OBJECTIVES: To investigate the factors associated with the timeliness of electronic nursing documentation using the entry time on the Electronic Medical Record (EMR) system. METHODS: As a retrospective study, data were extracted from January 1 to February 28, 2014 from a hospital EMR system and a nurses’ personnel information system. The timeliness of instances of nursing documentation was categorized into ‘timely’ or ‘untimely’ according to whether the entry time was time-stamped within the working hours during each day, evening, or night shift. Factors associated with the timeliness of the electronic nursing documentation were included in the logistic regression models as nurse- and patient-associated factors. RESULTS: Among 1,700,247 instances of electronic nursing documentation, 79.3% (n = 1,347,711) were completed within the working hours. Years of nursing experience, nursing shift, days of the week, patients’ age, and medical department had a statistically significant associated with the timeliness of nursing records. Nurses with experience of more than 1 year entered nursing records over 2 times more during their working hours than did less experienced nurses. During the evening and night shifts, nurses were 1.49 times and 9.19 times more likely to enter nursing documents in a timely manner, respectively, as compared to those in the day shift. CONCLUSIONS: Nursing documentation was typically completed outside of working hours when a nurse had little experience, worked during the day shift or weekdays, and when tasks were unpredictable. This shows that new nurses need support to familiarize them with various tasks and the overall workflow.
Electronic Health Records ; Information Systems ; Logistic Models ; Nursing Informatics ; Nursing Process ; Nursing Records ; Nursing* ; Retrospective Studies

OBJECTIVES: Clinical documents (CDs) have evolved from traditional paper documents containing narrative text information into the electronic record sheets composed of itemized records, where each record is expressed as an item with a specific value. We defined medical record (MR) items to be information entities with a specific value. These entities were then used to compile form-based clinical documents as part of an electronic health record system (EHR-s). METHODS: We took a reusable bottom-up developmental approach for the MR items, which provided three things: efficient incorporation of the local needs and requirements of the medical professionals from various departments in the hospital, comprehensive inclusion of the essential concepts of the basic elements required in clinical documents, and the provision of a structured means for meaningful data entry and retrieval. This paper delineates our experiences in developing and managing medical records at a large tertiary university hospital in Korea. RESULTS: We collected 63,232 MR items from paper records scanned into 962 CDs. The MR item database was constructed using 13,287 MR items after removing redundant items. During the first year of service users requested changes to be made to 235 (1.8%) attributes of the MR items and also requested the additional 9,572 new MR items. In the second year, the attributes of 70 (0.5%) of the existing MR items were changed and 3,704 new items were added. The number of registered MR items increased by 72.0% in the first year and 27.9% in the second year. CONCLUSIONS: The MR item concept provides an easier and more structured means of data entry within an EHR-s. By using these MR items, various kinds of clinical documents can be easily constructed and allows for medical information to be reused and retrieved as data. The success of the use of MR items in a large tertiary university hospital system provides evidence that verifies our approach as being an efficient means of user-oriented and structured data entry, enabling the easy reuse of medical records.
Electronic Health Records ; Electronics ; Electrons ; Medical Records

Omija berry (Schisandra fructus) is a traditional Korean fruit, which contains lots of medicinal ingredients. In order to analyze whether Omija contains antibacterial components, we extracted Omija using five different methods including water precipitation, ethanol precipitation, hot water extract, methanol-ultrasonication, and water-ultrasonication, and examined their antimicrobial activities against Escherichia coli (E. coli), and Bacillus cereus (B. cereus). Most of Omija extracts did not inhibit bacteria growth in the paper disc diffusion assay except hot water extract for 60 minutes. Hot water extract for 60 minutes made clear inhibition zone around the disc at all the concentrations (x1, x1/10, x1/100) in both E. coli and B. cereus. However, hot water extracts for 90 minutes and 120 minutes showed antimicrobial activities only at x1 stock solution, which indicates that 60 minutes extraction at hot water is the best method to obtain Omija extract with the best antimicrobial activities in disc diffusion assay. In turbidimetric assay, water extract in soak, hot water extract, and methanol extract in ultrasonicator inhibited growth of both E. coli and B. cereus. Ethanol extract in soak and water extract in ultrasonicator had no effect on bacterial growth in both E. coli and B. cereus. In this study, we found that Omija extracts showed antimicrobial activities against E. coli and B. cereus. Therefore, water soluble materials of Omija can be used as a drink supplement and developed as an antibacterial cleanser.
Bacillus cereus* ; Bacillus* ; Bacteria ; Diffusion ; Escherichia coli ; Ethanol ; Fruit ; Methanol ; Methods ; Water

