• Title/Summary/Keyword: Patient Related Management

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Oral Health and Oral Health Behavior as Risk Factors for Depression (우울증에 대한 구강건강 및 관리행태 위험요인)

  • Lee, Kyung Hee
    • Science of Emotion and Sensibility
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    • v.24 no.3
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    • pp.17-26
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    • 2021
  • This study investigated the association between depression and oral health and the factors influencing depression in adults. Data on 13,199 people (male 5,793, female 7,406; age ≥19 years old) were extracted from the Korean National Health and Nutrition Examination Survey VIII (KNHANES VIII) (2016~2018) and analyzed using frequency, percentage, an x2 test, a T-test, and logistic regression analysis. Depression was defined as either a medical diagnosis or a score ≥10 on Patient Health Questionnaire-9. The probability of depression was found to be statistically different for general characteristics, such as gender, age, school grade, income, and drinking. The logistic regression analysis showed that the independent variables, general health awareness (OR=9.094, 95% CI 7.139~11.585) and oral health awareness (OR=1.936, 95% CI 1.465~2.560), were associated with depression, and speaking discomfort, chewing discomfort, oral pain (within 1 year), and prosthesis were found to increase depression probability. The depression probability was also was found to significantly increase by 1.81 times if brushing frequency was less that once a day, if people used dental floss (OR=1.42), and had to have an oral examination (OR=1.31). These results indicated that oral health and oral health behaviors are associated with the depression, with the influencing factors having oral health and behavior-related characteristics. Therefore, proper oral health and oral health risk factor behavior management programs should be developed to assist in reducing depression.

Intraoperative Neurophysiological Monitoring and Neuromuscular Anesthesia Depth Monitoring (수술 중 신경계 추적 감시 검사와 근 이완 마취 심도의 측정)

  • Kim, Sang-Hun;Park, Soon-Bu;Kang, Hyo-Chan;Park, Sang-Ku
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.4
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    • pp.317-326
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    • 2020
  • Deep blocking of consciousness alone does not prevent a reaction to severe stimuli, and copious amounts of pain medication do not guarantee unconsciousness. Therefore, anesthesia must satisfy both: the loss of consciousness as well as muscle relaxation. Muscle relaxants improve the intra-bronchial intubation, surgical field of vision, and operating conditions, while simultaneously reducing the dose of inhalation or intravenous anesthesia. Muscle relaxants are also very important for breathing management during controlled mechanical ventilation during surgery. Excessive dosage of such muscle relaxants may therefore affect neurological examinations during surgery, but an insufficient dosage will result in movement of the patient during the procedure. Hence, muscle relaxation anesthesia depth and neurophysiological monitoring during surgery are closely related. Using excessive muscle relaxants is disadvantageous, since neurophysiological examinations during surgery could be hindered, and eliminating the effects of complete muscle relaxation after surgery is challenging. In the operation of neurophysiological monitoring during the operation, the anesthesiologist administers muscle relaxant based on what standard, it is hoped that the examination will be performed more smoothly by examining the trends in the world as well as domestic and global trends in maintaining muscle relaxant.

Actual situation and prescribing patterns of opioids by pain physicians in South Korea

  • Kim, Min Jung;Kim, Ji Yeon;Lim, Yun Hee;Hong, Sung Jun;Jeong, Jae Hun;Choi, Hey Ran;Park, Sun Kyung;Kim, Jung Eun;Lee, Min Ki;Kim, Jae Hun
    • The Korean Journal of Pain
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    • v.35 no.4
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    • pp.475-487
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    • 2022
  • Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions: The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

A Study on Sustainable Service Improvement - Case of Seoul National University Hospital, Korea - (지속적인 서비스 개선을 위한 연구 - 서울대학교병원 사례를 중심으로 -)

  • Sung, Hyun Jin;Kim, Young Se
    • Korea Science and Art Forum
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    • v.19
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    • pp.417-424
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    • 2015
  • The healthcare service industry has become one of the business industries in South Korea where service design is most actively being researched on and applied. In accordance with the recent upsurge of the interest in health, healthcare service is expanding its area including disease prevention, patient management, and rehabilitation treatment as well as cure and nursing care. The health manpower is the supplier, and their professional knowledge and ability and the patients' trust in medical technology are the most important factors for their customers. In addition, service design has come into the spotlight given that the medical institute system, health manpower attitude, and information delivery system and touch point are considered important factors contributing to customer satisfaction. It is very hard to satisfy customers only through professionalism, the environment, and product improvement because healthcare service deals with much more sensitive and emotional customers compared to other service industries. This means that a change in the service mind-set and the attitude of the health manpower as emotional labourers have practical effects. Therefore, the fundamental solution is to establish a system that provides related education with manpower and that settles various problems by itself. This paper introduces several solutions, such as education for health manpower and a service design system applied to a national-university-affiliated hospital in South Korea, and takes a close look at its effects.

