• 중환자간호학회지
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• 제12권1호
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• pp.22-35
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• 2019

Purpose : This study was to determine the levels of environmental stressor, posttraumatic stress disorder, and quality of life in intensive care units (ICU) survivors after intensive care, and to explore the factors affecting posttraumatic stress disorder and quality of life. Methods: With a longitudinal survey design, data were collected from 116 patients who were discharged from the ICU of a university hospital. The environmental stressor, posttraumatic stress disorder, and quality of life were measured immediately following and 1 month after the ICU discharge. Results: Of all the subjects, 16.4% experienced posttraumatic stress disorder after discharge. Multiple regression analysis revealed that ICU environmental stressors, experience of ICU readmission, using psychotropic drugs and narcotic analgesics, and ICU admission after surgery or cardiac intervention accounted for 22.2% of posttraumatic stress disorder. Posttraumatic stress disorder and sedation status when entering ICU accounted for 28.3% of the quality of life 1 month after ICU discharge. Conclusion: Nursing interventions focused on ICU environmental stressors would not only reduce environmental stress but also contribute to the reduction of posttraumatic stress disorder and later improvement of quality of life.

• 한국간호교육학회지
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• 제6권2호
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• pp.376-389
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• 2000

The Purpose of this study was to grasp the status of drug uses in college students, and to investigate the knowledge and attitude when they use it. We collected through questionnaires from Sep. 1 to Oct. 30 in 1999. The subjects were 490 college students in Seoul and northern of the Kyunggi-do. The data analysis was performed using SPSS (version 7.0) and ANOVA. The results of this study were as follows. 1. There was no correlation for all factors in the relationship between general characteristics of subjects and knowledge for drugs. On the contrary, in the relation of the general characteristics and attitude for drug of subjects, some factors are statistically significant e.g., department (F=3.049, p<.010), satisfaction for school life (F=6.167,p<.002), body shape(F=8.092, p<.000), and the relationship with ones parents (F=3.728, p<.005). 2. In the analysis of drug use status and knowledge, only in the factor of administration control was statistically significant(F=4.304, p<.014) and in the relation of attitude for drug uses, drug administration was statistically significant (F=4.521, p<.004). 3. In the mean scores for the drug knowledge analysis, the highest factor was 'A narcotic make deformed persons through poisoning of physical and mental' (M=4.14), the lowest factor was 'If catch the flu during the pregnancy, should be take drug as possible as quickly to reduce negative effect for fetal' (M=1.94). 4. In the analysis for drug attitude, the highest factor was 'A drug is alike a poison' (M=3.48), 'Should be keep the usage and dosage of drug' was the lowest (M=1.48). 5. From the investigation for status of drug use, it was revealed that the most subjects (73.6%) were purchase drugs after explain their symptoms to pharmacist. And they take drugs only when they felt painful in 43.1%. The most students (70.4%) were experienced control of drug administration. It was inquired that subjects were mainly obtained information about drugs from pharmacist and television (or radio) advertisement, 33.5% and 33.1%, respectively. In the examination for existence of long-term administrators in their family, 'none' and 'only parents' are 49.6% and 37.3%, respectively. When their parents have illness, the persons go to drugstore and hospital for heath-care, 47.8% and 44.3%, respectively. On the basis of results of this study, we suggest as follows. 1. This study was analyzed data from questionnaires for college students in a part of local areas, so we suggest that the next research should be perform for national-wide students as subjects to generalize the results. 2. It is need more intensive research methodologies such as interview and observation. 3. Additional research is required for knowledge and behaviors of drug uses that will how impact on ones health behavior.

• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.270-277
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• 2014

목적: 본 연구는 중등도 이상의 통증을 호소하는 암환자의 통증간호기록을 분석하여 통증의 특성과 통증완화를 위한 중재 및 중재의 효과를 조사하는 후향적 연구이다. 방법: 대상자는 2011년 2월 1일부터 2월 28일까지 서울시에 소재한 C 대학교 병원의 암병동에 입원 환자 중 재원일수가 3일 이상 30일 이하이며, 18세 이상의 성인으로 NRS로 측정한 통증의 강도가 4점 이상인 363명이었다. 결과: 입원 후 4점 이상의 통증을 호소한 건수는 1,394건이었다. 통증의 부위는 복부가 가장 많았고, 통증의 악화요인은 움직였을 때가, 완화요인은 진통제를 투여받았을 때가 가장 많았다. 통증의 유형은 돌발성 통증이 가장 많았다. 통증을 조절하기 위해 사용한 비약물적 중재 중 온요법이 가장 많았다. 약물을 투여하기 전 통증의 강도는 평균 6.68점이었으며 약물투여 후 1시간에 평균 2.81점으로 감소되었다. 정규처방으로 진통제를 투여한 경우는 52.2%였으며, 마약성 진통제 중 Morphine sulfate가, 비마약적 진통제 중 Gabapentin이 가장 많이 사용되었다. 퇴원 시 통증의 강도는 3점 이하가 82.5%였다. 결론: NRS 4점 이상의 통증을 호소하는 암환자는 입원 초기부터 적극적으로 통증을 조절하는 것이 중요하다. 마약성 진통제로 통증을 조절하는 암환자와 가족은 물론 간호사를 대상으로 약제의 효과와 부작용에 대하여 교육하고, 또한 퇴원 후 가정에서 환자와 가족이 통증을 평가하고 기록하여 추후 치료에 반영할 수 있도록 교육하는 것이 필요하다.

