No abstract available.
Fluconazole* ; Tinea Capitis* ; Tinea*

Since the hospital bankruptcy rate is increasing, it has been an important issue to predict the bankruptcy of hospital using the existing hospital management information. Fortunately, the implementation of data mining methodology and decision support system(DSS) are becoming popular. Therefore, this study developed the statistical software for predicting hospital bankruptcy using data mining tool. Stepwise procedures were taken as follows: 1) adopting the HGLM and Logit Models; 2) implementing the input and output processes; 3) linking to the iBITs interface, the data miming tool; and 4) evaluating the software by fitting the hospital management data in practice. The software is written in Visual C++ 5.0 under windows NT/95, and allows the interconnection with other interfaces and libraries. This program initiates encouragement of implementation of DSS models using data mining methodology, in health care fields. This kind of software will play a pivotal role in improving the efficiency and adequacy of managing health care institutions.
Bankruptcy* ; Data Mining* ; Delivery of Health Care ; Logistic Models ; Models, Statistical

No abstract available.
Animals ; Cricetinae* ; Macrophage Activation* ; Macrophages* ; Macrophages, Peritoneal* ; Mice* ; Nitric Oxide ; Phagocytosis

Purpose: This study was conducted to determine the malignancy risk and diagnostic value of various types of nonshadowing echogenic foci (NEF) in the risk stratification of thyroid nodules. Methods: A total of 1,018 consecutive thyroid nodules (≥1 cm) with final diagnoses were included. The presence of NEF was determined and types of NEF were classified according to the presence of a comet tail artifact (CTA), location, and size through a prospective evaluation. The associations with malignancy, malignancy risk, and diagnostic value of various types of NEF were assessed. Results: Intrasolid punctate NEF without CTA was the only type of NEF that was an independent predictor of malignancy (P<0.001). The malignancy risk of intrasolid punctate NEF without CTA was substantially higher in solid hypoechoic nodules than in isoechoic or nonsolid nodules (71.3% vs. 9.2%, P<0.001). In solid hypoechoic nodules, slightly increased sensitivity (70.8% vs. 67.9%) for malignancy and a similar malignancy risk (71.4% vs. 71.3%) were observed for intrasolid punctate NEF (with or without CTA) and intrasolid punctate NEF without CTA, respectively. NEF with CTA at the margin of the cystic component was not associated with malignancy or benignity in nonsolid nodules (P>0.05). Conclusion Intrasolid punctate NEF without CTA was the only independent predictor of malignancy. However, solid hypoechoic nodules with intrasolid punctate NEF should be classified as high-suspicion nodules regardless of coexisting CTA. Other types of NEF had no added value for detecting malignancy compared to intrasolid punctate NEF without CTA.

Objective: This study was evaluated the behavior intention of emergency medicine residents before and after education using a vignette case about professionalism, particularly in physician impairment. The residents’ reaction to this type of education was evaluated. Methods: Thirty-four residents from five teaching hospitals participated in this education program consisting of lecture and discussion using cases. They wrote their behavioral intention and their opinions before and after education. Their satisfaction and reaction to the education experience were also collected. Results: The frequencies of the common reasons for the action or the basis of the judgment, concerns during decision making, and desired help were similar, but their action decisions changed into more systemic and reasonable ones after the education. They had fewer learning experiences of non-clinical skills and were satisfied with this type of professionalism education. Furthermore, they felt the importance and educational needs of professionalism beyond this topic and would cope with similar problem situations the way they learned in this education. Conclusion In the professionalism education using the case discussion of impairment and self-monitoring, little had changed in the participants’ reasons for the action, concerns when decision making, and desired help, but their behavior intentions changed as they learned. This study provided the opportunity to recognize the importance of professionalism, patient safety, and peer relationship. Small group discussions using the vignette case can be suggested to provide professionalism education for the emergency medicine residents.