Development of a Prediction Model for Fall Patients in the Main Diagnostic S Code Using Artificial Intelligence (인공지능을 이용한 주진단 S코드의 낙상환자 예측모델 개발)

  • Ye-Ji Park;Eun-Mee Choi;So-Hyeon Bang;Jin-Hyoung Jeong
    • The Journal of Korea Institute of Information, Electronics, and Communication Technology
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    • v.16 no.6
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    • pp.526-532
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    • 2023
  • Falls are fatal accidents that occur more than 420,000 times a year worldwide. Therefore, to study patients with falls, we found the association between extrinsic injury codes and principal diagnosis S-codes of patients with falls, and developed a prediction model to predict extrinsic injury codes based on the data of principal diagnosis S-codes of patients with falls. In this study, we received two years of data from 2020 and 2021 from Institution A, located in Gangneung City, Gangwon Special Self-Governing Province, and extracted only the data from W00 to W19 of the extrinsic injury codes related to falls, and developed a prediction model using W01, W10, W13, and W18 of the extrinsic injury codes of falls, which had enough principal diagnosis S-codes to develop a prediction model. 80% of the data were categorized as training data and 20% as testing data. The model was developed using MLP (Multi-Layer Perceptron) with 6 variables (gender, age, principal diagnosis S-code, surgery, hospitalization, and alcohol consumption) in the input layer, 2 hidden layers with 64 nodes, and an output layer with 4 nodes for W01, W10, W13, and W18 exogenous damage codes using the softmax activation function. As a result of the training, the first training had an accuracy of 31.2%, but the 30th training had an accuracy of 87.5%, which confirmed the association between the fall extrinsic code and the main diagnosis S code of the fall patient.

A Statistical Study on the Key Words in the Titles of Nursing Related Theses (학위논문의 주요어 분석 (간호학 및 간호학관련 학위논문을 중심으로 : 1960-1991. 8))

  • 고옥자;김상혜;김희걸;이금재;이영숙
    • Journal of Korean Academy of Nursing
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    • v.24 no.1
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    • pp.58-69
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    • 1994
  • In order to see the development of Nursing related research activities in Korea over the last three decades, abstracts of almost all of the Master and Ph.D theses that appeared from 1961 up to August 1991 were collected. The number of theses was 2354, from which an index of key words has been constructed. Key words were defined as those terms in each thesis title that convey major objectives of the given thesis study and the important nursing concepts dealt with in the thesis. Although all the key words were picked from the thesis title only, full use was made of the abstracts in deciding the principal objectives and essential contents of the thesis studies and their important concepts as well. In total, 539 kinds of key words were identified from the 2354 titles, and the identified words were all found to be in the International Nursing Index. On an average each title has two key words. Which key words were most frequently used, how they have changed with time, what kind of concept is preferably dealt with by each graduate school, and the concepts to which a given key word is likely to be connected were examined. The results are summerized below : 1) For each decade the theses numbers were as follows : 54(2.3%) from the 60’s, 413(17.5%) from the 70’s, 1523(64.7%) from the 80’s, and 364(15.5%) from the 90’s. Master’s thesis contributed 96% (2252) of the papers and Ph. D’s theses filled the remaining 4%(102). 2) A total of 539 key words were used, averaging about 2 for each thesis. The most frequently used key words were ‘Nurse’, ‘Anxiety’, ‘Knowledge / Attitude /Practice’, ‘Stress /Stressor’, ‘Attitude’, ‘Job-Satisfaction’, ‘Mental Disorder’, ‘Operation’, ‘Elderly’, ‘Nursing Role’. 3) Each decades key words can be classified as : the 60’s : ‘Nursing Education’, ‘Pulmonary Tuberculosis’, ‘Mother-Child Health’, ‘Growth & Development’, ‘Public Facilities’, ‘Mental Disorder’ : the 70’s : ‘Nurse’, ‘Family Planning’, ‘Attitude’ / ‘Knowledge, Attitude / Practice’, ‘Curriculum in Nursing Education’, ‘Clinical Practice in Nursing’, ‘Analysis of the Work of the Nurse’, ‘Health Education of School’, : the 80’s : ‘Nurse’, ‘Anxiety’, ‘Stress /Stressor’, ‘Operation’, ‘Nursing Role’, ‘Job Satisfaction’ : the 90’s : ‘Nurse’, ‘Elderly’, ‘Family-Support’, ‘Stress /Stressor’, ‘Home Care’. Key word ‘Nurse’ appears continuously and most frequently through the years, which indicates that there has been active study of the characteristics of nurses and related fields. The concept ‘Anxiety’ has been studied steadly from the 80’s and it shows that interest in health and disease are increasing Which comes as a result of society changing to an industrial and informational community. 4) Looking into each graduate school’s study area key words ‘Anxiety’, ‘Nurse’, ‘Mental Disorder’, ‘Stress /Stressor’, ‘Operation’, ‘Attitude’, ‘Hemo-dialysis’, were studied in the regular graduate school : ‘Family Planning /Contraception’, ‘Knowledge / Attitude /Practice’, ‘Physical Health-State /Physical Health Examination’, ‘Nurse’, ‘Using Clinical Facilities’, ‘Health Education of School’, were studied in the Graduate School of Public Health’ ; ‘Nurse’, ‘Anxiety’, ‘Stress / Stressor’, ‘Job-Satisfaction’, ‘Clinical Practice Education’, ‘Nursing Education’, were studied in the Graduate School of Education : ‘Nurse’, ‘Job Satisfaction’, ‘Nursing Role’, ‘Administration - Employment /Employment Management’, ‘Leadership’, ‘Personnel Profile’, ‘Nursing Manpower / Changing Working Place’, were studied in the Graduate School of Public Administration. 5) The Connection between key words were : ‘Nurse Job Satisfaction’, ‘Stress / Stressor ⇔ Coping / Ajustment’, ‘Nurse ⇔ Nursing Role’, ‘Anxiety ⇔ Giving Information’, ‘Nurse ⇔ Stress / Stressor’, ‘Anxiety ⇔ Operation’, ‘Nurse ⇔ Burnout’, ‘Knowledge, Attitude, Practice ⇔ Family Planning’, ‘Nurse Administration ⇔ Employment’, ‘Anxiety Muscle ⇔ Relaxation Technic’, ‘Anxiety ⇔ Mental Disorder’. From the above it can be noted that many nursing concepts were handled in the thesis titles. But there were more than enough papers on the characteristics of the nurse. It is suggested that in depth research be made on ‘Nursing Accidents’, t-‘Ethics’, ‘Nurse - Patient Interactions’, ‘Spritual Care’, ‘Dying’, ‘Hospice’, ‘Resident Helper’ and that there should be in depth research relating to the physical and mental development of youth and in particular physical concepts like ‘Drug - Abuse’, ‘Child -Abuse and Teaching’.

