ABSTRACT
PURPOSE: This study was done to identify the intensive care unit nurses' knowledge of and compliance with the standard precautions (universal precaution) as stated in infection control guidelines. METHOD: From September 14 to September 28, 2006, data were collected via a questionnaire survey from 189 Intensive Care Unit nurses working at three university branch hospitals and one general hospital in Gyeonggi province. RESULTS: The mean knowledge score was 18.8/20.0 (93.9%). The mean compliance score was 3.4/4.0 (85.8%). Two factors influencing compliance were perception of the standard precautions and experience of needle stick injuries over the past year (p<.05). Two factors influencing knowledge were support of co-workers in the use of protective devices and the availability of hand-washing device or waterless alcohol gel (p<.05). CONCLUSION: In order to improve knowledge and compliance with standard precautions, all factors of importance for knowledge and compliance must be taken into consideration in the clinical work place and in education.
Subject(s)
Compliance , Hospitals, General , Hospitals, Satellite , Hypogonadism , Infection Control , Critical Care , Intensive Care Units , Mitochondrial Diseases , Needlestick Injuries , Ophthalmoplegia , Protective Devices , Surveys and Questionnaires , Universal Precautions , WorkplaceABSTRACT
BACKGROUND: Laboratory studies as diagnostic tools of scrub typhus have shown PCR to be sensitive and specific, but there have been few clinical studies. The aims of this study were to determine the diagnostic accuracy and clinical usefulness of the nested PCR through a prospective comparison of the nested PCR and indirect immunofluorescence assay (IFA). MATERIALS AND METHODS: We conducted a multicenter prospective study of patients with possible scrub typhus. Adult patients who have had fever together with eschar or a maculopapular skin rash and more or equal to two of the following symptoms: headache, malaise, myalgia, coughing, nausea, and abdominal discomfort were enrolled. Each patient was admitted between September, 2004 and December, 2004 to Chosun University Hospital and one of its three community branch hospitals (Haenam General Hospital, Jangheung Hospital, Muan Hospital), which are all located in the southwest of Korea. Whole blood samples were collected for PCR testing and sera were obtained for serology evaluation using the IFA and passive hemagglutination assay (PHA). RESULTS: We enrolled 135 possible scrub typhus patients, and 118 scrub typhus patients were confirmed on the basis of either a single indirect immunofluorescent specific IgM titer against O. tsutsugamushi of > or =1:10 or 4-fold or greater rise in IFA follow up titer. One hundred eighteen patients were confirmed as scrub typhus, 7 patients were undetermined and 10 patients were confirmed as the other diseases. The result of nested PCR assay demonstrated a sensitivity of 82.2% (95% confidence interval 0.74-0.88), a specificity of 100% (95% confidence interval 0.66-1), positive predictive value of 1 (95% confidence interval 0.95-1) and negative predictive value of 0.32 (95% confidence interval 0.17-0.51). 96 patients out of 118 patients were positive for IgM on the admission day. Of 22 patients with negative for IgM antibody at admission, 19 had positive results for nested PCR using buffy coat. CONCLUSION: The nested PCR assay of buffy coat is useful for rapid and reliable test for confirmation of the diagnosis of scrub typhus.
