OBJECTIVES: This study aimed at investigating the diagnostic predictability of Cognitive Impairment Diagnosing Instrument(CIDI) in diagnosing dementia of elderly people aged 60 years or more. METHODS: The subjects were 129 patients with other mental diseases than dementia whose ages were more than 60 years and 86 patients with dementia. Psychiatric diagnoses were made by according to the DSM-IV criteria. Converted age(chronological age minus 59) was employed for the statistical reason. The length of education was classified into 4 intervals:1 for less than one year schooling, 2 for grade schooling, 3 for junior or senior high schooling and 4 for college or more schooling and each number expresses ordinal scale. The converted age, length of education expressed by one of 4 interval scores, and total CIDI score were independent variables while the diagnosis(dementia vs nondementia) was dependent variable in the logistic regression analysis. RESULTS: -2 log likelihood was 102.773 when the length of education, converted age and total CIDI score were included while it was 289.395 when only the constant was included(K 2=186.622, df=3, p=0.000). The goodness-of-fit statistic was 156.798(K 2=6.5843, df=8, p=0.5821), and the overall concordance of diagnostic classification was 90.2%. The logistic regression equation for the diagnosis of dementia was generated as follows:y=7.5752+0.0940*X 1+0.9820*X 2-0.1811*X 3(y=ln{pai/(1-pai)}, X 1:converted age, X 2:education intervals, X 3:total CIDI score, pai:possibility of dementia, > OR =0.50 indicating dementia and <0.50 indicating nondementia). The e bs(95% C.I.) for the converted age, education interval and total CIDI score were 1.0985(1.0107-1.1940), 2.6699(1.4134-5.0436), 0.8344(0.7898-0.8815), respectively. CONCLUSIONS: The CIDI could be considered as a useful diagnostic tool for dementia using the logistic regression analysis.
Aged ; Classification ; Cognition ; Dementia* ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Humans ; Logistic Models

The risk of developing colorectal cancer is increased in patients with inflammatory bowel disease. Surveillance colonoscopy has not been shown to prolong survival and rates of interval cancer are reported to be high. Continuing colonic inflammation has been shown to be important in the development of colorectal cancer and therefore anti-inflammatory agents such as the 5-aminosalicylates and immunomodulators have been considered as potential chemopreventive agents. This review focuses on various chemopreventive agents that have been clearly shown to reduce the risk of colorectal adenoma and cancer in the patients with inflammatory bowel disease.
Anti-Inflammatory Agents/therapeutic use ; Chemoprevention ; Colorectal Neoplasms/*complications/*prevention & control ; Folic Acid/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Inflammatory Bowel Diseases/*complications/drug therapy ; Mesalamine/therapeutic use ; Ursodeoxycholic Acid/therapeutic use

OBJECTIVES: This study was conducted in order to evaluate reliability and diagnostic validity of the CIDI. METHODS: 64 patients with DSM-IV dementia and 90 elderly patients with other mental disorders entered this study. Inter-subtest Pearson's correlations, corrected subtest-total correlations and Cronbach's alpha were computed for reliability while correlations of the total scores on CIDI with the performances on other scales relating to dementia, sensitivity and specificity, area under curve using the receiver operating characteristic curve, and group comparison were used for the assessment of validity. RESULTS: The CIDI's inter-subtest correlations ranged from 0.596 to 0.813, with a mean of 0.707. The corrected subtest-total correlations were between 0.759 and 0.890. Cronbach's alpha of the subtests was 0.941 and the Cronbach's alpha were between 0.928 and 0.948 when any subtest was deleted. In the demented subjects, the correlation coefficients of the total CIDI score with the performances on S-SDQ, IADL, BADL, BDRS, and MMSEK were around 0.5. Area under the receiver operating curve of CIDI was 0.933 with the standard error of 0.021(95% CI, 0.891-0.975). At the CIDI cutoff point of 65/66, sensitivity and specificity were 95.3% and 85.6%, respectively. The corresponding values of MMSEK were 0.930, 0.020 (95% CI, 0.891-0.969), 22/23, and 89.1% and 85.6%. The demented scored much poorer in all CIDI subtests than the nondemented mental patients, and the differences were highly significant. CONCLUSIONS: The CIDI was satisfactory regarding to reliabilities and diagnostic validities. The CIDI and MMSEK are thought to be reciprocal in assessment of cognitive functions: CIDI is preferable for clinical assessment of cognitive dysfunction and MMSEK for as a screening test.
Aged ; Area Under Curve ; Cognition ; Dementia ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mental Disorders ; Mentally Ill Persons ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

