Characteristics of Medication Administration Error Alerts in Application of Mobile Medication System / 기본간호학회지

Purpose@#To assess characteristics the application of mobile medication system and medication administration error (MAE) alerts in a general hospital. @*Methods@#The subject hospital adopted a mobile medication system in 2016. All medication administrations in the general wards and ICUs were automatically recorded in real-time using identification barcodes, drug barcodes, and hand-held point-of-care devices. MAE alert logs were recorded from April 1st 2017 to March 31st 2018. For this study analysis was done using Pearson’s chi-squared test for potentially related factors of MAE alerts included administration time, order type, medication route, and length of nurse’s employment. @*Results@#The total number of medications during the period of this study was 3,227,990. Among them, 2,698,317 medication doses were recorded, resulting in the system application rate of 83.6%. The system application rate was significantly correlated with all factors related to potential MAE alters. In this study 23,314 MAE alerts(0.9% of the total medication doses) were identified. The MAE alerts were related to new (OR=2.26, p<.001) and emergency (OR=2.25, p<.001) orders, and administration at a non-standard time (OR=2.032, p<.001). Medication route (p<.001), and nurse’s employment duration(p<.001) were also related. @*Conclusion@#A mobile medication system contributes to improving patient safety by preventing potential MAEs. The MAE alerts were related to administration time, order type, medication route, and duration of nurse’s employment. In order to prevent medication administration errors, it is necessary to standardize the process of medication and create an environment in which medication administration can be performed in a planned situation.

Severe recurrent nocturnal hypoglycemia during chemotherapy with 6-mercaptopurine in a child with acute lymphoblastic leukemia

Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.

Changes of antithroglobulin antibody in children with congenital hypothyroidism

PURPOSE: It has been reported that antithroglobulin (anti-TG) antibody is increased in the sera of both children with transient congenital hypothyroidism and their mothers. And transplacental transport of thyroid autoantibody was proposed as the pathogenesis of transient congenital hypothyroidism. However this is not known in nontransient congenital hypothyroidism. This study was done to see changes of anti-TG antibody in children with nontransient congenital hypothyroidism. METHODS: Study patients consisted of 60 patients diagnosed as congenital hypothyroidism in the Department of Pediatrics, Kyungpook National University Children's Hospital, Daegu, Republic of Korea between January 2010 and March 2013. Healthy control were 45 children showing normal thyroid function. Anti-TG antibody and various laboratory tests were analyzed retrospectively, and compared in both children with congenital hypothyroidism and controls. RESULTS: Anti-TG antibody was significantly higher in children with congenital hypothyroidism compared to healthy controls, 119.4+/-34.7 U/mL versus 80.6+/-19.6 U/mL, respectively (P<0.001). There was no significant difference of anti-TG antibody in gender and age. CONCLUSION: We observed a significant increase of anti-TG antibody in children with nontransient congenital hypothyroidism compared to healthy controls. Further study focusing pathogenetic role of anti-TG antibody in nontransient congenital hypothyroidism is necessary. Furthermore, the clinical significance in the course of congenital hypothyroidism need to be known.

Polyclonal gammopathy related to renal bleeding in a peritoneal dialysis patient / 소아과

Polyclonal gammopathy represents the diffuse activation of B cells and is usually related to inflammation or immune-related diseases. However, the mechanisms leading to polyclonal gammopathy are essentially speculative. Generally, infectious, inflammatory, or various other reactive processes may be indicated by the presence of a broad-based peak or band in the gamma region on serum protein electrophoresis results. A 15-year-old girl, who had been receiving peritoneal dialysis, presented with polyclonal gammopathy and massive gross hematuria. Renal artery embolization was performed, after which the continuous bleeding subsided and albumin-globulin dissociation resolved. This is a rare case of polyclonal gammopathy related to renal bleeding.

