• Title/Summary/Keyword: e-clinical data

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A contact investigation after exposure to a child with disseminated tuberculosis mimicking inflammatory bowel disease

  • Kim, Dongsub;Lee, Sodam;Kang, Sang-Hee;Park, Mi-Sun;Yoo, So-Young;Jeon, Tae Yeon;Choi, JoonSik;Kim, Bora;Choi, Jong Rim;Cho, Sun Young;Chung, Doo Ryeon;Choe, Yon Ho;Kim, Yae-Jean
    • Clinical and Experimental Pediatrics
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    • v.61 no.11
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    • pp.366-370
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    • 2018
  • Purpose: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. Methods: A 4-year-old child without Bacille Calmette-$Gu{\acute{e}}rin$ vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. Results: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. Conclusion: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.

Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

  • Desiderio, Jacopo;Stewart, Camille L.;Sun, Virginia;Melstrom, Laleh;Warner, Susanne;Lee, Byrne;Schoellhammer, Hans F.;Trisal, Vijay;Paz, Benjamin;Fong, Yuman;Woo, Yanghee
    • Journal of Gastric Cancer
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    • v.18 no.3
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    • pp.230-241
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    • 2018
  • Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GCERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. Materials and Methods: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. Results: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). Conclusions: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

A Study on Development of Questionaire for Use in Epidmiologic Survey on Respiratory Illness in Korea (호흡기계(系) 질환의 역학적(疫學的) 조사방법 게발에 관한 연구(II) -한국(韓國) 실정에 맞는 설문조사서 개발-)

  • Ahn, Yoon-Ok;Kim, Keun-Youl;Kwon, E-Hyock
    • Journal of Preventive Medicine and Public Health
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    • v.15 no.1
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    • pp.57-73
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    • 1982
  • Questionaires on symptoms of respiratory disease have been used in Korea to elicit the probable health effects of air pollution in epidemiologic studies: The objectives of such studies often include comparing prevalence of symptoms of respiratory system between different population groups or between the same population groups, at different times. Unfortunately, little attention has, been paid to standardization of those questionaires, whether those are Korean. versions or not. Furthermore, no attempt to develop Korean ,questionaire on respiratory symptoms and relevant information has been made. Followed by 'a comparative study on responses to Korean version questionaires(English origin) of CMI, MRC, and ATS-DLD-78' two types of questionaires on respiratory symptoms and relevant information for Korean adult, which are short form (SUN-81-AS) and long forms (optional questions are added to the short one, SUN-81-AL), have been designed suitable to Korean background by authors (see Annex). The self-administered and closed-question questionaire were tested their validity and reliability by administration to l80 normal adults (medical and nursing students) and 60 clinical patients of Seoul National University Hospital, with spirometric exam. The results obtained and conclusions drawn are as follow: 1. It took less than 10 minutes to complete the questionaire SNU-81-AS and SNU-81-AL. 2. The test-retest reliability of each questions in AS and AL ,were observed as 92.7% and 92.1%, respectively. And all of the level of agreement are statistically significant with kappa statistic. 3. In addition to higher prevalence rate of symptoms in patients group compared, with, normal. group, the correlations between FEV 1.0/FVC predictive value(%) and number of symptoms were statistically significant inpatients group (See Fig. 1 and, Table 7). 4. The answer rate to optional questions in AL form among those who are not to do was about 10%, while the no-answer rate among who are to do was about 15% in Normal (medical and nursing students) group. 5. From the viewpoints of validity and reliability, the new Korean questionaire (SNU-81-AS and AL) developed by authors are to be recommendable to use in epidemiologic studies on respiratory illness in Korea. The self-administration, however, of optional questions in AL form may not assure the quality of data gathered.

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The Trends and Prospects of Health Information Standards : Standardization Analysis and Suggestions (의료정보 표준에 관한 연구 : 표준화 분석 및 전망)

  • Kim, Chang-Soo
    • Journal of radiological science and technology
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    • v.31 no.1
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    • pp.1-10
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    • 2008
  • Ubiquitous health care system, which is one of the developing solution technologies of IT, BT and NT, could give us new medical environments in future. Implementing health information systems can be complex, expensive and frustrating. Healthcare professionals seeking to acquire or upgrade systems do not have a convenient, reliable way of specifying a level of adherence to communication standards sufficient to achieve truly efficient interoperability. Great progress has been made in establishing such standards-DICOM, IHE and HL7, notably, are now highly advanced. IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based integration profiles for information exchange with three interrelated efforts. HL7 is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. Most SDOs produce standards (protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance transactions. HL7's domain is clinical and administrative data. HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. The ASTM specification for Continuity of Care Record was developed by subcommittee E31.28 on electronic health records, which includes clinicians, provider institutions, administrators, patient advocates, vendors, and health industry. In this paper, there are suggestions that provide a test bed, demonstration and specification of how standards such a IHE, HL7, ASTM can be used to provide an integrated environment.

