• Archives of Plastic Surgery
• /
• 제46권6호
• /
• pp.572-579
• /
• 2019

Background Even with satisfactory anastomosis technique and adequate experience of the surgeon, flap loss due to thrombosis can still occur due to the patient's underlying condition. Patients with hypercoagulability due to etiologies such as malignancy, hereditary conditions, and acquired thrombophilia are among those who could benefit from free flap procedures. This review aimed to evaluate the risk of free flap thrombosis in patients with hypercoagulability and to identify the most effective thromboprophylaxis regimen. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The PubMed, Embase, and Cochrane Library databases were explored. Types of free flaps, types of hypercoagulable states, thrombosis prevention protocols, thrombosis complication rates, and flap vitality outcomes were reviewed. Samples from the included studies were pooled to calculate the relative risk of free flap thrombosis complications in patients with hypercoagulability compared to those without hypercoagulability. Results In total, 885 articles underwent title, abstract, and full-text screening. Six articles met the inclusion criteria. The etiologies of hypercoagulability varied. The overall incidence of thrombosis and flap loss in hypercoagulable patients was 13% and 10.3%, respectively. The thrombosis risk was two times higher in hypercoagulable patients (P=0.074) than in controls. Thromboprophylaxis regimens were variable. Heparin was the most commonly used regimen. Conclusions Hypercoagulability did not significantly increase the risk of free flap thrombosis. The most effective thromboprophylaxis regimen could not be determined due to variation in the regimens. Further well-designed studies should be conducted to confirm this finding.

• 대한영양사협회학술지
• /
• 제4권1호
• /
• pp.53-64
• /
• 1998

This study was performed to investigate the cost of nutrition counseling service at present and to suggest the guideline for the payment. Data were collected using questionnaires and the cost of counseling was expected by analyzing the time consumed and needed for nutrition counseling. The results were as follows; In the case of diabetes, mean time of nutrition counseling was 69.7$\pm$35.3min/case, but the dietitian asked 82.7$\pm$44.6min/case for counseling and in the cases of renal diseases, mean time of counseling was 64.3$\pm$24.1min/case and the time asked was 84.8$\pm$34.5min/case (P<001) It was found that time was not enough to educate or counsel the clients. The cost of counseling was not counted in 20.3% of the respondants and the mean nutrition counseling fee was 5,460.6$\pm$3,547.7won/case in in-patient. The group education fee was 6,168$\pm$2,813won/case. The estimations of the cost for nutrition counseling services using labor cost were 18,463.5won in case of diabetes and 18,463.5won/case for patients of renal disease and in group education 8,111.5won and 7,404.3won respectively.

• 한국융합학회논문지
• /
• 제7권6호
• /
• pp.115-124
• /
• 2016

본 연구는 간호사의 암성통증관련 지식과 수행도를 융합적으로 조사하기 위한 연구로 M시의 간호사 295명을 대상으로 하였다. 암성통증관련 지식과 수행도는 조은경(2009)의 연구도구를 사용하였다. 수집된 자료는 SPSS 18.0, t-test, ANOVA, Multiple Linear Regression 으로 분석하였다. 대상자의 지식은 30점 만점에 평균 $19.21{\pm}6.16$, 수행도는 4점 만점에 평균 $3.12{\pm}0.41$으로, 같은 도구를 사용한 다른 연구들에 비해 낮은 수준이었다. 권고안을 인지하고 있는 간호사의 지식과 수행도 사이에 유의한 차이가 있었고, 대상자의 지식과 수행도 사이에 정적인 상관관계가(r=.488, p=.001) 있었다. 대상자의 권고안인지도는 38.6%에 불과하였으므로, 간호사의 권고안 인지 및 활용능력 향상 내용을 포함한 암성통증관리관련 교육으로 암성통증관련 지식도를 높여 통증관리 수행도를 높여야 할 필요성이 있다.

• Journal of Acupuncture Research
• /
• 제30권5호
• /
• pp.185-192
• /
• 2013

Objectives : Weight loss and loss of appetite in amyotrophic lateral sclerosis patients are common symptoms, these are associated with survival as well as nutritional condition. The changes in weight and appetite were reported after treatment using Megestrol acetate and Korean medical treatments. Methods : Amyotrophic lateral sclerosis patient with weight loss and loss of appetite were treated by administering megestrol acetate a known anti-malignant tumor agent and Korean medical treatments such as acupuncture, pharmacopuncture and herbal medicine. The changes in weight and appetite were checked using body mass index(BMI) and simplified nutritional appetite questionnaire(SNAQ). Results : There was a more than 17 kg increase in weight. BMI increased from 15.94 $kg/m^2$ to 21.97 $kg/m^2$ and SNAQ score increased from 7 to 16. Owing to several side effects, Megestrol acetate was stopped after which only Korean medical treatments were provided. After which the lasting effects in BMI and appetite could be seen. Conclusion : There are few studies on weight loss and loss of appetite in ALS patients. Using only megestrol acetate can cause several considerable side effects. Which respect to this, the findings in this study could open up new clinical guideline possibilities.