Two Cases of Cervical Dystonia in Tuberculous Meningitis

Secondary cervical dystonia caused by tuberculous meningitis is extremely rare. Sixteen year-old female and 56 year-old male were admitted with fever, headache and mental change. Several days after admission they presented neck deviation and polygraphic study revealed prolonged muscular contraction of sterocleidomastoid and trapezius muscles without EEG changes. Their MRI revealed bilateral lesions in the basal ganglia. Recognition of dyskinesias associated with meningitis may be helpful in the diagnosis of tuberculous meningitis.

Patient knowledge of upper respiratory infections an unnecessary utilization of antibiotics

BACKGROUND: Upper respiratory infections account for many of the visits in primary care. As most URIs are caused by viruses, antibiotic therapy is not desirable. However, for URI treatment antibiotic therapy is commonly used, which causes many public health problems such as drug resistant bacteria and high medical cost. This paper examines patient knowledge of the normal presentation of a URI, beliefs in the effectiveness of antibiotics and health care utilization. METHODS: A survey of 200 outpatients or their families was conducted in one university hospital from March to April, 1998. Two URI conditions were given for the survey:(1) a condition of 5 days' duration with a cough, sore throat, and clear nasal discharge (question 1), (2) a condition of the same symptom as (1) except a discolored nasal discharge (question 2). For various questions in each of these conditions they were to answer in 5 point Likert type scale. Statistical softwares of SAS 8.0 and GAUSS 3.21 were used for analyzing the survey data. RESULTS: For question 1, 61 % of the sample reported that they would seek care from a physician while for question 2, 75 % of the sample reported that they would do so (p<.01). The health service suppliers, in the order of visiting frequencies, were pharmacy (58 %), hospital (38 %), no visit (2.5 %), public health center (0.5 %), and Chinese medicine clinic (0.5 %) for question 1 and pharmacy (54 %), hospital (42 %), no visit (2 %), Chinese medicine clinic (0.5 %) and public health center (0.0 %) for question 2. For question 1, 54 % of the sample and for question 2, 63 % reported that they believe antibiotics were effective (p=.068). For question 1, 79.5 % and for question 2, 89.5 % of the subjects reported that they had complied to prescriptions of doctors or pharmacists (p<0.05). Out of those subjects, only 19.5 % for question 1 and 21.2 % for question 2 reported that they checked the presence of antibiotics in the prescriptions. A multivariate analysis shows that older people, normally used antibiotics and current smokers had higher tendency of seeking care and stronger beliefs in the effectiveness of antibiotics. CONCLUSION: There is a lack in patient understanding of normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning ofa discolored nasal discharge is particularly evident. The patients visited pharmacies more often than hospitals, and majority of them (80 %) did not know the details of their prescriptions.

The Role of Clinical and Biololgical Parameters to Predict Malignant Gestational Trophoblastic Tumor in Patients with Hydatidiform Mole / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to reevaluate the prognostic factors by investigating the clinical and biological parameters concerned malignant gestational trophoblastic tumor in patients with hydatidiform mole. METHODS: From March 1995 to February 2000, 41 patients admitted to department of the Obstetrics and Gynecology, Yonsei University College of Medicine who were diagnosed with pathologically-proven gestational trophoblastic disease were selected. Parameters such as age, gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction were compared between malignant gestational trophoblastic tumor group and spontaneous remission group. RESULTS: Considering the clinical prognostic factors, the patients were divided into two age groups; the first group consisted of those older than 40 years of age and the second control group consisted of those under 40. The number of patients older than 40 in the spontaneous remission group and malignant gestational trophoblastic tumor group were 4(15.4%) and 7(46.7%), respectively, showing a significantly higher number in the group over 40years. Other parameters such as gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction showed no statistically significant difference between the two groups. CONCLUSION: The progression rate from hydatidiform mole to malignant gestational trophoblastic tumor was significantly higher in patients over 40 years of age. Therefore, more aggressive therapeutic approach should be considered in such patients.

