While Joint Commission on Accreditation of Healthcare Organizations(JCAHO) and American College of Surgeon(ACS) have identified certain audit filters in trauma care, there are few studies to substantiate the value of these audit filters. Some researchers found that audit filters qualifiers were significantly associated with adverse outcomes, however, others were unable to reproduce such association. It is also necessary to test their validity and applicability in Korea. The purpose of this present study was to validate two trauma audit filters proposed by the JCAHO and the ACS, through the analysis of the relationship between timeliness of operation and risk-adjusted mortality. Among trauma audit filters, timeliness of operation in epidural or subdural hematoma(EDH/SDH) and intraabdominal injury were selected. By stratified random cluster sampling, 19 emergency medical centers (EMCs) were selected from 30 EMCs and all patients who received craniotomy or laparotomy in 1996 were evaluated in each hospital. Six medical records administrators reviewed medical records of 463 patients with EDH/SDH and of 508 patients with intraabdominal injury retrospectively. In other to adjust risk of mortality, timeliness of operation, age, Revised Trauma Score(RTS), ICD-9CM based ICISS, and experiences of transfer were included in logistic regression model. In the logistic regression models of all EDH/SDH or intraabdominal injury patients, timeliness of operation was not significant predictor of mortality. However, if patients who have been operated later than 12 hours were excluded from the statistical model, timeliness of operation showed significant or marginally significant relationship with mortality in the following situations; craniotomy > 4 hours in EDH(OR=30.46, p=0.032), craniotomy > 8 hours in SDH(OR=6.50, p=0.020), laparotomy > 2 hours in shock patients(OR=9.26, p=0.055). In addition to timeliness of operation, RTS and ICISS were significant variables in every logistic regression model, and experience of transfer and types of EMC were significant or marginally significant only in EDH. Timeliness of operation as audit filters for trauma care could not be applied to all cases. Early operations seem to improve clinical outcome only in the patients for whom emergent craniotomy or laparotomy were indicated. It could be interpreted as a phenomenon of 'confounding by indication'. Additional studies to establish more objective eligibility criteria for these audit filiters are needed.
Accreditation ; Administrative Personnel ; Craniotomy ; Delivery of Health Care ; Emergencies ; Humans ; Joint Commission on Accreditation of Healthcare Organizations ; Joints ; Korea ; Laparotomy ; Logistic Models ; Medical Records ; Models, Statistical ; Mortality ; Retrospective Studies ; Shock

Sole prints were analyzed from one thousand normal volunteers (500 males and 500 females) to establish dermatoglyphics of Korean people, and the following resuIts were obtained: The triradius P was present in 49.1% of the right soles and 40.6% of the lefts, or 44.9% of the entire series. The fibular radiant of triradius P was directed into the fourth interdigital intervals in 54.9% of the soles, and the next common terrninations were in the digital triradius c 15.3%, the third interdigital interval, 12. 5% and distal portion of the fibular border, 9.4%. In right soles the tendeney was for the radiant to extent farther tibialward than in lefts, where the inverse tendency was reflected in sharp rise in the number of endings on the fibular borders and decrease of endings tibialward. The distal radiant of triradius P terminated in the first interdigital interval, 46.5%, the interdigital triradius a, 32. 5%, and the second interdigital interval,. 20.5%, and rarely the distal radiant fused with digital triradius, 0.6% Of the alignments of ridges of the soles, 72.7;. of the soles exhibited transvcrsely coursing ridges in the mid-region, and the remainder were slight fibuloproximal slants,Grade 2) 18.2%, and slight fibulodistal slants (Grade 4) 8, 7%. There was a tendency of right soles to favor the fibulo-proximal slant, and of lefts, the fibulo-distal sIant. In the calcar region 44.1% of the soles presented a slight fibulo-distal slant, and the next cmmon direction was transverse, 37.4% Right soles tended more to the transverse alignment, while lefts displayed a ... (continue)
Dermatoglyphics ; Healthy Volunteers ; Humans ; Male

PURPOSE: The purpose of this study was to evaluate the factors that affected self efficacy, social support and learning achievement in the web-based learning of graduate school students. METHODS: The data were collected from 79 nurses in a web-based learning. A self-reported questionnaire was used to assess the level of self-efficacy, social support and learning achievement. RESULTS: The learning achievement was significantly improved to 4.05 points after web-based learning compared to 2.69 points before web-based learning, and all other items were also improved. Self-efficacy was improved to 3.91 points from 3.66 points after web-based learning and so was social support to 4.18 points from 3.94 points. Fatigue and stress among health behavior characteristics were significantly decreased after web-based learning. CONCLUSION: This study shows that the web-based learning improved self-efficacy and social support of the students. And self-efficacy was an important factor in learning achievement. It is necessary to develop a strategy to improve self-efficacy as well as to manage social support for increasing interactions among the nurses in a web-based learning.
Achievement ; Fatigue ; Health Behavior ; Humans ; Learning ; Surveys and Questionnaires ; Self Efficacy

Colonic sarcomatoid carcinomas are known to be extremely rare tumors, with only 22 cases reported either as sarcomatoid carcinomas or carcinosarcomas in the literature. The known characteristics are rapid growth, a high recurrence rate, and an extremely poor prognosis. Herein we report a case of a patient who had a sarcomatoid carcinoma of the sigmoid colon and died only 22 days after surgery due to rapid tumor growth.
Carcinosarcoma ; Colon ; Colon, Sigmoid ; Humans ; Prognosis ; Recurrence

