Purpose: To report our experience of gastrointestinal operations performed in neonates including low birth weight infants and to evaluate their clinical characteristics. Methods: We retrospectively reviewed the medical records of patients who underwent neonatal gastrointestinal surgery or had necrotizing enterocolitis (NEC) or inguinal hernia from January 2008 to December 2010 at Pusan National University School of Medicine. Results: The main disease was anorectal malformation and male patients were dominant. Twenty four patients (19.2%) had one or more associated anomalies including hydronephrosis and congenital heart disease. Eighteen patients (43.9%) of anorectal malformation had other anomalies. Seventy six percent of NEC cases were very low birth weight infants. Concerning mean days of full enteral feeding after operation, NEC patients needed 30.8 days, which was the longest period. Overall mortality of operation (except NEC and inguinal hernia operation) was 1.6%. The mortality of NEC with surgical treatment was 18.8%. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC patients. Conclusion: The morbidity and mortality after neonatal gastrointestinal surgery were excellent. The direct bilirubin in the operation group was significant higher than in the non-operation group in NEC.
Background: Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010. Materials and Methods: Kaplan-Meier productlimit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends. Results: Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment. Conclusions: We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.
Kim, Rockli;Choi, Narshil;Subramanian, S.V.;Oh, Juhwan
Perspectives in Nursing Science
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v.15
no.2
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pp.49-69
/
2018
Purpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or ${\geq}4$) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended ${\geq}4$ ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as "low" quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as "low" quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.
Kim, Hee Jin;Chun, Byung Chul;Kwon, AmyM;Lee, Gyeong-Ho;Ryu, Sungweon;Oh, Soo Yeon;Lee, Jin Beom;Yoo, Se Hwa;Kim, Eui Sook;Kim, Je Hyeong;Shin, Chol;Lee, Seung Heon
Tuberculosis and Respiratory Diseases
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v.78
no.4
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pp.349-355
/
2015
Background: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. Methods: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. Results: The mean duration of follow-up was $3.9{\pm}0.9years$. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ ${\geq}$ 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). Conclusion: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.
Lee, Keun-Bae;Kim, Byung-Soo;Park, Yu-Bok;Moon, Eun-Sun;Choi, Jin
Journal of Korean Foot and Ankle Society
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v.9
no.2
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pp.140-145
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2005
Purpose: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. Materials and Methods: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. Results: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. Conclusion: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.
Park, Jung-Kyoung;Park, Young-Eun;Song, Yun-Hui;Lee, Eun-Hee;Kim, Tae-Hee
The Journal of Korean Obstetrics and Gynecology
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v.21
no.1
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pp.231-241
/
2008
Purpose: This study estimated HRV and CBC of Qi deficiency-risky group and non-risky group at the seventh day after parturition, and found out their correlation with autonomic nervous system and immunity for the purpose of expressing diagnosis of Oriental Medicine objectively. Methods: The subjects of this study were 33 postpartum women who admitted for postpartum care in Oriental Hospital of Woosuk University from 17th July 2007 to 15th August 2007. We made inquiries based on Qi-Hyul-Su chart of Terasawa Katsutoshi and tested their HRV and CBC. Results: 1. The average age of Qi deficiency-risky group was higher than non-risky group and showed statistical nonsignificances. 2. Normalized LF was higher in Qi deficiency-risky group than non-risky group and Normalized HF was higher in Qi deficiency-non-risky group than risky group, both showed statistical significances. 3. WBC is higher in Qi deficiency-risky group than non-risky group showed statistical significances. WBC and Qi deficiency score had positive correlation. 4. LYM was higher in Qi deficiency-non-risky group than risky group and Grn was higher in Qi deficiency-risky group than non-risky group, both showed statistical significances. Conclusion: We found out that in Qi deficiency-risky group of postpartum women, immunity is lower than in non-risky group.
Objective : The aim of this study is to analyze on the external ventricular drainage [EVD] related ventriculitis, especially on their risk factors, management, and prevention. Methods : From January 2003 to December 2005, a total of 174 EVD catheters were placed in 112 patients at our institution. Of these patients, EVD-related ventriculitis were developed in 15 cases. Clinical variables such as age, sex, prior clinical diagnosis, placement of EVD insertion, duration of EVD, total numbers of EVD per person, and outcome were analyzed in theses cases to verify the risk factors, causative agents and outcomes. Results : Fifteen cases of EVD related ventriculitis were noted presenting infection incidence of 13.39 % per patient and 8.62% per procedure. Of these, five patients died from sepsis, seven patients were recovered from infection but neurological complications remained and three patients were recovered without any complications. Microbes were obtained from cerebrospinal fluid only in six patients. Acinetobactoer baumanii was the most common pathogen in our study [4 cases]. Among the various risk factors, only the prior clinical diagnosis showed the statistical significance. Patients who underwent decompressive craniectomy after severe brain trauma showed unfavorable outcome because of possible contaminative environment compared with other cases. Conclusion : EVD is considered as a safe procedure with good control of intracranial pressure if meticulous care is provided for EVD procedure and maintenance. With regards to risk factors and prevention, the higher incidence and unfavorable outcome was seen especially in patients with severe head trauma. Thus, special attention is required in these clinical settings.