The Immunohistochemical analysis for the expression of survivin, an inhibitor of apoptosis protein, in non-small cell lung cancer / 결핵

BACKGROUND: Defects in apoptotic signaling pathways play important role in tumor initiation, progression, metastasis and resistance to treatment. Several proteins which may promote tumorigenesis by inhibiting apoptosis were identified. The survivin protein is the member of inhibitor of apoptosis protein(IAPs) family which inhibits apoptosis. Unlike other IAPs, it is expressed in during the fetal period but not in adult differentiated tissues. Many reports have stated that survivin is selectively expressed in many cancer cell lines and cancer tissues. We performed immunohistochemical analysis for survivin expression in non-small cell lung cancer to get evaluate its clinical implication. METHODS: Twenty nine surgically resected lung cancers were examined. Immunohistochemical staining were performed by immuno-peroxidase technique using avidin-biotinylated horseradish peroxidase complex in the formalin-fixed, paraffin-embedded tissue 4 µm section. Anti-survivin polyclonal antibody was used for primary antibody and anti-p53 monoclonal antibody was also used to analyze the correlation between survivin and p53 expression. The survivin expression scores were determined by as the sum of the stained area and intensity. RESULTS: Immunohistochemical analysis showed cancer specific expression of survivin in 20 of 29 cases (69.0%). Western blot analysis also showed the selective survivin expression in turmor tissue. There was no correlation between survivin expression and clinicopathological parameters and prognosis. We analyzed the correlated between survivin expression and p53 expression, but found none. CONCLUSION: We confirmed the tumor specific expression of survivin in non-small cell lung cancer But this pression was not correlated with clinical parameters as well as histlogy, tumor stage recurrence, and sur rate. Also it ws not statistically correlated with the expression of p53.

Pathologic Correlations of Various Indications for Large Loop Excision of Transformation Zone(LLETZ) in Patients with Cervical Lesion / 대한부인종양콜포스코피학회잡지

OBJECTIVE: This study was performed to evaluate the effects of mutiple indications and age on the likelihood of finding cervical lesion in large loop excision of transformation zone(LLETZ). METHOD: We reviewed the medical records of 471 evaluable LLETZ of cervix for cervical neoplasia at the Yonsei University College of Medicine, from April 1996 to August l998. The indications for the LLETZ were grouped as being for treatment(biopsy-proven disease)(indication A), significant discrepancy among cytologic and histologic results(indication B), unsatisfactory colposcopic finding(transformation zone not fully visualized)(indication C), possible microinva- sion(indication D), and combinations of the above. RESULTS: The prevalence rates of cervical lesion in performed LLETZ for indication A alone, for indication B alone, for a combination of indication A and C, for a combination B and C, and for indication D alone were 85.7%, 56.5%, 82.3%, 42.6%, 95%, respectively. The data were then reanalyzed to determine the likelihood of finding high-grade disease on LLETZ specimen. Overall, those with preoperative high-grade cytologic or histologic characteristics were much more likely to have high grade disease(78.1%) than were those with preoperative low-grade cytologic or histologic characteristics(27.2%)(p<0.001). The influence of age on the likelihood of identifying diasease on the LLETZ is undertermined. CONCLUSION: Neither age nor the preoperative grade of disease are good discriminators of the likelihood that disease will be found on a LLETZ specimen, However, patients with preoperative high-grade disease are much more likely than those with preoperative low-grade disease to have high-grade dysplasia or invasive cancer on LLETZ.

A Case of Klinefelter Syndrome Combined with Hydrops Fetalis / 대한산부인과학회잡지

Nonimmune hydrops fetalis(NIHF) is a heterogenous disorder resulting from a vast number of underlying pathologies. Chromsomal abnormalities underlie a large percentage of cases of NIHF in most series. There are many reports identifying the association of Turner syndrome and Trisomy 21, 18, 13 with NIHF, but few reports about Klinefelter syndrome. In this article, we experienced a case of Klinefelter syndrome combined with hydrops fetalis and report the case with brief review of literature.