PURPOSE: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). METHODS: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. RESULTS: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. CONCLUSION: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.
Aged ; Humans ; Inpatients ; Insurance, Health ; Long-Term Care* ; Nursing ; Pneumonia*

BACKGROUND: Intention to leave was an important managerial issue among physicians working in public health centers. This study was conducted to explore the relationship between job participations and intention to leave among physicians working in health centers. METHODS: A cross-sectional questionnaire survey was conducted to gather information about job participation, intention to leave and demographics among physicians (n=243) in public health centers in Korea. Job participation was measured by 15 items categorized 3 dimensions. Multiple regression analysis was performed to determine the effect of job participation on intent to leave among physicians working in public health center. RESULTS: Participation of medical treatment and administrative job were significantly associated with intention to leave adjusted for sex, age, income, working area, working duration, tenure, and overall job satisfaction. Therefore, physicians who actively participated in administrative job showed a lower turnover intention. Physicians who actively participated in medical treatment job had a higher quit intention. CONCLUSION: To retain qualified physicians in public health center, education should be reinforced to physician for administrative capacity building.
Capacity Building ; Demography ; Education ; Intention* ; Job Satisfaction ; Korea ; Public Health Practice ; Public Health*

OBJECTIVE: Hypotension after emergent endotracheal intubation is a serious complication related to in-hospital mortality. We investigated factors including modified shock index to predict the development of hypotension after emergent intubation. METHODS: This retrospective observational study was conducted between January 2011 and December 2016. The study population included intubated patients among all medical patients admitted to the emergency department (ED) except for patients whose systolic blood pressure was below 90 mmHg at any time before intubation. The postintubation hypotension (PIH) groups were compared with the non-PIH group. The secondary outcome was in-hospital mortality. RESULTS: A total of 285 patients were included in this study, of which 92 patients (32.3%) PIH. The age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.06; P=0.001), serum albumin level (OR, 0.62; 95% CI, 0.41–0.92; P=0.019), shock index (OR, 3.25; 95% CI, 1.26–8.38; P=0.015), and modified shock index (MSI) (OR, 2.18; 95% CI, 1.06–4.47; P=0.034) were more closely associated with PIH than any other factors. The average survival of the PIH group was significantly shorter than that of the non-PIH group (13.6±3.5 vs. 35.6±12.0, log-rank test P=0.019). CONCLUSION: Overall, 32.3% of hemodynamically stable medical patients developed PIH in ED. MSI was associated with PIH.
Blood Pressure ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Hypotension* ; Intubation ; Intubation, Intratracheal ; Mortality ; Observational Study ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Shock*

Cytokines play a pivotal role in maintaining bone homeostasis. Osteoclasts (OCs), the sole bone resorbing cells, are regulated by numerous cytokines. Macrophage colony-stimulating factor and receptor activator of NF-κB ligand play a central role in OC differentiation, which is also termed osteoclastogenesis. Osteoclastogenic cytokines, including tumor necrosis factor-α, IL-1, IL-6, IL-7, IL-8, IL-11, IL-15, IL-17, IL-23, and IL-34, promote OC differentiation, whereas anti-osteoclastogenic cytokines, including interferon (IFN)-α, IFN-β, IFN-γ, IL-3, IL-4, IL-10, IL-12, IL-27, and IL-33, downregulate OC differentiation. Therefore, dynamic regulation of osteoclastogenic and anti-osteoclastogenic cytokines is important in maintaining the balance between bone-resorbing OCs and bone-forming osteoblasts (OBs), which eventually affects bone integrity. This review outlines the osteoclastogenic and anti-osteoclastogenic properties of cytokines with regard to osteoimmunology, and summarizes our current understanding of the roles these cytokines play in osteoclastogenesis.
Cytokines ; Homeostasis ; Interferons ; Interleukin-1 ; Interleukin-10 ; Interleukin-11 ; Interleukin-12 ; Interleukin-15 ; Interleukin-17 ; Interleukin-23 ; Interleukin-27 ; Interleukin-3 ; Interleukin-33 ; Interleukin-4 ; Interleukin-6 ; Interleukin-7 ; Interleukin-8 ; Macrophage Colony-Stimulating Factor ; Necrosis ; Osteoblasts ; Osteoclasts ; RANK Ligand

Vestibular schwannoma is a rare tumor that develops in the nerves responsible for vestibular function and hearing. It usually affects middle-aged people, and is diagnosed by hearing and imaging tests. In the majority of cases, it occurs in the retro-cochlear space and very rarely in the labyrinth. Several vestibular schwannoma localized in the labyrinth have been reported worldwide. Since then 5 cases have been reported. With advances in the imaging study, the diagnosis of intralabyrinthine schwannomas have increased. Our report describes the characteristics and treatments of intralabyrinthine schwannomas reported in Korea, including five previously reported cases and the case experienced by authors.

