Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea

Objective@#To compare short-term treatment outcomes at hospital discharge and hospital length of stay (LOS) in patients with spontaneous intracerebral hemorrhage (sICH) before and after introduction of resident physician work time limit (WTL). @*Methods@#We retrospectively reviewed consecutive patients treated for sICH at our institution between 2016 and 2019. Then we dichotomized these patients into two groups, pre-WTL and post-WTL. We analyzed demographic elements and clinical features, and hospital length of stay (LOS). We evaluated short-term outcome using modified Rankin scale score at hospital discharge and then divided it into “good” and “poor” outcome groups. We subsequently, compared short-term treatment outcome and hospital LOS between the pre-WTL and post-WTL groups. @*Results@#Out of 779 patients, 420 patients (53.9%) were included in the pre-WTL group, and 359 (46.1%) in post-WTL. The mortality rate in sICH patients was higher in the post-WTL group (pre-WTL; 13.6% vs. post-WTL; 17.3%), but there was no statistically significant difference in short-term outcome including mortality (p=0.332) between the groups. The LOS also, was not significantly different between the two groups (pre-WTL; 19.0 days vs. post-WTL; 20.2 days) (p=0.341). The initial Glasgow Coma Scale score, personal stroke history, and mean age were the only independent outcome predicting factors for patients with sICH. @*Conclusions@#Some neurosurgeons may expect poorer outcome for sICH after implementation of the WTL of the K-MHW for resident physician however, enforcement of the WTL did not significantly influence the short-term outcome and hospital LOS for sICH in our hospital. Further well-designed multi-institutional prospective studies on the effects of WTL in sICH patient outcome, are anticipated.

Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea

Objective@#To compare short-term treatment outcomes at hospital discharge and hospital length of stay (LOS) in patients with spontaneous intracerebral hemorrhage (sICH) before and after introduction of resident physician work time limit (WTL). @*Methods@#We retrospectively reviewed consecutive patients treated for sICH at our institution between 2016 and 2019. Then we dichotomized these patients into two groups, pre-WTL and post-WTL. We analyzed demographic elements and clinical features, and hospital length of stay (LOS). We evaluated short-term outcome using modified Rankin scale score at hospital discharge and then divided it into “good” and “poor” outcome groups. We subsequently, compared short-term treatment outcome and hospital LOS between the pre-WTL and post-WTL groups. @*Results@#Out of 779 patients, 420 patients (53.9%) were included in the pre-WTL group, and 359 (46.1%) in post-WTL. The mortality rate in sICH patients was higher in the post-WTL group (pre-WTL; 13.6% vs. post-WTL; 17.3%), but there was no statistically significant difference in short-term outcome including mortality (p=0.332) between the groups. The LOS also, was not significantly different between the two groups (pre-WTL; 19.0 days vs. post-WTL; 20.2 days) (p=0.341). The initial Glasgow Coma Scale score, personal stroke history, and mean age were the only independent outcome predicting factors for patients with sICH. @*Conclusions@#Some neurosurgeons may expect poorer outcome for sICH after implementation of the WTL of the K-MHW for resident physician however, enforcement of the WTL did not significantly influence the short-term outcome and hospital LOS for sICH in our hospital. Further well-designed multi-institutional prospective studies on the effects of WTL in sICH patient outcome, are anticipated.

Structural and Functional Alterations at Pre-Epileptic Stage Are Closely Associated with Epileptogenesis in Pilocarpine-induced Epilepsy Model

Pilocarpine-induced rat epilepsy model is an established animal model that mimics medial temporal lobe epilepsy in humans. The purpose of this study was to investigate neuroimaging abnormalities in various stages of epileptogenesis and to correlate them with seizure severity in pilocarpine-induced rat epilepsy model. Fifty male Sprague-Dawley rats were subject to continuous video and electroencephalographic monitoring after inducing status epilepticus (SE) and seizure severity was estimated by frequency and total durations of class 3 to 5 spontaneous recurrent seizures (SRS) by modified Racine's classification. The 7.0 Tesla magnetic resonance imaging (MRI) with high resolution flurodeoxyglucose positron emission tomography (FDG-PET) was performed at 3 hours, 1, 3, 7 days and 4 weeks after the initial insult. The initial SRS was observed 9.7±1.3 days after the pilocarpine injection. MRI revealed an abnormal T2 signal change with swelling in both hippocampi and amygdala in acute (day 1 after injection) and latent phases (days 3 and 7), in association with PET hypometabolism in these areas. Interestingly, the mean frequency of class 3 to 5 SRS was positively correlated with abnormal T2 signals in hippocampal area at 3 days. SRS duration became longer with more decreased glucose metabolism in both hippocampi and amygdala at 7 days after pilocarpine injection. This study indicates that development and severity of SRS at chronic phase could be closely related with structural and functional changes in hippocampus during the latent period, a pre-epileptic stage.