Objective: This study determined the threshold for recurrent depressive episodes that predicted conversion from major depressive disorder (MDD) to bipolar disorder (BD). Methods: We retrospectively reviewed the medical records of 296 patients diagnosed with MDD for a minimum of 5 years in two university hospitals. We examined their the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses and detailed clinical information at the initial admission and yearly assessments after discharge to establish the threshold for recurrent depressive episodes indicating a risk of diagnostic conversion from MDD to BD. Optimal cut-offs were derived using receiver operating characteristic (ROC) curves. Results: ROC curve analysis revealed that more than four recurrent depressive episodes was indicative of potential diagnostic conversion from MDD to BD (area under the curve, 0.604; sensitivity, 0.353; specificity, 0.855; positive predictive value, 0.421; negative predictive value, 0.816). Conclusion These findings suggest that the best predictor of conversion from MDD to BD is more than four recurrent depressive episodes. Our findings have the potential to enhance diagnostic accuracy and treatment efficiency. To validate our results, longitudinal prospective studies are necessary.

BACKGROUND: The suicide rate in Korea has been the highest among the Organization for Economic Cooperation and Development countries since 2003. However, there is a lack of in-depth data regarding the characteristics of suicide attempters. Understanding the intent of suicide attempters will help improve the effectiveness of suicide prevention strategies. Therefore, to provide a resource for developing the necessary interventions, this study aimed to examine the differences in suicide-related and clinical variables according to the strength of suicidal intent. METHODS: The subjects were 328 suicide attempters admitted to emergency departments at 5 university hospitals in Daegu-Gyeongbuk province between 2011 and 2014. We used various scales to examine suicide-related and clinical variables and a structured questionnaire to explore psychosocial characteristics. We evaluated suicidal intent using the Pierce Suicide Intent Scale and a clinician-rated scale that measured suicidal authenticity. RESULTS: Individuals with high suicidal intent were significantly older, had higher Hamilton Depression Rating Scale (HDRS) scores, higher rates of premeditation, and sustained suicidal ideation. Furthermore, suicide methods, timing, and psychiatric treatment histories differed by the strength of subjects' suicidal intent. Moreover, multiple logistic regression showed that depressed mood as a reason for attempting suicide, premeditation, and higher HDRS scores were significantly associated with higher suicidal intent. CONCLUSION: Depression, premeditation, older age, and sustained suicidal ideation were characteristics of individuals with high suicidal intent, and it is necessary to evaluate and monitor these factors to prevent repeated suicide attempts.
Depression ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, University ; Intention ; Korea ; Logistic Models ; Organisation for Economic Co-Operation and Development ; Suicidal Ideation ; Suicide* ; Suicide, Attempted ; Weights and Measures

OBJECTIVE: Our purpose is to propose the guideline for developing web services components from HL7 (Health Level 7) standard. METHODS: All business processes describing in HL7 are modeled using UML (Unified Modeling Language). Both UML diagrams and web services profiles can be presented with XML (Extensible Markup Language). Therefore we suggest a framework to derive web services from HL7 standards semi-automatically. RESULTS: We show that skeletal XML documents for web services can be generated from HL7 standards. Additionally we propose a way to program with Java for web services using given web service profiles. CONCLUSION: This paper presents the methodology of developing HL7-compatible electronic health record systems using web services.
Commerce ; Electronic Health Records ; Indonesia

