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윤성상,장혜정,권영대 대한신경과학회 2012 Journal of Clinical Neurology Vol.8 No.1
Background and Purpose Stroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges. Methods This study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients’demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors. Results More-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges. Conclusions Itemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.
A Case of Klebsiella pneumoniae Meningitis Associated with Brain Abscess and Endophthalmitis
윤성상,Baeseoup Song,Sung Sang Yoon,우호걸 대한신경초음파학회 2022 대한신경초음파학회지 (JNN) Vol.14 No.2
Meningitis, brain abscess, and endophthalmitis are rare manifestations of K. pneumoniae infection. We present a case of Klebsiella meningitis associated with a brain abscess and endophthalmitis. A 58-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma presented with fever, pain in the right eyeball, and vision loss. Endophthalmitis and urinary tract infections were identified through ophthalmologic examination and urine analysis, respectively, and empirical antibiotic therapy was administered. Approximately seven days after treatment, the patient presented with persistent headaches. In the cerebrospinal fluid study, the white blood cell count was 210/mm3, the protein level was 540 mg/dL, and the glucose level was 28.6 mg/ dL. Magnetic resonance imaging of the brain revealed diffuse brain abscesses in both hemispheres. Klebsiella pneumoniae was isolated from the blood and urine cultures. After intravenous injection of antibiotics (vancomycin and ceftriaxone) for 2 months, the headache resolved and the results of the cerebrospinal fluid study were normal.
NIH Stroke Scale을 이용한 초기 뇌졸중 중증도에 대한 후향적 평가의 타당성
윤성상,부선희,박기정,장혜정,권영대 대한신경과학회 2006 대한신경과학회지 Vol.24 No.1
Background: The retrospective severity scoring system of NIHSS for acute stroke patients was found to be valid and reliable by using patients' medical records in studies abroad. However, in Korea, medical records are often summarized and contain missing information which makes it difficult to conduct a restropective outcome study. The purpose of this research was to evaluate the validity and reliability of the retrospective NIHSS scoring system according to patients' medical records with written clinical histories and physical admission notes. Methods: An algorithm for the retrospective NIHSS scoring system was developed and applied to 75 patients with acute ischemic stroke. Missing data on physical examination results were scored as normal. One neurologist who was blinded to this study measured the NIHSS score prospectively on the initial patient examination. After the patient's discharge, two other neurologists, blinded to the patient's clinical condition, evaluated the NIHSS score independently based on the information collected from the patient's physical admission notes. The criterion-related validity was evaluated by the Pearson Correlation Coefficient, and the measure of agreement between two raters was evaluated by the Kappa Statistic. Results: The criterion-related validities of the retrospective NIHSS scoring system were high in the total and each itemized scores, except for the items of LOC command, limb ataxia, dysarthria, and neglect. The interrater reliabilities were also high except for the items of LOC command, limb ataxia, and dysarthria. Conclusions: The retrospective NIHSS scoring algorithm was found to be a reliable and unbiased tool even when some physical examination elements are missing from the written medical records.
급성기 허혈성 뇌졸중에서 10개 교육병원의 정맥주사 헤파린 이용 실태
윤성상,허성혁,박기정,장혜영,안태범,장대일,정경천,권영대 대한신경과학회 2005 대한신경과학회지 Vol.23 No.4
Background: Treatment with heparin has been an area of great controversy among neurologists. The goal of this study was to compare the actual usage patterns of intravenous heparin according to the stroke subtype, location, severity of the stroke, different hospitals, and various departments. Methods: The records of 1204 patients with acute ischemic stroke admitted to 10 teaching hospitals between January 2000 and December 2000 were reviewed. The patients were divided into two groups of whether or not they were given intravenous heparin. Cases of acute ischemic stroke were subdivided according to the TOAST classification. Patients with NIH Stroke Scale scores were categorized as having mild, moderate, and severe stroke. Terminal hospital stays were subdivided further by department: internal medicine, neurology, neurosurgery, rehabilitation medicine, and others. Results: 512 patients (42.5%) were treated with heparin. The usage of heparin in the case of large artery atherosclerosis occupied 46%, small vessel occlusion 31 percent, cardioembolism 73%, other determined etiology 33%, and undetermined etiology 46%. Heparin was used to treat 46% of the patients with a lesion of anterior circulation, 49% of posterior circulation, and 38% of both anterior and posterior circulation. Heparin was more frequently used for moderate and severe strokes compared to mild strokes. Conclusions: The utilization of intravenous heparin was more frequent in treatment of the cardioembolism subtype and moderate-to-severe strokes. Practice variation according to the hospitals and discharge departments were manifested