Analysis of the Proportion of Patients Who Were Admitted to the Emergency Department of the Tertiary Care Hospital for Primary Care

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.

The Characteristics of Terminally Ill Cancer Patients in Hospice and Palliative Care according to Family Composition / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to investigate the family composition of terminally ill cancer patients admitted to the hospice unit and how it affects their hospice care. METHODS: We retrospectively analyzed the medical records of terminal cancer patients who died in one hospice unit between January 2009 and March 2014. The demographic and clinical characteristics of the patients were examined, and any different made by their marital status was evaluated. We calculated the time interval between cancer diagnosis and hospice admission and the survival period from hospice admission to death and analyzed their association with family composition. RESULTS: When divided by the median time of 13 months between diagnosis and admission, Group B (>13 months) had a significantly higher proportion of patients living with their spouses; (P < 0.01). The main decision maker was a spouse (52.9%) in Group B; (P=0.04). CONCLUSION: Among the characteristics of the family composition, the presence of spouse was an important factor associated with admission to a hospice unit. Clinicians need to be aware of the impact of marital status on end-of-life care. This study indicates that it is helpful to understand family composition of terminally-ill cancer patients for an effective palliative and hospice care.

Depolarizing Effectors of Bradykinin Signaling in Nociceptor Excitation in Pain Perception

Inflammation is one of the main causes of pathologic pain. Knowledge of the molecular links between inflammatory signals and pain-mediating neuronal signals is essential for understanding the mechanisms behind pain exacerbation. Some inflammatory mediators directly modulate the excitability of pain-mediating neurons by contacting the receptor molecules expressed in those neurons. For decades, many discoveries have accumulated regarding intraneuronal signals from receptor activation through electrical depolarization for bradykinin, a major inflammatory mediator that is able to both excite and sensitize pain-mediating nociceptor neurons. Here, we focus on the final effectors of depolarization, the neuronal ion channels, whose functionalities are specifically affected by bradykinin stimulation. Particular G-protein coupled signaling cascades specialized for each specific depolarizer ion channels are summarized. Some of these ion channels not only serve as downstream effectors but also play critical roles in relaying specific pain modalities such as thermal or mechanical pain. Accordingly, specific pain phenotypes altered by bradykinin stimulation are also discussed. Some members of the effector ion channels are both activated and sensitized by bradykinin-induced neuronal signaling, while others only sensitized or inhibited, which are also introduced. The present overview of the effect of bradykinin on nociceptor neuronal excitability at the molecular level may contribute to better understanding of an important aspect of inflammatory pain and help future design of further research on the components involved and pain modulating strategies.

Symptom Features of Terminally Ill Cancer Patients and Depression of Family Caregivers / 한국호스피스완화의료학회지

PURPOSE: There has been very little study on the associations between patient's symptoms themselves and family caregiver (FC)'s depression in the palliative phase. This cross-sectional study was to investigate the relationship between symptom features of terminally ill cancer patients and their FC's depression. METHODS: We performed a multicenter survey using the MD Anderson symptom inventory and the Hospital Anxiety and Depression Scale. A total of 293 patient-FC pairs were recruited from seven tertiary medical centers. A multivariate regression analysis was applied for identifying the relevant factors associated with FC depression and for estimating adjusted depression score of FCs. RESULTS: Among various psychosocial factors, low FC quality of life, low social support, spouse, and more caregiving time were significantly associated with FCs' depression. According to the presence of FCs' depression, there were significant differences in some symptom characteristics of patients. Even after adjusting for the relevant confounders, depression scores were lower in FCs caring for patients who had negative symptoms (loss of appetite, P=0.005; drowsiness, P=0.024; and dry mouth, P=0.043) than in FCs caring for patients who had not. FCs caring for patients with severe appetite loss had lower depression scores than those with not severe one (P=0.039). CONCLUSION: Our result suggests that patient's symptom characteristics might be helpful when evaluating a FC's depression.

Factors Affecting Research Participation of Bereaved Families of Terminal Cancer Patients: A Prospective Preliminary Study / 한국호스피스완화의료학회지

PURPOSE: Little is known regarding the factors associated with the willingness of family caregivers of terminal cancer patients to participate in a bereaved survey. This study aimed to ascertain the pre-loss factors that predict actual participation in a bereaved survey. METHODS: We conducted a prospective observational study using data from two multi-center surveys at the end-of-life and after loss. In order to identify the pre-loss factors associated with participating in the bereaved survey, we used a step-wise multivariate logistic regression analysis. RESULTS: Among 185 bereaved individuals, 30 responded to the survey (response rate: 16.2%). There were differences between the participation group and the non-participation group regarding religion, economic status, and perceived quality of care as assessed by the Quality Care Questionnaire-End of Life. A final multivariate model revealed that bereaved individuals who professed a religion (adjusted odds ratio [aOR]=5.01; P=0.008), had a high income (aOR=4.86, P=0.003), and satisfied with the care for familial relationship (aOR=4.49, P=0.003) were more likely to engage in the bereaved survey. CONCLUSION: Our finding suggests that improving the quality of end-of-life care may promote actual participation in a bereaved survey through easing post-loss distress. More attention should also be paid to those bereaved individuals who are hesitant to participate in a bereaved survey.

