BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

OBJECTIVE: We investigated the usefulness of shortening of the fetal femur length (FL) and humeral length (HL) to predict Down syndrome at the middle gestation of pregnancy in Korean subjects. METHODS: This retrospective study involved 41 fetuses with Down syndrome and 328 fetuses with normal chromosome between 14+0 and 28+6 weeks of gestation. The expected FL and HL for any biparietal diameter (BPD) was calculated based on the control group data. The odds ratios for measure to expected FL and HL in comparison between normal fetuses and Down syndrome fetuses were calculated. The sensitivities of short FL and HL to predict Down syndrome were analyzed at a fixed false positive rate of 5%. RESULTS: The lengths of femur and humerus long bone for any BPD in Down syndrome group were significantly shorter than the lengths in control group (P<0.001). A low ratio of measured to expected FL and HL increased the risk of fetal Down syndrome (P<0.001). At a fixed false positive rate of 5%, the sensitivities were 21.3% (95% confidence interval [CI] 0.698~0.852, P<0.001) in FL and 29.9% (95% CI 0.773~0.914, P<0.001) in HL. CONCLUSION: Both of short FL and HL are poor marker for Down syndrome at the middle gestation of pregnancy in Korean population though the sensitivity of HL was higher than FL.
Down Syndrome ; Femur ; Fetus ; Humerus ; Odds Ratio ; Pregnancy ; Prenatal Diagnosis ; Retrospective Studies

The aim of this study was to examine the therapeutic potential of sulfasalazine and prednisolone in a mouse collagen antibody-induced arthritis (CAIA) model. Twenty-five male BALB/c mice were randomly divided into five groups: group 1 (G1): control, group 2 (G2): probe control, group 3 (G3): CAIA, group 4 (G4): CAIA+sulfasalazine (10 mg/kg, oral), and group 5 (G5): CAIA+prednisolone (100 mg/kg, oral). Fluorescence bioimaging was performed in vivo 24 and 48 h after treatment with a fluorescence probe (OsteoSense® 680 EX), and all mice were sacrificed. The hind knee joints were fixed in 10% neutral phosphate-buffered formalin, and micro-computed tomography (micro-CT) and histopathological analyses were performed. The paw thickness increased in a time-dependent manner in G3 mice, but trended toward a decrease in both G4 and G5 mice. Fluorescence intensity increased in G3 mice at 24 and 48 h after fluorescence probe treatment, but the fluorescence intensity in G4 and G5 mice was lower than that in G3. Micro-CT analyses showed that the joint surfaces of G3 mice had a rough and irregular articular appearance, but the occurrence of these irregularities was lower in G4 and G5. Hematoxylin and eosin and Safranin O-fast green staining confirmed that destruction of the cartilage and bony structures, synovial hyperplasia, and inflammatory cell infiltration all occurred in G3, and that the occurrence of these phenomena was lower in G4 and G5 than in G3. Taken together, these results suggest that sulfasalazine and prednisolone can reduce acute rheumatoid arthritis in mice.
Animals ; Arthritis* ; Arthritis, Rheumatoid ; Cartilage ; Collagen* ; Eosine Yellowish-(YS) ; Fluorescence ; Formaldehyde ; Hematoxylin ; Humans ; Hyperplasia ; Joints ; Knee Joint ; Male ; Mice* ; Prednisolone ; Sulfasalazine

OBJECTIVE: This study investigated the relationship between orthodontic treatment and temporomandibular disorders (TMD) in South Korean population. METHODS: This study obtained data from the 2012 Korean National Health and Nutrition Examination Survey. The final sample size was 5,567 participants who were ≥ 19 years of age. Logistic regression analysis was performed to evaluate the relationship between orthodontic treatment and TMD. RESULTS: Participants who underwent orthodontic treatment showed higher educational level, lower body mass index, reduced chewing difficulty, and reduced speaking difficulty. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) for orthodontic treatment and TMD were 1.614 (1.189–2.190), 1.573 (1.162–2.129) and 1.612 (1.182–2.196) after adjusting for age, sex and psychosocial factors. Adjusted ORs and their 95% CIs for orthodontic treatment and clicking were 1.778 (1.289–2.454), 1.742 (1.265–2.400) and 1.770 (1.280–2.449) after adjusting for confounding factors. However, temporomandibular joint pain and functional impairment was not associated with orthodontic treatment. CONCLUSIONS Temporomandibular joint pain and dysfunction was not associated with orthodontic treatment.

