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Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study

  • Baratloo, Alireza;Mirbaha, Sahar;Kasmaei, Hossein Delavar;Payandemehr, Pooya;Elmaraezy, Ahmed;Negida, Ahmed
    • The Korean Journal of Pain
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    • v.30 no.3
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    • pp.176-182
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    • 2017
  • Background: Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. Methods: We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively. Results: In total, 70 patients (35 patients in each group) with the mean age of $33.1{\pm}11.3years$ were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001). Conclusions: It is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.

The dental status of foreign workers in the pocheon city and the analysis of their oral health behavior (포천시 외국인 근로자의 구강건강행태와 치과진료 이용실태)

  • Choi, Eun-Mi;Song, Yun-Sin
    • Journal of Korean society of Dental Hygiene
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    • v.12 no.1
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    • pp.135-143
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    • 2012
  • Objectives : The purpose of this study on the oral health behavior of foreign workers and dental care in the community is to identify actual oral health conditions of immigrated labors, to promote their oral health and to gather basic data providing them with proper oral health services Methods : Based on previous studies, The researchers wrote their own surveys in English, in Vietnamnese, in Tagalogue, in Thai. Making questions on the paper to 114 foreign workers in Pocheon, Gyeonggi-do were surveyed. Using the program SPSS 17.0 for Windows, the collected data were analyzed. The frequency analysis, the chi-square analysis and the correlation analysis was performed to recognize their relevance between the oral health status and the actual oral care and the subjective perception of oral health. Results : General characteristics of the foreign workers is the overwhelming majority of male demographic 78.9%. By age, 20-29 years of age accounted for 50%, and duration of stay in the city is less than 3-5 years to 68.4%, It was most common. The percentage going to the dentist when teeth hurt is although 56 percent. But the ratio to endure the pain without going to the dentist, was 44%. The main reason to not go to the dentist was the time 55.2% and cost 11.9%. A mere 9.6% of respondents knew about the free dental care and used. 67.5% of them was not aware of the free dental care agency, 59.6% were keen to use the free care. However, 40.4% did not want a free dental care because they did not have the time(26.3%), the distance is far away(3.5%), and difficulties in communication(3.5%) and the other(66.7%). Conclusions : The major percentage of the other reason(66.7%) why they did not want to go to free dental service, must be specifically identified. For the activation of free dental services, the active support of central and local governments is needed. By focusing on health-related departments of the University in the community, it is necessary to operate the program of the oral health care for foreign workers.

Clinicopathological Characteristics of Triple Negative Breast Cancer at a Tertiary Care Hospital in India

  • Dogra, Atika;Doval, Dinesh Chandra;Sardana, Manjula;Chedi, Subhash Kumar;Mehta, Anurag
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10577-10583
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    • 2015
  • Background: Triple-negative breast cancer (TNBC), characterized by the lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2, is typically associated with a poor prognosis. The majority of TNBCs show the expression of basal markers on gene expression profiling and most authors accept TNBC as basal-like (BL) breast cancer. However, a smaller fraction lacks a BL phenotype despite being TNBC. The literature is silent on non-basal-like (NBL) type of TNBC. The present study was aimed at defining behavioral differences between BL and NBL phenotypes. Objectives: i) Identify the TNBCs and categorize them into BL and NBL breast cancer. ii) Examine the behavioral differences between two subtypes. iii) Observe the pattern of treatment failure among TNBCs. Materials and Methods: All TNBC cases during January 2009-December 2010 were retrieved. The subjects fitting the inclusion criteria of study were differentiated into BL and NBL phenotypes using surrogate immunohistochemistry with three basal markers $34{\beta}E12$, c-Kit and EGFR as per the algorithm defined by Nielsen et al. The detailed data of subjects were collated from clinical records. The comparison of clinicopathological features between two subgroups was done using statistical analyses. The pattern of treatment failure along with its association with prognostic factors was assessed. Results: TNBC constituted 18% of breast cancer cases considered in the study. The BL and NBL subtypes accounted for 81% and 19% respectively of the TNBC group. No statistically significant association was seen between prognostic parameters and two phenotypes. Among patients with treatment failure, 19% were with BL and 15% were with NBL phenotype. The mean disease free survival (DFS) in groups BL and NBL was 30.0 and 37.9 months respectively, while mean overall survival (OS) was 31.93 and 38.5 months respectively. Treatment failure was significantly associated with stage (p=.023) among prognostic factors. Conclusions: Disease stage at presentation is an important prognostic factor influencing the treatment failure and survival among TNBCs. Increasing tumor size is related to lymph node positivity. BL tumors have a more aggressive clinical course than that of NBL as shown by shorter DFS and OS, despite having no statistically significant difference between prognostic parameters. New therapeutic alternatives should be explored for patients with this subtype of breast cancer.

