INTRODUCTIONWe performed this study to find clinical features and laboratory parameters that could facilitate the process of selecting patients who should receive lumbar punctures from among those who present with headache and fever.

METHODSWe selected patients aged ≥ 16 years who presented to and received lumbar puncture in the emergency department of Kangwon National University Hospital, South Korea, between 2011 and 2013. Patients who received lumbar punctures were divided into two groups - those who were diagnosed with viral meningitis and those who were not. We compared the clinical features and laboratory data between the two groups. Key indices were then used to develop a scoring system to diagnose viral meningitis in patients and identify those who should receive lumbar punctures.

RESULTSAmong the patients who were included in the study, 42 had viral meningitis and 96 did not. The variables of C-reactive protein level ≤ 1.291 mg/dL, neck stiffness and vomiting were assigned 3 points, 2 points and 1 point, respectively, in the scoring system. Overall scores ≥ 4 yielded a positive likelihood ratio of 7.79 (sensitivity 0.600, specificity 0.923), while negative likelihood ratio decreased to less than 0.1 (0.072) for overall scores < 3.

CONCLUSIONUsing the proposed scoring system, we were able to determine the likelihood of viral meningitis in patients presenting with fever and headache, and to successfully identify those who should receive lumbar punctures.

BACKGROUND: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. METHODS: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. RESULTS: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). CONCLUSIONS: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.
Aged ; Female ; Humans ; Lumbar Vertebrae/surgery ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Scoliosis/complications/surgery ; Spinal Fusion/methods ; Spinal Stenosis/complications/diagnosis/*surgery ; Spondylolisthesis/complications/surgery ; Treatment Outcome

OBJECTIVE: The goal of this article is to analyze the clinical characteristics of intramural pregnancy through the review of currently available 36 case reports. METHODS: A comprehensive computer literature search was performed in MEDLINE and EMBASE database from 1966 to 2003. And domestic literature search was preformed in KSOG database. After data collection, we reviewed and analyzed meaningful clinical variables of each case report. RESULTS: 36 articles were included. The age at diagnosis ranged from 20 to 41 years old, and the mean age was 31.2 years (S.D.:5.6). The gestational period at diagnosis ranged from 6th to 30th weeks, more than half of the cases occurred from 6th to 10th week (58.3%). Significant risk factors were history of dilatation and curettage (47.2%) and history of cesarean section (25.0%). Common clinical symptoms and signs were vague abdominal pain (58.3%) and vaginal bleeding (54.2%) in unruptured case, and sudden onset of severe abdominal pain (100%) and muscle guarding (75.0%) in ruptured case. The preoperative diagnostic accuracy was 0% before introduction of ultrasonography into the clinical practice, 48.2% after ultrasonography was available. Of 36 patients, 27 patients (75.0%) were treated with laparotomy, and 5 patients (13.8%) were treated with methotrexate. Survival outcome of fetus was very poor. Only in 1 case, the pregnancy persisted beyond the 30th week, and the fetus survived after cesarean hysterectomy. CONCLUSION: With the advanced diagnostic tools and close monitoring of patients, we can improve the diagnostic accuracy and clinical outcome of intramural pregnancy.
Abdominal Pain ; Adult ; Cesarean Section ; Data Collection ; Diagnosis ; Dilatation and Curettage ; Female ; Fetus ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Pregnancy* ; Risk Factors ; Ultrasonography ; Uterine Hemorrhage

PURPOSE: To analyze trends in salaries for registered nurses when compared with salaries for elementary school teachers from 2002 to 2009 and identify salary gaps of nurses according to workplace size and geographic location. METHODS: Data were obtained from the Occupational Employment Statistics collected by the Korea Employment Information Services each year from 2002 to 2009. The study sample consisted of 2,281 registered nurses and 2,578 elementary school teachers. Linear multiple regression analyses were conducted to analyze salary trends and differences. RESULTS: Elementary school teachers had higher monthly salaries than nurses with a baccalaureate degree after adjusting for years of work. Salary differences increased significantly by 40,000 won every year (p<.001). Nurses working in large facilities in Seoul had the highest salaries, whereas those in small/medium, non-Seoul facilities had the lowest salaries consistently over time. Salary differences between the two groups increased by 47,000 won every year (p=.001); salary differences between nurses in large, non-Seoul facilities and those in small/medium, non-Seoul facilities also increased by 40,000 won annually (p=.001). CONCLUSION: Geographical imbalances in the nurse workforce and nurse shortages in small/medium, non-capital facilities could be reduced by increasing the salary of nurses working in those facilities.
Employment ; Humans ; Information Services ; Korea ; Salaries and Fringe Benefits

