• 제목/요약/키워드: Patient Related Management

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Efficacy and Rebleeding Risk of Preoperative Ventriculostomyin Aneurysmal Subarachnoid Hemorrhage

  • Lee, Young-Jin;Min, Kyung-Soo;Lee, Mou-Seop;Kim, Dong-Ho;Kim, Young-Gyu
    • Journal of Korean Neurosurgical Society
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    • v.41 no.2
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    • pp.100-104
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    • 2007
  • Objective : Despite the widespread use of preoperative ventriculostomy in aneurysmal subarachnoid hemorrhage [SAH], there is no general consensus regarding the risk of bleeding associated with its use before aneurysm repair. This study was conducted to define the efficacy and rebleeding risk of ventriculostomy in aneurysmal SAH. Methods : The authors reviewed 339 consecutive patients with aneurysmal SAH who were treated at our hospital between January 1998 and December 2004. Results : Preoperative ventriculostomy was performed on 73 patients for acute hydrocephalus after aneurysmal SAH. The Hunt-Hess[H-H] grades of patients who underwent ventriculostomy were higher. Out of the 73 patients who underwent preoperative ventriculostomy, 58 [79%] demonstrated immediate clinical improvement after ventriculostomy. Of those same 73 patients 22 [30%] suffered aneurysmal rebleeding, whereas only 11 [4%] of the 266 patients who did not undergo ventriculostomy showed preoperative aneurysm rebleeding. The causes of rebleeding in the 22 patients who underwent ventriculostomy before surgery were related to the ventriculostomy procedure itself, subsequent cerebrospinal fluid [CSF] drainage, angiography and patient care procedures, such as endotracheal suction and nursing care. The mean time interval between SAH and surgery in the patients who underwent ventriculostomy was not statistically different from those who did not receive preoperative ventriculostomies [44.66 compared with 42.13 hours; p=0.73]. Conclusion : The preoperative ventriculostomy improved patients' clinical condition but increased the risk of rebleeding after aneurysmal SAH. When necessary, however, rapid change in transmural pressure during ventriculostomy must be avoided, careful management during ventricular drainage is needed, and surgery should be performed as soon as possible to prevent or reduce the incidence of rebleeding.

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

  • Jeong, Ho-Gul;Hwang, Jae Joon;Lee, Jeong-Hee;Kim, Young Hyun;Na, Ji Yeon;Han, Sang-Sun
    • Imaging Science in Dentistry
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    • v.47 no.1
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    • pp.45-50
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    • 2017
  • Purpose: The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ. Materials and Methods: The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ. Results: Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years. Conclusion: Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

Treatment Outcomes of Traumatic Duodenal Injury (외상성 십이지장 손상의 치료 성적)

  • Yu, Byunghyuk;Cho, Jayun;Lim, Kyoung Hoon;Park, Jinyoung
    • Journal of Trauma and Injury
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    • v.28 no.3
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    • pp.129-133
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    • 2015
  • Purpose: The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. Methods: A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. Results: Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is $13.6{\pm}9.6$. The mean AIS is $8.9{\pm}6.5$. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. Conclusion: ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.

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Blockade of Ganglion Impar and Superior Hypogastric Plexus Block for Perineal Cancer Pain -Case report- (회음부 암성통증에 대한 외톨이 신경절 블록과 상 하복 신경총 블록 -증례 보고-)

  • Han, Seung-Yeon;Yoon, Duck-Mi
    • The Korean Journal of Pain
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    • v.12 no.2
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    • pp.238-241
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    • 1999
  • Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

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Knowledge, Attitude and Prevalence Status of Clonorchiasis for the Inhabitants in the Nakdong Riverside Area (낙동강 유역 지역민의 간흡충 관련 지식, 태도 및 감염실태)

