No abstract available.

PURPOSE: In this study active surveillance culture for ICU patients, in whom the risk of VRE infection was high were conducted, and through this the VRE colonization rate and the characteristics of the colonization were examined and risk factors involved in VRE colonization and acquisition were analyzed. METHOD: This research was performed with 635 patients admitted to ICU between July 1 and December 31, 2006. RESULTS: On admission to ICU, the VRE colonization rate was 2.36%, 93% identified from active surveillance culture. The VRE colonization rate was significantly higher in those patients with cancer (OR=9.43; 95% CI=1.38~62.50; P=.022), liver cirrhosis (OR=55.5; 95% CI=7.29~500; P=.005), transferred from other hospitals (OR=200; 95% CI=22.73~1000; P=.000), high APACHE II score (OR=1.107; 95% CI=1.010~1.213; P=.029), or antibiotics within the last 3 months (OR=15.87; 95% CI=2.27~111.11; P=.005). The VRE acquisition rate was 5.2%. It was significantly higher in those who were using a ventilator (OR=26.31; 95% CI=5.13~142.86; P=.000), three or more kinds of antibiotics during admission (OR=58.82; 95% CI=16.13~200; P=.000), or high APACHE II score (OR=1.16; 95% CI=1.08~ 1.24; P=.000). CONCLUSION: The results of this study show that active surveillance culture can detect VRE colonization on admission to ICU and those who have acquired VRE in ICU. The analyzed VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in ICU.
Anti-Bacterial Agents ; APACHE ; Colon ; Enterococcus ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Liver Cirrhosis ; Risk Factors ; Vancomycin Resistance ; Ventilators, Mechanical

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization

BACKGROUND: Because acute cholecystitis in elderly hip fracture is not easily distinguishable from other gastrointestinal symptoms and involves atypical clinical behaviors, it may not be diagnosed in the early stage. However, the exact incidences could not be reported. We utilized data from a nationwide claims database and attempted to assess the incidence of acute cholecystitis in elderly hip fracture patients and how cholecystitis affects mortality rates after hip fracture. METHODS: Study subjects were from the Korean National Health Insurance Service-Senior cohort. From a population of approximately 5.5 million Korean enrollees > 60 years of age in 2002, a total of 588,147 participants were randomly selected using 10% simple random sampling. The subjects included in this study were those who were over 65 years old and underwent surgery for hip fractures. RESULTS: A total of 15,210 patients were enrolled in the cohort as hip fracture patients. There were 7,888 cases (51.9%) of femoral neck fracture and 7,443 (48.9%) cases of hemiarthroplasty. Thirty-six patients developed acute cholecystitis within 30 days after the index date (30-day cumulative incidence, 0.24%). Four of the 36 acute cholecystitis patients (11.1%) died within 30 days versus 2.92% of patients without acute cholecystitis. In the multivariate-adjusted Poisson regression model, hip fracture patients with incident acute cholecystitis were 4.35 (adjusted risk ratio 4.35; 95% confidence interval, 1.66–11.37; P = 0.003) times more likely to die within 30 days than those without acute cholecystitis. CONCLUSION: Incidence of acute cholecystitis in elderly patients after hip fracture within 30 days after the index date was 0.24%. Acute cholecystitis in elderly hip fracture patients dramatically increases the 30-day mortality rate by 4.35-fold. Therefore, early disease detection and management are crucial for patients.
Abdominal Pain ; Aged ; Cholecystitis ; Cholecystitis, Acute ; Cohort Studies ; Femoral Neck Fractures ; Hemiarthroplasty ; Hip Fractures ; Hip ; Humans ; Incidence ; Mortality ; National Health Programs ; Odds Ratio

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group
Aging ; Aircraft* ; Airports ; Blood Pressure* ; Female ; Hearing Loss* ; Hearing* ; Humans ; Hypertension ; Male ; Military Personnel ; Noise* ; Presbycusis ; Psychological Tests ; Stress, Psychological*

Interstitial deletions involving the chromosome band 15q22q24 are very rare and only nine cases have been previously reported. Here, we report on a 12-day-old patient with a de novo 15q22q23 interstitial deletion. He was born by elective cesarean section with a birth weight of 3,120 g at 41.3-week gestation. He presented with hypotonia, sensory and neural hearing loss, dysmorphism with frontal bossing, flat nasal bridge, microretrognathia with normal palate and uvula, thin upper lip in an inverted V-shape, a midline sacral dimple, severe calcanovalgus at admission, and severe global developmental delay at 18 months of age. Fluorescence in situ hybridization findings confirmed that the deleted regions contained at least 15q22. The chromosome analysis revealed a karyotype of 46,XY,del(15) (q22q23). Parental chromosome analysis was performed and results were normal. After reviewing the limited literature on interstitial 15q deletions, we believe that the presented case is the first description of mapping of an interstitial deletion involving the chromosome 15q22q23 segment in Korea. This report adds to the knowledge of the clinical phenotype associated with the 15q22q23 deletion.
Birth Weight ; Cesarean Section ; Developmental Disabilities ; Female ; Fluorescence ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; In Situ Hybridization ; Karyotype ; Korea ; Lip ; Muscle Hypotonia* ; Palate ; Parents ; Phenotype ; Pregnancy ; Uvula

