• Title/Summary/Keyword: Failure Study

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Ventilator-Associated Pneumonia in Neonatal Intensive Care Unit : Clinical Manifestations, Ddiagnostic Availability of Endotracheal Tip Culture (신생아 집중치료실에서 인공 환기요법 관련 폐렴의 임상양상과 기관내 삽관의 유용성에 관한 연구)

  • Kim, Nam Young;Sung, Tae Jung;Shin, Seon Hee;Kim, Sung Koo;Lee, Kon Hee;Yoon, Hae Sun
    • Pediatric Infection and Vaccine
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    • v.12 no.1
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    • pp.67-74
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    • 2005
  • Purpose : The incidence of mortality associated with respiratory difficulties is decreasing nowadays contributed to the development of neonatology. However, complications associated with mechanical ventilator are increasing. This study is to determine clinical manifestations, diagnositc availability of the endotracheal tip culture in patients with Ventilator-Associated Pneumonia(VAP) in neonatal intensive care unit(NICU). Methods : A retrospective analysis of 50 neonates who were admitted to the NICU of Kangnam Sacred Heart Hospital and had given mechanical ventilator from 1 January 2000 to 30 June 2003. VAP group defined as neonates who had pneumonia with mechanical ventilation longer than 48 hours. They were classified into VAP group(n=13) and control group (n=37) and the prevalence, microorganisms cultured from the endotracheal tube tip and risk factors were investigated. Results : The prevalence of VAP was 26.0%(n=13) and the most dominant microorganism cultured in our NICU was methicillin-resistant coagulase negative staphylococcus(MR-CNS) in 4 cases. Other microorganisms were Pseudomonas, Enterobacter, methicillin-resistant Staphylococcus aureus(MRSA) and Klebsiella. Gestational age, birth weight, Apgar score, respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, renal failure, pulmonary hemorrhage, pneumothorax were not different significantly between two groups except intraventricular hemorrhage(P<0.001) and patent ductus arteriosus(P<0.05). Duration of hospital stay and mortality rate were also not different significantly. Conclusion : VAP occurred at a significant rate among mechanically ventilated NICU patients. Despite of limitation of encotracheal tip culture, the most common microorganism was MR-CNS. We should be aware of occurrence of VAP in NICU neonate who were with mechanical ventilator and should treat with great care.

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Cystic Diseases of the Kidney in Children (소아의 낭포성 신질환)

  • Lee Ji-Suk;Rho Kwang-Sik;Kim Ji-Hong;Lee Jae-Seung;Kim Pyung-Kil
    • Childhood Kidney Diseases
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    • v.1 no.2
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    • pp.144-150
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    • 1997
  • Purpose : The kidney is one of the most common sites of cyst formation. Cystic diseases of the kidney are a diverse group of clinicopathologic entities and variable prognosis. They span a wide range of both age of presentation and severity of the renal disease. And many of them are systemic disorders, sharing similar process of cyst formation in other organs. Recently, development of imaging studies has been contributing widely to the diagnosis of the diseases. Treatment, however, is not established satisfactorily. We performed this study to evaluate the occurrence and treatment of cystic diseases of the kidney. Methods : We reviewed retrospectively the medical records of 44 patients with cystic diseases of the kidney in the Department of Pediatrics, during last 11 years. Results : In the 44 patients with cystic diseases of the kidney, 31 patients(71%) had multicystic dysplastic kidney and 11(35%) of them received nephrectomy due to differentiation from neoplasms or severe abdominal distension. Seven patients(16%) had polycystic kidney disease, and all of them were infantile type. Five patients(11%) were diagnosed as having a simple renal cysts. Progression to renal failure was noted in none of the cases. In 14(32%) out of total 44 patients, the diagnosis was made in neonatal or infantile pelted. Conclusion : The incidence of cystic diseases of the kidney appeared very low, but further investigation on their pathogenesis, classification, and indication of treatment is needed.

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Clinical Characteristics and Prognostic Factors of Vesicoureteral Reflux (방광요관역류의 임상적 특징 및 예후인자)

  • Kim, Wun-Kon;Ha, Tae-Sun
    • Childhood Kidney Diseases
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    • v.18 no.1
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    • pp.29-35
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    • 2014
  • Introduction: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. Methods: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. Results: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. Conclusion: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.

