Korea Ministry of Health and Welfare launched legislation for reimbursement for Nutrition Support Team (NST) activities from August 1st, 2014, which can be applied as a flat rate fee per day once a week. The indicated patients are those with hypoalbuminemia, on parenteral nutrition or enteral nutrition, critically ill patients in intensive care unit's, and any patient on suspicion of malnutrition by the physician in charge. NST should be comprised of a professional physician, an educated nurse, an educated pharmacist, and a professional and experienced dietitian. The maximum number of patients that can be treated by one NST is 30 per day. Such a reimbursement system has resulted in some complex problems with NSTs. The low price does not provide adequate reward for the team's workload because the output of NST belongs to the department in charge and there is no ensured incentive. The Department of Health Insurance Review and Assessment Service cannot detect the quality problem of NST, non-compliance of physicians in charge. There are no stratified codes according to severity of disease and no difference between the first visit and the repeated visit. Every NST should be certified with accreditation and should participate in a qualified education program. Korea Health Insurance does not cover the fees for feeding tubes, formulas, and pumps. Evidence that NST activities can reduce medical cost of hospital-admitted in-patients is needed. Cost-effectiveness can be achieved by quality improvement of NST.
Accreditation ; Critical Illness ; Education ; Enteral Nutrition ; Fees and Charges ; Humans ; Hypoalbuminemia ; Insurance, Health ; Critical Care ; Korea ; Malnutrition ; Motivation ; Nutritional Support* ; Nutritionists ; Parenteral Nutrition ; Pharmacists ; Quality Improvement ; Reward

Malnutrition of hospitalized patients is a prevailing issue, especially in the perioperative period. As the elderly population increases progressively, surgeons should become more alert to preventing the risk of iatrogenic malnutrition. The consequences of malnutrition, such as delayed wound healing, exposure to infection, pressure sores, gastrointestinal bacterial overgrowth, and compromised immunity can be prevented or attenuated by vigorous nutritional support. Enhanced recovery after surgery is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery, in which nutritional intervention is the most important and integral part. Preoperative nutritional assessment, intraoperative considerations against postoperative nutritional problems, and an appropriate postoperative nutritional supply will result in better outcomes of surgery, and, in turn, in reduced postoperative complications, shorter hospital stays, and decreased medical costs. Though enteral nutrition is preferable over parenteral nutrition, parenteral nutrition should be supplemented selectively in those for whom enteral nutrition will inevitably be inadequate.
Aged ; Enteral Nutrition ; Humans ; Length of Stay ; Malnutrition ; Nutrition Assessment ; Nutritional Support ; Parenteral Nutrition ; Perioperative Care ; Perioperative Period ; Postoperative Complications ; Pressure Ulcer ; Wound Healing

No abstract available.

OBJECTIVES: Breast cancer has been the most prevalent female cancer in South Korea since 2001. Early detection of this disease is the most effective strategy for reducing mortality. The objective of this study was to identify factors which could predict advanced stage at diagnosis of breast cancer. METHODS: Participants who were initially diagnosed with breast cancer and referred to the Stress Clinic of the Breast Cancer Center at Kyungpook National University Hospital were included. Through a semi-structured interview, the authors investigated psychosocial variables such as the extent of marital and family functioning and emotional-economic family burden as well as sociodemographic and health behavior-, health characteristic- and cancer-related variables. RESULTS: Data were collected from 219 participants. One hundred and twenty(54.8%) subjects were diagnosed with advanced-stage breast cancer. Variables that were significantly different between the advanced-stage and early-stage groups included : monthly breast self examination(p<0.000), annual mammographic screening(p< 0.000), mode of tumor detection(p<0.000), nature of the first symptoms(p<0.000), time to treatment after di-agnosis(p<0.000), overloaded economic and family burden(p=0.018), marital functioning(p<0.000) and family functioning(p<0.00). Logistic regression analysis indicated that irregular annual mammography screening(OR=7.431 ; 95% CI 2.407-22.944) or a lack of screening(OR=25.299 ; 95% CI 7.855-81.482) and a dysfunctional marital relationship(OR=4.772 ; 95% CI 2.244-10.145) were significantly associated with advanced stage at diagnosis of breast cancer. CONCLUSIONS: We reconfirmed screening behavior to be a risk factor for delayed diagnosis of breast cancer. Our findings also emphasized the importance of psychosocial factors such as marital functioning in early detection of breast cancer. Psychiatric consultation in the area of martial functioning could be beneficial for increasing early detection in breast cancer.
Breast ; Breast Neoplasms* ; Delayed Diagnosis* ; Diagnosis ; Female ; Gyeongsangbuk-do ; Humans ; Korea ; Logistic Models ; Mammography ; Marriage* ; Mass Screening ; Mortality ; Psychology* ; Risk Factors ; Time-to-Treatment

