Comparison of Wage Treatment, Employment Environment, and Job Stability before and after Conversion to Indefinite Contract Status for School Foodservice Employees in Gangwon Province

The purpose of this study was to compare wage treatment and the employment environment of school foodservice employees before and after conversion to indefinite contract status since September 2012 when the Ordinance on the Appointment of Education Officials (indefinite contract) under the Gangwon Provincial Superintendent of Education was applied as well as to examine the effects of wage treatment and the employment environment on job stability. The questionnaire survey was conducted from March 31 to April 10, 2017 for school foodservice employees working at 97 schools in Gangwon province. A total of 477 questionnaires were distributed and 470 questionnaires were used for the analysis. Statistical analysis was conducted using SPSS Window Ver.18.0. The detailed results of this study were as follows. First, wage treatment (2.29 vs. 3.16), employment environment (3.45 vs. 4.22) and job stability (1.88 vs. 2.35) revealed significantly positive perceptions after conversion to indefinite contract status compared to before conversion. Second, after analyzing leading factors influencing job stability, it was revealed that wage treatment (before: βâ = 0.516, P < 0.05; after: βâ=0.465, P < 0.05) had a positive (+) effect on job stability, whereas employment environment did not affect job stability. In conclusion, in the context that most school foodservice employees are contract employees, this study is significant in that the changes in the employment policies of the national government and education office were confirmed to have effects on school foodservice employees.

Elimination of Lancet-Related Needlestick Injuries Using a Safety-Engineered Lancet: Experience in a Hospital / 감염과화학요법

BACKGROUND: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. MATERIALS AND METHODS: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. RESULTS: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. CONCLUSION: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.

Elimination of Lancet-Related Needlestick Injuries Using a Safety-Engineered Lancet: Experience in a Hospital / 감염과화학요법

BACKGROUND: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. MATERIALS AND METHODS: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. RESULTS: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. CONCLUSION: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.

Comparison of Physical Activity Level, Physical Activity Pattern and Energy Expenditure in Male and Female Elementary School Soccer Players using Accelerometer and Physical Activity Diary / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to compare the physical activity level (PAL), the physical activity pattern and the energy expenditure in male and female elementary school soccer players using the accelerometer and the physical activity diary. METHODS: Twenty-five (male 11, female 14) elementary school soccer players (9–12 years) participated in this study. During their daily activities, they wore an accelerometer for seven days (five weekdays and two weekend days) and completed the physical activity diary for three days (two weekdays and one weekend day). PAL was calculated by using the physical activity diary and three equations (Pate Preschool, Freedson Children, and Freedson) were used to calculate the intensity of physical activity and energy expenditure from the counts of accelerometer. RESULTS: The average of physical activity by day of the week, CPM (Counts Per Minute) and METs (Metabolic Equivalents) were significantly higher in males (723.3 ± 149.2 CPM, 2.07 ± 0.18 METs) compared to females (505.6 ± 119.9 CPM, 1.79 ± 0.20 METs), but there was no significant difference in PAEE (Physical Activity Energy Expenditure) between the two groups (males: 15.5 ± 9.1 kcal/day, females: 11.5 ± 6.0 kcal/day). During weekdays, physical activity intensity was significantly higher in males compared to females at lunch time and training time than at other times. In both genders, the PAL was higher during weekdays (males 1.98, females 1.89) compared to weekend (males 1.62, females 1.61) (p<0.05). CONCLUSIONS: Our study observations suggest the necessity to develop an accelerometer equation for accurately evaluating the physical activity of elementary school athletes.

Accuracy of Accelerometer for the Prediction of Energy Expenditure and Activity Intensity in Athletic Elementary School Children During Selected Activities / 대한지역사회영양학회지

OBJECTIVES: Accurate assessment of energy expenditure is important for estimation of energy requirements in athletic children. The objective of this study was to evaluate the accuracy of accelerometer for prediction of selected activities' energy expenditure and intensity in athletic elementary school children. METHODS: The present study involved 31 soccer players (16 males and 15 females) from an elementary school (9-12 years). During the measurements, children performed eight selected activities while simultaneously wearing the accelerometer and carrying the portable indirect calorimeter. Five equations (Freedson/Trost, Treuth, Pate, Puyau, Mattocks) were assessed for the prediction of energy expenditure from accelerometer counts, while Evenson equation was added for prediction of activity intensity, making msix equations in total. The accuracy of accelerometer for energy prediction was assessed by comparing measured and predicted values, using the paired t-test. The intensity classification accuracy was evaluated with kappa statistics and ROC-Curve. RESULTS: For activities of lying down, television viewing and reading, Freedson/Trost, Treuth were accurate in predicting energy expenditure. Regarding Pate, it was accurate for vacuuming and slow treadmill walking energy prediction. Mattocks was accurate in treadmill running activities. Concerning activity intensity classification accuracy, Pate (kappa=0.72) had the best performance across the four intensities (sedentary, light, moderate, vigorous). In case of the sedentary activities, all equations had a good prediction accuracy, while with light activities and Vigorous activities, Pate had an excellent accuracy (ROC-AUC=0.91, 0.94). For Moderate activities, all equations showed a poor performance. CONCLUSIONS: In conclusion, none of the assessed equations was accurate in predicting energy expenditure across all assessed activities in athletic children. For activity intensity classification, Pate had the best prediction accuracy.