Subject(s)
Adult , Humans , Cough , Diagnosis , Exanthema , Fever , Fluorescent Antibody Technique, Indirect , Follow-Up Studies , Headache , Hemagglutination , Hospitals, General , Hospitals, Satellite , Immunoglobulin M , Korea , Myalgia , Nausea , Orientia tsutsugamushi , Polymerase Chain Reaction , Prospective Studies , Scrub Typhus , Sensitivity and SpecificityABSTRACT
BACKGROUND: Laboratory studies as diagnostic tools of scrub typhus have shown PCR to be sensitive and specific, but there have been few clinical studies. The aims of this study were to determine the diagnostic accuracy and clinical usefulness of the nested PCR through a prospective comparison of the nested PCR and indirect immunofluorescence assay (IFA). MATERIALS AND METHODS: We conducted a multicenter prospective study of patients with possible scrub typhus. Adult patients who have had fever together with eschar or a maculopapular skin rash and more or equal to two of the following symptoms: headache, malaise, myalgia, coughing, nausea, and abdominal discomfort were enrolled. Each patient was admitted between September, 2004 and December, 2004 to Chosun University Hospital and one of its three community branch hospitals (Haenam General Hospital, Jangheung Hospital, Muan Hospital), which are all located in the southwest of Korea. Whole blood samples were collected for PCR testing and sera were obtained for serology evaluation using the IFA and passive hemagglutination assay (PHA). RESULTS: We enrolled 135 possible scrub typhus patients, and 118 scrub typhus patients were confirmed on the basis of either a single indirect immunofluorescent specific IgM titer against O. tsutsugamushi of > or =1:10 or 4-fold or greater rise in IFA follow up titer. One hundred eighteen patients were confirmed as scrub typhus, 7 patients were undetermined and 10 patients were confirmed as the other diseases. The result of nested PCR assay demonstrated a sensitivity of 82.2% (95% confidence interval 0.74-0.88), a specificity of 100% (95% confidence interval 0.66-1), positive predictive value of 1 (95% confidence interval 0.95-1) and negative predictive value of 0.32 (95% confidence interval 0.17-0.51). 96 patients out of 118 patients were positive for IgM on the admission day. Of 22 patients with negative for IgM antibody at admission, 19 had positive results for nested PCR using buffy coat. CONCLUSION: The nested PCR assay of buffy coat is useful for rapid and reliable test for confirmation of the diagnosis of scrub typhus.
Subject(s)
Adult , Humans , Cough , Diagnosis , Exanthema , Fever , Fluorescent Antibody Technique, Indirect , Follow-Up Studies , Headache , Hemagglutination , Hospitals, General , Hospitals, Satellite , Immunoglobulin M , Korea , Myalgia , Nausea , Orientia tsutsugamushi , Polymerase Chain Reaction , Prospective Studies , Scrub Typhus , Sensitivity and SpecificityABSTRACT
BACKGROUND: There has been no general agreement in classifying basal cell carcinoma (BCC), and little is known about the immunohistochemical profiles in each subtypes of BCC. BCC is a locally-invasive tumor, but its aggressive forms tend to recur and metastasize. OBJECTIVE: In this study, we have compared the histolopathological subtypes of BCC by immunohistochemical study. We also focused on identifying representative markers of growth in the aggressive forms of BCC by assessing VEGF, p53 and alpha-SMA expression. METHODS: A total of 87 BCC specimens were collected at the 7 branch hospitals of The Catholic University of Korea from July 1997 to June 2003. For multiple immunohistochemical staining, a tissue microarray technique was used. The 87 samples were divided into 6 subtypes: 18 nodular, 19 nodular infiltrative, 12 micronodular, 14 infiltrative, 11 morphea and 13 basosquamous. Overall, 18 samples were classified as non-aggressive and the remaining 69 as aggressive. RESULTS: The following results were obtained after immunohistochemical staining with antibodies alpha-SMA, VEGF and p53. A significant increase of alpha-SMA expression was observed in aggressive forms of BCC, whereas the expression of p53, VEGF, the number of mast cells remained the same. The representative markers of tumor growth such as alpha-SMA were most highly expressed in the basosquamous type, and least expressed in the micronodular type compared to the nodular type. CONCLUSION: alpha-SMA was considered as an appropriate immunohistochemical marker in BCC to represent aggressiveness.
Subject(s)
Antibodies , Carcinoma, Basal Cell , Hospitals, Satellite , Immunohistochemistry , Korea , Mast Cells , Scleroderma, Localized , Vascular Endothelial Growth Factor AABSTRACT
BACKGROUND: There has been no general agreement on classifying basal cell carcinoma (BCC), and little is known about the squamous cell differentiations of each subtype of BCC. BCC is a locally-invasive tumor, but its aggressive forms tend to recur and metastasize. OBJECTIVE: We have compared the histolopathological subtypes of BCC by squamous differentiation, with special emphasis on basosquamous carcinoma and the difference between the non- aggressive and aggressive forms of BCC. MATERIALS AND METHOD: A total of 87 BCC specimens were collected from the 7 branch hospitals of The Catholic University of Korea from July 1997 to June 2003. RESULTS: 1. The 87 samples were divided into 6 subtypes: 18 nodular, 19 nodular infiltrative, 12 micronodular, 14 infiltrative, 11 morpheaform, 13 basosquamous. Overall, 18 samples were classified as non- aggressive and the remaining 69 as aggressive. 2.In nodular-infiltrative BCC and basosquamous carcinoma, squamous cell differentiation was significantly more prominent than in the nodular BCC. CONCLUSION: Squamous cell differentiation should be considered as one of the aggressive markers, especially in nodule-forming BCC.