BACKGROUND/AIMS: There has been a lot of controversy about the treatment methods in the management of residual & recurrent biliary stones. So we performed the study to clarify the important factors in choosing the treatment modality of the residual & recurrent biliary stones. METHODS: 154 patients who were diagnosed as residual or recurrent biliary stone between January 1995 and August 2000 were divided into 4 groups according to their first re- treatment methods (surgery, stone removal via T-tube, PTBD*, ESTP**) and analyzed the results of these treatments to determine what is the significant factor affecting the prognoses. RESULTS: The necessity of the second re-treatment for residual & recurrent stones was affected by the complete- ness of stone removal only, and no other factors affected it in view of multivariate analysis. The rate of residual & recurrent stones among the patients who have had the first operation in our department was 6.7%. Furthermore the clearance rate of residual & recurrent stones was relatively high value (82.2%), as a result of multidisciplinary treatments. CONCLUSION: Thus, as long as the residual stones can be removed completely, any treatment modality can be applied to these patients. We don't have to insist on surgery.
Humans ; Multivariate Analysis ; Prognosis

We describe a case of tumoral calcinosis in a 13-month-old female Beagle dog presenting for surgical removal of a 4x3x3 cm mass in the soft tissues of the medial right shoulder joint. On radiologic examination, the mass showed increased radiopacity. Blood analysis data indicated chronic renal failure with hyperphosphatemia and hypercalcemia. Grossly, the mass was irregular, round and multilocular, with hard consistency. Histologically, there were many variable-sized loculi surrounded by capsule and interstitial connective tissues were generated among the loculi. Inflammatory cells, fibroblasts, fibrocytes and multinucleated giant cells were present at the margins of the loculi. Most of the loculi were filled with calcium or chalky material. To our knowledge, this is the first case of tumoral calcinosis in Korea.
Animals ; Calcinosis ; Calcium ; Connective Tissue ; Dogs ; Female ; Fibroblasts ; Giant Cells ; Humans ; Hypercalcemia ; Hyperphosphatemia ; Infant ; Kidney Failure, Chronic ; Korea ; Shoulder Joint

PURPOSE: The subcutaneous fat tissue is separated into 2 layers by the subcutaneous fascia: the superficial and deep fat layers. The two fat layers have different structures according to the body regions. The purpose of this study is to evaluate the distribution and pattern of the two fat layers in the human body by computed tomography (CT) and histological analysis according to age, sex, anatomical region, and body mass index (BMI). METHODS: This study included 200 males and 200 females who underwent 64-channel dynamic CT in our hospital. The patients were divided into 5 groups according to 10 years of their ages separately in either male or female gender. The thickness of the superficial and deep fat layers was measured in the abdominal, pelvic, and femoral regions, and we analyzed the values. Statistical analyses were performed using SPSS software. The 3 x 3-cm whole fat layers were harvested from the same sites of 3 cadavers for histological examination, and one cadaver was dissected for gross evaluation. RESULTS: The total thickness of subcutaneous fat tissue was greater in females than in males, and the ratio of the superficial fat layer to the whole fat layer was higher in females. The superficial fat layer became thinner with increasing age in males. As BMI increased, the total fat layer became thicker, and the superficial fat layer became thicker than the deep fat layer. On histological examination, the superficial fat layer had small adipose lobules and showed a densely distributed pattern in the abdominal region, whereas in the femoral region, it had large adipose lobules and showed a sparsely distributed pattern. There were no significant differences in the histological findings of the deep fat layer between the 3 body regions. CONCLUSION: Significant differences in histological findings of the two fat layers were found in relation to age, sex, anatomical region, and BMI. The superficial fat layer became thinner with increasing age in males, but it was constant in females. As BMI increased, the total thickness of subcutaneous fat tissue became greater, and the superficial fat layer became thicker than the deep fat layer. Our measurements can be used to understand the characteristics of the fat layers in relation to age, sex, anatomical region, and BMI.
Body Mass Index ; Body Regions ; Cadaver ; Female ; Human Body ; Humans ; Lipectomy ; Male ; Obesity ; Subcutaneous Fat

