Formative Evaluation of Standard Terminology-based Electronic Nursing Record System in Clinical Setting / 대한의료정보학회지

The Objectives of this study are to evaluate the user satisfaction and actual data input time through an enterprise ICNP-based electronic nursing record system using the controlled vocabulary in a secondary care hospital (BSNUH). Study design is a formative evaluation using the QUIS (Questionnaire user interaction satisfaction) self-reported in a secondary care hospital operating EMR(electronic medical record) system in Korea. Participants were two hundred fifty nurses in BSNUH. All of them were registered nurses participated in day-to-day nursing care during study periods. Participants were asked to fill in the SNCEQ(The Staggers Nursing Computer Experience Questionnaire) and QUIS(Questionnaire for User Interaction Satisfaction). Also requested were the data input time(sec) required for entry of approximately 20 times of nursing documentation tasks and the number of standardized precoordinated phrases used for documenting routine nursing records. The mean score of user satisfaction was 4.56 (SD 1.25) and the mean time of data input and the average number of precoordinated phrases used in nurses notes was 2.25min and 3.7 respectively.

Multiple basal cell carcinoma associated with keratoacanthoma

We report a case of multiple basal cell carcinoma associated with keratoacanthoma. A 65-year-old Korean female had suffered from multiple, variable-sized papules and nodules on the face for 20 years previous to treatment. She had no history of arsenic intake, irradiation, herb medication, or hereditable or preexisting dermatoses. Histopathologically, the tumors revealed typical findings of solid and adenoid types of basal cell carcinoma and keratoacanthoma.

Experimental Study on Ileocystoplasty: 1. A New Technique of Ileocystoplasty: Two Layer Open-flap Method / 대한비뇨기과학회지

The treatment of bladder contraction remains as one of the most difficult problems in urological field today despite numerous attempts to overcome this difficulty. Many etiologic factors can be elicited as for the cause of such contractions; more common and important ones being interstitial cystitis, tuberculous infection, various chemical and radiation damages etc. Extensive subtotal bladder resection may also result in limited fluid capacity. All of these can produce severe urinary symptoms of frequency and incontinence and further bilateral renal damages. Until recently the prevalent treatment for the disease complex caused by contracted bladder was diversion of urine either to large bowel or skin, or the use of an indwelling urethral catheter. eliminating the bladder as a reservoir. Although these techniques were proven to be valuable for a certain extent there have been many undesirable aspects. Among the undesirable aspects of diversion of urine are 1. recurrent chronic pyelonephritis caused by organisms from the skin or feces. 2, hydronephrosis from stricture of anastomotic sites, and 3. electrolyte imbalance following transplantation of ureter to bowel. The use of an isolated intestinal segment to segment bladder capacity merits s serious consideration, and the technique of ileocystoplasty may be a possible solution to these difficultise. Results of recent reports on clinical and experimental application of this technique are promising though their methods vary greatly. In the majority a closed tube was anastomosed to the bladder in varying positions but some applied the ileum as an open sheet. The latter method was applied by some in the belief that on open patch of ileum would empty itself more efficiently than a closed type since closed type of ileocystoplasty frequently retained urine. However, control of bleeding during preparation of ileal open sheet have been a major difficulty for application of an open-sheet technique. The purpose of this investigation was to develop a new technique for augmentation of bladder capacity in physiologic manner with diminution of bleeding during the procedure. MATERIALS AND METHODS: Healthy eight Korean dogs weighing from 15 to 18kg were used. Female dogs were exclusively utilized for the convenience of urinary drainage and catheterization postoperatively. pregnant dogs were not used. In each dog, the bladder was mobilized and then subtotally resected leaving one third of the normal bladder. The level of excision was just above the trigone sothat the ureteral orifices were undisturbed. A 20cm segment of ileum approximately 20cm, from the ileocecal valve was isolated with an intact pedicle of mesentery. The continuity of the bowel was restored by end-to-end anastomosis. The isolated ileum was folded at the middle portion with two clamps each placed on half of isolated segment in length for control of bleeding when incision was made on stitch type and then a cap type of ileal bladder with two layers was sutured to the bladder stump by a mucosa-to-mucosa technique forming a bladder composed principally by ileum. The peritoneal cavity was closed without drainage.In the immediate postoperative period urinary drainage was maintained by urethral catheter. RESULTS AND SUMMARY: l. Eight dogs were subjected to ileocystoplasty by the use of two layer ileal open flap. One of them expired because of an accident and seven others survived without incident. 2. The use of the clamps on ileal segment was reliable in controlling bleeding for wider incision to make open ileal flap. 3. Ratio of augmentation of bladder capacity by this technique was twice of that by closed loop technique. 4. The fluid capacity of reconstructed bladder of this technique approached to the tidal capacity 5. One patient with contraction of bladder due to tuberculosis has been satisfactorily palliated by this technique.

