During the last 10 years, we have experienced 169 cases of congenital melanocytic nevi of the face at Seoul National University Children's Hospital. In these patients, various modalities of treatment have been used, including excision, staged excision, skin graft, local flap, and composite graft. Dermabrasion, electrocoagulation, and laser therapy were excluded because these were not definitive treatments. We reviewed over 169 cases based on the involved on the aesthetic units of the face and the length of the defect perpendicular to wrinkle lines. We have attempted to create a stadard for the selection of the appropriate treatment modality. Cases which involved orbital unit(38 cases), cheek(30 cases), and parotid-masseteric unit(18 cases) were analysed statistically. To avoid the statistical error, units of sufficient number of cases and involving only one unit were included. In each unit, we used Receiver Operator Characteristic Method to identify the turning points of the length of the defect perpendicular RSTL which decided the treatment modality. And we used t-test to show the statistical difference between the lengths of the defect perpendicular to RTSL in each modality. The turning point were 0.9-1.0 cm between excision/staged excision, 2.0 cm between staged excision/FTSG, in orbital unit, 1.3 cm between excision/staged excision in cheek unit, 1.6-1.9 cm between excision/staged excision in parotid-masseteric unit. And it was identified by ANOVA test and t-test that the above groups were statistically different. Till now, the treatment modality of the congenital melanocytic nevus was based on the experiences of the surgeon. But now, we have presented the stadard of the treatment according to the size in each aesthetic unit. Therefore we can choose the approproate treatment modality among the severals in accordance with the standards.
Cheek ; Child* ; Dermabrasion ; Electrocoagulation ; Humans ; Laser Therapy ; Nevus, Pigmented* ; Orbit ; Seoul ; Skin ; Transplants

To survey user satisfaction, correlates of satisfaction, and self reported evaluation about order communication system in Seoul National University Hospital, we performed this study. We met 63 users who were involved in hospital's digitalization committee and surveyed the Questionnare for User Interaction Satisfaction(QUIS) as evaluation tool and self-evaluation about OCS. We received 55 replies out of 63 users. The users were generally satisfied with order communication system(mean scale = 5.8 on a 1 to 9 scale). QUIS scored highest in the area of screen design and lowest in the area of system capability. Overall user satisfaction was most highly correlated with task-flow. Users noticed retrieval of laboratory result as the most useful aspect and worried about system stability and system response time. But, system response time was weekly correlated with overall user satisfaction. In SNUH, user showed that satisfaction with order communication system was good. Satisfaction was more correlated with perceptions about order communication system's efficiency than with order communication system response time.
Diagnostic Self Evaluation ; Reaction Time ; Self Report ; Seoul*

To survey user satisfaction, correlates of satisfaction, and self reported evaluation about order communication system in Seoul National University Hospital, we performed this study. We met 63 users who were involved in hospital's digitalization committee and surveyed the Questionnare for User Interaction Satisfaction(QUIS) as evaluation tool and self-evaluation about OCS. We received 55 replies out of 63 users. The users were generally satisfied with order communication system(mean scale = 5.8 on a 1 to 9 scale). QUIS scored highest in the area of screen design and lowest in the area of system capability. Overall user satisfaction was most highly correlated with task-flow. Users noticed retrieval of laboratory result as the most useful aspect and worried about system stability and system response time. But, system response time was weekly correlated with overall user satisfaction. In SNUH, user showed that satisfaction with order communication system was good. Satisfaction was more correlated with perceptions about order communication system's efficiency than with order communication system response time.
Diagnostic Self Evaluation ; Reaction Time ; Self Report ; Seoul*

A total of 120 infants, children, and teenagers, who were admitted to the Department of Pediatrics, Severance Hospital from April 1989 to August 1989, were examined by cross-sectional echocardiography. Right and left atrial and ventricular dimensions and areas were measured in the parasternal, apical, and subcostal views. Dimensions of the inferior caval vein, the pulmonary and the aorta were obtained in the parasternal, suprasternal, and subcostal views. The results were as follows : 1) Statistical analysis showed no difference between boys and girls. 2) For all parameters, a positive linear correlation was found with age, height, weight, and body surface area. The best correlation was with body surface area. 3) The correlation was further improved if the logarithmic values of the measurements and body surface area were considered. 4) Measurements by cross-sectional echocardiography are clinically useful, especially in the study of the right-sided cardiac structures that are difficult to evaluate with M-mode echocardiography, but the problems of reproducibility have to be taken into account.
Adolescent ; Aorta ; Body Surface Area ; Child* ; Echocardiography* ; Female ; Humans ; Infant* ; Pediatrics ; Reference Values ; Veins

No abstract available.