• The Korean Journal of Pain
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• 제31권2호
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• pp.102-108
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• 2018

Background: Nefopam is a non-opioid, non-steroidal analgesic drug with fewer adverse effects than narcotic analgesics and nonsteroidal anti-inflammatory drugs, and is widely used for postoperative pain control. Because nefopam sometimes causes side effects such as nausea, vomiting, somnolence, hyperhidrosis and injection-related pain, manufacturers are advised to infuse it slowly, over a duration of 15 minutes. Nevertheless, pain at the injection site is very common. Therefore, we investigated the effect of warmed carrier fluid on nefopam injection-induced pain. Methods: A total of 48 patients were randomly selected and allocated to either a control or a warming group. Warming was performed by diluting 40 mg of nefopam in 100 ml of normal saline heated to $31-32^{\circ}C$ using two fluid warmers. The control group was administered 40 mg of nefopam dissolved in 100 ml of normal saline stored at room temperature ($21-22^{\circ}C$) through the fluid warmers, but the fluid warmers were not activated. Results: The pain intensity was lower in the warming group than in the control group (P < 0.001). The pain severity and tolerance measurements also showed statistically significant differences between groups (P < 0.001). In the analysis of vital signs before and after the injection, the mean blood pressure after the injection differed significantly between the groups (P = 0.005), but the heart rate did not. The incidence of hypertension also showed a significant difference between groups (P = 0.017). Conclusions: Use of warmed carrier fluid for nefopam injection decreased injection-induced pain compared to mildly cool carrier fluid.

• The Korean Journal of Pain
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• 제35권4호
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• pp.361-382
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• 2022

The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α₂ agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.

• 한국학교보건학회지
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• 제3권1호
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• pp.101-118
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• 1990

학생들 간에 사용되고 있는 각종 약물 남용에 관한 실태와 문제점을 알아보기 위하여 1989년 3월 15일부터 3월 29일 사이에 부산 시내에 위치한 인문계 실업계, 남 녀 고등학교 각각 1개교씩 총 4개교의 학생 2,411명을 대상으로 지난 1년간 약물 남용실태를 설문조사한 결과를 요약하면 다음과 같다. 대상학생들의 24.4%가 흡연경험이 있었고, 현재 피우는 학생은 11.6%였으며, 실업계 학생이 인문계보다 더 많았다. 안정제, 최면제, 각성제를 제외한 모든 약물의 약명 파악률은 90% 이상이었고, 지난 1년간 복용경험자 비율은 진통제, 소화제, 자양강장제가 70~80% 수준이었고 각성제는 15.6%, 안정제는 1.4%, 최면제는 0.5%, 본드 1.4%, 신나 0.5%였다. 약물 사용 경험자중에서 매일 복용 혹은 사용하고 있는 자의 비율은 진통제 7.7%(145명), 소화제 6.2%(118명), 자양강장제 5.2%(96명), 안정제 5.9%(2명), 각성제 5.0%(19명), 마약류 2.8%(1명)였으나 최면제와 본드의 매일 사용자는 없었다. 이로 미루어 볼때 고등학생은 비마약성 약물의 남용이 심각하다고 하겠다. 약물을 치료목적 이외에 사용한 학생은 남 녀 각각 진통제 8.4%, 6.5%, 소화제 20.7%, 14.7%, 자양강장제 65.4%, 55.5%였으며 마약류는 우울할 때나 호기심으로 쓰는 율이 높았다. 특히 각성제는 대부분 공부를 위하여 사용되고 있는 것으로 나타나 입시제도의 심각성이 지적되고 있다. 구입 장소별로는 마약류, 본드, 신나는 구멍가게나 행상, 친구에게서 구입률이 가장 높았고, 그 이외의 약품은 약국과 의료기관에서의 구입률이 높았다. 흡연자가 비흡연자에 비하여 모든 약물을 월등히 많이 사용하고 있었으며, 특히 마약류의 사용은 흡연과 아주 밀접한 연관성이 있었다. 대상 학생들의 약물의 이름을 알고 있는 비율은 높으나, 약물을 타당한 목적(신체적, 정신적 건강향상)에 사용하지 않는 경우가 많았고, 약물의 처음 사용시기가 중학시절(14~15세)이 많았으며 호기심에서 사용한 율이 높아기 때문에 약물남용의 부작용과 의존성에 대한 경각심을 일찍부터 고취시켜 줄 필요가 있다고 판단되어 국민학교 교육과정에서부터 약물 남용예방을 위한 보건교육 및 홍보가 시급하다고 하겠다. 이와 함께 학생들의 금연에 관한 교육 및 홍보가 우선되어야 할 것이다. 또한 약물을 약국, 구멍가게 등에서 쉽게 구입할 수 있었다는 사실로 보아 약물 통제를 위한 규제를 검토 보완해야 하며, 의약 분업의 조속한 실시가 필요한 것으로 생각된다.

