• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.46-53
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• 2006

Background: Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) ${\geq}12mmHg$ or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) ${\leq}60mmHg$. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP ${\geq}20mmHg$ together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU. Methods: At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day. Results: A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was $15.1{\pm}8.5mmHg$. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004). Conclusion: In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.

• Journal of Hospice and Palliative Care
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• v.17 no.1
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• pp.27-33
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• 2014

Purpose: Although vitamin D deficiency is more commonly found in cancer patient than in non-cancer patients, there have been little data regarding the prevalence of vitamin D deficiency in cancer patients at the very end of life. We examined vitamin D deficiency in terminally ill cancer patients and related factors. Methods: This study was based on a retrospective chart review of 133 patients in a hospice ward. We collected data regarding age, sex, serum 25-hydroxyvitamin D level, cancer type, physical performance, current medications and various laboratory findings. We investigated factors related to serum vitamin D levels after multivariate adjustment for potential confounders. Serum 25-hydroxyvitamin D<20 ng/mL was considered deficient and <10 ng/mL severely deficient. Results: Ninety-five percent of the patients were serum vitamin D deficient. Severe vitamin D deficiency was more common in male patients, non-lung cancer patients, $H_2$ blocker users and non-anticonvulsant users. Elevated levels of serum alanine aminotransferase (ALT) were also associated with low serum vitamin D levels. Multiple regression analysis showed that severe vitamin D deficiency was associated with male gender (aOR 3.82, 95% CI: 1.50~9.72, P=0.005), $H_2$ blocker users (aOR 3.94, 95% CI: 1.61~9.65, P=0.003) and elevated serum ALT levels (aOR 4.52, 95% CI: 1.35~15.19, P=0.015). Conclusion: Vitamin D deficiency was highly prevalent among terminally ill cancer patients. Severe vitamin D deficiency was more common in male patients, $H_2$ blocker users, and patients with elevated ALT levels.

• The Korean Nurse
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• v.32 no.5
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• pp.66-77
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• 1994

The purpose of this study was to develop a new nursing unit which can meet changing health care needs, enhance patients' satisfaction and nurses' job satisfaction, and finally guarantee quality nursing care with present manpower. For this, one medical unit was selected as a unit for quality care. And one medical unit which is similar in staffing and patients' characteristics was selected as a control unit. To assess present problems and identify the remedies to the problems a hospital-wide survey and a workshop were performed. According to the survey results, educational programs and improvement of the facilities and equipment supply system, managereal support for interdepartmental cooperation and intensification of bed-side nursing care were adopted as main principles for operating model unit, This model unit was operated for 3 months from Sep. 1, 1992 to Nov. 30, 1992. To evaluate the effectiveness of the model unit, derect/indirect nursing care hours, patients' satisfaction to nursing care, nurses' job satisfaction, and quality care index were measured. Direct/indirect nursing care hours were compared with that of the control unit, and patients' and nurses' satisfaction and quality care index were measured before and after operating model unit and compared with each other. The results of the study were as follows; 1. In the model unit mean direct nursing care hours per cach shift was 146.88 minutes and indirect nursing care hours was 354.72 minutes. The ratio of the direct nursing care hour to indirect nursing hour was 29.6 ; 70.4 and that of the control unit was 26.9 : 73.1. Direct nursing care hour in model unit was longer than that of the control unit. But, the difference was not significant. In subcategories of direct nursing care, the time spent in mobility and exercise, conservation of body temperature, hygiene, and communication and health education were longer than that of the con" trol unit. 2. Indirect nursing care hour in model unit was shorter than that of the control unit. But, the difference was not significant. In subcategories of indirect nursing care, the time spent in drug management and ward arrangement was shorter than that of the control unit. 3. Patients' satisfaction to nursing care was increased significantly after operating the model unit (T=-3.48, P=-0.002) and satisfaction to subcategories of physical comfort measure, psychological cate, and unit management components were significantly higher than before. 4. In the model unit, nurses' total job satisfaction was increased significantly after operating the model unit(Z=2.1004, P=.0357) and satisfaction to subcategory of satisfaction to administration was significantly higher than before (Z=-2.0732, P=.0382). 5. After operating the model unit, quality care index was increased from 89 to 93. With this results, it can be summarized that all the measures tried for quality care, such as educational programs, managereal support for interdepartmental cooperation, and improvement of the equipment and facility provision resulted in partial increase in direct nursing care hours, nurses satisfaction to their job and patients' satisfaction to nursing care. In can be postulated that managereal support and motivation without proper staff supplementation is not enough for increasing direct nursing care hours. And for the enhancement of the level in clinical nursing, and staff supplement must be considered sincerely and the measures for reducing indirect nursing care hours, such as computerization of nursing care activities, improvement of facilities and equipment and facilities supply system, must be instituted in addition.

