OBJECTIVES: This study explored the reuse of data captured by nurses to support nursing decisions related to pressure-ulcer care. METHODS: To examine the existence of coded data in an electronic nursing record system for the identified concepts, we used the electronic nursing documents of a teaching hospital in Gyeonggi-Do, in Korea. A surgical intensive care unit (SICU) was selected as the test unit due to the high incidence of pressure ulcers. The concepts were identified from literature review and refined through the involvement of staff nurses. RESULTS: We found that 93.4% of the necessary concepts were matched semantically with data items at the input level of the electronic medical record system. Eighteen concepts (60%) were directly matched with the data variables of structured electronic nursing records. Five concepts (16.7%) were matched into more than two items. Including the standard nursing statements coded in Nurses' notes, five concepts were mapped more. CONCLUSIONS: More than 90% of the concepts were matched successfully, which suggests that the secondary use of the routine data collected in an EMR system could be used to develop an automated risk assessment tool for pressure ulcers.
Electronic Health Records ; Electronics ; Electrons ; Hospitals, Teaching ; Incidence ; Critical Care ; Korea ; Medical Records Systems, Computerized ; Nursing Records ; Pressure Ulcer ; Risk Assessment

OBJECTIVE: To evaluate the effect of caffeine on balance control of hemiparetic stroke patients, we investigated the difference in postural stability before and after drinking coffee by observing changes in stability index (SI) from posturography. METHODS: Thirty patients with history of stroke and 15 age-matched healthy subjects participated in this study. Effect of group factor (of the control and stroke groups) and treatment factor (pre- and post-drinking of coffee) on SI were tested in three conditions: with eyes opened, with eyes closed, and with a pillow support. The effects of these factors on visual deprivation and somatosensory change of subjects were also tested. RESULTS: Under all conditions, SI was higher in the stroke group than in the control group. Under eyes-open condition, the treatment factor was not statistically significant. Under eyes-closed condition, the interaction between group and treatment factor was statistically significant. After the subjects drank coffee, SI in the control group was increased. However, SI in the stroke group was decreased. Under pillow-supported condition, the interaction between group and treatment factor appeared marginally significant. For visual deprivation effect, the interaction between treatment and group factor was statistically significant. After caffeine consumption, the visual deprivation effect was increased in control group but decreased in the stroke group. For somatosensory change effect, the interaction between group and treatment factor was not statistically significant. CONCLUSION: Postural stability of hemiparetic stroke patients related to somatosensory information was improved after intake of usual dose of caffeine.
Caffeine* ; Coffee ; Drinking ; Humans ; Stroke*

Autoimmune diseases are occasionally associated with other autoimmune diseases in the same patients. Graves disease has been associated with systemic rheumatic diseases including systemic lupus erythematosus (SLE). The diagnosis of Graves disease in patients with SLE is well known, especially in adults, but few case reports have involved children and adolescents. We report a 14-year-old female who presented with Graves disease, proteinuria, arthralgia, decreased complement, and positive antinuclear antibody and who was diagnosed with SLE. Renal biopsy revealed class IV lupus glomerulonephritis. These clinical, laboratory, and histological findings indicate that class IV lupus nephritis may be associated with Graves disease. This possibility should be borne in mind when following patients with Graves disease in order to avoid any delay in the diagnosis and treatment of serious systemic autoimmune diseases such as SLE.
Adolescent ; Adult ; Antibodies, Antinuclear ; Arthralgia ; Autoimmune Diseases ; Biopsy ; Child ; Complement System Proteins ; Female ; Graves Disease ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Proteinuria ; Rheumatic Diseases

Autoimmune diseases are occasionally associated with other autoimmune diseases in the same patients. Graves disease has been associated with systemic rheumatic diseases including systemic lupus erythematosus (SLE). The diagnosis of Graves disease in patients with SLE is well known, especially in adults, but few case reports have involved children and adolescents. We report a 14-year-old female who presented with Graves disease, proteinuria, arthralgia, decreased complement, and positive antinuclear antibody and who was diagnosed with SLE. Renal biopsy revealed class IV lupus glomerulonephritis. These clinical, laboratory, and histological findings indicate that class IV lupus nephritis may be associated with Graves disease. This possibility should be borne in mind when following patients with Graves disease in order to avoid any delay in the diagnosis and treatment of serious systemic autoimmune diseases such as SLE.
Adolescent ; Adult ; Antibodies, Antinuclear ; Arthralgia ; Autoimmune Diseases ; Biopsy ; Child ; Complement System Proteins ; Female ; Graves Disease ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Proteinuria ; Rheumatic Diseases

