PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

BACKGROUND: The occurrence of cutaneous malignant tumors has been increasing worldwide due to changes in various environmental factors. OBJECTIVE: Our study aimed to analyze the overall tendency of clinical characteristics in single-center patients with cutaneous malignant tumors according to sex, age, duration, size, anatomic site, treatment, and concomitant diseases. METHODS: We retrospectively reviewed the medical records and clinical photographs of 319 patients diagnosed with cutaneous malignant tumors (basal cell carcinoma, squamous cell carcinoma, melanoma, lymphoma, Paget's disease, metastatic skin cancer, mycosis fungoides, angiosarcoma, dermatofibrosarcoma protuberans, Kaposi sarcoma, malignant fibrous histiocytoma, Merkel cell carcinoma) and 109 patients diagnosed with premalignant tumors (Bowen's disease) between January 2007 and January 2017. RESULTS: The average annual incidence of malignant cutaneous tumors was 2.4%. In total, 158 males (36.9%) and 270 females (63.1%) were included with a mean age of onset of 66 years. Among the malignant tumors, basal cell carcinoma (30.8%) was the most common, while the incidences of squamous cell carcinoma (18.9%), melanoma (6.3%), and lymphoma (4.4%) were also high. The predominantly involved anatomic sites were the face (67.3%), trunk (11.5%), and legs (10.9%). Most cases involved solitarily existing tumors (77.3%), and pruritus (21.7%) was the most common accompanying symptom. Among the 69.6% of patients who received treatment for their tumors, the most common method was surgical removal. No significant increase in concomitant diseases or environmental factors was detected. CONCLUSION: Our study is meaningful as an overall and recent review of various types of cutaneous malignancies that provides preliminary data for further large-scale nationwide studies.
Age of Onset ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Chungcheongnam-do ; Dermatofibrosarcoma ; Female ; Hemangiosarcoma ; Histiocytoma, Malignant Fibrous ; Humans ; Incidence ; Leg ; Lymphoma ; Male ; Medical Records ; Melanoma ; Methods ; Mycosis Fungoides ; Pruritus ; Retrospective Studies ; Sarcoma, Kaposi ; Skin Neoplasms ; Statistics as Topic

BACKGROUND AND OBJECTIVES: In clinical settings, some deep neck infections may be managed by conservative treatment but some still require surgical treatment. In this study, we use univariate and multivariate analysis to discuss whether or not there are significant differences between conservative treatment and surgical treatment on patients with deep neck infections. SUBJECTS AND METHOD: We conducted a retrospective analysis using medical records of 88 patients with deep neck infections from January 2010 to December 2015. Among 88 patients, 56 patients were managed by conservative treatment with antibiotics and 32 patients were managed by surgical treatment via transcervical approach with antibiotics. As for data analysis, Mann-Whitney U test and multiple logistic regression analysis was used. RESULTS: Age, duration from symptom onset to hospitalization, hospital days, incidence of underlying disease, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were found higher in the surgical treatment group than in the conservative treatment group. But there was no statistical significance except for the incidence of high blood pressure and CRP. CONCLUSION: CRP and incidence of high blood pressure were significant predictive factors for choosing the surgical treatment in deep neck infection. Contrary to our expectations, the incidence of diabetes mellitus was not a significant factor that determined the treatment options for the patients with deep neck infection.
Anti-Bacterial Agents ; Blood Sedimentation ; C-Reactive Protein* ; Cohort Studies* ; Diabetes Mellitus ; Hospitalization ; Humans ; Hypertension* ; Incidence ; Leukocyte Count ; Logistic Models ; Medical Records ; Methods ; Multivariate Analysis ; Neck* ; Regression Analysis ; Retrospective Studies* ; Statistics as Topic

OBJECTIVES: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana. MATERIALS AND METHODS: A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance. RESULTS: Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions. CONCLUSION: From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.
Acquired Immunodeficiency Syndrome ; Candidiasis, Oral ; CD4 Lymphocyte Count* ; Cell Count ; Classification ; Cross-Sectional Studies ; Diagnosis ; European Union ; Female ; Ghana* ; Gingivitis ; HIV ; Hospitals, Teaching ; Humans ; Hyperpigmentation ; Immune System ; Immunosuppression ; Leukoplakia, Hairy ; Male ; Medical Records ; Opportunistic Infections ; Oral Manifestations* ; Periodontitis ; Prospective Studies ; Statistics as Topic ; Xerostomia

OBJECTIVETo analyze the change in postoperative complication rate after gastric cancer surgery registered in the Peking University Cancer Hospital in recent 11 years and the learning curve of complication registration, and to investigate how to improve the complication registration and evaluation in gastric cancer surgery.

