No abstract available.
Prognosis* ; Stomach Neoplasms*

Particulate wear debris(polyethylene, polymethylmethacrylate and metal particles, or combination of these) can initiate aseptic loosening. To eliminate polyethylene debris and reduce the total amount of wear, metal on metal bearings(Metasul) which were made of a wrought Co-28Cr-6Mo-0.2C alloy, were introduced. From May 1994 total hip replacements using a Metasul metal on metal articulation were performed by the authors. 34 patients with 40 hips with minimum follow-ups during 24 months were analysed in this study. The mean follow up period was 31 months(ranging from 24 to 47 months). We used Armor cups and standard cups as acetabular comporients and SL stems, CLS stems and cone stems as femoral components. Preoperative average Harris hip score of 48 points became postoperatively 93(from minimum 81 to maximum 100). And there were slight and occasional thigh pains in 2 cases(5%). There were no revisions for the early aseptic loosening of femoral stems or stem failures. Radiologic evaluation which revealed mild calcar atrophy was developed in 33 cases(82.5%), revealing cortical hypertrophy in 10 cases(25%). Osteolysis was not noted around the prosthetic stem nor around the cup. Radiolucent lines were found in 9 cases of femoral components(22.5%) and in 1 case of acetabular component(2.5%) and subsidence of more than 3mm in 1 case of femoral components(2.5%) were also found. There was 1 case of definitive loosening of acetabular component(2.5%). These also showed that endosteal bone formation adjacent to femoral prosthesis was developed in 22 cases(55%) but no distal pedestal and stem shift occurred. The short-term but satisfactory results of the contemporary metal on metal articulation investigated in this study were encouraging and warrant continued study.
Acetabulum ; Alloys ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Atrophy ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Osteogenesis ; Osteolysis ; Polyethylene ; Polymethyl Methacrylate ; Prostheses and Implants ; Thigh

PURPOSE: The purpose of this study was to identify how empathy mediates the relationship between teachers' knowledge of Attention Deficit Hyperactivity Disorder (ADHD) and educational interventions. METHODS: A survey for structural equation modeling was conducted with 334 teachers from 61 schools in D and Y cities in Korea. Data were collected from April 2012 to July 2012 through self-report questionnaires using standardized instruments. The data were analyzed using SPSS Win 20 and AMOS 20, and Sobel tests were conducted to determine the significance of mediation and Bootstrapping tests to construct confidence intervals. RESULTS: Teachers' empathy provided complete mediation between teachers' knowledge and educational interventions in classrooms. Results showed that empathy contributes positively to educational interventions in ADHD by increasing understanding of children with ADHD and the situation. CONCLUSION: Based on the findings of this study, teachers need to enhance their empathy towards students with ADHD to increase the effectiveness of their educational interventions for ADHD. These results suggest the importance of focusing on increasing teachers' empathy in the classroom in order to provider better education interventions for children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Child ; Empathy ; Humans ; Korea ; Negotiating ; Surveys and Questionnaires

PURPOSE: This study was a meta-analysis designed to identify effects of Cognitive Behavioral Therapy (CBT) interventions in alleviating main symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among school-aged children in Korea. METHODS: Examination of several databases including Research Information Sharing Service, Korean Studies Information Service System, Data Base Periodical Information Academic and hand-searched article references, resulted in identification of 1,298 studies done between 2000 and 2013 of which 21 met the inclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and its trim-and-fill analysis. RESULTS: Overall effect size of CBT intervention was large (g=1.08) along with each outcome of self-control (g=1.26), lack of attention (g=1.02), social skills (g=0.92), and hyperactivity (g=0.92). For heterogeneity, moderator analysis was performed, but no significant differences were found between the RCT (Randomized Controlled Trials) group and the NRCT (Non RCT) group. Also, meta-regression was performed using sample size, number of sessions, and length of session as predictors, but no statistically significant moderators were found. Finally, a funnel plot along with trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected. CONCLUSION: Based on these findings, there is clear evidence that CBT intervention has significant positive effects on the main symptoms of school-aged children suffering ADHD. Further research is needed to target diverse age groups with ADHD along with more RCT studies to improve the effectiveness of the CBT intervention.
Attention ; Attention Deficit Disorder with Hyperactivity/*therapy ; Child ; *Cognitive Therapy ; Databases, Factual ; Humans ; Psychomotor Agitation ; Republic of Korea ; Self-Control/psychology ; Social Skills

No abstract available.
Dementia* ; Epidemiologic Studies*

OBJECTIVES: This study is for developing the prediction model of outpatient's revisit in target hospital. Using this model, hospital managers can make efficient customer relationship. METHODS: This is based on the medical record data of patients in target hospital (with 967 beds). They are divided into two groups, which are used each for different purpose. One(raw data) is used to make the prediction model of revisit and the other(test data) is used to evaluate the model. For raw data were used the 4,273 outpatient cases, where patients visited the first time between august and september in 2000, and visited till december in 2003. For the test data were used 9,392 outpatient cases, where patients visited the first time between august and september in 2003, and visited till december in 2006. That is, each data was selected from the outpatient's medical records for three-years. RESULTS: The decision tree model is better than the logistic regression model as prediction model of outpatient's revisit in target hospital. The decision tree model is evaluated more excellent in ROC curve and classification accuracy in test data. For predicting the outpatient's revisit, it is more useful to have 4 variables - non-insured expenses, special medical service, cooperation service with oriental medicine and visit via ER. We can predict the revisit of outpatients over 39.5% rate by these variables. CONCLUSIONS: By using decision tree model, target hospital can make more accurate prediction of outpatient's revisit and make good customer relation management. So, target hospital can use some CRM program including 4 variables. To make more useful model for other hospitals in Korea, each hospital managers need to understand more their hospital environment and patient's characteristics.
Data Mining ; Decision Trees ; Humans ; Korea ; Logistic Models ; Medical Records ; Medicine, East Asian Traditional ; Outpatients ; ROC Curve