A 25-year-old man developed tracheal stenosis due to prolonged intubation for five days. Immediately after bougienage, his left lung was not possible to ventilate and emergency tracheostomy was performed to produce ample space for airflow. Fiberoptic bronchoscopy showed that his left main bronchus was totally obstructed by sputum at the entrance of the superior and inferior lobar bronchi. Inadequate airway clearance increases the risk of infection and airway obstruction. We suggest chest physiotherapy be applied to all patients in the intensive care unit (ICU), especially patients with tracheal stenosis, due to its positive impact on pulmonary functional ability and ICU stay.
Adult ; Airway Obstruction ; Bronchi ; Bronchoscopy ; Emergencies ; Humans ; Intensive Care Units ; Intubation ; Lung ; Sputum* ; Thorax ; Tracheal Stenosis ; Tracheostomy

OBJECTIVE: Although aripiprazole has been widely used to treat various psychiatric disorders, little is known about the adequate dosage for Asian patients in clinical practice. Hence, we evaluated the initial and maximum doses of aripiprazole from 2004 to 2014 to estimate the appropriate dosage for Korean psychiatric inpatients in clinical practice. METHODS: In this retrospective study, we reviewed the medical records of patients who were hospitalized in five university hospitals in Korea from March 2004 to December 2014. The psychiatric diagnosis according to the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition during index hospitalization and the initial and maximum doses of aripiprazole were evaluated. RESULTS: There were 74 patients in Wave 1 (2004–2006), 201 patients in Wave 2 (2007–2010), and 353 patients in Wave 3 (2011–2014). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. The maximum doses of aripiprazole in each diagnostic group were not significantly different among Waves 1, 2, and 3. CONCLUSION: The relatively low initial doses of aripiprazole documented in our study may reflect a strategy by clinicians to minimize the side effects associated with aripiprazole use, such as akathisia.
Aripiprazole* ; Asian Continental Ancestry Group ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitalization ; Hospitals, University ; Humans ; Inpatients* ; Korea* ; Medical Records ; Mental Disorders ; Psychomotor Agitation ; Retrospective Studies

OBJECTIVES: The purpose of this study was to compare aripiprazole versus bupropion augmentation therapy in older adult patients with major depressive disorder unresponsive to selective serotonin reuptake inhibitors(SSRIs).METHODS: This is a post-hoc analysis of a 6-week, randomized prospective open-label multi-center study in thirty older adult patients with major depressive disorder. Participants were randomized to receive aripiprazole(N=16, 2.5–10mg/day) or bupropion(N=14, 150–300mg/day) for 6 weeks. Montgomery Asberg Depression Rating Scale (MADRS), 17-item Hamilton Depression Rating scale(HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales(anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: There was a significantly greater decrease in MADRS scores in aripiprazole group compared to bupropion group at 4(p<0.05) and 6(p<0.05) weeks. There were significantly higher response rate at week 4(p<0.05) and 6(p<0.05) and remission rate at week 6 in aripiprazole group compared to bupropion group. Individual HAM-D17 items showing significantly greater change with adjunctive aripiprazole than bupropion: insomnia, late(ES=0.81 vs. −0.24, p=0.043), psychomotor retardation(ES=1.30 vs. 0.66, p=0.024), general somatic symptoms(ES=1.24 vs. 0.00, p=0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than bupropion with respect to mean change for drive(p=0.005).CONCLUSION: Results of this study suggested that aripiprazole augmentation have superior efficacy in treating general and core symptoms of depression in older adult patients. Aripiprazole augmentation is associated with greater improvement in specific symptoms of depression such as psychomotor retardation, general somatic symptoms and drive.
Adult ; Aripiprazole ; Bupropion ; Depression ; Depressive Disorder, Major ; Fatigue ; Humans ; Iowa ; Prospective Studies ; Serotonin ; Sleep Initiation and Maintenance Disorders ; Weights and Measures

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.
Abdominal Pain ; Adult ; Anticoagulants ; Early Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Humans ; Infarction ; Mesenteric Ischemia ; Mesenteric Vascular Occlusion ; Mortality ; Prevalence ; Pulmonary Embolism ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator