BACKGROUND: It is well known that Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among pathogens of nosocomial infection. The MRSA infection control measures have been initiated at a brand new tertiary care teaching hospital which was opened in June, 1994. However, the control measures did bring out little effect. In 1997, reenforcement of all control measures were practiced in intensive care units. The measures brought out a significant improvement in reducing the incidence of MRSA infection, subsequently the same control measures were implemented through-out the entire inpatient area. METHODS: The following control measures have been reenforced since March 1997: first, application of thorough surveillance of confirmed MRSA infected patients: second, providing cohort care: third, enforcing handwashing practices after patient contact; fourth, establishing infected patients isolation zone: fifth, tagging infected patient's bed and medical record, providing disinfectant spray for washing hands, identifying and treating carriers among patient contact staffs, separate disposal of contaminated wastes, and finally repeating education of nursing staff and family members of the patients. Each month the number of incidence in MRSA nosocomial infection were followed and the leu supervisors were notified the outcome. RESULTS: The incidence of MRSA infection started to decline soon after the initiation of the control measures, from 132% in March 1997 to 5.8% in July 1997. In 1998, the infection rate maintained close to 2-3%. There had been 467 MRSA infected cases (5.7%) out of 8,253 discharges during the study period; among them 319 cases were infected once; 40 cases twice; 15 cases three times: four cases four times and 1 case seven times. The order of preference of organs infected are lungs (56.3%), wounds(11.8%), blood (7.9%), and urinary tract (1.9%). The highest incidence of this infection was found in Medicine (34.8%) and Neurosurgery (22.8%) CONCLUSION: The implementation and reenforcement of infection control measures are key to successful control of nosocomial infection, in particular, hand washing of patient contact staffs and eradication of carriers could be the most effective measures.
Cohort Studies ; Cross Infection* ; Education ; Hand ; Hand Disinfection ; Hospitals, Teaching ; Humans ; Incidence ; Infection Control ; Inpatients ; Intensive Care Units* ; Critical Care* ; Lung ; Medical Records ; Methicillin-Resistant Staphylococcus aureus* ; Neurosurgery ; Nursing Staff ; Tertiary Healthcare ; Urinary Tract

Blood utilization review has recently been used to minimize inappropriate transfusion, reduce post transfusion infections and improve the quality of transfusion practices. Ajou University Hospital is a 906 bed tertiary care teaching institution. Since March, 1995, the concurrent review of blood transfusion requests using institutional blood transfusion criteria has been initiated. To evaluate the effectiveness of the transfusion review, the units of blood components transfused per patient(total number of units of blood components transfused/total number of patients discharged) and inappropriate transfusion ratio of blood components(total number of units of blood components inappropriately transfused/total number of units of blood components transfused) were compared during the concurrent review for 9 months and pre-concurrent review for 9 months, respectively. The possible savings of blood components realized by the review were also extrapolated. The results were as follows : 1. The unit transfused per patient for pre-review and during review were 0.675 (9,080/ 13,422) and 0.654(12,123/18,546) for packed RBC(PRBC); 0.417 (5,602/ 13,422) and 0.296 (5,444/18,546) for fresh frozen plasma(FFP); 0.372(5,007/13,422) and 0.424(7,868/18,546) for platelet con-centrates(PC), respectively. 2. The inappropriate transfusion ratio of blood components for pre-review and during review were 0.039 and 0.009 for PRBC; 0.321 and 0.064 for FFP; 0.143 and 0.008 for PC, respectively. These differences were statistically significant(p=0.000). 3. The PRBC and FFP anticipated to have been saved by this review was 519 units and 2,992 units annually, respectively. 4. However, 2,621 units of PC were used additionaly during this review due to increased number of oncology patients and better hemostatic therapy practiced during the same period. In conclusion, the concurrent review of transfusion requests was very effective tool to educate residents in clinical departments the transfusion medicine and improve utilization of blood and its components.
Blood Platelets ; Blood Transfusion* ; Concurrent Review* ; Humans ; Income ; Tertiary Healthcare ; Transfusion Medicine ; Utilization Review

