ABSTRACT
BACKGROUND: In 2026, the elderly population (age> or =65 years) in Korea is projected to be 20.8% of the total population. Along with this rise will be the rise in need for medical care in geriatric hospitals. Geriatric inpatients are vulnerable to infections because of functional disabilities and comorbidities. We investigated the clinical features of pneumonia in the elderly at these facilities. METHODS: We performed a retrospective study based on medical records looking at pneumonia, which was identified in 63 inpatients >65 years admitted to a geriatric hospital from October 2013 to December 2014. RESULTS: In-hospital mortality was 31.7%(20/63) and the 30-day mortality was 17.5%(11/63) of the total number of patients. Median age was 83 years (range, 67-94 years). Univariate analysis showed that the following factors were significantly different between survivors and nonsurvivors, number of comorbidities, history of antibiotics therapy in preceding 90 days, clinical improvement in 72 hours, alteration of mentality, respiration rate, serum albumin level, and peripheral blood leukocyte count. Multivariate analysis showed that the independent factors for predicting increased mortality were number of comorbidities > or =4 (odds ratio [OR], 9.803; p=0.030), failure to improve clinically in 72 hours (OR, 6.150; p=0.046), respiration rate> or =30/min (OR, 9.370; p=0.021), and serum albumin level or =30/min), and hypoalbuminemia (< or =3.0 g/dL), escalation of empiric antibiotics or transfer to an acute care setting is necessary to reduce mortality.
Subject(s)
Aged , Humans , Anti-Bacterial Agents , Comorbidity , Geriatrics , Hospital Mortality , Hypoalbuminemia , Inpatients , Korea , Leukocyte Count , Medical Records , Mortality , Multivariate Analysis , Pneumonia , Respiration , Respiratory Rate , Retrospective Studies , Serum Albumin , Survivors , TachypneaABSTRACT
BACKGROUND: Telemedicine can be useful in dermatology in which there is a physical barrier between the dermatologist and patient or primary care giver. OBJECTIVE: Our purpose of this study is to examine a usefulness of teledermatology system in Korean situation. METHODS: We made store-and forward teledermatology system on world wide web for it's usefulness. We examined the difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images. RESULTS: The merits of our teledermatology system are summarized as follows1. It has more diagnostic accuracy than classic store-and forward system. 2. The real-time additional history taking and request of laboratory examinations are possible by chatting system between dermatologist and primary care giver. 3. Patient follow-up is easier than store-and forward system. The difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images are summarized as follows. 1. There is no difference of diagnostic accuracy between photographic readers and digital image readers. 2. There is no difference of level of certainty between photographic readers and digital image readers. 3. In assesment of quality of photographs, no difference was founded between photographic readers and digital image readers 4. The satisfaction of quality of photographs is very high in all groups. The average is 97.5%. CONCLUSION: This study provides evidence that our teledermatology system is useful in korean situation and still digital image can substitute historic photographs in teledermatology.
Subject(s)
Humans , Dermatology , Equidae , Follow-Up Studies , Internet , Primary Health Care , TelemedicineABSTRACT
BACKGROUND: Electronic bulletin board systems have been used for education, information exchange, and medical consultation for a number of years. However, most of these systems have been text-based. The field of dermatology has never had a system that allowed a quick exchange of visual information. OBJECTIVE: Dermatology is a field of medicine which especially requires a visual image for an accurate diagnosis, and subsequent effective treatment. We have developed a web-based bulletin board system which can be used by any clinician with access to the internet to view clinical images of skin diseases with accompanying clinical findings. METHODS: A web-based bulletin board system was developed for the internet. The system is designed to operate independently of client hardware and software using hyper text markup language so participants using different platforms can access and use the site effectively. RESULTS: Any participant can easily upload a diagnostic image to the board along with relevant clinical information. Other participants can make comments regarding the presented case which may prove useful to the presenter in diagnosis and development of an effective treatment modality. CONCLUSION: Our web-based bulletin board system for discussion of skin diseases has the potential to help in the diagnosis and treatment of various skin diseases. Dissemination of information relating to clinical cases and participation of a widespread audience of experienced clinicians will allow better practice of dermatology and aid in further training of inexperienced clinicians.