PURPOSE: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. METHODS: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. RESULTS: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p < 0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. CONCLUSION: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.
Alcoholics ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Health Policy ; Homeless Persons ; Hospitals, Public ; Humans ; Insurance ; Insurance, Health ; Length of Stay ; Mass Screening ; Medicaid ; Referral and Consultation ; Retrospective Studies

PURPOSE: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 µm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient's number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. RESULTS: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. CONCLUSION: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Humidity ; Korea ; Lung Diseases ; Meteorological Concepts ; Particulate Matter* ; Pulmonary Disease, Chronic Obstructive* ; Regression Analysis ; Retrospective Studies ; Seoul ; Sunlight

Here we report a single-stage operation we performed on a patient with a large schwannoma that extended from the lower clivus to the cervico-thoracic junction caudally. A number of authors have previously performed multilevel laminectomy to remove giant schwannomas that extend for considerable length. This technique has caused cervical instability such as kyphosis or gooseneck deformity on several occasions. We removed the tumor with a left lateral suboccipital craniectomy with laminectomy only at C1 and without any subsequent surgery-related neurologic deficits. However, this technique requires meticulous preoperative evaluation on existence of Cerebrospinal fluid (CSF) cleft between the tumor and spinal cord on magnetic resonance imaging, of tumor origin located at the upper cervical root, and of detachment of tumor from the origin site.
Cerebrospinal Fluid ; Congenital Abnormalities ; Cranial Fossa, Posterior ; Humans ; Kyphosis ; Laminectomy* ; Laminoplasty ; Magnetic Resonance Imaging ; Neurilemmoma* ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Neoplasms

We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
Arteries ; Constriction, Pathologic* ; Head and Neck Neoplasms ; Hepatic Artery ; Humans ; Ligaments ; Pancreaticoduodenectomy* ; Stents

We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
Arteries ; Constriction, Pathologic* ; Head and Neck Neoplasms ; Hepatic Artery ; Humans ; Ligaments ; Pancreaticoduodenectomy* ; Stents

Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience.
Adult ; Aged ; Dura Mater/pathology ; Female ; Humans ; Male ; Meningeal Neoplasms/pathology/*surgery ; Meningioma/pathology/*surgery ; Middle Aged

PURPOSE: The purpose of this study was to identify the learning style, learning efficacy, transfer of learning, and confidence in performance competence of Core Basic Nursing Skills (CBNS) and factors influencing confidence in performance competence of CBNS by nursing students. METHODS: A descriptive study design was used. Participants were 148 nursing students. Data were analyzed using SPSS 20.0 for descriptive statistics, ANCOVA, correlation and regression. RESULTS: Learning styles of the participants were assimilator 33.11%, accommodator 26.35%, diverger 23.65%, and converger 16.89%. Learning efficacy was significantly different according to learning styles, however, transfer of learning and confidence in performance competence of CBNS were not significantly different according to learning styles. Confidence in performance competence of CBNS positively correlated with transfer of learning and learning efficacy. Transfer of learning was a significant predictor of confidence in performance competence of CBNS. CONCLUSION: The findings of this study indicate that transfer of learning influences confidence in performance competence of CBNS. Thus, nursing faculty should develop educational strategies to enhance and improve transfer of learning, and development of effective confidence in performance competence of CBNS programs.
Clinical Competence ; Faculty, Nursing ; Humans ; Learning ; Mental Competency* ; Nursing* ; Students, Nursing* ; Transfer (Psychology)

PURPOSE: There was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B). METHODS: A prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients. RESULTS: There was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1. CONCLUSION: Establishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.
Child ; Drug Resistance ; Hemagglutinins ; Hospitalization ; Humans ; Influenza, Human ; Inhibitory Concentration 50 ; Neuraminidase ; Orthomyxoviridae ; Oseltamivir ; Prevalence ; Prospective Studies ; Respiratory System ; Seasons ; Viruses ; Zanamivir

Pyogenic granuloma is a benign inflammatory vascular lesion, mainly found in the skin and oral mucosa. A few cases of pyogenic granuloma in the gastrointestinal tract have been reported, and the esophagus was the main site in these cases. These patients were diagnosed with pyogenic granuloma after they underwent upper endoscopy and biopsy. Endoscopic resection is a favorable treatment option for esophageal pyogenic granuloma. Recently, we observed characteristic endosonographic findings in two cases with esophageal pyogenic granuloma, which were then treated successfully by endoscopic resection.
Biopsy ; Endoscopy ; Endosonography ; Esophagus ; Gastrointestinal Tract ; Granuloma, Pyogenic ; Humans ; Mouth Mucosa ; Skin

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.
Adrenal Gland Neoplasms ; Adrenalectomy ; Adrenocortical Adenoma ; Cushing Syndrome ; Dexamethasone ; Epinephrine ; Fatigue ; Female ; Headache ; Humans ; Hydrocortisone ; Korea ; Lymphoma ; Middle Aged ; Norepinephrine ; Pheochromocytoma ; Weight Gain