Immunosuppressants are vital in organ transplantation including facial transplantation (FT) but are associated with persistent side effects. This review article was prepared to compare the two most used immunosuppressants, cyclosporine and tacrolimus, in terms of mechanism of action, efficacy, and safety and to assess recent trials to mitigate their side effects. PubMed and Google Scholar queries were conducted using combinations of the following search terms: “transplantation immunosuppressant,” “cyclosporine,” “tacrolimus,” “calcineurin inhibitor (CNI),” “efficacy,” “safety,” “induction therapy,” “maintenance therapy,” and “conversion therapy.” Both immunosuppressants inhibit calcineurin and effectively down-regulate cytokines. Tacrolimus may be more advantageous since it lowers the likelihood of acute rejection, has the ability to reverse allograft rejection following cyclosporine treatment, and has the potential to reinnervate nerves. Meanwhile, graft survival rates seem to be comparable for the CNIs. To avoid nephrotoxicity, various immunosuppressants other than CNIs have been studied. Despite averting nephrotoxicity, these medications show increases in acute rejection or other types of adverse effects compared to CNIs. FT has been a topic of interest for oral and maxillofacial surgeons, and the postoperative usage of immunosuppressants is crucial for the long-term prognosis of FT. As contemporary transplantation regimens incorporate novel medications along with CNIs, further research is required.

PURPOSE: Falling is one of the most common causes of injury for preschool children. Here, we aim to identify the characteristics and risk factors of injuries by falling-down in preschool children. METHODS: Between January 2010 and December 2011, we enrolled patients under the age of 7 years, who were injured by falling down and visited an urban regional emergency center. We retrospectively surveyed the medical record of these patients, including age, sex, place and height of fall, type of floor, guardian's witness, traumatic brain injury (TBI), and fracture of extremities. RESULTS: The odds ratios sex (male), age (under 2 years old), height of fall, type of floor (hard), and guardian's witness (presence) that resulted in TBI were 1.35 (95% confidence interval [Cl], 0.72?2.55; p=0.352), 3.83 (95% Cl, 1.78?8.65; p<0.05), 6.38 (95% Cl, 3.27–12.44;p<0.05), 3.58 (95% Cl, 0.47–27.30; p=0.218), and 1.47 (95% Cl, 0.63–3.43; p=0.377), respectively. The odds ratios sex (male), age (over 2 years old), height of fall, type of floor (soft), and guardian's witness (absence) that resulted in fractures were 1.19 (95% Cl, 0.78–1.81; p=0.433), 3.10 (95%Cl, 1.99–4.84; p<0.05), 1.98 (95%Cl, 1.19–3.29; p<0.05), 2.41 (95% Cl, 1.29–4.54; p<0.05), and 1.15 (95%Cl, 0.72–1.85, p=0.554), respectively. CONCLUSION: In preschool children who experienced an injury from falling down, TBI was increased with younger patients and higher height of fall, but it was not related with patient's sex, type of floor, and guardian's witness; conversely, fractures were increased with older patients, higher height of fall, and soft floor, but not related with patient's sex and guardian's witness.
Accidental Falls ; Brain Injuries ; Child* ; Child, Preschool ; Emergencies ; Extremities ; Humans ; Medical Records ; Odds Ratio ; Retrospective Studies ; Risk Factors*

OBJECTIVE: The aim of the study was to compare the diagnostic performances of F-18 sodium fluoride positron emission tomography/computed tomography (bone PET/CT) and bone scintigraphy (BS) for the detection of thyroid cancer bone metastasis. MATERIALS AND METHODS: We retrospectively enrolled 6 thyroid cancer patients (age = 44.7 ± 9.8 years, M:F = 1:5, papillary:follicular = 2:4) with suspected bone metastatic lesions in the whole body iodine scintigraphy or BS, who subsequently underwent bone PET/CT. Pathologic diagnosis was conducted for 4 lesions of 4 patients. RESULTS: Of the 17 suspected bone lesions, 10 were metastatic and 7 benign. Compared to BS, bone PET/CT exhibited superior sensitivity (10/10 = 100% vs. 2/10 = 20%, p = 0.008), and accuracy (14/17 = 82.4% vs. 7/17 = 41.2%, p < 0.025). The specificity (4/7 = 57.1%) of bone PET/CT was not significantly different from that of BS (5/7 = 71.4%, p > 0.05). CONCLUSION: Bone PET/CT may be more sensitive and accurate than BS for the detection of thyroid cancer bone metastasis.
Adult ; Bone Neoplasms/*radiography/secondary ; Bone and Bones/*radiography ; Contrast Media/*chemistry ; Female ; Fluorine Radioisotopes/chemistry ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Sodium Fluoride/*chemistry ; Thyroid Neoplasms/*pathology ; Tomography, X-Ray Computed ; Whole Body Imaging

