• 가정간호학회지
• /
• 제16권1호
• /
• pp.49-58
• /
• 2009

Purpose: This study aimed to clarify the needs for hospital-based home care nursing medical services in elder care institutions by analyzing the details and frequency of medical services provided by, and the needs for, hospital based home care nursing in select institutions in Korea. Methods: Seventy-seven staffs at elderly care institutions located throughout the country completed self-report questionnaires between February 1 and May 31, 2009. SPSS ver. 14.0 was used for data analysis regarding frequency and percentage, mean and standard deviation. Results: Forty-eight hospital-based home care nursing medical services in eight domains were identified as being needed in elderly care institutions. The most commonly used medical services were providing instruction in oral drug administration, checking drug beneficial/adverse effects, and administering blood glucose test, while the most needed medical services requiring hospital based home care nursing were complex pressure ulcer care, followed by diabetic foot ulcer management and nutrient injection. Conclusion: The present results should provide fundamental data for better healthcare services with hospital based home care nursing at elderly care institutions as part of a 'win-win' strategy through which medical expenses are reduced, insurance costs are kept stable, and safe and high-quality medical services are provided for residents of elder care institutions. Political decisions intended to promote visits by hospital based home care nurses to elder care institutions would be a prudent course.

• Tuberculosis and Respiratory Diseases
• /
• 제82권3호
• /
• pp.242-250
• /
• 2019

Background: Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods: A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results: A total of 156 patients treated with NIV were enrolled (mean age, $71.9{\pm}11.6years$). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion: AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.

• Journal of Hospice and Palliative Care
• /
• 제23권3호
• /
• pp.103-113
• /
• 2020

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

• Journal of Hospice and Palliative Care
• /
• 제26권2호
• /
• pp.69-79
• /
• 2023

Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

• 한국보육지원학회지
• /
• 제13권5호
• /
• pp.21-41
• /
• 2017

Objective: This study purposed to provide implications in regards to the Moon Jae-in Administration that launched in May 2017. Three sectors of childcare polices on administration of childcare centers were reviewed in terms of supporting the healthy development of young children. Methods: Medium and long-term childcare plans and the main policies of previous administrations since 2004 when the Childcare Act was completely reformed, as well as the 'Five-year policy for the Moon Jae-in administration of state affairs' that was announced on July, 2017, were reviewed in terms of publicness of childcare, regulations on operation of childcare services, and customized childcare programs for diverse needs. Results: It was proposed that the concept of publicness of childcare should be conservative when focusing on public childcare centers. The regulations on operating childcare services should focus on improving structural dimensions of childcare quality to keep the well-being of children a top priority. Furthermore, diverse programs should be designed and implemented to satisfy changes in childcare surroundings and the various needs of children and their families. Conclusion/Implications: The Moon Jae-in administration is expected to outline childcare policies and carry out tasks under the new paradigm. The healthy development of young children should be embodied as the final goal that forms the vision of childcare policies based on publicness, rationality, and diversity.

• Tuberculosis and Respiratory Diseases
• /
• 제65권3호
• /
• pp.239-242
• /
• 2008

외인성 지방성 폐렴은 자세한 병력 청취 없이는 의심하기 힘든 비교적 드문 질환이다. 저자들은 비특이적인 임상 증상과 방사선 소견을 보인 환자에서 스쿠알렌을 섭취한 과거력에 주목하였으며 외인성 지방성 폐렴을 의심 하에 기관지폐세척술 및 폐 생검을 통하여 확진하였다.

• Tuberculosis and Respiratory Diseases
• /
• 제72권2호
• /
• pp.212-217
• /
• 2012

Massive hemoptysis is a life-threatening condition and sometimes leads to death due to airway obstruction rather than exsanguinations. In a critical hemoptysis, endotracheal intubation may be necessary to maintain adequate gas exchange and protect the unaffected side of the lung. Bronchial blockers (BBs), commonly used technique for one-lung ventilation in thoracic or cardiac surgeries, are valuable devices for protecting the airway in massive endobronchial bleeding. We report three cases intubated with BBs, Univent$^{(R)}$, in massive hemoptysis. We suggest that BBs are one of the indispensable equipments for respiratory specialized wards and intensive care units.

• Tuberculosis and Respiratory Diseases
• /
• 제79권4호
• /
• pp.214-233
• /
• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

• Journal of Periodontal and Implant Science
• /
• 제29권2호
• /
• pp.325-333
• /
• 1999

The antibacterial efficacy of a mouthrinse(Denta Gargle) containing CPC(cetylpyridinium chloride), NaF and UDCA(ursodeoxycholic acid), on major periodontopathogens, was in vitro examined and compared with that of Listerine by a broth dilution method. The bacteria tested were Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Fusobacterium nucleatum subsp. vincentii, Prevotella intermedia, Porphyromonas gingivalis and Treponema denticola. The growth of all the bacteria were completely inhibited by a 1-min exposure to the both mouthrinses. When diluted at 1:5 or more, all bacteria analyzed but P. intermedia were not inhibited by Listerine. In contrast, Denta Gargle showed highly increased maximum inhibitory dilutions(MID) against all periodontopathogens included in this study, with MIDs ranging from 5-fold(F. nucleatum) to 160-fold dilutions(P. intermedia). The MIDs against A. actinomycetemcomitans, B. forsythus, P. gingivalis and T. denticola. were 1:40, 1:80, 1:80 and 1:80, respectively.

• Tuberculosis and Respiratory Diseases
• /
• 제63권2호
• /
• pp.200-203
• /
• 2007

폐선암이 공동성 종괴로 발현하는 것은 드문 것으로 알려져 있다. 그리고 폐기종이 폐암발생과 연관이 있다는 보고들이 있었다. 저자들은 방사선 검사에서 공동성 종괴를 가진 진균성폐렴으로 오인된, 폐기종 병변을 둘러싸고 진행한 폐선암을 경험하였다. 이 증례와 관련되어 문헌 고찰을 하였으며, 폐기종이 있는 환자에서 폐암이 잘 발생할 수 있다는 것을 알아야 할 것이다.