Basal Forebrain Cholinergic Deficits Reduce Glucose Metabolism and Function of Cholinergic and GABAergic Systems in the Cingulate Cortex

PURPOSE: Reduced brain glucose metabolism and basal forebrain cholinergic neuron degeneration are common features of Alzheimer's disease and have been correlated with memory function. Although regions representing glucose hypometabolism in patients with Alzheimer's disease are targets of cholinergic basal forebrain neurons, the interaction between cholinergic denervation and glucose hypometabolism is still unclear. The aim of the present study was to evaluate glucose metabolism changes caused by cholinergic deficits. MATERIALS AND METHODS: We lesioned basal forebrain cholinergic neurons in rats using 192 immunoglobulin G-saporin. After 3 weeks, lesioned animals underwent water maze testing or were analyzed by 18F-2-fluoro-2-deoxyglucose positron emission tomography. RESULTS: During water maze probe testing, performance of the lesioned group decreased with respect to time spent in the target quadrant and platform zone. Cingulate cortex glucose metabolism in the lesioned group decreased, compared with the normal group. Additionally, acetylcholinesterase activity and glutamate decarboxylase 65/67 expression declined in the cingulate cortex. CONCLUSION: Our results reveal that spatial memory impairment in animals with selective basal forebrain cholinergic neuron damage is associated with a functional decline in the GABAergic and cholinergic system associated with cingulate cortex glucose hypometabolism.

Effects of Silver-Care-Robot Program on Cognitive Function, Depression, and Activities of Daily Living for Institutionalized Elderly People

PURPOSE: The purpose of this study was to identify the effects on cognitive function, depression, and activities of daily living of Silver-Care-Robot Program for institutionalized elders. METHODS: This study was a nonequivalent control group pretest-posttest design. The participants were 42 institutionalized elders (17 in the experimental group and 25 in the control group). The Silver-Care-Robot Program was provided as an intervention which was conducted twice a week for 5 weeks. The Silver-Care-Robot Program is an integrated entertainment program to help the mental, emotional, and physical health of elderly people. Pre-test was conducted on the two groups, and, in order to examine the effects of intervention, a post-test was conducted after 5 weeks. RESULTS: There were significant differences in cognitive function and ADL (activities of daily living) between two groups after the program. But the difference in depression in the institutionalized elders was not statistically significant between the two groups. CONCLUSION: The Silver-Care-Robot Program should be considered as a regular program for cognitive function and activities of daily living for institutionalized elders.

Knowledge of and Compliance with Cough Etiquette among Nursing and Allied Health College Students / 병원감염관리

BACKGROUND: This study aims to examine the knowledge of nursing and allied health-college students on cough etiquette and their actual compliance to it. METHODS: For data collection, a structured questionnaire was created and handed out to students from 3 colleges from November 9 to November 18, 2011. The questionnaires were distributed to 300 students, and responses from 253 students were used for data analysis. RESULTS: In total, 54.85% students provided correct answers to questions regarding their knowledge on cough etiquette. The compliance score was 34.39 (compliance rate: 61.41%). There was a positive association between knowledge of proper cough etiquette and compliance with those procedures. CONCLUSION: It can be concluded that college student's knowledge of cough etiquette is low, and subsequently that their compliance with the proper procedures of cough etiquette was low. Therefore, it is necessary to develop a program to build knowledge of proper cough etiquette amongst these students.

Analgesic Mechanism of Electroacupuncture in an Arthritic Pain Model of Rats: A Neurotransmitter Study

PURPOSE: We investigated what kinds of neurotransmitters are related with electroacupuncture (EA) analgesia in an arthritic pain model of rats. MATERIALS AND METHODS: One hundred rats were assigned to six groups: control, EA, opioid, adrenergic, serotonin and dopamine group. A standardized model of inflammatory arthritis was produced by injecting 2% carrageenan into the knee joint cavity. EA was applied to an acupoint for 30 min in all groups except fo the control group. In the opioid, adrenergic, serotonin and dopamine groups, each receptor antagonist was injected intraperitoneally to their respective group before initiating EA. RESULTS: In the opioid receptor antagonist group, adrenergic receptor antagonist group, serotonin receptor antagonist group, dopamine receptor antagonist group and the control group weight-bearing force decreased significantly from 30 min to 180 min after EA in comparison with the EA group. CONCLUSION: The analgesic effects of EA are related to opioid, adrenergic, serotonin and dopamine receptors in an arthritic pain model of rats.

