• Title/Summary/Keyword: Improvement Methods

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Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals (소아청소년에서의 심경부 농양에 대한 임상적 고찰: 두 기관에서 도출된 10년간의 경험)

  • Kim, Eunhee;Jeon, Ju Hee;Lee, Won Uk;Kim, So Young;Kim, Eun Ryoung
    • Pediatric Infection and Vaccine
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    • v.18 no.2
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    • pp.163-172
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    • 2011
  • Purpose : The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. Methods : Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. Results : Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. Conclusion : The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.

Building the Process for Reducing Whole Body Bone Scan Errors and its Effect (전신 뼈 스캔의 오류 감소를 위한 프로세스 구축과 적용 효과)

  • Kim, Dong Seok;Park, Jang Won;Choi, Jae Min;Shim, Dong Oh;Kim, Ho Seong;Lee, Yeong Hee
    • The Korean Journal of Nuclear Medicine Technology
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    • v.21 no.1
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    • pp.76-82
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    • 2017
  • Purpose Whole body bone scan is one of the most frequently performed in nuclear medicine. Basically, both the anterior and posterior views are acquired simultaneously. Occasionally, it is difficult to distinguish the lesion by only the anterior view and the posterior view. In this case, accurate location of the lesion through SPECT / CT or additional static scan images are important. Therefore, in this study, various improvement activities have been carried out in order to enhance the work capacity of technologists. In this study, we investigate the effect of technologist training and standardized work process processes on bone scan error reduction. Materials and Methods Several systems have been introduced in sequence for the application of new processes. The first is the implementation of education and testing with physicians, the second is the classification of patients who are expected to undergo further scanning, introducing a pre-filtration system that allows technologists to check in advance, and finally, The communication system called NMQA is applied. From January, 2014 to December, 2016, we examined the whole body bone scan patients who visited the Department of Nuclear Medicine, Asan Medical Center, Seoul, Korea Results We investigated errors based on the Bone Scan NMQA sent from January 2014 to December 2016. The number of tests in which NMQA was transmitted over the entire bone scan during the survey period was calculated as a percentage. The annual output is 141 cases in 2014, 88 cases in 2015, and 86 cases in 2016. The rate of NMQA has decreased to 0.88% in 2014, 0.53% in 2015 and 0.45% in 2016. Conclusion The incidence of NMQA has decreased since 2014 when the new process was applied. However, we believe that it will be necessary to accumulate data continuously in the future because of insufficient data until statistically confirming its usefulness. This study confirmed the necessity of standardized work and education to improve the quality of Bone Scan image, and it is thought that update is needed for continuous research and interest in the future.

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Effect of Enzyme Replacement Therapy on Growth in Korean Patients with Mucopolysaccharidosis Type I (I형 뮤코다당증 환자들에서 효소 보충 요법이 성장에 미치는 영향)

  • Huh, Rimm;Cho, Sung Yoon;Chang, Mi Sun;Lee, Jieun;Kwun, Younghee;Kim, Su Jin;Sohn, Young Bae;Park, Sung Won;Maeng, Se Hyun;Kwon, Eun-Kyung;Han, Sun Ju;Jung, Jooyoun;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.13 no.2
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    • pp.111-119
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    • 2013
  • Purpose: Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder caused by deficiency of the enzyme ${\alpha}$-L-iduronidase, which leads to a broad spectrum of multisystemic manifestations. Short stature and decreased growth velocity are prominent features of MPS I. The aim of the present study was to evaluate the effect of enzyme replacement therapy (ERT) on growth of Korean MPS I patients from a single center. Methods: Height data were obtained by retrospective chart review of 10 Korean patients with MPS I who had received ERT for a minimum of 3 years. Height was expressed as standard deviation scores (SDS) based on normative data. Annual growth rates were calculated before and during ERT. A piecewise regression model was used to analyze height z-scores before and after treatment. Individual analysis was performed for impact of phenotype [(severe (Hurler) versus attenuated (Hurler-Scheie, Scheie)] on growth. Results: Annual growth was 3.3 cm (z-score= -0.21) in the year before ERT and 6.2 cm (z-score= 0.17), 5.8 cm (z-score= 0.07), and 3.8 cm (z-score= -0.4) in the first, second, and third years of ERT, respectively. Regression analysis showed improvement in the slope after ERT (difference= 0.04; P=0.022). Estimated slope differences between severe and attenuated phenotypes were statistically significant before (P=0.001) and after treatment (P<0.0001), although no significant difference was noted when stratified by phenotype. Conclusion: ERT with aldurazyme appears to have a positive impact on linear growth in patients with MPS I.

