• 한국간호교육학회지
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• 제16권1호
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• pp.51-60
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• 2010

Purpose: The purpose of this study was to compare the effects of nursing simulations between multi-mode simulation and $SimMan^{(R)}$ simulation on nursing students' nursing competency, satisfaction, and simulation participation experience in nursing care for patients with dyspnea. Method: Subjects were 107 junior nursing students in R College of Nursing in Seoul from June to November in 2009. Students were allocated to either a Multi-mode simulation group or a $SimMan^{(R)}$ simulation group. The multi-mode simulation consisted of standardized patients combined with Vital Sim, comparing the $SimMan^{(R)}$ group. Result: The Multi-mode simulation group reported higher levels of nursing competency (p=.017) but lower communication skills (p<.001) compared to the $SimMan^{(R)}$ simulation group. There were no meaningful differences in satisfaction of simulation education between the two groups. The $SimMan^{(R)}$ simulation group received a substantial health assessment and the Multi-mode simulation group experienced reality in caring for standardized patients. Conclusion: The findings of this study demonstrated that Multi-mode simulation has similar educational effects like $SimMan^{(R)}$ simulation and suggest that nurse educators should match simulation fidelity with educational goals for effective education.

• Tuberculosis and Respiratory Diseases
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• 제43권6호
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• pp.976-986
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• 1996

연구배경: 호흡곤란은 심폐질환 환자의 가장 흔한 증상이며 호흡 장애 결과로 인한 운동 능력저하는 일상 생활을 불가능하게 한다.(daily disability) 운동시 산소 소모량은 운동 능력 평가의 기능적 척도이며 심폐기능 정도를 반영하는 가장 좋은 지표로 얄려져왔다. 그러나 운동 부하 검사는 장비가 비싸고 복잡하며 증상이 심하거나 노령층의 환자에는 수행에 많은 제약점이 따른다. 반면 걷기검사는 일상 생할과 비슷한 운동량으로 실시하여 특별한 장비가 필요없고 재현성이 높은 좋은 방법으로 알려져 있다. 따라서 호흡 곤란을 호소하는 환자에서 걷기검사를 시행하여 동맥혈검사 및 폐기능 검사, Modified Borg Scale(MBS), 최대 산소 흡수율(maximal oxygen uptake; 이하 VO2max) 간의 상관 관계 및 6분과 12분 걷기검사간의 상관 관계를 알아보고자 본 연구를 시행하였다. 방법: 호흡곤란을 주소로 내원한 37 명의 환자를 대상으로 COPD, 심혈관질환, 기관지 천식, 운동시 호흡곤란을 호소하였으나 정상 소견을 보인 네 군으로 분류하여 각각의 환자에서 안정 상태에서 폐기능 검사와 동맥혈 가스 분석을 실시하였다. 안정 시 MBS를 이용하여 호흡곤란 지수를 기록하고, 걷기검사를 실시하였다. 증상 제한적 최대 운용 검사(Symptorn-limited maximal exercise)는 자전거 타기 검사로 시행하였다. 결과: (1) 전체 환자에서 VO2max 은 COPD 및 심혈 관질환에서 다른 두군에 비해 유의하게 낮았으며 (p<0.05), 걷기검사 역시 현저히 낮았다. (2) 전체 환자에서 12분 걷기 검사는 VO2max, PaCO2, FVC(% predicted), FEV 1 (% predicted)과 상관관계가 있었으며, COPD 환자군에서는 걷기검사와 VO2max간에만 상관 관계가 있었다. (3) COPD 환자군에서 VO2max와 FEV1, FVC간의 상관관계가 가장 컸고, VO2 max와 걷기검사간에 유의한 상관관계가 있었으나 걷기검사와 FEV1 FVC간에는 상관관계가 없었다. (4) 6분 걷기검사와 12분 걷기검사는 매우 유의한 상관관계가 있었다(r=0.92, p<0.01). 결론: 걷기검사는 심폐기능을 반영하는 운동능력 평가의 간단한 방법으로 VO2max의 간접적인 지표로 유용하였으나 최대 운동 능력과는 다른 개념인 'daily disability'를 평가할 수 있는 방법이다. 또한 6분 걷기검사는 12분 걷기검사보다 환자의 부담은 줄이면서 심폐질환자의 폐기능 및 운동 기능 평가에 비슷한 결과를 보였다.

• Journal of Chest Surgery
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• 제24권1호
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• pp.48-53
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• 1991

