• Title/Summary/Keyword: early infection

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Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results

  • Chang, Ye Rim;Chang, Sung Wook;Kim, Dong Hun;Yun, Jeongseok;Yun, Jung Ho;Lee, Seok Won;Jo, Han Cheol;Choi, Seok Ho
    • Journal of Trauma and Injury
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    • v.30 no.4
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    • pp.113-119
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    • 2017
  • Purpose: Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated. Methods: A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period. Results: Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3. Conclusions: An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.

Prevalent Characteristics of Fowl Typhoid and Antibiotic Susceptibility of Salmonella gallinarum (닭 티푸스의 발생상황과 Salmonella gallinarum의 항균제 감수성)

  • 박노찬;도재철;조광현;장성준;권헌일;박덕상
    • Korean Journal of Veterinary Service
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    • v.18 no.2
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    • pp.113-123
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    • 1995
  • The present study was conducted to investigate the prevalent characteristics of Fowl Typhoid and antibiotic susceptibility of Salmonella gallinarum isolated from 56 infective or dead chickens of 20 egg laying farms in Kyung Buk province during the period from August to December 1994. 1. Among 416, 000 chickens of 92 flocks in 20 egg laying farms, 17, 360 chickens of 31 flocks were died of Fowl Typhoid. 2. Salmonella gallinarum was isolated from 56 chickens in liver and spleen, and then blood of infective chickens was positive to Pullorum antigen. 3, In the survey of gross lesion of 56 chickens, 43 chickens(76.8%) were swelled at liver, 39(69.6%) were swelled at spleen, 12(21.4%) were changed with bronze, 3(5.4% ) were hemorrhagic in peritoneal cavity. 4. In transmission pattern, 4 farms were outbreaked the entrance of chicken house at first, but the others were outbreaked at various place. They were transmitted at right and left directions in flock. 5. 2 farms confirmed at the early stage of infection were eradicated by removing infective chickens and administrating antibiotics, but 18 farms at chronic stage were not. 6. The biochemical properties of 112 Salmonella gallinarum from chickens were generally identical to those of the referance, but H$_2$S was not productive, cellobiose was fermentive. 7 Minimum inhibitory concentration(MIC) of 20 isolates was performed by using 21 antibiotics, MICs of Amikacin(Ak), Gentamicin(Gm), Kanamycin(Km), and Tetracycline (Tc) were below 1.6 ug/ml, Ampicillin(Am), Furazolidone(Fu) and Neomycin(Nm) were below 3.1 ug/ml, Cephalothin(Ce), Cefazoline(Cf) and Chloramphenicol(Cm) were below 6.3 ug/ml, Nalidixic acid(Na), Polymyxin(Po) and Rifampicin(Rf) were below 12.5 ug/ml, Penicillin (Pm) was below 25 ug/ml, Colistin(Co) and Streptomycin(Sm) were below 50 ug/ml, Sulfamerazine(Sr) and Sulfamethazine (St) were below 200 ug/ml, Lincomycin(Lm) and Spiramycin(Sp) were below 400 ug/ml, Bacitracin(Ba) was below 800 ug/ml. 8. Among the 20 isolates, all(100%) of those were sensitive to Ak, Am, Ce, Cf, Cm, Fu, Gm, Km, Na, Nm, Po, Rf, Sr, St and Tc, but 6 isolates(30%) were resistent to Co, 20(100% ) to Ba, Lm, Pm, Sm, and Sp. The drug resistance patterns were simple which 6 strains were BaCoLmPmSmSp type, and 14 were BaLmPmSmSp type.

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Clinial Analysis of Surgical Management for Descending Necrotizing Mediastinitis (하행 괴사성 종격동염의 수술적 치료에 대한 임상적 고찰)