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Multicenter, Open-Labeled, Observational Clinical Trial to Investigate the Efficacy and Safety of Oral Administration of Megace Suspension in Patients with Head and Neck Cancer During Radiotherapy (방사선 치료 중인 두경부 종양 환자를 대상으로 메게이스 내복 현탁액 경구투여 후 유효성 및 안전성에 관한 다기관, 공개, 관측연구)

  • Kim, Se-Heon;Kim, Min-Sik;Kim, Young-Mo;Kim, Hyun-Su;Nam, Soon-Yuhl;Rho, Young-Soo;Park, Young-Hak;Baek, Chung-Hwan;Bong, Jung-Pyo;Lee, Kang-Dae;Lee, Yong-Seop;Jung, Kwang-Yoon;Chung, Sung-Min;Chung, Pil-Sang;Joo, Young-Hoon;Chu, Hyung-Ro;Choi, Eun-Chang;Tae, Kyung;Hong, Ki-Hwan
    • Korean Journal of Head & Neck Oncology
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    • v.24 no.1
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    • pp.57-63
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    • 2008
  • Background and Purpose:Nausea, vomiting and weight loss are common problems that are encountered in the course of cancer patient treatment who are receiving radiotherapy. In this study, we are aiming to analyze the effect of megestrol acetate on quality of life of head and neck cancer patients receiving radiotherapy, resulting from improvement of weight loss, appetite and nutritional status via multicenter, open-labeled, observational clinical trial. Material and Methods:A total of 270 patients from 10 medical institutes who are receiving radiotherapy or who have completed radiotherapy within 3 months, between February 2007 and February 2008, were selected as candidates for the study. Megestrol acetate suspension(megace) was given to the subjectives once a week for 4 weeks with the amount of 20ml(megestrol 800mg). Measurement of weight and questionnaire surveys were carried out three times: at the start of the study, 4 weeks after the start of the medication, and 4 weeks after the end of the medication, respectively. Results:The group who has received megace had a total number of 199, and control group was 70. The group who have received megace showed mean weight loss of 1kg in 8 weeks, compared with the weight loss of 5.5kg in control group, which showed that the medication was effective in reducing the amount of weight loss(P=0.027). The group who received megace had a tendency to report a reduced rate of decrease in the score of appetite, nausea and vomiting, and QOL score, but it did not have statistical significance(P>0.05). Conclusion:Megestrol acetate have reduced the degree of weight loss significantly, and it has a tendency to reduce the rate of decrease in appetite, aggravation of nausea and vomiting, and quality of life.

A Study on the Brand Characteristics According to Trends in the Children's Apparel Market

