After-hours care (AHC) provides medical care after the regular weekday work hours of clinics. In Korea, data from the National Emergency Department Information System showed that approximately 40% of the pediatric patients need AHC. To meet this need, many countries have different models of AHC. In this article, the authors tried to summarize and emphasize the advantages and disadvantages of AHC models in several leading countries. This article can be useful in designing AHC models in Korea because the proportions of potential patients requiring AHC are substantial, and the adoption of AHC models should be seriously considered.
After-Hours Care* ; Ambulatory Care Facilities ; Child ; Delivery of Health Care ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Night Care

BACKGROUNDMedical superstitions remain prevalent in today's stressful and technology driven healthcare environment. These irrational beliefs commonly involve night calls, which are periods of volatile workload. In Singapore and Hong Kong, it is commonly held that consumption of steamed buns ("bao") by on-call physicians is associated with increased patient admissions and mortality, due to a homonymous interpretation of the word "bao" in dialect.

MATERIALS AND METHODSA prospective unblinded randomised controlled trial with a permuted block randomisation design was performed on weekdays over 6 weeks. Steamed buns or control food were offered to the internal medicine night-call team of a tertiary-care hospital on a nightly basis. Information on admissions and mortality was collected from the hospital electronic database. Data on sleep patterns and shift duration were obtained by interview.

RESULTSThere were no significant differences in the median number of hours slept on days on "bao" administration versus "control" intervention (2 +/- median absolute variation of 1.5 h vs 2 +/- 1.5 h, P = 0.30) or in the number of hours spent in the hospital (30.8 +/- 1.9 h vs 30.5 +/- 2.2 h, P = 0.09). There were no significant differences in the median number of general ward admissions per night (n = 73 +/- 6 versus 71 +/- 7 admissions, P = 0.35), monitored care unit admissions (4 +/- 1.5 vs 4 +/- 1.5 admissions, P = 0.65) or inpatient mortality (2 +/- 1.5 vs 2 +/- 1.5 deaths per night, P = 0.47).

CONCLUSIONThe consumption of steamed buns ("bao") has no effect on inpatient admissions, mortality, or sleep duration on call. Regardless, our results indicate that the night call in Singapore remains a challenge in terms of workload and shift duration.

Food ; Hospital Mortality ; Humans ; Medical Staff, Hospital ; Night Care ; Patient Admission ; Superstitions ; Workload

PURPOSE: Attention has been focused recently on the impact of sleep deprivation, in-house staff, and overwork on patient outcome. The objective of this study was to determine whether any associations existed between the timing of a patient visit to an emergency setting and hospital mortality. METHOD: We analyzed retrospectively a series of consecutive visits to the emergency room of our hospital in 2003. Patients were divided according to the times of their visits to emergency room daytime (from 8:00 am to 6:00 pm) and nighttime (all others). We further divided nighttime visits into early nighttime (from 6:00 pm to 1:00 am) and late nighttime (from 1:00 am to 8:00 am) visits. The odds of death within 48 hours after visit for patients in the nighttime group were analyzed by using a multivariate logistic regression. The independent variable was visit to the emergency room during nighttime. RESULT: The patients visiting at night had a lower mortality (0.9% vs 1.6%, p=0.000), with an odd ratio for death within 48 hours, adjusted for severity of illness, of 1.265 (95% CI, 0.955-1.674). Severity of illness was the main contributor to the increased mortality rates of patients in the nighttime group. There was no significant difference in mortality rates between the early and the late nighttime subgroups. CONCLUSION: Nighttime visits to the emergency room are not associated with a higher mortality than daytime visits.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality* ; Humans ; Korea* ; Logistic Models ; Mortality ; Night Care ; Retrospective Studies ; Sleep Deprivation

The poverty families, who take care of the demented elderly, can suffer from the deficiency of social services for dementia and the condition and nature the families have. Therefore, This study examines the burden of the poverty caring for the demented elderly. This study focused on the three points : the level of care burden of the families, who take care of the demented elderly ; the needs of welfare services ; the differences of care burden and service demand on trait of the families and the demented elderly. In order to achieve them, the 250 families, who take care of the demented elderly at home, were sampled and the primary caregivers of family member interviewed. Then, the statistics of the 226 people were analyzed by SPSSWIN. The major findings of the study were as follows : First, the level of the care burden the families of the demented elderly have, participated in this research, is higher than 'a little yes'. In a type of the care burden, the social & personal restriction is higher than the other types, including physical restriction, economical restriction, and reciprocal restriction. Second, some families had used service and had a low satisfaction, because of no various and adequate services. It shows that the services for the demented elderly and their families is not enough to use, that the services is not various for the families having many problem related the demented elderly. Third, there are many services needed by the families caring for the demented elderly : residential care facilities for the demented elderly ; day care service center ; short-term care services ; family counseling service ; services at home ; nursing services at home ; night care services ; family meeting. Fourth, the most difficult thing of caring is the economic burden of the families. The families are willing to take care of the demented elderly at home, if the government supports economically them and serves proper services to them. Finally, the lower income of the families is, the more time of caring the demented elderly in a day is, the lower vital functions of the demented elderly are, and the lower level of academic achievement, the higher level of care burden of the families is. According to the result, the level of the care burden can be affected by the family's economic capacity, the vital function of the demented elderly, and the existence of service for the demented elderly. For the elderly welfare especially, the demented elderly and their poverty families, three opinions may be suggested. First, the service programs based on community should be developed to reduce the burdens-economic, psychological, medical burden, etc. - of the poverty families caring for the demented elderly. These programs may include preventive service, education programs of dementia, diagnosis services, family counseling, and medical service. Second, the national government and the local government must try to make policies to solve the temporary problems of the family having the demented elderly.
Aged* ; Caregivers ; Counseling ; Day Care, Medical ; Dementia ; Diagnosis ; Education ; Federal Government ; Humans ; Local Government ; Night Care ; Nursing Services ; Poverty* ; Social Work