Subject(s)
Carcinoma, Basal Cell , Carcinoma, Basosquamous , Cell Differentiation , Hospitals, Satellite , KoreaABSTRACT
OBJECTIVE: To study intrauterine or extrauterine misplacement of intrauterine devices in respect to their usage in diagnosis and therapy via retrospective analysis. METHODS: Data from 1993 to 2000 on a total of 32 patients from seven Catholic University branch hospitals who had been admitted to treat IUDs which had misplaced to intrauterine or extrauterine locations were analyzed for usage in a retrospective study. RESULTS: The data for intrauterine and extrauterine misplacement revealed no significant difference between from the statistical average in relation to age, parity and duration of insertion. In terms of removal method, all 15 patients with extrauterine misplacement underwent surgical extraction by open or laparascopic method under general anesthesia, but those patients with intrauterine misplacement had their device removed after cervical dilatation with a laminaria using local anesthesia. Concerning diagnosis, 81.2% of extrauterine misplacement were diagnosed using x-ray while 58% of intrauterine misplacement were diagnosed using vaginal US. The result of the Fisher's exact test showed a significant difference (p=0.043) in the rate of diagnosis for intrauterine and extrauterine misplacement of IUDs. Also, the results of multi-variable analysis performed for logistical regression analysis showed that intrauterine misplacement occurred 1.23 times more frequently than extrauterine misplacement. CONCLUSION: Further studies are required on a broader patient population, on more types of IUDs and with time variables taken into account. Despite more research, prevention of complications such as misplacement remains the most appealing situation, being influenced by such factors as technical skill of the physician inserting the IUD, appropriate duration of insertion and proper patient education.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, General , Anesthesia, Local , Diagnosis , Hospitals, Satellite , Intrauterine Devices , Labor Stage, First , Laminaria , Parity , Patient Education as Topic , Retrospective StudiesABSTRACT
Antecedentes: Las heridas ano-recto-perineales se presentan con frecuencia en las guardias del Hospital periférico. Objetivo: Presentar nuestra experiencia y alertar sobre la necesidad de incluir estas lesiones en los diagnósticos diferenciales del abdomen agudo, proctorragia y otras. Lugar: Hospital Zonal General de Agudos "Dr. Lucio A. Meléndez" de Adrogué, Pcia. de Bs. As. Diseño: Estudio retrospectivo. Presentación de casos. Población: de 2140 pacientes ingresados en el período comprendido entre enero de 1992 y enero de 1997 con Heridas de Arma Blanca (HAB), Heridas de Arma de Fuego (HAF) y Prácticas sexuales aberrantes (PSA), 8 fueron heridas Anorrectoperineales. Métodos: Observación, clínica y quirúrgica. Resultados: Se observa que en el 0.37 por ciento de los pacientes ingresados a la guardia del Hospital periférico en cuestión, por HAF, HAB y PSA son traumatismos ano-recto-perineales. Conclusiones: Debe plantearse siempre la posibilidad de una lesión ano-recto-perineal en los pacientes que ingresan por abdomen agudo, también en las proctorragias y otras patologías traumáticas. Por lo tanto recomendamos incluirlas en el diagnóstico diferencial ya que a pesar de no ser patologías muy frecuentes tienen elevada mortalidad (12,5 por ciento).
