The Effect of the Addition of Fentanyl and Midazolam to Lidocaine in a Supraclavicular Brachial Plexus Block / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effects of fentanyl and midazolam when used as adjuvant in a supraclavicular brachial plexus block. METHODS: 100 adult patients with an ASA status of I-II that were scheduled to undergo upper extremity surgery performed under a supraclavicular brachial plexus block were prospectively evaluated in this study.The patients were randomly divided into 4 study groups:Group 1, which received 40 ml of 1.5% lidocaine, Group 2, which received 3 mg of midazolam with 40 ml of 1.5% lidocaine, Group 3, which received 100microgram of fentanyl with 40 ml of 1.5% lidocaine, and Group 4, which received 3 mg of midazolam and 100microgram of fentanyl with 40 ml of 1.5% lidocaine.The onset time, as well as the duration of analgesia and motor blocks, proportion of successful blocks, hemodynamic parameters, and adverse events were then noted. RESULTS: The incidence of successful block was higher in group 4 (92%) than in any other groups (68-72%) (P = 0.185). In addition, the mean duration of analgesia was longer in groups 2 and 4 (165 min and 175 min) than in groups 1 and 3 (114 min and 131 min) (P < 0.05).Furthermore, the mean duration of motor block was longer in groups 2 and 4 (169 min and 180 min) than in groups 1 and 3 (123 min and 126 min) (P < 0.05).No significant difference was observed in the onset time of the sensory block and motor block when the groups were compared. CONCLUSIONS: Although the addition of 3 mg of midazolam and 100microgram of fentanyl to lidocaine in a supraclavicular brachial plexus block does not affect the onset of sensory or motor block, it does prolong the duration of analgesia and motor block.

Heath Promotion Priorities of Older Adults in a Rural Community

PURPOSE: The purpose of this study is to assess the priorities of health promotion for older adults in the rural community. The study attempts to display demographic characteristics subjective health status and chronic diseases status of the older adults. METHODS: We surveyed 384 senior residents in a community via face-to-face interviews in their homes, who were selected by proportional random sampling. We analysed the frequency, multiple responses and chi2 by SPSS 12.0K. RESULTS: The mean of subjective health status was 54.04+/-21.69 with a maximum of 100. Our study found that the high priorities in health promotion for older adults were prevention and management of hypertension and diabetes, strengthening of joint and muscles, cancer screening and physical exercise. Prevention of depression and social activities were low priorities. Strengthening of joints and muscles was a high priority among women while smoking cessation and social activities were high priorities of men. CONCLUSION: In conclusion, health promotion priorities of older adults differed by gender and subjective health status. Disease-related priorities received more attention than psycho-social health priorities. This study suggests comparing the priorities regionally and nationally.

Factors Associated with Gastric Cancer Screening of Koreans Based on a Socio-ecological Model / 예방의학회지

OBJECTIVES: We measured behavioral factors associated with Koreans receiving gastric cancer screening based on a socio-ecological model, in part to develop strategies to improve cancer screening rates. METHODS: A telephone survey was conducted with 2,576 people chosen through stratified random sampling from April 1- May 31, 2004. Collected information included gastric cancer screening, socio-demographic factors, and socio-ecological factors at intrapersonal, interpersonal, community, and public policy levels. RESULTS: Among 985 survey respondents (380 men and 605 women), 402 had received gastric cancer screening. Logistic analysis was performed to compare those screened and unscreened. 'Age' was the only demographic factor that showed a statistically significant association with getting screening. People in their fifties (OR=1.731, 95% CI=1.190-2.520) and sixties (OR=2.098, 95% CI=1.301-3.385) showed a higher likelihood of getting screened, compared to those in the forties. 'Accessibility to a medical institution' was a significant factor related to having gastric cancer screening at the intrapersonal level. At the interpersonal level, recommendations by family members to be screened and a family practice of routine cancer screening were significantly related. People with frequent education about cancer screening or with stronger social feelings that cancer screening is necessary also demonstrated significantly higher tendencies to be screened. CONCLUSIONS: In conclusion, a socio-ecological model seems appropriate for explaining gastric cancer screening behavior and associated factors. Health planners should develop integrated strategies to improve cancer screening rates based on socio-ecological factors, especially at the interpersonal and community levels.

The effect of the introduction of Picture Archiving and Communication System on interpretation rate of radiologic examinations / 대한의료정보학회지

OBJECTIVE: This study was designed to evaluate the effect of the introduction of picture archiving and communication system(PACS) by identifying the change of the interpretation rates of radiologic examinations. METHODS: The data about total of 297,314 radiologic examinations done from June, 2001 to June 2002 was collected through medical record. December, 2001 which was the month of PACS introduction was excluded from the analysis for controlling the bias. Data concerning the time spent on interpretation, types of patients, clinical departments and types of radiologic examinations were collected. Chi-square test was performed to evaluate differences before and after introduction of PACS. RESULTS: 1. The interpretation rates of total radiologic examinations significantly increased after the introduction of PACS. The interpretation rate within 1 day increased 2.3 times higher after the introduction of PACS. 2. Both of the interpretation rates of radiologic examinations for outpatients and inpatients were significantly increased after the introduction of PACS. The interpretation rate within 1 day of radiologic examinations among outpatients increased 2.1 times higher and that among inpatients increased 3 times higher after the introducton of PACS. CONCLUSION: There was overall increase of interpretation rate suggesting the improvement of performance in department of radiology. This indicated that introduction of PACS brought about a positive impact on medical service quality through improving operational efficiency.