PURPOSE: To evaluate near and far visual outcomes, subjective visual symptoms, and patient satisfaction with AcrySof(R) ReSTOR(R) diffractive multifocal intraocular lenses (IOL), and to study the reasons for postoperative dissatisfaction. METHODS: Twenty-three eyes of 19 patients received phacoemulsifications and implantation of AcrySof(R) ReSTOR(R) IOL. The main outcome measures, taken at postoperative 1 day, 1 week, 1 month, and 3 months, were uncorrected and corrected near and distant visual acuity, refractory errors, subjective visual symptoms (glare, halo, and night vision), and satisfaction. RESULTS: At the 3-month postoperative visit, the mean uncorrected near and distant visual acuities were 0.59+/-0.24 (0.25+/-0.22 LogMAR unit) and 0.78+/-0.27 (0.13+/-0.10 LogMAR unit), respectively. In addition, patients' satisfaction with uncorrected near vision, intermediate vision, far vision, and general visual performance were better than their satisfaction with night vision. Glare and halos were reported as severe by only 10.2% and 5.3% of patients, respectively. The seven eyes with poor patient satisfaction included eyes with a high incidence of preoperative ocular diseases or preoperative and postoperative high corneal astigmatisms of more than 1.0 diopter. CONCLUSIONS: The AcrySof(R) ReSTOR(R) IOL demonstrated good near and distant visual acuity with good patient satisfaction. Previous ocular disease, corneal astigmatism less than 1.0 diopter, and patient lifestyle should be considered to enhance patient satisfaction.
Astigmatism ; Cataract ; Corneal Diseases ; Eye ; Glare ; Humans ; Incidence ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Life Style ; Night Vision ; Outcome Assessment (Health Care) ; Patient Satisfaction ; Phacoemulsification ; Vision, Ocular ; Visual Acuity

PURPOSE: To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. METHODS: Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. RESULTS: Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2–5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys. CONCLUSION: Sleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health.
Adolescent* ; Ambulatory Care Facilities ; Bruxism ; Child* ; Female ; Gyeonggi-do ; Humans ; Incidence ; Korea ; Male ; Night Terrors ; Parents ; Prevalence ; Seoul ; Sleep Apnea Syndromes ; Sleep Initiation and Maintenance Disorders ; Snoring ; Somnambulism

After-hours care (AHC) provides urgent primary care at nighttime, weekends, and holidays. In Korea, individual primary care physicians seldom participate in AHC and many parents have difficulty in receiving primary care during non-office hours without going to an emergency department (ED). The ED is currently the only place to access a full range of services at any time. However, the ED is not optimized for AHC, and using it for AHC is not an efficient use of resources. Therefore, many countries are seeking a safe, efficient non-ED AHC model which provides the best care considering the limitations. Different models for AHC exist worldwide, varying from family doctor-based to hospital-based models, and some countries use several different models including 24-hr telephone triage and advice services (TTA). Common problems of AHC include the inaccessibility to primary care, discontinuity of care, expensive healthcare costs, and work dissatisfaction among health care professionals. These are the major reasons for the recent changes made to the AHC system in many countries, such as the integration into one single national TTA in the United Kingdom, support for group practices in Canada, reorganization of small practice rotation groups into large scaled, general practitioner cooperatives in the Netherlands, and rapid expansion of the urgent care industry in the United States. This review presents a brief overview of the current AHC in Korea and the need for an effective non-ED AHC model. An effective AHC system will improve the quality of care, financial saving, and job satisfaction of the health care professionals.
After-Hours Care* ; Ambulatory Care ; Ambulatory Care Facilities ; Canada ; Child ; Delivery of Health Care ; Emergency Service, Hospital ; General Practitioners ; Great Britain ; Group Practice ; Health Care Costs ; Holidays ; Humans ; Job Satisfaction ; Korea ; Netherlands ; Night Care ; Parents ; Physicians, Primary Care ; Primary Health Care ; Telephone ; Triage ; United States