• Title/Summary/Keyword: Long-term compliance

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Acceptability of Low Intensity Anticoagulation Therapy after Mechanical Heart Valve Replacement (기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구)

  • Kim, Jong-Woo;Rhie, Sang-Ho;Kim, Young-Chun;Yang, Jun-Ho;Jang, In-Seok;Choi, Jun-Young
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.193-200
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    • 2009
  • Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy.

Long-term Oxygen Therapy for Chronic Respiratory Insufficiency: the Situation in Korea after the Health Insurance Coverage: a Multi-center Korean Survey -Study for the Development and Dissemination of the COPD Guidelines, Clinical Research Center for Chronic Obstructive Airway Disease- (가정산소치료의 보험급여 실시 이후 처방 실태: 다기관 조사 -만성기도폐쇄성질환 임상연구센터 제3세부과제 만성기도폐쇄성질환 진료지침 개발/보급 연구-)

  • Park, Myung Jae;Yoo, Jee-Hong;Choi, Cheon Woong;Kim, Young Kyoon;Yoon, Hyoung-Kyu;Kang, Kyung Ho;Lee, Sung Yong;Choi, Hye Sook;Lee, Kwan Ho;Lee, Jin Hwa;Lim, Sung-Chul;Kim, Yu-Il;Shin, Dong Ho;Kim, Tae Hyun;Jung, Ki-Suck;Park, Yong Bum
    • Tuberculosis and Respiratory Diseases
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    • v.67 no.2
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    • pp.88-94
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    • 2009
  • Background: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. Methods: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. Results: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3${\pm}$13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56${\pm}$0.68 L/min at rest, 2.08${\pm}$0.91 L/min during exercise or 1.51${\pm}$0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18${\pm}$10.48% and 91.64${\pm}$7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85${\pm}$6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414${\pm}$15,618 won/month and 40,352${\pm}$36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). Conclusion: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

A Study on the Physiological and Psychological Factors related to Successful Weaning from a Mechanical Ventilator (기계환기기 이탈의 성공과 관련된 생리적${\cdot}$심리적 요인에 관한 조사 연구)

  • Kim, Cho-Ja;Kim, Hwa-Soon;Jang, Yeon-Soo;Kim, Eun-Sung
    • Journal of Korean Academy of Nursing
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    • v.30 no.4
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    • pp.995-1005
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    • 2000
  • This study was performed to identify the physiological and psychological variables related to successful weaning from a mechanical ventilator. The subjects of this study were 22 patients who received mechanical ventilation therapy for more than 3 days in intensive care units. Before the weaning trial, baseline data for following physiologic variables were obtained: spontaneous respiration rate, blood pressure, pulse rate, PaO2, PaCO2, PEEP, static compliance, minute ventilation, tidal volume, rapid shallow breathing index(f/VT), SaO2, PaO2/FiO2 and mean arterial pressure. During spontaneous breathing, physiologic and psychologic variables such as vital signs, ABG, perspiration, chest retraction, paradoxical respiration, dyspnea, anxiety, confidence and efficacy were measured. Successful weaning was defined as sustaining spontaneous respiration over 24 hours after extubation. Weaning failure was defined as the development of more than one of following signs: (1) hypoxemia, (2) CO2 retention or (3) perspiration, tachypnea, chest retraction, tachycardia, arrhythmia, hypotension or hypertension. Subjects (N=18) who successfully weaned from mechanical ventilator were compared with subjects (N=4) who failed. The results are as follows; Eighteen percents of the subjects failed during the weaning trial. Most subjects in the failed group were mechanically ventilated for long-time. This result shows that the success of weaning is more difficult in long-term ventilation patients. In the baseline data that was measured before weaning trial, the mean score of PaO2 in the successfully weaned group was 121mmHg. This is significantly higher than the mean score of PaO2 in the failed group(95mmHg). However, the scores of pH, tidal volume, f/VT, pulse rates, blood pressure, mean airway pressure, SaO2, and PaCO2 were similar between the two groups. Specially the scores of f/VT index as a predominant predictor for successful weaning were not significant (f/VT=44.4) and (f/VT=47). During spontaneous breathing, the scores of dyspnea and anxiety level in the successfully weaned group were less than those of the failed group. On the contrary, the scores of confidence and efficacy in the successful group were greater than those of the failed group. In conclusion, the baseline data that were measured before weaning trial were similar between the both groups, therefore future studies are needed to focus on searching other variables besides physiological parameters related to weaning outcome.

