• Journal of Korean Academy of Nursing
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• v.29 no.1
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• pp.61-71
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• 1999

Sleep is a necessity for survival. Disruption of sleep leads to numerous adverse physiological and psychological consequences. These could be particularly undesirable for older patients, who are subject to many additional factors. But there is limited research related to hospitalized elderly in Korea. The purpose of the study is to explore sleep patterns and disturbing factors of before and after hospitalization, in order to present basic information regarding elderly sleep to develop nursing intervention. The sample consisted of 32 elderly men and women between the ages of n and 87 years. Data collection was done from September to November 1997. Measures of sleep patterns and related factors were obtained from self-reported sleep questionnaires. Analysis of data was done by use of t-test, paired t-test, ANOVA, and Pearson Correlation Coefficient. The results of this study were summarized as follows : 1. In comparision between before and after admission of their sleep pattern, “sleep onset” tends to be delayed and nocturnal sleep time was significantly reduced. So, hospitalized elderly reported less total sleep time than before admission. 2. Regarding the sleep disturbing factors, medication(hypnotics ; 37.5%), physiological factor (snoring ; 59.4%) environmental factor (pillow ; 78.1%), emotional factor(anxiety related to disease ; 37.5%), and illness factor(fatigue ; 34.7%) were reported. 3. Significant differences in gender were found. Men had more disturbances in sleep than women owing to difficulty in falling a sleep and lack of nocturnal sleep. Women consumed more sleep inducing drugs. Significant increase was reported in napping during the day with increasing age. 4. Significant differences between good sleepers and poor sleepers were found for the following variables : nocturnal sleep time, total sleep time, bed time, sleep onset latency time, sleep latency time after nocturnal awakening, time spent in bed upon arousal, environmental factors, and emotional factors. In conclusion, it was found that the quantity and quality of sleep were significantly altered in hospitalized elderly, but adequate strategies for better sleep were not practiced. Further research is needed to develop Intervention strategies to promote sleep and to prevent sleep problems.

• Sleep Medicine and Psychophysiology
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• v.4 no.1
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• pp.77-88
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• 1997

The purpose of this study was to investigate the prevalence, primary causes, and management of insomnia newly admitted patients in a university hospital. Subjects consisted of 168 adult patients (95 men and 73 women, 88 medical and 94 surgical patients) newly admitted to Gyeongsang National University Hospital from September 7 through September 27, 1996. Sleep patterns of all subjects in the usual nights before admission(UN), the previous night to admission(PN), the night on admission(ON), and the 5th night after admission(5N) were investigated using the Korean version of the St. Mary's Hospital Sleep Questionaire. In addition, all insomnia patients and their doctors and nurses in charge were interviewed by psychiatric residents. Additionally, their medical records were reviewed. Prevalence of insomnia were 22.6% in the UN, 42.9% in PN, 51.8% in ON, and 43.5% in 5N. The prevalence of insomnia was significantly increased immediately before and after admission. There were no significant differences in the prevalence of insomnia by age and sex. The most ammon primary causes of insomnia were somatic symptoms and psychological factors in PN, somatic symptoms and noise in ON and 5n. Only 17 (10.1%) of insomnia patients took medicstions for insomnia control(analgesics in 15, hypnotics in 2). These results shorred that the prevalence of insomnia was significantly increased on hospitalization due to somatic symptoms, environmental factors, and psychological factors, but nearly none were adequately managed.

• YAKHAK HOEJI
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• v.59 no.5
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• pp.230-234
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• 2015

This paper includes a review of 555 drug-facilitated sexual assault (DFSA) cases analyzed at the National Forensic Service (NFS), South Korea, between 2006 and 2012. The results of toxicological analyses of blood and urine samples were also reported, and furthermore the results were interpreted with respect to the number of drugs detected. The number of DFSA cases was highest during warmer summer months and the mean age of the victims was 25 years, with 48% being between 20 and 29 years. Accommodations or entertainment places were the most frequent place of the sexual assault (57%); and the assailant was a stranger in 72% of the DFSA cases. Drugs were identified in the blood or urine samples in 145 cases (26%) and sedative-hypnotics, such as benzodiazepines and zolpidem, were the most commonly detected, along with sedative antihistamines such as doxylamine and diphenhydramine. The frequent presence of sedative drugs in biological samples tends to implicate their use in chemical submission. However, interpreting the analytical results in terms of voluntary vs. surreptitious administration of drugs requires further detailed investigation and knowledge of the victim's health status and medication used at the time of event.

