• Title/Summary/Keyword: IS Audit

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The Use of Analgesics in the Last 24 hours of Life of Patients with Advanced Cancer : A Comparison of Medical Physicians and Surgeons (말기 암 환자의 마지막 24시간 동안 진통제 사용의 분석 : 내과의사와 외과의사의 비교)

  • Choi, Youn-Seon;Kim, Jong-Min;Lee, Young-Mee;Lim, Jong-Kuk;Lee, Tai-Ho;Hong, Myung-Ho
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.47-55
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    • 1998
  • Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

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Hydroponic Nutrient Solution and Light Quality Influence on Lettuce (Lactuca sativa L.) Growth from the Artificial Light Type of Plant Factory System (인공광 식물공장에서 수경배양액 및 광질 조절이 상추 실생묘 생장에 미치는 영향)

  • Heo, Jeong-Wook;Park, Kyeong-Hun;Hong, Seung-Gil;Lee, Jae-Su;Baek, Jeong-Hyun
    • Korean Journal of Environmental Agriculture
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    • v.38 no.4
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    • pp.225-236
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    • 2019
  • BACKGROUND: Hydroponics is one of the methods for evaluating plant production using the inorganic nutrient solutions, which is applied under the artificial light conditions of plant factory system. However, the application of the conventional inorganic nutrients for hydroponics caused several environmental problems: waste from culture mediums and high nitrate concentration in plants. Organic nutrients are generally irrigated as a supplementary fertilizer for plant growth promotion under field or greenhouse conditions. Hydroponic culture using organic nutrients derived from the agricultural by-products such as dumped stems, leaves or immature fruits is rarely considered in plant factory system. Effect of organic or conventional inorganic nutrient solutions on the growth and nutrient absorption pattern of green and red leaf lettuces was investigated in this experiment under fluorescent lamps (FL) and mixture Light-Emitting Diodes (LEDs). METHODS AND RESULTS: Single solution of tomatoes (TJ) and kales (K) deriving from agricultural by-products including leaves or stems and its mixed solution (mixture ration 1:1) with conventional inorganic Yamazaki (Y) were supplied for hydroponics under the plant factory system. The Yamazaki solution was considered as a control. 'Jeockchima' and 'Cheongchima' lettuce seedlings (Lactuca sativa L.) were used as plant materials. The seedlings which developed 2~3 true leaves were grown under the light qualities of FL and mixed LED lights of blue plus red plus white of 1:2:1 mixture in energy ratio for 35 days. Light intensity of the light sources was controlled at 180 μmol/㎡/s on the culture bed. The single and mixture nutrient solutions of organic and/or inorganic components which controlled at 1.5 dS/m EC and 5.8 pH were regularly irrigated by the deep flow technique (DFT) system on the culture gutters. Number of unfolded leaves of the seedlings grown under the single or mixed nutrient solutions were significantly increased compared to the conventional Y treatment. Leaf extension of 'Jeockchima' under the mixture LED radiation condition was not affected by Y and YK or YTJ mixture treatments. SPAD value in 'Jeockchima' leaves exposed by FL under the YK mixture medium was approximately 45 % higher than under conventional Y treatment. Otherwise, the maximum SPAD value in the leaves of 'Cheongchima' seedlings was shown in YK treatment under the mixture LED lights. NO3-N contents in Y treatment treated with inorganic nutrient at the end of the experiment were up to 75% declined rather than increased over 60 % in the K and TJ organic treatment. CONCLUSION: Growth of the seedlings was affected by the mixture treatments of the organic and inorganic solutions, although similar or lower dry weight was recorded than in the inorganic treatment Y under the plant factory system. Treatment Y containing the highest NO3-N content among the considered nutrients influenced growth increment of the seedlings comparing to the other nutrients. However effect of the higher NO3-N content in the seedling growth was different according to the light qualities considered in the experiment as shown in leaf expansion, pigmentation or dry weight promotion under the single or mixed nutrients.