Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition

PURPOSE: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments. METHODS: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information). RESULTS: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015~August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016~August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P < 0.01). CONCLUSION: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.

Various Upper Endoscopic Findings of Acute Esophageal Thermal Injury Induced by Diverse Food: A Case Series

Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors.

Body Image, Risk of Disturbed Eating Attitudes and Weight Control of Female Junior High School Students by the Body Mass Index in Seoul / 대한지역사회영양학회지

OBJECTIVES: In this study, perception of body image, eating attitudes and weight control were examined by the degree of obesity using Body Mass Index (BMI). METHODS: Out of 420 questionnaires distributed to the female middle school students (aged 12-16 years), 407 were returned (97% response rate) and 395 were analyzed (94% analysis rate). Female students were divided into two groups based on the BMI percentile using the 2007 Korean National Growth Charts. (1) normal weight (5 th percentile < or = BMI < 85th percentile) (2) obese (85th percentile < or = BMI) by 2007 Korean National Growth Charts. Satisfaction of self-body shape, risk of disturbed eating attitudes (Eating Attitude Test : EAT-26), and weight control behaviors were examined. RESULTS: Distribution of the subjects by BMI was 74.5% of normal and 25.5% of obese. There were significant differences between self-perceived current body image and self-perceived ideal body image. The dissatisfaction of body image was higher in obese than in normal groups (p < 0.001). 51.4% of female students were unsatisfied with their body image, while 2.6% were very satisfied. Among the students unsatisfied with their body image, 150 (52.1%) were of normal weight and 48 (49.4%) were obese. EAT-26 total scores were significantly higher in the obese group (16.42 +/- 8.23) compared with normal group (13.72 +/- 8.10) (p < 0.01). Attempted to weight control were significantly different by the BMI (p < 0.001). CONCLUSIONS: This study concludes that there was desire to become thinner than current status in female students, even those with normal BMI. Many female students were dissatisfied with their body image and attempted to lose weight. It is harmful to their health and nutritional status if they choose undesirable methods. These findings suggested that there are needs to encourage female students for maintaining healthy weight. A higher score of EAT-26 was associated with dissatisfaction of selfbody image and this may lead to unhealthy behaviors in obese female students.

Is There a Difference in the Prevalence of Gastroesophageal Reflux Disease between Peritoneal Dialysis and Hemodialysis Patients? / 대한소화기학회지

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder in patients with chronic kidney disease (CKD). However, little is known about the prevalence of GERD in dialysis patients. The aim of the present study was to investigate the difference in the prevalence of GERD in peritoneal dialysis and hemodialysis patients. METHODS: From July 2010 to August 2011, peritoneal dialysis patients (n=30) and hemodialysis patients (n=38) were enrolled. The prevalences of GERD were assessed at a single center with endoscopic findings and interviews using a questionnaire. Also, risk factors of GERD were evaluated. RESULTS: The prevalences of GERD in peritoneal dialysis and hemodialysis patients were 33.3% and 39.5% (p=0.748), respectively. The prevalences of erosive reflux esophagitis (ERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 23.7% (p=0.477), respectively. The prevalences of nonerosive reflux disease (NERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 13.2% (p=0.685), respectively. The prevalences of GERD, ERD and NERD were higher than those of the general population. The risk factor for GERD was age in hemodialysis patients. CONCLUSIONS: The prevalence of GERD in dialysis patients was higher than that in the general population. However, there was no significant difference between peritoneal dialysis and hemodialysis patients.

A Case of Rectal Ulcer Bleeding Caused by Garlic Inserted into the Rectum

Lower gastrointestinal bleeding can be caused by various etiologies including hemorrhoids, diverticulitis, neoplasms, and ulcerative colitis. However, a rectal ulcer is rarely caused by lower gastrointestinal bleeding, and an anorectal foreign body is a very rare cause of a rectal ulcer. We report the case of a 48-year-old male patient who presented to the emergency department with massive hematochezia and hypovolemic shock that occurred 5 days after inserting garlic into the rectum for treatment of benign prostate hyperplasia.