OBJECTIVE: Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS. METHOD: We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups. RESULTS: In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS. CONCLUSION: The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.
Isometric Contraction ; Knee ; Patellofemoral Pain Syndrome* ; Quadriceps Muscle ; Rehabilitation ; Torque ; Weight-Bearing

BACKGROUND: Actinic keratoses (Aks) are common precancerous lesions and they affect a great portion of the elderly Caucasian population. Many studies have been conducted on Aks and mainly in Western society. Only a few clinical and histopathological studies of Aks have been conducted in Korea. OBJECTIVE: The aim of this study was to investigate the clinical and histopathological features of Aks in Koreans. METHODS: Ninety six patients were enrolled. We reviewed the medical records and the biopsy specimens. RESULTS: The ratio of males to females was 1:4.05 and the most frequent age groups were the 8th (39.6%) and 9th decade (35.4%). Multiple lesions (53.1%) were more common than single lesion (46.9%). The duration of disease was less than 1 year in many cases (43.8%). The most commonly involved site was the face (82.3%). The color was erythematous in 55.2% of the cases, brownish in 34.4% and dark-brownish in 10.4%. Scale and crust were noted in 33.3% and 24.0% of the cases, respectively. Aks were associated with squamaous cell carcinoma in 12.5% of the cases, basal cell carcinoma in 6.3% and verrucous carcinoma in 2.1%. Histopathologically, the hypertrophic type of Aks was noted in 40.6% of the cases, atrophic in 39.6%, acantholytic in 10.4% and bowenoid in 9.4%. The most common treatment modality was cryotherapy with liquid nitrogen (95.8%). CONCLUSION: Aks in Koreanse usually presented on the face of elderly females. The lesions were more commonly noted as multiple lesions than single lesion. Various histopathologic types were noted, including the hypertrophic, atrophic, acantholytic and bowenoid subtypes. The greater association with cutaneous malignancies was noted as compared to that in the previous reports. Close follow-up and physical examination are recommended.
Actins ; Aged ; Asian Continental Ancestry Group ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Verrucous ; Cryotherapy ; Female ; Humans ; Keratosis, Actinic ; Korea ; Male ; Medical Records ; Nitrogen ; Physical Examination

PURPOSE: The incidence of neonatal hyperbilirubinemia is twice as high in Eastern Asians as in Caucasians. Although it has not been clearly defined, the UDP-glucuronosyltransferase gene (UGT1A1) mutation was found to be a risk factor of neonatal hyperbilirubinemia. This study is to find an association of 1956G>C polymorphism of the UGT1A1 gene, which encodes for a key enzyme of bilirubin metabolism and neonatal hyperbilirubinemia in Korean infants. METHODS: The genomic DNA was isolated from 80 Korean full term neonates whose serum bilirubin greater than 12 mg/dL with no obvious cause. The genomic DNA was also isolated from 164 Korean neonates of the control population. We studied a single nucleotide polymorphism (SNP) of 1956G>C in the untranslated region of the UGT1A1 gene by direct sequencing. RESULTS: Three of the 80 neonates with a serum bilirubin level above 12 mg/dL had homozygous mutation and 10 of the neonates with a serum bilirubin level above 12 mg/dL had heterozygous mutation. Thirteen of the 164 neonates of the control group had homozygous mutation and 16 neonates of the control group had heterozygous mutation. The allele frequency of 1956G>C polymorphism of UGT1A1 in the hyperbilirubinemia group was 10.0 percent, which was not significantly different from the allelic frequency of 12.8 percent in the control group. CONCLUSIONS: In this study, the 1956G>C polymorphism of the UGT1A1 gene was detected in the Korean neonates with neonatal hyperbilirubinemia. Our results indicated that this SNP is not associated with the prevalence of hyperbilirubinemia in Korean.
Asian Continental Ancestry Group ; Bilirubin ; DNA ; Gene Frequency ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Incidence ; Infant ; Infant, Newborn ; Metabolism ; Polymorphism, Single Nucleotide ; Prevalence ; Risk Factors ; Untranslated Regions

