Objectives: This study aims to understand the perceptions regarding preventive dental services among dental professionals. Methods: In-depth interviews were conducted with three groups of dental professionals―dentists, dental hygienists, and dental hygienists that specialized in preventive service―who were selected using a convenience sampling method. Results: First, there was limited awareness among dentists regarding the need for preventive care, because of the treatment-oriented philosophy and scarcity of preventive care success models. Second, dental hygienists commented that there was a lack of the person in charge and systematic process for preventive services. It would not help when they decided to change working place even though they had high anxiety working for preventive care. However, both these professionals agreed that preventive treatment is important as the core of care and that it was important to develop various improvement methods to promote preventive services. Conclusions To activate preventive services in dental clinics, it is essential to improve the operating system and encourage dental professionals to realize the importance of preventive services.

In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.8±3.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.
Fireflies* ; Humans ; Indocyanine Green ; Lymph Node Excision* ; Lymph Nodes* ; Thyroid Gland ; Thyroidectomy*

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

PURPOSE: We performed this study to evaluate the risk of rehospitalization for respiratory syncytial virus(RSV) infection among premature infants discharged from a neonatal intensive care unit(NICU). METHODS: We performed a retrospective study for rehospitalization for RSV infection and risk factors among premature infants who were admitted to NICU and discharged between May 2001 and April 2003 in Wonkwang University Hospital. RSV detection was utilized by direct fluorescent antibody tests in nasopharyngeal aspirates. We also reviewed various risk factors including gestational age, birth weight, sex, ventilatory care, surfactant administration, chronic lung disease(CLD), siblings in school or kindergarten age, and month of discharge. RESULTS: The rehospitalization rate for RSV infection was 6.6%(26/381) in premature infants and 22.2%(4/18) in premature infants with CLD. The most common season of rehospitalization for RSV infection was between November to January, this was 69.2%(18/26) in premature infants, the same as children: 61.2%(93/152). The risk factors for RSV rehospitalization among premature infants were CLD, siblings in school or kindergarten age and discharge between October to December from NICU. CONCLUSION: The risk for RSV rehospitalization among premature infants from NICU was low. Preterm infants subject to risk factors of CLD, siblings in school or kindergarten age, and discharge between October to December from NICU, were most likely to require hospitalization for RSV disease. In CONCLUSION: Prophylaxis for RSV infection should be considered one month before discharge from NICU in the RSV season between October and December.
Birth Weight ; Child ; Gestational Age ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Lung ; Respiratory Syncytial Viruses* ; Retrospective Studies ; Risk Factors* ; Seasons ; Siblings

True malignant mixed tumor (carcinosarcoma) of the salivary gland is an extremely rare tumor. By definition, it is a heterologous neoplasm that's composed of both malignant epithelial and mesenchymal components. We report here on a case of an 83 year old female patient with a parotid gland mass. Histologic examination showed a biphasic pattern of growth with both a poorly differentiated epithelial component and a sarcomatous spindle cell background. The immunohistochemical and ultrastructural findings support the diagnosis of a small cell neuroendocrine epithelial tumor and an undifferentiated malignant mesenchymal features. The histologic and ultrastructural features along with the immunohistochemical findings are presented. We also review the literature and we discuss the different opinions on the exact histogenesis of the true malignant mixed tumor of the salivary gland. To the best of our knowledge, this histological pattern has not been previously reported in the English medical literature.
Female ; Humans

Objectives: This study aimed to evaluate the registered dentists’ program, from the dentist’s perspective, before its nationwide implementation. Methods: In-depth interviews were conducted with 18 dentists who had participated in the registered dentists’ program in G Province. A questionnaire was prepared based on previous research. The data were collected by transcription of interview recordings. Qualitative research methodology was implemented and the data were coded according to the grounded theory. A paradigm model was presented and the core categories were indicated. Results: The findings were organized into 6 categories, 25 subcategories, and 315 codes, based on open coding of the first categorization of collected data. The central phenomenon was found to be the experience of dissatisfaction with the program. The causal conditions were shown as problems of the program, while contextual and intervening conditions were shown as passive participation of dentists and positive effects of the program, respectively. The action/interaction strategies were summarized as an improvement plan and the consequence was an increased intention to participate. Conclusions The study proposes the need to strengthen primary dental care through this registered dentists’ program, by performing continuous evaluations. The standards and guidelines, cooperation of participants, and appropriate compensation should be considered to promote successful implementation.

Objectives: This study aimed to evaluate the registered dentists’ program, from the dentist’s perspective, before its nationwide implementation. Methods: In-depth interviews were conducted with 18 dentists who had participated in the registered dentists’ program in G Province. A questionnaire was prepared based on previous research. The data were collected by transcription of interview recordings. Qualitative research methodology was implemented and the data were coded according to the grounded theory. A paradigm model was presented and the core categories were indicated. Results: The findings were organized into 6 categories, 25 subcategories, and 315 codes, based on open coding of the first categorization of collected data. The central phenomenon was found to be the experience of dissatisfaction with the program. The causal conditions were shown as problems of the program, while contextual and intervening conditions were shown as passive participation of dentists and positive effects of the program, respectively. The action/interaction strategies were summarized as an improvement plan and the consequence was an increased intention to participate. Conclusions The study proposes the need to strengthen primary dental care through this registered dentists’ program, by performing continuous evaluations. The standards and guidelines, cooperation of participants, and appropriate compensation should be considered to promote successful implementation.

P53 and its family member p63 play important roles in cellular senescence and organismal aging. In this study, p53 and p63 immunoreactivity were examined in the hippocampus of young, adult and aged mice by using immunohistochemistry. In addition, neuronal distribution and degeneration was examined by NeuN immunohistochemistry and fluoro-Jade B fluorescence staining. Strong p53 immunoreactivity was mainly expressed in pyramidal and granule cells of the hippocampus in young mice. p53 immunoreactivity in the pyramidal and granule cells was significantly reduced in the adult mice. In the aged mice, p53 immunoreactivity in the pyramidal and granule cells was more significantly decreased. p63 immunoreactivity was strong in the pyramidal and granule cells in the young mice. p63 immunoreactivity in these cells was apparently and gradually decreased with age, showing that p63 immunoreactivity in the aged granule cells was hardly shown. However, numbers of pyramidal neurons and granule cells were not significantly decreased in the aged mice with normal aging. Taken together, this study indicates that there are no degenerative neurons in the hippocampus during normal aging, showing that p53 and p63 immunoreactivity in hippocampal neurons was progressively reduced during normal aging, which might be closely related to the normal aging processes.
Adult ; Aging ; Animals ; Cell Aging ; Fluorescence ; Hippocampus ; Humans ; Immunohistochemistry ; Mice ; Neurons ; Pyramidal Cells

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. METHODS: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. RESULTS: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. CONCLUSIONS: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective.
Ampulla of Vater ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct* ; Diagnosis ; Endosonography ; Fistula ; Humans ; Pancreatitis ; Sphincterotomy, Endoscopic

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called lateonset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.