Objective: This study was evaluated the behavior intention of emergency medicine residents before and after education using a vignette case about professionalism, particularly in physician impairment. The residents’ reaction to this type of education was evaluated. Methods: Thirty-four residents from five teaching hospitals participated in this education program consisting of lecture and discussion using cases. They wrote their behavioral intention and their opinions before and after education. Their satisfaction and reaction to the education experience were also collected. Results: The frequencies of the common reasons for the action or the basis of the judgment, concerns during decision making, and desired help were similar, but their action decisions changed into more systemic and reasonable ones after the education. They had fewer learning experiences of non-clinical skills and were satisfied with this type of professionalism education. Furthermore, they felt the importance and educational needs of professionalism beyond this topic and would cope with similar problem situations the way they learned in this education. Conclusion In the professionalism education using the case discussion of impairment and self-monitoring, little had changed in the participants’ reasons for the action, concerns when decision making, and desired help, but their behavior intentions changed as they learned. This study provided the opportunity to recognize the importance of professionalism, patient safety, and peer relationship. Small group discussions using the vignette case can be suggested to provide professionalism education for the emergency medicine residents.

PURPOSE: In this study, the etiology and the change of clinical characteristics of hyponatremia, in relation to the increased used of thiazide diuretics, have been assessed. METHODS: To perform a retrospective cohort study, a total sum of 322 patients who have been admitted in a single tertiary referral hospital between 2004 and 2009, were included. RESULTS: The most common cause of hyponatremia was due to thiazide diuretics (37.6%). Among the 121 patients who suffered from thiazide induced hyponatremia, 60 (48.0%) patients took combination thiazide. The incidence of hyponatremia has shown a tendency to increase from 2004 to 2009 (trend test, p<0.001). The incidence of hyponatremia due to the use of combination types has also increased (trend test, p<0.001). Thiazide induced hyponatremia showed no difference when compared to hyponatremia due the other causes, except the fact that the portion of female patients was higher (73.6% vs 64.6%, p<0.001), mean age was older (74.7 vs 69.9 years-old, p<0.001), and incidence of cerebrovascular accident was also higher (19.8% vs 6.5%, p<0.001). CONCLUSION: The use of thiazide is increasing and hence thiazide-induced hyponatremia is also increasing. This is thought to be particularly related to the increase of thiazide-combined drugs. Thiazideinduced hyponatremia shows a higher incidence in old age, female sex and those who have a history of a cerebrovascular event. Hence more caution is needed when using thiazide diuretics as antihypertensives, and plasma sodium levels should be monitored carefully.
Antihypertensive Agents ; Cohort Studies ; Diuretics ; Female ; Humans ; Hyponatremia ; Incidence ; Plasma ; Retrospective Studies ; Sodium ; Sodium Chloride Symporter Inhibitors ; Stroke ; Tertiary Care Centers

BACKGROUND: Endometrial carcinomas are pathogenetically classified into two major types; endometrioid carcinoma (EC) and serous carcinoma (SC). The most frequently altered gene in EC is the PTEN tumor suppressor gene (TSG). SC is usually associated with mutations in the p53 TSG. METHODS: To further determine the role of PTEN and p53 mutation in endometrial carcinogenesis, the analysis of 33 endometrial carcinomas, including 28 ECs and 5 SCs, for loss of heterozygosity (LOH) on 10q23 and for mutation in all 9 coding exons of PTEN and the 5-8 exons of p53, using SSCP-PCR methods was carried out. RESULTS: LOH was detected in at least one marker in 12 (54.5%) of 22 ECs, but in only one (20.0%) of 5 SCs. Somatic PTEN mutations were detected in 10 (35.7%) of 28 ECs. PTEN was altered in 67.9% of ECs and in 20.0% of SCs, including those with 10q23 LOH. No PTEN mutations were found among the SCs. Somatic p53 mutations were detected in 2 (7.1%) of 28 ECs and 3 (60.0%) of 5 SCs. CONCLUSIONS: PTEN gene alterations contribute to the pathogenesis of an endometrioid subtype of endometrial carcinoma, but not to the serous type. In contrast, p53 plays an important role in the pathogenesis of SCs.
Carcinogenesis ; Carcinoma, Endometrioid ; Clinical Coding ; Endometrial Neoplasms* ; Exons ; Female ; Genes, p53 ; Genes, Tumor Suppressor ; Loss of Heterozygosity