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The Neuroprotective Effect of White Ginseng (Panax ginseng C. A. Meyer) on the Trimethyltin (TMT)-Induced Memory Deficit Rats (Trimethyltin으로 유도된 기억장애 흰쥐에서 백삼의 신경보호효과)

  • Lee, Seung-Eun;Shim, In-Sop;Kim, Geum-Soog;Yim, Sung-Vin;Park, Hyun-Jung;Shim, Hyun-Soo;Ye, Min-Sook;Kim, Seung-Yu
    • Korean Journal of Medicinal Crop Science
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    • v.19 no.6
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    • pp.456-463
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    • 2011
  • The present study examined the effects of Korean white ginseng (WG, Panax ginseng C. A. Meyer) on the learning and memory function and the neural activity in rats with trimethyltin (TMT)-induced memory deficits. The rats were administered with saline or WG (WG 100 or 300 mg/kg, p.o.) daily for 21 days. The cognitive improving efficacy of WG on the amnesic rats, which was induced by TMT, was investigated by assessing the Morris water maze test and by performing immunohistochemistries on choline acetyltransferase (ChAT), acetylcholinesterase (AchE), cAMP responsive element binding protein (CREB) and brain derived neurotrophic factor (BDNF). The rats treated with TMT injection (control group) showed impaired learning and memory of the tasks, but the rats treated with TMT injection and WG administration produced significant improvement of the escape latency to find the platform in the Morris water maze at the 2nd and 4th days compared to that of the control group. In the retention test, the WG 100 and WG 300 groups showed significantly increased crossing number around the platform compared to that of the control group (p < 0.001). Consistently with the behavioral data, result of immunohistochemistry analysis showed that WG 100 mg/kg significantly alleviated the loss of BDNF-ir neurons in the hippocampus compared to that of the control group (p < 0.01). Also, treatment with WG has a trend to be increased the cholinergic neurons in the hippocampal CA1 and CA3 areas as compared to that of the control group. These results suggest that WG may be useful for improving the cognitive function via regulation of neurotrophic activity.

The Effect of the Range of Motion Exercise on Powerlessness and Life Satisfaction in the Elderly (근관절운동이 노인의 무력감 정도에 미치는 영향)

  • 신재신
    • Journal of Korean Academy of Nursing
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    • v.23 no.1
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    • pp.107-117
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    • 1993
  • This study was a clinical Quasi-experiment to examine the effects of the range of motion exercise on powerlessness and life satisfaction among the E-Institutionalized elderly in Pusan. The purpose was to test the effect of the range of motion exercises on powerlessness and life satis-faction, and to examine the correlation between powerlessness and life satisfaction. The subjects for this study were 54 elderly people, both were over 60 and residing at I-Institution in Pusan. The research samples of 54 elderly were divided into an experimental and control group by matching randomized assignment. The instruments for this study were the Assessment Tool of Powerlessness in the elderly developed by Miller, Life satisfaction developed by Yoon Jin, and the Active-Passive Range of Motion Exercise Program which was developed and utilized by Shin, Jae-Shin. The data were collected from December 15, 1990 to November 1991. The paired t-test, t-test and ANCOVA were used to test hypothesis I and II, related to the Effect of the Range of Motion Exercises to powerlessness and life satisfaction. To identify the relationship of the range of motion exercises to powerlessness and life satisfaction, path analysis was done through multiple regression. The interrelationship of the variables was analyzed using t-test paired t-test. The results of the three hypothesis can be summarized as follows : 1. Hypothesis I -the experimental group which participated in the Range of Motion Exercise gets lower powerlessness score than that of the control group-was accepted by t-test (t = -3.40, p = .001) but not accepted by ANCOVA (F = .1, p =.96). 2. Hypothesis II - the experimental group which participated in the Range of Motion Exercise gets a higher Life Satisfaction Score than that of the control group-was not supported by t-test(t = 1.01, p = .316) but was accepted by ANCOVA (F = 4.39, p = .006). 3. Hypothesis III - if the powerlessness Score becomes higher, the Life Satisfaction Score will be-come lower - was accepted by Pearson Correlation Coefficient (pre-exercise : r : -.34, p=.006), (post exercise : r = -.06, p=.32) . The relation-ship between the score of powerlessness and life satisfaction was negatively correlated. The results obtained clearly showed that the effects of the range of motion exercises on powerlessness and life satisfaction are beneficial to the elderly The relation between the scores of powerlessness and life satisfaction was negatively correlated and the range of motion exercise had a direct influence to powerlessness. Therefore, it is concluded that the relationship between powerlessness and life satis-faction was not a causal one. Also it is concluded that the range of motion exercises can be applied as a nursing intervention to reduce powerlessness and to improve life satisfaction in the elderly.