METHODSPatients who underwent open or laparoscopic gastric cancer surgery between April 14, 2005 and February 15, 2016 in our institution were included in the study, and those without essential clinical and administrative data were excluded. Data were biennially collected, and linear regression was performed to investigate the changes of the following parameters, including overall complication rate, severe complication proportion (proportion of complications with Clavien-Dindo score ≥III(a in the total registered complications), re-operation rate and the major complication rate.

RESULTSA total of 5 666 patients were included in the analysis, with 4 111 males (72.56%) and 1 555 females (27.44%). The average age was (58.87±11.50) years and average BMI was(23.15±3.30) kg/m. There were 305 patients included in the 2005-2006 interval, 810 patients in 2007-2008, 957 patients in 2009-2010, 1 163 patients in 2011-2012, 1 421 patients in 2013-2014, and 1 010 patients in 2015-2016, respectively. The overall re-operation rate was 2.34%(133/5 666), postoperative mortality was 0.41%(23/5 666), registered complication rate was 19.66%(1 114/5 666), severe complication proportion was 32.28%(338/1 047), and the proportion of complication missing the Clavien-Dindo score was 6.01%(67/1 114). The linear regression showed the re-operation rate (r=0.13, P=0.801) and postoperative mortality (r=0.58, P=0.231) remained low (< 4% and < 1% respectively) since 2005, and showed no statistical significance. The registered complication rate showed evident increase from 3.93%(12/305) to 29.13%(414/1 421) between 2005 and 2014 (r=0.92, P=0.010), and slight decrease to 22.77%(230/1 010) in 2015-2016. The severe complication proportion significantly decreased from 6/9 in 2005-2006 to 22.73%(50/220) in 2015-2016 (r=0.90, P=0.014). The proportion of complication missing the Clavien-Dindo score significantly decreased from 25.00%(3/12) in 2005-2006 to 4.35%(10/230) in 2015-2016(r=0.82, P=0.044). The most common complications were infection (9.12%, 517 cases), effusions (6.26%, 355 patients), gastrointestinal motility disorder (4.45%, 252 cases), anastomotic leakage (3.19%, 181 cases) and bleeding (2.31%, 131 cases). The registered rates of these complications all increased since 2005, and the rates of leakage and effusions decreased since 2012 while the others decreased after 2014.

CONCLUSIONSAccording to the data from our institution in the recent 11 years, a learning curve exists in our institution for complication registration in gastric cancer surgery. The administrative data appears to be more reliable than registered complication data in quality and safety evaluation during the learning period. A detailed classification with the Clavien-Dindo score aids to the use of complication data for the quality and safety measurement.

Aged ; Anastomotic Leak ; etiology ; Data Collection ; methods ; statistics & numerical data ; Female ; Gastrectomy ; adverse effects ; mortality ; Humans ; Laparoscopy ; adverse effects ; Male ; Medical Records ; statistics & numerical data ; Middle Aged ; Postoperative Complications ; epidemiology ; Registries ; statistics & numerical data ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery

OBJECTIVES: The purpose of this study was to identify the differences in nutrient intake according to using diuretics, symptom severity and degree of physical functioning in heart failure patients. METHODS: A secondary data analysis was conducted by using baseline data of an intervention study for heart failure patients. In this study, 131 heart failure patients were included. Data were collected using medical records, NYHA (New York Heart Association functional classification) class, and 6-minute-walking test and 24-hour diet recall. Data were analyzed using descriptive statistics and Chi-square test by SPSS 21.0. Nutrient intake was assessed using CAN-pro 2.0. RESULTS: Majority of the participants consumed total calorie less than Estimated Energy Requirement (EER) and consumed carbohydrates more than 65% of their total calorie intakes. 24.4% of the participants consumed fat more than 30% of their total calorie intakes and 23.7% consumed saturated fat more than 7% of their total calorie intakes. 100.0% of the participants consumed protein less than 7% of their total calorie intakes and 73.3% of the participants consumed more than recommended intakes of sodium. More than 90.0% of the participants consumed less than adequate intakes of potassium (90.1%) and Vitamin D (91.6%), respectively. 100% and 62.6% of the participants consumed less than Estimated Average Requirement (EAR) of magnesium and Vitamin B1, respectively. Nutrient intakes in heart failure patients were different for potassium intake according to the usage of diuretics. The participants with symptom severity tended to intake protein less properly and the participants walking more than 300.0 m tended to intake sodium improperly high. CONCLUSIONS: The findings of this study indicated the need for screening nutrient intakes of heart failure patients. It is necessary to increase the intake of total calories and most nutrients and to restrict sodium intakes among heart failure patients.
Carbohydrates ; Diet ; Diuretics* ; Heart Failure* ; Heart* ; Humans ; Clinical Trial ; Magnesium ; Mass Screening ; Medical Records ; Potassium ; Sodium ; Statistics as Topic ; Thiamine ; Vitamin D ; Walking