Scapular fractures are being seen with increasing frequency in our mechanized society, specially in patients who have multiple injuries. Most of the scapular fractures have been treated non-operatively, with early mobilization of the shoulder. The result of such functional treatment have been predictably good. However, this non-operative approach may not yield such good results in patients who have a fracture of the scapular neck in association with the ipsilateral clavicular fracture or other double disruptions of the superior shoulder suspensory complex. Ipsilateral fractures of the scapular neck and clavicle disrupt the suspensory mechanism of the shoulder resulting in fuctional loss and deformity. From January 1989 to June 1995, twelve patients were identified with this specific pattern of injury. The follow up period was 39.2 months in average. Seven patients were treated operatively using 3.5mm DCP or reconstruction plate, and five patients were performed K-wire fixation or wiring. Upon review all were healed radiographically. According to the scoring system of Rowe, five patients had an excellent fuctional result, five had a good result, and two had a fare result. The average score for the twelve patients was 85 points. The results of our retrospective study show that operative treatment for these complex fractures is safe and that functional recovery is predictably good.
Clavicle* ; Congenital Abnormalities ; Early Ambulation ; Follow-Up Studies ; Humans ; Multiple Trauma ; Neck* ; Retrospective Studies ; Shoulder

Purpose: This study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes. Methods: A before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence postadmission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed. Results: Regarding nurse outcomes, handover quality (p < .001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between preintervention and postintervention. Conclusion Despite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.

The authors have experienced 9 cases of postgastrectomy efferent loop obstruction during the past 16 months' period and analyzed the clinical features, radiological findings, causes, and types of obstruction. The incidence of efferent loop obstruction was 1.3%(9/673). Among the 9 cases, eight patients were male and one patient was female. Median age was 60 years and more than half(5 out of 9 cases) of the patients were obese(defined by more than 110% of ideal body weight). None of the cases showed signs of strangulation, including persistent pain, fever, focal abdominal tenderness, and/or leukocytosis. Gastrointestinal anastomoses were done using a GIA stapler in 6 cases, and manually in 3 cases. The diagnoses were made on the basis of clinical symptoms and signs, further supported by radiologic contrast studies. All the patients were initially treated with conservative measures, including nasogastric drainage and fluid therapy for about 2 weeks in average. 7 cases underwent re-laparotomy using separate left subcostal incisions as conservative management had failed. Among the relaparotomy cases, adhesiolysis and side to side jejunojejunostomy were performed in 5 patients, Roux-en-Y gastrojejunostomy in 1 patient, and gastrojejunostomy revision in 1 patient. Causes of the obstruction in the seven re-opened cases were confirmed as postoperative adhesion. The authors have analyzed the pattern of obstruction and classified the patterns into 4 types. One of the remaining two patients underwent balloon dilatation successfully and the other was managed with prolonged nasogastric decompression. The average hospital stay was 32 days. Adequate omentectomy, gentle tissue handling during dissection, avoidance of ischemia along the suture line of anastomosis, and the use of biologically inert suture material would prevent this kind of postoperative adhesive obstruction.
Adhesives ; Decompression ; Diagnosis ; Dilatation ; Drainage ; Female ; Fever ; Fluid Therapy ; Gastric Bypass ; Humans ; Incidence ; Ischemia ; Length of Stay ; Leukocytosis ; Male ; Stomach Neoplasms ; Sutures

The depolarizing neuromuscular blocking agent succinylcholine, which was synthesized by Hunt and Taveau in 1906, is still regarded as the drug of choice when speed of onset and good intubating conditions matter most. This agent has several disadvantages, some of which may be unpredictable, serious and immediate, for example, muscle pain, bradycardia, rise in intragastric pressure, increase in intraocular pressure and elevation of serum potassium. These disadvantages may be regarded as the side effects of depolarization and indicate a need for a nondepolarizing neuromuscular blocking agent with rapid onset and good muscle relaxation. Simpson et al. described the neuromuscular blocking properties of the nondepolarizing .neuromuscular blocking agent, Fazadinium (AH 8165) in 1972. This initial work indicated a more rapid onset of action than occurs with succinyleholine and without muscle fasciculation or concomitant rise in plasma potassium concentration. However, Coleman et al., Young, t al., Hartley and Fidler, and Metha et al., concluded that using succinylcholine, a ignificantly greater number of patients had excellent intubating conditions at predetermined times after administration than when using Fazadinium. Several reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents would markedly diminish the fasciculation and muscle pains which so frequently occur, when succinylcholine is given. Many other reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents could attenuate or eliminate the adverse effects of succinylcholine such as increased intra-gastric pressure and intraocular pressure, bradycardia, arrhythmia and hyperkalemia. Several investigators have recommended that when small doses of nondepolarizing neuromuscular blocking aKent are given before succinylcholine administration, larger doses of succinylcholine should be given to achieve satisfactory relaxation. A comparative study using d-tubocurarine, gallamine and pancuronium for precurarization indicates that any of them successfully attenuates fasciculation. They have a little antagonizing effect of vocal cord relaxation after succinylcholine administration, but there was no difficulty during endotracheal intubation.
Arrhythmias, Cardiac ; Bradycardia ; Fasciculation ; Gallamine Triethiodide* ; Humans ; Hyperkalemia ; Intraocular Pressure ; Intubation, Intratracheal ; Muscle Relaxation ; Myalgia ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium* ; Plasma ; Potassium ; Relaxation ; Research Personnel ; Succinylcholine ; Tubocurarine* ; Vocal Cords