• Perspectives in Nursing Science
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• v.3 no.1
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• pp.35-45
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• 2006

In Korea, about 8.3% over aged 65 are suffering from Alzheimer's disease or other type of dementia. Among dementia-related behaviors, wandering is the one of strongest factors on burden and stress of caregivers. On Lee and Kwon's report with community living persons with dementia, upto 85% of caregivers reported wandering as a problem. Wandering is a frequently encountered problem in communities and long-term care facilities, but it is among least understood dementia. related behavior. Despite the prevalence of wandering, its significant adverse outcomes, and the increase in persons with dementia in Korea, no systematic research has been conducted in Korea. The purpose of this study is to review on literature related to wandering behavior among persons with dementia. The specific topics related to wandering are included: definition, the prevalence of dementia and wandering behavior, the influencing factor on wandering, outcomes of wandering behavior, and the measurement method. Wandering is defined as "aimless walking" and "Meandering, aimless or repetitive locomotion that exposes one to harm and is incongruent with boundaries, limits, or obstacles". Wandering is viewed as a problematic behavior, however, it has to be understood as need-driven compromised behavior. For example, wandering may be an expression of searching for familiar person and/or place. Recently, in Korea, there is an effort for establishing the therapeutic environment for elders who are wanderers in long-term-care facilities. Cognitive impairment of persons with dementia is found to be a consistent factor on wandering behavior through many national and international studies. The adverse outcomes of wandering are serious problem in persons with dementia as well as their caregivers. The adverse outcomes include falls, fractures, getting lost, use of restraints, or even death. In fact, wandering is one of the major reasons for a patient to be institutionalized. For measurement of wandering behavior, two methods are broadly used: observation using stop watch, and survey form. A revised instrument of the Korean version of Algase wandering scale (K_RAWS) is established the psychometric properties (Son, Song, & Lim, 2006) demonstrating valid and reliable instrument in measuring wandering behavior among persons with dementia who are residing in communities. K_RAWS has a 39 items with six subscales including persistent walking, repetitive walking, spatial disorientation, eloping behavior, negative outcome, and mealtime impulsivity. In conclusion, studies including the prevalence of wandering behavior and predictive factors on wandering should be conducted to understand wandering clearly before developing any types of intervention.

• Pediatric Infection and Vaccine
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• v.19 no.3
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• pp.111-120
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• 2012

Purpose: The aim of this study is to investigate the colonization rate of Methicillin-resistant Staphylococcus aureus (MRSA) in neonates by different clinical characteristics, to presume the origin of MRSA acquisition, and to identify the risk factors associated with MRSA colonization. Methods: We retrospectively reviewed the medical records of 1,733 neonates admitted to Seoul Eulji hospital Neonatal Intensive Care Unit between January 2008 and December 2011. Nasal, inguinal and rectal swab specimens were obtained upon admission and each week until discharge. We classified the route of MRSA acquisition as; hospital associated (HA-MRSA) and community associated (CA-MRSA) according to the case definition. Results: Among 1,733 neonates, 415 (23.9%) were colonized with MRSA. Gestational age, birth weight, delivery type, maternal antibiotics usage before delivery, birth place and care place before admission were influencing factors in colonization of MRSA. The colonization rate was significantly high in neonates without maternal prophylactic antibiotics use before delivery than in the other group (relative risk 2.77, 95% CI 1.88-4.07; P<0.01), and outborns showed higher MRSA colonization rate compared to inborns (relative risk 2.28, 95% CI 1.17-4.42; P=0.015). Conclusion: We identified the neonatal MRSA colonization rate to be 23.9%. We estimated HA-MRSA colonization rate to be 10% (51/511) and CA-MRSA colonization rate to be 36% (309/858). We ascertained that risk factors in MRSA colonization in neonates were prophylactic use of antibiotics in mothers and the birth place.