This report documents the clinical k pathologic features of 33 patients treated for thymoma for 11 years & 6 months between September 1977 and February 1989. At the Thoracic & Cardiovascular Surgery, Yonsei University, College of Medicine of the group, 31 patients treated with surgery were examined for the result of operation & prognosis. Mean age was 50 years. Thirteen were female and twenty were male. Dyspnea on exertion and chest discomfort were common in the patients without myasthenia gravis. Fourteen patients[42.6%] had myasthenia gravis and one patient had autoimmune thyroid disease. Four patients[12.1%] presented without symptoms attributable to their thymoma. Histologic review disclosed 12[36.4%] epithelial thymoma, 10[30.3%] mixed lymphoepithelial, 9[27.3%] lymphocytic, 1[3.0%] spindle cell and 1[3.0%] unknown cell thymoma. They were classified according to Masaoka`s clinical staging criteria; by these criteria, 8 patients were stage I, 5 patients were stage II, 15 patients were stage III and 3 patients were stage IV. Total excision of mass was possible in 20 patients. Partial excision of mass in 4 patients and biopsy in 7 patients were carried out during the operation. There was only one operation mortality. Follow-up was possible in 26 patients and follow-up ranged from 4 months to 10.5 years[mean 28.9 months]. One-year survival rates were 77.8% and eight patients expired during follow-up period. Eleven[78.6%] patients with myasthenia gravis were improved after the operation. This observation suggests that the most significant factor determining the survival is whether or not total surgical excision had been performed.

• Tuberculosis and Respiratory Diseases
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• 제70권4호
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• pp.323-329
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• 2011

Background: Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea. Methods: We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities. Results: The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group. Conclusion: Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.

• Journal of Hospice and Palliative Care
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• 제21권3호
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• pp.75-83
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• 2018

목적: 호스피스 완화의료에서 환자의 기대 여명 예측뿐 아니라 퇴원형태를 예측하여 적절한 치료를 제공할 필요가 있다. 이번 연구에서는 입원 초기 환자의 퇴원 형태 예측에 유의한 요소들을 알아보고 효율적인 완화의료의 방향에 대해 제시하고자 한다. 방법: 2016년 4월 1일부터 2017년 12월 31일까지 P병원 호스피스 병동에 입원한 말기암환자 568명 중 377명을 대상으로 하였으며 입원 시 사정한 환자의 수행 지수, 증상 및 징후, 사회 경제적 상태와 혈액검사 자료를 바탕으로 연구를 진행하였다. 결과: 입원 당시 높은 수행지수, 양호한 증상 및 징후, 정상에 가까운 혈액검사 수치를 보일 때 생존 퇴원할 가능성이 높았다. 결론: 환자의 퇴원형태 예측에 ECOG, KPS, Global health, Mental status와 같은 수행지수, dyspnea, anorexia, dysphagia, fatigue와 같은 증상 및 징후, CBC, LFT, BUN, CRP 혈액검사 수치가 유의한 지표임을 확인하였다.

• Tuberculosis and Respiratory Diseases
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• 제72권4호
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• pp.367-373
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• 2012

Background: Chronic obstructive pulmonary disease (COPD) is now regarded as a heterogenous disease, with variable phenotypes. Acute exacerbation of COPD is a major event that alters the natural course of disease. The frequency of COPD exacerbation is variable among patients. We analyzed clinical features, according to the frequency of acute exacerbation in COPD. Methods: Sixty patients, who visited Gyeongsang National University Hospital from March 2010 to October 2010, were enrolled. Patients were divided into two groups, according to their frequency of acute exacerbation. Frequent exacerbator is defined as the patient who has two or more exacerbation per one year. We reviewed patients' medical records and investigated modified Medical Research Council (MMRC) dyspnea scale, smoking history and frequency of acute exacerbation. We also conducted pulmonary function test and 6-minute walking test, calculated body mass index, degree of airway obstruction and dyspnea and exercise capacity (BODE) index and measured CD146 cells in the peripheral blood. Results: The number of frequent exacerbators and infrequent exacerbators was 20 and 40, respectively. The frequent exacerbator group had more severe airway obstruction (forced expiratory volume in one second [$FEV_1$], 45% vs. 65.3%, p=0.001; $FEV_1$/forced vital capacity, 44.3% vs. 50.5%, p=0.046). MMRC dyspnea scale and BODE index were significantly higher in the frequent exacerbator group (1.8 vs. 1.1, p=0.016; 3.9 vs. 2.1, p=0.014, respectively). The fraction of CD146 cells significantly increased in the frequent exacerbator group (2.0 vs. 1.0, p<0.001). Conclusion: Frequent exacerbator had more severe airway obstruction and higher symptom score and BODE index. However, circulating endothelial cells measured by CD146 needed to be confirmed in the future.

• Journal of Chest Surgery
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• 제27권4호
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• pp.292-296
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• 1994

From March, 1985, to June, 1993, 244 patients with 345 episodes of spontaneous pneumothorax treated at Koryo General Hospital were reviewed. Most of the patients were male, and the ratio of male to female was 8:1. The average age of the patients with spontaneous pneumothorax was 32.8 years old. The site of pneumothorax was revealed left side in 53.3%, right side in 42.6%, and bilateral in 4.1%. The cause of pneumothorax were shown primary spontaneous pneumothorax in 73.4%, and secondary spontaneous pneumothorax in 26.6%. The underlying pathologic lesion in secondary spontaneous pneumothorax showed pulmonary tuberculosis in 56patients[86.1%], COPD in 4patients[6.2%], bronchial asthma in 2patients[3.1%], lung cancer in 2patients[3.1%], and pneumoconiosis in a patient[1.5%]. The usual clinical symptomes were dyspnea, chest pain and chest discomfort. Recurrence rate was as follow; 2nd episode 33.6%, 3rd episode in 26.8%, and above in 4th episode in 18.2%. All the patient of pneumothorax was treated as following; Closed thoracostomy tube drainage in 127patients, bullectomy in 88patients, lobectomy in 5patients, wedge resection in 2patients, conservative treatment with oxygen therapy in 21patients, and video assisted thoracoscopic bullectomy in a patient. The course of treatment of all of the patients were smooth and uneventful.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1563-1569
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• 1992

