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 purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations. METHODS: This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies. RESULTS: The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41–6.38). CONCLUSION: In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.
Cohort Studies* ; Delivery, Obstetric ; Female ; Gestational Age ; Humans ; Infant Death* ; Infant* ; Korea ; Mortality ; Parturition ; Pregnancy ; Pregnancy, Multiple* ; Pregnancy, Triplet ; Pregnancy, Twin ; Retrospective Studies ; Stillbirth* ; Twins ; Vital Statistics

This study aimed to analyze infant, maternal, perinatal, and fetal mortality statistics in the Republic of Korea (Korea), 2014. It was based on the open-access data available from the Statistics Korea website (http://kostat.go.kr/portal/eng/index.action). Recent trends in these vital statistics were also examined. The results of this study constitute a descriptive presentation and analysis of the national data. The number of infant deaths was 1,305 out of 435,435 live births in 2014, and the infant mortality rate was 3.0. The number of maternal deaths was 48. The maternal mortality ratio per 100,000 live births was 11.0. The maternal mortality ratio per 100,000 women of child-bearing age (15 to 49 years old) was 0.37. The number of perinatal deaths was 1,365, and the perinatal mortality rate was 3.1. The number of fetal deaths was 5,317. The fetal mortality rate was 12.1. The trends in those vital statistics in recent years were consistent except for a few findings, including a decrease in the maternal mortality ratio of pregnant women 40 years old and older and a change in the proportions of the causes of infant death, with a decrease in mortality due to neonatal respiratory distress and an increase in mortality due to bacterial sepsis. Although these vital statistics were generally consistent, some aspects varied by year. Pregnant women less than 20 years old should be monitored more intensively for their babies' health. Our findings can serve as basic data supporting the establishment of health policies by the Korean government.
Cause of Death ; Female ; Fetal Death ; Fetal Mortality ; Health Policy ; Humans ; Infant Death ; Infant Mortality ; Infant* ; Korea ; Live Birth ; Maternal Death ; Maternal Mortality ; Mortality ; Perinatal Death ; Perinatal Mortality* ; Pregnant Women ; Republic of Korea* ; Sepsis ; Vital Statistics

OBJECTIVES: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. METHODS: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. RESULTS: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). CONCLUSIONS: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.
Cause of Death ; Child Mortality/*trends ; Child, Preschool ; Communicable Diseases/mortality ; Databases, Factual ; Female ; Humans ; Infant ; Male ; Neoplasms/mortality ; Nervous System Diseases/mortality ; Republic of Korea ; Sex Ratio ; Vital Statistics

PURPOSE: Of numerous health status indicators, those of neonate and peripartum encompass nation's maternal, birth, neonatal and infantile health level. The goal of this study was to investigate the changes during the past 50 years of neonatal and perinatal indicators in Korea. METHODS: We analyzed the changes of population, number of live births per year, crude birth rate (CBR), total fertility rate (TFR), incidence of low birth weight infant (LBWI) and preterm infants, neonatal mortality rate (NMR), infant mortality rate (IMR), perinatal mortality rate (PMR), and maternal mortality ratio (MMR) of Korea, and especially compared those indicators of Korea with those of other OECD nations during the past 50 years. RESULTS: Korea has accomplished a marked improvement in the above indicators during the past 50 years. The average index of OECD and Korean rank among 34 OECD nations in the above health indicators in 2010 are as follows: population 49,410,370 (36,285,235, 9th), CBR 9.4 (12.1, 4th), TFR 1.23 (1.75, 1st), LBWI incidence 5.0 (6.8, 6th), NMR 1.8 (2.9, 8th), IMR 3.2 (4.3, 10th), PMR 3.3 (6.0, 4th), MMR 15.7 (8.7, 29th). CONCLUSION: Birth rate of Korea was very low among OECD nations with relatively low LBWI incidence. It is inspiring that NR, IMR, and PMR were lower than the average. However, MMR was very higher than the average of OECD. The present review provides the neonatal and perinatal health indicators in Korea and it might be helpful to improve clinical practice and outcome in the future.
Birth Rate ; Epidemiology ; Health Status ; Health Status Indicators ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea ; Live Birth ; Maternal Mortality ; Mortality ; Parturition ; Perinatal Mortality ; Peripartum Period ; Republic of Korea* ; Vital Statistics*

OBJECTIVETo evaluate the results of the active follow-up among registered cancer patients in 2002 - 2005 in urban areas of Beijing.