BACKGROUND/AIMS: The quality of care in inflammatory bowel disease (IBD) has not been systematically estimated. The aim of this study was to investigate the current status of quality of IBD care in Asian countries. METHODS: A questionnaire-based survey was conducted between March 2014 and May 2014. The questionnaire was adopted from "An adult inflammatory bowel disease physician performance measure set" developed by the American Gastroenterological Association. If the respondent executed the performance measure in more than 70% of patients, the measure was regarded as well performed. RESULTS: A total of 353 medical doctors from Asia completed the survey (116 from Korea, 114 from China, 88 from Japan, 17 from Taiwan, 8 from Hong-Kong, 4 from India, 3 from Singapore, and 1 each from the Philippines, Malaysia and Indonesia). The delivery of performance measures, however, varied among countries. The documentation of IBD and tuberculosis screening before anti-tumor necrosis factor therapy were consistently performed well, while pneumococcal immunization and prophylaxis of venous thromboembolisms in hospitalized patients were performed less frequently in all countries. Physician awareness was positively associated with the delivery of performance measures. Variations were also noted in reasons for non-performance or low performance of quality measures, and the two primary reasons cited were consideration of the measure to be unimportant and lack of time. CONCLUSIONS: The delivery of performance measures varies among physicians in Asian countries, and reflects variations in the quality of care among the countries. This variation should be recognized to improve the quality of care in Asian countries.
Adult ; Asia* ; Asian Continental Ancestry Group* ; China ; Colitis* ; Humans ; Immunization ; India ; Inflammatory Bowel Diseases* ; Japan ; Korea ; Malaysia ; Mass Screening ; Necrosis ; Philippines ; Seoul* ; Singapore ; Surveys and Questionnaires ; Taiwan ; Thromboembolism ; Tuberculosis

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is increasing in Asian countries. Functional dyspepsia (FD) or irritable bowel syndrome (IBS) are also prevalent and commonly overlapped with GERD. This study was conducted to compare the proportion and risk factors for overlapping reflux esophagitis (RE) and non-erosive reflux disease (NERD) with functional gastrointestinal disorders (FGIDs). METHODS: A total of 2,388 [male, 55.9%; mean age (+/- SD), 43.2 years (+/- 8.4)] Korean subjects who underwent the upper endoscopy for health screening were prospectively included. The subjects were asked about demographic, medical and social history by using a structured questionnaire, and FD and IBS were assessed according to the Rome III criteria. RESULTS: The subjects with RE were 286 (12.0%, male 88.5%, 42.8 years) and 74 subjects had NERD (3.1%) while the prevalence of FD and IBS were 8.1% and 10.1%, respectively. The proportion of FD and IBS in NERD was higher than that of RE (74.3% vs. 10.5%, p = 0.000; 41.9% vs. 11.2%, p = 0.000, respectively). The epigastric pain syndrome (EPS) was more prevalent than postprandial distress syndrome in NERD. According to multiple regression analysis, high somatization score and the presence of FD increased the odd ratio for NERD. However, male gender and current smoker were significant risk factors for RE. CONCLUSIONS: Compared to RE, NERD is more frequently overlapped with FD, especially EPS, and also are associated with significantly increased frequency of IBS. Our data draws attention to the possibility of subgrouping FGIDs and GERD to be important in understanding the pathophysiology of these conditions.
Asian Continental Ancestry Group ; Dyspepsia ; Endoscopy ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Male ; Mass Screening ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Risk Factors ; Rome