A Model to Measure the Success of a Web-based Information System at a Government Agency - the Chungwadae Case (공공기관 업무관리시스템 성과평가 모형 개발에 관한 연구: 청와대 업무관리시스템(e지원시스템)을 중심으로)

  • Bae, Lee-Chul;Hong, Il-Yoo
    • Asia pacific journal of information systems
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    • v.18 no.1
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    • pp.97-115
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    • 2008
  • Introduction The e-government is concerned with using Internet and Web technologies to exchange information and services with citizens, businesses and other related organizations, and it centers on three functions, namely informational, interactive, and transactional [UN, 2001]. Many developed countries like the U.S. have been actively involved in e-government projects, since they enable both more effective public services for citizens and more efficient internal operations. Korea is among these leading countries that are planning to leverage computer and communication technologies to provide for integration of work processes and information as well as convenient access to information and services. For this reason, evaluating e-government projects is becoming a crucial issue for both researchers and policy-makers. However, most research to date has primarily focused on a model of success of an e-government system designed for citizens, overlooking internal systems specifically created for employees working in a public organization. This paper is intended to propose a model to measure the success of a Web-based information system designed for use by internal users at Chungwadae, the executive branch of Korea's central government. The paper is also aimed at applying the model to the assessment of the present system being used at Chungwadae in comparison with the preceding system. Evaluating an e-Government System The most widely cited model of information systems success today is that of DeLone and McLean[1992, 2003, 2004]. The original model states that the success of an information system can be measured using six dimensions, including system quality, information quality, use, user satisfaction, individual impact, and organizational impact. Although the ultimate success of an information system may be reflected in the impact that the system has upon individuals as well as an organization, aspects of using the system such as system use and user satisfaction can play an important role in determining the system success, because the system would be a sheer failure if users don't like and use the system. As a response to criticisms given by numerous researchers, the authors adapted their model to fit the emerging Web-based environment. The revised model[DeLone and McLean, 2003] they offered included an additional quality dimension, namely service quality, and combined individual and organizational impacts into net benefits which can also influence user satisfaction. The e-government system success model can be built around this updated model. Our model incorporates information quality, system quality, and service quality as in the DeLone and McLean model. However, the 'system use' dimension has been replaced by perceived usefulness, as suggested by Seddon[1998]. In addition, because the e-government systems that this paper focuses on are internal public systems used in government agencies, the 'net benefits' dimension has been replaced by perceived work efficiency. Based on the proposed model, a total of nine hypotheses have been formulated which we tested using an empirical analysis. Methods A questionnaire form has been created with items that are designed to examine the relationships among the variables in the model. The questionnaire has been handed over, in person, to 65 members of Chungwadae staff who are now actively using the E-Support System, the present information system created to support internal work at Chungwadae. We made arrangements to meet with each individual who agreed to participate in our survey, and helped to fill out the survey form with explanations. Of the 65 copies that were delivered, only 33 were returned, and 30 responses of these have been adopted for our analysis, since three were not valid. The extremely small sample size was due to the limited number of staff members who had adequate experience required of this study. Results We gathered data from the questionnaire survey and analyzed them using a regression analysis to test the hypotheses. As shown in the table below, the results indicated that all three dimensions of an information system’s quality are positively related to user satisfaction. However, information quality and system quality were found to be positively related to perceived usefulness, while service quality was not. In addition, perceived usefulness is not positively related to user satisfaction, implying that a user may find a system useful, but may not be satisfied with it. Finally, user satisfaction and perceived usefulness both are positively related to perceived work efficiency. This suggests that workers' positive experience with the system is important to guarantee favorable work efficiency. Conclusions We conclude that the proposed model proved useful in measuring the success of an internal information system used by a government agency. To demonstrate the applicability and usefulness of the model in the paper, we applied the model to the assessment of the present internal system used at Chungwadae in comparison with the preceding system. The results showed that the present system outperforms the preceding one in a statistically significant way. Future research will have to focus on applying the model to Korea's governmental agencies other than Chungwadae and examine whether it proves applicable in different types of governmental organizations.