  • Song, Yeon-Yi;Park, Kyung-Soon;Kwon, Young-Sook;Kim, Nan-Hee;So, Young-Sook;Lee, Myeong-Soon;Hong, Soon-Kyou;Hwang, Sung-Ho
    • Journal of Korean Academy of Rural Health Nursing
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    • v.4 no.2
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    • pp.87-93
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    • 2009
  • Purpose: This study was done to investigate the knowledge, attitude and prevalence status of Clonorchiasis Sinensis (C.S.) for inhabitants in the Nakdong riverside area. Method: Data were collected from December 16, 2008 to January 10, 2009. Participants were 552 people who responded to a questionnaire and had a stool examination. Results: The overall prevalence of C.S. was 13.8%. As for knowledge of C.S., the Clonorchiasis group had a mean score of 10.78 $({\pm}3.54)$ on a 17-point scale compared to a score of 10.58 $({\pm}4.15)$ for the negative group. The intended behavioral change related to risk of infection, according to presence of infection or not, was not significant but the Clonorchiasis group had a greater desire for behavioral change intention than the negative group. Conclusion: These results suggest that prevalence investigation of C.S. in all areas in the Nakdong riverside is needed and indicates that it is necessary to set up persistent and systematic management programs for patient care and prevention of C.S..

A Case Report of Salivary Duct Carcinoma (이하선에 생긴 침샘관암의 치험례)

  • Park, Sung Wook;Kang, Sang Yoon;Kim, Tae Hun;Kim, Chung Hun
    • Archives of Plastic Surgery
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    • v.35 no.5
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    • pp.607-610
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    • 2008
  • Purpose: Salivary duct carcinoma(SDC) is uncommon but high grade adenocarcinoma arising in the ductal epithelium of salivary glands. SDC is characterized by distinctive clinical and pathologic features. The most important histologic aspect of this neoplasm is its resemblance to ductal carcinoma of the breast. Clinically SDC is defined by cervical lymph node involvement and distant metastasis with a high rate of recurrence and mortality. We described some of the clinical and pathological features of SDC and the management using case report for our patient. Methods: We present a case of a 40-year-old male with 2-year history of a swelling arising in his left preauricular region. There was a single painless, firm and solid $2{\times}1.5cm$ mass in the left parotid area. Facial nerve function was intact and no cervical lymph node were palpable. In August 2005, we found out $1.7{\times}1.8cm$ sized cystic, nodular lesions that were located in the superficial lobe of left parotid gland through Computed tomography. And then superficial parotidectomy and postoperative radiation therapy were performed in Jan 2007. Results: Pathologically, the specimen were consisted of homogeneous, chondoid to myxoid type of tissues. It was yellow mass that has multiloculated cystic lesions. In postoperative PET(Positiron emission tomography) CT, there was no evidence of uptaking FDG(Fluorodeoxyglucose) into the deep layers of parotid gland and distant metastasis were not seen. Conclusion: Salivary duct carcinoma(SDC) is a rare but high grade adenocarcinoma related to pleomorphic adenocarcinoma. The prognosis of SDC can be different according to the type of tumor such as mucoepidermoid adenocarcinoma, adenoid duct carcinoma and acinar cell carcinoma. So we need to study more carefully for accurate diagnosis in early stage of diagnosis. Although radiotherapy has not yet proven to be a significant factor in overall survival, the combination of parotidectomy and postoperative radiation therapy can lead to more favorable results in treating of SDC.

Development of Case-based Multimedia Learning Contents for Preventing Malpractice in Operating Room (수술실 간호오류 예방을 위한 사례중심 멀티미디어 학습콘텐츠 개발)

  • Park, Ji Myung;Hwang, Seon Young
    • The Journal of the Korea Contents Association
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    • v.16 no.10
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    • pp.522-532
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    • 2016
  • Purpose: This study was conducted to develop case-based self-learning multimedia contents for preventing malpractice that frequently occurred among nurses working in the operating room. Methods: Based on the learning needs of operating room nurses, real case reports, and literature reviews, the case-based multimedia learning contents were developed according to the instructional design procedure. The assessment of learning needs was performed by the combination of surveys using structured questionnaire and of interviews for 40 operating room nurses. Results: The learning contents included four learning modules with real malpractice cases from the areas of operating preparation, nursing skills during operation, environmental management of operating room, and patient safety and observation-related. The 80 minute long case-based multimedia learning contents were finally developed after content validity tests from clinical experts. Each module contained photos, sounds and flash animation with voice recording on the contents of nursing error cases and standardized protocols. Conclusion: The developed multimedia learning contents based on real error cases in this study can be utilized as an educational hands-on training materials for nurses to prevent malpractice in the operating room.