Efficacy and Safety of Red Ginseng Extract Powder in Patients with Erectile Dysfunction: Multicenter, Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE: To evaluate the safety and efficacy of red ginseng extract powder (OKBT) for treating erectile dysfunction. MATERIALS AND METHODS: Sixty-nine adult patients with mild to moderate erectile dysfunction of various etiologies were randomized to receive placebo or red ginseng extract powder. The red ginseng extract powder used in the present study was named OKBT. The primary efficacy parameter was response to the International Index of Erectile Function (IIEF) erectile function domain at baseline and week 8. Other IIEF domain scores were evaluated as secondary parameters. For safety evaluation, we performed history taking, physical examination, clinical laboratory tests, and hormonal tests at baseline and week 8. RESULTS: There were no significant differences in the patients' characteristics between the 2 groups. After 8 weeks of administration, primary efficacy (erectile function domain) and all secondary efficacy domains were significantly improved in the OKBT group compared with the placebo group (p<0.05). Notably, even the domain related to sexual desire, frequency and degree of sexual desire, was also improved in the OKBT group (p<0.001). There were no significant adverse reactions with OKBT administration, and there were also no significant differences in the results of laboratory tests between the 2 groups after administration. CONCLUSIONS: Our data show that red ginseng extract powder can be used as an alternative remedy for Korean men suffering from mild to moderate erectile dysfunction.

Cognitive Function, Mood, Problematic Behavior and Response to Interaction with Robot Pet by Elders with Dementia / 기본간호학회지

PURPOSE: The purpose of this study was to identify the effects on cognitive function, mood, problematic behaviors and response to interaction with robot pet by elderly people with dementia. METHOD: A methodological triangulation design with quantitative and qualitative methods was used. The participants were 9 elderly people with dementia. The intervention was conducted twice a week for 4 weeks. Qualitative data were collected by interviews and video-taping for analysis of the responses of participants. RESULTS: 1) Cognitive function, mood and problematic behaviors did not show any significantly differences after the program. 2) Analysis of the responses showed increases in verbal communication and positive action. CONCLUSION: The robot pet program had positive effects such as increasing communication and interaction. Therefore, this program could be considered as an effective program for emotional support for elderly people with dementia. However further repetitive study is need to validate the result

Analysis of Factors Influencing Secondary Traumatic Stress, Burnout, and Physical Symptoms in Firefighters / 기본간호학회지

PURPOSE: This study was done to evaluate the factors that influence secondary traumatic stress, burnout, and physical symptoms experienced by firefighters. In addition, a hypothetical model was developed. METHOD: The data were collected using self-reported questionnaires from 410 field service firefighters. Data analysis was done with the SPSSWIN 10.0 program for descriptive statistics and Windows LISREL program to determine the causal relationship between the measurement variables. RESULTS: The hypothetical model which was developed fits well with actual data(chi-square=3.16, p=0.99, GFI=1.00, AGFI=0.99, NFI=0.99, and NNFI=1.06). The variable, personality type, social support, and impact mobilization frequency had a significant effect and accounted for 7% of the secondary traumatic stress in firefighters. The variables, career, social support, and secondary traumatic stress had a significant effect and accounted for 24% of the burnout in firefighters. Social support, impact mobilization frequency, and secondary traumatic stress were important variables and accounted for 31% of the physical symptoms in firefighters. CONCLUSION: It is necessary for firefighters to manage themselves according to their personality types. Strategies that can increase the firefighters' social support and decrease their perceived secondary traumatic stress also need to be developed to minimize or prevent a negative effect on their health.

The Effect of Regular Exercise Program on Body Composition and Body Image in Adults Using One Fitness Center / 기본간호학회지

PURPOSE: This study was done to compare of adult body composition and body image before and after regular exercise program at a sports center. METHOD: The participants were 32 adults who were beginning regular exercise at a sports center in D city. The body composition was measured by body weight, soft lean mass, fat mass, percent body fat, fat distribution, degree of obesity and BMI, using the Inbody 3.0. Body image. Data were collected using structured questionnaires and analyzed using paired t-test. RESULTS: 1. Significant improvement was shown in body composition. 2. The score for body image increased after the program, but the change was not statistically significant. CONCLUSION: The short-term exercise program was very effective in improving body composition, but changes in the evaluation of body image need long-term exercise. Also, we were concluded that it is very important to consider preference level when evaluating body composition and body image.

