1.The Effect of the Transfusion Indication Verification Program on the Appropriateness of Fresh Frozen Plasma Transfusion
So Yeon KIM ; Ga Hyun BAE ; Hye Ryun LEE
Korean Journal of Blood Transfusion 2020;31(1):43-54
Background:
Fresh frozen plasma (FFP) has been inappropriately using in spite of limited transfusion indications. Our institution applied the transfusion indication data-entry to a computerized order system in February 2018. Physicians should select the indication during transfusion order. In January 2019, the warning pop-up additionally applied for informing whether or not the coagulation test results correspond to FFP transfusion indications. We investigated the effects of a new applied program on the appropriateness of FFP transfusion.
Methods:
By comparing the appropriateness of transfusion before applying the transfusion indication data-entry, we investigated whether there were improvements of appropriateness after applying the transfusion indication data-entry and after applying the warning pop-up. We compared the percentages of performing pre-transfusion coagulation tests and transfusion among FFP requests before and after applying the warning pop-up.
Results:
After applying the transfusion indication data-entry, the appropriateness improved from 54.5% to 66.7%. The appropriateness of the surgery department was the lowest compared with that of the medical departments and emergency departments. The warning pop-up would be effective to induce pre-transfusion coagulation tests from surgery departments and emergency department. However, there was no further improvement in the appropriateness. Many requests from the surgery departments did not lead to transfusion. As the results of the analysis conducted by dividing each department that belonged to surgery departments, we could determine the wrong transfusion practice specific to each department.
Conclusion
The transfusion indication data-entry contributed to improving the appropriateness of FFP transfusion. Department-specific education and real-time auditing are needed for further improvement.
2.The factors influencing the continuity of patient care in family practice.
Hyun Joo JUNG ; Ga Young LEE ; Tae Jin PARK ; Byung Sung KIM ; Eun Jung HAN ; Jin Ju BAK ; Kwang Sug BAE
Journal of the Korean Academy of Family Medicine 1997;18(7):731-738
BACKGROUND: Continuity is very important in primary care, and in most studies continuous care has been reported to have a good effect on the result of care. So we studied the factors influencing the continuity of patient care by physician in charge, especially in case of out-patient department in a university hospital. METHODS: We posed questionnaires to 55 persons who had visited continually to Paik Hospital in Pusan for at least 6 months. We classified them into three groups according to the degree of continuity using 'Modified Continuity Index', and compared the lower group (18 patients) with the higher group(18 patients). RESULTS: The incame of the higher continuity group was significantly less than that of the lower continuity group(P=0.042). But there were no significant differences between the two groups according to sex, age, the type of family, marital status, job and the level of education. The higher continuity group agreed more significantly than the lower continuity group with the question whether it is important to be treated continually from physician in charge(P=0.005). About the reasons for visiting to other doctors instead of the physician in charge, most of them in both group replied that they could not keep appointment. And there were no significant differences in the care pattern of disease between the groups. CONCLUSIONS: To improve the continuity of patient care by physician in charge, it is necessary to instruct the importance of continuous care to the patients and to motivate them through various methods.
Busan
;
Continuity of Patient Care*
;
Education
;
Family Practice*
;
Humans
;
Marital Status
;
Outpatients
;
Primary Health Care
;
Surveys and Questionnaires
3.Attitude Toward Psychiatric Medication among College Students Majoring in Nursing Science and Social Welfare.
Cheol PARK ; Sung Wan KIM ; Ju Yeon LEE ; Hyun Ju NA ; Ga Young LEE ; Ji Hyun PARK ; Kyung Yeol BAE ; Jae Min KIM ; Il Seon SHIN ; Jin Sang YOON
Korean Journal of Schizophrenia Research 2014;17(2):86-92
OBJECTIVES: Nurses and social workers are key persons connecting patients with psychotic disorders to psychiatric treatment. This study investigated the attitude of college students majoring in nursing science and social welfare toward psychiatric medication and stigma toward the mentally ill. METHODS: The study enrolled 553 college students (369 nursing science, 184 social welfare). We administered a five-item questionnaire to assess attitude toward psychiatric medication and a 20-item scale to assess stigma (prejudice regarding the dangerousness of the mentally ill and discrimination against the mentally ill). Factors associated with attitude toward psychiatric medication were identified. In addition, the stigma scale scores were compared with each item on attitude toward psychiatric medication. RESULTS: In the multivariate analysis, students majoring in social welfare had a significantly poorer attitude toward psychiatric medication than those majoring in nursing science. Age, senior grade, and experience to contact the mentally ill were also significantly associated with a good attitude toward medication, while attending psychiatry lectures, having a religion, and gender were not significantly associated with attitude toward psychiatric medication, although they showed relationships in the univariate analyses. For three of the five items, a negative attitude toward psychiatric medication was significantly associated with higher scores on the prejudice and discrimination scales. CONCLUSION: Prejudice toward and discrimination against the mentally ill are closely associated with a negative attitude toward psychiatric medication. An anti-stigma campaign should be developed that includes education to promote knowledge about psychiatric medications and reduce the stigma against the mentally ill. In addition, our findings suggest that experience to contact the mentally ill might improve attitudes toward psychiatric medication.