Distribution of Weeds with Different Surface Management Systems of Greenhouse Soil in Gyeongnam Province (경남지역 시설원예작물 재배지 및 표토관리별 잡초발생 양상)

  • Hwang, Jae-Bok;Yun, Eul-Soo;Park, Chang-Young;Park, Sung-Tae;Nam, Min-Hee
    • Korean Journal of Weed Science
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    • v.31 no.3
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    • pp.221-228
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    • 2011
  • Weed control is of fundamental importance when planting horticultural crops, particularly during the establishment phase. Weeds compete for nutrients, water and light, and can severely threaten the survival and early growth of newly planted crops. Failure to control weeds represents one of the single most important factors leading to crop loss. Knowledge on the existence of the diversity of weed species in greenhouses is of our main concern in this study in order to develop a most efficient and effective weed control strategies. Sixty-two greenhouses were surveyed in 3 cities and counties of Gyeongnam area in March to October 2009 to investigate the feature of weed occurrence in polyvinyl chloride (PVC) after harvesting of the main crops. Forty-one weed species were identified and classified to 18 families which were composed of 14 annual weeds, 18 summer annual weeds and 9 perennial weeds. On the other hand, broadleaf, grasses and sedges recorded with 30, 7 and 4 weed species, respectively. Asteraceae was the most dominant weed species (9 species) noted followed by Poaceae (7 species), Cyperaceae (4 species), Caryophyllaceae and Brassicaceae (3 species respectively) and other families have 1~2 species. The dominant weed species occurred in the greenhouse based on the summed dominance ratio. These weeds were Digitaria sanguinalis, Cyperus iria, Portulaca oleracea, Rorippa islandica, Mazus japonicas, Cardamine flexousa, and Eclipta prostrata and others. Weed occurrence in the greenhouse after horticultural crops consisted of summer annuals (4 species), winter annuals (3 species), and perennial annuals (1 specie). The dominant species occurred in tilled soil based on summed dominance ratio of weeds were Cardamine flexousa (88.1%), Eclipta prostrate (57.4%) and Portulaca oleracea (55.2%). Comparison of weed occurrence was thoroughly surveyed also in which field without PVC, weed species were Portulaca oleracea (55.2), Eclipta prostrata (57.9%) and Trigonotis peduncularis (25.1%) and field with PVC, the identified weeds were Portulaca oleracea (98.75), Trigonotis peduncularis (49.1%), and Eclipta prostrata (36.8%).

Initial $^{99m}Technetium-dimercaptosuccinic$ Acid (DMSA) Renal Scan Finding and Vesicoureteral Reflux as Predicting Factor of Renal Scarring (신반흔 예측인자로서 초기 $^{99m}Technetium-dimercaptosuccinic\;Acid$ 신주사 소견과 방광요관 역류의 유무 및 정도)

  • Lee Soo-Yeon;Lim So-Hee;Lee Dae-Yeol
    • Childhood Kidney Diseases
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    • v.7 no.1
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    • pp.44-51
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    • 2003
  • Purpose : Acute pyelonephritis in children may result in permanant renal damage which later in life may lead to hypertension and renal failure. The purpose of this study was to evaluate the factors that might be useful for predicting the development of renal scar in children with urinary tract infection(UTI). Methods : We retrospectively reviewed 442 patients with UTI who were admitted to the Department of Pediatrics of Chonbuk National University Hospital, during the period from April 1992 to March 2002. The patients were divided into two groups according to the presence of renal scar on the follow-up DMSA renal scan, and we compared the factors associated with renal scarring between the two groups. Results : There were no significant differences in sex, causative organism and acute phase reactants between the groups with and without renal scar. The age at diagnosis was significantly higher in the renal scar group compared to that without scar. Of the 60 patients with renal scar, 78% had vesicoureteral reflux(VUR), but 13% of patients without scar had VUR. Furthermore, the severity of VUR was significantly correlated with renal scar formation. 53% showed multiple cortical defects on the initial DMSA renal scan, compared to 32% in the non-scar group. In addition, 76% of patients showing multiple cortical defects on the initial DMSA renal scan with VUR had renal scar. Conclusion : The presence and grade of VUR, and findings on the initial DMSA renal scan would contribute to predict risk of renal scar formation in children with UTI.