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Influence of CSR Activities on Corporate Reputation Depending on Brand Equity (기업의 브랜드자산에 따른 CSR활동이 기업평판에 미치는 영향)

  • Yoon, Ki-chang
    • Journal of Venture Innovation
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    • v.1 no.2
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    • pp.13-34
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    • 2018
  • In this case, research has been conducted to verify that the purpose of establishing a reputation for establishing a reputation for identifying brand equity is research and investigation in the context of establishing a reputation for establishing a reputation, and conducting research on CSR activities that are essential to the essential activities of companies. The survey conducted a survey on behalf of the National Center for Adult Women and Girls and Girls ' Generation, using the final round of Section 305 to develop a series of findings, including the analysis of the feasibility analysis, feasibility analysis, reliability, correlation analysis, and factors analysis. A summary of the effects of research on corporate reputation on corporate reputation according to corporate CSR activities is as follows. 1st. Brand equity will have a positive effect on the Company's reputation. The hypothesis had a significant impact on brand recognition, brand loyalty, and perceived quality, but did not have significant impact on the brand image. 2st. Brand equity will have a positive effect on ethical responsibility. The hypothesis had a significant impact on brand recognition, brand loyalty, and perceived quality, but did not have significant impact on the brand image. 3st, the brand equity will have a positive effect on the benefit of the benevolent. The hypothesis had a significant impact on brand recognition, brand loyalty, and perceived quality, but did not have significant impact on the brand image. 4st, The theory that the influence of positive(+) will affect the company's reputation has a significant impact on both ethical and philanthropic factors. 5st. The ethical responsibility was found to have no effect on the usefulness of the brand between brand assets and corporate reputation. 6st. The philanthropic responsibility was partly attributable to the fact that there was a substitution between brand equity and corporate reputation. In sum, the company needs to prioritize its brand recognition before establishing its reputation, and the reason why it should be implemented is that the other elements of the brand equity should be evaluated with the presence of other elements of the brand equity, thereby ensuring continued compliance with continuous CSR activities. As a result, consumers expect to see the performance-based role of the company as a strategic and long-term perspective, as consumers want to see the CSR activity and the corporate reputation in a long-term manner, as opposed to the financial responsibility and legal responsibilities of the past, as opposed to the past.

The Effect of Steroid Therapy in Patients with Late ARDS (후기 급성호흡곤란증후군환자에서 스테로이드의 사용 효과)

  • Huh, Jin Won;Lim, Chae-Man;Jegal, Yang-Jin;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Koh, Youn Suck
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.4
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    • pp.376-384
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    • 2002
  • Background : The mortality from acute respiratory distress syndrome(ARDS) in the late stage, which is characterized by progressive pulmonary fibroproliferation, is ${\geq}80%$. Although previous prospective trials failed to show a survival benefit of steroid therapy in early ARDS, recently, a few of reports have described the survival benefit of the long-term use of steroid in patients with late ARDS. In this study, we analyzed the effect of steroid therapy on patients with late ARDS retrospectively in a single. Medral intensive care unit (MICU). Methods : Over a 3-year period, the medical records of 48 ARDS patients who had been on mechanical ventilation more than 8 days were reviewed. 14 patients were treated by the long-term use of methylprednisolone and another 34 patients served as a control. Both groups were comparable regarding clinical and physiologic data lung injury score(LIS), multiple organ failure score, APACHE III and SAPS II score. Because steroid was instituted after 8 days of advanced mechanical ventilatory support in average, we arbitrarily defined the $8^{th}$ day of ARDS as first day of the study. Results : Initially, the groups had similar PF($PaO_2/FiO_2$) ratio, LIS, APACHE III and SAPS II score. By 7th day after the start of steroid therapy, there were significant improvements in PF ratio, LIS, APACHE III and SAPS II score. The mortality in the steroid treated group was significantly lower(42.9% vs 73.5%, p<0.05). Conclusion : Although the data of this study was retrospective and was not randomized, in order to improve the patient's outcomes, steroid therapy should be considered in late ARDS patients. However, prospective trials are needed to define the indication and the effect of steroid therapy in late ARDS.