• 한국호스피스완화의료학회:학술대회논문집
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• 2004.07a
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• pp.100-102
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• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.170-178
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• 2014

Purpose: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. Methods: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. Results: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE < 24), depression ($BDI{\geq}16$), and insomnia ($ISI{\geq}15$) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. Conclusion: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

• Pediatric Infection and Vaccine
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• v.22 no.2
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• pp.63-68
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• 2015

Purpose: This study analyzed a small outbreak of measles at a single hospital located in northern Gyeonggi-do in 2013. Methods: We reviewed the medical records of measles patients at The Catholic University of Korea Uijeongbu St. Mary's Hospital from August to October, 2013. Results: Fifteen children were confirmed to have measles by RT-PCR and serum IgM test; 1 neonate, 11 infants, and 3 toddlers. None of the patients had received Measles-Mumps-Rubella vaccination. All patients showed B3 type in viral genotyping. Nine children (60%) had been exposed to measles during treatment for other diseases in the pediatric ward. Incubation period was between 8 and 15 days. Fever started at a median 10 days after exposure and persisted for a median of 8 days. Rash showed at a median 13 days after exposure. Respiratory complications were observed in 40% of patients. Diarrhea developed in 53% of patients. Conclusion: Although measles has been well-controlled due to the high rate of vaccination coverage, it is possible to have an outbreak at any given time, especially in infants. We must learn from this outbreak, and remain fully aware of the possibility of reemergence and provide proper management, including vaccination or immune globulin administration, to infants exposed to measles. Reevaluation of serum IgG titer of neonates, infants, and pregnant women may be the first step to prevent further outbreaks.

• Clinical and Experimental Pediatrics
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• v.49 no.4
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• pp.394-400
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• 2006

Purpose : This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. Methods : The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. Results : In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. Conclusion : Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.537-545
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• 1994

Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.26-33
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• 2006

Background: Noninvasive positive pressure ventilation(NPPV) has been increasingly used over the past decade in the management of acute or chronic respiratory failure and weaning of mechanical ventilation. We performed this clinical study to evaluate the usefulness of NPPV in patients who developed acute respiratory failure or post-extubation respiratory failure. Methods: We analysed thirty four patients(sixteen males and eighteen females, mean ages 58 years) who applied NPPV(BIPAP S/T, Respironics co., USA) for respiratory failure or weaning difficulty at medical intensive care unit(MICU), emergency room and general ward of a tertiary hospital. We evaluated the underlying causes of respiratory failure, duration of treatment, the degree of adaptation, complication and predictive parameters of successful outcome. Results: The overall success rate of NPPV was seventy-one percent. The duration of NPPV applying time, baseline blood pressure, pulse rate, respiration rate, $PaO_2$, $PaCO_2$, $SaO_2$ were not different between success group and failure group. But, the baseline pH was higher in the success group. Predictors of success were higher baseline pH, patients with underlying disease of COPD, improvement of vital sign and arterial blood gas value after NPPV application. The success rate in patients with post-extubation respiratory failure was eighty percent. There were no serious complication on applying NPPV except minor complications such as facial skin erythema, abdominal distension & dry mouth. Conclusion: NPPV may be effective treatment in patients with acute respiratory failure or post-extubation respiratory failure in selected cases.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.2
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• pp.97-100
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• 2018

Purpose The glomerular filtration rate (GFR) test is an important indicator of glomerular filtration and has been used to test renal function and the extent of its function. The GFR test is performed by intravenous injection of radioactive medicines made of $^{51}Cr$-EDTA, and blood concentration is measured by taking blood according to the elapsed time. also, PET-CT, bone scan, transfusion and so on will affect the outcome. Therefore, we will improve the quality of the test by providing guidelines for the GFR test for more accurate testing. Materials and Methods 5 mL of physiological saline solution and 2 mL of $^{51}Cr$-EDTA solution are used to make 5 mL of the radiopharmaceutical solution to be injected into the patient. First, the syringe weight is measured before the injection, and then the radioactive medicine is injected into the patient's vein and the syringe weight is measured after the injection. Blood sampling is performed twice in total. In adults, blood is collected 3 hours / 5 hours after injection and in children 2 hours / 5 hours after injection. The blood sample is centrifuged at 3300 rpm for 5 minutes. Standard solution is prepared by filling diluent water up to the scale indicated in the 200-mL volumetric flask, discarding $500{\mu}L$, injecting $500{\mu}L$ of GFR reagent and mixing well. $500{\mu}L$ each of the standard solution is dispensed into two test tubes, and $500{\mu}L$ of each of the plasma samples collected in time is dispensed into two test tubes and measured with a Cobra Counter. Results At present, the reference range applied in this study is $119.5{\pm}30.3ml/min/1.73m2$ for males and $125.2{\pm}28.2ml/min/1.73m^2$ for females. Conclusion The GFR test is conducted using radioactive medical products. GFR testing is performed as a scheduled test, but PET-CT, dialysis and transfusion, which may affect GFR testing, may be scheduled during GFR testing. Therefore, we could get accurate GFR test results by notifying the ward and department beforehand when booking.