BACKGROUND: The HLA-DR and DQ genes are known to show in strong linkage disequilibrium. Authors investigated the allele frequencies of HLA-DQB1 genes and HLA-DQB1-DRB1 haplotypic associations in Koreans. METHODS: HLA-DRB1 and DQB1 typing were performed in 120 unrelated Koreans consisting of normal tissue donors and patients with hematologic diseases using polymerase chain reaction-reverse dot blot hybridization method with INNO-LiPA HLA-DRB and DQB kits (INNOGENETICS, Zwijndrecht, Belgium). Haplotypic associations between DRB1 and DQB1 alleles were calculated according to the formula from Mattiuz et al. RESULTS:1. Allele frequencies of the five most common DQB1 alleles were DQB1* 0301, 14.4%; 0303, 11.0%; 0302, 9.6%; 0601, 9.2%; 0401, 8.7%. 2. Haplotype frequencies (%) of the ten most common DQB1*-DRB1* haplotypes were 0303-0901, 9.17%; 0401-0405, 8.71%; 0602-1501/03/04, 7.35%; 0501-0101, 7.35%; 0601-0803, 5.98%; 0609-1302, 5.10%; 0503-1405, 4.69%; 0302-0406, 4.26%; 0301-1101/10/12 or 1104, 4.26%; 02-0701, 4.23%. They consisted 61.1% of total haplotypes in this study. CONCLUSIONS: The results of this study may be useful as basic data of Koreans for anthropology, accurate interpretaion of DRB1 and DQB1 typing and quality control of genotyping.
Alleles* ; Anthropology ; Gene Frequency* ; Haplotypes ; Hematologic Diseases ; HLA-DR Antigens ; HLA-DRB1 Chains ; Humans ; Linkage Disequilibrium ; Quality Control ; Tissue Donors

The demand for high quality, safe and quantity for healthcare is increasing while the resources remain unchanged. Adoption of better information technology can achieve significant improvements in quality and safety of healthcare delivery in the environment of increasing pressure on healthcare systems. This will also contribute to contain healthcare cost in the long run. Many developed and developing countries in the world pay attention on appropriate use of information communication technology(ICT) in healthcare domain. Some countries such as the US, UK, Australia, Canada and others adopted strategic plan of National Health Information Infrastructure for next 10 years. The objectives for ICT application of developed countries are summarized as: - To improve access to clinical records; - To reduce clinical errors and improve safety of patients; - To improve access to quality information on health for patients and healthcare professionals; - To improve efficiency of healthcare processes; and - To contain healthcare costs. The core of the ICT adoption in health is to have universal availability of electronic health and clinical records(EHR) at the point of care. This review, therefore, briefly described the definition, architectures, essential functionalities and applicable standards of EHR.
Australia ; Canada ; Delivery of Health Care ; Developed Countries ; Developing Countries ; Electronic Health Records* ; Health Care Costs ; Humans

PURPOSE: The clinical significance of preoperative serum levels of CEA and CA19-9, levels of CEA and CA19-9 in peritoneal washing fluid and free cancer cells in peritoneal washing fluid in gastric cancer patients were evaluated in this study. MATERIALS AND METHODS: Serum and peritoneal levels of CEA and CA19-9 and peritoneal washing cytology in 115 patients with gastric cancer were analyzed with respect to the prognostic factors using univariate and multivariate analysis. RESULTS: Positive rate of serum CEA and CA19-9 was 16.5%, 13.0%. And that of peritoneal washing CEA, CA19-9 and cytology was 15.7%, 7.8% and 9.6%. A univariate analysis showed that tumor markets in serum and peritoneal washing fluid and peritoneal washing cytology had significant correlations with the progression of the tumors, and patients with positive serum or peritoneal tumor markers had poorer survival after operation than did the patients with negative tumor markers. But in a multivariate analysis showed that only peritoneal CA19-9 was an independent risk factor. And combination of these five markers provided rnore predictable prognostic informations in a multivariate analysis. CONCLUSION: Combination of serum or peritoneal levels of CEA, CA19-9 and washing cytology appeared to be a useful marker for managing gastric cancer patients.
Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Biomarkers, Tumor

Sebaceous carcinoma is a particularly common malignant tumor of the eyelid. Therefore, this lesion is important to ophthalmologist. Recently, there appears to have been an increased incidence or recognition of sebaceous carcinomas of the eyelid, which had been previously believed to be very rare. Frequently mistaken for a recurrent chalazion, invasion by sebaceous carcinoma is frequently enhanced by repeat curettage and forms of therapy that obscure the true diagnosis. This tumor is difficult to completely resect due to intraepithelial widespread, so its prognosis is poor. The authors experienced two cases of sebaceous carcinoma of the eyelid. One was a 57 year old female patient who was treated with surgical resection and the other was a 71 year old male with cervical lymph node metastasis. He was treated with surgical resection, but he rejected radiotherapy.
Aged ; Chalazion ; Curettage ; Diagnosis ; Eyelids* ; Female ; Humans ; Incidence ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Radiotherapy