  • Han, Gyung-Hee
    • Journal of Fashion Business
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    • v.9 no.6
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    • pp.160-174
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    • 2005
  • Despite the decrease in the number of children due to low birth rate, the domestic children's apparel market has been achieving steady growth as family income is rising thanks to more opportunities for working women, parents spend more on their children, and they prefer brand products that make their children look special. In addition, the market is suffering from hard competition as large enterprises have joined the race. The present study purposed to survey the children's apparel market in Korea, which is in a transitional period, and to contribute to the development of the market with Korean brands. For this purpose, we analyzed the characteristics of children's apparel brands in the 21st century based on the current state of the domestic children's apparel market and, based on the findings, forecasted the future trend of children's apparel brands, suggested improvements for expected problems, proposed standards for coping with changes such as diversification, high quality and differentiation in the children's apparel market, and provided consumers with information on how to purchase products. According to the result of analyzing the characteristics of children's apparel brands in the 21st century, brands are categorized largely into four types - life cultural brands, functional product brands, character brands and brands advancing to China. Life cultural brands equipped with all necessities for children are expanding, and with the deepening social problems of environmental pollution and the reduction of the child population, functional products made of environment-friendly materials are spreading widely, targeting infants and children. Furthermore, for extending age targets and diversifying products, children's apparel is using characters. The use of characters is expected to have a considerable effect on the growth of brands because children are more subjective as consumers than before and they are more easily persuaded with characters. Domestic children's apparel brands advancing to China have a high expectation of success in overcoming the limitation of the local market that has reached its peak and growing into global brands. Korean apparel makers are struggling to overcome the depressed domestic market, to recover consumers' consumption, to cope with market opening, to pursue high value of sensibility and to expand the seniors' market, etc. In this situation, future trends of children's apparel brands will be the expansion of family brands, brand totalization, quality price, niche market (pre-teen market), etc. In response to these trends, we made the following suggestions for improvement. 1. Children's apparel brands are evolving into family brands as well as into total brands through voluming. Today, however, apparel makers are advancing to the children's apparel market with the concept of adults' apparel and, as a result, children's apparel is merely adults' apparel of reduced size, having problems in design, color and materials. Thus, apparel makers must develop design considering the wide range of size and the characteristics of children's apparel, strengthen sourcing abilities to create revenues, and make thorough survey of customers to find common denominators between adults' apparel and children's apparel considering that characteristic that the target class is different from the buyer class. Furthermore, they must make active investments in human resources, develop outstanding products through advanced planning and design, and support marketing techniques and management systems to stores. 2. As the declining birth rate will continue to have a negative effect on the market, it may be difficult to expand the market size but there is still a margin for growth through high-sensibility and high-quality products. The competitiveness of brands is determined by their market shares. Accordingly, concepts should be specialized according to lifestyle, customers' diverse needs should be satisfied, and cross-coordination should be achieved within a brand. 3. Considering Korean parents who do not spare investment in their children despite shrinking consumption, functional products must be high value-added goods that can enhance efficiency. However, in the current situation of the infants' apparel industry where a textile manufacturer supply its products to multiple brands, it is difficult to develop unique products only based on materials. Thus, it is considered urgent to appeal to consumers not by relying on materials only but by finding methods of applying their own characters to children's dress.

Arthroscopic Posterior Cruciate Ligament Reconstruction with Preservation of the Remnant Posterior Cruciate Ligament (남아 있는 후방 십자 인대 다발을 보존한 관절경하 후방 십자 인대 재건술)

  • Ahn Jin Hwan;Ha Kwon Ik;Chung Yoon Sung;Yang Il Soon
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.2
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    • pp.97-104
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    • 2000
  • Purpose : The majority of PCL deficient knees have some intact remnant PCL bundles. In these cases, the remnant PCL bundles were removed fur easy passage of graft(especially in bone-patellar tendon-bone graft). The purpose of study is to report the results of PCL reconstruction by posterior transseptal portal technique and by preserving the remnant posterior cruciate ligament bundles. Materials & Methods : From November 1993 to June 1999, 44 arthroscopic posterior cruciate ligament reconstructions have been performed by one surgeon. We studied 37 knees those were followed up over 1 year among them. The mean age($14\~56$ years) was 31.8 years. The average follow-up period was 17.8 months($12\~61$ months). The graft materials were 29 double-loop hamstring autografts, 4 double-loop hamstring allografts and 4 Achilles tendon-bone allograft. Results : There are significant improvement of the preoperative subjective symptoms. The last follow-up shows that the average Lysholm knee score was markedly improved from 59.8 pre-operation to 89.2 post-operation and the average KT 2000 side difference was decreased from 11.1mm pre-operation to 2.3 mm post-operation. Follow-up MRI showed that the graft was healed with remnant posterior cruciate ligament bundles as one ligament. Conclusion : The posterior trans-septal portal makes it possible to locate the exact tibial tunnel. The arthroscopic PCL reconstruction preserving the remnant of original PCL bundles seems to provide the good result.