Chronic kidney disease (CKD) is an important problem in the elderly as well as in general population. The CKD is defined either by a glomerular filtration rate (GFR) of less than 60 ml/min/1.73m(2) BSA or by the presence of kidney damage, assessed most commonly by the finding of albuminuria for three or more consecutive months. The severity of CKD can be classified as follows : stage 1, kidney damage with a normal or increased GFR (more than 90ml/min/1.73m(2) BSA); stage 2, kidney damage with a mild decrease in GFR (89 to 60ml/min/1.73m(2) BSA) ; stage 3, a moderate decrease in GFR (59 to 30ml/min/1.73m(2) BSA); stage 4, a severe decrease in GFR (15 to 29ml/min/1.73m(2) BSA); stage 5, kidney failure (i.e., a GFR of less than 15 ml/min/1.73m(2) or conditions requiring dialysis). The CKD in elderly population is closely related with a high risk of cardiovascular disease, cognitive impairment, functional limitation, and death. We now have to assess the risk among the elderly patients with CKD for the prevention of morbidity and mortality. Clinicians should measure albuminuria and estimate GFR from serum creatinine to detect CKD. Patients with CKD should be evaluated appropriately and treated according to the underlying cause of CKD. Moreover, the medical society should make an effort to inform individuals with increased risk to develop CKD and the necessity of simple diagnostic tests for CKD.
Aged* ; Albuminuria ; Cardiovascular Diseases ; Creatinine ; Diagnostic Tests, Routine ; Early Diagnosis ; Glomerular Filtration Rate ; Humans ; Kidney ; Mortality ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Societies, Medical

BACKGROUND: As information technology evolves rapidly computer-based surveillance systems for nosocomial infection have been developed. Well designed computerized system could provide an opportunity for improving, enlarging, and conducting hospital-wide surveillance more efficiently in the situation with limited resources. Recently, we launched a new computerized monitoring system in a hospital where digital medical information system has been operated without paper chart. METHODS: We developed a new surveillance program based on the total Electronic Medical Record (EMR) system. Numerous critical medical information can be easily accessible through this system without further work. This includes major demographic data, essential information from the inpatient medical record, the laboratory information system, and the pharmacy information, Comprehensive Clinical Data Repository (CDR) system was also developed. CDR is potentially very useful to conduct a hospital-wide surveillance by integrating all the available information. RESULTS: This system consists of several programs in the EMR and the CDR environment. In the EMR system, inquiry for patients with fever, case ascertainment and registration of nosocomial infections, inquiry for patients with indwelling devices, microbiological reports, and data on antibiotic prescriptions were included. The CDR has integrated comprehensive inquiries for frequency of major pathogens in clinical isolates and their trends of antibiotic resistance, nosocomial infection rates based on the duration of the devices or hospitalization, and the history of antimicrobial usage based on defined daily dosage. Data obtained from the EMR and the CDR systems could be easily accessed by infectious diseases specialists and healthcare workers of infection control services at any place within the hospital. A new reporting system has been built up to facilitate identification of notifiable diseases among the list of diagnoses on the EMR. In addition, the "Alert" notice was designed to highlight isolation precautions for indicated cases. CONCLUSION: This new computerized surveillance program might be a valuable model to which other hospitals can refer to develop newer version of programs in the future.
Clinical Laboratory Information Systems ; Communicable Diseases ; Cross Infection ; Delivery of Health Care ; Diagnosis ; Drug Resistance, Microbial ; Electronic Health Records* ; Fever ; Hospitalization ; Humans ; Infection Control ; Information Systems ; Inpatients ; Medical Records ; Pharmacy ; Prescriptions ; Specialization

