Development and Effects of a Hand-washing Program using Role-playing for Preschool Children

PURPOSE: A hand-washing program using role-playing was developed for preschool children and tested to verify its usefulness. METHODS: The participants were 46 preschool children (experimental group, 23; control group, 23). Data were collected from August 7, 2017 to September 20, 2017. The first posttest was carried out on the day after the initial intervention was completed, and the second posttest was performed after a month. Data were analyzed using the χ² test, Fisher exact test, Shapiro-Wilk test, Mann-Whitney test, and Friedman test. RESULTS: In the experimental group, the frequency of practicing hand-washing was significantly higher than in the control group on the next day (z=−4.94, p<.001) and after a month (z=−3.15, p=.002). The accuracy of hand-washing was significantly higher in the experimental group than in the control group on the next day (z=−4.02, p<.001) and after a month (z=−3.86, p<.001). CONCLUSION: The hand-washing program developed in this study was found to be an effective intervention strategy for improving the frequency and accuracy of hand-washing among preschool children.

Efficacy of Bispectral Index Monitoring for Midazolam and Meperidine Induced Sedation during Endoscopic Submucosal Dissection: A Prospective, Randomized Controlled Study

BACKGROUND/AIMS: Propofol induced sedation with bispectral index (BIS) monitoring has been reported to lead to higher satisfaction in patients and endoscopists during endoscopic submucosal dissection (ESD) procedures. There are no data, however, regarding the efficacy of midazolam and meperidine (M/M) induced sedation with BIS monitoring during ESD. The purpose of this study was to evaluate whether M/M induced sedation with BIS monitoring could improve satisfaction and reduce the dose of M/M required during ESD. METHODS: Between September 2009 and January 2010, 56 patients were prospectively enrolled and randomly assigned to a BIS group (n=28) and a non-BIS group (n=28). Patient and endoscopist satisfaction scores were assessed using the visual analog scale (0 to 100) following the ESD. RESULTS: The mean satisfaction scores did not significantly differ between the BIS and non-BIS groups (92.3+/-16.3 vs 93.3+/-15.5, p=0.53) or endoscopists (83.1+/-15.4 vs 80.0+/-16.7, p=0.52). Although the mean meperidine dose did not differ (62.5+/-27.6 vs 51.0+/-17.3, p=0.18) between the two groups, the mean dose of midazolam in the non-BIS group was lower than in the BIS group (6.8+/-2.0 vs 5.4+/-2.1, p=0.01). CONCLUSIONS: BIS monitoring during ESD did not increase the satisfaction of endoscopists or patients and did not lead to an M/M dose reduction. These results demonstrate that BIS monitoring provides no additional benefit to M/M induced sedation during ESD.

Two Cases of Cerebral Malaria Treated with Therapeutic Erythrocytapheresie / 대한수혈학회지

Cerebral malalria is a life-threatening complication of Plasmodium falciparum infection. RBC exchange transfusion (RCE) can reduce the burden of parasitemia in this situation. We have experienced two cases of cerebral malaria treated with automated RBC exchange as an adjunct to standard chemotherapy. Case 1: A 42-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Congo. Peripheral blood smear showed the P. falciparum parasitemia of 70-80%. Quinidine and doxycycline were administered but, mental state started to deteriorate. He underwent RCE on hospital day 2 to reduce the parasitemia to 10% after 8 hours. No parasite could be found on day 3 after the RCE. Case 2: A 62-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Cameroon. P. falciparum parasitemia was 10% on peripheral blood smear. Quinidine and doxycycline were immediately started but headache developed abruptly and he underwent RCE on hospital day 3. After 8 hours following the completion of RCE, parasitemia decreased to less than 1%. Automated RBC exchange transfusion can rapidly reduce the burden of parasitemia and achieve improvement of neurologic symptom and sign in patients with cerebral malaria.