Factors Associated with Care Burden among Family Caregivers of Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: It is important to alleviate care burden for terminal cancer patients and their families. This study investigated the factors associated with care burden among family caregivers (FCs) of terminally ill cancer patients. METHODS: We analyzed data from 289 FCs of terminal cancer patients who were admitted to palliative care units of seven medical centers in Korea. Care burden was assessed using the Korean version of Caregiver Reaction Assessment (CRA) scale which comprises five domains. A multivariate logistic regression model with stepwise variable selection was used to identify factors associated with care burden. RESULTS: Diverse associating factors were identified in each CRA domain. Emotional factors had broad influence on care burden. FCs with emotional distress were more likely to experience changes to their daily routine (adjusted odds ratio (aOR), 2.54; 95% confidence interval (CI), 1.29~5.02), lack of family support (aOR, 2.27; 95% CI, 1.04~4.97) and health issues (aOR, 5.44; 2.50~11.88). Family functionality clearly reflected a lack of support, and severe family dysfunction was linked to financial issues as well. FCs without religion or comorbid conditions felt more burdened. The caregiving duration and daily caregiving hours significantly predicted FCs' lifestyle changes and physical burden. FCs who were employed, had weak social support or could not visit frequently, had a low self-esteem. CONCLUSION: This study indicates that it is helpful to understand FCs' emotional status and family functions to assess their care burden. Thus, efforts are needed to lessen their financial burden through social support systems.

Unmet Medical Service Needs in Family Caregivers of Terminal Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: The unmet medical service needs of caregivers critically influence their caring for terminal cancer patients, but not much research has been done in this regard. Thus, the purpose of this study is to investigate the association between caregivers' characteristics and their unmet medical service needs. METHODS: The survey was conducted with 109 family caregivers of terminal cancer patients admitted to four hospice units. The data were collected from March 2014 through December 2014 using a structured questionnaire. The unmet medical service needs were measured using 14 items which were adopted and modified by authors. RESULTS: Seven areas of unmet medical service needs were shown to be significant. A well-educated group showed stronger needs for counsel about cancer screening and complementary-alternative medicine and health supplement food. A never-smoked group was identified with less need for sexual dysfunction counsel. Counsel about family and personal relations was more necessary for current drinkers and current workers, and less necessary for the married. Insurance counsel was more needed for a no-religion group. Occupation counsel was less necessary for healthy patients. Financial support was less necessary for the married group. CONCLUSION: Based on the results, it is highly recommended to further investigate the unmet medical service needs of family caregivers for terminal cancer patients and causes of the unmet needs.

Changes in the Degree of Patient Expectations for Patient-Centered Care in a Primary Care Setting / 가정의학회지

BACKGROUND: To date, the medical environment has been undergoing continual changes. It is therefore imperative that clinicians recognize the changing trends in the degree of patient expectations for patient-centered care. We conducted this study to examine changes in the degree of patient expectations for patient-centered care and the related socio-demographic factors in a primary care setting over a 5-year period. METHODS: We evaluated patients' attitudes toward patient-centered care using the Patient-Practitioner Orientation Scale, which provides 'sharing' and 'caring' scores. The study included 359 and 468 patients in phase I (March-July, 2005) and II (March-July, 2010). We also examined the relationship of their changes to their socio-demographic factors. RESULTS: In phase II, as compared with phase I, the 'sharing' score was higher (3.67 +/- 0.68 vs. 3.82 +/- 0.44; P < 0.001) and 'caring' one was lower (4.01 +/- 0.57 vs. 3.67 +/- 0.58; P = 0.001). Further, 'sharing' and 'caring' scores were associated with age, monthly income, education level, marital status, and the functional health status of patients. CONCLUSION: These results would be of help for providing patient-centered care for patients because it makes clinicians are aware of the degree to which patients' expect it.

Symptom Clusters in Advanced Cancer Patients / 한국호스피스완화의료학회지

Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.

