PURPOSE: To assess the incidence of coronary artery lesion(CAL) and the efficacy of intravenously administered immune globulin(IVGG) and aspirin therapy, identify risk factors for CAL, and analyze clinical characteristics in infants less than 12 months of age with Kawasaki disease. METHODS: Retrospective chart review of children less than 12 months of age with Kawasaki disease between 1994 and 1998, diagnosed at Chungnam National University Hospital. RESULTS: Of 202 patients with Kawasaki disease, 32(16 percent) were less than 1 year of age, including 7(3 percent) less than 6 months. Sex ratio of male to female was 2.5:1. Age at onset and Harada score were a predictor of the development of CAL:5(71 percent) of 7 children less than 6 months and 10(40 percent) of 25 children between 6 to 12 months of age acquired CAL (P<0.05), and 1(14 percent) of 7 children less than 6 months of age acquired giant CAL. No specific clinical or laboratory features predicted the development of CAL. Persistent(greater than 1 year) CAL were present in 2(7 percent) of 29 IVGG-treated children. The typical clinical features of Kawasaki disease was noted 24(75 percent) of 32 and the atypical one, 8(25 percent) of 32 children less than 12 months of age. CONCLUSION: Patients with Kawasaki disease of less than 12 months of age are at particularly increased risk of having CAL and difficulty in diagnosis due to atypical clinical features. So, it is suggested to intervene in the diagnostic criteria or risk factors for CAL, especially for patients with infant Kawasaki disease of less than 6 months of age.
Aspirin ; Child ; Chungcheongnam-do ; Coronary Vessels ; Diagnosis ; Female ; Humans ; Incidence ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Risk Factors ; Sex Ratio

PURPOSE: Amblyopia is the commonest cause of defective vision in childhood. It develops during the sensitive period of visual maturation which continues until about 7-8 years of age. The authors investigated the effect of a polaroid photoscreening camera designed to detect amblyogenic factors, including asymmetric and abnormal refractive errors, strabismus, ptosis and media opacities. METHODS: Fifty-four children aged 3-24 months were evaluated for amblyogenic factors using the polaroid photoscreening carnera from March 1998 to March 1999 in Chungnam National University Children's Hospital. Then each child underwent medical examination by an ophthamologist. Results The mean age was 9.0+/-4.5 months. The results of photoscreening were normal findings of 74.1%, abnormal findings of 25.9%, and slight eccentric fixation in 18 cases, normal findings in 9 cases, peripheral crescents in 13 cases, strabismus in 4 cases, myopia in 5 cases, hyperopia in 2 cases, anisometropia in 2 cases, ptosis in 1 case and reexam in 14 cases. The photoscreener had a sensitivity rate of 81.8%, a specificity rate of 88.4%, a positive predictive value of 64.3% and a negative predictive value of 95.0%. CONCLUSION: Polaroid photoscreening method is an easy, noninvasive and reliable mass screening method of detecting amblyogenic factors in undilated children.
Amblyopia ; Anisometropia ; Child* ; Chungcheongnam-do ; Humans ; Hyperopia ; Infant* ; Mass Screening ; Myopia ; Refractive Errors ; Sensitivity and Specificity ; Strabismus

PURPOSE: Amblyopia is the commonest cause of defective vision in childhood. It develops during the sensitive period of visual maturation which continues until about 7-8 years of age. The authors investigated the effect of a polaroid photoscreening camera designed to detect amblyogenic factors, including asymmetric and abnormal refractive errors, strabismus, ptosis and media opacities. METHODS: Fifty-four children aged 3-24 months were evaluated for amblyogenic factors using the polaroid photoscreening carnera from March 1998 to March 1999 in Chungnam National University Children's Hospital. Then each child underwent medical examination by an ophthamologist. Results The mean age was 9.0+/-4.5 months. The results of photoscreening were normal findings of 74.1%, abnormal findings of 25.9%, and slight eccentric fixation in 18 cases, normal findings in 9 cases, peripheral crescents in 13 cases, strabismus in 4 cases, myopia in 5 cases, hyperopia in 2 cases, anisometropia in 2 cases, ptosis in 1 case and reexam in 14 cases. The photoscreener had a sensitivity rate of 81.8%, a specificity rate of 88.4%, a positive predictive value of 64.3% and a negative predictive value of 95.0%. CONCLUSION: Polaroid photoscreening method is an easy, noninvasive and reliable mass screening method of detecting amblyogenic factors in undilated children.
Amblyopia ; Anisometropia ; Child* ; Chungcheongnam-do ; Humans ; Hyperopia ; Infant* ; Mass Screening ; Myopia ; Refractive Errors ; Sensitivity and Specificity ; Strabismus