METHODSA number of 63 997 cancer patients diagnosed during 2002 - 2005 were selected from the surveillance database of Beijing Office for Cancer Prevention and Control. By matching the identity information of the patients with the death surveillance database built by the vital statistic department in Beijing, 29 223 patients were confirmed to be alive.1149 cases were removed from the study due to lack of exact key variables, such as address and telephone numbers. 28 074 patients were, at last, included in the active follow-up study. The investigators and the inspectors, who accepted standard training program, investigated each patient's status of census register and survival condition by phone calling, household interview and visits at local police station or residential committee. The loss ratio of follow-up and the constituent ratio of the withdrawal reasons were calculated.

RESULTSAmong the 28 074 patients selected in active follow-up, 21 696 patients were followed successfully; 1453 of whom didn't have the census register of Beijing, which accounted for 6.70%. Out of the other 20 243 Beijing residents, 4715 patients (23.29%) were already dead and 84.22% (3971/4715) of them replenished the failure to report by passive follow-up. Among all the 4715 dead cases, 4405 (93.43%) patients were died from cancer. The follow-up study helped to replenish the vital statistics in different districts, the ratio ranged from 4.87% and 8.85%. 6378 patients were withdrawn from the study. The loss ratio was 22.72% (6378/28 074), and the total loss ratio was 12.03% ((6378 + 1149)/(63 997 - 1453)). Of these withdrawal cases, 3041 (47.68%) were lost to follow-up in that the investigators can't find the patients or the relatives of the patients according to the registered phone number or address information. The other reasons included: the patients removed to other areas (1199 cases, 18.80%), the patients and their family members were temporarily not at home (127 cases, 1.99%), the patients and their family members rejected to answer the interview (292 cases, 4.58%), and other reasons (1719 cases, 26.95%).

CONCLUSIONThe method of active follow-up towards registered cancer patients can replenish the missing information which could not be collected from passive follow-up procedure; and therefore effectively improve the quality of data in cancer registration.

PURPOSE: In Korea before 1996, the perinatal mortality rates (PMRs) were reported by individual studies, but the Korea Ministry of Health and Welfare started official reports of PMRs from 1996, and Statistics Korea provides the annual official data since 2007. The present study observed the decreasing trends of PMR and compared the PMRs between OECD nations. Thereby, we surveyed the terminology of PMR and the international trends in the usage of the calculation methods and intended to provide uniformity in calculating PMR in Korea. Also, the authors speculated some perinatal problems to be improved in the future in order to decrease PMR further. METHODS: Data before 1996 were gathered from individual reports, and after 1996 were utilized from Ministry of Health and Welfare, and Statistics Korea. Data of OECD nations were analyzed from OECD Health Data 2010. The changes in annual PMR of Korea was reviewed, which is helpful to recognize the current state of Korea, and was compared to that of OECD nations. RESULTS: During the past 50 years, the PMRs of Korea were remarkably improved (PMRs: 60 in 1960s, 35 in 1970s, 30 in 1980s, approximately, respectively). The official PMR values of Korea are as following: 6.0 in 1996, 5.2 in 1999, 4.6 in 2002, 4.2 in 2005, 3.6 in 2006, 3.7 in 2007, 3.6 in 2008, and 3.4 in 2009. The decreasing pattern of the annual PMR value was observed and the most recent value reflected the excellent situation in PMR compared to other OECD nations. CONCLUSION: Accordingly, we could observe the encouraging levels of PMR in Korea. We speculate that following efforts should be accompanied to achieve further improvement in PMR, such as improvements in neonatal and maternity transfer system, establishment in perinatal care centers, and establishment in perinatal research network system in Korea.
Epidemiologic Methods ; Korea ; Perinatal Care ; Perinatal Mortality ; Public Health ; Vital Statistics

