• Journal of Pharmacopuncture
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• v.21 no.2
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• pp.76-81
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• 2018

Objective: This study compared the safety and efficacy of $Safacto^{(R)}$ versus $xyntha^{(R)}$ in patients with severe hemophilia A. Methods: Thirty-three male patients with severe hemophilia A were randomly divided into two groups. Seventeen patients received $Safacto^{(R)}$ and 16 patients received $Xyntha^{(R)}$ for four consecutive times. The dosage of FVIII was 40-50 IU/kg for each injection. Plasma level of FVIII activity was evaluated before every injection, 15 minutes after the injection and one month after the start of the trial. The rate of factor VIII activity, pain and joint motion were also assessed before and after the treatment. Results: Plasma level of FVIII clotting activity in $Safacto^{(R)}$ and $Xyntha^{(R)}$ were $1.96{\pm}0.5IU/dl$ and $1.63{\pm}0.5IU/dl$ and increased to $88.84{\pm}25.2IU/dl$ and $100.09{\pm}17.8IU/dl$, respectively (P<0.001). Pain score and range of motion improvement were $9.3{\pm}0.9$ and $8.7{\pm}0.1$ in $Safacto^{(R)}$ (P=0.17); and $9.4{\pm}0.8$ and $8.8{\pm}0.3$ in $Xyntha^{(R)}$ (P=0.35), respectively. No allergic or other unfavorable reactions was observed with either of the preparations. Conclusion: This study showed that $Safacto^{(R)}$ has a favorable efficacy and safety profile.

• Journal of the Korea Society of Computer and Information
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• v.25 no.5
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• pp.169-178
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• 2020

This study was attempted to know the awareness of Advance Directives of adults in Gandwon-do province. Data was surveyed from 60 adults in Gangwon-do province by 42 item questionnaire for the awareness of Advance Directives. Subcategories of Advanced Directives questionnaire were knowledge, preference, experience for life-sustaining treatment and Advance Directives. The data was analyzed with the frequency and percentage using SPSS 24.0. 45% of Participants replied they knew the 'life-sustaining treatment' exactly. They preferred CPR 78.3%, mechanical ventilation 63.3% and blood transfusion 51.7% for their future special life-sustaining treatments. They did not preferred hemodialysis 8.3%, artificial respiration 6.7%, intensive care unit 6.7%, 8.3 percent of participants said that they well aware of Advance Directives. 86.6% of them hoped to write their Advance Directives. Despite such low awareness of the Advance Directives, the intention to write Advance Directives was high. Based on these results, it was found that the level of awareness of Advance Directives was very important for the intention to prepare Advance Directives. Therefore, regional programs and education on Advance Directives and periodic survey study for awareness of Advance Directives should be continued.

• Research in Community and Public Health Nursing
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• v.11 no.2
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• pp.358-372
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• 2000

The purpose of this study was to describe the way of life (such as smoking habits, alcohol consumption, exercise, duration of sleep, eating habits etc.), physical. psychological and overall health complaints and to identify the relationship between the way of life and health complaints of the nursing students. Data was collected with the self-administered OMI( Okayama Medical Index Health Questionnaire, devised Cornell Medical Index) from 766 nursing students and was analyzed. For data analysis, descriptive statistics and an ANOVA with an SPSS/PC+ program were used. The results were as follows: 1. The mean age of subjects was 21.0557(2.7618) years old in their 1st, 2nd, 3rd and 4th year-classes of nursing departments and college students in 4 regions of Korea. 62.1% of subjects were of the proper body weight, 2.0% were overweight, and 28.3% were underweight. Most subjects did not have a past history of disease, but 1.8% of subjects had experienced a blood transfusion. 2. 28.3% of the subjects had averaged 7 hours of sleep, 98.5% were nonsmokers, 91.2% were nondrinkers, 74.7% of subjects had milk intake sometimes, 53.7% of the subjects had an average salt intake, 49.6% of the subjects usually had a green vegetable intake, 45.4% of the subjects sometimes had fatty food intake, 64.8% of the subjects had good taste, 29.5% of the subjects enjoyed physical exercise. 3. The highest percentages of 'yes' among physical. psychological and overall health complaints were observed in the question 'Do you have gastric pain?'(60.2%), 'Are you confused of disorderly?' (37.2%), 'Physical body was burdensome and fatigued.'(57.3%). 4. The total O.M.I. score ranged from 1 to 89 with an average of 22.91(SD=12.10). A statistically significant difference was observed for the physical. psychological complaints for alcohol consumption. and for the psychological complaints for salt and fatty food intake. These conclusions should provide grounds for future studies of strategies for health promoting lifestyle for nursing students and their health concerns. Further research is required to investigate the life environmental and psychological factors affecting the way of life for nursing students and their health status, to analyze the health behavior of nursing students related with their culture and consciousness. Also epidemiologic research methodology, such as prospective cohort study should be considered to explore the performing process of nursing student's health behavior related with the occurrence of diseases.

