Background: Pharmacists communicate with a variety of healthcare experts to prevent medication errors. Situation-BackgroundAssessment-Recommendation (SBAR) is a tool used for concise and accurate communication. In 2018, we developed the pharmacy-SBAR (P-SBAR) to deliver pharmacists intervention more quickly and effectively through quality improvement activities. Objectives: This study evaluates the efficacy of P-SBAR on pharmacists’ intervention activities before and after the implementation of P-SBAR applications. We assessed the impact of P-SBAR on reducing the burden of intervention work, promoting pharmacists’ participation, and enhancing the acceptance rate. Methods: This is a retrospective study of the two groups before and after P-SBAR implementation. All pharmacists’ intervention records during two periods (2016-2017 and 2019-2020) were extracted from the data warehouse system at Kyunghee University Hospital at Gangdong, Seoul. The outcome was the number of inpatients and pharmacists who participated in the prescription monitoring activity, the number of interventions, and the physicians’ acceptance rate. Results: Although the total number of inpatients decreased (364,753 vs. 348,229), the number of pharmacists who participated in intervention activity increased (monthly mean: 15.8 vs. 18.0, p=0.001). The total number of interventions (2,767 vs. 4,389), the frequency of full acceptance (2,018 vs. 3,710), and the monthly acceptance rate increased significantly (73.8% vs. 83.8%, p<0.001). Conclusion P-SBAR improved accessibility and convenience by digitalizing the intervention activities performed in an offline environment. Improvement in work burden and acceptance rate using P-SBAR is expected to contribute toward reducing medication errors.

PURPOSE: Data are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study. METHODS: We enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed. RESULTS: The prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74). CONCLUSIONS: Moderate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.
Allergens ; Analgesics ; Animals ; Antipyretics ; Asian Continental Ancestry Group ; Asthma ; Bronchial Hyperreactivity ; Cats ; Child ; Classification ; Cohort Studies ; Comorbidity ; Dermatophagoides pteronyssinus ; Disease Management ; Humans ; Methacholine Chloride ; Odds Ratio ; Ownership ; Parturition ; Phenotype ; Prevalence ; Rhinitis, Allergic ; Risk Factors ; Skin

OBJECTIVE: To investigate whether computed tomography (CT) and fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) may be applied to distinguish thymic epithelial tumors (TETs) from benign cysts in the anterior mediastinum. MATERIALS AND METHODS: We included 262 consecutive patients with pathologically proven TETs and benign cysts 5 cm or smaller who underwent preoperative CT scans. In addition to conventional morphological and ancillary CT findings, the relationship between the lesion and the adjacent mediastinal pleura was evaluated qualitatively and quantitatively. Mean lesion attenuation was measured on CT images. The maximum standardized uptake value (SUVmax) was obtained with FDG-PET scans in 40 patients. CT predictors for TETs were identified with multivariate logistic regression analysis. For validation, we assessed the diagnostic accuracy and inter-observer agreement between four radiologists in a size-matched set of 24 cysts and 24 TETs using a receiver operating characteristic curve before and after being informed of the study findings. RESULTS: The multivariate analysis showed that post-contrast attenuation of 60 Hounsfield unit or higher (odds ratio [OR], 12.734; 95% confidence interval [CI], 2.506–64.705; p = 0.002) and the presence of protrusion from the mediastinal pleura (OR, 9.855; 95% CI, 1.749–55.535; p = 0.009) were the strongest CT predictors for TETs. SUVmax was significantly higher in TETs than in cysts (5.3 ± 2.4 vs. 1.1 ± 0.3; p < 0.001). After being informed of the study findings, the readers' area under the curve improved from 0.872–0.955 to 0.949–0.999 (p = 0.066–0.149). Inter-observer kappa values for protrusion were 0.630–0.941. CONCLUSION: Post-contrast CT attenuation, protrusion from the mediastinal pleura, and SUVmax were useful imaging features for distinguishing TETs from cysts in the anterior mediastinum.
Humans ; Logistic Models ; Mediastinum ; Multivariate Analysis ; Pleura ; Positron-Emission Tomography ; ROC Curve ; Thymus Neoplasms ; Tomography, X-Ray Computed