Subject(s)
Humans , Male , Adolescent , Adult , Female , Abdomen, Acute , Anal Canal , Colostomy , Diagnosis, Differential , Emergencies , Hospitals, Satellite , Paraphilic Disorders , Perineum , Rectum , Wounds and Injuries , Wounds, Penetrating , Sepsis , Wounds, GunshotABSTRACT
Se realizó un análisis retrospectivo de 518 cirugías de catara. 431 (83 por ciento) de ellas fueron hechas en el hospital Regional y 87 (17 por ciento) en hospitales periféricos: En las cirugías participaron 12 cirujanos del staff entre el año 1996 y 2001. El 90 por ciento de los pacientes fue operado en los años 1999 y 2000. Cuatro cirujanos operaron el 70 por ciento de los pacientes estudiados. El 52.5 por ciento fue operado con técnica extracapsular y el 47.5 por ciento con facoemulsificación. El 37.1 por ciento fueron hombres y el 62.9 mujeres. El promedio de edad fue de 70.5 años con una mínima de 6 años y una máxima de 96. El 53.1 por ciento ojos derechos y el 46.9 por ciento ojos izquierdos. El 27.6 por ciento tuvo complicaciones. 1 por ciento desprendimiento de retina (DR), 1.7 por ciento hipertensión, 6.2 por ciento opacidad de la cápsula posterior (OCP), 4.6 por ciento rotura cápsula posterior (RCP), 5.8 por ciento RCP más vitrectomía anterior, 2.3 por ciento iritis, 0.13 por ciento endoftalmitis. Las visiones pre operatorias eran en un 77.4 por ciento menos de 0.2 y el 22.6 por ciento entre 0.25 y 0.40 y las post operatorias 9.3 por ciento quedaron bajo 0.2 un 12.7 por ciento entre 0.25 y 0.4 y un 78 por ciento entre 0.5 y 1.0. El promedio de las visiones para los pre operados es de 0.14 con un rango de 0.04 al 0.40. El promedio para los post operados es de 0.56 con un rango de 0.04 al 1.0. Para evaluar el resultado de la operación se construye un incremento de la visión (vpost-vpre). Este incremento tiene un promedio de 0.421 y es significativo. Existe una diferencia significativa entre el incremento de la visión después de la operación de los pacientes operados dentro del hospital mayor que los operados fuera del hospital. Las complicaciones de las cirugías en los hospitales periféricos (17.2 por ciento) son menores estadísticamente que las efectuadas en el hospital Regional (29.7 por ciento). Objetivo: Analizar la posibilidad de efectuar operaciones de cataratas en la IX Región en un hospital distinto del Hospital Regional de Temuco, sin que eso significara riesgo para el paciente o malos resultados visuales.
Subject(s)
Cataract , Cataract Extraction , Hospitals, Satellite/statistics & numerical data , Hospitals, Satellite/trends , Retrospective StudiesABSTRACT
Hai Phong currently has 20 hospitals with 3,500 beds, 9 professional centers of medical colleges, 1 secondary medical school and 2 companies with 5,711 health cadres in which medical doctors: 974, professor: 4 phylosophy doctor: 6; masters of science: 9, 1st grade medical doctor: 329 and 2nd grade medical doctor: 133. The long term stratery of Hai Phong health branch aims at redution of the morbidity and mortality rate of the microbial and parasitological infections, gradual improvement the nutritional condition, assure of the standards of the food safety and hygience and enhancement of the health care services
Subject(s)
Health , Hospitals, SatelliteABSTRACT
OBJECTIVES: The purpose of study was to define the clinical and epidemiological factors of HNP and to provide the meaningful sources for establishing a prognosis and a rationale for clinical management of occupational low back problem. METHODS: This study was performed at eight branch hospitals of Catholic University of Korea and several governmental hospitals f or occupational disorders around the Kyunggi province of Korea since Jan. 1985. We analyzed the several factors about lumbar HNP through comparative study of the hospital admission series of each 200 patients in both occupation- and nonoccupation related, subjected to epidemiologic and clinical investigation, respectively. RESULTS: 1. Mean age of occupational HNP was younger(30.9+/-8.8) than non-occupational HNP(35.2+/-10.5) (p<0.05). 2. The duration of clinical symptom before admission was longer in non-occupational HNP(19.9+/-22.8 Mo.) than in occupational HNP(6.9+/-12.4 Mo.) (p<0.05). 3. The symptomatic attack before admission was more frequent in non-occupational HNP(3.7+1.9) than in occupational HNP(2.5+/-0.9) (p<0.05). 4. There were no significant differences in physical findings between two groups, except for low rate(63%) of straight leg raising test(SLR) limitation in occupational HNP compared to non-occupational HNP(83%) (p<0.05). 5. Even though The main reason for operative intervention was a failure of conservative treatment in both groups(p<0.05), extruded subligamentous type was predominant(50%) in occupational HNP(p<0.05), whereas extruded transligamentous type occupied major portion(67.8%) in non-occupational HNP(p<0.05). CONCLUSION: The clinical results were poor in occupational HNP in both conservative and operative management groups, compared to non-occupational HNP(p<0.05) and mean durations admission and re-admission rate was higher in occupational HNP, compared to non-occupational HNP (p<0.05).
