Staphylococcal cassette chromosome mec (SCCmec) type and coagulase serotype are important epidemiologic factors in methicillin-resistant Staphylococcus aureus (MRSA). To investigate correlation between SCCmec type and coagulase serotype of MRSA, we analyzed SCCmec types of MRSA strains isolated from clinical sources and compared the results to coagulase serotypes and antimicrobial susceptibility patterns. A total of 108 MRSA isolates were classified into four SCCmec types: II (55.6%), IV (21.3%) III (13.0%) and IIIA (8.3%), and five coagulase serotypes: II (54.6%), IV (21.3%), V (18.5%) and VII (2.8%). All of coagulase type II, IV and V strains belonged to SCCmec type II, III/IIIA and IV, respectively. SCCmec types II, III and IIIA were multidrug resistant, whereas SCCmec type IV strains were non-multidrug resistant except beta-lactams and erythromycin. The data provide that there is a significant correlation between SCCmec types and phenotypic characteristic of coagulase serotypes.
beta-Lactams ; Coagulase ; Epidemiologic Factors ; Erythromycin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus

PURPOSE: Our study aimed to determine whether obstructive sleep apnea (OSA) is common among branch retinal vein occlusion (BRVO) patients without systemic risk factors using a Watch PAT-100 portable monitoring device. METHODS: The study participants included consecutive patients with BRVO of less than 3 months duration without any risk factors known to be associated with OSA (diabetes, coronary artery disease, stroke, hematologic diseases, autoimmune disease, etc.) except for hypertension. All patients underwent full-night unattended polysomnography by means of a portable monitor Watch PAT-100 device. The apnea-hypopnea index (AHI) was calculated as the average number of apnea and hypopnea events per hour of sleep, and an AHI score of five or more events was diagnosed as OSA. RESULTS: Among 19 patients (6 males and 13 females), 42.1% (8 of 19) had an AHI reflective of OSA. In the 13 patients who had no concurrent illness, including hypertension, 30.8% (4 of 13) had positive test results for OSA; three of these patients were ranked as mild OSA, while one had moderate OSA. The OSA group had an average AHI of 12.3 ± 7.8, and the average AHI was 2.0 ± 0.9 in the non-OSA group. Although it was not statistically proven, we found that OSA patients experienced a more severe form of BRVO. CONCLUSIONS: We found a higher than expected rate of OSA in BRVO patients lacking concomitant diseases typically associated with OSA. Our findings suggest that OSA could be an additional risk factor in the pathogenesis of BRVO or at least a frequently associated condition that could function as a triggering factor.
Apnea ; Autoimmune Diseases ; Coronary Artery Disease ; Hematologic Diseases ; Humans ; Hypertension ; Male ; Polysomnography ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Risk Factors ; Sleep Apnea, Obstructive* ; Stroke

PURPOSE: The purpose of this study was to describe the sexual behavior, health risk related to reproductive health, and characteristics of sexual experience among college students in Korea. METHODS: Six thousands college students were selected through proportional quota sampling based on region, college, and gender. Structured questionnaires were used for data collection. Descriptive statistics and chi-square test were used to describe the data. RESULTS: Thirty eight percent (N=2,285) of the participants reported sexual intercourse. The mean age of first time sexual intercourse was 19.3 years old. Respondents reported the following health risks such as smoking, drinking, not exercising, no regular meal patterns, chronic disease status, and weight loss over 10 kg in the past three months showed significant differences by sexual intercourse experience (p<.01). Among those who had sexual intercourse experiences, 7.1% of them reported having a history of STDs and 11.6% reported a pregnancy or pregnancy of one's partner. CONCLUSION: The findings of this study reflect the current trends of sex behaviors among college students and correlations between health risks related to reproductive health and sexual intercourse experiences. Developing reproductive health education programs based on the findings and providing the programs to college students through a school nurse is suggested.
Chronic Disease ; Coitus ; Drinking ; Health Behavior ; Humans ; Meals ; Pregnancy ; Reproductive Health ; Risk-Taking ; Sexual Behavior ; Sexually Transmitted Diseases ; Smoke ; Smoking ; Surveys and Questionnaires ; Weight Loss

BACKGROUND: Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities. METHODS: The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared. RESULTS: The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma. CONCLUSIONS: The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.
Angiography ; Emergencies ; Humans ; Prescriptions ; Prognosis ; Pyridines ; Stroke ; Thiazoles

PURPOSE: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. METHODS: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. RESULTS: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. CONCLUSION: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.
Blood Pressure ; Chicago ; Creatinine ; Emergencies ; Glasgow Coma Scale ; Hematologic Tests ; Humans ; Injury Severity Score ; Leukocyte Count ; Medical Records ; Multivariate Analysis ; Organization and Administration ; Physical Examination ; Prognosis ; Prospective Studies ; Respiratory Rate ; Resuscitation ; Retrospective Studies ; Running ; Vital Signs

PURPOSE: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA) score, and serum procalcitonin level. METHODS: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. RESULTS: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0 (standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. CONCLUSION: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.
Adult ; Calcitonin ; Emergencies ; Humans ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Protein Precursors ; Sepsis ; Shock, Septic

