• Journal of Korean Clinical Nursing Research
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• v.24 no.1
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• pp.44-55
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• 2018

Purpose: This study aimed to explore and understand the experience of decision making among women undergoing or forgoing selective fetal reduction who have higher-order multiple pregnancies through assisted reproductive techniques. Methods: A qualitative study was conducted from August 1, to October 30, 2013. Eight participants were interviewed and the interviews were audio-recorded and transcribed verbatim. Six persons participated in in-depth interviews in person and two participated over the telephone. A thematic analysis was conducted. Results: Four themes were identified and carefully named: Confusion after higher-order multiple pregnancy; Obstacles to choice: Uncertain safety; Weighing between reality and ideality and; Influences of medical professionals. Conclusion: The results demonstrated a wide range of factors considered by women when making decisions about selective fetal reduction, and mothers' feelings of conflict and distress in the decision-making process. The results suggest that it is important for nurses to provide emotional support and consolation, in addition to sufficient information. These findings will help nurses improve their counseling techniques by understanding the situation of infertile couples.

• Journal of Korean Academy of Nursing Administration
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• v.10 no.2
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• pp.175-184
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• 2004

Purpose: The purpose of this study was to develop a nursing organization culture measurement tool and to test the validity and reliability of the tool. Method: This study conducted in three phases. In phase 1, theoretical framework choice, Phase 2, measurement items selection, Phase 3, testing of validity and reliability. In order to test validity and reliability of the measurement, data were collected from 915 nurses, working in the 22 hospitals with more 500 beds. The data obtatined were analyzed by SPSS-Win 10.0 program using percentages, Factor Analysis, Cronbach's alpha Coefficients. Result: As a result of the study, nursing organization culture measurement scale was consisted of 20 items, 4 factors. 4 factor explained 60.54% of the total variance, and the Cronbach's alpha of this scale was .8829. Conclusions: The Study supports the validity and reliability of the scales. Therefore, this scale can be effectively utilized for the evaluation of nursing organization culture in hospital setting.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.7-10
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• 2008

The early glottic cancers are traditionally treated by radiotherapy or endoscopic surgery. The excellent effectiveness of both treatment modalities for local control, larynx preservation, and disease specific death is similar. Therefore, functional voice outcome after treatment is one of the most important factors in the choice of treatment for early glottic cancer. To assess the functional outcomes and compare the voice quality in patients with early glottic cancer treated with curative intent with radiotherapy or laser cordectomy, we performed literature review. Most studies showed that the voice quality after radiation therapy is slightly better than that after laser cordectomy. Subanalysis according to types of laser cordectomy, however, indicates that voice quality depends on type of laser cordectomy. Especially, type I or type II laser cordectomy might be superior to other types of laser cordectomy and radiation therapy. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer including professional voice users.

• Sleep Medicine and Psychophysiology
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• v.8 no.1
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• pp.5-10
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• 2001

The prevalence of insomnia and the degree of impairment due to insomnia is greater than in the of young. The cause for insomnia in the elderly are various factors among the elderly is known to be high including medical, psychiatric, drug issues, circadian rhythm changes, sleep disorders, and psychosocial. So the careful evaluation to find the cause of insomnia is needed for the eldery. Treatment options for insomnia include behavior modification and pharmacotherapy. Outcome data from previous studies indicate that behavioral approaches produce reliable and durable therapeutic benefits, as evidenced by improved sleep efficiency and continuity and enhanced satisfaction with sleep patterns. Treatment methods such as stimulus control and sleep restriction, which target maladaptive sleep habits, are especially beneficial for older insomniacs, whereas relaxation-based interventions aimed at decreasing arousal, produce more limited effects. Cognitive and educational interventions are instrumental in altering age-related dysfunctional beliefs and attitudes about sleep. The choice of hypnotics is based on matching the nature of the insomnia to the hypnotic agent. The ideal agent has rapid onset, duration of action that lasts through the night but no residual daytime effects, and no adverse effects. The key for the healthcare professional is finding the appropriate treatment or treatment combination, including behavioral modification and pharmacotherapy. When hypnotics are indicated, the most appropriate short-acting agent should be considered.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.3595-3604
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• 2015