OBJECTIVES: This retrospective study aims to evaluate the prevalence of maxillofacial trauma in a developing country, along with its pattern, etiology and management. Data for the present study were collected from the Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai in India. MATERIALS AND METHODS: The medical records of patients treated for maxillofacial injuries between May 2014 and November 2015 were retrospectively retrieved and analyzed for prevalence, pattern, etiology, and management of maxillofacial trauma. SPSS software version 16.0 was used for the data analysis. RESULTS: Maxillofacial fractures accounts for 93.3% of total injuries. The mean and standard deviation for the age of the patients were 35.0±11.8 years and with a minimum age of 5 years and maximum age of 75 years. Adults from 20 to 40 years age groups were more commonly involved, with a male to female ratio of 3:1. There was a statistically significantly higher proportion of males more commonly involved in accident and injuries (P <0.001). CONCLUSION: The most common etiology of maxillofacial injury was road traffic accidents (RTA) followed by falls and assaults, the sports injuries seem to be very less. In RTA, motorized two-wheelers (MTW) were the most common cause of incidents. The majority of victims of RTA were young adult males between the ages of 20 to 40 years. The malar bone and maxilla were the most common sites of fracture, followed by the mandible. The right side of the zygomatic complex was the predominant side of MTW injury. The majority of the zygomatic complex fractures were treated by conservative management. Open reduction and internal fixation were performed for indicated fracture patients.
Accidental Falls ; Accidents, Traffic ; Adult ; Athletic Injuries ; Dentistry ; Developing Countries* ; Female ; Humans ; India ; Male ; Mandible ; Maxilla ; Maxillofacial Injuries ; Medical Records ; Prevalence* ; Retrospective Studies* ; Statistics as Topic ; Young Adult ; Zygoma

STUDY DESIGN: Retrospective case study by clinical and radiological data analysis. PURPOSE: To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. OVERVIEW OF LITERATURE: This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. METHODS: A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. RESULTS: Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. CONCLUSIONS: Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the Indian population. Tethered cord was the most common intraspinal anomaly, seen in 48% cases of congenital scoliosis. Hemivertebra was seen in 66% cases and was the most common vertebral defect. Hence MRI imaging of whole spine should be done in all cases of congenital scoliosis before any surgical intervention. Special attention should be given to physical examination and visualization of any neurocutaneous markers, which are associated with a higher incidence of intraspinal anomalies; absence of a neurocutaneous marker, however, does not rule out intraspinal anomaly.
Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Retrospective Studies ; Scoliosis* ; Spine ; Statistics as Topic

PURPOSE: The objectives of this study were to find factors related to medical intensive care unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. MATERIALS AND METHODS: We performed a retrospective cohort study of 343 consecutive patients who were admitted to the medical ICU of a single medical center from January 1, 2008 to December 31, 2012. We analyzed a broad range of patients' characteristics on the day of admission, extubation, and discharge from the ICU. RESULTS: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29-8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29-7.09), application of continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85-9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07-1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01-1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66-0.86). CONCLUSION: By using specific risk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.
Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Intensive Care Units/*statistics & numerical data ; Male ; Medical Records ; Middle Aged ; Odds Ratio ; Patient Readmission/*statistics & numerical data ; Predictive Value of Tests ; Regression Analysis ; Republic of Korea ; Retrospective Studies ; Risk Factors

INTRODUCTIONMedication discrepancies and poor documentation of medication changes (e.g. lack of justification for medication change) in physician discharge summaries can lead to preventable medication errors and adverse outcomes. This study aimed to identify and characterise discrepancies between preadmission and discharge medication lists, to identify associated risk factors, and in cases of intentional medication discrepancies, to determine the adequacy of the physician discharge summaries in documenting reasons for the changes.

METHODSA retrospective clinical record review of 150 consecutive elderly patients was done to estimate the number of medication discrepancies between preadmission and discharge medication lists. The two lists were compared for discrepancies (addition, omission or duplication of medications, and/or a change in dosage, frequency or formulation of medication). The patients' clinical records and physician discharge summaries were reviewed to determine whether the discrepancies found were intentional or unintentional. Physician discharge summaries were reviewed to determine if the physicians endorsed and documented reasons for all intentional medication changes.

RESULTSA total of 279 medication discrepancies were identified, of which 42 were unintentional medication discrepancies (35 were related to omission/addition of a medication and seven were related to a change in medication dosage/frequency) and 237 were documented intentional discrepancies. Omission of the baseline medication was the most common unintentional discrepancy. No reasons were provided in the physician discharge summaries for 54 (22.8%) of the intentional discrepancies.

CONCLUSIONUnintentional medication discrepancies are a common occurrence at hospital discharge. Physician discharge summaries often do not have adequate information on the reasons for medication changes.

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Medical Records ; Medication Errors ; prevention & control ; statistics & numerical data ; Medication Reconciliation ; statistics & numerical data ; Patient Admission ; Patient Discharge ; Retrospective Studies ; Risk Factors ; Singapore ; Tertiary Care Centers ; Treatment Outcome