• Title/Summary/Keyword: Primary care

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Korean physicians' attitudes toward the prenatal screening for fetal aneuploidy and implementation of non-invasive prenatal testing with cell-free fetal DNA

  • Kim, Soo Hyun;Kim, Kun Woo;Han, You Jung;Lee, Seung Mi;Lee, Mi-Young;Shim, Jae-Yoon;Cho, Geum Joon;Lee, Joon Ho;Oh, Soo-young;Kwon, Han-Sung;Cha, Dong Hyun;Ryu, Hyun Mee
    • Journal of Genetic Medicine
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    • v.15 no.2
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    • pp.72-78
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    • 2018
  • Purpose: Physicians' attitudes may have a strong influence on women's decision regarding prenatal screening options. The aim of this study is to assess the physicians' attitudes toward prenatal screening for fetal aneuploidy including non-invasive prenatal testing (NIPT) in South Korea. Materials and Methods: Questionnaires were distributed and collected at several obstetrics-gynecological conferences and meetings. The questionnaire included 31 multiple choice and 5 fill-in-the-blank questions. Seven questions requested physicians' demographic information, 17 questions requested information about the NIPT with cell-free fetal DNA, and 12 questions requested information about general prenatal screening practices. Results: Of the 203 obstetricians that completed the survey. In contrast with professional guidelines recommending the universal offering of aneuploidy screening, only 53.7% answered that prenatal aneuploidy testing (screening and/or invasive diagnostic testing) should be offered to all pregnant women. Physicians tended to have positive attitudes toward the clinical application of NIPT as both primary and secondary screening methods for patients at high-risk for fetal trisomy. However, for patients at average-risk for fetal trisomy, physicians tended to have positive attitudes only as a secondary screening method. Physicians with more knowledge about NIPT were found to tend to inform their patients that the detection rate of NIPT is higher. Conclusion: This is the first study to investigate expert opinion on prenatal screening in South Korea. Education of physicians is essential to ensure responsible patient counseling, informed consent, and appropriate management after NIPT.

DENTAL MANAGEMENT OF A PATIENT WITH MUSCULAR DYSTROPHY UNDER GENERAL ANESTHESIA: CASE REPORT (근이영양증(muscular dystrophy) 환자의 전신마취 하 치과치료 : 증례보고)

  • Chae, Jong Kyun;Song, Ji-Soo;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Young-Jae
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.15 no.1
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    • pp.50-54
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    • 2019
  • Muscular dystrophy (MD) is a heterogeneous group of inherited neuromuscular disorders, characterized by progressive muscle weakness. Severity of the disease ranges from mild to severe, and the disease is mostly caused by mutations in a number of genes. These genetic mutations cause lack of proteins which are essential for muscle cell stability. Muscle fibers are gradually replaced by fat and fibrous tissue. The muscles of the head and neck are affected in several types of MD that manifest as altered craniofacial morphology and dental malocclusion. A 3-year-10-month old, 15.0 kg boy with MD presented to Seoul National University Dental Hospital, Seoul, South Korea because of extensive carious teeth. A number of dental caries in primary dentition were identified during clinical oral examination. Due to dental anxiety and underlying systemic disease, general anesthesia was considered. General anesthesia was induced and maintained with intravenous anesthetics, propofol and remifentanil. Caries treatments - resin restoration, pulpectomy, zirconia crown restoration, stainless steel crown restoration - were performed. Under general anesthesia, successful dental procedure was done. Total intravenous anesthesia (TIVA) was performed instead of inhalation anesthesia in order to avoid risk of complications such as malignant hyperthermia and life-threatening rhabdomyolysis. With decreasing muscle function, plaque control becomes more difficult and leads to gingivitis. Especially, the open-mouth posture worsens gingivitis and can leads to malocclusions and problems in swallowing. Regular and periodic dental care is essential for maintaining oral health for patients with MD.

Analysis of the association of serum potassium and lactic acid with neurologic outcome in out-of hospital post-cardiac arrest adult patients (자발순환 회복된 병원 외 성인 심정지 환자의 신경학적 예후와 혈청 칼륨 및 젖산 농도와의 관련성 분석)

  • Lee, Yong Heon;Kim, Wonhee;Kang, Gu Hyun;Jang, Yong Soo;Choi, Hyun Young;Kim, Jae Guk
    • Journal of The Korean Society of Emergency Medicine
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    • v.29 no.5
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    • pp.493-499
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    • 2018
  • Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

Intravenous Fluid Selection for Unruptured Intracranial Aneurysm Clipping : Balanced Crystalloid versus Normal Saline