• Toxicological Research
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• 제11권2호
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• pp.315-327
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• 1995

Diverse neurotoxic insults result in proliferation and hypertrophy of astrocytes, a subtype of glia in central nervous system. The hallmark of this response, often terms "reactive gliosis", is the enhanced expression of the major intermediate filament protein of castrocytes, glial fibrillary acidic protein (GFAP). These changes in the astrocytes suggest that GFAP may be a useful biochemical indicator of neurotoxicity. To investigate this possibility, we administered intra-peritoneally prototype nerotoxicants, metharnphetamine (MAP, 5 mg/kg), cocaine (30 mg/kg), N-buthyl benzenesulfonamide (NBBS, 300 mg/kg) and trimethytin (TMT, 8 mg/kg) to Wistar Rats and then assessed the effects of these agents on content of GFAP, which were determined by Sandwish ELISA and evaluated with neurotoxic symptoms, and quantitative changes of imrnunoreactivity of GFAP by light microscopic image analysis in specific regions. We found that assay of GFAP revealed time- and region-dependant patterns of neurotoxicity. The GFAP immunoreactivity of rat brain was increased in substantia nigra and hippocampus by MAP, NBBS and TMT; in roedial septal nucleus and nucleus accurnbens, it was also increased by RrBBS. Sandwich ELISA showed that GFAP levels of cerebrum in all groups on days 3 and 7 and that of brainstem(including cerebellum) in MAP, NBBS groups on day 1 and 3 were increased. A review of the background, design and results of these experiments are presented in this paper. Our findings indicate that GFAP is a sensitive and specific biomarker of neurotoxicity.otoxicity.

• Journal of Hospice and Palliative Care
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• 제19권4호
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• pp.322-330
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• 2016

목적: 본 연구는 요양병원 간호사의 통증관리 지식, 태도, 수행정도를 파악하여 추후 요양병원 통증관리 교육을 설계하는데 기초자료로 활용하고자 실시되었다. 방법: 본 연구는 4개 요양병원에서 근무하는 간호사 120명을 대상으로 한 횡단적 조사연구이다. 통증관리 지식과 통증관리 태도는 원래 연구도구는 Watt-Watson이 개발한 도구를 사용하였고, 통증관리 수행정도는 요양병원에서의 통증관리 가이드라인들을 근거로 연구자가 개발하여 사용하였다. 결과: 본 연구의 결과 통증관리 지식은 40점 만점 평균 26.2점이었다. 가장 많이 틀린 문항은 통증의 주관성에 대한 항목으로 '통증에 따르는 환자의 생리적, 행동적 반응을 보고 통증의 유무와 강도를 파악할 수 있다(89.2%)'였고, 56.7%는 내성의 증가는 마약성 진통제 중독을 의미한다고 생각하였다. 통증관리 태도와 실무에 관해서는, 80.2%가 통증을 자주 호소하는 환자에게 위약을 사용한다고 하였고, 위약사용은 간호사가 두 번째로 자주 사용하는 통증관리 방법이었다. 결론: 본 연구는 요양병원 간호사의 통증관리 지식이 낮고 태도가 부적절한 것으로 나타났고, 이는 통증관리 실무에 부정적 영향을 미칠 수 있다. 요양병원 간호사들에게 통증관리 교육, 특히 통증의 속성과 위약남용에 대한 교육이 시급하다.