The Lived Experiences of the Middle-Aged Women / 성인간호학회지

PURPOSE: This study was explored the experiences of the middle-aged women and tried to understand their lived experiences. METHOD: The data was collected from 9 participants living in Seoul from Sep. to Dec. 2003. Collection of data was by means of in-depth interviews. The analysis of the data was made the phenomenological analytic method suggested by Colaizzi(1978). RESULT: The 10 themes were extracted in this study ; sense of emptiness, repentance of one's past, decline of physical functions, lost one's youth, worry of children, thinking about future, importance of husband, importance of job, composure of mind, content with present life. CONCLUSION: Therefore, the helpful program should be developed and applied to extend positive lived experiences, and relieve or exclude negative lived experiences for the middle aged women.

Three Cases of Tuberculous Otitis Media

We report the imaging features of three cases of tuberculous otitis media. All three patients underwenttemporal bone CT scanning, and in two, additional MRI scanning was performed. The three cases showed soft tissuedensity in the external auditory canal, and in two, destruction of the trabeculation and internal cortex of themastoid bone was noted. In two patients with facial palsy, erosion of the facial canal was seen. On MRI, abundantgranulomatous tissue was noted in the middle ear cavity and mastoid air cells. In one case, abnormal enhancementof the cochlea, and of the facial and eighth cranial nerve in the internal acoustic canal was seen. Another caseshowed enhancement of the vestibule and lateral semicircular canal. If radiologic evaluation of chronic otitismedia reveals destruction of the tegmen and trabeculation of the mastoid bone, together with abundant granulationtissue and enhancement of the internal ear, tuberculous otitis media may be included in the differentialdiagnosis.

The Role of Three-Dimensional Imaging in Evaluation of the Sinonasal Mass

PURPOSE: To investigate the role of 3D imaging in the sinonasal mass. MATERIALS AND METHODS: Twenty patients with sinonasal mass(squamous cell carcinoma[n=6], spindle cell carcinoma[n=1}, angiomatous polyp[n=1}, giant cell reparative granuloma[n=1}, non-Hodgkin's lymphoma[n=1}, melanoma[n=1}, angiofibroma[n=1}, pyocele[n=1}, inverted papilloma[n=1}) were studied with spiral CT. Reconstruction of surface rendered 3D images and segmentations were performed and compared with the 2D image. RESULTS: The 3D images enabled easy understanding of the characteristics of the mass in 12 casese. The 3D images displayed pathway of tumor extension in 5 cases and werehelpful in assessing the primary site of the mass in 3 cases. In two cases with encasement of ICA by the mass, assesment of relationship between the mass and vessels were possible through the segmentation. CONCLUSION: The 3D image, as an adjunct to the 2D image, can help to evaluate the virtual appearance of bony change, the degree of extension of mass, the spreading route, the evaluation of origin site. It also provides valuable 3-dimensional conception of the mass, especially for the surgeon.

Arterial Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Factors of Rebleeding

PURPOSE: To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. MATERIALS AND METHODS: Fifty-nine patients with massiveor recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequentyly operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. the extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization, this was regarded as initial success in thecontrol of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation,and extravasation. Using the chi-square test, differences in these findings between rebleeding and non-rebleeding cases were analysed. RESULTS: Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemiccollateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosison plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant There was no correlation between the period from initial diabnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. CONCLUSION: In cases with more advanced lesions of pulmonary tuberculosis on plainchest PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial systemic collateral vessels and shunt, the higher there bleeding rate after embolization.

CT Findings of Small Bowel Rupture after Abdominal Trauma

PURPOSE: The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel rupture after abdominal trauma is controversal. This study was conducted to ascertain CT finding of small bowel rupture result from abdominal trauma. MATERIALS AND METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel rupture was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel rupture including pneumoperitoneum or retroperitoneal air, discontinuity of the bowel wall and extravasation of oral contrast materials were observed in 33 cases(83%). Intraperitoneal or retroperitoneal free air was seen in 31 cases(78%) and intraperitoneal or retroperitoneal free fluid collection was seen in 38 patients(95%). Small bowel wall was thickened in 31 cases(78%), bowel wall was enhanced in 12 cases(30%) and bowel wall discontinuity and extravasation of oral contrast material was seen in 5 cases, respectively. CONCLUSION: The CT scan is sensitive and effective modality for evaluation of small bowel rupture after abdominal trauma, because of high detectability of diagnostic and suggestive CT findings.