BACKGROUND: There is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population. METHODS: We analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy. RESULTS: We collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001). CONCLUSION: This study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians.
Biopsy ; Delivery of Health Care ; Female ; Humans ; Incidence ; Korea* ; Male ; Medical Records ; Prevalence*

BACKGROUND: Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation. METHODS: We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress. RESULTS: Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051). CONCLUSIONS: Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.
Bronchoscopy ; Colon ; Female ; Humans ; Intensive Care Units ; Length of Stay ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Tracheostomy

PURPOSE: The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease. MATERIALS AND METHODS: This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006. RESULTS: All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin, and ethambutol. Streptomycin was additionally given in 72 patients (75%) for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses, including failure to sputum conversion (n = 13), relapse (n = 3), and MAC-related death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response. CONCLUSION: Standardized combination antibiotic therapy consisting of clarithromycin, rifampicin, and ethambutol with or without initial use of streptomycin is effective in treating patients with newly diagnosed MAC lung disease.
Aged ; Anti-Bacterial Agents/*therapeutic use ; Clarithromycin/therapeutic use ; Drug Therapy, Combination/*methods ; Ethambutol/therapeutic use ; Female ; Humans ; Lung Diseases/*drug therapy/*microbiology ; Male ; Middle Aged ; Mycobacterium Infections/*drug therapy ; Mycobacterium avium/*metabolism ; Retrospective Studies ; Rifampin/therapeutic use ; Streptomycin/therapeutic use ; Treatment Outcome

Background: We evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) used to treat patients with chronic obstructive pulmonary disease (COPD). Methods: Databases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised data from 913 patients. Results: The mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting a statistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.95). Mortality rates were reduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acute exacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawal rates between the two groups (RR, 0.99; 95% CI, 0.72–1.36; p=0.94). Conclusion Maintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD, decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.

BACKGROUND: This study aimed to examine the underreporting rate and related factors after needlestick injuries among healthcare workers (HCWs) in small- or medium-sized hospitals. METHODS: Convenience sampling was conducted for 1,100 HCWs in 12 small- or medium-sized hospitals with less than 500 beds. From October 1 to November 30, 2010, data were collected using self-report questionnaire that was developed by researcher. The response rate for the study was 98.3% (982 HCWs). Data were analyzed using Statistical Package for the Social Sciences (SPSS) Win 12.0. RESULTS: The reports showed that 239 HCWs (24.3%) sustained needlestick injuries within the last year. The under-reporting rate after a needlestick injury was 67.4% (161/239), and underreporting rates varied across the hospitals and ranged from 46.2% to 85.7%. The major reasons for underreporting after needlestick injuries were the assumption that no blood-borne pathogens existed in the source patient (62.8%), annoyance (17.9%), and no knowledge about the reporting procedure (6.0%). Multiple logistic regression analysis showed that the suggestion by colleagues to report the injury, the number of needlestick injuries, and the needle type were independently related to the underreporting of needlestick injuries. CONCLUSION: The underreporting rate of needlestick injuries in small- or medium-sized hospitals was similar to that in large-sized hospitals, and this finding confirmed that the suggestion by colleagues to report the injury was the most significant factor influencing the injury-report rate. Thus, creating an environment that encourages HCWs to report injuries is considered the most important method to decrease the underreporting rate of needlestick injuries in small- and medium-sized hospitals.
Blood-Borne Pathogens ; Delivery of Health Care ; Humans ; Logistic Models ; Needles ; Needlestick Injuries ; Occupational Exposure ; Risk Management ; Social Sciences ; Surveys and Questionnaires

The purpose of this study was to verify the validity of the Patient Severity Classification Tool by examining the correlations between the APACHE III and the Patient Severity Classification Tool and to propose admission criteria to the ICU. The instruments used for this study were the APACHE III developed by Knaus and thePatient Severity Classification Tool developed by Korean Clinical Nurses Association. Data was collected from the 156 Medical ICU patients during their first 24 hours of admission at the Seoul National University Hospital by three trained Medical ICU nurses from April 20 to August 31 1999. Data were analyzed using the frequency, X2, Wilcoxon rank sum test, and Spearman rho. There was statistically significant correlations between the scores of the APACHE III and the Patient Severity Classification Tool. Mortality rate was increased as patients classification of severity in both the APACHE III and the Patient Severity Classification Tool scored higher. The Patient Severity Classification Tool was proved to be a valid and reliable tool, and a useful tool as one of the severity predicting factors, ICU admission criteria, information sharing between ICUs, quality evaluations of ICUs, and ICU nurse staffing. 1) This paper was awarded the first prize at the Seoul National Hospital Nursing Department Research Contest.
APACHE* ; Awards and Prizes ; Classification* ; Humans ; Information Dissemination ; Mortality ; Nursing ; Seoul