OBJECTIVES: This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. METHODS: We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. RESULTS: Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. CONCLUSIONS: It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.
Delivery of Health Care ; Electronic Health Records ; Hospitals, Public ; Humans ; Outpatients

Subcutaneous fat necrosis of newborn (SCFNN) is a rare disease. Characteristically, full-term infants with associated perinatal problems such as hypoxia, hypothermia, and obstetric trauma are affected in the first week of life. We report a case of SCFNN, which presented as an erythematous subcutaneous mass on the back of a male neonate who suffered from meconium aspiration pneumonia with neonatal sepsis.
Anoxia ; Humans ; Hypothermia ; Infant ; Infant, Newborn* ; Male ; Meconium Aspiration Syndrome* ; Meconium* ; Necrosis* ; Pneumonia ; Rare Diseases ; Sepsis ; Subcutaneous Fat*

Disseminated superficial porokeratosis (DSP) is a rare variant of porokeratosis, which is characterized histologically by cornoid lamella and clinically by central atrophy with elevated borders. DSP is usually associated with immunosuppressive states and hematopoietic malignancies, but rarely with malignancies of visceral organs. A 65-year-old male presented with numerous brownish macules with elevated borders on the trunk and limbs that had been present for 1 year. Before the visit to our clinic, gastric cancer was diagnosed at about the same time the skin lesions suddenly increased in size and number. Clinical and histopathological examination revealed that the lesions were consistent with DSP. We herein report a rare case of disseminated superficial porokeratosis that occurred in association with gastric cancer.
Aged ; Atrophy ; Extremities ; Hematologic Neoplasms ; Humans ; Male ; Porokeratosis ; Skin ; Stomach Neoplasms

Although trivalent subunit vaccine has been available, the influenza vaccine has been under-utilized because of cumbersome route of vaccination and low level of protection. Therefore, there has always been a great need to develop live attenuated influenza vaccine which can be administered through nasal route and elicit better immunogenicity. Through conventional repeated passage at low temperature, a live influenza vaccine carrier could be established. By reassortant formation between the 'cold- adapted' vaccine carrier and virulent strains, a prototype of trivalent live influenza vaccine is developed. Influenza A virus was adapted to replicate at low temperature. Serial passage at progressively lower temperature (30degrees C, 27degrees C and 24degrees C)resulted in the generation of cold-adapted (ca), temperature-sensitive (ts) mutant and attenuation (att) phenotype. This strain was evaluated for their ability to protect mice from challenge with same subtype and different subtype of influenza A virus. The study showed that vaccination of mice with live attenuated influenza virus provided complete protection against homologous and heterologous virus challenge. We also evaluated therapeutic potential of ca influenza virus. The mice infected with ca virus before challenge with wild type viruses or infected with simultaneously showed reduced clinical symptoms suggesting potential therapeutic effects.
Animals ; Influenza A virus ; Influenza Vaccines ; Mice ; Orthomyxoviridae ; Phenotype ; Serial Passage ; Vaccination

Although trivalent subunit vaccine has been available, the influenza vaccine has been under-utilized because of cumbersome route of vaccination and low level of protection. Therefore, there has always been a great need to develop live attenuated influenza vaccine which can be administered through nasal route and elicit better immunogenicity. Through conventional repeated passage at low temperature, a live influenza vaccine carrier could be established. By reassortant formation between the 'cold- adapted' vaccine carrier and virulent strains, a prototype of trivalent live influenza vaccine is developed. Influenza A virus was adapted to replicate at low temperature. Serial passage at progressively lower temperature (30degrees C, 27degrees C and 24degrees C)resulted in the generation of cold-adapted (ca), temperature-sensitive (ts) mutant and attenuation (att) phenotype. This strain was evaluated for their ability to protect mice from challenge with same subtype and different subtype of influenza A virus. The study showed that vaccination of mice with live attenuated influenza virus provided complete protection against homologous and heterologous virus challenge. We also evaluated therapeutic potential of ca influenza virus. The mice infected with ca virus before challenge with wild type viruses or infected with simultaneously showed reduced clinical symptoms suggesting potential therapeutic effects.
Animals ; Influenza A virus ; Influenza Vaccines ; Mice ; Orthomyxoviridae ; Phenotype ; Serial Passage ; Vaccination

BACKGROUND: The prevalence of obesity is increasing year after year in Korean; and gastroesophageal reflux disease(GERD) is increasing in this population as well. The aim of this study is to assess the association between age, body mass index(BMI) and GERD in healthy Korean adults. METHODS: Analysis was done on 1,016 subjects who had not had malignancy, uncontrolled metabolic disease, enteric surgery and organic esophageal disease. They completed a questionnaire that included past history and reflux symptoms. Endoscopy was performed by two gastroenterologists who were not given any patient information. Existence of GERD was determined by the esophageal syndrome criteria of the Montreal guidelines. Subjects were categorized by BMI, initially as: underweight, normal(18.5< or =BMI<25), overweight(25< or =BMI<30) and obese by the WHO criteria, and then as: underweight, normal(18.5< or =BMI<23), overweight(23< or =BMI<25) and obese by the Asian-Pacific criteria. RESULTS: The overall[is this correct] prevalence of GERD in our subjects was 15.5%. Age and sex were not correlated factors for GERD. By the WHO and the Asian-Pacific criteria, GERD was present in underweight(10.0%, 12.1%), normal(13.9%, 14.4%), overweight(18.6%, 13.0%) and obese groups(21.0%, 18.8%). No meaningful association was seen between BMI and GERD in either of the classified groups. Erosive GERD was seen in 83 subjects (8.2%) on endoscopy. The obese(BMI> or =25) group(12.1%) showed a meaningful increment in the prevalence of erosive GERD compared to the non-obese(BMI<25) group(6.2%)(p value 0.002). CONCLUSION: The prevalence of GERD in healthy Korean adult subjects was not closely associated with obesity and age[according to BMI]; however, erosive GERD was found to have a strong association with obesity.
Adult ; Body Mass Index ; Endoscopy ; Esophageal Diseases ; Gastroesophageal Reflux ; Humans ; Metabolic Diseases ; Obesity ; Prevalence ; Surveys and Questionnaires ; Thinness