PURPOSE: This study was conducted to shorten the time spent at each stage of treatment and to reduce the total amount of time patients spend in the emergency department (ED) by applying Six Sigma in the treatment of major trauma patients. METHODS: This is a comparative study encompassing 60 patients presenting to the ED of Bundang CHA Hospital from January 2008 to December 2008 and from July 2009 to March 2010. The stages of treatment for major trauma patients were divided into six categories (T1: total emergency department staying time, T2: duration of visit-radiologic evaluation time, T3: duration of visit-consult to department of admission, T4: duration of consultation-issue of hospital admissions time, T5: duration of visit-issue of hospital admissions time, T6: duration of issue of hospital admission-emergency department discharge time) and the total time patients spent in the ED was compared and analyzed for periods; before and after the application of Six Sigma. RESULTS: After the application of Six Sigma, the numerical values in four of the six categories were significantly reduced; T2, T3, T4, and T5. However, the average of the total time patients spent in the ED did not show any remarkable change because the T6 increased highly. The level of Six Sigma increased 0.17sigma. CONCLUSION: The application of Six Sigma for major trauma patients in the ED resulted in a significant improvement in the error rate for the total time patients spent in the ED. The Six Sigma activity has shown great potential. Therefore, the project is expected to bring better results in every stage of treatment if the levels of the hospital facilities are improved.
Emergencies ; Humans

PURPOSE: To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS: Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS: In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION: Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.
Abdomen ; Classification ; Extremities ; Head ; Humans ; Medical Records ; Neck ; Neurologic Manifestations ; Pelvis ; Retrospective Studies ; Spine ; Thorax ; Upper Extremity

PURPOSE: To minimize the process that acute myocardial infarction (AMI) patients have to go through when visiting the emergency room (ER), and thus to provide prompt reperfusion therapy using the six sigma protocol, a business management renovation strategy to standardize the clinical process. METHODS: Analysis was done on data obtained both before and after implementation of the six sigma protocol. Data were collected from ST segment elevation myocardial infarction (STEMI) patients who visited the ER between February 2006 and March 2009 and received reperfusion therapy. For statistical analysis used we used an unpaired t-test. RESULTS: After the six sigma protocol was put into practice, total visiting time was reduced from 124.4+/-76.1 minutes to 91.5+/-50.3 minutes, and the reduction was statistically significant (p<0.0045). Six sigma (6 sigma) means 3.4 PPM, that is, among 1 million cases no more than 3.4 cases should exceed the time limit of 90 minutes from the arrival of the patient to the needle puncture, making the task hard to achieve. sigma score was greatly elevated-from 1.48 sigma to 2.48 sigma and the sigma error rate (the proportion of cases that exceeded 90 min) improved from 62% to 45% . CONCLUSION: In this study we verified that applying the six Sigma protocol significantly reduced the time to reperfusion therapy for AMI patients. The reduction in time was due to changes in software (developed from the existing system) rather than to hardware improvements such as changes in test facilities or manpower amplification. The entire process, from a patient arriving at the ER until the patient received reperfusion therapy was viewed as one systemic flow and applying the six Sigma protocol to such flow was successful as shown by the result of this study. This shows that the six sigma protocol can be applied to a medical system if configured effectively. Further, this method can be useful not only for AMI patients, but also for many other urgent procedures such as acute cerebral infarction patients who require prompt diagnosis and hemolytic therapy, when the definition of the error rate is corrected according to the specific patients groups.
Cerebral Infarction ; Commerce ; Emergencies ; Humans ; Myocardial Infarction ; Needles ; Punctures ; Reperfusion ; Total Quality Management

PURPOSE: To minimize the process that acute myocardial infarction (AMI) patients have to go through when visiting the emergency room (ER), and thus to provide prompt reperfusion therapy using the six sigma protocol, a business management renovation strategy to standardize the clinical process. METHODS: Analysis was done on data obtained both before and after implementation of the six sigma protocol. Data were collected from ST segment elevation myocardial infarction (STEMI) patients who visited the ER between February 2006 and March 2009 and received reperfusion therapy. For statistical analysis used we used an unpaired t-test. RESULTS: After the six sigma protocol was put into practice, total visiting time was reduced from 124.4+/-76.1 minutes to 91.5+/-50.3 minutes, and the reduction was statistically significant (p<0.0045). Six sigma (6 sigma) means 3.4 PPM, that is, among 1 million cases no more than 3.4 cases should exceed the time limit of 90 minutes from the arrival of the patient to the needle puncture, making the task hard to achieve. sigma score was greatly elevated-from 1.48 sigma to 2.48 sigma and the sigma error rate (the proportion of cases that exceeded 90 min) improved from 62% to 45% . CONCLUSION: In this study we verified that applying the six Sigma protocol significantly reduced the time to reperfusion therapy for AMI patients. The reduction in time was due to changes in software (developed from the existing system) rather than to hardware improvements such as changes in test facilities or manpower amplification. The entire process, from a patient arriving at the ER until the patient received reperfusion therapy was viewed as one systemic flow and applying the six Sigma protocol to such flow was successful as shown by the result of this study. This shows that the six sigma protocol can be applied to a medical system if configured effectively. Further, this method can be useful not only for AMI patients, but also for many other urgent procedures such as acute cerebral infarction patients who require prompt diagnosis and hemolytic therapy, when the definition of the error rate is corrected according to the specific patients groups.
Cerebral Infarction ; Commerce ; Emergencies ; Humans ; Myocardial Infarction ; Needles ; Punctures ; Reperfusion ; Total Quality Management