Mucinous Cystic Neoplasm of the Pancreas Presenting with Acute Pancreatitis, Initially Misdiagnosed as a Pseudocyst / 대한내과학회지

Pancreatic cystic lesions include retention cysts (congenital cysts), pseudocysts, and cystic neoplasms. Pancreatic cystic neoplasms have recently been diagnosed more commonly, possibly due to advances in imaging and widespread screening programs. Cystic neoplasms of the pancreas account for 10-20% of pancreatic tumors. Mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms are regarded as premalignant lesions, whereas serous cystadenoma is not. In the clinical setting of acute pancreatitis, pancreatic cystic lesions are usually diagnosed as pseudocysts. However, cystic neoplasms of the pancreas should be considered in the differential diagnosis of pancreatic cysts, even in patients with a history of pancreatitis. In the Korean literature, MCN combined with acute pancreatitis has rarely been reported. Here, we report a case of MCN presenting with acute pancreatitis in a 22-year-old female, which was initially misdiagnosed as pancreatic pseudocyst.

Effects of Newborn Care Education for First-time Fathers on Their Knowledge and Confidence in Newborn Care at Postpartum One Month

PURPOSE: This study was conducted to identify the effects of newborn care education for fathers on their knowledge and confidence in newborn care at postpartum one month. METHODS: A nonequivalent control group pretest posttest design was used. The participants were 53 first-time fathers of newborns, 27 in experimental group, and 26 in control group. They were recruited at the nursery of one municipal hospital in Seoul. For the experimental group, a 50-minute education on newborn care using video, verbal education, demonstration and practice were provided prior to discharge. Fathers' knowledge and confidence in newborn care and their satisfaction with the education program were measured at postpartum one month. RESULTS: The fathers in the experimental group showed significantly higher knowledge (t=-4.51, p<.001), and confidence in newborn care (t=-2.29, p=.026) compared to the control group at postpartum one month. Fathers in the experimental group had a satisfaction score of 27.37+/-2.73 immediately after the education, and 25.30+/-3.40 at postpartum one month. CONCLUSION: Results indicate that newborn care education for first-time fathers is an effective method in enhancing the level of knowledge and confidence in newborn care. It can be used in the nursery department before discharge as a useful nursing intervention.

Corrigendum: Effects of Newborn Care Education for First-time Fathers on Their Knowledge and Confidence in Newborn Care at Postpartum One Month

This article was published with an error.

Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital / 신경정신의학

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.

Skin Temperature Changes in Patients With Unilateral Lumbosacral Radiculopathy

OBJECTIVE: To clarify the relationship of skin temperature changes to clinical, radiologic, and electrophysiological findings in unilateral lumbosacral radiculopathy and to delineate the possible temperature-change mechanisms involved. METHODS: One hundred and one patients who had clinical symptoms and for whom there were physical findings suggestive or indicative of unilateral lumbosacral radiculopathy, along with 27 normal controls, were selected for the study, and the thermal-pattern results of digital infrared thermographic imaging (DITI) performed on the back and lower extremities were analyzed. Local temperatures were assessed by comparing the mean temperature differences (DeltaT) in 30 regions of interest (ROIs), and abnormal thermal patterns were divided into seven regions. To aid the diagnosis of radiculopathy, magnetic resonance imaging (MRI) and electrophysiological tests were also carried out. RESULTS: The incidence of disc herniation on MRI was 86%; 43% of patients showed electrophysiological abnormalities. On DITI, 97% of the patients showed abnormal DeltaT in at least one of the 30 ROIs, and 79% showed hypothermia on the involved side. Seventy-eight percent of the patients also showed abnormal thermal patterns in at least one of the seven regions. Patients who had motor weakness or lateral-type disc herniation showed some correlations with abnormal DITI findings. However, neither pain severity nor other physical or electrophysiological findings were related to the DITI findings. CONCLUSION: Skin temperature change following lumbosacral radiculopathy was related to some clinical and MRI findings, suggesting muscle atrophy. DITI, despite its limitations, might be useful as a complementary tool in the diagnosis of unilateral lumbosacral radiculopathy.