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The Changes of Cuff Pressure from Endotracheal Intubation for Long-term Mechanical Ventilation (장기간 기계호흡 환자에서 기관내 관의 기낭압의 변화)

  • Jung, Bock-Hyun;Park, Whan;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.156-165
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    • 2002
  • Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure ($P_{cuff}$) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low $P_{cuff}$. To prevent these complications, the $P_{cuff}$ should be kept appropriately because the appropriate $P_{cuff}$ appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume($V_{cuff}$) has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal $P_{cuff}$ instead of monitoring the $P_{cuff}$ directly at the patients' bedside. To address the necessity of continuous $P_{cuff}$ monitoring, the change in the $P_{cuff}$ was evaluated at various $V_{cuff}$ levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring $P_{cuff}$ was also investigated. Method: The change in $P_{cuff}$ according to the increase in $V_{cuff}$ was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in $P_{cuff}$ daily during the mechanical ventilation days. In addition, the $P_{cuff}$ measured by mercury column sphygmomanometer was compared with the $P_{cuff}$ measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of $P_{cuff}$ during more than 14 days of intubation for mechanical ventilation. However the $V_{cuff}$ required to maintain the appropriate $P_{cuff}$ varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the $P_{cuff}$ was observed from 10 $cmH_2O$ to 46 $cmH_2O$ at constant 3 cc $V_{cuff}$. The $P_{cuff}$ measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the $P_{cuff}$ to maintain the appropriate $P_{cuff}$ level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.

Effect of Oral Healthcare Program of Exemplary Kindergartens for Prevent the Dental Caries in Incheon City, Korea (치아우식증 예방을 위한 모범 유치원 구강건강관리프로그램 효과 - 인천 일부지역 유치원을 중심으로)

  • Ahn, Se-Youn;Hwang, Yoon-Sook;Han, Su-Jin
    • Journal of dental hygiene science
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    • v.13 no.4
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    • pp.501-509
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    • 2013
  • The purpose of the study is to confirm the effect of the oral health management program in exemplary kindergartens for prevent the dental caries. The study performs the survey on the parents about the changes in the oral health behaviors after the oral health education in April 2012 and measures the patient hygiene performance (PHP) index before the education, after the education and 3 weeks after the education to assess the removal capability to plaque on the teeth surface for the children. The analysis is performed on 130 people who join the program and respond the survey. There is no change in the behavior related to the tooth brushing of children after the oral health education. No change is found from the interest in the oral health education (p>0.05) but the recognition in the importance of the tooth positively change, as well as recognition of the tooth brushing method and the reaction to recommending to tooth brushing. The PHP index of children is significantly improved from 3.87 before the education through 2.71 after the education and 3.27 3 weeks after the education (p<0.001). The observation from the patents shows that their children have interest in preventing the cavities including 33.1% after having xylitol and 60.7% after the oral health education. In conclusion, the study confirms the effect of the oral health management program in exemplary kindergartens to prevent the cavities, meaning that it is required to activate the programs and keep implementing the programs including providing xylitol and education for teachers, parents and children to habituate the oral health behavior of the children and completely learn toothbrushing method under continuous management and reeducation.