The Distribution of Time to Death in Trauma Patients

OBJECTIVE: In trauma patients, the distribution of time to death can be used in many ways. We examined the distribution of time to death in trauma patients who expired during a 10-year and analyzed the risk factors of early deaths. METHOD: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospitals were enrolled. A retrospective study was done to determine the distribution of trauma mortality and compared the differences between patients who succumbed during the first 5 years and those who succumbed during the second 5 years. We also analyzed the risk factors associated with early deaths that occurred within 6 hours after injury. RESULT: The distribution was bimodal for both the first and the second 5 years. During the second 5 years, there was about two times as many death within 1 hour after injury. The average ages were 36.5 years for the first 5 years and 43.6 years for the second 5 years (p<0.05). The transport times were 35 minutes for the first 5 years and 31.5 minutes for the second 5 years, and the transports by EMS (119) increased from 45.2% to 77.1%. Motor vehicle accidents were the most common mechanism of injury in both periods, but the number was lower in the second 5 years (p<0.05). The most common causes of death were injuries of head and spine and hemorrhages. Risk factor of early deaths were injury of nervous system and chest trauma. CONCLUSION: In our study, the distribution of trauma mortality was bimodal pattern. The trauma system in Korea should be improved to decrease the early and the late peak. To decrease early deaths, it is important to prevent accident, develop EMS for early transport and pre-hospital management, and connect effectively with the trauma center. To decrease late deaths, aggressive resuscitation, suitable antibiotic therapy, and conservative treatment are important.

A Study on Depression, Anxiety and Quality of Life in Amenorrhea Schizophrenics Treated with Risperidone / 신경정신의학

OBJECTIVES: Amenorrhea, one of the most common side effects of neuroleptics, has known to be associated with prolactin elevation. Hyperprolactinemia seriously affects mental health causing depression, anxiety or hostility, while also affecting physical health causing amenorrhea, galactorrhea or sexual dysfunction. The possible correlation between risperidone-induced amenorrhea and depression, anxiety and quality of life was evaluated in a cross-sectional open study. METHODS: During a five-month period, WHO quality of life-BREF (WHOQOL), Beck depression inventory (BDI) and Statetrait anxiety inventory (STAI) were applied twice at two-month intervals for 30 patients with risperidone-induced amenorrhea and 22 patients without amenorrhea. RESULTS: Amenorrhea group had significantly higher scores in BDI and STAI-state, while showing lower scores in the quality of life than control group. The total BDI and STAI-state scores were more negatively correlated with WHOQOL score in amenorrhea group. CONCLUSION: Patients with risperidone-induced amenorrhea rated themselves significantly more depressed and more anxious, and a lower quality of life compared to the control group. Clinicians should be more active in evaluating and treating hyperprolactinemic side effects such as amenorrhea, galactorrhea, depression and anxiety.

Distribution of Refractive Errors and Quantified Optometric Values in Urban Elementary Fourth Graders in Korea

PURPOSE: To assess the distribution of ocular diseases, refractive errors, and quantified optometric values in urban elementary 4th graders in Korea. METHODS: A total of 234 schoolchildren were assessed in a population-based, cross-sectional study. The examination included uncorrected and corrected visual acuity measurements, corneal refractive power measurements using an autokeratometer (KR-8100, Topcon(R) Inc., Japan), ocular motility evaluation, slit-lamp biomicroscopy for the anterior segment and media, the measurements of anterior chamber depth, lens thickness, and axial length using an A-scan ultrasound biometry (A/B-scan system 835, Humphrey(R) Inc., Dublin, CA), retinoscopy under cycloplegia, and fundus examination. RESULTS: The prevalence rates of strabismus, epiblepharon, and amblyopia were 1.3%, 2.6%, and 1.7%, respectively. Mean visual acuity was -0.18 +/- 0.31 LogMAR. The prevalence rates of myopia (or=+1.00 D SE), and anisometropia (SE difference>or=1.00 D) were 46.2%, 7.3% and 5.9%, respectively. The means of corneal refractive power, axial length, and anterior chamber depth were 43.29 +/- 1.45 D, 23.42 +/- 1.26 mm, and 3.29 +/- 0.30 mm, respectively. CONCLUSIONS: We assessed the distribution of ocular diseases, refractive errors, and quantified optometric values in a population-based study. The results showed that increases in the prevalence of reduced vision and myopia are an important public health problem in urban elementary 4th graders in Korea.

Factors Affecting On-Line Medical Information Retrieval by Patients at a General Hospital in Seoul / 대한의료정보학회지

This study was designed to identify the factors relating to the retrieval of medical information from the Internet by patients at a general hospital in Seoul. A questionnaire survey was carried out for 440 inpatients and outpatients who visited the general hospital by 20 educated nurses between 24 and 25 October, 2002. The collected data were analyzed to evaluate the relationship between socioeconomic characteristics and Internet use, and opinions about medical information on the Internet and Internet use, by t-tests or chi-square tests. A logistic regression analysis was applied to find models explaining the factors affecting Internet use and the search for medical on the Internet. According to our logistic regression analysis, the younger, better educated, higher income, and singles showed a higher Odds ratio for Internet use. Age, education period, income and confidence level of the Internet contents were statistically significant in the search for medical information on the Internet(p< 0.05). The results showed the customers characteristics, needs, and problems with using the Internet in medical area on the customer s views. These results would be useful for building marketing strategies using the Internet as a way of servicing and communicating with the patients.