• Journal of Korean Clinical Nursing Research
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• v.17 no.1
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• pp.113-122
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• 2011

Purpose: This study was conducted to develop and evaluate an oral care protocol for cancer patients receiving chemotherapy. Methods: The participants in this study were cancer patients in Severance hospital in Seoul. A total of 31 patients were assigned to the experimental group, and 29 patients to the control group. Data were collected from August 1 to October 5, 2010. The protocol included definition and symptom of oral mucositis, self-check method of oral status, prophylactic method of oral mucositis (oral care, eating habits, and gargling) and management of oral mucositis. Oral Assessment Guide (OAG) was used as the measurement tool of oral mucositis in this study, Oral Care Performance Scale was used as the measurement tool of oral care performance status. Data were analyzed with a $x^2-test$ and t-test, and repeated measures ANOVA, using SPSS/WIN 18.0 program. Results: Patients in the experimental group receiving the oral care protocol had a significant difference (t=-2.938, p=.005) in the oral care performance compared to the control group. However, there was no significant difference (F=1.255, p=.274) in the oral mucositis status between two groups. Conclusion: This study showed that the oral care protocol could improve oral care performance status for the patients under chemotherapy.

• Clinical and Experimental Pediatrics
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• v.46 no.1
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• pp.42-50
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• 2003

Purpose : The acute respiratory distress syndrome(ARDS), an acute form of severe alveolar-capillary injury evolving after a direct or indirect lung insult is thought to be a common cause of respiratory failure though not many clinical studies on the subject have been made yet. Methods : Between January 1992 and December 2001, we conducted a retrospective study on 33 children who fulfilled the definition of the ARDS recommended by the American-European Consensus Conference in 1994. Results : A total of 33 patients(20 boys and 13 girls) were selected. Their age ranged from 4 months to 12 years with seven children younger than 1 year. The overall mortality rate was 78.8% and no significant difference was noted based on age or sex. Concerning seasonal variation, incidence of the ARDS increased in spring, especially in May(21.2%). Pneumonia(66.7%) was found to be the most common risk factor of the ARDS followed by sepsis(24.2%) and aspiration(3.0%). In immune compromised children(six cases), including a recipient of bone marrow transplantation, the mortality rate was 100%. Compared with children with multiple organ failure recording a 83.3% mortality rate, those with isolated respiratory failure, showed a lower mortality rate of 33.3%, although stastistically insignificant. Between survivor and non-survivor groups, significant differences were shown in hematocrit, $PaO_2$, $PaCO_2$, PEEP, and $PaO_2/FiO_2$ on the seventh day after the onset of the ARDS. Conclusion : According to our study, respiratory failure proved to have a great effect on mortality rate in the ARDS. More aggressive intervention and further studies on this subject should be done to improve the survival rate.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.106-110
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• 2006

Background: Bronchioloalveolar carcinoma (BAC) is an uncommon primary malignancy of the lung, and it accounts for $2{\~}14\%$ of all pulmonary malignancies. According to World Health Organization (WHO) categorisation, BAC is a subtype of adenocarcinoma. The current definition of BAC includes the following: malignant neoplasms of the lung that have no evidence of extrathoracic primary adenocarcinoma, an absence of a central bronchogenic source, a peripheral parenchymal location, and neoplastic cells growing along the alveolar septa. Previous reports had demonstrated a better prognosis following surgery for patients affected by BAC than those affected by other type of non-small cell lung cancer (NSCLC). We aim to analyse Asan Medical Center experiences of BAC. Material and Method: Between 1990 and 2002, 31 patients were received operations for BAC. We analyse retrosepectively sex, age, disease location, preoperative clinical stage, postoperative pathologic stage & complications, survival according to medical record. Result: There were 12 men and 19 women, the average age was 61.09$\pm$10.63 ($31{\~}79$) years. Tumor locations were 7 in RUL, 1 in RML, 4 in RLL, 8 in LUL, 11 in LLL. Operations were 28 lobectomies, 2 pneumonectomies. Postoperative pathologic stage were 12 T1N0M0, 15 T2N0M0, 1 T1N1M0, 1 T1N2M0, 1 T2N2M0, 1 T1N0M1. Mortality were 4 cases ($12.9\%$) and there were no early mortality. Cancer free death was 1 cases, other 3 were cancer related deaths. All of them were affected by distal metastasis and received chemotherapy and each metastatic locations were right rib, brain, and both lung field. The average follow up periods were 50.87$\pm$24.77 months. The overall 3, 5-year survival rate among all patients was $97.1\%,\;83.7\%$, stage I patients overall 2, 5year survival rate was $96.3\%$. The overall disease free 1, 2, 5-year survival rate among all patients was $100\%,\;90\%,\;76\%$ and 2, 5-year survival rate in cases of stage I was $96.4\%,\;90.6\%$. 7 cases ($22.58\%$) were chemotherapies, 1 case ($3.22\%$) was radiation therapy, and 2 cases ($6.45\%$) were chemoradiation therapies. Metastatic locations were 3 cases in lung, 1 case in bone, 1 cases in brain. Conclusion: BAC has a favourable survival and low recurrence rate compare with reported other NSCLC after operative resections.