• The Journal of the Korea Contents Association
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• v.13 no.9
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• pp.504-514
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• 2013

Purpose: This study was to identify the educational effects of self directed learning applying basic nursing practice contents of e-learning on nursing students' knowledge, self-confidence, and learning satisfaction. Method: This study applied a quasi-experimental pre-test and post-test control group design with 63 freshman nursing students (31 experimental group, 32 control group) of G. university in Incheon, Korea as subjects. The e-learning content was about the application of topical medications, central line care, and blood transfusion. All were available at the web site in school. Self-directed e-learning was more than 120 min.(3 times a week, 2 weeks)during Sep-Nov in 2011. In both groups, there were no significant difference in general characteristics, self-directed learning readiness, knowledge, and self-confidence for the pre-homogeneity. Results: The experimental group showed a higher level of improvement in knowledge and learning satisfaction but not significantly. However, the self-confidence was significantly improved in the experimental group. Conclusion: When self-directed learning using e-learning contents added to the conventional practical class, it may be beneficial for the nursing students to learn skills effectively.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.509-512
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• 1998

Although posterolateral thoracotomy(PLT) has been a standard thoracic incision in resection surgery of the lung for surgeons to achieve a good surgical field, there remains concern about severing a group of thoracic muscles remains. Muscle-sparing vertical thoracotomy (MVT) is an alternative to PLT, which gives cosmetic result and may preserve motion of the shoulder girdle as well as respiratory function of the patient in the early postoperative period. However, surgeons tend not to perfer it because of limited surgical field from the vertical wound made on the lateral thoracic wall. The purpose of this study is to compare the surgical outcomes of PLT versus MVT. We retrospectively reviewed 29 patients(15 who had PLT and 14 who had MVT, organized into those two groups) who had undergone lung resection surgery in our institute. There were no clinical differences between the two groups in terms of operation time, estimated amount of blood loss during the operation, amount of chest drainage on the first and the second postoperative day, duration of chest tube placement, incidence and amount of transfusion, and postoperative complications. We conclude that, from our limited experience, MVT can be applied to lung resection surgery as safely as PLT and that it may have a beneficial role for the patient with compromised lung function in addition to cosmetic effect.

• Journal of Chest Surgery
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• v.16 no.3
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• pp.281-288
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• 1983

Heparinization is an essential step in extracorporeal circulation for open heart surgery. But wide individual variation to heparin effect sometimes makes it difficult to anticoagulate safely or neutralize appropriately. Because the conventional set protocol of heparinization did not consider this individual variation, a new method of control of heparinization was proposed by Dr. Brian Bull in 1974. We compared the group in which a conventional set protocol was used [Control group] with the other in which a new protocol modified from that of Bull was used [ACT group], on the aspects of the dosages of heparin and protamine administered and postoperative bleeding. Our conventional protocol [Control group] consisted of: 1. Initial heparin was given at dose of 350U/Kg into the right atrium prior to bypass. 2. Additional heparin was given every hour during E.C.C., as much as a half of the Initial dose. 3. 600U of heparin was mixed into every 100ml. of priming solution. 4. The protamine dose was calculated by totalling the units of heparin given to the patient and giving 1 .8mg. of protamine per 100 units of heparin. ACT protocol [ACT group] consisted of: 1. Initial heparinization was same as that of conventional protocol. 2. ACT`s were checked before [A point] and 10 minutes after initial heparinization [B point]. With these 2 points, a dose response curve was drawn. 3. Heparin for the priming solution was same as in control group. 4. Every 30 minutes during E.C.C., ACT`s were checked with Hemochron [International Technidyne Corp.]. ACT between 450 and 600 seconds was regarded as safety zone. If ACT checked at a time was below 450 seconds, heparin dose was calculated on the dose-response curve to lengthen ACT to 480 seconds and was given into the oxygenator. 5. About 10 minutes before the term of E.C.C., ACT was checked to estimate the blood heparin level at the time. Then, protamine dose was calculated at dose of 1.Stag per 100 units of heparin. The calculated dose of protamine was mixed into 50 to lO0ml of 5% Dextrose Water and dripped intravenously during the period of 15 minutes. Compared these two groups mentioned above, results were obtained as follows: 1. Mean value of normal ACT checked with Hemochron on 30 preoperative patients was 124 seconds [range 95-145 sec.]. 2. Doses of heparin and protamine given to the patient were decreased in ACT group as much as 32.2% and 62.2% respectively. 3. Postoperative bleeding and transfusion were also decreased in ACT group in 60.5% and 67.1% respectively. 4. Our modified dose-response curve did not cause any problems in the control of heparinization. 5. Initial heparinization [Heparin 350U/Kg] was sufficient for the most patients until 60 minutes under extracorporeal circulation. 6. We used 1.5mg of protamine to neutralize 100 units of heparin. But smaller dose of protamine may be sufficient for appropriate neutralization.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.4
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• pp.570-577
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• 2017

The purpose of this study was to provide a basis for the development of a health insurance payment system by exploring inpatient hospice & palliative care activities in a long-term care hospital by occupational personnel. The contents and frequency of inpatient hospice-palliative care activities were obtained retrospectively from the chart review of 12 terminally ill patients who died during the 6 months before their deaths. According to their occupational personnel, doctors were doing blood transfusion, family counseling, and medication guidance. Nurses' main activities were airway suction, oxygen supply, EKG monitoring, observing patient's status, helping medication and tube feeding. Other workers' activities are as follows: social workers were applying individualized programs, physical therapists were doing electrostimulation, nutritionists were giving nutrition evaluation and meal rounding, and careworkers were assisting with meals and nutrition. Although certain nursing activities, like emotional support, were performed by nurses, the hospice-palliative activities from doctors, social workers and physical therapists were largely unavailable for terminally ill patients in a long-term care hospital. And some terminally ill patients were receiving too intensive and invasive medical cares for end end-of-life care. The results highlight the importance of valid measures of hospice-palliative care quality and the need for establishing an adequate reimbursement system for ensuring and improving end-of-life care.

• Journal of The Korean Society of Clinical Toxicology
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• v.12 no.2
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• pp.92-96
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• 2014

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of $138,000/mm^3$, activated partial thromboplastin time (aPTT) of 10 s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.336-343
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• 2019

Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.