Development of Pediatric Patient Classification System / 임상간호연구

Purpose@#This study was performed to develop a valid and reliable Pediatric Patient Classification System (PPCS). @*Methods@#The study was conducted in a children’s hospital which included various ward settings.Content validity was analyzed by Delphi method and to verify intraclass correlation reliability, 7 nurse managers and 29 staff nurses classified 216 patients. To verify construct validity, the staff nurses classified 216 patients according to PPCS comparing differences by age, days of stay, type of stay and medical department. @*Results@#The developed PPCS has 12 categories, 55 nursing activities and 80 criterions. High agreement among nurses (r=.90) suggested substantial reliability. Construct validity was verified by comparing differences in age, days of stay, type of stay and medical department (p<.05). The entire patient group were classified to four groups using PPCS. @*Conclusion@#The findings suggest that PPCS would be a useful tool for estimating nursing demands related to medications and the complexity of pediatric patients.

Relevance of Seizure with Mortality and Neurologic Prognosis of Out of Hospital Cardiopulmonary Arrest (OHCA) Patients Who had Treated with Therapeutic Hypothermia after Return of Spontaneous Circulation

PURPOSE: The purpose of this study is to evaluate relevance of postanoxic seizure with prognosis in cases of out-of hospital cardiac arrest (OHCA) patients treated with TH and to research the prognostic role of portable electroencephalography (EEG). METHODS: A total of 180 OHCA patients arrived during July of 2008 and June of 2011, and 144 patients who had been treated with therapeutic hypothermia were included in this study. Portable EEG was taken 24 hours after induction of TH and classified by the attending neurologist. As an outcome variable, overall mortality and neurological outcome after six months from discharge were evaluated (Good neurological outcome; Cerebral performance category (CPC) scale 1, 2, Poor neurological outcome; CPC scale 3~5). RESULTS: Among 144 patients, 93 patients (63.9%) were male, and mean age was 51. Eighty two patients (56.9%) survived and almost 30% (43/144) of patients had a good neurological outcome. Sixty five patients (45.1%) had seizures, and, among this group, 19 patients (29.2%) were discharged with a good neurological outcome. No statistical difference was observed between the seizure group and the non-seizure group. Initial rhythm, APACHI II score, and time from basic life support to return of spontaneous circulation (OR, 2.169; 95% CI, 1.158~4.063, OR 1.107; 95% CI 1.064~1.152, OR 1.014; 95% CI 1.006~1.022, respectively) showed statistical importance, however, the seizure group (OR, 0.67, 95% CI, 0.356~1.032, p=0.065) had no statistical relevance with mortality. Grading of EEG by the neurologist showed a positive association with neurological outcomes (p<0.001). Factors associated with good neurological outcome were VF/VT initial rhythm (p=0.005), cardiac cause of arrest (p=0.001), high initial body temperature (p<0.001), low APACHI II score (p=0.010), and shorter time interval between arrest from basic life support (p=0.005). CONCLUSION: In our study, the seizure group showed no relevance with mortality and prognosis. In hope of achieving a better outcome, careful treatment should be provided in cases of OHCA patients with seizure. Conduct of larger, prospective studies is needed.

Prognostic Importance of Hypoalbuminemia in Patients with Severe Sepsis and Septic Shock

PURPOSE: This study investigated the association between hypoalbuminemia and 28-day mortality in patients with severe sepsis and septic shock. METHODS: A prospective observational study, including consecutive patients with severe sepsis and septic shock, was performed from July 2008 to June 2011. Patient demographic data, comorbidities, blood test results (including albumin concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and non-survivors. Patients were divided into normal albumin (> or =3.3 mg/dl) and hypoalbuminemia (<3.3 mg/dl) groups. The Cox proportional hazards regression analysis was conducted to identify the predictors of 28-day mortality. Analysis of the area under the receiver operating characteristic curve was performed to compare the prognostic performance of albumin concentrations versus APACHE II scores. RESULTS: During the study period, a total of 493 patients were included and 140(28.4%) died. The albumin concentrations of non-survivors were significantly lower than those of survivors (3.3+/-0.6 mg/dl vs. 2.8+/-0.6 mg/dl, respectively) and the hypoalbuminemia group had a higher mortality rate than the normal albumin group (41.2% vs. 10.3%, respectively, p<0.01). In Cox analysis, hypoalbuminemia was associated with a 3.8-fold increased risk of death during the 28-day follow-up period (hazard ratio, 3.83; 95% CI, 2.22-6.59). The AUC of albumin concentration was 0.73(95% CI, 0.69-0.78), which was comparable with that of APACHE II score (0.77; 95% CI, 0.73-0.81). CONCLUSION: Hypoalbuminemia is an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.