Estimating the Compliance Cost of the Power and Energy Sector in Korea during the First Phase of the Emissions Trading Scheme (발전·에너지업종의 배출권거래제 제1차 계획기간 배출권 구입비용 추정과 전력시장 반응)

  • Lee, Sanglim;Lee, Jiwoong;Lee, Yoon
    • Environmental and Resource Economics Review
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    • v.25 no.3
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    • pp.377-401
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    • 2016
  • This study analyzes how much cost the power generation and energy sector in South Korea have to bear due to the introduction of emissions trading scheme during 2016 - 2017. To this end, the data on the seventh basic plan for long-term electricity supply and demand is applied to the electricity market simulation model called M-Core, and then the model forecasts carbon dioxide emissions to compare with the free emission allowances in the first national emissions permit allocation plan. The main results are as follows. Carbon dioxide emissions are estimated to be less in 2016 but more than the free emission allowances in 2017. When the price of the allowances is changed from \10,000/ton to \20,000/ton, the cost of purchasing the allowances is ranged from \70 billion to \140 billion. Under the assumption that CO2 cost is incorporated into the variable cost, a reversal of merit order between coal and LNG generation takes place when the price of the allowances exceeds \80,000/ton.

A Trend in Acquired Drug Resistances of Tuberculosis Patients Registered in Health Centers from 1981 to 2004 (1981년부터 2004년까지 보건소 재치료 결핵 환자의 항결핵제 내성률 추이)

  • Chang, Chulhun L.;Lee, Eun Yup;Park, Soon Kew;Jeong, Seok Hoon;Park, Young Kil;Choi, Yong Woon;Kim, Hee Jin;Lew, Woo Jin;Bai, Gill-Han
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.619-624
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    • 2005
  • Background : The drug resistance rate in tuberculosis patients with history of chemotherapy is an important indicator of for evaluation of appropriateness of treatment regimens and compliance of patients. This study examined the long-term changes in the drug resistance rates among TB patients failed in treatment or reactivated. Methods : The results of drug susceptibility testing data from patients registered in health centers from 1981 to 2004 were analyzed. Results : The rate of resistance to isoniazid decreased from 90% to 20%, and the resistance to ethambutol decreased from 45% to 6%. The rate of resistance to rifampicin varied from 13% to 28% and the resistance to pyrazinamide was 5% to 10%. Multidrug resistance was about 2-3% lower than any rifampicin resistance rates. The second-line drug resistance was ranged from 1% to 3%. There was no difference between patients' genders. Patient numbers per 100,000 population increased with age. The regional distribution was even at 4-6 patients per 100,000 population, and drug resistance rates were significantly lower in big city areas than in small towns and rural areas. Conclusion : The rates of resistance of Mycobacterium tuberculosis isolated from TB patients with history of chemotherapy to isoniazid, rifampin, ethambutol, and isoniazid plus rifampin were significantly decreased during over two decades.

5 YEARS EVALUATION OF COMPOSITE RESIN RESTORATION ON PERMANENT FIRST MOLAR IN CHILDREN (어린이 제 1 대구치 복합 레진 수복물의 5년 후 임상평가)