  • Yu, Jeong-Hwan;Lim, Seung-Pyung;Lee, Seok-Ki;Kim, Yong-Ho;Kim, Si-Wook;Kang, Shin-Kwang;Yu, Jae-Hyeon;Lee, Young
    • Journal of Chest Surgery
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    • v.41 no.4
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    • pp.463-468
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    • 2008
  • Background: Descending necrotizing mediastinitis (DNM) is a life-threatening cervico-mediastinal infection extending from the oropharynx or periodontal space. We reviewed clinical outcomes of DNM patients that underwent surgical management. Material and Method: We analyzed the demographic and surgical data from 8 patients (6 males and 2 females) that underwent surgical management for DNM between August 2003 and August 2007. Result: The mean age was $56.6{\pm}12.3$ ($34{\sim}72$) years, Types of DNM were I (n=2), IIA (n=1), and IIB (n=5), based on the classification system of Endo et al. Four patients were septic at the time of operation. The infectious organism was identified in three cases and turned out to be Streptococcus. ICU stay was $24.3{\pm}17.9$ ($3{\sim}58$) days, and hospital stay was $49.1{\pm}33.8$ ($20{\sim}125$) days, There were two deaths (25%), both of which were due to multi-organ failure. Conclusion: Despite aggressive surgical drainage and appropriate medical management, DNM still had a high mortality rate, Early diagnosis and prompt surgical intervention are key to DNM management. In addition, transcervical drainage should be used in limited disease only.

DENS INVAGINATUS IN MANDIBULAR CENTRAL INCISORS (하악 중절치에 발생한 치내치)

  • Lee, Jung-Jin;Choi, Byung-Jai;Lee, Jae-Ho;Choi, Hyung-Jun;Son, Heung-Kyu;Kim, Seong-Oh
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.2
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    • pp.313-318
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    • 2008
  • Dens invaginatus is a rare malformation resulting from invagination of the enamel before calcification has occurred. It is mostly found in permanent maxillary lateral incisors and mandibular teeth are rarely affected by this anomaly. The malformation is estimated to affect between 0.04 % and 10 % of people and has been associated with other abnormalities such as taurodontism, microdontia, gemination and dentinogenesis imperfecta. Dens invaginatus is classified in three types with respect to the depth of invaginatus and has a broad spectrum of morphologic variations. Invagination frequently allows the entry of irritants and microorganism, which usually lead to caries, pulp infection and pulp necrosis. Root canal treatment on such invaginatus tooth may present severe problems because of its complex anatomy of the tooth. Therefore, the early diagnosis of such malformation is crucial and preventive approach is strongly recommended.

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Awareness and Knowledge of Oral Cancer and Potentially Malignant Oral Disorders among Dental Patients in Far North Queensland, Australia

  • Formosa, Joseph;Jenner, Rachel;Nguyen-Thi, My-Duyen;Stephens, Caitlin;Wilson, Corey;Ariyawardana, Anura
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.10
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    • pp.4429-4434
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    • 2015
  • Background: Public awareness/knowledge on oral and pharyngeal cancer (OPC), potentially malignant disorders (PMODs) and their risk factors is crucial for prevention and early detection of OPC and PMODs. Yet, there are no published data available on the awareness and knowledge of OPC and PMODs among people living in Far North Queensland, Australia. Materials and Methods: This study was conducted as a cross sectional survey. A self-administered questionnaire was designed and consisted of relevant questions to ascertain socio-demographic information, awareness and knowledge of OPC, PMODs and risk factors and questions on participant's exposure to risk factors and dietary history were also included. Survey was carried out at the Dental Clinic of the James Cook University School of Dentistry (JCU Dental), Cairns, Australia. Subjects above the age of 20 years (n=366) were randomly selected during the period from 31st July to 6th September 2013 and questionnaire was distributed to complete while they are waiting for treatment. Data analysis was carried out using SPSS version 21 and the chi -squared test was employed to compare groups. P<0.05 was considered statistically significant. Results: The study revealed that 52.3% of the respondents were aware of the existence of OPC but only 19.0% were aware of PMODs. Of those who were aware of oral cancer, 92% agreed or strongly agreed that smoking is a strong risk factor for OPC. Similarly a relatively high proportion of the respondents agreed or strongly agreed that tobacco chewing (84%), tobacco chewing with areca nut (68%), chewing areca nut alone (51%) and exposure to actinic radiation (71%) as risk factors. However, the results for alcohol intake, age, and HPV infection were found to be relatively poor with proportions 33%, 34%, and 23% respectively. Conclusions: This study revealed an alarming lack of awareness and knowledge of OPC and PMODs.