Effects of Low-Dose Fractionated Total Body Irradiation on Murine Immune System (마우스에서 전신 저선량 분할 방사선 조사에 의한 면역학적 변화 평가)

  • Kim, Mi-Hyoung;Rhu, Sang-Young;Lim, Dae-Seog;Song, Jie-Young
    • Journal of Radiation Protection and Research
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    • v.39 no.3
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    • pp.134-141
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    • 2014
  • Along with the wide use of radiotherapy in cancer treatment, there is growing interest in beneficial effect of low-dose irradiation (LDI) in cancer therapy. Therefore, we investigate how LDI affects immune responses in mice model. Total body irradiation (TBI) on C57BL/6 mice was given at low-dose rate of $1mGy{\cdot}min^{-1}$ using $^{137}Cs$ source at three times for consecutive three days. Hematological examination, total cell numbers of spleen, populations and characteristics of splenocytes were determined. Total numbers of RBC or platelet in irradiated mice showed no significant changes. WBC counts were decreased in a dose-dependent manner 2 days after TBI, however, these differences are gradually waned until 28 days. Dose-dependent decrease in the number of splenocytes of TBI mice at day 2 was also improved as time progressed. While the level of Foxp3 mRNA was decreased, the frequency of $CD4^+$ T cells and $CD69^+$ cells in spleen was increased at day 2 and 14. Fractionated low-dose TBI on mice exhibited normal body weight with no distinguishable behavior during whole experimental periods. These results suggest that some parameters of immune system could be altered and evaluated by fractionated low-dose TBI and be used to broaden boundary of low dose radiation research.

Measurement of Nursing Service Quality using SERVQUAL Model (SERVQUAL 모델을 이용한 간호 서비스 질 측정)

  • Lim, Ji-Young;Kim, So-In
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.2
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    • pp.259-279
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    • 2000
  • This study is a descriptive analytic research measuring nursing service quality, using SERVQUAL model, to make fundamental data and strategies for nursing service improvement. Data were collected by self-reported questionnaire from 202 patients and 142 nurses, from June 7 to 14, 1999. The reliability of instrument were adequate(Cronbach ${\alpha}=.94$). SAS program was utilized for statistical analysis of collected data. The results were as follows; 1. There was a gab between patient's expectation and perception on nursing service(Gap B). Gap D was indicated an affecting factor to decide nursing service quality. Gap C was indicated an indirect affecting factor of nursing service quality. Because it was not statistically significant in total item analysis, but in individual item analysis, 7 items were appeared statistically significant. Gap A was not a gap occurrence factor of nursing service quality. 2. Focuses of nursing service quality improvement strategies were; (1) to direct qualitative improvement of nursing service in order to correspondence patient's nursing service expectation. (2) to make nurse's service activity modified because nurse's practice were not reached patient's expectation level. (3) to need internal, external factor analysis affecting nurse's service activity. 3. Nursing service quality was decided by rather environmental inappropriateness provided nursing service than itself. Therefore, to make nursing service quality improvement, it is required to improve nursing service environment. For this, followings are required; (1) to strengthen nurse's education on lower part of nursing service satisfaction and QI activities. (2) to balance demand and supply of nursing personnel. 3) to fix computerized system for reducing other duties weight except nursing care through analysis of nursing activity. (4) to construct rational cooperating system among related departments. 4. The important parts for nursing service quality improvement were indicated as follows: (1) Gap B: 'prompt reaction', 'examination symptom before patient's complaint', 'hearted nursing service reducing patient's dissatisfaction', 'explanation goals of nursing activities', 'having special Knowledge enough', 'maintenance position comfortably', 'management of patient's physical hygiene'. (2) Gap C: 'maintenance physical safety', 'explanation about hospital rules and facilities'. (3) Gap D: 'tender, safe injection and wound care'. Because above items are mostly improved through nurse's attitude change and quality improvement, it is required to establish nursing standardization and to strengthen nurse's clinical education. As the based on above results, followings are suggested; 1. SERVQUAL model is very useful to make strategies for nursing service quality improvement because it indicates multiple factors affecting hap occurrence. 2. At individual items analysis of Gap C, statistically significant 7 items appeared higher nurse's perception level than patient's perception level on nursing service were trouble perception level on nursing service quality improvement. So. it need further research to analysis about these difference occurring factors. 3. At analysis of Gap D, it is indicated that in nursing service performance process, multiple factors lowing nursing service quality were intruded. So it needs further research to analysis what these factors are and how each factors affect on nursing performance process. 4. nursing service quality measurement is changeable according to sample select time or sampled subject's characteristics. So to develope strategy for nursing service quality improvement is based on the results of periodical analysis.