PURPOSE: Treatment of Kawasaki disease with intravenous gamma globulin(IVGG), together with aspirin, has been dernonstrated to be safe and effective in preventing coronary artery lesion and systemic inflarnmation, but optimal IVGG dosage and administration method are still controversial. We compared the therapeutic efficacy and clinical response of single IVGG 1g/kg to that of IVGG lg/kg for comparable risk group of Kawasaki disease. METHODS: We conducted a prospective study involving 63 children with Kawasaki disease requiring IVGG treatment(Harada score> or =4) at Chungnam National University Hospital from February 1996 to January 1999. The children were assigned to receive IVGG either as a single infusion of 1g/kg(A group, 32 person) or 2g/kg(B group, 31 person) and aspirn(100mg/kg/day through acute phase, then 3 to 5mg/kg/day for 8 weeks of duration). RESULTS: There were no significant difference between the two groups according to clinical and laboratry data, including coronary artery lesions(group A, 31.3% and group B, 29.0%) before treatment. After IVGG treatment ratio of complication with coronary artery lesion(group A 1/32=3.1% and group B, 2/31=6.5%) and that of retreatment(group A, 4/32=12.5%, group B, 2/31=6.5%), duration of fever(group A, 1.3+/-1.6 days and group B, 0.7+/-1.4 days), hospital stay(group A, 7.0+/-1.4 days and group B, 6.5+/-2.0 days), laboratory finding and side effects of IVGG were not significantly different(P>0.05). The total dosage of IVGG was significantly lower in group A than group B(group A, 1.16+/-0.37g/kg, 375,421+/-207,351won and group B, 2.10+/-0.40g/kg, 641,498+/-274,750won (P<0.05). CONCLUSION: The therapeutic efficacy and clinical response of single 1g/kg therapy are comparable to that of single 2g/kg therapy.
Aspirin ; Child ; Chungcheongnam-do ; Coronary Vessels ; gamma-Globulins* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Prospective Studies

PURPOSE: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. METHODS: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. RESULTS: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. CONCLUSION: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.
Caregivers ; Classification ; Hospitals, General ; Humans ; Inpatients* ; Nurse Administrators ; Nursing Care* ; Nursing* ; Patient Care ; Tertiary Care Centers

PURPOSE: This survey was aimed to examine the current dietary restrictions practices for neutropenic patients among hospitals with 500 and more beds. METHODS: Self-administered questionnaires were sent to 100 head or charge nurses of oncology or hemato-oncology wards by mail during October 2009, and 51 questionnaires were returned. The data were analyzed with descriptive statistics using SPSS (WIN version 12.0). RESULTS: Of the hospitals surveyed, 47.1% (n=24) had guidelines on the dietary restrictions, and 80.4% (n=41) placed patients with neutropenia on restricted diets. The major decisional criteria of the dietary restriction was absolute neutrophil count (30.5%) and cooking status (29.2%). The most commonly restricted foods were raw fish or fresh meat (98.0%), uncooked intestine (98.0%), raw eggs (98.0%), draught beer (96.1%), and fresh fruits or vegetables (86.3%). CONCLUSION: The results showed variation in pattern of dietary restrictions and lower rate of guideline among hospitals, so that the need for the standard dietary restriction guideline is high. However, the role of diet in the development of infection in neutropenic patients is still unclear, which makes it difficult to establish dietary restriction guideline. Therefore, additional research are required to identify the relationship between dietary factors and infections.
Beer ; Cooking ; Diet ; Eggs ; Fruit ; Head ; Humans ; Intestines ; Meat ; Neutropenia ; Neutrophils ; Nursing, Supervisory ; Ovum ; Postal Service ; Surveys and Questionnaires ; Vegetables

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.