Retrospective validation of the Step-by-Step approach for febrile infants younger than 90 days in the emergency department

PURPOSE: To retrospectively validate the Step-by-Step approach, a sequential algorithm for prediction of serious bacterial infections (SBI) using the appearance, age, and inflammatory markers, in febrile infants younger than 90 days. METHODS: The presence of SBI was reviewed in febrile infants younger than 90 days undergoing blood and urine cultures (using perineal adhesive bags), assays for procalcitonin, C-reactive protein and absolute neutrophil count, and urinalysis at the emergency department from September 2015 through August 2017. The low-risk infants were classified according to the Step-by-Step approach. SBI was defined as urinary tract infection (UTI), bacteremia or meningitis. We measured the sensitivity and negative predictive value (NPV) of the approach in predicting SBI, and compared the values to those of the Rochester criteria and the Lab-score. RESULTS: Of 488 febrile infants (44.7% underwent lumbar puncture), 71 (14.5%) had SBI, including 67 UTI, 5 bacteremia, and 3 meningitis (mutually inclusive). Of 208 low-risk infants (42.6%), no SBI was found. The Step-by-Step approach showed a 100% sensitivity (95% confidence interval [CI]: 94.9–100.0) and NPV (95% CI: not applicable). The Rochester criteria showed a 98.6% sensitivity (95% CI: 92.4–100.0) and 99.6% NPV (95% CI: 97.1–99.9), and missed 1 meningitis. The Lab-score showed a 59.2% sensitivity (95% CI: 46.8–70.7) and 93.2% NPV (95% CI: 91.2–94.8), and missed 2 meningitis and 27 UTI. CONCLUSION: The Step-by-Step approach showed a 100% sensitivity and NPV in predicting SBI. This approach may help predict SBI without lumbar puncture in febrile infants younger than 90 days.

Trends in Anger and Aggression Across the Life Span in Korean Population

OBJECTIVES: This study was to investigate the trends in anger and aggression with aging in Korean population aged from twenties to eighties. METHODS: Two hundreds ninety-five subjects included, ranged 22 to 92 years old. All subject participate in a clinical interview with psychiatrists who use the MINI (Mini international Neuropsychiatric Interview) to diagnosis psychiatric disorders, and were not any psychiatric disorders. RESULTS: In elderly group, the scores of Trait anger, Anger expression, and totol of STAXI were higher than adult group, where as the scores of State anger of STAXI, Hostility of AQ, and Disturbances, Embarrassing, Unpleasant circumstances, and total of RI were higher in adult group. Trait anger and Anger expression were shown trends to increase with age. On the other hands, State anger, Hostility, and Reaction to external stimuli were shown trends to decrease with age. CONCLUSION: The reaction to anger situation and aggression decrease with age, although anger increase with age. Various factor, such as defense mechanism may affect on aggressive expression and response. There will be needed to investigate associated factors between anger and aggression.

Treatments of the Nonunion of Femoral Shaft Fractures after Interlocking Intramedullary Nailing

PURPOSE: To investigate and analyze the clinical result in the treatment of aseptic nonunion of femoral shaft fracture after interlocking intramedullary nailing MATERIALS AND METHODS: We reviewed 23 cases of aspetic nonunion of femoral shaft fracture after interlocking intramedullary nail from March 1995 to February 2003 and follow up more than one year. 8 cases were treated by metal exchange, 3 cases by autogenous bone graft and the rest 12 cases by metal exchange and bone graft on the basis of fracture gap and type of nonunion. We evaulated nonunion type, union time and clinical result. Those patients were treated by interlocking intramedullary nail with or without bone graft. Union were accepted when the radiographic evidences showed bridging callus on both end of femoral shaft fracture with clinical evidences showing abscence of pseudomotion or pain. RESULTS: All patients were united by one operation. Average union time were 4.8 months in metal exchange group, 3.9 months in metal exchange with autograft bone graft group, and 4.3 months in bone graft group. 15 patients (65.2%) showed hypervascular nonunion including 7 Elephant foot types (46.7%) and 8 oligotrophic types (53.5%), and 8 patients (34.8%) showed avascular nonunion according to Weber-Brunner classification CONCLUSION: Based on our analysis on clinical outcome and stability of nonunion occuring after initial interlocking intramedullary nailing in femoral shaft fracture, interlocking intramedullary nailing with bone graft made early ambulation possible and promoting returning to normal daily life much earlier, thus based on this data, we recommend interlocking intramedullary nailing for treating femoral shaft fracture along with bone graft.

A Study of Psychiatric Accidents in Korea / 대한법의학회지

Followings are results from analyzing 263 responses out of 1,000 survey questionaires, which were mailed to Korean psychiatrists, for purpose to discover current status of psychiatric accidents in Korea, and to find appropriate solutions. 1) More accidents were experienced by 30-40 years-old psychiatrists than any other age level. More experience in practice they had, more accidents were experienced. 2) 74.5% of responding psychiatrists reported that they had experienced accidents. The rate has steadily increased. 3) Quite a few accidents were involved with schizophrenic patients, who were between 20-30 years of age level 4) 58% of reported accidents were suicides, which was the highest rate. In legal suit regarding malpractice, the highest rate of 47.9% were suicides, as well. It calls special attention to careful evaluation and treatment of suicidal patients. 5) More accidents tended to be dealt in private rather than in legal. Accidents tended into legal suits asked for more compensation. 40.4% of accidents upset patient's family to take actions. It is suggested that Special Case Settlement Policy be established and Accident Dispute Intervention Committee be actively involved for efficient solutions against accidents.