From Jan. 1981 to Dec. 1991, we had treated 25 patients with congenital coronary art-eriovenous fistulas [CAVF] in Seoul National University Hospital. A retrospective review was made to delineate the course and the management of CAVF and to clarify the role of surgical treatment. Fifteen patients were male and 10 were female with The mean age of 17.4 years[from 3 months to 58 years]. The most frequent symptom was dyspnea on exertion[56%]. Other symptoms were angina and palpitation. Sixty-eight percent of the patients were symptomatic. Fifty-three percent of patients less than 20 years old were symptomatic and 100% of patients over 20 years old were symptomatic. Three patients had multiple CAVFs. The fistula drained into the right ventricle in 13, pulmonary artery in 9, left ventricle in 4, right atrium in 2, and left atrium in 1. Thirteen patients had other associated cardiac lesions. The mean pulmonary-to-systemic blood flow[Qp /Qs] in the isolate CAVF group was 2.19. All patients were operated on to correct the fistulas and other associated cardiac lesions. All patients were followed from 1 month to 11 years without late death. Postoperative complication rate was 24% -significant arrhythmia [3], recurred CAVF[1], psychosis[1], pneumonia [1]. Symptomatic improvement was evident postoperatively. Below 20 years old, 94% of patients were asymptomatic, but above 20 years old, symptoms persisted in 25%. In summary, early elective repair of CAVF is indicated in all patients because of higher complication rate and frequent persistent symptoms in older patients.

• Journal of Chest Surgery
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• 제17권1호
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• pp.32-40
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• 1984

During the past six years from July 1977 to June 1983, fifteen adult patients of patent ductus arteriosus were surgically treated. The results were as follows: 1. Of the 15 patients, their age range was 17 to 34 years with a mean of 24 years, and sexual predominance was women [9. cf. 6 men]. 2. The most common symptom showed exertional dyspnea, and 10 patients were classed in NYHA class II, the rest were all class III. 3. On physical examination, all patients were auscultated continuous murmur, but concomitantly diastolic murmur was noted apical region in 2 patients. 4. On roentgenogram of chest, normal finding was 3 patients, and the other patients were revealed the evidence of pulmonary congestion. 5. The electrocardiogram was normal in 6 patients, but LVH was seen in 5, and 2 patients were LVH+ LAH. 6. Cardiac catheterization was performed in 12, and mean value of SO2[LPA-RV] was 6.3%, Q/Q 2.09, peak systolic pulmonary arterial pressure 45.3 mmHg, and Rp/Rs 0.365. 7. All operations were carried out by posterolateral thoracotomy. In 6 patients, division and suture of ductus were possible, the other patients were treated by division and ligation with heavy silk or Dacron patch. 8. Postoperative complications were hoarseness, persistent murmur, reoperation for bleeding, and atelectasis. Early and late mortality was 20% [3 patients], and cause of death was mainly aneurysmal rupture of previous operative site.

• Tuberculosis and Respiratory Diseases
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• 제69권1호
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• pp.24-30
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• 2010

Background: A novel 2009 influenza A (H1N1) virus emerged and disseminated to all over the world. There are few reports on the clinical characteristics of patients with complications. We describe the clinical features of pneumonia in adult patients hospitalized, who have novel influenza infection. Methods: There were 43 adult patients enrolled into the study with pneumonia of 528 hospitalized patients confirmed influenza A (H1N1) virus infection by real-time reverse transcriptase polymerase chain reaction testing, between 24 August 2009 and 31 January 2010. The clinical data of patients with pneumonia were collected retrospectively. Results: There were 22 of 43 (51.2%) influenza patients with pneumonia that had higher risk factors for complications. Compared to 28 patients with influenza A (H1N1) viral pneumonia and 15 patients, who had isolated bacteria from cultures, those with mixed viral and bacterial pneumonia were significantly more likely to have unilobar consolidations on chest radiographs (53.3 vs. 10.7%, p<0.01) and higher scores of pneumonia severity index (PSI; 90 [66~100] vs. 53 [28~90], p=0.04). Six patients required mechanical ventilation support in an Intensive Care Unit and were more likely to have dyspnea (83.3 vs. 29.3%, p=0.02) and low levels of $PaO_2$ (48.3 [37.0~70.5] vs 64.0 [60.0~74.5] mm Hg, p=0.02) and high levels of pneumonia severity index (PSI) score (108.0 [74.5~142.8] vs. 56.0 [40.5~91.0], p=0.03). Conclusion: The majority of pneumonia patients infected with novel influenza improved. Chest radiographic findings of unilobar consolidations suggest that mixed pneumonia is more likely. Initial dyspnea, hypoxemia, and high levels of PSI score are associated with undergoing mechanical ventilation support.