OBJECTIVES: This study aimed at assessing the quality of dental services, as perceived by the disabled, and analyzing the factors identified to be of both high importance and low performance, as identified by IPA. METHODS: The data were collected from June 8 to November 2, 2016, after approval by the institutional review board. Questionnaires were distributed to 1466 disabled dental service consumers, of which 349 cases were included. The data were analyzed by frequency analysis, multi-regression analysis for implicit importance, and IPA matrix for marketing strategy. RESULTS: The performance results revealed that cost level, reduction of the fee, and waiting time for treatments were the sources of greatest dissatisfaction. The IPA matrix results categorized the next appointment, explanation of the fee, waiting time for treatment, professionalism of the staff, and convenient facilities as high-importance, low-performance factors. Meanwhile, the results of the IPA matrix for consumer segmentation, according to recently used dental institutions were different. The dental clinic users evaluated professionalism of the staff, convenience of the facility, explanation of the fee, and cost level as high-importance, low-performance attributes. The dental hospital users indicated that waiting time for treatment and next appointment were high-importance, low-performance attributes. Finally, the public health center users indicated that convenience of booking, waiting time for treatment, convenience of facilities, reduction of the fee, and next appointment as high-importance, low-performance attributes. CONCLUSIONS: To improve the quality of dental service, we need to understand the needs of the dental patients with disability. All attributes that were categorized as high-importance, low-performance must be improved first and should accordingly be used as strategic factors to increase satisfaction with oral medical institutions.
Dental Clinics ; Ethics Committees, Research ; Fees and Charges ; Humans ; Marketing ; Professionalism ; Public Health

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.
Analgesics, Opioid ; Anemia ; Anorexia ; Anxiety ; Benzodiazepines ; Cachexia ; Comorbidity ; Constipation ; Delirium ; Depression ; Dyspnea ; Education ; Fatigue ; Gastroparesis ; Haloperidol ; Humans ; Hyperthyroidism ; Hypogonadism ; Lung Diseases ; Malnutrition ; Metoclopramide ; Natural History ; Nausea ; Ondansetron ; Palliative Care ; Quality of Life ; Stomatitis ; Terminal Care ; Terminally Ill* ; Tetrahydrocannabinol ; Uremia ; Vomiting

Sclerosing hemangioma of the lung is uncommon benign neoplasm of uncertain histogenesis, although their radiological appearance is relatively distinct and well-defined. Recently, we experienced 2 cases of sclerosing hemangiomas of the lungs in 61 and 39 years old women. The light microscopic findings of the tissues are similar to the features reported by Liebow and Hubbell(1956). The basic cellular response is thought to be type II pneumonocytes because of findings of multilamellar-like bodies within stromal cells with electron microscopy in case I in addition to other characteristics generally found in epithelial cells.
Female ; Humans ; Hemangioma

Chromosome 4q deletion syndrome is a rare disease caused by partial deletion of the long arm of chromosome 4. Phenotypic severity and expressivity vary among patients with chromosome 4q deletions, depending on the size and region of the deletion of the affected chromosome. Although there have been many reports of proximal 4q deletion cases, very few have been confirmed by high-resolution array comparative genomic hybridization (aCGH). In the current study, we presented a new case of 4q proximal deletion, with detailed genetic and clinical characteristics, and compared these characteristics to those of six previous cases with available aCGH data. According to our review, several genes known to be associated with specific phenotypes of 4q12q21.1 deletion cannot sufficiently explain the variable phenotypes observed among the cases. These phenotypes include mental retardation, microcephaly, ocular anomalies, dental anomaly, and piebaldism. Consequently, we recommend further detailed investigations into the genes associated with 4q12q21.1 deletion to assist in identifying genotype-phenotype associations more clearly.

