• 대한암한의학회지
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• 제18권1호
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• pp.1-7
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• 2013

Objective : This study is purposed to report 2 cases of cancer patient whose symptoms related to radiation pneumonitis had been controlled with Saengmaek-san treatment. Methods : A 56-year-old female rectal cancer patient was prescribed with Saengmaek-san due to the symptoms which had developed 4 weeks after the completion of her radiotherapy session in both lungs. Her chief complaints were shortness of breath, dry cough and fatigue. Another case, 53-year-old male patient with hepatocellular carcinoma, had also developed symptoms of fatigue, weight loss and dry cough after his radiotherapy session in left upper lung zone. Radiological changes of both patients' chest X-ray suggested radiation pneumonitis. Results : Symptoms of the female patient were improved, especially shortness of breath, after Saengmaek-san treatment, without any aggravation in her chest X-ray result. However, infiltrative opacity in the left upper lung zone of the male patient was aggravated despite the improvement of his clinical symptoms. His remaining symptoms and radiological change were effectively controlled after steroid therapy. Conclusion : Seangmaek-san may be considered as a potential treatment for symptoms related to radiation pneumonitis with proper monitoring.

• 임상간호연구
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• 제23권3호
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• pp.376-387
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• 2017

Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

• 기본간호학회지
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• 제24권4호
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• pp.255-264
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• 2017

Purpose: The purpose of this study was to develop a smartphone app for use in patient controlled analgesia (PCA) education and to identify PCA knowledge and pain management following lower extremity orthopaedic surgery under spinal anesthesia in patients who received smartphone app education. Methods: Participants were 150 patients in an orthopaedic hospital located in Busan. The measurement variables used in this study were PCA knowledge, pain management and pain level. For data analysis, SPSS/WIN 21.0 program was used in the analysis of the relation of frequencies. In addition, percentage, mean and standard deviation, t-test, ANOVA, Duncan, Pearson's correlation coefficients were also assessed. Results: The score for knowledge regarding PCA was $4.27{\pm}1.64$. The correlations between knowledge and pain management (button push times

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.141-146
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• 2015

Background: An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery. Methods: A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time. Results: VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2. Conclusions: Diurnal variance in pain should be considered for effective dosing strategies.

• The Korean Journal of Pain
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• 제12권2호
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• pp.200-204
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• 1999

Background: Patient-controlled analgesia (PCA) has proven to be safe and effective in children from age 5 years, and older and compares favourably with continuous morphine infusion in the older child. We compared fentanyl and butorphanol for opioid use in PCA with ketorolac to determine a suitable drug combination for post-tonsillectomy pain control. Methods: We studied 60 patients, aged 5~12 yrs, undergoing tonsillectomy with or without adenoidectomy under general anesthesia using $N_2O-O_2$-enflurane. Patients were randomly assigned to receive fentanyl $250\;{\mu}g$ (Group 1: n=30) or butorphanol 5 mg (Group 2: n=30) mixed with ketorolac 90 mg and ondansetron 4 mg diluting 100 ml of 5% D/W solutions intravenously via PCA pump after operation. PCA pump were programmed to deliver a 0.05 ml/kg loading dose, 0.01 ml/kg/hr basal infusion, 0.01 ml/kg on demand bolus, 6 min lockout intervals between doses and 4 bolus hourly limit. Total infusion dosage of PCA drug, VAS pain scores, side effects and satisfaction score of both groups were monitored for 48 hrs. Results: Total infusion dosages were fentanyl $170.6\;{\mu}g$ with ketorolac 61.4 mg (Group 1) and butorphanol 2.8 mg with ketorolac 50.4 mg (Group 2). Total infusion dosage, quality of analgesia, side effects and overall satisfaction didn't differ between two groups. Conclusions: Both fentanyl and butorphanol mixed with ketorolac were effective for post-tonsillectomy pain control using PCA pump in children as young as 5 years old.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2004년도 제29회 추계학술대회 발표논문집
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• pp.140-143
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• 2004