A Case of Pulmonary Artery Endarteritis due to Staphylococcus lugdunensis in Patient with Clinically Silent Patent Ductus Arteriosus / 이화의대지

Staphylococcus lugdunensis (S. lugdunensis) is an unusually virulent coagulase-negative staphylococci (CNS) and uncommon cause of infective endocarditis (IE) involving mainly native left sided valves. S. lugdunensis IE, which was described previously as "surreptitious" and "wolf in sheep's clothing", runs an aggressive course with a high rate of severe in-hospital complications. Therefore, early surgical treatment has been considered for the treatment of S. lugdunensis IE. However, we experienced a case of S. lugdunensis pulmonary endarteritis which was cured with antibiotic therapy alone.

A Case of Thyroid Storm with Delayed Diagnosis in Old Aged Person with Parkinson's Disease

A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.

An Intraluminal Gallbladder and Bile Duct Hematoma after a Percutaneous Biopsy of Hepatic Adenoma / 대한내과학회지

Hepatocellular adenoma is a rare, but benign, tumor mostly found in women taking oral contraceptives. Hepatocellular adenoma must be treated when bleeding of the tumor, intraperitoneal hemorrhage, or malignant transformation occurs. A percutaneous liver biopsy is relatively safe and effective, but carries the risk of mild complications, such as pain, temporary hypotension, and bleeding, and severe complications, such as intraperitoneal bleeding, peritonitis, pneumothorax, hemothorax, other organ injury, and sepsis. We treated a 33-year-old woman with hemobilia and gallbladder hematoma following a sono-guided percutaneous liver biopsy. Complete quadrantectomy with anterior lobe resection was done after angiography and embolization of the hepatic artery.

Comparing School Lunch Program Served at Dining Room with Program at Classroom for Sanitation and Contentment at One Middle School / 대한지역사회영양학회지

School lunch programs at middle schools have increased in quantity. However, the quality of them is in fact not enough to reach the satisfactory standard, especially in the aspect of environment of school meals. It is true that there seems to be little attention to the environment. In this study, degree of satisfaction about school lunch program was surveyed for students in one middle school. Focus of survey was sanitary condition about the dining room and classroom where they have lunch. First, in order to investigate the degree of satisfaction about their dining place, questionnaire was sent out to the students at one middle school in Seoul. Questionnaire was made with reference to previous research. Second, for the study on environmental sanitation, dropping bacteria (general bacteria) is measured in three parts of dining place (entrance, serving table, dining table). Petriplate film was exposed to the responsible places for 15 minutes and then cultivated at the temperature of 32degrees C for 48 hours before counting the number of bacteria formed. For the statistical analysis, SPSS 12.0 was used. The results of the study show that students had more satisfaction in dining room service than in classroom service. Important factors for the meal program such as "taste of food", "amount of food per student", "state of keeping warm", "appearance of food", "diversity of menu", and "kindliness of feeding staff" had more points in dining room than in classroom. For the environmental and sanitary aspect, the result of dropping bacteria (general bacteria) in dining room and classroom showed that table (5.00) and fooddistribution corner (8.67) of dining room were cleaner than those of classroom (P < 0.05). Making a good environment for school feeding will have a positive effect on the improvement of satisfaction and sanitation of school feeding. There should be expansion of dining room service for the students.

Regulation of cementoblast differentiation and mineralization using conditioned media of odontoblast / 대한치주과학회지

For the regeneration of periodontal tissues, the microenvironment for new attachment of connective tissue fibers should be provided. At this point of view, cementum formation in root surface plays a key role for this new attachment. This study was performed to figure out which factor promotes differentiation of cementoblast. Considering anatomical structure of tooth, we selected the cells which may affect the differentiation of cementoblast - Ameloblast, OD11&MDPC23 for odontoblasts, NIH3T3 for fibroblsts and MG63 for osteoblasts. And OCCM30 was selected for cementoblast cell line. Then, the cell lines were cultured respectively and transferred the conditioned media to OCCM30. To evaluate the result, Alizarin red S stain was proceeded for evaluation of mineralization. The subjected mRNA genes are bone sialoprotein(BSP), alkaline phosphate(ALP), osteocalcin(OC), type I collagen(Col I), osteonectin(SPARC ; secreted protein acidic and rich in cysteine). Expression of the gene were analysed by RT-PCR. The results were as follows: 1. For alizarin red S staining, control OCCM30 didn't show any mineralized red nodules until 14 days. But red nodules started to appear from about 4 days in MDPC-OCCM30 & OD11-OCCM30. 2. For results of RT-PCR, BSP mRNAs of control-OCCM30 and others were expressed from 14 days, but in MDPC23-OCCM30 & OD11-OCCM30 from 4 days. Like this, the gene expression of MDPC23-OCCM30 & OD11-OCCM30 were detected much earlier than others. 3. For confirmation of odontoblast effect on cementoblast, conditioned media of osteoblasts(MG63) which is mineralized by producing matrix vesicles didn't affect on the mineralized nodule formation of cementoblasts(OCCM30). This suggest the possibility that cementoblast mineralization is regulated by specific factor in dentin matrix protein rather than matrix vesicles. Therefore, we proved that the dentin/odontoblast promotes differentiation/mineralization of cementoblasts. This new approach might hole promise as diverse possibilities for the regeneration of tissues after periodontal disease.