PURPOSE: Recently in Korea, there have been significant improvements in neonatal mortality rate (NMR) and infant mortality rate (IMR). This study aimed to investigate the proportion of the NMR among IMR, with the goal of discerning the influence of improved NMR on the reduction of IMR in the last 5 years in Korea. METHODS: All data were from Statistics Korea. Changes in the NMR percentage among IMR and the percentage of the death by the distribution of the birth weight and gestational were investigated. RESULTS: The total birth rate decreased, but the total number of preterm and low birth weight infants increased. These was a large decrease in NMR and IMR. The proportion of NMR among INR exceeded 50%. Early NMR was higher than late NMR. Among the total infant death, the mortality of preterm and low birth weight infants was high. CONCLUSION: Between 2005 and 2009, the total birth has declined in Korea, but the frequency of low birth weight infants is trending upward. The improvements in NMR and IMR, and the downtrend of the NMR percentage in IMR, are encouraging. It seems that the continued decrease of mortality of preterm and LBWI is required for better improvements NMR and IMR in Korea. This result is expected to be used for the basic data to improve the management of the newborns in Korea.
Birth Rate ; Birth Weight ; Data Collection ; Epidemiologic Methods ; Gestational Age ; Humans ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; International Normalized Ratio ; Korea ; Parturition ; Vital Statistics

Neonatal mortality rate (NMR) or infant mortality rate (IMR) are the rate of deaths per 1,000 live births at which babies of either less than four weeks or of one year of age die, respectively. The NMR and IMR are commonly accepted as a measure of the general health and wellbeing of a population. Korea's NMR and IMR fell significantly between 1993 and 2009 from 6.6 and 9.9 to 1.7 and 3.2, respectively. Common causes of infantile death in 2008 had decreased compared with those in 1996 such as other disorders originating in the perinatal period, congenital malformation of the heart, bacterial sepsis of newborns, disorders related to length of gestation and fetal growth, intra-uterine hypoxia, birth asphyxia. However, some other causes are on the increase, such as respiratory distress of newborn, other respiratory conditions originating in the perinatal period, other congenital malformation, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. In this study, we provide basic data about changes of NMR and IMR and the causes of neonatal and infantile death from 1983 to 2009 in Korea.
Anoxia ; Asphyxia ; Cause of Death ; Fetal Development ; Heart ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Korea ; Live Birth ; Parturition ; Pregnancy ; Sepsis ; Vital Statistics

Neonatal mortality rate (NMR) or infant mortality rate (IMR) are the rate of deaths per 1,000 live births at which babies of either less than four weeks or of one year of age die, respectively. The NMR and IMR are commonly accepted as a measure of the general health and wellbeing of a population. Korea's NMR and IMR fell significantly between 1993 and 2009 from 6.6 and 9.9 to 1.7 and 3.2, respectively. Common causes of infantile death in 2008 had decreased compared with those in 1996 such as other disorders originating in the perinatal period, congenital malformation of the heart, bacterial sepsis of newborns, disorders related to length of gestation and fetal growth, intra-uterine hypoxia, birth asphyxia. However, some other causes are on the increase, such as respiratory distress of newborn, other respiratory conditions originating in the perinatal period, other congenital malformation, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. In this study, we provide basic data about changes of NMR and IMR and the causes of neonatal and infantile death from 1983 to 2009 in Korea.
Anoxia ; Asphyxia ; Cause of Death ; Fetal Development ; Heart ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Korea ; Live Birth ; Parturition ; Pregnancy ; Sepsis ; Vital Statistics