Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results: Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. Conclusion The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.

PURPOSE: To evaluate the efficacy of an eye drop chart and to determine the factors contributing to adherence enhancement using the eye drop chart. METHODS: In this prospective study, enrolled glaucoma patients were educated on the administration of eye drops and use of the eye drop chart. They were required to complete a questionnaire on demographic characteristics and adherence. After 3 months, they completed a second questionnaire on adherence and satisfaction with the use of the eye drop chart. Changes in instillation behavior, relationships between performance scores and demographic characteristics, as well as factors contributing to the improvement of performance scores were analyzed. RESULTS: Forty-seven patients were enrolled in this study. The performance scores were significantly better for those who administered the eye drops by themselves (p = 0.002), those with an annual income > 60 million won (p = 0.036), and patients with at least a college degree (p = 0.002). After using the eye drop chart for 3 months, the average intraocular pressure was significantly reduced (p = 0.041) and the performance score was improved (p = 0.019). The working area (p = 0.009) and eye drop applicator (p = 0.001) were correlated with performance score enhancement. CONCLUSIONS: The eye drop chart was a cost-effective tool for improving the adherence and instillation practices of glaucoma patients. Adherence was improved among patients with more indoor activity, and those who practiced self-instillation. It is expected that the respective conditions of such patients would be more efficiently improved in a clinical setting.
Education ; Glaucoma ; Humans ; Intraocular Pressure ; Ophthalmic Solutions ; Prospective Studies

BACKGROUND: Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with single-injection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR. METHODS: Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 µg/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects. RESULTS: The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P < 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation. CONCLUSIONS: Continuous FNB combined with SNB can be an effective alternative to EPA for postoperative pain management in TKR.
Analgesia, Epidural* ; Anesthesia, General ; Arthroplasty, Replacement, Knee* ; Catheters ; Extremities ; Femoral Nerve* ; Fentanyl ; Humans ; Hypotension ; Incidence ; Knee ; Nausea ; Outcome Assessment (Health Care) ; Pain, Postoperative* ; Peripheral Nerves ; Pruritus ; Range of Motion, Articular ; Rehabilitation ; Sciatic Nerve* ; Vomiting

PURPOSE: This study investigated the possible relationship between viral infection and first trimester pregnancy loss. MATERIALS AND METHODS: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR. RESULTS: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases. CONCLUSION: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.
Abortion, Missed/*etiology ; Adult ; Coxsackievirus Infections/complications/*diagnosis/virology ; Enterovirus B, Human/genetics/*isolation & purification ; Female ; Humans ; Immunohistochemistry ; Placenta/virology ; Pregnancy ; Pregnancy Complications, Infectious/*virology ; Pregnancy Trimester, First ; Prevalence ; Prospective Studies ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Uterus/*virology

BACKGROUND: Plasminogen activator inhibitor type 1 (PAI-1), an important regulator of plasminogen activator system which controls degradation of extracellular membrane and progression of tumor cells, and PAI-1 gene polymorphic variants have been known as the prognostic biomarkers of non-small cell lung cancer patients. Recently, experimental in vitro study revealed that transforming growth factor-beta1 initiated PAI-1 transcription through epithelial growth factor receptor (EGFR) signaling pathway. However, there is little clinical evidence on the association between PAI-1 A15T gene polymorphism and prognosis of Korean population with pulmonary adenocarcinoma and the influence of activating mutation of EGFR kinase domain. METHODS: We retrospectively reviewed the medical records of 171 patients who were diagnosed with pulmonary adenocarcinoma and undergone EGFR mutation analysis from 1995 through 2009. RESULTS: In all patients with pulmonary adenocarcinoma, there was no significant association between PAI-1 A15T polymorphic variants and prognosis for overall survival. However, further subgroup analysis showed that the group with AG/AA genotype had a shorter 3-year survival time than the group with GG genotype in patients with EGFR mutant-type pulmonary adenocarcinoma (mean survival time, 24.9 months vs. 32.5 months, respectively; p=0.015). In multivariate analysis of 3-year survival for patients with pulmonary adenocarcinoma harboring mutant-type EGFR, the AG/AA genotype carriers had poorer prognosis than the GG genotype carriers (hazard ratio, 7.729; 95% confidence interval, 1.414-42.250; p=0.018). CONCLUSION: According to our study of Korean population with pulmonary adenocarcinoma, AG/AA genotype of PAI-1 A15T would be a significant predictor of poor short-term survival in patients with pulmonary adenocarcinoma harboring mutant-type EGFR.
Adenocarcinoma* ; Biomarkers ; Carcinoma, Non-Small-Cell Lung ; Genotype ; Humans ; Medical Records ; Membranes ; Multivariate Analysis ; Phosphotransferases ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Polymorphism, Single Nucleotide ; Prognosis* ; Receptor, Epidermal Growth Factor ; Retrospective Studies