• Journal of Korean Biological Nursing Science
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• v.2 no.1
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• pp.1-19
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• 2000

The purpose of this study was to define the content of the requisite knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs needed for clinical knowledge for nursing practice. Contents of knowlege on pathological physiology, clinical microbiology, and mechanisms and effects of drugs were constructed from syllabus of basic nursing subjects in 4 colleges of nursing, and textbooks. The degree of need of 72 items was measured with a 4 point scale. The subjects of this study were college-graduated 136 nurses from seven university hospital in Seoul and three in Chonnam Province, Kyungbook Province, and Inchon. They have been working at internal medicine ward, surgical ward, intensive care unit, obstetrics and gynecology ward, pediatrics ward, opthalmology ward, ear, nose, and throat ward, emergency room, rehabilitation ward, cancer ward, and hospice ward. The results were as follows : 1. The highest scored items of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice were side effects of drugs, anticoagulants, mechanisms of drugs, antihypertensive drugs, tolerance and addiction of drugs, interactions among drugs, hospital infection in the order of importance. The lowest scored item was structure of microorganisms. 2. The highest order of need according to unit was repair in tissue injury unit, definition etiology classification of inflammation in inflammation unit, transplantation and immunologic response in alterations in immunity unit, thrombus and thrombosis in disorders of cardiovascular function unit, gene disorders in genetic disorders unit, hospital infection in infection unit, virus in microorganisms unit, side reactions of drugs in introduction unit, anticonvulsants in drugs for central nervous system unit, local anesthesia in anesthesia unit, anticoagulants in drugs for cardiovascular system unit, anti-inflammatory drugs in antibiotics unit, anti-ulcer drugs in drugs for digestive system unit, and bronchodilators in drugs for respiratory system unit. 3. The common content of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs needed for all clinical areas in nursing were side effects of drugs, anticoagulants, interactions among drugs, and hospital infection. However, the degree of need of each pathological physiology, clinical microbiology, clinical microbiology, and mechanisms and effects of drugs was different depending on clinical areas. 4. Significant differences in the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice such as tissue changes due to injurious stimuli, degenerative changes of tissue, alterations in metabolism of carbohydrates, ischemia, hyperemia and congestion, hospital infection, structure of microorganism, classification of microorganism, bacteria, virus, antidepressants, antipsychotic drugs, antiemetic drugs, antiparkinsonism drugs, antianxiety drugs, antibiotics, tuberculostatics, antiviral drugs, antifungal drugs, parasiticides, antiulcer drugs, antidiarrheais, and anti constipation drugs were shown according to the work area. 5. Significant differences in the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice such as transplantation and immunologic response, alterations in the metabolism of uric acid, structure of microorganism, classification of microorganism, immunosuppressants, drugs for congestive heart failure were demonstrated according to the duration of work. Based on these findings, all the 72 items constructed by Korean Academic Society of Basic Nursing science should be included as contents of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs.

• Progress in Medical Physics
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• v.26 no.4
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• pp.258-266
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• 2015

The modern radiotherapy technique which delivers a large amount of dose to patients asks to confirm the positions of patients or tumors more accurately by using X-ray projection images of high-definition. However, a rapid increase in patient's exposure and image information for CT image acquisition may be additional burden on the patient. In this study, by introducing structural similarity (SSIM) index that can effectively extract the structural information of the image, we analyze the differences between daily acquired x-ray images of a patient to verify the accuracy of patient positioning. First, for simulating a moving target, the spherical computational phantoms changing the sizes and positions were created to acquire projected images. Differences between the images were automatically detected and analyzed by extracting their SSIM values. In addition, as a clinical test, differences between daily acquired x-ray images of a patient for 12 days were detected in the same way. As a result, we confirmed that the SSIM index was changed in the range of 0.85~1 (0.006~1 when a region of interest (ROI) was applied) as the sizes or positions of the phantom changed. The SSIM was more sensitive to the change of the phantom when the ROI was limited to the phantom itself. In the clinical test, the daily change of patient positions was 0.799~0.853 in SSIM values, those well described differences among images. Therefore, we expect that SSIM index can provide an objective and quantitative technique to verify the patient position using simple x-ray images, instead of time and cost intensive three-dimensional x-ray images.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.17-26
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• 2002

Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

• Journal of forensic and investigative science
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• v.2 no.1
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• pp.5-22
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• 2007

From the numerous social problems generated by the unbalanced social development and the social trend of belittling life overall, we found the causes of suicide getting worse in its seriousness day by day. In reality, the problem has been approached in a collateral level in contrast with other social problems. There have been an active involvement in studying the definition, causes and ways of prevention of suicide theoretically until now. However, different from other social problems, it is almost impossible to treat or fix the problem of suicide. Only ways to treat or fix the problem is when the suicide has ended in failure. Thus, this study intends to examine the suicide rate among the total accidents during the year 2005, perform the analyses on the actual causes according to the relations such as the means of suicide, occupation, age group, educational background, etc. In order to present a solution to the issue of suicide becoming serious each day. Among the total accidents in 2005, the suicide rate came out to be approximately 52.4%. Among the result, 52.4%, male with 69% resulted higher than female with 31%, which appears to be related to the social functions. While men tends to take more active(80%) means of suicide like jumping off, poison, hanging, etc., women tends to take more passive(60%) means of suicide like sleeping pills, slitting wrist, etc. In terms of the cause, pessimism, illness, denial, mental disorder, etc resulted more than 75%, and there were many cases of suicide after exhibiting the signs of depression. Also there were higher suicide rate of the unemployed engaged in direct labor with educational background lower than college level related to the pessimism regarding the family living cost. We were able to determine the recent increase in the suicidal tendency of the educated people higher than the college level and the retired people with depression caused by the sudden change in social status. Overall there are several reasons for suicide, however, in most cases the signs of depression were exhibited until the final suicide, which tells us the serious psychological problem of suicide. Assuming that the current development of suicide will continue in future, the result of this study will guide the corresponding social policies, be utilized in preparing the insurance or management at the national level dealing with the real social problems that are not just a conflict of an individual, but could spread like a fad and become much bigger than the present by the continuous support at the environmental, social and political levels, and be utilized as the basic data to establish the research plan.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.377-387
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• 1996

Background : In 1980, WHO made a definition in which the term "impairment" as applied to the respiratory system is used to describe loss of lung function, "disability" the resulting diminution in exercise capacity. The measurement of pulmonary function during exercise would give us information about overall functional capacity and respiratory performance that would be lacking in tests performed at rest. We conducted this study to investigate the role of resting pulmonary function test and exercise test for assessing impairment/disability in patients with chronic airflow obstruction(CAO). Method : We studied 19 patients with CAO. The spirometry and body plethysmograph were performed in stable condition. And then patients performed a progressive incremental exercise test to a symptom-limited maximum using cycle ergometer. Patients were divided in two groups, severe and non-severe impairment, according to the resting PFTs and compaired each other. A patient was considered to be severely impaired if FVC < 50 %, FEV1 < 40 % or FEV1/FVC < 40 %. Results : 1) The airway obstruction and hypoxemia of severe impairment group were more severe and exercise performance was markedly reduced compairing to non-severe impairment group. 2) The severe impairment group showed ventilatory limitation during exercise test and the limiting symptomes ware dyspnea in 9/10 patients. 3) The impairment and disability of the patients with tuberculous destructed lung were most marked in patients with CAO. 4) The FEV1 was the most prevalent criterion for the determination of severe impairment based on resting PFTs and was the valuable best correlated to V02max(r=0.81, p < 0.001). 5) The sensitivity of exercise limits for predicting severe disability according to resting PFTs was 80 % and specificity 89 %. Conclusion : In patients with severe CAO, FEV1 is a good predictive of exercise performance and impairment measured by resting PFTs can predict a disability by exercise test.