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Recent Advances in Cancer Diagnosis: On an Overview of Diagnostic Cytopathologic Modalities and Ancillary Techniques (세포병리학적 기초에 의한 암진단의 발전: 진단방법과 보조기법)

  • Kim, Ki-Tai;Ham, Eui-Keun
    • The Korean Journal of Cytopathology
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    • v.7 no.1
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    • pp.1-11
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    • 1996
  • From the concepts of cellular pathology and of exfoliative cytology, as elucidated by Virchow and Papanicolaou respectively in the late 19th and early 20th century, have evolved the primary methods for the diagnosis of cancer today. From Papanicolaou's concept of exfoliative cytology developed fine needle aspiration biopsy in the early 1960's, this has become a major diagnostic procedure and has contributed to a significant reduction in open biopsies and, therefore, to medical cost-effectiveness immunobiochemical techniques provided us with a supplement to cancer diagnosis in the 1980's. The immunoperoxidase method, using monoclonal antibodies, is applied primarily as an ancillary measure to elucidate the nature of cancers The availability of specific monoclonal antibodies has greatly facilitated the identification of cell products or surface markers. For example, antibodies directed against intermediate filaments have proved to be of value in determining the histogenesis oi poorly differentiated neoplasms. Tumor markers may serve as biochemical indicators of the presence of a neoplasm. They can be detected In plasma and other body fluids. Their concentration can be applied as a diagnostic test, for monitoring the clinical course of known cancer, and as a screening measure to detect certain cancers in a population at risk. Flow cytometry is a useful tool for distinguishing several cell characteristics, such as the immunophenotype of leukemia-lymphoma cells, the DNA content of neoplastic cells, and cell proliferation rate. Molecular biologic techniques provided a giant step for the management of cancer patients encompassing diagnosis, prognostic evaluation, and therapy. Nucleic acid hybridization techniques are utilized as Southern, Northern, and dot blots and in situ hybridization. Molecular biology and its techniques may bring a blight new horizon for understanding cancer biology and in designing therapy on the basis of gene manipulation.

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Research on the Leadership Types in Italian Restaurants (이태리 레스토랑 종사자들의 리더십 유형에 관한 연구)

  • Yim, Seoung-Bean;Kim, Pan-Jin
    • Journal of Distribution Science
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    • v.10 no.12
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    • pp.35-43
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    • 2012
  • Purpose - This study analyzes the effects of types of leadership on the employees of Italian restaurants, its efficacy, and organizational citizenship behavior, utilizing a causal assessment model. In this study, independent variables such as the type of leadership perceived in the manager or chef by an Italian restaurant's employees, and its efficacy were parameters, and the organizational citizenship behavior and organizational effectiveness were the variables representing the results in the hypothesis. The study aimed to draw implications by verifying the leadership via efficacy and the impact on organizational citizenship behavior of Italian restaurants. Research design, data, methodology - For the purpose of this analysis, specific questionnaire items were configured according to the theory and efficacy of the study. From a questionnaire used in organizational citizenship behavior comprising 22 questions, six were modified to suit the research purpose of this study. The configured questionnaire comprised 5 parts and 40 items. A Likert (Likert) 5-point scale was utilized to measure responses to the questionnaire items from the employees of an Italian restaurant in Seoul who participated in the survey. For data collection, 400 questionnaires were distributed, and 344 collected. Factor analysis and reliability verification were conducted using SPSS18.0 and AMOS18.0. A covariance structure analysis was conducted to test the research hypotheses. Results - Based on the results of the analyses, the summary and suggested implications of the research are as follows: The covariance structure analysis used to analyze the kind of effect transformational and transactional leadership styles in Italian restaurant employees had on self-efficacy, group-efficacy, and organizational citizenship behavior, indicated that among the characteristics of transformational leadership (such as, idealized influence, inspirational motivation, individual consideration, and intellectual stimulation), idealized influence and individual consideration had a positive influence on self-efficacy. Idealized influence, individual consideration, conditional reward, and management by exception also positively influenced self-efficacy and altruistic and conscientious behavior (organizational citizenship behavior). Conclusions - Results suggest that with regard to self-efficacy and group efficacy, managers in different departments and chefs should provide team members with a vision for the future, increase their confidence in their abilities, and build their trust in the organization. By evaluating employee performance and experiences, management can demonstrate leadership and encourage organizational citizenship behavior through enjoyable, voluntary participation. Transformational and transactional leadership is effective in group processes that include social-exchange relationships, self-efficacy and group efficacy, and organizational citizenship behavior. However, as this research study utilizes only self-reported data, it has several limitations, such as a vulnerability of errors caused by the various experiment types. A significant limitation of this study is the lack of potential for the duplication of results. The covariance structure analysis, however, provides complementation to limit the impact of errors from self-reporting studies. A future study can extend this research by utilizing different data collection methods.

