Hospitals are increasingly concerned with the construction of computer-based medical order communication system (MOCS), despite the fact that they are financially being pressed. With limited budget, management in hospitals ought to be pursuing both methodologically effective and technically sound way of constructing MOCS. This paper intends to contribute itself toward better design of database for MOCS with reference to a university hospital. Some structural characteristics pertaining to MOCS are identified in ways of systems approach. Based on those findings, construction methodologies are reviewed and put forward with flexibility to differing requirements of hospitals. Suggestions include the followings. (1) Designing step has to be distinguished among conceptual, logical, and physical design while prototyping for user interface is utilized only for the logical design. (2) Many modeling tools including entity life cycle diagram can be effective for system integration with other units. (3) 3 different types of distributed database servers are recommended.
Budgets ; Computer Communication Networks ; Hospital Information Systems* ; Life Cycle Stages ; Logic ; Pliability

Hospitals are increasingly concerned with the construction of computer-based medical order communication system (MOCS), despite the fact that they are financially being pressed. With limited budget, management in hospitals ought to be pursuing both methodologically effective and technically sound way of constructing MOCS. This paper intends to contribute itself toward better design of database for MOCS with reference to a university hospital. Some structural characteristics pertaining to MOCS are identified in ways of systems approach. Based on those findings, construction methodologies are reviewed and put forward with flexibility to differing requirements of hospitals. Suggestions include the followings. (1) Designing step has to be distinguished among conceptual, logical, and physical design while prototyping for user interface is utilized only for the logical design. (2) Many modeling tools including entity life cycle diagram can be effective for system integration with other units. (3) 3 different types of distributed database servers are recommended.
Budgets ; Computer Communication Networks ; Hospital Information Systems* ; Life Cycle Stages ; Logic ; Pliability

OBJECTIVES: The purpose of this study was to describe the status of mental activity participation in community-dwelling elderly and to evaluate the association between mental activity and cognitive function after adjustment for depression and anxiety. METHODS: This study was based on the Suwon Project, which was a cohort comprising of nonrandom convenience samples of ethnic Koreans aged 60 years and above. All the subjects completed the study questionnaire including their demographic characteristics, current and past illnesses history, drug history, Korean version-Mini Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale (SGDS-K), Beck Anxiety Inventory (BAI). We checked how many hours per day are used for each items of 11 mental activities through the checklist. RESULTS: Total time spent in 11 mental activities was 237.4+/-152.4 minutes per day. On multiple regression analysis, total time spent in 11 mental activities (MA-total), and time spent by watching television and reading book/newspaper showed statistically significant association with K-MMSE score after adjustment with age, sex, education, chronic medical illness, depression and anxiety. CONCLUSION: Our result suggested that mental activity may be associated with cognitive function in the elderly without cognitive impairment in the community after adjusting age, sex, education, chronic medical illness, depression and anxiety.
Aged ; Anxiety ; Cognition ; Cohort Studies ; Depression ; Humans ; Surveys and Questionnaires ; Television ; Periodicals

PURPOSE: We performed this study to determine the value of pharmacoerection with PGE1 for measurement of conduction velocity in the dorsal penile nerve and to identify the change in sensation in the glans penis between th pre-erection and posterection state. MATERIALS AND METHODS: We studied 14 patients with psychogenic impotence and premature ejaculation (mean age 45.2+/-6.5 years) who had no evidence of neurologic deficit and responded with a full erection lasting more than 1 hour to PGE1 injection. We measured penile length, penile temperature, sensory threshold of the glans penis to electrical stimulation, BCRL, pudendal sensory evoked potential (SEP), and dorsal nerve conduction velocity and amplitude before, directly after, and 1 hour after erection induced using PGE1(15~20 microgram). RESULTS: Neither PGE1 nor prolonged erection had any effect on the sensory threshold of glans penis, BCRL, pudendal SEP, or amplitude of the dorsal verve. Only the dorsal nerve conduction velocity changed. We could check the conduction velocity after erection in therr cases in which these values were not available at rest. CONCLUSIONS: Given the absence of change in the sensory condition of the glans penis, pharmacoerection using PGE1 has no effect on premature ejaculation except to prolong the erection state. Pharmacoerection seems to be the best method of calculating dorsal nerve sensory conduction velocity and amplitude, It can replace th normal erection state and also help in obtaining a recordable potential when this measurement is technically difficult at rest.
Alprostadil* ; Electric Stimulation ; Erectile Dysfunction ; Evoked Potentials ; Humans ; Male ; Neural Conduction* ; Neurologic Manifestations ; Penis* ; Premature Ejaculation ; Pudendal Nerve ; Sensation ; Sensory Thresholds*