The implementation of hospital information systems and inter-hospital collaborative strategies are becoming popular, therefore patients' information exchange among healthcare organizations has increasingly been an important issue in Korea. To improve the efficiency of communicating electronic data between information systems, standardization is required. To introduce the Health Level Seven(HL7) to health systems in Korea as a standard for messaging and communication, Korea recently joined to HL7 as an international affiliate. The HL7 refers to the application level, the highest level of ISO communication model for Open Systems Interconnection(OSI), and adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest. This paper focuses on the review and introduction of the HL7 and planned activities of HL7 Korea. The HL7 Korea initiates encouragement of implementation of HL7 in health informatics, the most widely used being a messaging standard that enables disparate healthcare applications to exchange key sets of clinical and administrative data of patients. The HL7 Korea will play a pivotal role in expanding the use of HL7 in Korea to establish a cost effective way of efficiently sharing electronic patients' information nationally. A stepwise strategies for future activities of HL7 Korea are suggested as follows: 1) studying HL7 and training potential users; 2) piloting inter-hospital message communications by using HL7 interface engine to find applicability and compatibility of HL7 in Korea; 3) adapting HL7 as a standard for health informatics messaging and communication in Korea; and 4) continuing expansion of HL7 application nationwide.
Consensus ; Delivery of Health Care ; Health Level Seven* ; Health Status* ; Hospital Information Systems ; Humans ; Informatics ; Information Systems ; Korea* ; Medical Records

BACKGROUND: The prognostic indicators of patients who received massive transfusion were studied to assist management of high risk patients. METHODS: Medical records and laboratory data of 184 adult patients who received massive transfusions during 1996-1998 were reviewed. The indicators studied were outcome of treatment, cause of transfusion, age, sex, vital signs at admission, number of units of blood components, results of platelet counts (Plt), hematocrit (Hct), prothrombin time (PT), activated thromboplastin time (aPTT) and arterial blood pH (pH) performed within 24 hours after transfusion. RESULTS: The percent and mean age of survivor were 60.3% and 44.8 years old and nonsurvivor were 39.7 and 49.7, respectively. The frequency and survival rate by causative disorders were as follows: trauma 33.2% and 56%; liver disease 23.9% and 57%, cancer 13.6% and 56%, cardiovascular disorders 7.5% and 78.6%. Nonsurvivors had lower systolic and diastolic pressures in liver disease and cancer, and lower body temperature in trauma patients than those of survivors. In trauma patients nonsurvivors had lower Plt counts and pH, and prolonged PT and aPTT results than those of survivors. In cancer patients nonsurvivors showed lower Hct and pH, but those of liver disease patients showed only lower Plt counts. The average unit of blood components transfused per patient in nonsurvivors were 27.3 of RBC, 13.4 of FFP, and 15.2 of platelet concentrate, respectively. The percent of patients who were transfused more than 20 units of RBC was 28% in survivors, but 55% in nonsurvivors. CONCLUSIONS: It is concluded that the patients transfused with more than 20 units of RBC showed low systolic and diastolic pressures, body temperature, Plt counts, Hct and arterial blood pH, and prolonged PT and aPTT results appeared to be poor prognostic indicator of massive transfusions.
Adult ; Blood Platelets ; Body Temperature ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Medical Records ; Platelet Count ; Prognosis* ; Prothrombin Time ; Survival Rate ; Survivors ; Thromboplastin ; Vital Signs

The International Oranization for Standardization (ISO) was as created in 1947 to provide assistance to it members in harmonizing national technical standards. Today its role h as changed to produce international technical standards in order to promote trade international In 1998 a new ISO/Technical Committee (TC) 215 was established to standardize the Health informaties worldwide. The efforts have increasingly been intensified through TC 215 activities in formulating international health informatics standards in order to meet the demand from the industry within its member countries for their international trade. The Republic of Korea joined ISO/TC 215 as the P-member body in 1999 unit Korean experts started to participate actively in TC 215 work processes. However, domestic standardization in health informaties is in its infancy Therefore, current activities of ISO/TC 215 and current status of Korean Health informaties Standard Committee base been reviewed to be able to generate interests from experts and technical professionals in the field of health informaties
Informatics* ; Republic of Korea

In March 1999, we have inaugurated the first academic Department Of Medical Jnformatics (DOMI) at Kyungpook National University School of Medicine in Korea. The initial intent of DOMI is to cover the basics of information science for medical students in order to cope with future medical environment. The purpose of this study is to analyze student response from the medical informatics class to settle in as a regular course of medical education curriculum. The informatics lecture consists of series of 18 lectures to introduce computer and information sciences, basics of internet, laboratory, radiology, telemedicine, patient administration, clinical and management information systems. We conducted a survey before and after the lecture for 150 first year medical students. Both evaluation results were compared to observe any significant changes were acquired. Before the lecture, respondents were reluctant to have computer-related lecture due to resistance of curriculum changes. After the lecture, it is surprising to note that student attitude toward informatics lecture was dramatically changed. Positive views of medical informatics were dominant, and respondents strongly recommended medical informatics lecture to be continued. In addition, a new graduate study program of medical informatics is in operational beginning 2000. The graduate study is designed to offer master s degree for training information specialists in hospital, and doctoral degree for developing faculty and researchers to prepare for the progress of medical informatics in the future.
Curriculum ; Surveys and Questionnaires ; Education ; Education, Medical ; Gyeongsangbuk-do ; Humans ; Informatics ; Information Science ; Information Services ; Internet ; Korea ; Lectures ; Management Information Systems ; Medical Informatics* ; Students, Medical ; Telemedicine