The number of physically disabled in Korea and their biodemographic characteristics are estimated through a national sample survey of about 100,000 population or 22,134 households. The results showed that 7.98 persons per 1,000 population were found to be physically disabled including inconvenience to body or limb, as well as being mute, deaf or blind. Males had a higher prevalence ratio of disability compared to females, particularly in rural areas, among the less educated, divorced or widowed males.
Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Disabled Persons*/classification ; Female ; Human ; Infant ; Infant, Newborn ; Korea ; Male ; Middle Age ; Rural Population ; Sex Factors ; Socioeconomic Factors

Hairless scalp areas can occur due to trauma, tumors, or congenital disease. This aesthetically unpleasing condition can lead to psychosocial distress, and thin skin flaps may be prone to scarring. Treating the hairless scalp by simple excision is challenging because of skin tension. Tissue expanders are a good option for hairless scalp resurfacing. However, a single expansion may be inadequate to cover the entire defect. This report describes good results obtained using a serial resurfacing method involving re-expansion of the flap with a tissue expander to treat two patients with large lesions: one due to aplasia cutis congenital and another who underwent dermatofibrosarcoma protuberance resection. The results suggest that scalp resurfacing by serial tissue expansion using a tissue expander can be used for extensive lesions.
Alopecia ; Cicatrix ; Dermatofibrosarcoma ; Humans ; Methods ; Scalp ; Skin ; Tissue Expansion ; Tissue Expansion Devices

Reactive oxygen species (ROS) performs a pivotal function as a signaling mediator in receptor-mediated signaling. However, the sources of ROS in this signaling have yet to be determined, but may include lipoxygenases (LOXs) and NADPH oxidase. The stimulation of lymphoid cells with TNF-alpha, IL-1beta, and LPS resulted in significant ROS production and NF-kappaB activation. Intriguingly, these responses were markedly abolished via treatment with the LOXs inhibitor nordihydroguaiaretic acid (NDGA). We further examined in vivo anti-inflammatory effects of NDGA in allergic airway inflammation. Both intraperitoneal and intravenous NDGA administration attenuated ovalbumin (OVA)-induced influx into the lungs of total leukocytes, as well as IL-4, IL-5, IL-13, and TNF-alpha levels. NDGA also significantly reduced serum levels of OVA-specific IgE and suppressed OVA-induced airway hyperresponsiveness to inhaled methacholine. The results of our histological studies and flow cytometric analyses showed that NDGA inhibits OVA-induced lung inflammation and the infiltration of CD11b+ macrophages into the lung. Collectively, our findings indicate that LOXs performs an essential function in pro-inflammatory signaling via the regulation of ROS regulation, and also that the inhibition of LOXs activity may have therapeutic potential with regard to the treatment of allergic airway inflammation.
Animals ; Antioxidants/metabolism ; Asthma/complications/metabolism/pathology/physiopathology ; Bronchial Hyperreactivity/drug therapy/pathology ; Bronchial Provocation Tests ; Bronchoalveolar Lavage Fluid/cytology ; Cells, Cultured ; Drug Evaluation, Preclinical ; Humans ; Inflammation/*etiology/metabolism ; Jurkat Cells ; Lipoxygenase/*physiology ; Lipoxygenase Inhibitors/pharmacology/therapeutic use ; Lymphocytes/drug effects/metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Nordihydroguaiaretic Acid/pharmacology/therapeutic use ; Reactive Oxygen Species/*adverse effects/*metabolism