The Severity and Variables Influencing Depression in Cancer Patients with Pain (통증이 있는 암환자의 우울 정도 및 우울에 영향을 미치는 요인)

  • Kim, Hyun-Sook;Yun, Young-Ho;Lee, So-Woo;Heo, Dae-Seog;Son, Haeng-Mi;Huh, Bong-Yul
    • Journal of Hospice and Palliative Care
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    • v.2 no.2
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    • pp.125-137
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    • 1999
  • Purpose : Surveying the rates, severity, and variables influencing depression and their correlation between pain and depression in Korean cancer patients, we attempted to provide a basic database for the effective depression management program. Methods : The results of survey were colleted from 10 patients who were hospitalized at Seoul National University Hospital for cancer treatment from February to June of 1999. Factors of depression and the level of pain were examined by self-reported survey employing Korean version of Beck Depression Inventory(BDI) and an abridged version of Brief pain Inventory respectively. The purpose of this study and guidelines for the questionnaires were clearly explained to participating patients by Resgitered Nurses before answering the survey. Demographic and clinical characteristics of patients were compiled by reviewing their medical records in corporation with a family physician. The difference in the level of depression among patient groups was analyzed with the t-test and ANOVA, and the correlation between variables with Pearson correlation coefficient. Results : 1) 142 subjects comprised 79 male and 63 female, and their mean age was 51.86. 2) The mean scores of the worst pain for last 24-hours was 6.08(SD 2.23), the average pain for last 24-hours 4.44(SD 1.85), and the mean scores of pain at the time of survey 3.48(SD 2.25), while the mean scores of the least pain for last 24-hours 2.25(SD 1.83). 3) The mean BDI scores were 23.73(SD 0.99), and 55.6% of patients were evaluated to be in depression(cutting point 21). Scores of depression for cancer patients were higher than normal population. 4) The correlation between worst pain for last 24-hours and depression(r=0.252, P=0.002), average pain for last 24-hours and depression(r=0.225, P=0.007), present pain and depression(r=0.291, P=0.000) were significant. 5) Significant differences were found among groups of cancer patients with pain with respect to gender(t=3.59, p=0.000), level of education(F=4.063, P=0.009), ECOG(F=3.352, P=0.021). There was significant positive correlation between depression and pain(r=0.171, P=0.042). Conclusions : More than 50% of cancer patients with pain are suffering from depression. We have shown that the variables like the degree of pain, gender, level of education, ECOG, and age are significantly related to the depression in cancer patients. The findings of this study may be used for assessing high-risk patients in need of intervention and for planning effective therapeutic strategies for them after the routine assessment. Further study is necessary to investigate the cultural differences and the variables influencing on depression in Korean cancer patients.

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Soft Tissue Sarcomas Presented with Hematoma (혈종을 동반한 연부 조직 육종)

  • Chung, Yang-Guk;Kang, Yong-Koo;Bahk, Won-Jong;Rhee, Seung-Koo;Lee, An-Hi;Park, Jeong-Mi;Cho, Hyun-Min
    • The Journal of the Korean bone and joint tumor society
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    • v.14 no.2
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    • pp.163-171
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    • 2008
  • Purpose: We analyze the characteristics of soft tissue sarcomas presented with hematoma, which were misdiagnosed as simple hematoma initially and the proper management were delayed. Materials and Methods: The 7 patients with histologically proven soft tissue sarcoma with hematoma presented since February 1997 were evaluated retrospectively. Neither patient had a medical history of bleeding tendency nor anticoagulant therapy. Two of them had minor traumas. There were 2 men and 5 women. Average follow up period was 58 months. MRI findings, provided treatments and oncologic outcome were reviewed with the reference of related articles. Results: Retrospective review of initial MR images revealed deep seated intramuscular masses with focal solid enhanced nodules at the peripheral margin. The diagnoses were delayed at least 1 month in 3 of them which included 2 cases of simple hematoma evacuation without biopsy initially. After histologic diagnosis of soft tissue sarcoma, wide resections were performed in 4 cases. one patient underwent above knee amputation and the remained 2 patients were managed with wide resection followed by amputation due to local recurrence. At last follow up there were CDF and NED in 2 cases, respectively and AWD in 3 cases. Conclusion: To avoid the delay of diagnosis and treatment of soft tissue sarcomas presented with hematoma, high degree of clinical suspicion, careful analysis of MR images and early biopsy were important.

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