Lexical and Phrasal Analysis of Online Discourse of Type 2 Diabetes Patients based on Text-Mining (텍스트마이닝 기법을 이용한 제 2형 당뇨환자 온라인 담론의 어휘 및 구문구조 분석)

  • Hwang, Moonl-Hyon;Park, Jungsik
    • Journal of Digital Convergence
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    • v.12 no.6
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    • pp.655-667
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    • 2014
  • This paper has identified five major categories of the T2D patients' concerns based on an online forum where the patients voluntarily verbalized their naturally occurring emotional reactions and concerns related to T2D. We have emphasized the fact that the lexical and phrasal analysis brought to the forefront the prevailing negative reactions and desires for clear information, professional advice, and emotional support. This study used lexical and phrasal analysis based on text-mining tools to estimate the potential of using a large sample of patient conversation of a specific disease posted on the internet for clinical features and patients' emotions. As a result, the study showed that quantitative analysis based on text-mining is a viable method of generalizing the psychological concerns and features of T2D patients.

A Qualitative Study on Job Satisfaction of Dental Hygienists with Low Experience

  • Park, Ji-Hyeon;Lim, Soon-Ryun
    • Journal of dental hygiene science
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    • v.20 no.3
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    • pp.163-170
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    • 2020
  • Background: Job satisfaction of dental hygienists has been discussed continuously in dental hygiene research. It has been the most representative performance variable in dental and human resource management. However, in quantitative research, most of the studies have analyzed the causal relationship with variables related to dental hygienists' job satisfaction. The existing qualitative research contains only the studies that targeted dental hygienists with an experience of more than 10 years. The present study aimed to understand and to characterize the job satisfaction of dental hygienists with an experience of 2 to 10 years and to compare it with the qualitative research on dental hygienists with an experience of 10 or more years. Methods: An in-depth interview of dental hygienists with 2 to 10 years of experience working in 10 dental clinics was conducted. For data analysis, Giorgi's analysis method was used. Results: After analyzing the meaning of job satisfaction of dental hygienists, 180 semantic words and 19 subcategories were derived. The results of the interview were categorized into for central meanings: recognition and rewards, work experience and ability improvement, occupational characteristics, and work characteristics. Recognition and rewards included workplace recognition, patient recognition, self-effort and recognition, and the feeling of being rewarded. Work experience and ability improvement included various work experiences and factors relates to improving the work ability. Occupational characteristics included professional job, interest and persistence, job extensibility, and no burden of employment. Work characteristics included working conditions and separation of work and private life. Conclusion: The development of tools to measure the level of dental hygienists' job satisfaction after long-term service and to conduct follow-up research regarding ways and effects to improve job satisfaction is needed.

A Study on Self-care Behavior Types of Hypertensives : Q-methodological Approach (고혈압환자의 자가간호행위 유형에 관한 연구 : Q 방법론 적용)

  • Park Young-Im
    • The Journal of Korean Academic Society of Nursing Education
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    • v.5 no.1
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    • pp.39-57
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    • 1999
  • Essential hypertension is a typical chronic disease requiring adequate and continuous management. And many studies supported that self-care was the essential factor to promote the wellbeing. The purpose of this study is to identify and understand the behavior patterns of self-care in hypertensives. As a research method, 35 Q-statements were collected through Individual interviews and review of the related literatures. 21 subjects were interviewed and the data were analyzed by the PC QUANL program with principal component analysis. There were 6 different self-care types classified as follows 1) Type 1 was the self-oriented control type, monitoring the blood pressure and taking the low salt diet. But they didn't take the anti -hypertensive drug and visit the health agency regularly. 2) Type 2 was the stress-control type. Their main activities were meditation to relieve the stress and communication with family. 3) Type 3 was called daily-life control type. This type tried to make their mind comfort and think positively. They also preferred walking and exercise regularly. 4) Type 4 was the medical-oriented control type, taking the anti-hypertensive drug, visiting the medical personnel and following the medical regimens. 5) Type 5 was the medication-oriented type. They only took the anti -hypertensive drug regularly and didn't any other self-care like as monitoring the blood pressure, taking the low salt diet and exercise. 6) Type 6 was called non-medication control type. This type had no medication, but tried to visit the health agency and health personnel. From the above results, it can be concluded that the self-care types were very various and self-care education have to provide individually according to the characteristics of self-care type. Another repeated study can be recommended to improve the nursing intervention the self-care behavior in chronic patient like as diabetics or rheumatoid arthritis.

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