A Case of Hemophagocytic Syndrome Manifested as Generalized Skin Eruption in Childhood Atopic Dermatitis / 대한피부과학회지

We report a case of 15-year-old patient, previously diagnosed with atopic dermatitis, who presented with generalized erythematous purpuric patches and petechiae on the face, trunk and extremities. The skin lesions appeared 7 days prior to presentation, accompaied by a high grade fever (38.9 degrees C). The lesions had rapidly become aggrevated after an upper respiratory infection, resulting in severe itching sensation. On physical examination, hepatosplenomegly and cervical lymphadenopathy were noted. The laboratory test showed marked pancytopenia, elevated liver enzymes, hypertriglyceridemia, elevated lactic dehydrogenase level and increased ferritin level. Many hemophagocytic macrophages were detected in bone marrow biopsy. A skin biopsy revealed panniculitis composed of histiocytes and lymphocytes. Hemophagocytic syndrome was diagnosed, and treatment with combination chemotherapy resulted in complete remission.

A Case of Ipsilateral Primary Ovarian Pregnancy After IVF-ET in a Patient with Previous Unilateral Salpingectomy / 대한산부인과학회잡지

Marcus and Brinsden have reported the first ovarian pregnancy achieved by IVT-ET in 1993. They reported seven cases of primary ovarian pregnancy from 116 ectopic pregnancies after IVF. With advancement of ART, the incidence of ectopic pregnancy is increasing, but ovarian pregnancy is still a rare complication. We report a case of ipsilateral primary ovarian pregnancy after IVF-ET with a patient with previous unilateral salpingectomy with a brief review of literature.

A Change of Peripheral CD56+Natural Killer Cell Fraction in Recurrent Pregnancy Loss Patients who Successfully Treated with Intravenous Immunoglobulin in Previous Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the change of peripheral blood CD56+NK cell fraction in recurrent pregnancy loss patients who successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy. METHODS: The study subjects were women with a history of two or more documented consecutive spontaneous pregnancy loss under 20 weeks of gestation and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, excluding any aneuploidy by karyotype analysis, and with no evidence of genetic, endocrine, infections or anatomic factors. We retrospectively analyzed the medical record study subjects of the change of peripheral blood CD56+NK cell fraction before and after successful birth of baby beyond 25 weeks since June, 1998 to September, 2003 in Samsung Cheil Hospital. Healthy women with no history of recurrent pregnancy loss and having one baby with pregnancy ongoing at least 25 weeks selected as a control group and we compare the CD56+NK cell fraction to that of study group. RESULTS: Pre- and after conceptional CD56+NK cell fraction in women with next pregnancy beyond 25 weeks after IVIg treatment (n=16, pre: 24.5 +/- 1.2, after: 22.5 +/- 1.5) were significantly high compared with control group (n=14,8.9 +/- 1.3) (T-test, p<0.05), but the difference between pre- and after conceptional CD56+NK cell fraction was not statistically significant. Among 16 women with IVIg treatment in previous pregnancy, after conceptional CD56+NK cell fraction below 15%, who regarded as have no need of IVIg treatment in next pregnancy were 3 women (3/16, 18.7%), but most of women with IVIg treatment in previous pregnancy (13/16, 81.3%) were regard as need of IVIg treatment in next preganacy. CONCLUSION: For the safety of pregnancy in women with history of recurrent spontaneous abortion and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, IVIg treatment should be considered in consecutive pregnancy.

Intramural Pregnancy after in vitro Fertilization and Embryo Transfer / 대한불임학회지

Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.