A Case of Perforated Gastrointestinal Stromal Tumor in the Jejunum as a Rare Cause of Acute Abdomen

Preoperative diagnosis of Gastrointestinal Stromal Tumors (GISTs) in the small intestine is often delayed until complications such as hemorrhage, bowel obstruction or perforation develop. Such GISTs are usually asymptomatic and tumor perforation is an uncommon clinical presentation. In this report, we review the diagnosis, pathology and treatment of a 32-year-old male with a perforated GIST in the jejunum who presented with symptoms of acute abdomen. Abdominal computed tomography (CT) showed a ruptured huge tumor with inhomogeneous density in the small intestine. The patient underwent a complete tumor excision and jejunal segmental resection. A histopathological examination of the tumor confirmed that it was a GIST. Postoperatively, the patient received medical treatment, using oral Imatinib 400 mg daily for 10 months without any signs of disease recurrence. Prognosis is worse in ruptured GISTs and in these cases, complete surgical resection of the tumor must be followed by adjuvant therapy with Imatinib.

A Case of Acute Colonic Diverticulitis as a Complication of Colonoscopy

Colonoscopy is a good diagnostic tool and facilitates treatment of various colonic diseases. Nevertheless, it can induce many serious complications such as perforation and hemorrhage. Diverticulitis has also been reported as a serious complication of colonoscopy, with an incidence ranging from 0.04% to 0.08%. A 44-year-old male with chronic hepatitis B was presented with general weakness, myalgia, and febrile sensation. After admission for evaluation, pneumonia detected in the left upper and lower lobe and treated. We performed colonoscopy for screening and found multiple colonic diverticula in the right side of the colon. After 48 hours, the patient complained of abdominal pain and febrile sensation. Physical examination revealed tenderness in the right side of the abdomen. Abdomen-pelvis computed tomography showed bowel wall thickening of the cecum and ascending colon and multiple inflamed diverticula at the cecum with pericolic fat infiltration and fluid collection. We diagnosed the patient with acute diverticulitis after colonoscopy. Thereafter, he was treated with bowel rest and broad-spectrum intravenous antibiotics, and recovered. With a review of the relevant literature, we report a case of acute colonic diverticulitis as a complication of colonoscopy.

A Case of Acute Aluminum Encephalopathy with Intraperitoneal Bladder Rupture Following Aluminum Bladder Irrigation in a Patient with Normal Renal Function / 대한내과학회지

Acute aluminum intoxication is uncommon in clinical practice but can be fatal. Most cases have been reported in patients with decreased renal function, especially dialysis patients. We describe a case of acute aluminum encephalopathy with intraperitoneal bladder rupture following aluminum bladder irrigation in a patient with normal renal function. A 51-year-old woman with a radical hysterectomy and external irradiation therapy for cervical cancer 15 years earlier was admitted due to gross hematuria. An aluminum intravesical irrigation was performed. After 1 day of intravesical irrigation, abdominal pain and fever developed. Abdominal CT images demonstrated bladder perforation and peritonitis. An emergency laparotomy was performed. Operative findings showed a perforated dome of the bladder with gray colored peritoneal fluids. Two days after the operation, she complained of numbness and pain in the left side of her face. Acute aluminum encephalopathy was diagnosed after excluding infectious, rheumatological, and other vascular causes. She was treated with combined intravenous deferoxamine and hemodialysis.

Incidence and Cinical Characteristics of Severe Community-Acquired Pneumococcal Pneumonia: Comparisons with Non-Pneumoccocal Pathogens / 대한내과학회지

BACKGROUND/AIMS: Only limited data are available on severe community-acquired pneumonia (severe CAP or SCAP) caused by Streptococcus pneumoniae in Korea. METHODS: All patients who were admitted to a tertiary hospital for CAP from January 2007 to December 2008 were reviewed retrospectively, and SCAP was defined by 2007 Infectious Disease Society of America/American Thoracic Society criteria. RESULTS: In total, 94 patients were diagnosed with SCAP (mean age, 73.5 +/- 14.3 years; male, 70). Among them, pneumococcal SCAP (P-SCAP) accounted for 24.5%, and non-P-SCAP accounted for 18.1% (four with Pseudomonas aeruginosa, [4.3%]; four with Staphylococcus aureus, [4.3%]), and no organisms were identified in 57.4% of the patients. A history of neoplasm was less frequent, and the incidence of shock and pneumonia severity index (PSI) scores were lower in patients with P-SCAP than in those with non-P-SCAP or with SCAP with no organism identified (p = 0.012, 0.023 and 0.007, respectively). Patients with P-SCAP had a lower rate of treatment failure (p = 0.048) and tended to have lower in-hospital and 30-day mortalities compared with those with non-P-SCAP. In a multivariate analysis, the history of neoplasm was the strongest independent factor for predicting 30-day mortality (odds ratio, 9.068; 95% confidence interval, 1.856-44.309). CONCLUSIONS: P-SCAP accounted for 24.5% of SCAP cases. P-SCAP was associated with lower disease severity and a tendency toward better hospital outcomes compared with non-P-SCAP.