Arthroscopic Treatment of Acute Acromioclavicular Dislocation using $TightRope^{(R)}$ ($TightRope^{(R)}$를 이용한 관절경적 급성 견봉쇄골 관절 탈구의 치료)

  • Kim, In-Bo;Shon, Myung-Hwan;Kim, Moon-Chan;Kim, Dong-Jun
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.1
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    • pp.13-18
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    • 2011
  • Purpose: The purpose of this study is to evaluate the radiologic and clinical results of the arthroscopic coracoclavicular fixation of the acute acromioclavicular dislocation using $TightRope^{(R)}$ (Arthrex, Inc, Naples, FL). Materials and Methods: We performed the arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ in twenty patients with the Rockwood type III or V acute acromioclavicular dislocation between February, 2009, and February, 2010. Mean follow-up was 13.4(range 8~22) months. Radiologic results were evaluated by comparing the distances between the clavicle and the coracoid process with those in the contralateral sides using the acromioclavicular stress radiographs. Clinical results were made according to the KSS(Korean Shoulder Scoring System), and the cosmetic satisfaction of the patient was assessed. Results: Radiologically, 18 cases showed excellent, 1 case showed good and 1 case showed fair results. Clinically, KSS was mean 98.5 (range 92~100) points and all cases revealed satisfactory cosmetic results. Because one case complained of skin tenderness and discomfort of palpation, we closed the knot with surrounding muscle & fascia. Then local wound infection occurred, so we treated it by incision and drainage under local anesthesia and antibiotic therapy for 2 weeks. Conclusion: Arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ for treating the Rockwood type III or V acute acromioclavicular dislocation showed satisfactory radiologic and clinical results. It seems to be a good treatment method that has little postoperative complication, provides an early rehabilitation and an excellent cosmetic result, and does not require secondary operation for removal of metal implant.

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THE LEVELS OF INTERLEUKIN-2, INTERFERON-γ, INTERLEUKIN-4 AND TLYMPHOCYTE SUBPOPULATIONS IN RAT PULPAL INFLAMMATION INDUCED EXPERIMENTALLY BY SPECIFIC BACTERIA (특정 세균으로 유도된 백서의 치수염에서 T 세포 아군집의 분포와 interleukin-2, interferon-γ, interleukin-4의 수준에 관한 연구)

  • Kim, Seon-Ah;Lim, Sung-Sam
    • Restorative Dentistry and Endodontics
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    • v.27 no.1
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    • pp.1-11
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    • 2002
  • Immune responses associated with bacterial infection involve various inflammatory cells. Clinical symptoms and pathologic features are particularly influenced by the predominant cells Among inflammatory cells, T cells have the heterogenity. T cells may develop into the mature cells expressing the cell surface markers with different functions and T helper cells are categorized into Th1 and Th2 cells based on their different patterns of cytokine production. The objective of this study was to investigate the change of expression of surface markers on T cells and the Th1/Th2 immune response in pulpal inflammation associated with specific bacteria. We experimentally induced pulpal inflammation in rat incisors by drilling without coolant and innoculated with Streptococcus mutans (S.M. group), Porphyromonas endodontalis (P.E. group), or only sterile cotton (control group). After 1, 2, and 5 days, mandibular incisors were extracted and the pulp tissues were extirpated The expressions of IL-2 recepters (CD25) and ICAM-1 (CD54) on CD4+ and CD8+ cells in the pulps were determined using a flow cytometer, and the concentration of IL-2, IFN-$\gamma$ and IL-4 was measured by enzyme-linked immunosorbent assay. The results were as follows: 1 In the S.M. group, CD4+ cells were more increased at 2nd day than 1st day and in the P.E. group, CD8+ cells were more increased at 2nd day than 1st day. 2. The percentages of CD4+, CD4+25+ and CD4+54+ cells were decreased in the pulp tissues at 5th day after irritation in all groups. 3. The ratios of CD4+/CD8+, CD4+/CD4+25+ and CD4+/CD4+54+ in the pulps at 2nd day after irritation by P. endodontalis were significantly lower than the other groups. 4. The higher concentrations of IFN-$\gamma$ than IL-4 in the pulps at 2nd day after irritation by P. endodontalis showed that T helper 1 reaction were predominant in the early stage of the pulpal inflammation induced by P. endodontalis. 5. The higher concentrations of IL-4 than IFN-$\gamma$ in the pulps at 1st day and 5th day after irritation by S. mutans were measured but the differences were not significant.