PURPOSE: The aim of this study is to investigate the anesthetic effect on a modified subcutaneous single-injection digital block in accordance with the location of the finger. METHODS: We recruited volunteers from the workshop training course. We injected less than 5 mL of 2% lidocaine at the volar side, between the 3rd metacarpal and proximal phalangeal joint, until the swelling in the dorsal side of the finger increased. At 10 minutes post the modified subcutaneous single-injection digital block, we recorded the pain score (0-10) using 11-point numeric rating pain scale (NRPS) according to the location of the finger (volar proximal phalanx, VPP; volar middle phalanx, VMP; volar distal phalanx, VDP; dorsal distal phalanx, DDP; dorsal middle phalanx, DMP; dorsal proximal phalanx, DPP) via a pinprick test. We analyzed and compared the NRPS on the location of the finger by the Friedman test with a Pairwise comparison. RESULTS: Fifty-eight volunteers of healthy adult were enrolled in this study. The pain scales on DPP and DMP were 7.00 (4.00-8.00) and 2.00 (1.00-4.00), respectively. The pain scales on DDP, VDP, VMP and VDP were 0.00 (0.00-2.00), 0.00 (0.00-0.00), 0.00 (0.00-1.00) and 0.00 (0.00-1.00), respectively. The pain scales on DPP and DMP were significantly different among DDP, VPP, VMP and VPP (p<0.05). There were no significant differences of pain scale on DDP, VDP, VMP and VPP (DDP vs. VDP, p=0.592; DDP vs. VMP, p=0.749; DDP vs. VPP, p>0.999; VDP vs. VMP, p>0.999; VMP vs. VPP, >0.999). CONCLUSION: A modified subcutaneous single-injection digital block should be considered useful in regional anesthesia at the volar side of the finger and the dorsal side of the distal phalanx.
Adult ; Anesthesia, Conduction ; Anesthesia, Local ; Anesthetics* ; Education ; Finger Injuries ; Fingers ; Humans ; Injections, Subcutaneous ; Joints ; Lidocaine ; Nerve Block ; Pain Measurement ; Volunteers ; Weights and Measures

Objective: We aimed to investigate the epidemiological characteristics and trends of carbon monoxide (CO) poisoning in the National Emergency Department Information System (NEDIS). Methods: Using the NEDIS data from 2014 to 2018, we included patients who had visited the emergency department (ED) with CO poisoning (T58.0 in 7th Korean Standard Classification of Diseases [KCD-7]). We excluded patients with an uncertain time of onset, uncertain intentionality of poisoning, mental state, and unknown clinical outcome. We surveyed age, sex, time of onset, the intentionality of poisoning, mental state, results of emergency treatment, the proportion of admissions to intensive care units (ICU), the outcome of hospitalization, and the regional distribution. We analyzed the rate of incidence and trends of CO poisoning in patients using time series analysis. Results: A total of 18,533 patients, including 10,671 (57.6%) males and 7,862 (42.4%) females, with a mean age of 40.38±18.41 years, were included in this study. Gyeonggi Province (n=6,354, 34.3%) had the highest distribution of patients, followed by Seoul (n=3,357, 18.1%). The incidence of unintentional CO poisoning was more frequent in January and December, and less frequent in August and September. However, the incidence of intentional CO poisoning showed no seasonal variation. The severity, ICU hospitalization rate, and mortality rate for intentional CO poisoning were higher than unintentional CO poisoning (4.1% vs. 0.8%, 29.9% vs. 16.7%, and 2.0% vs. 0.8% respectively) (P<0.001). Applying Winter’s additive method, we could predict that the rate of unintentional CO poisoning would continue to increase and the seasonal fluctuation, such as cases increasing in January-December and decreasing in August-September, would also increase. Conclusion Intentional CO poisoning showed higher severity than unintentional CO poisoning. In the time series analysis, the rate of unintentional CO poisoning and seasonal fluctuation is predicted to increase.