A Case of Tuberculous Pericardial Abscess Mimicking Thymic Carcinoma / 결핵및호흡기질환

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.

The Clinical Outcomes of Photodynamic Therapy in Early Lung Cancer Patients / 결핵및호흡기질환

BACKGROUND: Photodynamic therapy (PDT) is effective in managing small superficial early lung cancer patients who were deemed nonsurgical candidates. However, we do not have any previous report on the usefulness of PDT in early lung cancer in South Korea. Thus we report here our experience of PDT in early lung cancer patients. METHODS: 10 patients who underwent PDT for managing early lung cancer between June 2006 and July 2010 were analyzed. PDT was carried out 48 hours after photosensitizer injection. Re-bronchoscopy was carried out 48 hours after PDT in order to remove a necrotic tissue from the PDT site. For evaluation of PDT response, bronchoscopy and chest computed tomography (CT) were performed after 3 months. RESULTS: The median age of patients was 69 (49~77) and all patients were male. The smoking history of patients was 48 (20~75) pack-year and the median follow up of patients was 25 (11~52) months. Complete remission was observed in 10 patients and the recurrence of lung cancer was observed in 3 patients. Out of 10 patients, 3 patients died (one case of lung cancer progression and two cases of pneumonia). CONCLUSION: The PDT is a safe and effective treatment in early lung cancer patients who are not suitable for surgical resection. The PDT in clinical practice is an attractive option in the treatment of early lung cancer.

The Relationship between the Left Atrial Volume and the Maximum P-wave and P-wave Dispersion in Patients with Congestive Heart Failure

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110msec and a P-wave dispersion (PWD) > or = 40msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110msec or or = 40msec or or = 110ms or a PWD > or = 40ms and those with a Pmax < 110ms or a PWD < 40ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogenous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.

A Case of Extensive Ventricular Wall Rupture from the Posterior Wall to the Ventricular Septum after Acute Myocardial Infarction Demonstrated by Real-Time 3D Echocardiography

2D echocardiography (2DE) is a well established tool for the diagnosis of the mechanical complications after acute myocardial infarction (AMI) such as free wall and ventricular septal rupture. However, the extension of the rupture and the relationship with contiguous anatomic structures may not be clearly defined by 2DE. Real-time 3D echocardiography (RT3DE) is known to provide surgical enface view allowing complete visualization of the cardiac structures and comprehension of their spatial orientations to other anatomic structures. Obtaining such information with RT3DE before operation in AMI patient with mechanical complication may be essential for the optimal surgical treatment. We report a case of extensive ventricular wall rupture from the posterior wall to the ventricular septum after AMI demonstrated by RT3DE.

A Case of Left Vocal Cord Palsy and Pulmonary Hypertension in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Laryngeal involvement in systemic lupus erythematosus (SLE) is rare. It can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. The causes of vocal cord paralysis included vasculitis of the vasa nervorum, neuritis, thromboembolic effect on recurrent laryngeal nerves, and compression of the left recurrent laryngeal nerve by an enlarged left pulmonary artery. Few cases on the association of vocal cord palsy and pulmonary hypertension in SLE patient have been reported. We report a case of left vocal cord palsy and pulmonary hypertension in a patient with SLE who experienced improvement of vocal cord palsy and dyspnea after steroid pulse therapy.

Micro-Structural Profiles of Trabecular Bone at the Ankle Joint / 대한족부족관절학회지

PURPOSE: This study aimed to investigate and compare the micro-structural profiles of trabecular bone from different facets at the ankle joint. MATERIALS AND METHODS: In a fresh cadaver ankle, four cored 10 mm of diameter cylindrical specimens of trabecular bone were harvested from the distal tibia, the talar dome, the medial malleolus, and the lateral malleolus. Using a micro-computed tomography, two-dimensional and three-dimensional micro-structural indices of the trabecular bone were analyzed. RESULTS: Each specimen from the tibia, talus, medial malleolus, and the lateral malleolus showed unique micro-structural pattern. Tibia versus talus, the talus was seen a higher bone volume fraction and a wider supporting zone subchondrally whereas the tibia was seen a relatively lower bone volume fraction and a much narrower supporting zone subchondrally. Lateral malleolus versus medial malleolus, the lateral malleolus was seen the thicker but sparse trabeculae pattern whereas the medial malleolus was seen the thinner but more compact trabecular pattern. CONCLUSION: Each four locations from the different facet at the ankle joint have distinct own micro-structural patterns of the trabecular bone, suggesting different mechanical properties.