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Peritoneal Dialysis Associated Peritonitis and Empirical Antibiotics Therapy in Korean Children with Chronic Renal Failure (소아 복막 투석 환자에서 발생한 복막염의 경험적 항생제 치료에 관한 연구)

  • Lee, Sang-Goo;Cho, Joong-Bum;Sohn, Young-Bae;Park, Sung-Won;Kim, Su-Jin;Jin, Dong-Kyu;Paik, Kyung-Hoon
    • Childhood Kidney Diseases
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    • v.12 no.2
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    • pp.213-220
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    • 2008
  • Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06$\pm$15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2%), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.

Radiation Therapy in Elderly Skin Cancer (노령의 피부암에서 방사선치료)

  • Kim, Jin-Hee
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.113-117
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    • 2008
  • Purpose: To evaluate the long term results(local control, survival, failure, and complications) after radiation therapy for skin cancer in elderly patients. Material and Methods: The study spanned from January 1990 to October 2002. Fifteen elderly patients with skin cancer were treated by radiotherapy at the Keimyung University Dongsan Medical Center. The age distribution of the patients surveyed was 72 to 95 years, with a median age of 78.8 years. The pathologic classification of the 15 patients included squamous cell carcinoma(10 patients), basal cell carcinoma(3 patients), verrucous carcinoma(1 patient) and skin adnexal origin carcinoma(1 patient). The most common tumor location was the head(13 patients). The mean tumor diameter was 4.9 cm(range 2 to 9 cm). The radiation dose was delivered via an electron beam of 6 to 15 MeV. The dose range was adjusted to the tumor diameter and depth of tumor invasion. The total radiation dose ranged from $50{\sim}80$ Gy(mean: 66 Gy) with a 2 Gy fractional dose prescribed to the 80% isodose line once a day and 5 times a week. One patient with lymph node metastasis was treated with six MV photon beams boosted with electron beams. The length of the follow-up periods ranged from 10 to 120 months with a median follow-up period of 48 months. Results: The local control rates were 100%(15/15). In addition, the five year disease free survival rate(5YDFS) was 80% and twelve patients(80%) had no recurrence and skin cancer recurrence occurred in 3 patients(20%). Three patients have lived an average of 90 months($68{\sim}120$ months) without recurrence or metastasis. A total of 9 patients who died as a result of other causes had a mean survival time of 55.8 months after radiation therapy. No severe acute or chronic complications were observed after radiation therapy. Only minor complications including radiation dermatitis was treated with supportive care. Conclusion: The results suggest that radiation therapy is an effective and safe treatment method for the treatment of skin cancer in elderly patients who achieved a good survival rate and few minor complications.

Clinical Analysis of the Belsey Mark IV Operation in Hiatal Hernia with Gastroesophageal Reflux and Achalasia (위 식도 역류를 가진 열공 헤르니아 환자와 식도 무이완증 환자에서 시행한 Belsey Mark IV 수술의 임상적 고찰)

  • 최영호;조원민;류세민;황재준;손영상;김학제;김광택
    • Journal of Chest Surgery
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    • v.35 no.3
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    • pp.217-222
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    • 2002
  • Background: The incidence of gastroesophageal reflux disease(GERD) is increasing recently, but medical management for GERD has many limitations. Therefore, variable surgical treatments have been introduced. Material and Method: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001. Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. Result: Mean age of the patients was 54.3$\pm$19.0 years. Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1$\pm$2.6 days. We routinely practiced follow-up endoscopy on postoperative 3rd, 6th, 9th, and 12th months. After remission for reflux and esophagitis, they were transferred to internal medicine department. Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded) had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms, postoperatively. We experienced 10% operation failure rate. Conclusion: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.

Clinical Outcome of Emergency Coronary Artery Bypass Grafting after Failed Percutaneous Transluminal Coronary Angioplasty (경피적 관상동맥 성형술의 실패에 의해 발생한 응급환자의 임상경과)

  • Kim, Do-Kyun;Yoo, Kyung-Jong;Youn, Young-Nam;Yi, Gi-Jong;Lee, Sak;Chang, Byung-Chul;Kang, Meyun-Shick
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.209-214
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    • 2007
  • Background: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. Material and Method: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was $63.7{\pm}8.9\;(46{\sim}80)$ years, with 14 male patients (51.9%). Result: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was $53.6{\pm}63.4$ months. Conclusion: Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.