Clinical features and results of recent neonatal cardiac surgery - A review of 82 cases in one hospital (최근 신생아 심장 수술의 특징과 결과 - 단일 병원에서의 82례 고찰)

  • Oh, Ki Won;Kim, Jung Ok;Cho, Joon Yong;Hyun, Myung Chul;Lee, Sang Bum
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.665-671
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    • 2007
  • Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

Effect of Virus-free Plant and Subsoiling Reversion Soil for Reduction of Injury by Continuous Cropping of Sweet Potato (고구마 연작장해 경감을 위한 바이러스 무병묘 재배와 심토반전 효과)

  • Song, Hae-Ahn;Kim, Kab-Cheol;Lee, Seung-Yeob
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.57 no.3
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    • pp.254-261
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    • 2012
  • To reduce the injury by continuous cropping of sweet potato (Ipomoea batatas (L.) Lam.), the farmer's plant and virus-free plant were cultivated with the density of $70{\times}25cm$ (June 10, 2011) in continuous cropping soil (CCS) and subsoiling reversion soil (SRS). Fertilizer was applied at the rates of 55-63-156 $kg\;ha^{-1}$ ($N-P_2O_5-K_2O$) and 10 $ton\;ha^{-1}$ of cattle manure in CCS, and it was applied the 50% increased cattle manure compost and nitrogen in DRS. Symptoms of viral infection were revealed in the farmer's plant at 30 days after planting, but there were no symptoms in virus-free plant. The yield of virus-free plant was more increased 15% and 10.5% than that of farmer's plant in DRS and CCS, respectively. The yield of sweetpotato in SRS was more increased 8.8% and 3.2% in farmer's plant and virus-free plant compared to CCS, respectively. In DRS, the rate of marketable tuber of virus-free plant was increased by 80% compared to the farmer's plant (60.1%). The virus-free plant was produced the tuber with more brilliant peel color and well-formed shape compared to the farmer's plant. The increased yield of virus-free plant and in SRS soil condition showed a positive relationship (p=0.05) with the number of leaf per plant at 30 days and the number of branch per plant at 120 days after planting. The results showed that the early growth after planting was very important for the development of storage root. Therefore, the deep-subsoil reversion and cultivation of virus-free plant could be reduced the injury by continuous cropping of sweet potato, and increased farm income.

Minimal Invasive Plate Osteosynthesis in Proximal Humerus Fractures (상완골 근위부 골절에서의 최소 침습적 금속판 술식)

  • Shin, Sang-Jin;Do, Nam-Hun;Song, Mi-Hyun;Sohn, Hoon-Sang
    • Clinics in Shoulder and Elbow
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    • v.13 no.2
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    • pp.202-208
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    • 2010
  • Purpose: In this study we introduced minimal invasive plate osteosynthesis (MIPO) and analyzed clinical outcomes to determine the effectiveness of this intervention in proximal humerus fractures. Materials and Methods: We studied 27 patients including 16 cases with a 2-part fracture, 10 cases with a 3-part fracture, and 1 case with a 4-part fracture. Clinical outcomes were evaluated using UCLA score, KSS score and recovery of range of motion. Time to union and humerus neck-shaft angle change were estimated by radiologic assessment. The average follow up period was 19 months. Results: UCLA scores were "excellent" for 15 patients, "good" for 12 patients. The mean KSS score was 91.4 at final follow-up. The average shoulder range of motion was $167.2^{\circ}$ in forward elevation. Bone union occurred by 14.1 weeks postoperatively. Humerus neck-shaft angle recovery was "excellent" in 24 patients and "moderate" in 3 patients. There were no complications such as axillary nerve paralysis, deep infection, or subacromial impingement of the plate. Conclusion: MIPO for proximal humerus fractures is an effective procedure if performed with sufficient understanding of the anatomical structures. MIPO leads to minimized dissection of soft tissue, low complication rates and early recovery of range of motion.