  • Kang, Jian;Song, Young Joo;Jeon, Sujeong;Lee, Junghwa;Lee, Eunsook;Lee, Ju-Yeun;Lee, Euni;Bang, Jae Seung;Lee, Si Un;Han, Moon-Ku;Oh, Chang Wan;Kim, Tackeun
    • Journal of Korean Neurosurgical Society
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    • v.64 no.4
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    • pp.534-542
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    • 2021
  • Objective : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

Analysis on the Relationship between the Number of Clinics and the Use of Preventable Hospital Service: focusing on asthma patients (지역 내 의원 수와 예방 가능한 병원 서비스 이용 간의 관계분석: 천식 환자를 중심으로)

  • Lee, Hyun-Ji;Park, You-Hyun;Cho, Hyung-Kyung;Seol, Jin-Ju;Kwak, Jin-Mi;So, Ye-Kyeong;Park, Su-Jin;Lee, Kwang-Soo
    • Korea Journal of Hospital Management
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    • v.25 no.4
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    • pp.94-102
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    • 2020
  • Purposes: The purpose of this study was to analyze the trends of hospitalization and emergency room visits of asthma patients over the three years in 25 districts of Seoul. And analyzed the relationship between preventable hospital service uses and number of clinics for asthma patients. Methods: Data was collected from a customized database of the NHI(National Health Insurance) for 2016 to 2018. The number of clinics means Internal Medicine, Pediatrics, Ear-Nose-Throat, and Family Medicine clinics. The hospital service means the number of adults admission for asthma and the number of total asthma emergency visits. This study used kappa analysis to assess the agreements of indicators between years, and structural equation modeling analysis was applied to analyze the relationship. Findings: The kappa value of the number of adults admission for asthma was compared between 2016 and 2017(kappa score=0.68), and was lowered when compared between 2016 and 2018(kappa score=0.26). And the value of kappa in the number of total asthma emergency visits due to asthma between 2016 and 2017(kappa score=0.51) was lower than that of between 2016 and 2018(kappa score=0.60). And the results showed that the number of clinics significantly negatively related to the uses of hospital services in asthmatic patients(β=-0.5, p=0.005). Practical Implication: This research could provide policy implications for strengthening primary care services that can contribute to the reduction of preventable hospital services.

An Analysis of the Prevalence and Pattern Identification of Korean Medicine for Acute Stress Disorder and Post Traumatic Stress Disorder in Patients with Traffic Injuries (교통사고 상해증후군 환자의 급성 스트레스 장애와 외상 후 스트레스 장애의 유병률과 한의변증유형 분석)

  • Lee, Yu Jin;Lee, Sung Joon;Cheong, Moon Joo;Lim, Jung Hwa;Jo, Hee Geun;Kim, Bo Min;Chung, Sun-Yong;Kwak, Hui-Yong;Park, Bo Ra;Park, Tae-Yong;Shin, Byung-Cheul;Kang, Hyung Won
    • Journal of Oriental Neuropsychiatry
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    • v.32 no.1
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    • pp.1-11
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    • 2021
  • Objectives: To investigate the prevalence of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) in patients with traffic injuries. In addition, PTSD patients was classified using 'pattern identification for jing ji and zheng chong'. Methods: Questionnaires such as the primary care PTSD screen for DSM-5(PC-PTSD-5), Korean version of PTSD checklist-5 (PCL-5-K), and the instrument of pattern identification for jing ji and zheng chong were conducted on 195 patients within 3 days to 1 year after traffic accidents. Patients were recruited from six medical institutions. Collected data were used to determine the prevalence of acute stress disorder and post-traumatic stress disorder. Results: On PC-PTSD-5, the prevalence was 39.1% for ASD and 50% for PTSD. On PCL-5-K, the prevalence was 20.4% for ASD and 29.3% for PTSD. Satisfying both PC-PTSD-5 and PCL-5-K, the prevalence was 18.2% for ASD and 25.8% for PTSD. As a result of pattern identification for jing ji and zheng chong, 'weakness of heart and gall bladder type' accounted for the highest proportions in both ASD and PTSD groups. Conclusions: In this study, the prevalence was 39.1% for ASD and 50% for PTSD by PC-PTSD-5. Satisfying both PC-PTSD-5 and PCL-5-K, the prevalence was 18.2% for ASD and 25.8% for PTSD. Further large-scale prospective studies are needed to analyze the prevalence of ASD and PTSD, the rate of progression from ASD to PTSD, and the type of pattern identification.

