An Analysis of Organizational Performance Based on Hospital Specialization Level and Strategy Type.

INTRODUCTION: Hospitals are studying the focused factory concept and attempting to increase their power in a competitive industry by becoming more specialized. METHODOLOGY: This study uses the information theory index (ITI) and the Herfindahl-Hirschman index (HHI) to analyze the extent of specialization by Korean hospitals that receive national health insurance reimbursements. Hierarchical regression analysis is used to assess the impact of hospital specialization on the following four aspects of operational performance: productivity, profitability, efficiency and quality of care. STUDY RESULTS: The results show that a focused strategy (high HHI) improves the income and adjusted number of patients per specialist through the efficient utilization of human resources. However, a diversified strategy (high ITI) improves the hospital utilization ratio, income per bed and adjusted number of patients per bed (controlling for material resources such as beds). In addition, as the concentration index increases, case-mix mortality rates and referral rates decrease, indicating that specialization has a positive relationship with quality of care.

Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Ultrasound contrast-enhanced study as an imaging biomarker for anti-cancer drug treatment: preliminary study with paclitaxel in a xenograft mouse tumor model (secondary publication)

PURPOSE: The purpose of this study was to assess tumor angiogenesis using contrast-enhanced ultrasonography (CEUS) of human prostate cancer cells (PC3) that were implanted in mice before and after paclitaxel injection. METHODS: Twelve mice were injected with human PC3. The mice were grouped into two groups; one was the paclitaxel-treated group (n=6) and the other was the control group (n=6). Before administering paclitaxel into the peritoneal cavity, baseline CEUS was performed after the administration of 500 μL (1×108 microbubbles) of contrast agent. The area under the curve (AUC) up to 50 seconds after injection was derived from the time-intensity curves. After injection of paclitaxel or saline, CEUS studies were performed at the 1-week follow-up. Changes in tumor volume and the AUC in both two groups were evaluated. After CEUS, the microvessel density (MVD) was compared between the groups. RESULTS: In the paclitaxel-treated group, the AUC from CEUS showed a significant decrease 1-week after paclitaxel administration (P=0.030), even though the tumor volume showed no significant changes (P=0.116). In the control group, there was no significant decrease of the AUC (P=0.173). Pathologically, there was a significant difference in MVD between both groups (P=0.002). CONCLUSION: The AUC from the time intensity curve derived from CEUS showed an early change in response to the anti-cancer drug treatment that preceded the change in tumor size. The findings of CEUS could serve as an imaging biomarker for assessing tumor responses to anti-cancer drug treatment.

The comparative evaluation of expanded national immunization policies in Korea using an analytic hierarchy process.

The purpose of this paper is to propose new evaluation criteria and an analytic hierarchy process (AHP) model to assess the expanded national immunization programs (ENIPs) and to evaluate two alternative health care policies. One of the alternative policies is that private clinics and hospitals would offer free vaccination services to children and the other of them is that public health centers would offer these free vaccination services. Our model to evaluate the ENIPs was developed using brainstorming, Delphi techniques, and the AHP model. We first used the brainstorming and Delphi techniques, as well as literature reviews, to determine 25 criteria with which to evaluate the national immunization policy; we then proposed a hierarchical structure of the AHP model to assess ENIPs. By applying the proposed AHP model to the assessment of ENIPs for Korean immunization policies, we show that free vaccination services should be provided by private clinics and hospitals rather than public health centers.

The Correlations of Parameters Using Contrast Enhanced Ultrasonography in the Evaluation of Prostate Cancer Angiogenesis