(The Utility of Cancer Registry Software in Korea): The Software of 'CANCER' by Korea Central Cancer Registry Program / 대한의료정보학회지

The Korean Central Cancer Registry Program analyses data on the incidence and characteristics of cancer gathered from training hospitals across the nation in order to prepare coherent and accurate summary. The program has had these data computer processed through CANCER (version 1.5), a computer program for registry, since 1996. In 2002, we conducted a survey of the registered hospitals on the status of utilization for this cancer registry related-computer program and on the additional requirements to the existing variables. The results showed that the number of hospitals using the CANCER program has slightly outnumbered the hospitals using their own computer system for hospital information. That is because the number of cancer registry cases of the large-scale hospitals such as general hospitals, which comprises the majority of registered hospitals, is so many that they are able to sort out cancer registry data from their own system. They also reported a middle level of satisfaction with the program utilization. Among the least satisfactory items were the program's lack of portability to different situations and the necessity for double input of the same registry field. The field most requested by the surveyed hospitals for addition to the program was one on metastatic site. This study should lead to follow-up measures such as the development of a variety of algorithms to enhance the accuracy of the data by further reducing the errors in processing the data, and the recommendation of standards which are likely to enhance data adaptability. The result will be utilized as a basic reference for building a systematic and effective database on the national cancer registry.

Therapeutic Leukapheresis for Acute Lymphoblastic Leukemia with Severe Hyperleukocytosis in a Six-Week-Old Infant (4.7 kg) / 대한소아혈액종양학회지

We report a 4.7 kg infant who received a therapeutic leukapheresis as an immediate treatment for acute lymphoblastic leukemia with severe hyperleukocytosis. By decreasing the number of circulating white blood cells, therapeutic leukapheresis helps prevent the risks of hyperviscosity and cerebrovascular and pulmonary leukostasis. In addition, it potentially reduces metabolic and renal complications associated with rapid cell lysis when applied before chemotherapy. This six-week-old female presented with vomiting for 15 days. Initial WBC count was 1,532,800/muL. After placement of 4 french two-lumen central venous catheter in both femoral vein, the CS 3000 plus was primed with 250 mL of paternal whole blood mixed with 150 mL of normal saline. After therapeutic leukapheresis, the CBC showed WBC count of 560,000/muL. Our successful experience in performing this procedure suggests that therapeutic leukapheresis be a feasible treatment even for very young infants with hyperleukocytosis.

Accuracy about Cancer Registration Data of Daegu Metropolitan City in 1997-1998 by Reabstracting Method / 대한의료정보학회지

This reabstracting study was initiated to estimate accuracy and reliability of quality control for the Daegu Cancer Registry data in 1997-1998. The study population was 7,837 incident cases registered as malignant primary tumor in the Daegu Cancer Registry and two samples were selected for agreement study of the tumor and demographic information and for usual residence survey, separately. The 10 items reabstracted from medical records of 696 cases were compared to original data and classified as major and minor disagreement by the Centralized Cancer Patient Data System. The usual residence of 143 cases of one district was traced back actually through the computerized personal identification system of the government. The highest rate of major disagreements, 12%, was for morphology, followed by 12.0% for date of diagnosis and 5.6% for site. Demographic items had good reproducibility (exact agreement rates > 95%). Usual residence of 13 cases (9.1%) was out of Daegu. These results suggest that periodic assessment of the validity is necessary for quality control of the Daegu cancer registration data by the standardization of the cancer registration method including data collection method.

Accuracy about Cancer Registration Data of Daegu Metropolitan City in 1997-1998 by Reabstracting Method / 대한의료정보학회지

This reabstracting study was initiated to estimate accuracy and reliability of quality control for the Daegu Cancer Registry data in 1997-1998. The study population was 7,837 incident cases registered as malignant primary tumor in the Daegu Cancer Registry and two samples were selected for agreement study of the tumor and demographic information and for usual residence survey, separately. The 10 items reabstracted from medical records of 696 cases were compared to original data and classified as major and minor disagreement by the Centralized Cancer Patient Data System. The usual residence of 143 cases of one district was traced back actually through the computerized personal identification system of the government. The highest rate of major disagreements, 12%, was for morphology, followed by 12.0% for date of diagnosis and 5.6% for site. Demographic items had good reproducibility (exact agreement rates > 95%). Usual residence of 13 cases (9.1%) was out of Daegu. These results suggest that periodic assessment of the validity is necessary for quality control of the Daegu cancer registration data by the standardization of the cancer registration method including data collection method.