• 대한예방한의학회지
• /
• 제10권2호
• /
• pp.63-80
• /
• 2006

Public health oriental medical doctor has played a great role in providing oriental medical treatment and oriental medical health program with public health medical services, the basic infrastructure, however, is not sufficient. In this study, the researcher surveyed the treatment working or service condition of public health oriental medical doctor. 1. The payment, allowance of doctors are fixed upon the law and guideline according to the financial status of local government. The branch of public health center has more support like an official residence with expenses. 2. The public health center mainly has assitants and ratio of full-timer is more than the branch public health center without any assistants if any, they are temporary employee 3. The public health center has 5.22 beds while the branch has 3.14 beds. The daily average number of patient for public health center is 15.01 while the branch has 8.7 More than half of outpatients are over sixties with musculoskeletal disease. 4. Regarding the traveling clinic, the public health center put into more operation than the branch. The 3rd year serving public doctor gives negative about the traveling clinic much more than 1st and 2nd year serving public doctor. The treatment service condition of public doctor of the public health center is better than the branch doctor, but we are on the point of role-changing as health promotion and preventive treatment to bring up motivation, education and competence strengthening for execution the local-bound health program.

• 대한한방소아과학회지
• /
• 제18권1호
• /
• pp.179-191
• /
• 2004

Objective: The aim of this study was to investigate enuretic children attending oriental hospital and classify subtypes and evaluate possible factors that enhance or hamper of continence. Methods: Children attending kyeongju dongguk oriental hospital pediatrics between January 2000 and December 2003 with chief complaint of nocturnal enuresis were enrolled. The data of present symptoms and improvement progress was collected via telephone interviews with their parents. Results: The total number of children was 61. 32 of them were male and 29 female. Sex ratio was 1.1:1. Patient under 6 years of age was 68.8%. Using acupuncture, acupressure or chimsband with herb medicine, treatment frequency was increased. Patients with nocturnal enuresis(NE) was 48, and primary nocturnal enuresis(PNE) 39, secondary (SNE) 9. 13 was impossible to diagnose. The ratio of male to female was 1:1.09. PNE was 4 times as many as SNE. Male was predominent in PNE, and female in SNE. In the progress of PNE, male and female were similiar. but SNE, male was all cured, female remained 50%. And elapsed time of male to improve was longer than that of female. In the progress of improvement, many parents mentioned that their child was improved spontaneously regardless of subtype. Conclusion: We consider age, sex distinction, subtype, bladder symptoms, frequency, time of progress as influencing factor of prognosis, but failed to verify significance. To develop guideline of NE and find influencing factor of prognosis, more prospective study through taking history carefully and using questionnaire is needed.

• Archives of Plastic Surgery
• /
• 제36권3호
• /
• pp.262-268
• /
• 2009

Purpose: Recently medical dispute about plastic surgery is increasing rapidly as result of growing surgery itself due to high interest in appearance and advertisement of plastic surgery. So we want to find a way to prevent similar medical accident by making better solution of plastic surgery through case analysis of medical dispute. Method: 161 cases about plastic surgery asked for aid at Korea Consumer Agency and 41 cases judged at the court was surveyed and gender, location and kind of hospital, goal and kind of operation, making operation agreement or not, kind of damage, result of process, result of lawsuit was studied from 2004.1.1. to 2006.12.31. Result: Medical doctor have to explain about symptoms of disease, method of treatment, possibility of complication, prognosis to patients before therapy so they can make decision if they take operation by doctor or not. On this survey, among the patients who underwent re - operation or had complication, 88.1%(96 from 109 cases) of them didn't get enough explanation about possibility of complication before surgery They brought lawsuit insisting they would not undergo operation if they got enough explanation about possibility of complication and result of operation before surgery. Conclusion: It is advisable that doctor must observe the duty of explanation before surgery and respect the right to decide of patient, make operation agreement and put down concrete progress note and store the pre and post operative photo to avoid medical accident. It is also needed to have guideline of therapy, Code of ethics, organization which deals with medical dispute, reconsideration of law to control that.