To appropriately control or compensate breathing motion of targets in thorax or abdomen during radiotherapy is still demanding. Our idea is that a visual signal may help regulate patient's breathing pattern, by controlling its amplitude and cycle. The system involving breathing control with a visual signal for aperture maneuver with controlled breath (AMC) has been developed. A thermocouple is used to detect the temperature change due to patient's breathing. The system also consists of a mask, in which the thermocouple is installed, an operational amplifier, a converter, etc. Patients were instructed to control their respiration by breathing following the visuals signal, as watching a display that shows both patients' current breathing pattern and the signal. The patterns of patients' controlled breathing and the signals coincided well. Therefore, when AMC technique is applied, a target moves in the range that is 60 % less than the range of free breathing motion with the help of the system and so target margins can be reduced significantly. This study reveals that a visual signal is not only useful to control patient's breathing but also clinically effective.

• 한국임상약학회지
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• 제28권1호
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• pp.17-23
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• 2018

Objective: Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR. Methods: The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records. Results: Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different. Conclusion: The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

• 성인간호학회지
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• 제21권4호
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• pp.379-390
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• 2009

Purpose: The study was done to investigate the effect of ethanol inhalation on postoperative nausea in patients using Patient Controlled Analgesia (PCA). Methods: The data were collected from June 1st 2006 to September 30th, 2007. The subjects were 70 patients who had had orthopedic surgery under general anesthesia. The levels of the Visual Analogue Scale (VAS) was used to measure postoperative nausea. The experimental group was given ethanol inhalation using ethanol pads and the control group received normal saline pads. All participants were instructed to take two deep sniffs with the pad one inch from the nose. This was repeated every five minutes for three doses. The collected data were analyzed using SPSS/WIN 12.0 program. Results: The study supported all hypotheses. "The experimental group given first dose of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -5.900, p = .000). "The experimental group given second doses of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -7.507, p = .000). "The experimental group given third doses of ethanol inhalation would have a lower level postoperative nausea compared to the control group"(t = -6.685, p = .000). Conclusion: According to these results, the ethanol inhalation can be considered an effective nursing intervention for relieving the postoperative nausea in patients using PCA.

• Clinical and Experimental Reproductive Medicine
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• 제25권2호
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• pp.217-231
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• 1998

The effectiveness of intrauterine insemination (IUI) combined with controlled ovanan hyperstimulation (COH) in the treatment of infertility with various etiologies was compared in a total of 152 cycles. Patients received a maximum of three IUI cycles for the treatment. Severe male ($<2\times10^6$ motile sperm) or age factor (> 39 y) patients were excluded in this study. Pregnancy was classified as clinical if a gestational sac was seen on ultrasound. The overall clinical pregnancy rate was 7.9% per cycle (12/152) and 9.7% per patient (12/124). The pregnancy rates were 0% in unstimulated natural (0/18), 7.5% in CC (3/40), 8.2% in CC+hMG (4/49), 5.9% in GnRH-a ultrashort (1/17), 5.9% in GnRH-a long (1/17) and 27.3% in dual suppression cycles (3/11), respectively. The pregnancy rate was higher in dual suppression cycle than other stimulated cycles, but this was not significant. The multiple pregnancy rates were 25.0% (2 twins and 1 triplet). No patient developed ovarian hyperstimulation. Abortion rates were 66.7% in CC (2/3) and 100% in ultrashort cycles (1/1). The livebirth rate was 5.9% per cycle (9/152) and 7.3% per patient (9/124). There were no differences in age, duration of infertility, follicle size, total ampules of gonadotropins and days of stimulation between pregnant and non-pregnant groups. However, significant(P<0.05) differences were observed in the level of estradiol $(E_2)$ on the day of hCG injection ($3,266.6{\pm}214.2$ vs $2,202.7{\pm}139.4$ pg/ml) and total motile sperm count ($212.1{\pm}63.4$ vs $105.1{\pm}9.9\times10^6$) between pregnant group and non-pregnant group. These results suggest that IUI combined with successful ovarian stimulation tends to improve the chance of pregnancy as compared to IUI without COH and a total motile sperm count may be considered predictive of the success for pregnancy.

• The Korean Journal of Pain
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• 제26권1호
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• pp.39-45
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• 2013

Background: Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. Methods: We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. Results: Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. Conclusions: Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.