PURPOSE: The purpose of this study is to investigate the correlations of various kinetic parameters derived from the time intensity curve in a xenograft mouse model injected with a prostate cancer model (PC-3 and LNCaP) using an ultrasound contrast agent with histopathologic parameters. MATERIALS AND METHODS: Twenty nude mice were injected with human prostate cancer cells (15 PC-3 and five LNCaP) on their hind limbs. A bolus of 500 microL (1 x 10(8) microbubbles) of second-generation US contrast agent (SonoVue) was injected into the retroorbital vein. The region of interest was drawn over the entire tumor. The time intensity curve was acquired and then fitted to a gamma variate function. The maximal intensity (A), time to peak (Tp), maximal wash-in rate (washin), washout rate (washout), area under the curve up to 50 sec (AUC50), area under the ascending slope (AUC(in)), and area under the descending slope (AUC(out)) were derived from the parameters of the gamma variate fit. Immunohistochemical staining for VEGF and CD31 was performed. Tumor volume, the area percentage of VEGF stained in a field, and the count of CD31 (microvessel density, MVD) positive vessels showed correlation with the parameters from the time intensity curve. RESULTS: No significant differences were observed between the kinetic and histopathological parameters from each group. MVD showed positive correlation with A (r=0.625, p=0.003), washin (r=0.462, p=0.040), AUC50 (r=0.604, p=0.005), and AUC(out) (r=0.587, p=0.007). Positive correlations were also observed between tumor volume and AUC50 (r=0.481, p=0.032), washin (r=0.662, p=0.001), and AUC(out) (r=0.547, p=0.012). Washout showed negative correlations with MVD (r=-0.454, p=0.044) and tumor volume (r=-0.464, p=0.039). The area percentage of VEGF did not show any correlation with calculated data from the curve. CONCLUSION: MVD showed correlations with several of the kinetic parameters. CE-US has the potential for prediction of tumor vascularity in a prostate cancer animal model.

US Contrast Enhanced Study as an Imaging Biomarker of Anti-cancer Drug Treatment: Preliminary Study with Paclitaxel and a Xenograft Mouse Tumor Model

PURPOSE: We wanted to assess tumor angiogenesis of human prostate cancer cells (PC3) implanted in mice before and after paclitaxel injection via contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: Twelve mice were injected with human prostate cancer cells (PC3) on the back or hind limbs. The mice were grouped into two groups; one was the paclitaxel treated group (n = 6) and the other was the control group, which was treated with normal saline (n = 6). Before injection of paclitaxel into the peritoneal cavity, baseline CEUS was performed by the administration of 500 microl (1x108 microbubbles) of contrast agent. The area under the curve (AUC) up to 50 seconds after contrast injection was derived from the time-intensity curves. After injection of paclitaxel or saline, one week follow up CEUS studies were performed. The changes of the tumor volume and the AUC in both two groups were evaluated. After CEUS, the mice were sacrificed and the microvessel density (MVD) was compared. RESULTS: In the paclitaxel treated group, the AUC from CEUS showed a significant decrease one week after paclitaxel administration (p = 0.03), even though the tumor volume showed no significant changes (p = 0.116). In the control group, there was no significant decrease of the AUC (p = 0.173). Pathologically, there was a significant difference of microvessel density in both groups (p = 0.002). CONCLUSION: The AUC from the time intensity curve derived from CEUS showed early change in response to the anti-cancer drug treatment in advance of a tumor size response. The findings of CEUS could be an imaging biomarker for assessing the tumor response to anti-cancer drug treatment.

[Epidemiology of psychosocial distress in Korean employees].

OBJECTIVE: To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample. METHODS: A total of 6977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress. RESULTS: The results showed that 23% of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand. CONCLUSIONS: The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e.g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.

[Correlates of self-rated fatigue in Korean employees].

OBJECTIVE: To elucidate the correlates of self-rated fatigue in Korean employees. METHODS: The data for 10,176 (men, 7984; women, 2192; mean age, 34.2; SD: 8.8) employees recruited from a nation-wide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS). RESULTS: According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (< 1000 employees). CONCLUSIONS: These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health,outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.

Transradial Coronary Intervention: Comparison of the Left and Right Radial Artery Approach

BACKGROUND AND OBJECTIVES: We evaluated the efficacy and safety of the left transradial approach as compared to the right radial approach when performing transradial coronary intervention. SUBJECTS AND METHODS: We performed the transradial coronary intervention in 711 cases via the left approach (Lt. group) and in 614 cases via the right approach (Rt. group) for patients with a normal Allen's test of both arms. We evaluated the procedural success rate, the crossover rate, the puncture time, the total procedural duration, the fluoroscopy time, the amount of contrast agent used and the local vascular complications of both groups. RESULTS: The baseline clinical and angiographic profiles were comparable between both groups. The puncture time, the amount of contrast agent used, choice of the guide catheter and local vascular complications were similar for the two groups. There was no difference in the procedural success rate (Rt. group; 96.4% vs. Lt. group; 96.2%, p=NS). However, there was tendency for a higher success rate via radial access for the Lt. group than for the Rt. group (Rt. group; 91.9% vs. Lt. group; 93.5%, p=0.056). The crossover rate was lower for the Lt. group than for the Rt. group (2.7 % vs. 4.6%, respectively; p=0.04). The total procedural time (32.3+/-15.4. vs. 30.7+/-17.6 min, respectively; p=0.03) and fluoroscopy time (16.9+/-12.6 vs. 13.9+/-7.9 min, respectively; p<0.01) were shorter in the Lt. group. The number of guide catheters used was higher in the Rt. group compared to the Lt. group (1.21+/-0.48 vs. 1.08+/-0.33, respectively; p=0.04). CONCLUSION: The left radial approach may provide increased procedural efficacy for transradial PCI compared to the right radial approach along with similar complications.