It is well accepted that kidney transplantation cannot be done if the recipient has antibodies showing a positive HLA cross-match to the donor. Recently, Schweitzer and his associates used a combination therapy with plasmapheresis, IV gamma globulin, and potent immunosuppression to induce HLA cross-match negative conversion in patients with a positive HLA cross-match to living donors and they reported good results after the trials. Therefore, we treated a patient with combination therapy who had persistent-positive HLA cross-match to multiple living donors. The patient was a 38-year-old female suffering from chronic renal failure and she showed persistent positive HLA cross-match to multiple living donors. Using a combination therapy with plasmapheresis, IV gamma globulin and immunosuppression, we have successfully achieved a HLA cross-match negative conversion in a patient and we did kidney transplantation without any sign of hyperacute or acute rejection. Although we present possibility of a HLA cross-match negative conversion by combination therapy, especially in a recipient with a low titer cross-match positive to a family donor, further long-term study with more patients is needed for evaluation of the efficacy of this trial.
Adult ; Antibodies ; Female ; gamma-Globulins ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Plasmapheresis* ; Tissue Donors

BACKGROUND: Many invasive and life-threatening infections are diagnosed by the culture of normally sterile body fluids. Because microorganisms are present in very low concentrations, and these infections are often caused by fastidious or slow-growing microorganisms, they may not be detected by conventional culture methods. The present study was designed to assess the performance of the BacT/Alert blood culture system in order to recover microorganism with standard aerobic and anaerobic bottles and FAN aerobic and anaerobic bottles versus conventional culture methods for culturing normally sterile body fluids other than blood. METHODS: Between February and April 2003, sterile body fluids, such as cerebrospinal fluids (CSF), pleural fluids, peritoneal fluids, continuous ambulatory peritoneal dialysate (CAPD), and other fluids submitted to the microbiology laboratory for culture were entered into the study. Only specimens with a minimum volume of 3.0 mL were included, and the specimens were divided equally among three arms of the study. All BacT/Alert bottles were monitored for up to 5 days. Conventional blood agar plate and thioglycollate broth were incubated for up to 3 days before being discarded as negative, while anaerobic cultures were maintained for a minimum of 5 days. Bacterial identification and antimicrobial susceptibility tests were performed using standard laboratory protocols. RESULTS: A total of 247 specimens (CSF 85, pleural fluids 68, peritoneal fluids 71, CAPD 17, others 6) were included in this study, with 45 isolates recovered from 43 specimens. The recovery rates for each method were standard bottles 65.1% (28/43), FAN bottles 79.1% (34/43), and conventional culture 48.9% (21/43). For CSF and peritoneal fluids, more isolates were recovered from the FAN bottles compared to the conventional culture or standard bottles. The FAN bottles recovered more coagulase negative staphylococci than those from the conventional culture or standard bottles. CONCLUSIONS: Even though the BacT/Alert system using FAN bottles improved the recovery rate for CSF and peritoneal fluids compared to either the standard bottles or conventional culture, coagulase negative staphylococci were also frequently recovered. Therefore, further evaluations are required to assess the clinical usefulness of culturing sterile body fluids using the Bact/Alert blood culture system.
Agar ; Arm ; Ascitic Fluid ; Body Fluids* ; Cerebrospinal Fluid ; Coagulase ; Peritoneal Dialysis, Continuous Ambulatory

PURPOSE: Delivering bad news (DBN) to a patient or patient's family is one of the most difficult tasks for physicians. As a complicated task, DBN requires better than average communication skills. This study investigated trainee's attitude and awareness of DBN based on a self-assessment of their experiences and performance in practice. Survey subjects were also asked to assess their perception and the need for education in conducting DBN. METHODS: A survey was carried out on their experiences with DBN, how they currently deal such situations, how they perceive such situations and the need for education and training programs. A SPIKES protocol was used to assess how they currently deal with DBN. RESULTS: One hundred one residents and fellows being trained in a teaching hospital participated in the survey. Around 30% had bad experiences due to improperly delivered bad news to a patient. In terms of self-assessment of how to do DBN, over 80% of trainees assessed that they were doing DBN properly to patients, using a SPIKE protocol. As for how they perceived DBN, 90% of trainees felt more than the average level of stress when they do DBN. About 80% of trainees believed that education and training is much needed during their residency program for adequate skill development regarding DBN. CONCLUSION: We suggest that education and training on DBN may be needed for trainees during the residency program, so that they could avoid unnecessary conflict with patients and reduce stress from DBN.
Disclosure ; Education ; Hospitals, Teaching ; Humans ; Internship and Residency ; Self-Assessment