• 한국실내디자인학회논문집
• /
• 제23권5호
• /
• pp.174-182
• /
• 2014

As patients prefer large scale hospitals recently, the interior design of general hospitals are conspicuously improving. In the past, most patients visit hospitals to get treatment on diseases; however, recently patients visiting hospitals for the early prevention of disease is rapidly increasing. Accordingly, contemporary hospitals should meet the wish of patients who want to get medical service in more clean and comfortable environment. The existing studies on hospital interior design were mostly limited on analyzing the functionality of each space; however, studies on the interior design of common use space, which is open to all hospital users, are required now. Accordingly, this study classified the common use space in contemporary general hospitals into lobby space, corridor space, waiting space and resting space. The interior design characteristics of each space were classified into; connectivity with external environment, level change by void, introduction of natural elements, dynamics of space and variety of color. Then a case analysis was done by selecting 12 common use spaces in overseas general hospitals. According to the analysis result, the interior design characteristics were more conspicuous in the sequence of corridor space, lobby space, resting space and waiting space. The interior design elements such as overall space arrangement and material-finishing were relatively acceptable; however, the aspect of a user's environmental behavior, in other words, the psychological aspect, which can lead a patient to natural healing, was relatively insufficient. It is believed that an in-depth interior design focusing on practical users would enable various spatial behaviors. It is hoped that this study would be a help to the interior design of domestic general hospitals as a guideline.

• 보건행정학회지
• /
• 제9권3호
• /
• pp.70-94
• /
• 1999

This paper was performed for a cost-effectiveness analysis of pharmacologic treatment of hypercholesterolemia. Agents modeled were cholestyramine, gemfibrozil. bezafibrate, lovastatin, pravastatin, simvastatin. Pharmacologic effectiveness was estimated by regression from reported clinical trials. Pharmacologic effects were expressed as the percent change of blood cholesterol level. Cost estimates included patients' travel expenses and time loss as well as resource consumption in the health care sector. Bezafibrate was the most efficient agent for reducing total cholesterol levels, having an cost over 1 year of ￦31.400 per percent reduction in total cholesterol. Simvastatin (10mg/d) was also efficient(￦33,100 per percent reduction). Chole styramine(8g/d) was least efficient at ￦90,200. For low-density lipoprotein cholesterol. simvastatin(10mg/d) was most efficient, at ￦23,200 per percent reduction, followed by lovastatin(20mg/d) at ￦28,000. Gemfibrozil was least efficient at ￦77,800 per percent reduction. For high-density lipoprotein cholesterol. bezafibrate(400mg/d) was most efficient at ￦39,300 per percent increase of high-density lipoprotein cholesterol. Cholestyramine was least efficient at ￦514,700. Analyses combining low-density lipoprotein cholesterol and high-density cholesterol effects suggest that bezafibrate(600mg/d) and simvastatin (10mg/d) were most efficient for reducing cardiovascular risk. The cost-effectiveness analysis results show that both simvastatin and bezafibrate could be efficient treatment. Simvastatin provide more effective treatment at higher cost, whereas bezafibrate is more cost-effective, as it may be less effective, at lower cost. Therefore, clinicians should choose reasonable treatment according to the patient's needs This pharmacoeconimc analysis will provide a guideline for efficient pharmacologic treatment and also be reference data for pricing new drugs.

• Journal of Korean Neurosurgical Society
• /
• 제45권2호
• /
• pp.90-95
• /
• 2009

Objective : We aimed to identify clinico-radiological risk factors that may predict unfavorable neurological outcomes in traumatic brain injury (TBI), and to establish a guideline for patient selection in clinical trials that would improve neurological outcome during the early post TBI period. Methods : Initial clinico-radiological data of 115 TBI patients were collected prospectively. Regular neurological assessment after standard treatment divided the above patients into 2 groups after 6 months : the Favorable neurological outcome group (GOS : good & moderate disability, DRS : 0-6, LCFS : 8-10) and the Unfavorable group (GOS : severe disability-death, DRS : 7-29 and death, LCFS : 1-7 and death). Results : There was a higher incidence of age $\geq$35 years, low initial GCS score, at least unilateral pupil dilatation, and neurological deficit in the Unfavorable group. The presence of bilateral parenchymal lesions or lesions involving the midline structures in the initial brain CT was observed to be a radiological risk factor for unfavorable outcome. Multivariate analysis demonstrated that age and initial GCS score were independent risk factors. The majority of the Favorable group patients with at least one or more risk factors showed improvement of GCS scores within 2 months after TBI. Conclusion : Patients with the above mentioned clinico-radiological risk factors who received standard treatment, but did not demonstrate neurological improvement within 2 months after TBI were deemed at risk for unfavorable outcome. These patients may be eligible candidates for clinical trials that would improve functional outcome after TBI.