Prognostic Importance of Hypoalbuminemia in Patients with Severe Sepsis and Septic Shock

PURPOSE: This study investigated the association between hypoalbuminemia and 28-day mortality in patients with severe sepsis and septic shock. METHODS: A prospective observational study, including consecutive patients with severe sepsis and septic shock, was performed from July 2008 to June 2011. Patient demographic data, comorbidities, blood test results (including albumin concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and non-survivors. Patients were divided into normal albumin (> or =3.3 mg/dl) and hypoalbuminemia (<3.3 mg/dl) groups. The Cox proportional hazards regression analysis was conducted to identify the predictors of 28-day mortality. Analysis of the area under the receiver operating characteristic curve was performed to compare the prognostic performance of albumin concentrations versus APACHE II scores. RESULTS: During the study period, a total of 493 patients were included and 140(28.4%) died. The albumin concentrations of non-survivors were significantly lower than those of survivors (3.3+/-0.6 mg/dl vs. 2.8+/-0.6 mg/dl, respectively) and the hypoalbuminemia group had a higher mortality rate than the normal albumin group (41.2% vs. 10.3%, respectively, p<0.01). In Cox analysis, hypoalbuminemia was associated with a 3.8-fold increased risk of death during the 28-day follow-up period (hazard ratio, 3.83; 95% CI, 2.22-6.59). The AUC of albumin concentration was 0.73(95% CI, 0.69-0.78), which was comparable with that of APACHE II score (0.77; 95% CI, 0.73-0.81). CONCLUSION: Hypoalbuminemia is an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.

N-terminal Pro-Brain-type Natriuretic Peptide as a Prognostic Factor in Severe Sepsis and Septic Shock

PURPOSE: This study was performed to evaluate whether N-terminal pro-brain-type natriuretic peptide (NT-proBNP) could predict 28-day mortality in patients with severe sepsis and septic shock. METHODS: We performed a retrospective analysis of prospectively collected data from patients with severe sepsis and septic shock. Patients' demographic data, comorbidities, blood test results (including NT-proBNP concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and nonsurvivors. NT-proBNP levels were categorized into quartiles by their concentration (6,000 pg/ml). Multivariate Cox proportional hazard regression analysis was performed to identify the predictors of mortality during a 28-day follow-up period. RESULTS: Out of 349 patients, 117(33.5%) died. NT-proBNP concentrations were significantly higher in nonsurvivors compared to survivors (median 4,630 [IQR, 1,876-10,582] vs. 1,552 [IQR, 440-4,064] pg/ml, respectively, p6,000 pg/ml were 12.9%, 26.1%, 39.8%, and 51.1%, respectively. By Cox proportional hazards analysis, compared to patients with the lowest NT-proBNP levels (600 pg/ml (HR, 2.30; 95% CI, 1.15-6.14). CONCLUSION: NT-proBNP is an independent prognostic factor for 28-day mortality in patients with severe sepsis and septic shock.

Korean Version of Revised Terminology and Concepts for Organization of Seizures and Epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009 / 대한간질학회지

No abstract available.

Korean Version of Revised Terminology and Concepts for Organization of Seizures and Epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009

No abstract available.

Serum S100B Protein as a Marker of Ischemic Stroke Severity During Hyperacute Stage / 대한뇌혈관외과학회지

OBJECTIVE: Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. METHODS: Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. RESULTS: Mean serum S100B protein was normal in 27 patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose, blood pressure and other lipid profiles. CONCLUSION: Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.

Serum S100B Protein as a Marker of Ischemic Stroke Severity During Hyperacute Stage / 대한뇌혈관외과학회지

OBJECTIVE: Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. METHODS: Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. RESULTS: Mean serum S100B protein was normal in 27 patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose, blood pressure and other lipid profiles. CONCLUSION: Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.

Neurosyphilis Presenting With Unilateral Tonic Pupil

No abstract available.

A Fatal Case of Pulmonary Embolism after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma / 대한내과학회지

Transcatheter arterial chemoembolization (TACE) is one of the most common palliative treatment modalities for patients with advanced hepatocellular carcinoma (HCC). TACE is an invasive procedure associated with several potential complications of varying severity. A pulmonary embolism after TACE for HCC is a rare complication. We report a case of pulmonary Lipiodol embolism after a third TACE resulting in death.

The Prevalence of a Low Response to Aspirin and its Association with Recurrent Ischemic Cerebrovascular Events / 대한뇌혈관외과학회지

BACKGROUND: Aspirin is one of the effective antiplatelet agents with proven benefits for the prevention of ischemic stroke. However, ischemic stroke may recur in some patients despite aspirin therapy. We investigated the prevalence of laboratory assessed low-responsiveness to aspirin in patients who are treated with aspirin for secondarily preventing cerebrovascular events, and we did so by using the VerifyNow(R) Aspirin assay. METHODS: We measured the platelet function using the VerifyNow(R) test in the recurrent (RG) and no-recurrent groups (NRG) that were treated with aspirin for secondarily preventing cerebrovascular events, We analyzed the association of a low response to aspirin with the clinical ischemic events and the factors associated with a low response. RESULTS: There were 110 patients on aspirin for secondary prevention and the mean treatment duration was 17 months. The incidence of a low response to aspirin was significantly higher in the RG than that in the NRG (26.2% vs. 5.8%, respectively, p=0.03). Multivariate analysis revealed that smoking was an independent predictor of a low response to aspirin (p=0.003). CONCLUSIONS: We found that up to 26.2% of the patients with recurrent stroke are laboratory assessed aspirin low-responsive (as measured with the VerifyNow(R) Aspirin assay), despite that they are on chronic aspirin therapy. Aspirin lowresponsiveness may be associated with the clinical failure to prevent recurrent ischemic cerebrovascular diseases, and this is known as clinical aspirin low-responsiveness.