No abstract available.
Amniotic Fluid* ; beta-Endorphin* ; Female

PURPOSE: Although, there have been many reports about factors involved in the severity and prognosis of organophosphate toxicity, there are few reports on integrated application of scoring methods using those factors for prognosis. Our report is about the possible application of such scoring methods in the early stage of organophosphate intoxication. METHODS: This study included organophosphate intoxication patients who were admitted to the Emergency department (ED) between March 1, 2004 and February 28, 2008. We limited enrolment in the study to patients who had required assisted mechanical ventilation and used atropine for therapy. This was a retrospective study about age, drug toxicity, mental status, existence of metabolic acidosis and QT prolongation for each patient. RESULTS: Thirty seven patients were enrolled in this study. Among the 37, 22 survived and 15 died. For survivors, drug toxicity and mental status were correlated with total dose of atropine, and the existence of metabolic acidosis was correlated with the duration of mechanical ventilation. Survivors had lower total scores than non-survivors. CONCLUSION: Application of scoring methods that include five factors (age, drug toxicity, mental status, existence of metabolic acidosis, existence of QTc prolongation) when acute, severe, organophosphate poisoning patients arrive at an ED can be helpful for their prognosis.
Acidosis ; Atropine ; Drug Toxicity ; Emergencies ; Humans ; Organophosphate Poisoning ; Organophosphates ; Prognosis ; Research Design ; Respiration, Artificial ; Retrospective Studies ; Survivors

This research proposes a safety strategy for coronavirus disease 2019 (COVID-19) walkthrough booths to optimize pandemic preparedness. These booths, designed for respiratory sample collection during the COVID-19 pandemic, effectively reduce infection risk and personal protective equipment-related fatigue among healthcare workers. However, inadequate disinfection and glove management could escalate infection transmission. Using computational fluid dynamics simulations, we analyzed droplet dispersion on booth surfaces and gloves under various wind conditions. Our findings suggest that when setting up COVID-19 walk-through booths, their location should be strategically chosen to minimize the effects of wind. All surfaces of booth gloves must be thoroughly disinfected with a certified disinfectant after nasopharyngeal swab collection. It is also recommended to wear disposable gloves over booth gloves when changing between patient examinations. In wind-affected areas, individuals nearby should not solely rely on the 2-meter distancing rule due to potential droplet spread from walk-through booths. We strongly recommend consistent and proper mask use for effective droplet blocking. Adherence to these guidelines can significantly enhance the safety and efficiency of walk-through booths, particularly in potential future pandemics.

BACKGROUND AND OBJECTIVES: The patient presenting to the emergency department with the complaint of dizziness is one of the most common as well as most challenging problems confronting the emergency physician today. Dizziness is a vague symptom of disease ranging from serious to benign. The differential diagnosis and proper management of dizziness in a department of emergency medicine are the most important things. We undertook this study to evaluate the character and clinical analysis of the dizzy patients and to discuss the significance and necessity of primary care in a department of emergency medicine. MATERIALS AND METHOD: From September 1999 to October 2003, we sampled the 1,371 dizzy patients who visited the Emergency Department(ED). Of these patients, the 650 patients performed electronystagmography(ENG) and rotatory chair test were selected, except for the patients with loss of consciousness, known psychiatric disease or direct brain injury. RESULTS: The 650 patients were attributed to acute peripheral vestibulopathy in 88.5% (575 patients) of patients, benign paroxysmal positional vertigo in 9.5% (62 patients) of patients, central origin in 1.4% (9 patients) of patients, other organic origin in 0.6% (4 patients) of patients. In a retrospective analysis of patients with central origin, the symptoms estimated at central origin, for example, persistent headache, were found. CONCLUSION: The exact diagnosis and management for the dizzy patients in a department of emergency medicine require the primary physician's concern and understanding for dizziness.
Brain Injuries ; Diagnosis ; Diagnosis, Differential ; Dizziness ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Headache ; Humans ; Primary Health Care ; Retrospective Studies ; Unconsciousness ; Vertigo ; Vestibular Neuronitis