Broken Guidewire Fragment in the Radio-brachial Artery During Transradial Sheath Placement: Percutaneous Retrieval via Femoral Approach

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire was captivated into the guiding catheter. By inflating the balloon catheter inside of the guiding catheter, seized broken guidewire between the inflated balloon and the guiding catheter was removed successfully by withdrawing the whole system en bloc.

Feasibility of the Radial Artery as a Vascular Access Route in Performing Primary Percutaneous Coronary Intervention

We aimed to evaluate the feasibility of transradial primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) by comparing the procedural results and complications with those of transfemoral intervention. From April 1997 to October 2004, we enrolled 352 consecutive cases of STEMI who underwent primary PCI. The femoral route was used in 132 cases (TFI group) and the radial route was used in 220 cases (TRI group). Cases with Killips class IV, a negative Allen test or a non-palpable radial artery were excluded from our study. Baseline clinical and angiographic profiles were comparable in both groups. Vascular access time was 3.8 +/- 3.5 min in the TFI group and 3.6 +/- 3.1 min in the TRI group, and cath room to reperfusion time was 25 +/- 11 min in the TRI group and 26 +/- 13 min in the TRI group. The procedural success rate was 89% in the TFI group and 88% in the TRI group. Crossover occurred in 9 cases (4%) due to approaching vessel tortuosity in the TRI group. Major access site complications occurred in 7 cases (5%) in the TFI group, and there were no complications in the TRI group (p < 0.001). Although radial occlusion occurred in 5 cases of the TRI group, there was no evidence of hand ischemia. The total hospital stay was significantly shorter in TRI group than in TFI group. In conclusion, use of the radial artery might be a potential vascular access route in performing primary PCI in selected cases.

A Diagnostic Value of Ischemia Modified Albumin in Patients with Suspected Acute Coronary Syndrome with Normal EKG and Cardiac Markers

BACKGROUND AND OBJECTIVES: In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. SUBJECTS AND METHODS: We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. RESULTS: The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. CONCLUSION: IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain.

A Case of Brachial Plexus Block in a Patient with Multiple Sclerosis / 대한마취과학회지

Multiple sclerosis is an acquired, demyelinating disease of the central nervous system Clinically, it is characterized by episodes of focal disorder of the optic nerves, spinal cord, and brain, which remit to a varying extent and recur over a period of many years. Because of the possibilities of neurologic exacerbation, general anesthesia is usually recommended, while spinal anesthesia is discouraged. Epidural anesthesia may be less of a risk than spinal anesthesia, because the concentration of local anesthetic in spinal cord white matter is lower. Other regional anesthesia is not likely to predispose postoperative exacerbation of multiple sclerosis, but a controlled study has not been performed. A 17 year-old female patient with advanced multiple sclemsis was successfully managed for internal fixation of ulnar fracture using brachial plexus block. The patient recovered well after block without any aggravation of neurologic symptoms.

Correlation between P300 Latency and Cognitive Capacity Screening Examination in Patients with Brain Lesion

OBJECTIVE: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion. METHOD: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE. RESULTS: The mean latency of P300 was 383.07+/-50.63 msec. The mean score of CCSE was 17.10+/-8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r= 0.686), between score of CCSE and age (p<0.05, r= 0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771). CONCLUSION: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.

