No abstract available.
De Lange Syndrome*

No abstract available.
Aged, 80 and over* ; Humans ; Transurethral Resection of Prostate*

BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

BACKGROUND: Desmopressin acetate (DDAVP) may improve hemostasis in congenital or acquired disorders of coagulation and reduce operative blood loss in patients undergoing surgical procedures. The effects of DDAVP on coagulation in hemorrhagic shock were studied in rabbits subjected to severe hemorrhage. METHODS: 20 rabbits were bled to shock and infused lactated Ringer's solution simultaneously so that the mean arterial pressure were maintained above 50 mmHg. Animals were randomly received DDAVP 0.3 ug/kg (group Dl), 3 ug/kg (group D10) or saline (group S) over 15 minutes. Bleeding time and factor VIII coagulant activity (FVIII:C) were measured before, after shock and 45 minutes after DDAVP or saline infusion. RESULTS: After shock, bleeding time was not changed but FVIII:C was decreased significantly in all groups. After saline or DDAVP infusion, bleeding time was not changed in group S and group Dl, whereas shortened in group D10 from 107.5+/-11.3 second to 87.5+/-17.5 second (P<0.05). After saline or DDAVP infusion, FVIII:C was decreased in group S and group Dl (P<0.05), but not changed in group D10. CONCLUSIONS: Infusion of DDAVP 3 ug/kg shortens bleeding time and causes an increase of FVIII:C than other groups in rabbits resuscitated from hemorrhagic shock.
Animals ; Arterial Pressure ; Bleeding Time ; Deamino Arginine Vasopressin* ; Factor VIII ; Hemorrhage ; Hemostasis ; Humans ; Pharmacology ; Rabbits* ; Shock ; Shock, Hemorrhagic*

No abstract available.
Anemia, Hemolytic* ; Humans ; Infant, Newborn ; Infant, Premature* ; Vitamin E* ; Vitamins*

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

No abstract available.
Mediastinal Emphysema*

PURPOSE: The purpose of this study was to identify effects of 'mental illness education using movies' on the perceptions and attitudes toward mental illness held by middle and high school teachers. METHODS: The participants were 66 middle and high school teachers, 33 in the experimental group and 33 in the control group. The 'mental illness education using movies' was given to the experimental group twice a week for two weeks. The perceptions and attitudes toward mental illness were measured using the Knowledge and Attitude toward Mental Illness Questionnaire developed by Park, Paik, and Kwack (1995). RESULTS: After the mental illness education, there was a significant difference between the experiment and control group for psychological and environmental concepts toward mental illness (t=7.10, p<.001). CONCLUSION: 'Mental illness education using movies' has limited effects on the perceptions and attitudes of middle and high school teachers toward mental illness. The results of this study indicate that further research is needed with a revised contents of 'the mental illness education using movies' if perceptions and attitudes are to be changed.
Education* ; Humans ; Mental Health ; Surveys and Questionnaires

No abstract available.
De Lange Syndrome*

Suicide notes are essential for investigating the psychological state of suicide victims and establishing suicide prevention programs. Since only a few studies have attempted to identify the causes of suicidal behavior through suicide notes, it would be worth examining suicide notes. Quantitative research on suicide has offered a limited understanding of suicide. Results showed that the suicide victims had used the suicide note as a tool for their last communication. Further, in addition to neutral contents such as directions for funeral, the note often contained information about precipitating events that caused the suicidal ideation. Writing a suicide note seemed to help the victims consider concrete plans for suicide. This study proved that qualitative research on suicide notes would be helpful for researchers to understand suicide victims in depth, which cannot be achieved by quantitative methods alone. Based on these results, several suggestions for suicide prevention programs were discussed.
Qualitative Research ; Suicidal Ideation ; Suicide* ; Writing