Hepatocellular carcinoma (HCC) has been one of the most fatal malignant tumors worldwide and its associated morbidity and mortality remain of significant concern. Based on in-depth reviews of serological diagnosis of HCC, in addition to AFP, there are other biomarkers: Lens culinaris agglutinin-reactive AFP (AFP-L3), descarboxyprothrombin (DCP), tyrosine kinase with Ig and eprdermal growth factor (EGF) homology domains 2 (TIE2)-espressing monocytes (TEMs), glypican-3 (GPC3), Golgi protein 73 (GP73), interleukin-6 (IL-6), and squamous cell carcinoma antigen (SCCA) have been proposed as biomarkers for the early detection of HCC. The diagnosis of HCC is primarily based on noninvasive standard imaging methods, such as ultrasound (US), dynamic multiphasic multidetector-row CT (MDCT) and magnetic resonance imaging (MRI). Some experts advocate gadolinium diethyl-enetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and contrast-enhanced US as the promising imaging madalities of choice. With regard to recent advancements in tissue markers, many cuting-edge technologies using genome-wide DNA microarrays, qRT-PCR, and proteomic and inmunostaining studies have been implemented in an attempt to identify markers for early diagnosis of HCC. Only less than half of HCC patients at initial diagnosis are at an early stage treatable with curative options: local ablation, surgical resection, or liver transplant. Transarterial chemoembolization (TACE) is considered the standard of care with palliation for intermediate stage HCC. Recent innovative procedures using drug-eluting-beads and radioembolization using Yttrium-90 may exhibit beneficial effects in HCC treatment. During the past few years, several molecular targeted agents have been evaluated in clinical trials in advanced HCC. Sorafenib is currently the only approved systemic treatment for HCC. It has been approved for the therapy of asymptomatic HCC patients with well-preserved liver function who are not candidates for potentially curative treatments, such as surgical resection or liver transplantation. In the USA, Europe and particularly Japan, hepatitis C virus (HCV) related HCC accounts for most liver cancer, as compared with Asia-Pacific regions, where hepatitis B virus (HBV) may play a more important role in HCC development. HBV vaccination, while a vaccine is not yet available against HCV, has been recognized as a best primary prevention method for HBV-related HCC, although in patients already infected with HBV or HCV, secondary prevention with antiviral therapy is still a reasonable strategy. In addition to HBV and HCV, attention should be paid to other relevant HCC risk factors, including nonalcoholic fatty liver disease due to obesity and diabetes, heavy alcohol consumption, and prolonged aflatoxin exposure. Interestingly, coffee and vitamin K2 have been proven to provide protective effects against HCC. Regarding tertiary prevention of HCC recurrence after surgical resection, addition of antiviral treatment has proven to be a rational strategy.

• Journal of Korean society of Dental Hygiene
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• v.11 no.6
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• pp.901-911
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• 2011

Objectives : This study was conducted during the period from August 30 to September 9, 2011 in order to survey difference in the general perception of medical market opening and factors related to the choice of foreign hospitals among dental hygiene and nursing students at universities in Seoul. Methods : For this purpose, 438 students were surveyed using a questionnaire and collected data were analyzed using SPSSWIN 18.0. Conclusions drawn from this study are as follows. Results : 1. With regard to dental hygiene and nursing students' perception of medical market opening according to general characteristics, significant difference was not observed according to gender, experience in working at a hospital, medical institution used, and the frequency of using medical institutions, but significant difference was observed according to department, and interest in healthcare-related news. 2. There was significant difference in dental hygiene and nursing students'pro/con attitude toward medical market opening, but not in gender, experience in working at a hospital, medical institution used, and the frequency of using medical institutions. 3. With regard to intention to visit and revisit foreign hospitals, there was significant difference between dental hygiene and nursing students in intention to visit but not in intention to revisit. Conclusions : The results of this study suggest that more research on the medical market opening portion dental hygiene and nursing students' perception and attitude did not differ significantly, so the more accurate and open markets for a variety of medical education and school education and a variety of materials through hands-on experience be grasped should allow. Furthermore, students' acquisition of accurate prior knowledge about medical market opening is expected to be helpful to activate their employment in overseas.