In order to verify exact dose distributions in the state-of-the-art radiation techniques, a newly designed three-dimensional dosimeter and technique has been took strongly into consideration. The main purpose of our study is to verify the optimized parameters of polymer gel as a real volumetric dosimeter in terms of the various study of MRI. We prepared a gel dosimeter by combing 8% of gelatin, 8% of MAA, and 10 mM of THPC. We used a Co-60 gamma-ray teletherapy unit and delivered doses of 0, 2, 4, 6, 8, 10, 12, and 14 Gy to each polymer gel with a solid phantom. We used a fast spin-echo pulse to acquire the characterized T2 time of MRI. The signal noise ratio (SNR) of the head & neck coil was a relatively lower sensitivity than the body coil; therefore the dose uncertainty of head & neck coil would be lower than body coil's. But the dose uncertainty and resolution of the head & neck coil were superior to the body coil in this study. The TR time between 1,500 ms and 2,000 ms showed no significant difference in the dose resolution, but TR of 1,500 ms showed less dose uncertainty. For the slice thickness of 2.5 mm, less dose uncertainty of TE times was at 4 Gy, as well, it was the lowest result over 4 Gy at TE of 12 ms. The dose uncertainty was not critical up to 6 Gy, but the best dose resolution was obtained at 20 ms up to 8 Gy. The dose resolution shows the lowest value was over 20 ms and was an excellent result in the number of excitation (NEX) of three. The NEX of two was the highest dose resolution. We concluded that the better result of slice thickness versus NEX was related to the NEX increment and thin slice thickness.
Animals ; Comb and Wattles ; Gelatin ; Head ; Neck ; Noise ; Organophosphorus Compounds ; Polymers ; Uncertainty

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

The purpose of this was to investigate the measurement of fluence dose map for the specific patient quality assurance. The measurement of fluence map was performed using 2D matrixx detector. The absorbed dose was measured by a glass detector, Gafchromic film and ion chamber in Hybrid Optimized VMAT Phantom (HOVP). For 2D Matrixx, the results of comparison were average passing rate 85.22%+/-1.7 (RT_Target), 89.96%+/-2.15 (LT_Target) and 95.14%+/-1.18 (G4). The dose difference was 11.72%+/-0.531, -11.47%+/-0.991, 7.81%+/-0.857, -4.14%+/-0.761 at the G1, G2, G3, G4. In HOVP, the results of comparison for film were average passing rate (3%, 3 mm) 93.64%+/-3.87, 90.82%+/-0.99. We were measured an absolute dose in steep gradient area G1, G2, G3, G4 using the glass detector. The difference between the measurement and calculation are 8.3% (G1), -5.4% (G2), 6.1% (G3), 7.2% (G4). The using an Ion-chamber were an average relative dose error -1.02%+/-0.222 (Rt_target), 0.96%+/-0.294 (Lt_target). Though we need a more study using a transmission detector. However, a measurement of real-time fluence map will be predicting a dose for real-time specific patient quality assurance in volume modulated arc therapy.
Chimera ; Glass ; Humans