PURPOSE: We performed this study to determine the value of pharmacoerection with PGE1 for measurement of conduction velocity in the dorsal penile nerve and to identify the change in sensation in the glans penis between th pre-erection and posterection state. MATERIALS AND METHODS: We studied 14 patients with psychogenic impotence and premature ejaculation (mean age 45.2+/-6.5 years) who had no evidence of neurologic deficit and responded with a full erection lasting more than 1 hour to PGE1 injection. We measured penile length, penile temperature, sensory threshold of the glans penis to electrical stimulation, BCRL, pudendal sensory evoked potential (SEP), and dorsal nerve conduction velocity and amplitude before, directly after, and 1 hour after erection induced using PGE1(15~20 microgram). RESULTS: Neither PGE1 nor prolonged erection had any effect on the sensory threshold of glans penis, BCRL, pudendal SEP, or amplitude of the dorsal verve. Only the dorsal nerve conduction velocity changed. We could check the conduction velocity after erection in therr cases in which these values were not available at rest. CONCLUSIONS: Given the absence of change in the sensory condition of the glans penis, pharmacoerection using PGE1 has no effect on premature ejaculation except to prolong the erection state. Pharmacoerection seems to be the best method of calculating dorsal nerve sensory conduction velocity and amplitude, It can replace th normal erection state and also help in obtaining a recordable potential when this measurement is technically difficult at rest.
Alprostadil* ; Electric Stimulation ; Erectile Dysfunction ; Evoked Potentials ; Humans ; Male ; Neural Conduction* ; Neurologic Manifestations ; Penis* ; Premature Ejaculation ; Pudendal Nerve ; Sensation ; Sensory Thresholds*

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by bilateral stenosis or occlusion of the terminal portions of the internal carotid arteries. MMD is also accompanied by typical net-like collateral vessels in the basal ganglia. Although the etiology of MMD remains unknown, hereditary, immunogenic, and hemodynamic factors have been implicated as underlying mechanisms of MMD. Here, the authors report on one patient with a rare combination of Graves' disease-associated thyrotoxicosis, myasthenia gravis, and MMD, where cerebrovascular ischemic events occurred during a thyrotoxic state.
Basal Ganglia ; Brain Ischemia ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Constriction, Pathologic ; Graves Disease ; Hemodynamics ; Humans ; Moyamoya Disease ; Myasthenia Gravis ; Thyrotoxicosis

BACKGROUND/AIMS: Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. METHODS: Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). RESULTS: The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 +/- 3.67 ng/mL vs. 0.50 +/- 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. CONCLUSIONS: This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.
Adult ; Aged ; Area Under Curve ; Bacterial Infections/*blood/complications/*diagnosis/microbiology ; Biomarkers/blood ; Calcitonin/*blood ; Case-Control Studies ; Female ; Humans ; Inflammation Mediators/*blood ; Kidney Failure, Chronic/*complications/diagnosis/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Predictive Value of Tests ; Protein Precursors/*blood ; ROC Curve ; Renal Dialysis ; Reproducibility of Results ; Up-Regulation

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.
Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aortic Aneurysm ; Brain Abscess ; Diabetes Mellitus ; Drainage ; Endophthalmitis ; Humans ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Meningitis ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pyomyositis ; Suppuration ; Transplants

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.
Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aortic Aneurysm ; Brain Abscess ; Diabetes Mellitus ; Drainage ; Endophthalmitis ; Humans ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Meningitis ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pyomyositis ; Suppuration ; Transplants

Purpose: We aimed to evaluate whether pediatric emergency practice has improved since the introduction of pediatric specialist care (PSC). Methods: Retrospective observational study was conducted using the data retrieved from the emergency department (ED) of a tertiary university hospital in Cheongju, Korea. Patients younger than 19 years who visited the ED from January 2019 through December 2023 were enrolled in this study. Hospitalization (overall and intensive care unit [ICU]), in-hospital mortality, and return visit within 24 hours were compared between the periods before (January 2019-January 2021) and after (June 2021-December 2023) the introduction of PSC. Adjusted odds ratios with 95% confidence intervals were calculated for the outcomes using multivariable logistic regression. Results: During the study period, a total of 36,162 patients visited the ED. The visits increased from 12,196 before to 22,387 after the introduction of PSC (increase by 83.6%). Annual numbers of the visits have increased since 2020 and reached 10,942 in 2023. After the introduction of PSC, decreases were noted in the hospitalization (adjusted odds ratio, 0.67; 95% confidence interval, 0.62-0.72) and return visit within 24 hours (0.73; 0.61-0.88). Hospitalization to the ICU increased (2.90; 2.29-3.69), while there was no significant difference in the in-hospital mortality (1.31; 0.77-2.25). Conclusion After the introduction of PSC, overall hospitalization and return visit decreased, while hospitalization to the ICU increased without a difference in the in-hospital mortality. Multidisciplinary efforts are needed to continue providing the pediatric specialist-centered emergency practice.