Experimental Study on Ileocystoplasty: 2. Production of Collateral Blood Supply to the Ileac Segment After Ileocystoplasty / 대한비뇨기과학회지

The use of isolated segment of ileum as urinary conduits has found wide acceptance in recent years in urological field. The procedures by various investigators have been proven valuable by fairly extensive clinical trial. However, to achieve a satisfactory ileocystoplasty by a viable flap serious consideration should be given to the lymphatic and vascular factors involved in this procedure. It was therefore decided to observe carefully a production of collateral blood supply to the ileal segment after ileocystoplasty. MATERIALS AND METHODS: Healthy 9 Korean dogs: weighing from 15 to 30 kg were used. One animal was used for a preliminary study. The two layer open flap ileocystoplasty previously described was performed in four dogs and the other four dogs received ringplastic type operation. All of the animals were divided into our different groups to receive different manipulation. In the first group of two dogs. the blood supply to the ileal segment from its mesentery was clamped, cut and ligated immediately after each procedure. In the second group of two dogs cessation of blood supply was performed as above 2 weeks after ileocystoplasty. In the third group of two dogs, the same have been done 4 weeks after the initial operation. The last group of two dogs 8 weeks elapsed before interruption of blood supply was carried out. Animals were sacrificed two weeks after interruption of blood supply from mesentery and gross and microscopic studies were made. RESULTS AND SUMMARY: 1. When the blood supply to the ileal bladder from its mesentery was interrupted immediately after ileocystoplasty, animals expired in 3 to 6 days suffering from gangrene of the ileal segment. Purulent exudate was present between the ileal segment and urinary bladder. 2. When the blood supply to the ileal bladder was interrupted 2 weeks after ileocystoplasty. animals survived and were found to have undergone spontaneous omentopexy but anastomosed ileal segment appeared not viable because of atrophy. 3. When cessation of blood supply was done 8 weeks after ileocystoplasty, animals made an uneventful postoperative recovery and the ileal segment and urinary bladder appeared normal with good collateral circulation from omentum and original bladder 4.There was no significant difference among the types of ileocystoplasty in the formation of collateral blood supply.

Experimental Study on Ileocystoplasty: 3. Function of Bladder after ileocystoplasty / 대한비뇨기과학회지

The purpose of ileocystoplasty is to augment bladder capacity and the reconstructed bladder must not only be able to empty but also be able to contain urine in a physiologic manner. Low intravesical pressure with minimum reabsorption of electrolytes is desirable. In previous studies I have described a new reliable technique of ileocystoplasty with a satisfactory clinical application. The purpose of this study was to evaluate the physiologic aspects concerning several different types of ileocystoplasty. METHODS AND RESULTS: Healthy 8 Korean dogs were utilized. The animals weighed from 15 to 20kg. The two layer open flap method of ileocystoplasty was performed in four dogs and the other four dogs received ring plastic type. Intravesical pressure was measured by a water manometer and all measurements were read directly from the manometer tube. In order to obtain standard controls cystometrograms were done in 3 normal dogs. The normal dog bladder was found to respond to increased intravesical fluid and the average bladder capacity was 130cc. The voiding pressure was 28cm in water. The average fluid capacity of the reconstructed bladder was 120cc in two layer open flap method and 150c. c. in ring plastic method. The cystometry 10 minutes after intermuscular injection of 1.0cc. of 1:2000 prostigmin solution disclosed a definite increase in vesical fluid pressure in ring plastic type whereas the two layer open flap type did not show any elevation. Administration of 0.4mg of atropine intramuscularly decreased intravesical pressure in ring plastic type but was not significant in two layer open flap type. Injection of 10cc. of 0.25% pentothal sodium intravenously caused decrease of fluid pressure in both types. Emptying activity of the reconstructed bladder was measured by x-ray retrograde cystogram methods. The opaque medium remained in the ileal loop for 24 hours after onset of voiding in ring plastic type but no opaque medium was seen in the two layer open flap type. Absorption of electrolytes from the bladder after the two layer open flap ileocystoplasty was not altered significantly. The postoperative electrolyte plasma values of potassium and sodium chlorides were within normal limits. Histologic examinations of the ileal bladder 2 months after the open flap ileocystoplasty disclosed varying degrees of non-specific inflammatory reactions. No metaplasia or loss of mucous glands was seen.