• 대한한방내과학회지
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• 제44권2호
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• pp.231-243
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• 2023

Background: Diabetic polyneuropathy is the most common complication in diabetics, occurring in 50% of all cases. About 10-20% of all diabetics are accompanied by neurological pain, showing a tendency to increase with age. Clinical aspects are very diverse, from mild abnormalities on nerve conduction tests to severe abnormalities in all sensory, motor, and autonomic nerves; however, sensory symptoms usually precede motor symptoms. Patients typically express sensory symptoms, such as positive and negative symptoms, which decrease the quality of life and have marked clinical implications, such as increased morbidity and mortality. Although Western medical drugs, such as tricyclic antidepressants, anticonvulsants, and narcotic analgesics, are used for diabetic polyneuropathy, a standard treatment has not been established. Case report: A 65-year-old male with paresthesia and pain due to diabetic polyneuropathy was treated with Uchashinki-hwan, acupuncture, electroacupuncture, moxibustion, and Jungsongouhyul pharmacopuncture for 10 days. We used the Toronto Clinical Neuropathy Scoring System, EuroQol-5 Dimension, and Visual Analog Scale to evaluate symptoms. Subsequently, the Neuropathy Scoring System, EuroQol-5 Dimension, and subjective discomfort improved. Conclusion: The present case report suggests that combined Korean medicine treatment might be an effective treatment for paresthesia and pain with diabetic polyneuropathy. Several follow-up studies should be conducted to clarify the effectiveness of the treatment.

• The Korean Journal of Pain
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• 제1권1호
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• pp.64-73
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• 1988

Recent studios have shown that narcotic drags produce an unusually intense, prolonged and segmental analgesic action in man whoa injected into the spinal subarachnoid or epidural space (Wang et al, 1979; Behar et al, 1979; Cousins et al, 1979; Magora et a., 1980, Johnston and McCaughey, 1980). Since 1960, many investigators claimed that low molecular weight(LMW) dextran increased the clinical duration of lidocaine(Loder, 1960; Loder, 1962), tetracaine (Chinn and Wirjoatmadja, 1967) and bupivacaine(Kaplan et al, 1975) in man but the mechanism of the action of dextran was unclear. But Curtiss and Scurlock(1979), and Buckled and Fink(1979) claimed that LMW dextran has no effect on the duration of action of bupivacaine in animal studies. The present study was performed to evaluate the clinical efficacy of analgesia by the thoracic epidural injection of morphine and bupivacaine mixture for the relief of pain due to fractured or contused ribs, to evaluate the duration of analgesic effect by the use of the above mixture in a hypertonic solution(dextran 70 or 50% dextrose in water) and to observe the possibility of improvement in the lung function after the pain block. The complications following the pain block were also observed. The 50 single thoracic epidural injections of the mixture were divided into three groups : Group 1(n=15) served as a control group and drags used for the relief of pain were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}1.64\;mg$), 0.5% bupivacaine($3.10{\pm}1.04\;ml$) and 0.9% saline($3.64{\pm}1.11\;ml$). Group 2(n=16) serves as an experimental group and drugs were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}0.72\;mg$), 0.5% bupivacaine($3.06{\pm}0.77\;ml$) and dextran 70($3.75{\pm}1.29\;ml$). Group 3 (n=19) served as an experimental group and drags were as follows(Mean$\pm$S.D.) : morphine($2.42{\pm}0.51\;mg$), 0.5% bupivacaine($3.21{\pm}0.71\;ml$) and 50% dextrose in water($3.58{\pm}1.11\;ml$). The results are were follows: 1) The Dumber of patients who obtained excellent and good analgesic effects following the block were greater in the experimental Croup 2(94%) and Group 3 (90%) than theme of the control Group 1 (80%). 2) The duration of pain relief which lasted more than 3 days after the epidural block was longer in the experimental Group 2 (81%) and Group 3 (75%) than those of the control Croup 1(67%). 3) The pulmonary reserve(FVC%+FEV 1.0%) of 27 cases who were treated by the pain block between 1 and 31 drys following the chest injury was increased to about 13% than those before the block, and that of 13 cases between 32 and 82 days following the chest injury was decreased to about 4% than those before the block. 4) Of the complications following the pain block, there were 5 cased(10%) of nausea within 2 hours following the block, 4 cases(8%) of vomiting after 2 hours following the block, 10 cases(20%) of pruritus after 3~4 hours following the block, 17 cases(34%) of transient urinary retention which tasted 8 to 19 hours, 3 cases(6%) of headache within 2 hoers following the block and 2 cases(4%) of dural puncture. In conclusion, it is suggested that the clinical duration of analgesic effect produced by morphine and bupivacaine mixture can be prolonged by addition of the hypertonic solution to the mixture.