OBJECTIVE: As an electronic health record system is implementing in Korean health care sectors, concerns about key functionalities of electronic health record systems are increasing. The purpose of this study was to identify core functions and set the priority in electronic health record systems under the Korean contexts in order to assure and improve the quality of the systems. METHODS: A survey was conducted using questionnaire developed by the study team based on literature review. The subjects were medical record administrators working at medical record department in general hospitals. RESULTS: The response rate was 59.8%(55/92). The functions which more than ninety percent of subjects responded as necessary right now and/or in near future related to 'drug alert', 'clinical guideline', 'chronic disease management', 'automated real-time surveillance', 'coded data', 'result reporting', 'de-identifying data', 'disease registry', and 'provider-provider communication and connectivity'. CONCLUSION: The results showed the high prioritized functions were decision support and health information/data management.
Electronic Health Records* ; Health Care Sector ; Hospitals, General* ; Humans ; Medical Record Administrators ; Medical Records ; Needs Assessment* ; Surveys and Questionnaires

The electronic medical record is gradually penetrating the world-wide healthcare environment, including Korea. Users of electronic medical record want to get full advantages of it, but benefits would not be realized by simple implementation. Wellorganized architecture and controlled medical vocabulary are needed for achieving effective electronic medical record system. Many terminologies are introduced in healthcare system but single noble terminology to cope with users' need is not present. To extract clinically useful and standardized set of chief complaints for electronic medical record in our institutional environment, we analyzed chief complaints in 235,426 discharge summaries in Seoul National University Hospital. We normalized the chief complaint by 27 medical experts. First of all, researchers parsed chief complaints as main concept, qualifier, and modifier. We normalized main concepts, keeping applicability and usability of extracted set to electronic medical record in mind. And then, mapping set of chief complaint to SNOMED CT was done by 4 physicians. Among 94,913 unique strings, we selected 6,317 terms as standard set of chief complaint. The potential users of electronic medical record were asked to evaluate usability of the set and accepted it as representative of chief complaint. The majority of terms in set were completely mapped to SNOMED CT. We discussed several principles in normalizing chief complaints. We also pointed pros and cons of SNOMED CT as reference terminology to chief complaint domain. Through this study, we developed conceptually standardized chief complaint domain with user-friendly terms in Seoul National University Hospital Environment. Furthermore, this result would be the starting point to evolve medical terms in Korea into ontology based terminology system.
Delivery of Health Care ; Electronic Health Records* ; Korea ; Seoul ; Systematized Nomenclature of Medicine* ; Vocabulary

OBJECTIVES: Of 339 patients with systemic lupus erythematosus(SLE) observed at Seoul National University Hospital in Seoul, 221 fulfilled criteria for lupus nephritis. We evaluated the clinicopathologic findings, outcomes and prognostic factors of patients' survival. METHODS: We searched computer system of our center using disease code for SLE from January 1973 to January 1995 and found 339 SLE patients among whom there were 221 definite lupus nephritis patients. We retrospectively reviewed medical records and investigated the influence of multiple prognostic factors on patients' survival using Cox hazard function analysis. RESULTS: Of 221 patients, 89.6% were female. The mean age of onset of SLE was 27.7+/-10.4 years and the mean follow-up duration was 42.5+/- 40.2 months. The most frequent symptoms at diagnosis were skin manifestations. Hypertension was diagnosed in 21.7% of patients and 21.6% had serum creatinine greater than 1.4mg/dL. Overall, 37.7% were nephrotic. Renal biopsy performed on 159 patients showed the following World Health Organization Class distribution : Class I 1.3%, class II 8.8%, class III 6.3%, class IV 65.4%, class V 13.2%, class IV+V 5.0%. Remission of nephritis was observed in 31.3% of patients. At the last follow-up period, there were 23 patients with deteriorated renal function among 168 patients and renal failure developed in 3.2%. Twenty eight patients died, primarily from infection, with 86.2% and 78.3% 5-year and 10-year survival rates, respectively. Initial presence of renal insufficiency(serum creatinine>or=1.4mg/dL) and treatment with prednisolone only were most important in predicting patients' survival. Combination treatment of high dose prednisolone and cytotoxic drug(azathioprine, oral cyclophosphamide, or iv cyclophosphamide) appeared to be beneficial for nephritis. Treatment modality was only independent risk factor associated with lower survival probability. CONCLUSION: The characteristics of our patients were not so different from those of others. Treatment modality and renal function were important predictors of fatality. Treatment with high dose prednisolone and cytotoxic drug improved the clinical outcome of lupus nephritis, as compared with prednisolone alone.
Age of Onset ; Biopsy ; Computer Systems ; Creatinine ; Cyclophosphamide ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Lupus Nephritis* ; Medical Records ; Nephritis ; Prednisolone ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Seoul ; Skin Manifestations ; Survival Rate ; World Health Organization