.51) for all patients, 1.99 (1.01-3.93) for leukemia, and 6.50 (1.57-26.80) for aplastic anemia. None of the RR for the medium volume group was statistically significant. Patient factors showing significant relationship with survival were donor-recipient relation, human leukocyte antigen matching status, time from diagnosis to transplant, and disease stage. CONCLUSION: The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.
Anemia, Aplastic ; Bone Marrow Transplantation* ; Bone Marrow* ; Diagnosis ; Humans ; Leukemia ; Leukocytes ; Logistic Models

OBJECTIVES: To investigate the current status of hospital-based health promotion programs in Korea and to elucidate the factors which affect to the process of implementation. METHODS: We conducted a mail survey of all 875 hospitals in Korea from March to May 2001. In reference to 12 specific kinds of health promotion programs, hospital CEOs were asked whether their hospital have such programs, whether they are fully staffed and whether the program is paid for by the patients. Contextual factors(location, hospital type, number of beds, length of operation, public/private status, economic level of the community, the level of competition) and organizational factors (the extent of market, compatibility with vision, formalization), strategic types of the CEOs (defender/analyser/prospector) were also surveyed. The relationships between each variable and the implementation of health promotion services, activation of services, and the target groups(patient/community resident) were analyzed by univariate analysis and the independent effects of these variables were examined with multiple logistic regression. RESULTS: 106 of 125 hospitals responding (84.8%) had more than one health promotion program. However, they showed fluctuations in the adoption rate of each programs, meaning that comprehensive health promotion services were not provided. Many programs were not fully staffed and few hospitals had paid programs. In factors affecting health promotion service implementation, private hospitals showed a higher rate in implementation than public hospitals. In contrast, when the competition among nearby hospitals was intense, the level of implementation of service lowered. In the strategic type of the CEOs, the prospectors were shown to have instituted more health promotion programs in their hospitals and the analysers had a greater tendency to have programs for community residents than the defenders. CONCLUSION: Considering the above results, contextual factors may contribute greatly to the introduction of health promotion services in Korean hospital, although the CEO's personal preference and organizational factors play a larger role in the activation of services. Additionally, the CEO's personal preference may be the major influencing factor in the introduction of programs for community residents.
Chief Executive Officers, Hospital ; Health Promotion* ; Hospital Administration ; Hospitals, Private ; Hospitals, Public ; Humans ; Korea* ; Logistic Models ; Organizational Innovation ; Postal Service

No abstract available.
Humans

No abstract available.
Cytarabine* ; Cytosine* ; Drug Therapy, Combination* ; Idarubicin* ; Leukemia, Myeloid, Acute*

OBJECTIVES: To examine the prophylactic antibiotic use in reducing surgical site infection. METHODS: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. RESULTS: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. CONCLUSIONS: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.
Adolescent ; Adult ; Antibiotic Prophylaxis/*standards ; Female ; Humans ; Male ; *Quality Indicators, Health Care ; Republic of Korea ; Retrospective Studies ; Surgical Wound Infection/*prevention & control ; Young Adult

BACKGROUND: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. METHODS: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. RESULTS: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. CONCLUSION: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.
Heart ; Humans ; Insurance, Health ; Korea ; Logistic Models ; Methods ; Mortality ; Quality of Health Care ; Thoracic Surgery ; Treatment Outcome*