• Korea Journal of Hospital Management
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• v.21 no.4
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• pp.13-22
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• 2016

목적: 이 연구는 당뇨와 고혈압 환자의 상급종합병원 이용에 미치는 요인을 관찰하였다. 방법: 이 연구는 한국보건사회연구원과 국민건강보험공단이 공동으로 조사하는 한국의료패널 자료를 사용하였다(2008년, 2010년, 2012년). 연구대상은 20세 이상 성인이었으며 각 2008년에 2409명, 2010년에 2424명, 2012년에 2429명을 관찰하였다. 당뇨와 고혈압에 대한 외래방문 건수는 총 64,438건이었으며 당뇨 또는 고혈압 환자의 3차 의료기관 선택에 영향을 주는 요인을 관찰하기 위해 다수준 로지스틱 회귀분석을 활용하였다. 결과: 교육수준이 높은 환자가 낮은 환자에 비해 상급종합병원을 이용할 확률이 각각 2008년에 2.04배, 2010년에 1.83배, 그리고 2012년에 1.65배 더 높았다. 또한 고소득 환자가 저소득 환자에 비해 3차 의료기관을 이용할 확률이 2008년에 1.77배, 2010년 1.91배 그리고 2012년 1.94배 더 높았다. 결론: 정책입안자들은 의료전달 시스템과 관련하여 정책을 실행할 때 이러한 환자의 특징을 고려할 필요가 있다.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.111-124
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• 2002

Purpose : Although the average life expectancy has increased due to advances in medicine, mortality due to cancer is on an increasing trend. Consequently, the number of terminally ill cancer patients is also on the rise. Predicting the survival period is an important issue in the treatment of terminally ill cancer patients since the choice of treatment would vary significantly by the patents, their families, and physicians according to the expected survival. Therefore, we investigated the prognostic factors for increased mortality risk in terminally ill cancer patients to help treat these patients by predicting the survival period. Methods : We investigated 31 clinical parameters in 157 terminally ill cancer patients admitted to in the Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital between July 1, 2000 and August 31, 2001. We confirmed the patients' survival as of October 31, 2001 based on medical records and personal data. The survival rates and median survival times were estimated by the Kaplan-Meier method and Log-rank test was used to compare the differences between the survival rates according to each clinical parameter. Cox's proportional hazard model was used to determine the most predictive subset from the prognostic factors among many clinical parameters which affect the risk of death. We predicted the mean, median, the first quartile value and third quartile value of the expected lifetimes by Weibull proportional hazard regression model. Results : Out of 157 patients, 79 were male (50.3%). The mean age was $65.1{\pm}13.0$ years in males and was $64.3{\pm}13.7$ years in females. The most prevalent cancer was gastric cancer (36 patients, 22.9%), followed by lung cancer (27, 17.2%), and cervical cancer (20, 12.7%). The survival time decreased with to the following factors; mental change, anorexia, hypotension, poor performance status, leukocytosis, neutrophilia, elevated serum creatinine level, hypoalbuminemia, hyperbilirubinemia, elevated SGPT, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), hyponatremia, and hyperkalemia. Among these factors, poor performance status, neutrophilia, prolonged PT and aPTT were significant prognostic factors of death risk in these patients according to the results of Cox's proportional hazard model. We predicted that the median life expectancy was 3.0 days when all of the above 4 factors were present, $5.7{\sim}8.2$ days when 3 of these 4 factors were present, $11.4{\sim}20.0$ days when 2 of the 4 were present, and $27.9{\sim}40.0$ when 1 of the 4 was present, and 77 days when none of these 4 factors were present. Conclusions : In terminally ill cancer patients, we found that the prognostic factors related to reduced survival time were poor performance status, neutrophilia, prolonged PT and prolonged am. The four prognostic factors enabled the prediction of life expectancy in terminally ill cancer patients.

• Annals of Clinical Neurophysiology
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• v.12 no.1
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• pp.3-6
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• 2010

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

• Korean Journal of Head & Neck Oncology
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• v.36 no.2
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• pp.1-7
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• 2020

Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC). Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary's Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups (23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; P=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; P=0.008) and bilaterality (HR, 11.477; P=0.022) as significant risk factors for DFS. Conclusion: Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.