PURPOSE: The incidence of neonatal hyperbilirubinemia is twice as high in East Asians as in Caucasians. However, its metabolic basis has not been clearly explained. The UDP-glucuronosyltransferase gene(UGT1A1) mutation was found to be a risk factor of neonatal hyperbilirubinemia. We studied whether neonatal hyperbilirubinemia is associated with the 1828G>A(rs 10929303) polymorphism of the UGT1A1 gene, which encodes for a key enzyme of bilirubin metabolism. METHODS: The genomic DNA was isolated from 80 Korean full term neonates who had greater than a 12 mg/dL level of serum bilirubin with no obvious cause, and the genomic DNA was also isolated from 164 Korean neonates of the control population. We studied a single nucleotide polymorphism (SNP) of 1828G>A in the untranslated region of the UGT1A1 gene by direct sequencing. RESULTS: Three of the 80 neonates with a serum bilirubin level above 12 mg/dL had homozygous mutations and 10 of the 80 neonates with a serum bilirubin level above 12 mg/dL had heterozygous mutations. Thirteen of the 164 neonates of the control group had homozygous mutations and 16 neonates of the control group had heterozygous mutations. The allele frequency of 1828G>A polymorphism of UGT1A1 in the hyperbilirubinemia group was 10.0 percent, which was not significantly different from the allele frequency of 12.8 percent in the control group. CONCLUSION: In this study, the 1828G>A polymorphism of the UGT1A1 gene was detected in the Korean neonates with neonatal hyperbilirubinemia. Our results indicated that this SNP is not associated with the prevalence of hyperbilirubinemia in Koreans.
Asian Continental Ancestry Group ; Bilirubin ; DNA ; Gene Frequency ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Incidence ; Infant, Newborn ; Metabolism ; Polymorphism, Single Nucleotide ; Prevalence ; Risk Factors ; Untranslated Regions

PURPOSE: Human angiotensin converting enzyme (ACE) gene shows an insertion/deletion polymorphism in 16 intron, and three genotypes are determined by whether a 287 bp fragment of the DNA is present or not; II, ID and DD genotype. DD genotype has been suggested as a risk factor of chronic nephrotic disease such as IgA nephropathy and diabetic nephropathy, various cardiovascular diseases and several other diseases. ACE activity increases in acute hepatitis, chronic persistent hepatitis, chronic active hepatitis and cirrhosis. On the other hand, patients with fatty livers have normal ACE activity. This study was designed to find out the relation between polymorphsims of the ACE genes and neonatal hyperbilirubinemia in Koreans. METHODS: The genomic DNA was isolated from 110 full-term Korean neonates who had hyperbilirubinemia with no obvious causes (serum bilirubin?12 mg/dL) and 164 neonates of a control population (serum bilirubin?12 mg/dL). We performed polymerase chain reaction (PCR) to see the allele of the ACE gene. Electrophoresis was done in the PCR products in 1.5 percent agarose gel, and then DNA patterns were directly visualized under ethidium bromide staining. RESULTS: ACE genotypes in the hyperbilirubinemia group are as follows; 26.36 percent for II, 53.64 percent for ID, 20.00 percent for DD, 0.532 for I allele and 0.468 for D allele. These distributions were not significantly different from those in the control group; 24.39 percent for II, 51.83 percent for DI, 23.78 percent for DD, 0.503 for I allele and 0.497 for D allele. CONCLUSION: In this study, ACE gene polymorphism was detected in the neonatal hyperbilirubinemia and control group. The most frequent genotype was ID. Our results indicate that the ACE gene polymorphism is not associated with the prevalence of neonatal hyperbilirubinemia in Koreans.
Alleles ; Angiotensins* ; Cardiovascular Diseases ; Diabetic Nephropathies ; DNA ; Electrophoresis ; Ethidium ; Fibrosis ; Genotype ; Glomerulonephritis, IGA ; Hand ; Hepatitis ; Hepatitis, Chronic ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant, Newborn ; Introns ; Korea* ; Liver ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Prevalence ; Risk Factors ; Sepharose

PURPOSE: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. METHODS: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. RESULTS: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. CONCLUSION: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.
Acute Kidney Injury ; Coloring Agents ; Creatinine ; Hospitals, Teaching ; Humans ; Medical Records ; Paraquat ; Physical Examination ; Proteinuria ; Pulmonary Fibrosis ; Retrospective Studies ; Skin ; Ulcer ; Vomiting