Chronic diseases as well as a growing population of older adults are currently the leading cause of ill health and economic burden worldwide. Managing those diseases in one-on-one medical consultations poses substantial challenges due to limited time and resources in the current health care system. Various approaches have been taken to manage these conditions, most with limited success. Shared medical appointments (SMAs) are an innovative care delivery option to make the testing of alternative care modalities a prime concern. SMAs are individual medical consultations carried out in a group of patients with similar diseases by providing education, medication management, and disease monitoring. SMAs, since their initial conceptualization in 1998, have gained much popularity and adopted as one of the standard processes in many countries. Accumulated evidence-based studies show outcomes for increasing access to care, behavioral change facilitated through self-management education, maintained/better outcomes, physician productivity, and enhanced resource management. This review summarizes current evidence regarding the existing status of SMAs abroad. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar. This study suggests to explore and exploit the SMAs which have unique potential as a healthcare delivery innovation in Korea.

Since 2012, outbreaks of the Middle East respiratory coronavirus (MERS-CoV) have been reported, including the Republic of Korea. To date, most of the people infected with the virus are adults. Herein we describe the clinical characteristics of cases of MERS-CoV infection among children. As of October 29, 2015, MERS-CoV has caused 34 pediatric infections, which accounts for 2.1% of all cases. The median age was 13 years (range 9 months to 17 years) and where gender has been reported (n=33), 57.6% cases were male. About half of the patients were asymptomatic and the majority of the symptomatic patients had respiratory symptoms. In general, the clinical outcome in children was favorable. Among the four patients who died of progressive pneumonia, three had documented comorbidities. MERS-CoV infection in children has a lower incidence and mortality compared to adults.
Adult ; Child* ; Comorbidity ; Coronavirus Infections* ; Coronavirus* ; Disease Outbreaks ; Humans ; Incidence ; Korea ; Male ; Middle East* ; Mortality ; Pneumonia ; Republic of Korea

PURPOSE: This study was to investigate the relationship between self-esteem and satisfaction with volunteer work in a population of health care center volunteers. Ultimately, the results from this study would help to find ways to keep volunteers continuing their work. METHODS: The participants of this study were 179 volunteers who were affiliated with three health care centers located in Gyeonggi-do. Descriptive statistics and multi-stage regression were conducted to analyze data. RESULTS: Self-esteem was significantly associated with the satisfaction with volunteer activity. In addition, the relationship with clients rather than volunteers' general characteristics was also significantly related to the satisfaction with volunteer work. CONCLUSION: Therefore, it is necessary to increase a volunteer's self-esteem so that the volunteer can keep continuing his or her volunteering activities. Also, in order to promote good relationships between the volunteers and the clients, it will be important to teach communication skills to volunteers.
Delivery of Health Care ; Public Health

BACKGROUND: Pediatric outpatient anesthesia is beneficial because it is more comfortable to children and more convenient for families, but delayed discharge causes distress for parents and children and increases health care personnel workload. Therefore, we examined past medical records to evaluate factors affecting discharge time in pediatric outpatient anesthesia. METHODS: We reviewed the anesthetic and post-anesthetic care records of 119 children who required ventilation tube insertion for ambulatory surgery, and who were anesthetized and monitored by an anesthesiologist between June 2001 and February 2004. Data were classified according to the anesthetic technique and agents used, duration of operation and anesthesia, and complications in the recovery room. We then examined the relationships between these factors and discharge time. RESULTS: Compared to intravenous anesthesia, endotracheal anesthesia increased anesthesia time (P <0.05), but not discharge time. Ketamine dosage was found to be closely correlated with discharge time (P <0.01), and complications in the recovery room delayed discharge time (P <0.05). CONCLUSION: We conclude that excessive ketamine use and postoperative complications delay discharge in pediatric outpatient anesthesia. More attention should be paid to minimize ketamine use and reduce postoperative complications so as not to delay discharge in pediatric outpatient anesthesia.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthesia, Intravenous ; Child* ; Delivery of Health Care ; Ear, Middle* ; Humans ; Ketamine ; Medical Records ; Middle Ear Ventilation* ; Outpatients* ; Parents ; Postoperative Complications ; Recovery Room ; Ventilation

The aim of this study was to identify the effects of speaking up climate, psychological safety, organizational learning culture, and supervisor support for patient safety on clinical nurses’ silence behavior. Methods: A cross-sectional online survey was conducted among 189 nurses working at a tertiary hospital. Data were analyzed using Pearson correlation coefficients and multiple linear regression. Results: The average score of nurses’ silence behavior was 2.23±0.62 out of 5 points. The strongest factor influencing nurses’ silence behavior was speaking up climate (β=-.33, p<.001), followed by psychological safety (β=-.20, p=.013), and organizational learning culture (β=-.15, p=.040). The regression model explained approximately 38% of the overall variance in the nurses’ silence behavior. Conclusion: This study found that the speaking up climate was the most important predictor of nurses’ silence behavior. Thus, we suggest that hospital administrators and nurse managers should encourage nurses to speak up by having regular meetings among healthcare professionals to enhance the psychological safety of nurses. In addition, to reduce nurses’ silence behavior, it is essential to create a culture wherein all members of the organization can constantly learn from mistakes or errors, which will, in turn, make it possible to improve patient safety at the system level.