Dangerous Behavior
;
Discrimination (Psychology)
;
Education
;
Humans
;
Lectures
;
Mentally Ill Persons
;
Multivariate Analysis
;
Nursing*
;
Prejudice
;
Psychotic Disorders
;
Surveys and Questionnaires
;
Schizophrenia
;
Social Welfare*
;
Social Workers
;
Weights and Measures
4.Geriatric functional assessment for decision-making on adjuvant chemotherapy in older colon cancer patients
Hyun Jin BANG ; Hyun Jeong SHIM ; Ga Ram KIM ; Jun Eul HWANG ; Woo Kyun BAE ; Ik Joo CHUNG ; Sang Hee CHO
The Korean Journal of Internal Medicine 2022;37(3):660-672
Background/Aims:
Despite the increasing need for geriatric assessment prior to chemotherapy, the method for this assessment remains inadequate for older cancer patients. We aimed to propose a simple assessment method to predict the performance of adjuvant chemotherapy in older patients after colon cancer surgery.
Methods:
This prospective study included patients over 65 years of age who were scheduled for adjuvant chemotherapy after colon cancer surgery. Before initiating chemotherapy, their functional status was assessed on the basis of activities of daily living (ADL)/instrumental activities of daily living (IADL). These parameters were analyzed with clinical characteristics and the patterns of adjuvant chemotherapy. The focus was on the completion rate of adjuvant chemotherapy.
Results:
A total of 89 patients with a median age of 72 years were analyzed. Among them, 54 (61%) were non-impaired and 35 (39%) were impaired regarding their ADL/IADL classification. Low body mass index and impairment of ADL/IADLs were significantly associated with chemotherapy interruption. Among toxicities, fatigue and hand-foot syndrome were independent prognostic factors for chemotherapy interruption. Impairments of ADL/IADL were significantly associated with fatigue regardless of age. Based on age and ADL/IADL stratification, younger patients (≤ 72 years) and/or those who were ADL/IADL non-impaired were significantly more likely to complete adjuvant chemotherapy than older patients (> 72 years) and ADL/IADL impaired patients (p = 0.038). This was regardless of the chemotherapy regimen.
Conclusions
Functional assessment using ADL/IADL is a convenient method to predict chemotherapy toxicity and performance. These results suggested that routine screening for ADL/IADLs could guide appropriate patient selection for the completion of adjuvant chemotherapy and predict expected outcomes.
5.Evaluation of Automated Architect Syphilis TP as a Diagnostic Laboratory Screening Test for Syphilis.
Jeeyong KIM ; Woo Hyeun KIM ; Chihyun CHO ; Juyeon KIM ; Ga Yeong KIM ; Myung Hyun NAM ; Jang Su KIM ; Sook Young BAE ; Yunjung CHO
The Korean Journal of Laboratory Medicine 2008;28(6):475-482
BACKGROUND: The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS: A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS: The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS: Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.
Adolescent
;
Adult
;
Aged
;
Aged, 80 and over
;
Algorithms
;
Autoanalysis
;
Child
;
Child, Preschool
;
False Positive Reactions
;
Female
;
Fluorescent Treponemal Antibody-Absorption Test/methods
;
Hemagglutination Tests/methods
;
Humans
;
Male
;
Middle Aged
;
Reagent Kits, Diagnostic
;
Sensitivity and Specificity
;
Syphilis/*diagnosis
;
Syphilis Serodiagnosis/*methods
6.A Case of Sarcoidosis Associated with Renal Failure in a Kidney Transplant Patient.