PURPOSE: This study was conducted to examine activities of daily living (ADL) of older adults admitted to Korean long-term care hospitals (LTCHs), and to explore the patient and organizational factors that have an impact on the ADL of this population. METHODS: A secondary analysis of the Korean minimum data set (K-MDS) of patients (N=14,369) and of the profiles of LTCHs (N=358) from the Health Insurance Review and Assessment Service was done between January and July 2008. The outcome variable was ADL score 6 months after baseline assessment. Multi-level linear regression was employed to explore the patient and organizational factors that affected ADL scores. RESULTS: Of the patients, 45.4% had a baseline ADL score of between 31 and 40, with a score of 40 indicating that the patient was entirely dependent for all items. None of the organizational characteristics were significantly associated with effects on the ADLs of older adults who had been in a LTHC for at least 6 months. However, patient characteristics, such as age, baseline ADL, frequency of physical therapy, urinary incontinence, fecal incontinence, pressure ulcers, and having a tube or catheter, were significantly associated with ADL 6 months after baseline. CONCLUSION: In order to maintain and improve the ADL of older adults in LTCHs, we should develop strategies to prevent urinary and fecal incontinence, pressure ulcers, unnecessary tubes or catheters, providing adequate physical therapy. Additional studies should include more detailed information regarding nursing staff, including RN hours for direct care, education level and turnover.
*Activities of Daily Living ; Age Factors ; Aged ; Aged, 80 and over ; Catheterization ; Fecal Incontinence ; Female ; Hospitals/*statistics & numerical data ; Humans ; Long-Term Care ; Male ; Pressure Ulcer ; Republic of Korea ; Urinary Incontinence

No abstract available.
Age of Onset* ; Aged* ; Diabetes Complications* ; Humans

PURPOSE: The aims of this study were to describe general characteristics and needs of home health care, and to find the differences between home health care needers and non-needers. METHOD: In this study, 642 subjects participated who lived in Muan, Jollanam-do. Data were collected in August 2001 using a self-reported questionnaire. The questionnaire was a revised and simplified form of the Organization of Community Health System Program at the Seoul National University. Collected data were analyzed through Kruskal-Wallis test. t-test. and Chi-squire for cross-sectional analysis. RESULT: The average age of the subjects was 52.6 years and 33.3% of them aged over 65 years. Twenty six percent of them had chronic degenerative diseases. The percentages of hypertension patients and D.M. patients were 6.4% and 2.5%, respectively. The number of family members was 2.95 on the average, 2.19 in cases of families with the elderly and 3.33 in cases of families without the elderly. The rate of disability of the elderly was 10.5%. Marital status (p=.000), the number of family members (p=.000), education (p=.000), job (p=.000) and health insurance (p=.027) were significantly different between home care needers and non-needers. Home care needers had less living expenses (p=.001), more frequent hospital admissions (p=.004), higher chronic disease rate (p=.000) and more frequent visits to public health center (p=.027) than non-needers. Home care needers who wanted free service were twice as many as non-needers. CONCLUSION: Home care need was very high in rural areas and the needers had worse characteristics (low educational level. low income, no job and no family). Therefore, it is necessary to develop cheaper and more accessible services for home care needers in rural areas.
Aged ; Chronic Disease ; Community Health Planning ; Cross-Sectional Studies ; Delivery of Health Care* ; Education ; Home Care Services ; Humans ; Hypertension ; Insurance, Health ; Marital Status ; Public Health ; Seoul ; Surveys and Questionnaires

Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and followup strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.
Public Health ; Population Surveillance ; Mortality/trends ; Male ; Korea ; Humans ; *Genome, Human ; *Genetic Predisposition to Disease ; Female ; Epidemiologic Studies ; Cohort Studies

No abstract available.
Aldosterone* ; Humans ; Hyperaldosteronism*

Recently, dipeptidylpeptidase-4 (DPP-4) inhibitors have been widely used as a second-line therapy for type 2 diabetes because of their glucose-lowering efficacy, weight neutral effects and minimal hypoglycemia. However, there have been concerns regarding the lack of evidence of the long-term consequences of DPP-4 inhibitors on cardiovascular disease, acute pancreatitis and cancers; therefore, the effects of DPP-4 inhibitors on these three major diseases are reviewed in this article. A growing body of evidence demonstrates the cardioprotective role of DPP-4 inhibitors in animal and small clinical studies. However, clearly conflicting data regarding the effects of DPP-4 inhibitors on cancers and pancreatitis have been presented in preclinical and epidemiologic studies. The forthcoming long-term clinical studies on cardiovascular safety will provide more conclusive answers relating to the safety of DPP-4 inhibitors, including their effects on cancer and pancreatitis.
Animals ; Cardiovascular Diseases ; Cardiovascular System ; Dipeptidyl-Peptidase IV Inhibitors ; Hypoglycemia ; Pancreatitis