No abstract available.
Scarlet Fever*

The effects of C-phycocyanin (C-pc), a phycobiliprotein, on the expression of pro-fibrotic mediators in hyper-tropic scarring such as connective tissue growth factor (CTGF) and α-smooth muscle actins (α-SMA) were investigated in relation to trans-differentiation of fibroblast to myo-fibroblast, an icon of scar formation. C-pc was isolated from Spirulina Platensis extract using sonication method and C-pc concentration was determined by Bennet and Bogorad equation. α-SMA and CTGF levels in wounded primary human dermal fibroblasts were determined by western blot analysis and immuno-fluorescence confocal microscope was employed. Fibroblast contractility was examined by three-dimensional collagen lattice contraction assay. There was an elevation of α-SMA (121%) and CTGF (143%) levels in wound cells as compared with non-wound cells. The does-response profiles of down regulation demonstrated that the maximum inhibitions of α-SMA by 63% (p<0.05) and CTGF by 50% (p<0.1) were achieved by C-pc (6 nM) treated cells. In confocal assay, non-wound fibroblasts exhibited basal level of α-SMA staining, while wounded cells without C-pc treatment showed strong up-regulation of α-SMA by 147% (p<0.05). C-pc (6 nM) inhibited α-SMA expression by 70% (p<0.05) and reduced collagen contraction by 29% (p<0.05). C-pc seemed to lessen the over expression of CTGF, α-SMA, subsequently alleviating the fibrotic contracture. This study suggests the potential application of C-pc to regulation of the expression of pro-fibrotic mediators in scarring process and its potential usage as an efficient means for anti-fibrosis therapy.
Actins* ; Blotting, Western ; Cicatrix ; Collagen ; Connective Tissue Growth Factor* ; Connective Tissue* ; Contracture ; Down-Regulation ; Fibroblasts ; Humans ; Methods ; Myofibroblasts ; Phycocyanin* ; Sonication ; Spirulina ; Up-Regulation ; Wound Healing ; Wounds and Injuries

No abstract available.
Scarlet Fever*

PURPOSE: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinical characteristics of invasive infections due to S. pyogenes in children in Korea. METHODS: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at Seoul National University Children's Hospital between March 1992 and December 2012, and Seoul National University Bundang Hospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratory findings, treatment, mortality and morbidity of all patients were reviewed. RESULTS: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. There was a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years) and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus (4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxic shock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin and clindamycin resistance rates were low by 3.8% and 7.5%, respectively. CONCLUSION: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years in Korean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognition and prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.
Abdomen ; Bacteremia ; Bacterial Infections ; Central Nervous System Infections ; Child* ; Clindamycin ; Demography ; Erythromycin ; Humans ; Joints ; Korea ; Male ; Mortality ; Retrospective Studies ; Seoul ; Shock, Septic ; Skin ; Soft Tissue Infections ; Streptococcus pyogenes*

PURPOSE: This study aimed to investigate the association between respiratory virus infection and pneumococcal colonization in children. METHODS: From May 2009 to June 2010, nasopharyngeal (NP) aspirates were obtained from patients under 18 years old who visited Seoul National University Children's Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses (influenza virus A and B, parainfluenza virus 1, 2 and 3, respiratory syncytial virus A and B, adenovirus, rhinovirus A/B, human metapneumovirus, human coronavirus 229E/NL63 and OC43/HKU1) by RT-PCR and pneumococcus by culture. RESULTS: Median age of the patients was 27 months old. A total of 1,367 NP aspirates were tested for respiratory viruses and pneumococcus. Pneumococcus was isolated from 228 (16.7%) of samples and respiratory viruses were detected from 731 (53.5%). Common viruses were rhinovirus (18.4%), respiratory syncytial virus (RSV) A (10.6%), adenovirus (6.9%), influenza virus A (6.8%). Pneumococcal isolation rate was significantly higher in the cases of positive virus detection than negative detection [21.3% (156/731) vs. 11.3% (72/636), P<0.001]. For individual viruses, pneumococcal isolation rate was positively associated with detection of influenza virus A [24.7% (23/93) vs 16.1% (205/1274), P=0.001], RSV A [28.3% (41/145) vs 15.3% (187/1222), P=0.001], RSV B [31.3% (10/32) vs 16.3% (218/1335), P=0.042], rhinovirus A/B [22.6% (57/252) vs 15.3% (171/1115), P=0.010]. CONCLUSION: The study revealed that pneumococcal isolation from NP aspirates is related with respiratory virus detection. The result of this study could be used to investigate how respiratory viruses and pneumococcus cause clinical diseases.
Adenoviridae ; Child* ; Colon* ; Coronavirus ; Humans ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Respiratory Syncytial Viruses ; Rhinovirus ; Seoul ; Streptococcus pneumoniae