Subject(s)
Humans , Hospitals, Satellite , Korea , Leg , Occupations , Prognosis , SpineABSTRACT
Se aborda la problemática de la relación entre médicos generalistas y especialistas y su disociación con las frecuecias de las patologías susceptibles de ser resueltas en el Primer Nivel de atención (80 a 93,5 por ciento). El objetivo formulado para esta primera etapa del estudio consiste en establecer la magnitud y las características de la consulta atendida por médico generalista a nivel de centros de salud situados en la periferia de la ciudad de La Plata (Argentina). El volumen más importante de consultas se ubicó dentro de las causadas por morbilidad. La demanda predominante responde a patologías propias de las condiciones de vida, con amplio predominio de infecciones respiratorias, seguidas por las gastrointestinales. Por otro lado, los controles se hallan predominantemente referidos al binomio materno-infantil, observándose una reducida carga de exámenes de salud, propios del adulto. La concentración de consultas resulta sumamente reducida como consecuencia del modelo prestacional vigente, el que carece de capacidad de retención. Los controles representan algo más del 20 por ciento de la demanda, con una concentración un poco más alta. El predominio de la demanda femenina es notorio, pero deben ser contempladas las causas obstétricas a fin de establecer el alcance genuino de esta preponderancia
Subject(s)
Ambulatory Care , Ambulatory Care/statistics & numerical data , Ambulatory Care/statistics & numerical data , Primary Health Care/statistics & numerical data , Primary Health Care , Physicians, Family/supply & distribution , Referral and Consultation/classification , Referral and Consultation/statistics & numerical data , Argentina , Hospitals, Satellite/statistics & numerical data , Hospitals, SatelliteABSTRACT
BACKGROUND: Dermatophytosis is sometimes difficult to diagnose deinitively if it has atypical clinical characteristics and mycological tests are negative. Histopathologic findings may be different depending upon the location and causative dermatophytes. OBJECTIVE: The purpose of the present study was to evaluate histopathologic characteristics nf dermatophytosis depending upon the areas of involvement. METHODS: We evaluated the clinical and histopathologic features of 32 cases of dermatophytosis which were diagnosed by skin biopsies at the Dermatology Department of branch hospitals of Catholic University Medical College from March 1985 to August, 1994. Histopathologic features were observed in three dilferent groups divided by location, area of terminal hair, areas of vellus hair and hairless areas. RESULTS: Epidermal changes including hyperkeratosis, parakeratos, acanthosis, spongiosis and neutrophilic exocytosis were frecuently observed in the three groups of Iermatophytosis. In 7 cases of tinea capitis and linea barbae, follicular and inflamma or changes of the deep dermis were important. Hyphae and spores were observed in 71%(5 cases) and 57%(4 cases) respectively, in the follicles. In 19 cases of tinea faciale, tiriea corporis and tinea cruris, change epidermis and superficial dermis as well as findings of follicular infundibulum were important. Herphae were observed in 84%(16 cases) and 53%(10 cases) in the stratum corneum and vellus hir follicle respectively, and in 3 cases the hyphae were observed only in the vellus hair follicle. Sandwich sign, known to be important clue of dermaliophytosis, was observed in only 5%(1 cacse, In 6 cases of tinea manus and linea pedis, hyphae and spores were rebserved in 100% (6 cases) and 33%(2 cases) respectively, in the stratum corneum. CONCLUSION: We consider tha histopathologic observations may of great help to diagnose some difficult cases of dermatophytosis and the presence of hyphae n .he vellus hair follicle may be a more frequent and important finding than the sandwich sign the dermatophytosis of the vellus hairy regions.