An Analysis on Curriculum Content of Child Nursing in Korea / 아동간호학회지

The purpose of nursing education is to prepare the professional practitioner as nurse who will be interested in the health and the related aspects of community and will assume responsibility for contributing toward the improvement of the health for the all. This means that nursing education must provide opportunities for the development of knowledge, skills, and attitudes which make this possible. Consequently, this approach has relevance for nursing education. Faculty engaged in endless debates about what is to be included, and to what death, and what will be given short shrift as a result. Thus, it can be seen why there is so much confusion and lack of agreement between the emphasis and objectives in nursing. This study attempted to review and identify the curriculum content of child nursing in Korea to build and develop the standard curriculum contents for national board examination for nurses and child's health needs for the coming 21st century. The questionnaire was consisted of items for selection and organization of the knowledge components and type of unit with weigh to be attained in child nursing. Response of 34% of nursing program in university and junior college. Content analysis was done by using consensual validation of essential knowledge for curriculum content to identify what is obvious or trivial. This study pointed out that it is not yet apparent that demographic fact has greatly influenced child nursing curriculum content. In a similar vein the majority of content of child nursing devote little time and weigh to social and epidemically significant to child health. It seems to be needed that the content of child nursing may push the paradigm shift in nursing education such as health promotion and prevention for postretinal roles of child and family. In conclusion, it is time to convoke and content and standardization on job analysis for national board exam for nurses in Korea.

A Case of Torsades de Pointes Induced by Complete Atrioventricular Block and Hypokalemia

Torsades de pointes (TdP) is a rare complication of a complete atrioventricular block with QT prolongation. Additional risk factors, such as hypokalemia, may increase the risk of TdP during atrioventricular (AV) block. We experienced a case of TdP, caused by a complete heart block and hypokalemia, which was successfully treated by implanting a permanent pacemaker and correction of the electrolyte imbalance.

The Clinical Significance of Serum-Hydroxyproline in Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: The serum hydroxyproline level (SHL) has been regarded as evidence of collagen breakdown or extra-cellular matrix reorganization. The role of SHL as a diagnostic parameter in acute coronary syndrome, and the SHL changes depending on the left ventricular remodeling after acute myocardial infarction, was evaluated. SUBJECTS AND METHODS: Venous blood samples were obtained from 122 patients with AMI at the time of admission, and on days 7, 21 and 90, and once from 15 patients with stable angina, 15 with unstable angina and 12 healthy subjects. The SHL was measured using the amino acid analysis system (HPLC). The regional wall motion index (RWMI), LVEF and LV dimensions were determined in the early (0.05). However, there was a significant elevation in the SHL 14 day after AMI in the patients of the non-reperfusion group (4.36+/-1.46, 7.63+/-2.69 microgram/L, p=0.032). After 2 week, there was no significant difference in the SHL. There was a significant relationship between the late left ventricular ejection fraction and the SHL (r=-0.414, p=0.037), but no significant relationship between the other factors and the SHL (p>0.05). CONCLUSION: The serum hydroxyproline levels were significantly increased in patients with acute coronary syndrome, which reflect the early change in left ventricular remodeling in acute myocardial infarction.

A Case of Percutaneous Removal of Cutted Left Atrial Pressure Catheter after Mitral Valve Replacement

We experienced a case of the successful retlement of a remnant cutted left atrial pressure catheter found in the left ventricle and ascending aorta on the 67 th day after a mitral valve replacement, using a PTCA guiding catheter and a guide wire.

The Experience of Transradial Coronary Intervention for Chronic Total Occlusion

BACKGROUND AND OBJECTIVE: We try to evaluate the feasibility of transradial approach in patients with a chronic total occlusion. SUBJECTS AND METHODS: Between Mar., 2000 and Oct., 2002, 52 consecutive patients, with 54 lesions, underwent transradial coronary intervention for a chronic total occlusion, which was defined as duration of an occlusion of more than 1 month. The patients were divided into the success or failure group, with the clinical, angiographic and procedural factors compared between the two groups. RESULTS: The overall success rate of the transradial approach was 57.7% (31/54). The most common cause of failure of the transradial coronary intervention was an inability to pass the lesions using a guidewire (17 of 23 failures, 74%). Five cases were crossed over to the femoral artery due to an approach failure of the guiding catheter into the coronary ostium; severe subclavian tortuosity and stenosis in 2 cases, radial artery looping in 1 and poor guiding support in the other 2. A procedural success was more common in lesions with no side branch, no bridging collateral, short duration of occlusion and lesions less than 15mm in length. Non-Q wave myocardial infarction occurred in 1 case. There were no major entry site complications. CONCLUSION: The radial artery might be a feasible vascular route in the percutaneous coronary intervention of chronic total occlusions with comparable procedural success rates and no major access site complications.