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Production and Action of Microbial Piscicidal Substance (미생물에 의한 살어성물질의 생성 및 그 작용)

  • 도재호;서정훈
    • Microbiology and Biotechnology Letters
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    • v.6 no.1
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    • pp.41-46
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    • 1978
  • Piscicidal substance produced by Streptomyces sp. isolated from soil was toxic against various kinds of fish. After extraction with CH$Cl_3$ from the culture medium, the substance was purified by avicel column chromatography. In order to test toxicity, various kinds of fish were subjected to the acqueous solution of 100 us of the substance per liter of water. Generally, the substance was toxic to most fish, but Macropodus chinenes and Misgurnus mizolepis are resistant to the substance than Gobius similis and Pseudorasbora parva. The substance was stable at pH range, 3.0 to 7.0, but labile at alkaline pH, and to heat as well. Succinic dehydrogenase on most of tissue cell of Cyprinus carpio was inhibited by this substance strongly, but spinal cord was not inhibited. By addition of Cu and Pb salts to the culture medium, piscicidal substance producibility was activated.

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Epidemiologic Characteristics of Human Bocavirus-Associated Respiratory Infection in Children (소아 보카바이러스 호흡기 감염증의 역학적 특징)

  • Choi, Jae Hong;Paik, Ji Yeun;Choi, Eun Hwa;Lee, Hoan Jong
    • Pediatric Infection and Vaccine
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    • v.18 no.1
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    • pp.61-67
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    • 2011
  • Purpose : This study was performed to investigate the epidemiologic characteristics of human bocavirus (HBoV)-associated lower respiratory tract infections (LRTIs) in children. Methods : Nasopharyngeal aspirate samples were obtained from 658 children who had been hospitalized for LRTIs in Seoul National University (SNU) Children's Hospital and SNU Bundang Hospital from March 2000 to September 2005. Multiplex RT-PCR was performed to detect 11 respiratory viruses including respiratory syncytial virus, adenovirus, rhinovirus, parainfluenza viruses 1 and 3, influenza viruses A and B, human metapneumovirus, HBoV, human coronavirus (HCoV) OC43/ 229E, and HCoV-NL63. Clinical data were reviewed retrospectively. Results : Overall, respiratory viruses were detected in 325 (49.4%) among 658 patients. HBoV was detected in 62 cases (9.4%) and was responsible for 19.1% of virus-positive cases. HBoV was prevalent among infants and young children aged from 3 months to 5 years with the mean age of 25.3 months. Co-detection of HBoV and other respiratory viruses was observed in 37.1% which is significantly higher than average co-detection rate (12.3%) among overall virus-positive cases (P=0.000). HBoV was identified mainly in late spring and early summer from May to July. Conclusion : This study describes epidemiologic features of HBoV in Korean children compared with those associated with other respiratory viruses. HBoV was prevalent among LRTIs in childhood, especially in late spring and early summer season in Korea.

Radiation Therapy of Nasopharyngeal Cancers (비인강암의 방사선치료성적)

  • Shin, Sei-One;Kim, Sung-Kyu;Kim, Myung-Se
    • Journal of Yeungnam Medical Science
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    • v.9 no.2
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    • pp.312-320
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    • 1992
  • Radiotherapeutically, nasopharyngeal cancer is an important disease in korea. Because of its blind anatomic location, early detection is relatively uncommon. Clinically, most of cases are locally advanced and nodal involvement are common. Recently better understanding of nature of the disease and improvement of radio-therapy technique permit better treatment results, including locoregional control and survival rate, and minimal normal tissue damages comparing with previously published data. We analyzed 31 patients of pathologically proven and previously untreated naso-pharyngeal carcinoma with different treatment techniques, retrospectively. Minimal and maximal follow up period of the survuor is 6 months and 68 months, respectively. Thirteen patients with squamous cell carcinoma are included in this analysis. The median age is 49 years(range from 20 to 64 years). Twenty two patients are stage III. Eleven patients are treated with radiotherapy alone and 20 are treated with comblined modalities treatment. The degree of responses after radiotherapy are categorized by 3-classes, i.e. complete response, partial response. In spite of simioarities of complete response rate and 1-year survival rate between two different treatment techniques, those patients with undifferentiated carcinoma appear to benefit from the adjuvant chemotherapy. In addition, systemic failure is more prominant in radiotherapy alone group than in combined modalities treatment group. These results suggest that adjuvant therapy in the radiotherapeutic management of nasopharyngeal cancers needs additional research according to histologic types and future extensive clinical trials.

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Efficacy of Clomiphene Citrate Stimulated Cycle in Poor Responders in in vitro Fertilization (Poor Responder 환자에서 Clomiphene Citrate 주기와 Controlled Ovarian Hyperstimulation 주기의 체외수정 결과 비교)

  • Song, Ji-Hong;Koong, Mi-Kyoung
    • Clinical and Experimental Reproductive Medicine
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    • v.25 no.3
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    • pp.239-244
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    • 1998
  • The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol<600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected $3\sim4$ times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 pg/ml and mean follicle diameter>16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of $E_2$ ($810{\pm}112$ vs $412{\pm}55$ pg/ml) and greater number of retrieved oocytes ($3.0{\pm}0.2$ vs $2.0{\pm}0.2$) than CC group. CC group had transferred embryos $(1.8{\pm}0.2)$ compared with $(2.1{\pm}0.2)$ in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly (p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.

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