OBJECTIVES: This paper describes a mobile Electronic Medical Record (EMR) platform designed to manage and utilize the existing EMR and mobile application with optimized resources. METHODS: We structured the mEMR to reuse services of retrieval and storage in mobile app environments that have already proven to have no problem working with EMRs. A new mobile architecture-based mobile solution was developed in four steps: the construction of a server and its architecture; screen layout and storyboard making; screen user interface design and development; and a pilot test and step-by-step deployment. This mobile architecture consists of two parts, the server-side area and the client-side area. In the server-side area, it performs the roles of service management for EMR and documents and for information exchange. Furthermore, it performs menu allocation depending on user permission and automatic clinical document architecture document conversion. RESULTS: Currently, Severance Hospital operates an iOS-compatible mobile solution based on this mobile architecture and provides stable service without additional resources, dealing with dynamic changes of EMR templates. CONCLUSIONS: The proposed mobile solution should go hand in hand with the existing EMR system, and it can be a cost-effective solution if a quality EMR system is operated steadily with this solution. Thus, we expect this example to be shared with hospitals that currently plan to deploy mobile solutions.
Electronic Health Records* ; Hand ; Information Storage and Retrieval ; Mobile Applications

Purpose: Meconium aspiration syndrome (MAS) occurs when aspiration of meconium itself or meconium-stained amniotic fluid enters into the airways. The relationship between MAS and how they affect the respiratory outcome after recovery from MAS remains unknown. The purpose of this study was to determine the type of lower respiratory tract illness (LRTI) in those surviving MAS survivors and to find out whether any clinical findings or treatment determine the type of LRTI. Methods: We used the Catholic Medical Center’s clinical data warehouse to review data from 4 university hospitals. We first included 1,331 newborns born between March 2016 and February 2021 with diagnostic codes including labor and delivery complicated by fetal stress (distress), intrauterine hypoxia, and neonatal aspiration syndromes. We finally included 239 patients who visited the outpatient clinic with diagnosis of pneumonia, acute bronchitis, acute bronchiolitis, and asthma, according to the Korean Standard Classification of Diseases. Results: We observed a significantly higher number and fraction of eosinophils at birth in the bronchitis group. We also found significantly lower levels of white blood cells in the asthma group. After a regression analysis, we found that mechanical ventilation and steroid usage for treatment for of MAS was significantly related to bronchitis, and that antibiotics treatment acted as a protective factor for bronchiolitis. Conclusion Laboratory findings and treatment at birth in infants with MAS appear to have impact on determining LRTI in those who survived MAS.

We report the case of an infant with a 4q35.1 deletion with 10p duplication. This mutation is rarely reported in the literature and has been found to have variable clinical findings, often including developmental delay. In this case, the condition was detected by chromosomal microarray analysis after initial manifestation of a feeding problem and developmental delay. Minor dysmorphic features with abnormal neurological examination led to further evaluation. The father’s chromosome complement was 46, XY, t(4;10)(q35;p12.2). Parental balanced translocation can go unrecognized, because affected individuals are often phenotypically healthy until they have fertility issues such as recurrent miscarriages or children with severe congenital disorders. Genetic diagnoses help to establish a clear family genetic background that permits the development of clear treatment strategies. Prenatal counseling can also help to understand the possible risks associated with pregnancy or future child planning.