A Qualitative Study of the Parenting Experience of Adolescents (청소년기 자녀 어머니의 양육경험에 대한 질적 연구)

  • Choi, Ji-Won;Kim, Soo-young
    • The Journal of the Korea Contents Association
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    • v.21 no.5
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    • pp.837-854
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    • 2021
  • This study was conducted to explore parenting experiences for mothers of adolescent children. Participants in the study were 7 primary caregivers of children in the first to third grades of middle school in the Seoul area, and in-depth interviews were conducted from September to November 2019. After recording the interviews of each participant, the transcripts of verbal words and documents that were the summary of the interview were collected as data. In this study, the participants' perceptions of experiences and actions were analyzed by Smith & Osborn (2003)'s interpretative phenomenological method, which allows researchers to make meanings. As a result of data analysis, 6 major topics and 25 sub-themes were derived. The results derived from the parenting experiences of mothers of adolescents are largely six types: the implications of spending time with their children, unnatural act, the aesthetics of expression, the way to recharge energy, the mental heritage that they want to leave for their children, and resilience. The research results of this study can be presented so that they can learn the healthy responses and interaction of care-givers in a preventive educational dimension, as it provides both generality and specificity of how mothers should interact with their adolescent children in the field of clinical practice.

The Analysis of Research Trends in Korea on Nursing Informatics Competencies: A Scoping Review (간호정보역량 국내 연구동향 분석: 주제범위 문헌고찰)

  • Roh, Min;Kang, Hyun Seon;Kwon, Yong Eun
    • Journal of Digital Convergence
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    • v.20 no.4
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    • pp.779-790
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    • 2022
  • The purpose of this study was to identify research trends related to nursing informatics competency and to present further directions. This study was scoping review designed and used methodological framework by Arksey and O'Mally. The reviewed study were found through electronic databases and published from January 2000 to December 2021. There were a total of 18 studies that were included in the analysis. The framework is comprised of evaluating the characteristics and the topic of research conducted. Research in regards to nursing informatics competency has increased after 2010, and quantitative research and research with nurses as the primary subject accounted for the majority of the studies performed. Factors that influenced the outcome for the nursing informatics competency were education, position, and key variables were work performance, self-leadership, job satisfaction, nursing work achievements, nursing organizational culture, and working environment. This research is significant that it systematically reviewed the nursing informatics competency and set a direction for further studies. In the further study, it is necessary to reflect changes in the health care system and nursing work environment and it is suggested to develop educational programs to improve nursing informatis competency for nurses and nursing students.

Factors Affecting Fear of Dementia of Aged in the Community (지역사회 거주 노인의 치매두려움에 미치는 영향 요인)

  • Kim, Min Suk;Kim, Jeong Sun
    • 한국노년학
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    • v.40 no.1
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    • pp.179-196
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    • 2020
  • The purpose of this study was to identify the factors impacting fear of dementia, targeting the aged in the community. The study targeted 258 seniors aged 65 or older attending the senior college or using the senior citizen community center in areas of Jeollannam-do. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and a stepwise multiple linear regression. Fear of dementia of the aged showed significant positive correlations with dementia anxiety, and aged anxiety. dementia anxiety, aged anxiety, dementia experience, use of a hearing aid, religion, level of dementia interest were significant predictors influencing fear of dementia of aged in the community, and these variables accounted for 37.2% of the variance. Therefore, this study suggests that in order to p revent fear of dementia of aged people in the primary health care setting, it is necessary to have a nurse's assessment on the factors affecting dementia as well as a multi-faceted education strategy for proper recognition of dementia.

Interest in Health and Hygiene of Hairdressers and Their Awareness of COVID-19 (헤어 미용인들의 보건위생 관심과 COVID-19에 대한 인식정도 연구)

  • Shim, Sang Hee;Lee, Keun Kwang
    • Journal of Naturopathy
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    • v.10 no.2
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    • pp.93-107
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    • 2021
  • Background: The need for an investigation into the hygiene and awareness of hairdressers regarding Corona infection has emerged. Purpose: To investigate the level of interest in health and hygiene of hairdressers and their awareness of COVID-19. Methods: A questionnaire survey was conducted with hairdressers located in Daejeon Metropolitan City. The SPSS 26.0 program analyzed a total of 260 collected questionnaires. Results: The interest in the health and hygiene of hairdressers showed a statistically significant difference according to age, educational background, job title, type of hairdresser, and years of service. The hairdresser's risk and degree of awareness of COVID-19 were higher in those in their 30s or older, managers, medium-sized stores, and ten years of service. In terms of optimism about Corona, it was found to be high among those in their 20s, assistant staff, large stores, and less than five years of service. In addition, there was a positive (+) correlation between health care concerns, hand hygiene and mask hygiene, and awareness of corona risk and optimism. Conclusions: The level of health and hygiene interest and awareness of hairdressers significantly increased according to age, educational background, job title, type of hairdresser, and length of service. Therefore, it evaluated that this result would serve as primary data for research in this field.