Background: Occupational injuries and diseases are life events that significantly impact an individuals’ identity. In this study, we examined the trajectories of self-esteem among victims of occupational injury and disease and their relation to health. Methods: The Panel Study of Workers’ Compensation Insurance conducted annual followups on workers who had experienced occupational injury or disease. A total of 2,000 participants, who had completed medical care, were followed from 2013 to 2017. Growth mixture modeling was utilized to identify latent classes in the self-esteem trajectory.Additionally, logistic regressions were conducted to explore the association between trajectory membership, baseline predictors, and outcomes. Results: Three distinct trajectory classes were identified. Total 65.8% of the samples (n = 1,316) followed an increasing self-esteem trajectory, while 31.1% (n = 623) exhibited a constant trajectory, and 3.1% (n = 61) showed a decreasing trajectory. Individuals with an increasing trajectory were more likely to have a higher educational attainment (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.20–2.88), an absence of a moderate-to-severe disability rating (OR, 0.49; 95% CI, 0.25–0.96), no difficulty in daily living activities (OR, 0.81; 95% CI, 0.75–0.88), and were economically active (re-employed: OR, 2.46; 95% CI, 1.52–3.98; returned to original work: OR, 4.46; 9% CI, 2.65–7.50). Those with a decreasing self-esteem trajectory exhibited an increased risk of poor subjective health (OR, 1.89; 95% CI, 0.85–4.85 in 2013 to OR, 3.17; 95% CI, 1.04–13.81 in 2017), whereas individuals with an increasing trajectory showed a decreased risk (OR, 0.54; 95% CI, 0.43–0.68 in 2013 to OR, 0.44; 95% CI, 0.33–0.57 in 2017). Conclusion Our findings emphasize the diversity of psychological responses to occupational injury or disease. Policymakers should implement interventions to enhance the self-esteem of victims.

Methods: To operationalize precarious employment, we utilized data from the Korean Working Conditions Survey and focused on three distinct dimensions: employment insecurity, income inadequacy, and a lack of rights and protections. By constructing a summative scale ranging from -16 to 2, with lower scores indicating higher precariousness, we measured employment precariousness among Korean wage workers. To compare employment precariousness according to survey participant characteristics, we employed the Wilcoxon Rank Sum Test. Results: We analyzed a weighted number of 38,432 workers. The overall sample showed a median (Q1, Q3) summative scale score of -3 (-6, -1). The median summative score was lower for women compared to men (men: -2; women: -5; p < 0.001), as well as for young or older workers compared to middle-aged workers (young: -4; middle-aged: -2; older: -5; p < 0.001). Similarly, workers with lower educational levels (middle school or below: -8; high school: -5; college or above: -2; p < 0.001) and non-white collar workers (blue collar: -5; service/sales worker: -6; white collar: -2; p < 0.001) experienced higher levels of employment precariousness. Conclusion Our findings indicate that certain vulnerable groups, such as women, young or older adults, workers with low educational attainment, and caregiving or low-skilled elementary workers, are disproportionately exposed to high employment precariousness. Active policy interventions are needed to improve the employment quality of vulnerable groups.

Malignant skin tumors, including squamous cell carcinoma and malignant melanoma, have occurred in tattoos. Seven documented cases of basal cell carcinoma associated with tattoos have also been reported in the medical literature. We encountered a patient with basal cell carcinoma in a tattooed eyebrow. We report on this case as the eighth reported case of a patient with basal cell carcinoma arising in a tattooed area.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Eyebrows ; Humans ; Melanoma ; Skin

Infants with Sandhoff disease typically appear normal until 3–6 months of age. As the disease progresses, they present with symptoms such as loss of motor skills, exaggerated startle response to loud noise, seizures, visual loss, and paralysis. We encountered a rare case of a 22-month-old girl with Sandhoff disease characterized by progressive motor weakness and dysphagia, who initially showed signs of aspiration at 20 months of age. The major problems related to dysphagia were oromotor dysfunction and abnormal feeding posture. Within 3 months of identification of difficulty in swallowing, the patient showed a significant decrease in food intake, with rapid deterioration of nutritional status. We report our case with a review of the literature.
Deglutition Disorders ; Deglutition* ; Eating ; Female ; Humans ; Infant ; Motor Skills ; Noise ; Nutritional Status ; Paralysis ; Posture ; Reflex, Startle ; Sandhoff Disease* ; Seizures