High-pressure (HP) injection injury to the upper extremity often causes a very serious clinical problem, leading to poor outcomes, including amputation, so that a true surgical emergency is required. The outcomes can be improved with emergent wide surgical debridement. However the diagnosis of these injuries is often delayed due to underestimated evaluation at first appearance and lack of common knowledge of the seriousness of this injury. The type and pressure of the infecting material is an important factor in prognosis and organic solvents infected pressure injury can cause poor outcome and increased amputation rate. In this case, we report on reconstruction of HP oilbased paint injection injuries of the finger using T-shaped pedicles and multiple venous anastomoses. In this concept, arterial flow can be maintained by the reverse flow of distal anastomosis when there is difficulty with the proximal anastomosis. And venous flow can be preserved by deep and superficial vein anastomosis. This concept has various advantages including preserving patency of the pedicle in chronic vasculopathy or trauma cases and maintaining the arterial flow by the reverse flow of distal anastomosis and can improve the free flap survival by a two vascular anastomosis system.
Amputation ; Debridement ; Diagnosis ; Emergencies ; Fingers* ; Free Tissue Flaps* ; Paint* ; Prognosis ; Solvents ; Upper Extremity ; Veins

Aerococcus viridans is a rare pathogen in humans, with only six cases of A. viridans urinary tract infections reported worldwide. Nosocomial urinary tract infections with bacteremia caused by A. viridians are even rarer, with no prior reports of urosepsis caused by A. viridans occurring in the Republic of Korea. Here we report a case of urosepsis caused by A. viridans in a 79 year-old female nursing home resident. The patient was admitted to the hospital presenting a fever of 39degrees C, chills, and oliguria for two days prior to admission. Urine culture yielded a robust growth of 105 CFU/mL of A. viridians, with blood culture positive for the same organism. Following diagnosis, the patient was treated with ciprofloxacin intravenously for 2 weeks, resulting in clearance of the infection and a full recovery from urosepsis. Although A. viridans is rarely associated with human infections, this case shows that, under the right conditions, it can be responsible for severe infections like urosepsis.
Aerococcus* ; Bacteremia ; Chills ; Ciprofloxacin ; Diagnosis ; Female ; Fever ; Humans ; Nursing Homes ; Oliguria ; Republic of Korea ; Urinary Tract Infections

Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.
Adult ; Biopsy, Fine-Needle ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Leg ; Male ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Positron-Emission Tomography ; Technetium Tc 99m Sestamibi ; Thyroid Gland

BACKGROUND: Use of universal leukoreduction for prevention of leukocyte associated transfusion reactions is common practice in many countries. This study was conducted in order to evaluate the performance of a newly developed leukoreduction filter for red blood cells (RBCs), the RF300 (Kolon Industries, Inc, Gumi, Korea). METHODS: Filtration time, RBC recovery, residual leukocyte count, and leukocyte removal rate were evaluated. To assess the quality of RBCs after filtration, percent hemolysis was monitored for a period of 21 days. Performance of the RF300 (N=78) was compared with that of the Bio-R O2 plus (Fresenius, Hamburg, Germany), the Pall Purecell RC (Pall Co., Washington, USA), and the Sepacell R-500N (Asahi, Tokyo, Japan). RESULTS: The shortest filtration time was observed using the RF300 (P<0.05). Using the RF300, recovery of RBC was 96.5%, which was higher than that of two filters (P<0.05). Mean residual leukocyte count was 0.26x10(6)/unit, with a leukocyte removal rate of 3 log. Using the RF300, mean percent hemolysis was 0.32% at day 21, which was comparable with that of two filters, but lower than that of one filter (P<0.05). CONCLUSION: The RF300 meets all established quality requirements for conduct of safe and effective leukoreduction of RBCs.
Blood Group Incompatibility ; Collodion ; Erythrocytes ; Filtration ; Hemolysis ; Leukocyte Count ; Leukocytes ; Tokyo ; Washington