Analysis of attachment, proliferation and differentiation response of human mesenchymal stem cell to various implant surfaces coated with rhBMP-2 / 대한치과보철학회지

PURPOSE: In this paper we tried to evaluate the most appropriate surface for rhBMP-2 coating among 4 rough titanium surfaces. MATERIALS AND METHODS: We used machined surface as a control group and anodized, RBM and SLA surfaces as test groups. We coated rhBMP-2 on the 4 surfaces and with uncoated surfaces for each case, we cultured human mesenchymal stem cells on all 8 surfaces. 24 hours after we measured the stem cell'attachment with SEM, and on 3rd, 7th, and 14th days, we checked the cell proliferation and differentiation by using MTT and ALP activity assay. And on the 7th day after the culture, we performed RT-PCR assay to determine whether the expression levels of Type I collagen, osteocalcin, osteopontin were changed. RESULTS: We observed with SEM that 4 rhBMP-2 coated surfaces exhibited wider and tighter cell attachment and more cell process spreading than uncoated surfaces. The anodized rhBMP-2 surface caused robustest effects. In MTT assay we could not find any meaningful difference. In ALP assay there was a significant increase (P<.05) in the ALP activity of anodized rhBMP-2 coated surface compared with that of the control (3rd and 14th days) and with that of the RBM rhBMP-2 coated surface (14th day). In RT-PCR assay there was increased expressions in the anodized rhBMP-2 coated surface for osteocalcin, and osteopontin. CONCLUSION: We found that the anodized rhBMP-2 coated surface were most prominent stem cell attachment and differentiation in compared to control and Machined rhBMP-2 coated, RBM rhBMP-2 coated surface.

Gabapentin Attenuates the Activation of Transient Receptor Potential A1 by Cinnamaldehyde

Gabapentin is used as an effective drug for relieving pain, but the main mechanism is still unclear. Recently, voltage-gated Ca2+ channel subunits are suggested for the main target for the analgesic action of gabapentin. We wonder whether gabapentin directly modulates other specific ion channels peripherally expressed in the sensory neurons. To test this, we used a heterologous expression system in which the cell lines transiently expressed thermosensitive transient receptor potential ion channels (thermoTRPs) as well as the primary cultured mouse trigeminal neurons. The application of gabapentin reduced the increases in the intracellular Ca2+ level caused by TRPA1 activation in the heterologous expression system whereas the responses via actions of other thermoTRPs were not dramatically affected by the gabapentin treatment. Gabapentin also attenuated the TRPA1-mediated intracellular Ca2+ increases in the cultured trigeminal neurons. These findings suggest TRPA1 in the peripheral sensory neurons as a novel target for the analgesic of gabapentin.

Patient-centered Attitudes in Primary Care Patients

BACKGROUND: As the society changes to consumer-oriented trend, physician-patient relationship is in need of change. Patients tend to be highly satisfied when their physicians show more patient centered view or have similar character with their own. There have been studies on the patient-centeredness of medical students and physicians in Korea, but none was performed on the patient's patient-centeredness. The aim of this study was to investigate attitudes toward patient-centeredness and its associated factors in patients who visited local family practitioner's clinics. METHODS: The subjects were 359 patients who visited 10 local family practitioner's clinics from March 1 to July 1, 2005. Our survey utilized PPOS (Patient-Practitioner Orientation Scale) which composed of Sharing (sharing information, take part in decision making) and Caring (respecting one's feelings, interpersonal relationships) subscale. It also included demographic variables and health status by self questionnaire. Factors affecting patient-centeredness was analyzed via the t-test, ANOVA and Pearson Correlation. RESULTS: The total PPOS score was 3.85. The Sharing and Caring subscales were 3.68 and 4.02, respectively. We found that the patients, who were functionally healthier, younger than 40 years old, college-educated, and earning higher income, were significantly more patient-centered. CONCLUSION: The patients' desire to obtain medical information and to take part in decision making (Sharing) were lower than that of patients' expectations for gaining respect of one's feelings and interpersonal relationships (Caring). The patients, who were healthier, younger, more educated, and earn more income, were shown to be significantly more patient-centered.

Hemosiderotic Histiocytoma

A 25 year old woman who presented a severely pruritic eruption of 1 month's duration on the lateral surface of her left shin is described. The histopathologic examination revealed dense cellularity consisting of hemosiderin laden macrophages and multinucleated giant cells of both the Touton type-like and the foreign body type, associated with many blood vessels, suggesting hemosiderotic histiocytoma. Given the additional finding of foamy cytoplasm, this case could be called xanthomatized hemosiderotic histiocytoma

Apocrine Adenocarcinoma and Three Different Benign Skin Tumors Probably Arising in an Organoid Nevus

We herein present a case of simultaneous occurrence of apocrine adenocarcinoma, syringocystadenoma papilliferum, syringoma, and eccrine hydrocystoma arising in an organoid nevus (nevus sebaceus of Jadassohn) which had been present on the right occipitoparietal scalp of a 60-year-old man since birth.