BACKGROUND: The aim of this study was to observe long-term outcomes of very low birth weight infants (VLBWIs) born between 2013 and 2014 in Korea, especially focusing on neurodevelopmental outcomes. METHODS: The data were collected from Korean Neonatal Network (KNN) registry from 43 and 54 participating units in 2013 and 2014, respectively. A standardized electronic case report form containing 30 items related to long-term follow up was used after data validation. RESULTS: Of 2,660 VLBWI, the mean gestational age and birth weight were 291/7 ± 26/7 weeks and 1,093 ± 268 g in 2013 and 292/7 ± 26/7 weeks and 1,125 ± 261 g in 2014, respectively. The post-discharge mortality rate was 1.2%–1.5%. Weight < 50th percentile was 46.5% in 2013 and 66.1% in 2014. The overall prevalence of cerebral palsy among the follow up infants was 6.2% in 2013 and 6.6% in 2014. The Bayley Scales of Infant Developmental Outcomes version II showed 14%–25% of infants had developmental delay and 3%–8% of infants in Bayley version III. For the Korean developmental screening test for infants and children, the area “Further evaluation needed” was 5%–12%. Blindness in both eyes was reported to be 0.2%–0.3%. For hearing impairment, 0.8%–1.9% showed bilateral hearing loss. Almost 50% were readmitted to hospital with respiratory illness as a leading cause. CONCLUSION: The overall prevalence of long-term outcomes was not largely different among the VLBWI born between 2013 and 2014. This study is the first large national data study of long-term outcomes.
Birth Weight ; Blindness ; Cerebral Palsy ; Child ; Child Development ; Follow-Up Studies ; Gestational Age ; Hearing Loss ; Hearing Loss, Bilateral ; Humans ; Incidence ; Infant* ; Infant, Very Low Birth Weight* ; Korea ; Mass Screening ; Mortality ; Prevalence ; Weights and Measures

Thirty seven species of Fusarium were evaluated for their ability of producing extracellular enzymes using chromogenic medium containing substrates such as starch, cellobiose, CM-cellulose, xylan, and pectin. Among the tested species Fusarium mesoamericanum, F. graminearum, F. asiaticum, and F. acuminatum showed high beta-glucosidase acitivity. Xylanase activity was strongly detected in F. proliferatum and F. oxysporum. Strong pectinase activity was also found in F. oxysporum and F. proliferatum. Amylase activity was apparent in F. oxysporum. No clear activity in cellulase was found from all the Fusarium species tested.
Amylases ; beta-Glucosidase ; Cellobiose ; Cellulase ; Fusarium* ; Polygalacturonase ; Starch

Objective: Bipolar disorder (BD) is complex genetic disorder. Therefore, approaches using clinical phenotypes such as biological rhythm disruption could be an alternative. In this study, we explored the relationship between melatonin pathway genes with circadian and seasonal rhythms of BD. Methods: We recruited clinically stable patients with BD (n=324). We measured the seasonal variation of mood and behavior (seasonality), and circadian preference, on a lifetime basis. We analyzed 34 variants in four genes (MTNR1a, MTNR1b, AANAT, ASMT) involved in the melatonin pathway. Results: Four variants were nominally associated with seasonality and circadian preference. After multiple test corrections, the rs116879618 in AANAT remained significantly associated with seasonality (corrected p=0.0151). When analyzing additional variants of AANAT through imputation, the rs117849139, rs77121614 and rs28936679 (corrected p=0.0086, 0.0154, and 0.0092) also showed a significant association with seasonality. Conclusion This is the first study reporting the relationship between variants of AANAT and seasonality in patients with BD. Since AANAT controls the level of melatonin production in accordance with light and darkness, this study suggests that melatonin may be involved in the pathogenesis of BD, which frequently shows a seasonality of behaviors and symptom manifestations.

Objective: Bipolar disorder (BD) is complex genetic disorder. Therefore, approaches using clinical phenotypes such as biological rhythm disruption could be an alternative. In this study, we explored the relationship between melatonin pathway genes with circadian and seasonal rhythms of BD. Methods: We recruited clinically stable patients with BD (n=324). We measured the seasonal variation of mood and behavior (seasonality), and circadian preference, on a lifetime basis. We analyzed 34 variants in four genes (MTNR1a, MTNR1b, AANAT, ASMT) involved in the melatonin pathway. Results: Four variants were nominally associated with seasonality and circadian preference. After multiple test corrections, the rs116879618 in AANAT remained significantly associated with seasonality (corrected p=0.0151). When analyzing additional variants of AANAT through imputation, the rs117849139, rs77121614 and rs28936679 (corrected p=0.0086, 0.0154, and 0.0092) also showed a significant association with seasonality. Conclusion This is the first study reporting the relationship between variants of AANAT and seasonality in patients with BD. Since AANAT controls the level of melatonin production in accordance with light and darkness, this study suggests that melatonin may be involved in the pathogenesis of BD, which frequently shows a seasonality of behaviors and symptom manifestations.