PURPOSE: Compression of the ulnar nerve in the ulnar tunnel is a relatively uncommon condition. Many authors have described several etiologies of ulnar nerve compression. We experienced two cases of ulnar nerve compression in the ulnar tunnel due to an anomalous pulsatile S-shaped ulnar artery. METHODS: Case 1: A 51-year-old man was referred with numbness and paroxysmal tingling sensation along the volar side of the ring and little fingers of his right hand for 6 months. When exploration, the ulnar artery was pulsatile S-shaped and was impinging on the ulnar nerve. To decompress the ulnar nerve, the tortuous ulnar artery was mobilized and translocated radially onto the adjacent fibrous tissue. Case 2: A 41-year-old man was referred with tingling sensation on the 4th, 5th finger of the right hand for 4 months. Sensory nerve conduction velocities of the ulnar nerve was delayed. Preoperative 3D angio CT scan showed an anomalous S-shaped ulnar artery. Same operation was done. RESULTS: The postoperative course was uneventful. After decompression, paroxysmal tingling sensation decreased to less than 1 minute per episode, occurring 1 or 2 times a day. After 4 months, they had no more episodes of numbness and tingling sensation. Examination demonstrated good sensation to pinprick and touch on the ulnar aspect of the hand. CONCLUSION: We report two cases of ulnar nerve compressive neuropathy that was caused by an anomalous pulsatile S-shaped ulnar artery in the ulnar tunnel. Although this is an unusual cause of ulnar nerve compression, the symptoms will not spontaneously resolve. The prompt relief of compressive neuropathic symptoms following the translocation of the impinging ulnar artery from the affected ulnar nerve onto adjacent tissue proved that the ulnar nerve compression is due to the anomalous vessel.
Adult ; Decompression ; Fingers ; Hand ; Humans ; Hypesthesia ; Middle Aged ; Neural Conduction ; Sensation ; Ulnar Artery ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes

PURPOSE: Various types of flaps, with their own advantages and disadvantages, have been described for reconstruction of soft tissue defect with exposure of tendons, bones, or joints in the hand or foot. Local flaps with random vascularity have a limitation by their length. Free flaps are time-consuming procedure that may require the sacrifice of some major vessels. The ideal flap for covering soft tissue defects of the hand or foot must provide subcutaneous tissue that tendons can glide through which, supply enough subcutaneous tissue for cover of vital neural, bony, vascular and joint structures, and it has to be aesthetically pleasing. The adipofascial flap fulfills these criteria. It allows immediate or early closure of difficult wound of hand and foot in an easy way, and is especially indicated for small to medium-sized defects. METHODS: From October 2005 to December 2006, seven cases underwent this procedure to reconstruct soft tissue defect on hand or foot. RESULTS: All flaps survived completely, and no complications were observed. CONCLUSION: The adipofascial flap is a convenient flap for coverage of soft tissue with exposure of vital structure in the hand or foot, and provide several advantages, as following; easy and safe, short operating time, one stage procedure, thinness and good pliability of the flap, preservation of the major vascular pedicles, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar.
Cicatrix ; Extremities ; Foot* ; Free Tissue Flaps ; Hand* ; Humans ; Joints ; Pliability ; Skin ; Subcutaneous Tissue ; Tendons ; Thinness ; Tissue Donors ; Wounds and Injuries

We examined the effect of class II transactivator (CIITA) down-modulation on allograft rejection. To inhibit the function of CIITA, we constructed a series of CIITA mutants and found one exhibiting the dominant-negative effect on the regulation of major histocompatibility complex (MHC) class II expression. To test whether the CIITA dominant-negative mutant reduces immunogenecity, CIITA-transfected melanoma cells were injected into allogeneic host and assessed for immune evading activity against host immune cells. We demonstrated that the CIITA dominant-negative mutant allowed tumor nodules to develop earlier in the lung than control by this tumor challenge study. Furthermore, skin grafts deficient for CIITA also survived longer than wild-type in allogeneic hosts. Both the tumor challenge and skin graft studies suggest the inhibition of CIITA molecules in donor tissue would be beneficial to the control of allo-response.
Transplantation, Homologous ; Transfection ; Trans-Activators/genetics/*immunology/metabolism ; Trans-Activation (Genetics)/genetics/immunology ; Skin Transplantation ; Nuclear Proteins/genetics/*immunology/metabolism ; Mutation ; Mice, Transgenic ; Mice, Knockout ; Mice, Inbred C57BL ; Mice, Inbred BALB C ; Mice ; Melanoma, Experimental/genetics/immunology/pathology ; Male ; Interferon Type II/pharmacology ; Humans ; Histocompatibility Antigens Class II/genetics/*immunology/metabolism ; Graft Survival/genetics/immunology ; Graft Rejection/genetics/*immunology ; Genes, MHC Class II/genetics/immunology ; Flow Cytometry ; DNA, Complementary/genetics ; Cell Proliferation/drug effects ; Cell Line, Tumor ; Animals