Hae Lin PARK ; Ga Young BAN ; Chang Bum BAE ; Hyun Ee YIM ; Heung Soo KIM ; Inwhee PARK ; Gyu Tae SHIN
Korean Journal of Medicine 2013;84(2):290-294
Sarcoidosis, systemic inflammatory disease characterized by non-caseating granulomas, is rarely associated with renal failure in a kidney transplant. We report a 51-year-old woman with a kidney transplant who was diagnosed to have renal sarcoidosis. After 7 years of renal transplantation, the patient presented with relatively rapid deterioration of renal function and, subsequently, she underwent kidney transplant biopsy. Renal biopsy revealed interstitial nephritis with non-caseating granulomas compatible with granulomatous interstitial nephritis (GIN). She was also found to have granulomatous lymphadenitis and skin lesions. Diagnosis of sarcoidosis was made based on histopathologic findings, the high serum angiotensin converting enzyme level and exclusions of other causes of GIN including tuberculosis, ANCA associated glomerulonephritis and tubulointerstitial nephritis and uveitis syndrome. The patient was started on oral prednisolone, and subsequently her renal function improved.
Antibodies, Antineutrophil Cytoplasmic
;
Biopsy
;
Female
;
Glomerulonephritis
;
Granuloma
;
Humans
;
Kidney
;
Kidney Transplantation
;
Lymphadenitis
;
Nephritis, Interstitial
;
Peptidyl-Dipeptidase A
;
Prednisolone
;
Renal Insufficiency
;
Sarcoidosis
;
Skin
;
Transplants
;
Tuberculosis
;
Uveitis
7.Anterior Diabetic Retinopathy Studied by Ultra-widefield Angiography.
Kunho BAE ; Ju Yeon LEE ; Tae Hyup KIM ; Ga Eun CHO ; Jeeyun AHN ; Sang Jin KIM ; Jae Hyun KIM ; Se Woong KANG
Korean Journal of Ophthalmology 2016;30(5):344-351
PURPOSE: To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence. METHODS: A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated. RESULTS: Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients (p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis (p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients (p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients (p = 0.010). CONCLUSIONS: Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles.
Angiography*
;
Blood Glucose
;
Diabetic Retinopathy*
;
Fluorescein Angiography
;
Humans
;
Incidence
;
Lipoproteins
;
Logistic Models
;
Prevalence
;
Retinaldehyde
;
Retrospective Studies
8.Adaptation and Validation of the Korean Version of the Urticaria Control Test and Its Correlation With Salivary Cortisone.
Ji Ho LEE ; Yoon Ju BAE ; So Hee LEE ; Su Chin KIM ; Hyun Young LEE ; Ga Young BAN ; Yoo Seob SHIN ; Hae Sim PARK ; Juergen KRATZSCH ; Young Min YE
Allergy, Asthma & Immunology Research 2019;11(1):55-67
PURPOSE: Frequent changes in chronic urticaria (CU) activity over time can cause psychological stress, which also serves as a trigger of CU. To measure the control status of CU, the Urticaria Control Test (UCT) was developed in Germany. This study aimed to investigate the validity, reliability and responsiveness to changes in CU for the Korean version of the UCT (K-UCT) and its relation with salivary cortisol and cortisone levels. METHODS: Linguistic adaptation of the UCT into Korean was conducted. A total of 96 CU patients were enrolled, and 80 of them completed the study. The K-UCT and other outcome scores for CU were measured and repeated after 4 weeks of treatment. Control status was classified by physicians into well-controlled, partly-controlled, and uncontrolled CU. Salivary cortisol and cortisone were measured by liquid chromatography-tandem mass spectrometry. RESULTS: Excellent internal consistency and intra-class reliability were obtained. Strong correlations between the K-UCT and disease severity, reflected in the Urticaria Activity Score (UAS)/global assessment of urticaria control by physicians/patient assessment of symptom severity/CU-specific quality of life were noted. K-UCT scores ≥12 were found to be optimal for determining well-controlled CU (sensitivity, 75.0%; specificity, 758%; area under the curve, 0.824). Perceived stress scale scores were significantly correlated with the UAS and the K-UCT. Salivary cortisone levels were significantly correlated with K-UCT (r = 0.308, P = 0.009) and differed significantly according to control status determined by a K-UCT ≥12. CONCLUSIONS: This study demonstrated that the K-UCT can be a valid instrument with which to gauge CU control status in Korean patients. Further studies are needed to validate salivary cortisone as a biomarker for CU control.