We report a case of tuberculosis verrucosa cutis in a 33-year-old male patient who presented with mild itching verrucous plaque over the perineum. The Mantoux test revealed a positive reaction. The histophathologic picture consists of slight hyperkeratosis, irregular ac:anthosis overlying an inflammatory iafitrate in the dermis. Tuberculous granulomas with caseation necrosis were seen in the dermis. Tuber clebacillus was demonstrated. The patient was treated with Isoniazid, Rifampicin, and Pyrazine made for 6 months. To date, the skin lesions have markedly improved.
Adult ; Dermis ; Granuloma ; Humans ; Isoniazid ; Male ; Necrosis ; Perineum ; Pruritus ; Rifampin ; Skin ; Tuberculosis*

Metabolomics, a novel "omics" platform, is a powerful tool for the discovery of clinically useful biomarkers and biochemical processes to improve diagnosis and therapy. Through the use of advanced analytical technologies, metabolomics enables the assessment of comprehensive metabolic profiles that are affected by both genotype and environmental factors. Recently, attention has been focused on the concept of pharmacometabolomics, an emerging field that is derived from metabolomics. Pharmacometabolomics is focused on the use of individual metabolic signatures for the prediction and evaluation of drug efficacy and safety, eventually accelerating clinical pharmacology toward personalized drug therapy.
Biochemical Processes ; Biomarkers ; Diagnosis ; Drug Therapy ; Genotype ; Humans ; Precision Medicine ; Metabolome ; Metabolomics ; Pharmacology, Clinical

No abstract available.
Breast Implants* ; Breast*

Subretinal fluid drainage produces the indentation of the sclera by facilitating firm adhesion between the retina and either retinal pigment epithelium or Bruch's membrane and has the advantage that show the state of fundus and degree of indentation of sclera accurately during the operation. Becaulse it has complications such as choroidal bleeding, retinal incarceration, iatrogenic retinal break, choroidal detachment and loss of vitreous, it should be done carefully. The authors analyzed the clinical data of 128 cases(137 eyes) of retinal detachment surgery with subretinal fluid drainage at the Department of Ophthalmology, Pusan Paik Hospital, College of medicine, Inje University from May, 1988 to April, 1990. And the results were as follows: 1. The most common operative method of rhegmatogenous retinal detachment were explant buckling and encirclement with subretinal fluid drainage, and the success rate of first operation was 86.13% and the overall success rate of rhegmatogemous retinal detachment was 91.2% in 137 eyes of operation. 2. In 116 cases(92.8%) who were done subretinal fluid drainage, absorption of residual subretinal fluid took in a day. 3. The most common cause of surgical failure was proliferative vitreoretinopathy. 4. The most common complication was choroidal hemorrhage and it was developed 14 eyes(10.2%) mong 137 eyes. 5. The preoperative duration of symptom and extent of detachment were influenced to the surgical success rate and they had statistical significance(p<0.05). 6. The power of refraction was changed to myopia and ERG b-wave amplitude were increased and 89 eyes out of 137 eyes(69.6%) showed an improvement of vision at the three months after retinal detachment surgery.

The purposes of this study were: 1) to determine the normal range of CR-CO discrepancy in normal occlusion group: 2) to evaluate the changes of condylar position and craniofacial morphology between centric relation and centric occlusion before and after stabilization splint therapy in malocclusion group outside the normal range of CR-CO discrepancy. The normal occlusion group consisted of 80 subjects who had well-balanced faces and good occlusions with acceptable Class I molar relationship. They had not been treated orthodontic ally and had no signs or symptoms of temporomandibular joint dysfunction. 71 malocclusion patients enrolled for orthodontic treatment at the Department of Orthodontics, College of Dentistry, Chosun University comprised the malocclusion group, little variation of growth factor by the second molar eruption. They had CR-CO discrepancy beyond normal range and were subdivided into anterior-posteriorly -[25 Class I (0 or = 4), and 24 Class III (ANB < or = 0)]; vertically - [20 Normodivergentscy (30 or = 34), and 18 Hypodivergency (SNGoMe < or = 30)] ; and sexually - [26 Male and 45 Female]. For malocclusion group, stabilization splint with mutually protected type of occlusal scheme was applied for three months. Panadent articulators, Panadent condylar position indicator (CPl), and lateral headfilm were used to investigate the influence of stabilization splint on condylar position and craniofacial morphology. The results of this study were as follows: 1. The amounts of CR-CO discrepancy in normal occlusion were that the antero-posterior component (delta X) was 0.56 +/- 0.46mm (Male: 0.63 +/- 0.42rnm, Female: 0.49 +/- 0.50mm) ; the supero-inferior component (delta Y) was -0.75 +/- 0.48rnm (Male: -0.76 +/- 0.52rnm, Female: -0.73 +/- 0.43rnm) ; and the transverse component (delta Z) was -0.33 +/- 0.28mrn (Male: -0.38 +/- 0.29mm, Female: -0.31 +/- 0.27mm). 2. The condylar position was in normal range after stabilization splint therapy. 3. The mandible was always rotated infero-posteriorly after stabilization splint therapy. 4. Antero-posteriorly, Class III malocclusion responded very well to the stabilization splint therapy. 5. Vertically, Hyperdivergency responded very well to the stabilization splint therapy. 6. Sexually, Male responded very well to the stabilization splint therapy.
Centric Relation ; Dental Articulators ; Dentistry ; Female ; Humans ; Male ; Malocclusion ; Mandible ; Molar ; Orthodontics ; Reference Values ; Splints* ; Temporomandibular Joint

No abstract available.
Korea*