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Endoscopic Carpal Tunnel Release Using Single Portal Technique (단일 입구를 이용한 내시경적 수근관 감압술)

  • Cheon Sang-Jin;Kim Hui-Taek;Suh Kuen-Tak;Suh Jeung-Tak;Yoo Chong-Il
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.2
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    • pp.159-165
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    • 2000
  • Purpose : Endoscopic carpal tunnel release technique was developed and has being used to decrease postoperative morbidity and complications. The purpose of this study was to evaluate the clinical results and clinical usefulness of endoscopic carpal tunnel release using single portal technique. Methods and Materials : 18 carpal tunnel syndrome patients who were diagnosed by means of clinical symptoms, physical examination, and electrodiagnostic study had endoscopic carpal tunnel release using single portal technique with about 1 cm oblique wrist incision on 30 hands. And then they were followed-up and reviewed in the same way. Late results of operation were analysed by grading system according to patient's own assessments of relief of symptoms at the final fellow-up. The follow-up period ranged 6 to 13 months from surgery. Results : There were postoperative improvements with respect to clinical symptoms, physical examination, and electrodiagnostic study. 23 of 30 hands$(76.7\%)$ had complete resolution of symptoms. 27 hands$(90\%)$ were able to return to normal activities and work within 6 weeks, and 30 hands$(100\%)$ returned within 8 weeks. In grip strength study, 29 hands$(96.6\%)$ regained preoperative strength in 6 months. 12 of 22 hands$(55\%)$ had improvement with respect to thenar atrophy within 6 months. Late results were as follows . 23 hands$(76.7\%)$ was graded as excellent, 6 hands$(20\%)$ graded as good and 1 hand$(3.3\%)$ graded as fair, and there was no poor result. Conclusion : We think that endoscopic carpal tunnel release with single portal technique is technically safe and simple, if the surgeon takes step to stay within the safety zone based on local anatomy and selects an appropriate patient and that endoscopic carpal tunnel release does have advantages over open release. We agree that the surgeon must be prepared to perform an open technique, if technical difficulties arise, difficulty in introducing the device into the carpal tunnel is encountered, or the transverse fibers of the transverse carpal ligaments are not clearly seen.

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Arthroscopic Rotator Cuff Repair For Partial Articular-Surface Tendon Avulsion (PASTA) Lesion (회전근 개 관절내 부분 파열 환자의 관절경적 봉합술)

  • Lee, Bong-Gun;Cho, Nam-Su;Park, Keun-Ho;Moon, Seong-Cheol;Rhee, Yong-Girl
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.3
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    • pp.242-248
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    • 2009
  • Purpose: To evaluate the clinical and radiologic results of the arthroscopic rotator cuff repair for partial articular surface tendon avulsion lesion. Materials and Methods: Twelve patients with symptomatic, partial articular surface tendon avulsion underwent arthroscopic rotator cuff repair between Mar. 2006 and Sep. 2008. The mean follow-up period was 18.3 months(12~36 months), and the mean age at the time of surgery was 46.9-year-old(19~64 years). Three cases had underwent rotator cuff repair after conversion to full-thickness tear and nine cases had transtendon repair with preserving bursal side cuff. Results: The mean VAS during motion was 6.2 before treatment and 2.0 at final follow-up (p<0.001). The passive forward flexion improved from $163.3^{\circ}$ preoperatively to $169.8^{\circ}$ postoperatively (p=0.038). The mean UCLA score improved from 18.4 preoperatively to 30.1 with 2 excellent, 8 good and 2 fair results at final follow-up. The mean KSS improved from 61.8 preoperatively to 76.8 at final follow-up. By examining the postoperative MR images of 5 patients, complete healing was observed in all of them. Conclusion: Arthroscopic rotator cuff repair may be an effective procedure for partial articular surface tendon avulsion in pain relief and improvement of the range of motion. If the remaining bursal side cuff fibers are intact, transtendon repair procedure with preserving the intact bursal layer of the tendon can be considered. If the remaining bursal side cuff fibers are friable or little, completion from partial-thickness to full-thickness tears with subsequent cuff repair can be considered.