Cortisone*
;
Germany
;
Humans
;
Hydrocortisone
;
Korea
;
Linguistics
;
Mass Spectrometry
;
Quality of Life
;
Sensitivity and Specificity
;
Stress, Psychological
;
Urticaria*
9.Efficacy and Safety of Rituximab in Korean Patients with Refractory Inflammatory Myopathies
Ga Young AHN ; Chang-Hee SUH ; Yong-Gil KIM ; Yong-Beom PARK ; Seung Cheol SHIM ; Sang-Heon LEE ; Shin-Seok LEE ; Sang-Cheol BAE ; Dae Hyun YOO
Journal of Korean Medical Science 2020;35(38):e335-
Background:
Rituximab (RTX), a monoclonal antibody that selectively binds to CD20+ B cells, showed favorable outcomes in patients with idiopathic inflammatory myopathies (IIM) in small case series, but the evidence is still not enough. Our goal was to determine the efficacy and safety of RTX for Korean patients with refractory IIM.
Methods:
We retrospectively analyzed the medical records of 16 patients with refractory IIM treated with RTX in seven tertiary rheumatology clinics in the Korea. The efficacy of RTX was evaluated with the improvement of serum creatine phosphokinase (CPK) level and physician's global assessment (PGA), and daily corticosteroid dose reduction. A > 25% decrease in CPK level, corticosteroid dose, or PGA was considered significant. A complete response (CR) was designated by meeting three efficacy criteria and a partial response (PR) by only two criteria.
Results:
Sixteen patients with IIM were evaluated (13 female; median age, 51.8 years). All patients had received at least one conventional immunosuppressive agent (median, 3.6 [2.0–5.0]) and concomitant corticosteroids. The median CPK level and median dose of prednisolone was 421.0 units/L and 20.0 mg/day respectively. Eleven patients were treated with intravenous immunoglobulin. Seven patients received 2,000 mg of RTX and the others received lower dose. Twenty-four weeks after RTX treatment, 11 patients achieved a > 25% reduction in corticosteroid dose and CPK levels, and nine showed improved PGA. The overall response rate was 68.8% (11 patients). At the end of follow-up (median 24 weeks), 12 (75.0%) patients responded overall: four (25.0%) and eight (50.0%) patients achieved CR and PR, respectively. Baseline muscle enzyme levels were higher in responders than non-responders, but disease duration, RTX dose, ESR and serum CRP were not significantly different between the two groups. The rate of adverse event was 25.4/1,000 person-years.
Conclusion
RTX could be an effective and relatively safe therapeutic option in patients with refractory IIM.
10.Efficacy of administration of weekly docetaxel combined with platinum as a first-line treatment for patients with advanced non-small cell lung cancer.
So Yeon KIM ; Hun Mo RYOO ; Sung Hwa BAE ; Hyun Young JUNG ; Kyung Chan KIM ; Dae Sung HYUN ; Sang Chae LEE ; Kyeong Ok KIM ; Kyung Hee LEE ; Myung Soo HYUN ; Young Lan KWEON ; Ga Young KIM ; Gyu Young KIM ; Chi Young JUNG ; Yeon Jae KIM ; Byeung Gi LEE ; Jung Lim LEE ; Won Sik LEE
Korean Journal of Medicine 2007;72(6):625-631
BACKGROUDN: Docetaxel is a highly effective chemotherapeutic agent with proven efficacy for non-small cell lung cancer (NSCLC). However, myelosuppression can be a substantial concern when docetaxel is administered every 3 weeks. Weekly administration of low-dose docetaxel has demonstrated a comparable efficacy together with a distinct toxicity profile with reduced myelosuppression. We conducted a phase II study of weekly administration of docetaxel and cisplatin or carboplatin in patients with advanced NSCLC to evaluate efficacy and safety. METHODS: Twenty-nine patients with advanced or metastatic NSCLC who had not received prior treatment were enrolled in the study. The patients received intravenous infusions of docetaxel (35 mg/m2 on days 1, 8, 15) and cisplatin (75 mg/m2 on day 1) or carboplatin (AUC 6), followed by a week of rest. RESULTS: Twenty-six patients were assessable for efficacy and all patients were assessable for toxicity determination. The overall response rate of the regimen was 44.8%. The median survival was 11.3 months, and the 1-year survival rate was 37%. Of the hematologic toxicities, grade 3/4 neutropenia were observed in 12.6% of the patients, but there were no episodes of neutropenic fever. Non-hematologic toxicities were mild. CONCLUSIONS: With this weekly dosing regimen, although efficacy is comparable, myelosuppression is substantially less, and the overall tolerability profile is better than with dosing every 3 weeks.
Carboplatin
;
Carcinoma, Non-Small-Cell Lung*
;
Cisplatin
;
Fever
;
Humans
;
Infusions, Intravenous
;
Neutropenia
;
Platinum*
;
Survival Rate