Cancer Incidence in Daegu in 1997~98: The First Results of the Daegu Cancer Registry / 대한암학회지

PURPOSE: A population-based cancer registry was set up in January 1, 1997 to estimate the incidence of cancer in Daegu, South Korea. MATERIALS AND METHODS: Data sources for case-finding and abstracting were hospital inpatients, other sources in hospitals other than inpatients, and private pathology laboratories. The registered cases were matched against two external databases, the death certificate and medical insurance claims. RESULTS: A total of 7,837 cases (4,203 males, 3,634 females) were registered in 1997~98 excluding 2,718 cases of DCN. The crude incidence rates of all cancers combined were 170.7/100,000 (ASR 255.0) in males and 149.8 (ASR 154.4) in females. In males, the most common cancer was stomach (47.3, ASR 69.0), followed by liver (28.0, ASR 37.6), lung (26.0, ASR 44.1), colorectum (14.9, ASR 23.3),urinary bladder (4.5, ASR 7.0) and prostate (3.5, ASR 7.0). The most common cancer in females was stomach (25.8, ASR 26.9), followed by breast (21.7, ASR 20.4), cervix uteri (21.1, ASR 20.4), colorectum (14.9, ASR 16.0), lung (9.9, ASR 11.0), liver (9.3, ASR 10.1), and thyroid (6.1, ASR 5.7). The overall percentage of microscopically verified and the DCN% were 80.3%, 27.7% in males and 88.7%, 20.7% in females, respectively. CONCLUSION: These results show that the incidence level of all cancers combined in both sexes in Daegu is approaching that of other industrialized regions in Asia as well as in the world.

Cost, Benefit Analysis of Operation System Change in the Hospital Foodservice

Environmental pressures from such sources an economic condition, the government and inter-institutional competition create managerial challenges. Economic pressures may be forcing dietetic dept, in hospital to utilize cost, benefit analysis to assist them in their problem solving. Cost, benefit analysis have been widely used in business, industry and many other fields with only limited application to foodservice. Due to the lack or this information the purposes of this study were to identify use of cost, benefit analysis in hospital foodservice system to evaluate the economic efficiency of alternatives, and to make recommendation for operation system change. Using the cost?benefit method, cash flows are separated into cost and benefits. For an alternative to be selected, indicators, such as NPV, benefit-cost ratio (B/C ratio) with 5% discount rate per annum. The sensitivity analysis was also conducted with difference rate 3%, 7% respectively and reduced employee payroll change. The result of this study can be summarized as follows : 1. The total cost of investment for operation system change was 390,570 thousand won and the total benefit through operation system change was 865,808 thousand won. 2. Net present value(NPV) for 5 years was 475,239 thousand won and benefit-cost ratio was 2.22. 3. In sensitivity analysis with different discount rate 3%, 7%, benefit-cost ratio was 2.25, 2.18 respectively, with total reduced employee payroll change, benefit-cost ratio was 2.86. In conclusion, total benefits were exceeded total costs. Therefore, the project of operation system change in hospital foodservice was found to be economically efficient.

Correlation Between Spiritual Well-Being and Hope in Patients with Cancer / 성인간호학회지

This study will test one's spiritual well-being which can be an effective hope factor, and, if so found, suggests the importance of such factors in healing cancer. From this research, a total of 97 samples were used, either hospitalized in or outpatients of the general hospitals in Seoul. The hope scale proposed by Paloutzion and Ellison(1982) and Nowotny's Hope Scale(1989) was used. Data was collected from February to April 1998 to be processed by the SAS statistical package. The study has resulted as follows: 1. The average score and the standard deviation of the overall spiritual well-being recorded 82.36 +/- 15.93, with religious and existential sectors being 40.81 +/- 10.27 and 41.55 +/- 7.72, respectively. 2. The spiritual well-being scores differed significantly according to the sample's level of education, religion, belief, the length of period of religious practices, and the frequency of participation in the religious meeting. 3. THe hope score of the sampled cancer patients showed an average of 82.94 with the standard deviation of 10.27. 4. The demographic characteristics were found to have resulted in a significant difference in the hope scores in such areas as religion and strength of the faith. 5. The hypothesis was supported that the spiritual well-being has a positive effect on the patient's hope (r=.632, p=.0001). 6. A multiple regression analysis indicated that the existential well-being(50%), age(5%), and the religious well-being(2%) significantly explained the hope scores. Viewing that religion and faith contributed significantly to a patient's spiritual well-being and hope, nurses should better regard and furthermore encourage the religious life of the cancer patient. Also suggested is that spiritual caring proven very effective by this study be applied actively in enhancing the hope for the cancer patients.