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent agents of hospital infections. The aim of this study was to evaluate the polymorphism of MRSA strains from our hospital by pulsed-field gel electrophoresis (PFGE) and ribotyping, and to compare effectiveness of two methods for epidemiologic investigation. METHODS: A total of 40 MRSA isolates were studied. All strains were isolated from patients from October 1990 to May 1995: 13 isolates from NS ward, 9 from GS and OS ward, 11 from medical ward, and 7 from other medical centers. All strains were analyzed and classified by ribotyping and PFGE patterns. RESULTS: Eight different ribotypes (H1-H8) and ten ribotypes (E1-E10) were seen by HindIII and EcoRI digestion. The problem was that some isolates showed discordance between classifications by HindIII and EcoRI digestion and three isolates from other medical centers had same ribotypes with that of our hospital strains. PFGE analysis revealed 19 different types (A to S). The PFGE analysis showed ward specificity, 54% of isolates from NS ward and 54% of isolates from medical ward were PFGE types D and J respectively, and 33% of isolates from GS and OS ward was H type and 33% was G type. CONCLUSIONS: PFGE was a more effective epidemiological tool for the typing of MRSA strains but a combination with ribotyping could provide more detailed strain differentiation.
Classification ; Cross Infection ; Digestion ; Electrophoresis, Gel, Pulsed-Field* ; Epidemiologic Studies* ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Ribotyping* ; Sensitivity and Specificity

BACKGROUND: The epidemiology of Candida species isolated from nonsterile as well as normally sterile sites is important because colonization of the former may precede invasive Candida infections. METHODS: We investigated the epidemiology and antifungal susceptibility of Candida species recovered in Busan Paik Hospital during the past 6 years and compared these results according to the type of specimens. RESULTS: Among the 2364 strains, C. albicans (53.8%) was the most frequently isolated, followed by C. tropicalis (17.5%), and C. guilliermondii (10.0%). Non-albicans Candida species were more prevalent in normally sterile sites (P<0.001); the prevalence of C. tropicalis and C. parapsilosis was significantly higher in normally sterile than in nonsterile sites (P<0.001). The prevalence of C. parapsilosis was higher in blood, intravenous catheter tips, and ear discharge, whereas C. tropicalis was more frequently isolated from urine. C. guilliermondii was the most frequently isolated from bronchial washings. The susceptibilities of Candida species to 5-flucytosine, amphotericin B, nystatin, miconazole, econazole, and ketoconazole were 98.3, 99.3, 99.7, 94.9, 86.3, and 94.5%, respectively. The susceptibilities of the organisms from normally sterile sites were lower than those from nonsterile sites. CONCLUSION: The distribution of Candida species differed among various types of specimens, especially those from normally sterile versus nonsterile sites. We assume that the frequency of infections of exogenous origin is high. We presume that the candidemia of C. parapsilosis is associated with the use of central venous catheter and that C. parapsilosis is acquired from exogenous sources.
Amphotericin B ; Busan ; Candida* ; Candidemia ; Catheters ; Central Venous Catheters ; Colon ; Ear ; Econazole ; Epidemiology ; Ketoconazole ; Miconazole ; Nystatin ; Prevalence

Refractory anemia with excess blasts (RAEB), the most commom type of myelodysplastic syndrome (MDS), accounts for 40-60% of all patients newly diagnosed with MDS. Various clonal cyto-genetic abnormalities are found in 30 to 50% of the cases. But, trisomy 9 as a sole chromosomal aberration is not common, which was observed in our patient. We report a 65-year-old female with trisomy 9. She was diagnosed with RAEB-II four years ago, and she had no evidence of progression to acute leukemia without therapy.
Aged ; Anemia, Refractory* ; Chromosome Aberrations* ; Female ; Humans ; Leukemia ; Myelodysplastic Syndromes ; Trisomy*