• Journal of Preventive Medicine and Public Health
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• v.45 no.4
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• pp.219-226
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• 2012

Objectives: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. Results: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. Conclusions: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.2
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• pp.51-60
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• 2010

Purpose: The aim of this study was to investigate toxic exposures in emergency centers with using a toxic exposure surveillance system-based report form as a preliminary study. Methods: We retrospectively reviewed the medical records of toxic exposure patients who visited emergency centers from January to December 2008. Results: 3,157 patients from 11 emergency centers were enrolled. Males were involved in 47.9% of the total cases of exposure and in 60.1% of the cases of fatal exposure. Suicidal intent was the most common (61.0%) reason and most (87.4%) fatal exposures were suicidal. Pesticides were involved in 30.7% of the cases and sedative/hypnotics/antipsychotics were involved in 20.5%. The substances most frequently involved in fatalities were pesticides, and a 48.4% fatality rate was recorded for paraquat exposure. Conclusion: The toxic exposure data showed the preliminary poisoning events in emergency centers. It is recommended that toxicology professionals should develop a toxic surveillance system and serial reporting should be performed.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.2
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• pp.91-98
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• 2008

Purpose: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. Methods: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. Results: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: $0.2{\sim}7.4\;mg/L$). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. Conclusion: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.304-314
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• 2021

Background: The study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic. Methods: In this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients' satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed. Results: Procedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients' satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study. Conclusions: VR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.30-36
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• 2023

Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.28 no.2
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• pp.132-140
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• 2017

Objectives: Very early-onset schizophrenia (VEOS) is a type of psychosis having a low frequency, insidious onset, and devastating clinical outcome. In this study, the demographic features, information on medication, clinical outcomes, and intellectual capability of patients diagnosed with VEOS in a hospital were analyzed to provide therapeutic strategies for this type of schizophrenia. Methods: Using the electronic medical records of the National Center for Mental Health, 69 patients with VEOS were identified based on the DSM-5 criteria of schizophrenia. The data were summarized and analyzed according to the demographic characteristics, medications used, intellectual strength measured by the full intelligence quotient (FIQ) score, and current clinical status measured by the Clinical Global Impression-Severity (CGI-S) and various combinations of these parameters. Results: The screened study group contained similar numbers of males and females. The younger the onset of psychosis, the lower the frequency. The study population included a significantly higher proportion of births in the winter season than that of the general population. The 3 most frequently used antipsychotic medications were risperidone and its derivatives, clozapine and olanzapine. Valproic acid and divalproex sodium were the most commonly added drugs for outcome augmentation. 53.5% of the study population had received benzodiazepines and/or hypnotics. The average FIQ of the study population was 69.4, which is quite low compared to previous Korean studies with similar populations. There was a weak negative correlation between FIQ and CGI-S, but it was not statistically significant. The average CGI-S score was 4.2, which meant that the patients were moderately ill. Conclusion: This study demonstrated that patients with VEOS showed more frequent intellectual deficits at baseline and poorer outcomes than the control group. Risperidone, clozapine, valproic acid and their combinations were the most preferred medications for the treatment of psychosis. Benzodiazepines were quite commonly added for various reasons.

• Journal of Oriental Neuropsychiatry
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• v.20 no.3
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• pp.89-119
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• 2009

Objectives : This study was to investigate the association of Pittsburgh Sleep Quality Index(PSQI), Insomnia Questionaire(IQ), Beck Depression Inventory(BDI) and Diagnos system of oriental medicine(DSOM) in the Insomnia Patients. Methods : For this study, we carried out PSQI, IQ, BDI and DSOM of 37 patients with insomnia who have come to Donguei oriental hospital of Donguei university from November 2008 to May 2009. And Using cross tabulation analysis, verified the association of PSQI, IQ, BDI and DSOM. Results : 1. The most Frequent Pathogenic Factor is blood-deficiency(血虛) in total patients. 2. The score of BDI has positive correlation with sc10 of deficiency of qi(氣虛), damp(濕), kdney(腎) in total patients. 3. The score of PSQI has positive correlation with zp of liver(肝) in total patients. 4. The score of PSQI has positive correlation with sc10 and zp of insufficiency of Yin(陰虛), and the score of BDI has positive correlation with sc10 of blood stasis(血瘀) and zp of liver(肝) in female patients. 5. The score of PSQI has positive correlation with sc10 of deficiency of qi(氣虛) and zp of heart(心), and the score of IQ has positive correlation with sc10 of liver(肝) in male patients. 6. The duration from onset in the group of 22-59years are longer than the group of 60-80 years and the duration of using hypnotics have positive correlation with total sleep time in 22-59years group. 7. The score of PSQI has positive correlation with zp of liver(肝) in 22-59years group. 8. The score of PSQI has positive correlation with the score of BDI in 60-80years group. 9. The score of BDI has positive correlation with sc10 of deficiency of qi(氣虛) and zp of blood-deficiency(血虛), and the score of IQ has positive correlation with zp of coldness(寒) in 60-80years group. 10. The score of IQ has positive correlation with sc10 and zp of dryness(燥) in below 6 Months Group. 11. The score of PSQI has positive correlation with the score of BDI in over 6 Months Group. 12. The score of PSQI has positive correlation with zp of liver(肝) in over 6 Months Group. 13. The score of IQ has positive correlation with sc10 of dryness(燥) in BDI 2nd Grade Group. 14. The score of BDI has positive correlation with sc10 of kidney(腎) and the age has positive correlation with zp of heart(心) in BDI 3rd Grade Group. 15. The age has positive correlation with sc10 of damp(濕) in BDI 4th Grade Group. Conclusions : This study provides insights into the complicated associations of the pattern of insomnia with depression and Diagnos system of oriental medicine. And especially this study showed apparent correlation between insomnia and depression in 60-80years group and over 6 months group.