Dissociation of Hangul and Hanja Reading After Left Parieto-occipital Infarction: Alexia with agraphia with Hangul, but preserved in Hanja

Korean vocabularies are composed of ideograms (Hanja) and phonograms (Hangle) just like Kanji (ideogram) and Kana (Phonogram) in Japanese. Double dissociation between the phonogram and ideogram has been reported in both languages. According to those studies, the ideograms are localized in more selective brain areas than the phonograms. We report on a case of alexia with agraphia for Hangle and intact reading for Hanja after a left parieto-occipital lobe infarction.

A case of Posterior Cortical Atrophy Presenting with Features of Atypical Dementia

Posterior cortical atrophy(PCA) is a presenile dementia that presents primarily with signs and symptoms of cortical visual dysfunction, while memory is relatively preserved until the late stage of the disease. We report a patient with PCA, confirmed by brain magnetic resonance imaging (MRI) and F18-fluorodeoxyglucose positron emission tomography(FDG PET). A 58-year-old right-handed woman presented initially with visual dimness and difficulty finding things around her. She had partial Balint's syndrome, partial Gerstmann syndrome, and idiomotor apraxia. She also had a mild memory disturbance, but preserved insight of her disease. Neuropsychological evaluation showed decreased parietal and left temporal functions bilaterally. Brain MRI and F18-FDG PET revealed typical bilateral occipitoparietal atrophy and hypometabolism, which were slightly worse on the right side. Cholinesterase inhibitor administration for 6 months improved the memory impairment slightly, but not the cortical visual dysfunction. This is a typical case of PCA, confirmed by neurologic signs and imaging findings.

A Study of the Pregnancy Weight Gains of Noncomplicated Primiparas and Multiparas / 대한주산의학회잡지

OBJECTIVE: To establish the biweekly standard values of pregnancy weight gains for primiparas and multiparas, and to investigate the influence of prepregnancy body mass index on biweekly weight gain during pregnancy. METHODS: We analyzed the biweekly weight gain data from 536 primiparas and 114 multiparas who had noncomplicated singleton term pregnancy. Data was categorized according to parity and body mass index (BMI). RESULTS: Biweekly weight gain was significantly different among prepregnancy BMI groups from the 15th week but was not different between primiparas and multiparas. CONCLUSION: To prevent a lot of complications which may be associated with abnormal weight gain during pregnancy, more careful prenatal care according to the prepregnancy BMI groups is needed. To establish the Korean standard value for antenatal weight gain, a nationwide multicenter study is needed.

A study of the biweekly weight gains of noncomplicated pregnancies / 대한산부인과학회지

OBJECTIVE: To establish the standard values for proper antenatal weight gain, biweekly mean weight gains, standard deviations were calculated from the 5th to the 42nd gestational week and their percentiles were determined. And the influence of prepregnancy body mass index and/or parity on biweekly weight gain was investigated. METHODS: We analyzed the biweekly weight gain data from 910 women who had noncomplicated singleton term pregnancy. Data was categorized in three groups according to body mass index (BMI). RESULTS: The biweekly weight gain table has been determined and 'Sigmoid(S) shaped' weight gain curves were presented. Primipara and multipara have significantly less weight gain than nullipara beyond the 25th weeks. Biweekly weight gain was significantly different among prepregnancy BMI groups from the 13th week. CONCLUSION: More careful prenatal care according to the biweekly weight gain-gestational week tables is needed to prevent a lot of complications which may be associated with abnormal weight gain during pregnancy. To establish Korean standard value for antenatal weight gain, a nationwide multicenter study is needed.

A study of the monthly weight gains of noncomplicated pregnancies among 20s, early and late 30s / 대한산부인과학회지

OBJECTIVE: To calculate monthly weight gains during pregnancy among 20s, early and late 30s, and to investigate the influence of age groups on monthly weight gains. METHODS: We analyzed the monthly weight gain data from 892 women who had visited before 20 weeks of gestation and had healthy singleton term pregnancy. Data was categorized in three groups according to age (20s, early and late 30s). RESULTS: The monthly weight gain tables among 20s, early and late 30s have been determined. Monthly weight gain was not significantly different among three age groups. CONCLUSION: Although statistically insignificant among three age groups, more cautious prenatal care according to the monthly weight gain-gestational month tables for each age group is needed to prevent complications which may be associated with abnormal weight gain during pregnancy.

Sister chromatid exchange induced by diethylstilbestrol in lymphocytes from pregnant, premenopausal & postmenopausal women / 대한산부인과학회잡지

No abstract available.

A clinical evaluation of CA 125 antigen values in patients of ovarian cancer / 대한산부인과학회잡지

No abstract available.