  • Kim, In-Young;Kim, Jae-Moon;Jeong, Tae-Sung;Kim, Shin
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.1
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    • pp.110-117
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    • 2008
  • Clinical performance of resin-based composite material depends on case selection and on the proficiency of the operator. Especially, composite resin restoration on permanent first molar in children have more limitations clinically than adult patients according to stage of tooth eruption and patient's compliance. This study was designed to evaluate the clinical performance of posterior composite resin restoration in children after 5 years. 35 teeth of 16 patients who were received composite resin restoration on permanent first molar in Department of Pediatric dentistry, Pusan National University Hospital between January 2001 and December 2001 were evaluated based on Modified USPHS criteria. From the finding in this study, following conclusions can be made. 1. 6 teeth(17%) of 35 teeth was replaced, so 5-years survival rate of posterior composite resin restoration is 82.9%. 2. As results of each evaluation criteria, on color match, anatomic form, surface roughness, sensitivity/ discomfort, ideal A grade score was 86.2%, 93.1%, 86.2%, 86.2%, clinically accepted B grade score was 13.8%, 0%, 13.8%, 10.3%. On marginal adaptation and marginal discoloration, A grade score was 13.8%, 44.8% and B grade score was 79.3%, 34.5% and secondary caries rate was 20.7%. 3. 69.1% of teeth (20 teeth) was clinically accepted on all evaluation criteria.

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The Effect of Yu-Dong-Kong on Physical Function and Emotional State in Elderly (유동공 체조가 노인의 신체기능과 정서상태에 미치는 효과)

  • Yoo Ji-Soo;Han Shin-Hee
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.6 no.3
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    • pp.507-521
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    • 1999
  • Yu-Dong-Kong exercise is to produce heat from rubbing hands and is composed of 10 different types of exercise using warmed hands. The objective of this research is to evaluate the effect of Yu-Dong-Kong exercise on physical function and emotional state in elderly. The design of research is Nonequivalent Control Group Pretest-Posttest Design. The independent variable is Yu-Dong-Kong exercise, and the dependent variables are physical function and emotional state. Subjects are 18 elderly in the experimental group and 16 elderly in control group. All of them are above 60 year old and live in 1-city, Kyonggi-do. The exercise period was 4 weeks and data were collected from April to August in 1998. The exercise frequency was once a day. The exercise duration was from 10 to 20 minutes. The measurement tools are modified 1) Cornell Medical Index-Health questionnaire and 2) Geriatric Depression Scale. Collected data were analyzed by t-test and paired t-test based on the purposes of research using SPSS-Window package. The results are summarized as follows : 1. There was no difference in pre-exercise physical function between two groups (t=-.95, p=.35). 2. The hypothesis that 'physical function in the experimental group will be improved compared to the control group' was not supported by t-test(t=-.925, p=.362). However. the physical function in the experimental group showed much improvement than that in the control group. 3. The hypothesis that 'emotional state in the experimental group will be improved compared to the control group' was not supported by t-test(t=-1.715, p=.096). However, the emotional state in the experimental group showed much improvement than that in the control group. 4. The hypothesis that 'physical function will be improved in the post-exercise compared to pre-exercise' was not supported by paired t-test(t=.302, p=.766) However, a slight improvement in the physical function was found. For the further study, it is recommended to reevaluate the effect of Yu-Dong-Kong exercise through large number of subjects and long-term study. Also, a separate study with different type of subjects is recommended. In addition, continuation and compliance this strategy for exercise should be developed.

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A Fundamental Study on Backfilling and Monitoring System for Stability of Underground Mine Openings (채굴공동의 안정성 유지를 위한 채움재의 충전과 계측시스템 구축에 관한 기초연구요)

  • Kim, Byung-Ryeol;Lee, Seung-Joong;Choi, Sung-Oong
    • Tunnel and Underground Space
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    • v.29 no.6
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    • pp.407-424
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    • 2019
  • To prevent possible accidents by surface subsidence, backfilling operation is known to be one of the most effective methods for ensuring the long-term ground stability because it can eliminate fundamentally the origin of underground mine opening collapse. Also, for effective backfilling of underground mine opening, it is necessary to keep monitoring of backfilled mine opening for analyzing several factors such as filling effect with change of backfill material and characteristics of backfill material. Therefore, in this study, a monitoring system which consists of measuring device and software program has developed to examine the performance of backfilling operation and verify to field applicability to underground mine. Sensors for measuring device have been selected through study of recent research papers and mock-up test has been performed to verify the system compliance. Also, monitoring result of the mock-up test compared to case studies in some countries. From monitoring result fo the mock-up test compared to case studies in some countries, consequently, it was concluded that the developed real-time monitoring system had ensured filed applicability in the underground mine.