Malignant bowel obstruction (MBO), an occasional complication in patients with advanced urological cancer, causes gastrointestinal symptoms such as nausea and vomiting leading to suffering which severely impairs quality of life (QOL). Drug therapy, especially octreotide, a synthetic analog of somatostatin, is reportedly effective in controlling the symptoms of MBO. In the present study, we administered octreotide to urological cancer patients with MBO and evaluated the improvement of subjective symptoms, oral intake, and nasogastric intubation. Fourteen terminally ill urological cancer patients suffering with MBO were included (age range 55-92, 10 male, 4 female). Octreotide was administered at $300{\mu}g/day$ to those patients subcutaneously as a continuous injection. Significant improvements in subjective symptoms were observed in thirteen patients (92.8%), and ten patients (71.4%) were able to resume oral intake. Four patients required nasogastric drainage before the administration of octreotide, but nasogastric intubation was discontinued in all these cases after the use of octreotide. Early initiation of octreotide resulted in better improvement of MBO symptoms, and no adverse event was observed in any of the patients. These results revealed that $300{\mu}g/day$ dose of octreotide is safe and effective for managing gastrointestinal symptoms of terminally ill urological cancer patients with MBO. We also recommend starting the treatment with ocreotide as soon as MBO is diagnosed.
Background: The aim of this study was to assess the predictive role of religious coping in quality of life of breast cancer patients. Materials and Methods: This multi-center cross-sectional study was conducted in Tehran, Iran, from October 2014 to May 2015. A total of 224 women with breast cancer completed measures of socio-demographic information, religious coping (brief RCOPE), and quality of life (FACT-B). Data were analyzed using descriptive statistics and the t-test, ANOVA, and linear regression analysis. Results: The mean age was 47.1 (SD=9.07) years and the majority were married (81.3%). The mean score for positive religious coping was 22.98 (SD=4.09) while it was 10.13 (SD=3.90) for negative religious coping. Multiple linear regression showed positive and negative religious coping as predictor variables explained a significant amount of variance in overall QOL score ($R^2=.22$, P=.001) after controlling for socio-demographic, and clinical variables. Positive religious coping was associated with improved QOL (${\beta}=0.29$; p=0.001). In contrast, negative religious coping was significantly associated with worse QOL (${\beta}=-0.26$; p=0.005). Conclusions: The results indicated the used types of religious coping strategies are related to better or poorer QOL and highlight the importance of religious support in breast cancer care.
Journal of Fisheries and Marine Sciences Education
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v.14
no.1
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pp.1-26
/
2002
In this paper, we studied the consciousness of Fisheries high school students Through these kinds of works, this paper will focus on how to activate the Fisheries high school in Kyungbuk province. Primarily, research of the consciousness of people living in the fisheries community of the Kyungbuk coast has been engaged in fisheries. Secondly, research is done the consciousness of Fisheries high school students. Thirdly, research of consciousness of neighboring middle school teachers. Finally, searching for reform measures toward activating Fisheries high schools in the whole country. The conclusions of the study were as follows: First, the proper view of fisheries should be settled again. The understandings of basic knowledge about maritime affairs and fisheries in the stages of elementary schools and middle schools are needed. Secondly, in order to find a way out of the difficulties in fishering villages, governmental financial support has to be presente. from the view of fisher folks who are engaged in the fisheries. Thirdly, larger portions of economic value should be allocated to fisheries villages by improving fisheries structure of the fishery. Actually, lower incomes have burdened fisheries villagers with more debts. Fourthly, academic and care counseling must concentrate on the diversification of courses after graduation from fisheries high schools. Realistically, students of fisheries high schools are longing to enter into universities. Fifthly, reorganization of specialized highschool systems, changes of titles of schools and reconstruction of departments should be steadily carried out. Finally, high morale of fisheries highschool teachers should be revised using various steps. They didn't appear to be proud of their teaching jobs. Supervisors ought to exchange their opinions with teachers for the purpose of development of fisheries high schools.
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