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Antidotes Stocking and Delivery for Acute Poisoning Patients at 20 Emergency Departments in Korea 2015-2017 (2015-17년 전국 20개 거점병원 응급해독제 비축 및 제공 결과)

  • Lee, Seungmin;Youn, Han Deok;Chang, Hanseok;Won, Sinae;Kim, Kyung Hwan;Oh, Bum Jin
    • Journal of The Korean Society of Clinical Toxicology
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    • v.16 no.2
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    • pp.131-140
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    • 2018
  • Purpose: The National Emergency Medical Center has been running a project for the storage and delivery of antidotes for acute poisoning patients of the Department of Health and Welfare, Korea. This study analyzed the results of this project over the past two years. Methods: The requests received by the National Emergency Medical Center and the data on the delivery process were analyzed. Results: This study analyzed a total of 121 patients with acute poisoning, who were requested to receive an antidote reserved at 20 key hospitals in 2015-2017, and whose age was $52.3{\pm}23.5\;years$; old; 54 were women. Intentional poisoning were 58.7%, and the home was the most common place of exposure (66.9%). The toxic substances were chemicals (32.2%), pesticides (27.3%), medicines (24.8%), and snake venom (4.1%). The patient's poison severity score was $2.4{\pm}0.7$ (median 3) indicating moderate-to-severe toxicity. Antidote administration was the cases treated in key hospitals 67.8% (82/121), in which transferred patients accounted for 57.3% (47/82). After receiving an antidote request from a hospital other than the key hospitals, the median was 75.5 minutes (range 10 to 242 minutes) until the antidote reached the patient, and an average of 81.5 minutes was required. The results of emergency care were intensive care unit (70.3%), general wards (13.2%), death (10.7%), and discharge from emergency department (5.0%). Conclusion: This study showed that the characteristics of acute poisoning patients treated with an antidote were different from previous reports of poisoned patients in the emergency department, and basic data on the time required for delivery from key hospitals was different.

Problems and Improvement Strategies of Environmental Impact Assessment by Local Government in South Korea - Case Studies of 8 Local Governments including Seoul, Jeju, Busan and Daejeon - (지방자치단체의 환경영향평가 제도 운영현황 및 개선방안 - 서울, 제주, 부산, 대전 등 8개 지자체를 중심으로 -)

  • Kim, Jin-Oh;Min, Byoungwook
    • Journal of Environmental Impact Assessment
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    • v.29 no.2
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    • pp.132-143
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    • 2020
  • The purpose of this study is to identify the accomplishments and limits of the local governments' environmental impact assessment operation system and to propose a policy plan to improve it through an analysis of the current status of the operations by local governments. As the research method, based on an understanding of the basic purpose and concept of the local government's environmental impact assessment, the current status of environmental impact assessment by major local governments such as Seoul, Jeju, Busan, Daejeon, etc. is analyzed and in-depth interviews with public officials in charge are conducted. Through the extensive discussions, the current situation and the problems are identified. The accomplishments of the local governments' operation of environmental impact assessment are: it is possible, first, to select evaluation targets and items in accordance with regional characteristics; second, to continuously strengthen the management and monitoring the evaluation result after through its own follow-up control. The limits revealed are; first, internal organization problems, which are largely due to the fact that the project approvers and the environmental impact assessment consultants are the same; second, poor cooperation system between the department of environmental impact assessment and other departments; third, lack of professionalism in the working forces; and forth, a limited pool of the skilled judges; and last, it was found that there could be frequent problems of overlapping regulation during coordinating target projects and evaluation contents.

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

  • Hwang, Soyun;Choi, Yoo Jin;Jung, Jae Yun;Choi, Yeongho;Ham, Eun Mi;Park, Joong Wan;Kwon, Hyuksool;Kim, Do Kyun;Kwak, Young Ho
    • The Korean Journal of Pain
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    • v.33 no.4
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    • pp.386-394
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    • 2020
  • Background: In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods: This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results: A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions: Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.