Subject(s)
Arthrodermataceae , Biopsy , Dermatology , Dermis , Epidermis , Exocytosis , Hair , Hair Follicle , Hospitals, Satellite , Hyphae , Neutrophils , Skin , Spores , Tinea Capitis , TineaABSTRACT
The authors developed a computerized documentation system to record and store all the data pertaining to an endoscopic examination of the upper digestive tract. The system was programmed using the database management system Clipper Version 5.01. It is easy and convenient to use due to advanced deaign of input screen using menu bars and pull down menu and windows. The system was designed to permit the easy storage and retrieval of data by personnel who lack computer skills and who may only have limited typing ability. Today this system has been in daily use for 1 year at the endoscopic units of 8 different branch hospitals of Catholic university,medical college. Overall the experience in these centers has been positive, with excelient or good participation. Characteristics of this system are a menu-driven system, data input by predefined list, instantaneous report generation, on line access to previous examination, late entry of yathologic regerts. and record retrieval, listing according to different criteria. For the description of endoscopic findings and diagnosis, structured input is maintained. All of the findings are chosen from predefined list using pop-up screen and also free text typing is allowed. Therefore time effort was not increased compared to conventional documentation. Structured input and the resulting categorical data affer several advantages.
Subject(s)
Database Management Systems , Diagnosis , Endoscopy , Endoscopy, Gastrointestinal , Gastrointestinal Tract , Hospitals, Satellite , Information SystemsABSTRACT
Foram estudados, pelo método da taxa de sobrevida acumulada, 174 pacientes que permaneceram por mais de três meses em hemodiálise num Centro Satélite da Baixada Fluminense. Apesar das baixas condiçöes sócio'culturais da populaçäo servida, o desempenho do Centro foi semelhante aos dados nacionais e internacionais. Assim, 58,62% eram brancos, 53,45% do sexo masculino e a média de idade 40,46 anos )(+ ou - 13,55%). Ao final do período de observaçäo (1980 a 1986), 47,70% persistiram em tratamento hemodialítico na Segumed, 22,42% foram transplantados, enquanto 29,89% morreram. A curva de sobrevivência para os indivíduos de baixo risco foi de 91,84% e 78% aos 12, 24 e 36 meses, respectivamente, enquanto para o grupo inteiro foi de 85,73 e 65%. O estudo de diferentes subgrupos aponta hipertensäo maligna, doenças sistêmicas, idade e raça negra como fatores determinantes de pior prognóstico
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Male , Female , Renal Dialysis/mortality , Hospitals, Satellite , Renal Dialysis/statistics & numerical data , Kidney Transplantation , Life Tables , Prognosis , Survival RateABSTRACT
One hundred and nineteen cases of congenital melanocytic nevi diagnosed clinically and/or histopathologically st Departments of Dermatology, Plastic surgery and Pedia trics of 7 branch hospitals of Catholic University Medical College from October, 1986 to October, 1988 were reviewed by their incidence, distribution, age, size and elinical findings. The results were summarized as follows . l. Among 2g73 newborn babies, 33(1.5%) melanocytic nevi were found clinically. 2. Amomg 119 congenital melanocytie nevi, 31 located on the head and neck area, 47 on the trunk, and 41 on the extremities. 3. Thirty (252%) were less than 0.6cm in greatest diameter, 42(353%) nevi 0.6 to 15cm, 15(12.7%) nevi 1.6 to 3.0cm, 26(218%) nevi 3.1 to 10.0cm and 6(5.0%) nevi greater than 10.0cm. 4. a) Seventy three nevi(613%) were uniform in color and 46(38.7%) were mixed brown r black with variable proportion. b) Fifty three(44.5%) nevi were flat, 36(303%) were slightly elevated, 17(14.3%) had pebble stone appearance and 13(10.9%) were dorne shaped. c)Thirteen(11%) nevi had terminal hair on the surface.