Tinea Capitis in a Postmenopausal Woman / 대한피부과학회지

Tinea capitis has become uncommon in Korea, and moreover is rare in adults. A 60 year-old woman who developed a seborrheic dermatitis-like tinea capitis caused by Microsporum canis is herein described.

Inflammatory Linear Verrucous Epidermal Nevus (ILVEN): A Perianal Case Improved by CO2Laser Irradiation / 대한피부과학회지

Herein I present a case of ILVEN treated by CO2irradiation. A 7 year-old girl has had pruritic skin colored or reddish, pinhead sized papules aggregated on the right side of perianal area since her neonatal period. The pruritus got severe 2 to 3 months prior to the first visit. The pruritic lesion subsided after CO2laser irradiation and didn't recur except for subsequent low grade hypertrophic scars until the follow-up visit one year thereafter.

Extensive Condyloma Acuminatum in a NIDDM Patient / 대한피부과학회지

A 20 year old woman with noninsulin-dependent diabetes mellitus (NIDDM) developed an extensive warty and focally cauliflower like mass located at anogenital area. Its histopathologic study and in situ DNA hybridization revealed this lesion an ordinary condyloma acuminatum without large bulbous downward proliferation of which HPV type was 6 and/or 11. The mass lesion was successfully treated by excision and electrodesiccation under spinal anesthesia. Intermittent recurrence of several papular condylomata acuminata was observed during a follow up period of 6 months, which were easily cured by podophylline application on each occasion.

Histopathologic Resemblance of Ovarian Dermoid Cyst to Various Skin Tumors

BACKGROUND: The wall of ovarian dermoid cysts shows various kinds of morphologic patterns. Some of them resemble the features of epidermal and epidermal appendageal tumors. OBJECTIVE: The purpose of this study is to classify the morphologic features of the wall of ovarian dermoid cyst from the dermatohistopathologic viewpoint. METHODS: H&E stained slides of 203 ovarian dermoid cysts were reviewed RESULTS: Thirteen different patterns of morphologic features were found. They included features of organoid nevus, sebaceous hyperplasia, steatocystoma multiplex, epidermoid cyst, nevus comedonicus, epidermal nevus, apocrine hidrocystoma, syringoma and trichilemmal cyst. CONCLUSION: Various epidermal and epidermal appendageal tumors may be associated with ovarian dermoid cyst.

Enhanced Expression of Proliferating Cell Nuclear Antigen in Psoriatic Epidermis

BACKGROUND: The proliferating cell nuclear antigen(PCNA), one of the markers for proliferating cells, has been detected in solid human neoplasms. Psoriasis is a benign hyperproliferative disorder of the skin. OBJECTIVE: This study has been made to investigate if PCNA can be detected in the psoriatic epidermis. METHODS: Specimens from 10 patients with psoriasis were stained for PCNA using the one hour immunoalkaline phosphatase technique. RESULTS: The psoriatic epidermis showed positive nuclear staining in 20%-61% (mean, 45.7%) of keratinocytes. CONCLUSION: PCNA seems to be involved in the mechanism of increased epidermal cell proliferation in psoriatic lesions.

Comparative Study on Expression of Proliferating Cell Nuclear Antigen ( PCNA ) and Ki - 67 Antigen in Several Skin Tumors / 대한피부과학회지

BACKGROUND: Both PCNA and Ki-67 have been used as marker for cellular proliferation. The drawback of Ki-67 antibody in immunohistochemistry was that it can be labelled only on fresh tissue, however, MIB1 is a newly developed Ki-67 antiboc which can be labelled on formalin-fixed tissue. OBJECTIVE: The purpase of the present study is to compir the stainability of the Ki-67 antibody with that of the ICNA antibody on formalin-fixed, para fin embedded tissues. METHODS: Using MIE1, the newly developed Ki-67 antibody and PC10(PCNA antibody), speci mens of squamous cell carcinoma(SCC), Bowens disease(BL), actinic keratosis(AK) and basal cell epithelioma(BCE) were stained by one hour immunocytial, mistry using a Microprobe immuno/DNA stainer. RESULTS: The labelling indices (LI) of MIB1 were 82.6%, 37.4%, 38.3% & 81.1% respectively in SCC, BD, AK & BC, while the LI of PC10 were 77.69%, 26.6% & 64.4%. The labelled cells of both antibodies differed in distribution patterns on turmor tissues. CONCLUSION: MIBI cain be used to be an alternative m.rl r for proliferating cells. MIBI PC10, when used together, will be mutually compensatory the study of proliferating cell kinetics.