Implantation Rate and Clinical Pregnancy Rate According to Dosage and Timing of Progesterone Administration for Secretory Endometrial Preparation in Frozen-Thawed Embryo Transfer Cycles / 대한불임학회지

OBJECTIVE: To evaluate the difference of implantation rate (IR) and clinical pregnancy rate (CPR) between two protocols of endometrial preperation in women undergoing frozen-thawed embryo transfer (FET) cycles. METHODS: This study was performed during the different time periods: A retrospective study from January 2000 to June 2001 (phase I) and a prospective study from July 2001 to March 2002 (phase II). All the patients received estradiol valerate (6 mg p.o. daily) starting from day 1 or 2 of the menstrual cycle without pituitary down regulation. Progesterone was administered around day 14 after sonographic confirmation of endometrial thickness > or = 7 mm and no growing follicle. In Group A (n=88, 99 cycles) of phase I, progesterone was administered i.m. at a dose of 50 mg daily from one day prior to thawing of pronuclear (PN) stage frozen embryo or three days prior to thawing of 6-8 cell stage frozen embryo and then each stage embryos were trasnsferred 2 days or 1 day later after thawing. In Group B (n=246, 299 cycles) of phase I, patients recieved progesterone 100 mg i.m. from one day earlier than group A; two days prior to PN embryo thawing, four days prior to of 6-8 cell embryo thawing. During the phase II, to exclude any differences in embryo transfer procedures, in Group 1 (n=23, 28 cycles) of phase II embryo was transfered by one who have used the progesterone protocol since the phase I. In Group 2 (n=122, 139 cycles) of phase II embryo was transfered by one who use the progesterone protocol from the phase II. RESULTS: When compared across the phase and group, there were no significant differences in the characteristics. During the phase I, there were significant increase in IR (14.4% vs 5.9%, p=0.001) and CPR (28.3% vs 14.5%, p=0.000) in group A. During the phases II, IR (11.8% vs 10.6%) and CPR (27.6% vs 27.3%) show no differences between two groups. CONCLUSIONS: In FET cycles, IR and CPR are increased significantly by the change of dosage and timing of progesterone administraton. And the timing is considered to be more important factor because the dosage of progesterone did not affect implantation window in previous studies. Therefore, we suggest that progesterone administration in FET cycle should begin from one day prior to PN stage embryo thawing and three days prior to 6-8 cell stage embryo thawing.

A Case of Thyroid Cancer Detected with Pet Scan

Although the utility of FDG-PET scan is usually limited to the follow up of a recurrence follow the resection of primary malignant tumors. Its usefulness may be widen to the diagnosis in some malignant neoplasms; that use mostly glucose their energy sources. Thyroid cancers use glucose for their metabolic activities and incidental focal thyroid uptake shown on FDG-PET scans may be representative of a primary tumor. Therefore, increased focal thyroid uptake shown on whole body FDG-PET scans should not be overlooked even when it is not marked, and prompt further investigation should be done to rule out a possible cancer. We present a case of thyroid cancer, incidentally detected with a PET scan in a 60-year-old-man. We also present a review of the literatures regarding the usefulness of PET scan in thyroid cancer.

Poorly Differentiated Endometrial Adenocarcinoma with Trophoblastic Differentiation / 대한산부인과학회잡지

Trophoblastic differentiation in gynecologic nontrophoblastic tumor is very rare. Here we present a 66-year-old female with poorly differentiated endometrial carcinoma showing trophoblast-like differentiation. This tumor was in advanced stage with metastases to lung, liver, and bone at diagnosis. The multinucleated, syncytiotrophoblast-like cells were positive for beta-human chorionic gonadotropin (beta-hCG) by immunochemical stain. The level of beta-hCG was also elevated (219 mIU/ml) in the patient's serum, but dropped after surgery and chemotherapy. beta-hCG may be used as tumor marker in this case.

No title available in English / 대한내분비외과학회지

No abstract available.

A Case of Embryonal Rhabdomyosarcoma Arising from Vaginal wall in a 5 Year Old Child / 대한부인종양콜포스코피학회잡지

Embryonal rhabdomyosarcoma, called sarcoma botryoides, is the most common malignant tumor arising from in the infant vagina. This tumor is diagnosed before the age of 5 and highly malignant. We experienced a case of embryonal rhabdomyosarcoma arising from vaginal wall in 5-year-old girl. Authors presented this case with a brief review of literature.