Analysis of Patient Satisfaction and Factors Influencing Satisfaction on Hospital Foodservice Quality

The purpose of this study is to provide the basic data and their analysis to improve hospital foodservice by identifying patient satisfaction with different attributes of hospital foodservice and its influencing factors using self written survey on nine hundred fifteen hospitalized patients in 28 general hospitals in Seoul and Kungki area. The statistical analysis of data was done by SAS/WIN package(Version 6.11) to determine Descriptive Analysis, T-test, Analysis of Variance, Pearson's Correlation, and Factor Analysis. The summary of the study results is as follows: 1. Among sixteen food-service quality attributes, the most unsatisfying one was the meal itself, the provision of nutrition informations, the possibility of menu choices, immediate response on meal problems, and the taste of the meal. 2. There was a positive correlation between the general quality satisfaction and freshness, nutritional considerations, and the temperature of the dishes and trays, and variety of menu in food-service quality were also correlated positively. 3. Based on the result of statistical analysis on the expectation and recognition in hospital food-service quality attributes vs quality satisfaction, expectation was negatively correlated with quality satisfaction: however, recognition was positively correlated.

Comparison of Radiographic Measurement and Clinical Parameters of Periodontal Condition on Premolars and Molars / 대한치주과학회지

No abstract available.

Peripheral Blood Stem Cell Collections in Childhood Tumor Patients Weighing Less than 25 kg Using Large Volume Leukapheresis / 대한소아혈액종양학회지

BACKGROUND: Peripheral blood stem cell (PBSC) transplantation has been widely used to support the hematopoietic recovery after high dose chemotherapy in patients with advanced malignancies. The procedure of PBSC collection in pediatric patients is similar to that in adults, but needs the 'fine tuning' of the volume shift of each procedure and the technical factors to achieve specific target goals. This article provides our experience with fourteen collections of PBSC from five patients less than 25 kg in weight. METHODS: Patient's diagnoses were 2 stage IV neuroblastoma, 1 non-Hodgkin's lymphoma, 1 stage IV Ewing sarcoma, and 1 stage IV rhabdoid tumor of kidney. Their age ranged from 2 to 7 years old. Collections were performed using COBE Spectra or CS3000 plus that had been primed with leukoreduced, irradiated red blood cells. Patients underwent large volume leukapheresis. Radial artery was used as draw line and subclavian vein was used as return line. The blood to ACD ratio was 24:1 with 3000 units of heparin added to each 500 mL of ACD, in addition, heparin (1000 units) was added to collection bag when performed with COBE Spectra. Simultaneously, calcium chloride solution was dripped into an another venous line. During one course of large volume leukapheresis, about 5,000 mL of blood (>three total blood volume) were processed at a flow rate of 25~35 mL/min. RESULTS: The mean of total WBCs in collected components per procedure was 5.9+/-2.9x109 (3.0-10.5x109) with yield of 3.6+/-2.0x108 per kg of body weight. The mean of total CD34+ cells was 5.2+/-4.5x106 per kg (1.6-14.6x106/kg) for each collection. The patients tolerated well during the procedure without any apparent symptoms related to anemia or volume deficit or overload. CONCLUSION: In children weighing less than 25 kg, peripheral blood progenitor cell collection can be safely and efficiently performed with continuous flow blood cell separators, primed with red cells and additional heparin anticoagulation.