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The effect of global disaster competency development program on paramedic and nursing undergraduate students (글로벌 재난 역량 개발 프로그램이 응급구조과와 간호학과 학생에게 미치는 효과)

  • Kang, Sun-Joo;Piao, Mei-Hua
    • The Korean Journal of Emergency Medical Services
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    • v.18 no.1
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    • pp.83-94
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    • 2014
  • Purpose : This study assessed the improvement of competency levels for participants, as well as their satisfaction from completion of the special international disaster response program. Methods : The program structure followed an intensive two-week course that included a combination of lectures, discussions, case studies, and field trips. "ICN Framework of Disaster Nursing Competencies" was used for designing the program. A pre-post survey was done to measure the change in the competencies of students and assess their satisfaction after finishing the program. Focus group interviews were also performed to further understand the attitudes of participants toward the disaster issues. Results : The overall pre-program test score for disaster competency was $2.18{\pm}0.68$ and the post-program test score was $6.30{\pm}0.84$, which showed statistically significant gains in all competency items (p <.001). The general satisfaction of participants with the program was quite high, demonstrated by a mean score of $4.5{\pm}0.51$. The benefits for students from program participation included increased knowledge and better understanding of the important roles of international organizations and NGOs. Conclusion : The international disaster education programs are necessary to provide an opportunity for students to increase their disaster competency. In addition, future development of a unified educational competency framework is also necessary.

Report on the External Quality Assessment Scheme of Hepatitis Viral Markers in Korea, (2016-2017) (간염바이러스 항원항체검사 신빙도조사 결과보고 (2016-2017))

  • Cho, Eun-Jung;Choi, Ae Ran;Ryu, Ji Hyeong;Yun, So Jeong;Lee, Woochang;Chun, Sail;Min, Won-Ki;Oh, Eun-Jee
    • Laboratory Medicine and Quality Assurance
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    • v.40 no.2
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    • pp.51-69
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    • 2018
  • As part of the immunoserology program of the Korean Association of External Quality Assessment Service, we organized two trials on the external quality assessment of hepatitis viral markers in 2016 and 2017. The hepatitis viral antigens and antibodies program consisted of 10 test items. We delivered two and three types of pooled sera specimens to 965 and 965 institutions for the first and second trials of external proficiency testing in 2016, respectively. The number of participating laboratories was 915 (94.8%) and 913 (95.0%) in the first and second trials in 2016, respectively. We also delivered three kinds of pooled sera specimens to 936 and 1,015 institutions for the first and second trials of external proficiency testing in 2017, respectively. The number of participating laboratories was 920 (98.3%) and 996 (98.1%) in the first and second trials in 2017, respectively. The most commonly tested items were hepatitis B surface antigen, followed by the antibodies to hepatitis B surface antigen, anti-hepatitis C virus, hepatitis B envelope antigen, antibodies to hepatitis B envelope antigen, anti-hepatitis A virus and antibodies to hepatitis B core antigen. The most frequently used methods for detecting viral markers were the chemiluminescence immunoassay and the electrochemiluminescence immunoassay, but they yielded a few-false positive results due to the matrix effect. The immunochromatographic assay yielded false-negative results for anti-hepatitis A virus due to low sensitivity. Continuous improvement in the quality of viral hepatitis testing through participation in the survey seems necessary.