Preapheresis WBC, mononuclear cell and CD34+ cell counts as predictors of optimal timing of peripheral blood stem cell collection / 대한수혈학회지

BACKGROUND: Peripheral blood stem cells (PBSC) transplantation has been widely used as a substitute of bone marrow transplantation in patients with hematologic malignancies and solid tumors. Because, PBSC harvest by serial daily apheresis procedure is expensive and time consuming, it is important to determine the best time to start the collection for reducing the number of apheresis procedure. We analyzed our experiences of PBSC collections and evaluated the preapheresis hematologic parameters that may predict the PBSC yields. METHODS: One hundred seventy six PBSC harvests from seventy cancer patients (median age : 32 yrs; fourty five males and twenty five females) were performed using our large volume leukapheresis protocol (total blood volume processed : over three total blood volume) after chemotherapy and infusion of G-CSF. Peripheral blood obtained immediately before the start of apheresis was analyzed for total WBC, mononuclear cell (MNC), and CD34+ cell counts. Total WBC, MNC, and CD34+ cell count were performed on selected samples of PBSC from each patient before freezing for determining the PBSC yields. Linear regression analysis was performed on logarithmized data whether preapheresis WBC, MNC, and CD34+ cell counts on the day of harvest in the peripheral blood might correlate well with the PBSC yield, respectively. RESLUTS: With the use of linear regression analysis, preapheresis WBC counts and MNC counts were not correlated significantly with the CD34+ cell yield in PBSC harvests (WBC/microliter in PB vs. CD34+ cell/kg in harvests, r=0.35, p=0.10; MNC/microliter in PB vs. CD34+ cells/kg in harvests, r=0.42, p=0.07). But the CD34+ cell count (CD34+ cells/microliter in peripheral blood) correlated most closely with the progenitor cell yield in the corresponding leukapheresis product (CD34+ cells/kg body weight, r=0.75, p<0.001). A number of 20 circulating CD34+ cells/microliter blood ensured 2.0 x 106 CD34+ cells/kg, that is known to be a threshold dose for rapid hematologic recovery, and the best time for the collection on the same day by a single leukapheresis in more than 85% cases. CONCLUSIONS: The number of CD34+ cells/microliter blood allows a reliable prediction of the CD34+ progenitor cell yield in subsequent leukapheresis procedure, while WBC and MNC counts did not predict the progenitor cell yield. A level of more than 20 CD34+ cells/microliter indicates that the threshold quantity of 2.0 x 106 CD34+ cells/kg is likely to be obtained by a single leukapheresis processing 15~20 liters of peripheral blood.

A Study on the Status of Nutrition Support in Bone Marrow Transplantation Patients

Recently, the number of patients who received Bone Marow Transplantation(BMT) has been increased dramatically and the diseases for which BMT if efficacious ard increasing. Adequate nutritional card for BMT patients is crucial for the success of BMT because nutritional deficienscy could provoke deteriorative effects. However, little is known about nutritional status amon BMT patients in Korea. This study was conducted to assess oral and parenteral intake of BMT patients and compare the change of nutritional status before and after BMT. Twenty-two BMT patients who were admitted to the Severance haspital from December in 1995 to September in 1997 participated in the study. Total calorie requirements were calculated for each patients individually and nutritional support for each patients consisted of oral and parenteral feeding. To assess oral intake of BMT patients, eash patients recorded the amount of food they bave eaten from 6 days before BMT to 28 days after BMT. The medical records of each patients were used to assess parenteral intake. To compare the nutritional status before and after BMT, the results of anthropometric and biochemical test from 14 days before BMT to 28 days after BMT were used. At the time of admission, the patients were in allowable nutritional status and their totoal calorie intake was 93% of total calorie requirement. When the preparative regimen for BMT was started, the patients' oral intake was dramatically decreased below 400kcal/day. Even though their oral intake was increased after BMT, their oral intake at the 4th week after BMT was only 752kcal/d, which is only 35.8% of total calorie requirement. The patients' mean oral intake during BMT period (from 6 days before BMT to 28 days after BMT) was onl 439kcal/d. Although Total Parenteral Nutrition(TPN) was added when the preparative regimen was started, the patients' mean total caloric intake during BMT period was 111% of basal energy expenditure and 83% of total calorie requirement. The mean total protein intake was only 58% of total protein requirement. In the comparison of nutritional status between pretransplant phase and posttransplant phase in BMT patients, their body weight and serum albumin level were significantly decreased(p<0.001). These results show inadequacies in nutritional intake among BMT patients, and indicate the need of TPN during BMT period.