The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.
Kim, Se-Mi;Kang, Hyun-Ah;Cho, Hea-Young;Shin, Sae-Byeok;Yoo, Hee-Doo;Yoon, Hwa;Lee, Yong-Bok
YAKHAK HOEJI
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v.52
no.3
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pp.195-200
/
2008
Gabapentin, [1-(aminomethyl) cyclohexaneacetic acid], a structural analog of $\gamma$-aminobutyric acid (GABA), is being developed for the treatment of epilepsy. Unlike GABA, gabapentin crosses the blood-brain barrier after systemic administration. Gabapentin is an effective antiepileptic drug in patients with partial and secondarily generalized seizures who are uncontrolled with use of existing anticonvulsant drug therapy. The purpose of the present study was to evaluate the bioequivalence of two gabapentin 400 mg capsules, $Neurontin^{(R)}$ capsule 400 mg (Pfizer Inc.) and Gabatin capsule 400 mg (Korean Drug Co. Ltd), according to the guidelines of the Korea Food and Drug Administration (KFDA). The release of gabapentin from the two gabapentin formulations in vitro was tested using KP VIII Apparatus II method with various dissolution media (pH 1.2, 4.0, 6.8 buffer solution and water). Twenty six healthy male subjects, 23.58$\pm$1.50 years in age and 66.74$\pm$8.31 kg in body weight, were divided into two groups and a randomized 2$\times$2 cross-over study was employed. After one capsule containing 400 mg as gabapentin were orally administered, blood was taken at predetermined time intervals and the concentrations of gabapentin in serum were determined using HPLC with fluorescence detector. The dissolution profiles of two formulations were similar at all dissolution media. In addition, the pharmacokinetic parameters such as $AUC_t$, $C_{max}$ and $T_{max}$ were calculated and ANOVA test was utilized for the statistical analysis of the parameters using logarithmically transformed $AUC_t$, $C_{max}$ and untransformed $T_{max}$. The results showed that the differences between two formulations based on the reference drug, $Neurontin^{(R)}$ capsule 400 mg, were 2.04, -3.68 and 16.79% for $AUC_t$, $C_{max}$ and $T_{max}$, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log 0.8 to log 1.25 (e.g., log 0.91$\sim$log 1.16 and log 0.87$\sim$log 1.11 for $AUC_t$ and $C_{max}$, respectively). Thus, the criteria of the KFDA bioequivalence guideline were satisfied, indicating Gabatin capsule 400 mg was bioequivalent to $Neurontin^{(R)}$ capsule 400 mg.
The purpose of this study is to verify the mediating effects of psychological flexibility on the relationship between emotional dissonance and mental health(depression, anxiety, somatic symptoms) in university administration staff. For this study, a sample of 191 university administration staff completed the questionnaires. The data was analyzed using the SPSS program and Sobel Test. The results of the analysis are as follows: 1. Most of the university administration staff had difficulties with emotional dissonance(52.36%), depression(47.12%), anxiety(58.12%), and somatic symptoms(62.83%). 2. The risk group of emotional dissonance had a significantly higher level of depression, anxiety and somatic symptoms compared with the normal group. 3. Emotional dissonance and psychological flexibility had a significant effect on depression, anxiety and somatic symptoms. 4. The mediating effects of psychological flexibility on the relationship between emotional dissonance and mental health(depression, anxiety, somatic symptoms) was verified. Finally, We suggested the need to intervene in emotional labor and mental health in university administration staff and psychological flexibility as an intervention and prevention method.
The purpose of this study is to develop an ACT group counseling program for the purpose of alleviating and healing the job stress and burnout of nursing care workers and to verify the effectiveness of the ACT group counseling program. To this end, the goal and theoretical model, content, operation and evaluation of the program were composed and applied according to the procedure. The main research results are as follows. First, as a result of measuring the job stress of the study subjects, there was a positive change in the group participating in the program. Second, as a result of measuring the level of job burnout of the study subjects, there was a positive change in the group participating in the program. Third, as a result of measuring the level of role conflict of the study subjects, there was a positive change in the group participating in the program. Fourth, as a result of measuring the level of over-role of the study subjects, there was a positive change in the group participating in the program. Fifth, as a result of measuring the level of role ambiguity of the study subjects, there was a positive change in the group participating in the program. As a practical implication, by including the ACT theory and practice plan in various nursing care providers training courses, the ability to respond to job burnout and job stress is increased, and ultimately, by increasing the psychological flexibility of nursing care workers, the opportunity for essential change in attitude toward work and life describe what to provide.
Cho, Ui Sang;Song, Young Joo;Jung, Young Mi;Choi, Kyung Suk;Lee, Eunsook;Lee, Euni;Han, Moon-Ku
Journal of Neurocritical Care
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v.11
no.2
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pp.110-118
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2018
Background: The role of clinical pharmacists in medication therapy to improve clinical and economic outcomes has been reported in the literature. This study was conducted to analyze the changes in details of medication interventions before and after the introduction of clinical pharmacists into the care of neurocritical care unit (NCU) patients, and to evaluate the economic effects of clinical pharmacists by calculating the avoidance cost. Methods: A retrospective study was conducted reviewing the electronic medical records from June 2013 to May 2014 (before), and from June 2016 to May 2017 (after). We calculated the number and rates of intervention, the acceptance rates of it, and also reviewed the list of interventions. We calculated avoidance cost if there was no intervention. Results: The monthly mean number of interventions increased from 8.0 (${\pm}5.7$) to 31.7 (${\pm}12.8$) (P<0.001) and the frequency of intervention also increased from 0.8% to 1.6% (P=0.003). The most frequently provided pharmacist intervention was nutritional support before introduction of clinical pharmacists and discussions on the medication plan after. The number of classified interventions was 14 before introduction of clinical pharmacist services and 33 after. The calculated cost avoidance associated with a clinical pharmacists' integration was 77,990,615 won per year. Conclusion: Introduction of clinicals pharmacist into the NCU was associated with increased intervention rates and expanded types of clinical interventions. The cost avoidance achieved by the pharmacists' interventions can be further explored to evaluate if similar expansions of pharmacists' services achieve similar results in other settings.
This study aimed to investigate the effect of cognitive-motor interaction-based instrument playing on the early social skills of children with autism spectrum disorder (ASD). Nine children with ASD, averaging 5.6 years of age, participated in twelve individual sessions lasting 30 minutes each. The intervention comprised five stages: self-regulation, motivation to engage in social interaction, acceptance of a partner in co-playing activities, interpersonal coordination with a partner, and engagement in joint music playing. To evaluate changes in early social skills, joint attention and social interaction behaviors were observed, and the Social Responsiveness Scale (SRS-2) was administered pre- and post-intervention. Social synchronization was measured through a dyadic drum task, measuring synchronization accuracy, duration, and timing. Following the intervention, all nine children demonstrated increased early social behaviors, although there were no significant differences in SRS scores. Moreover, synchronized movement improved significantly in accuracy and maintained duration but not in reaction time. This study highlights the significance of recognizing the cognitive-motor interplay as crucial element in facilitating early social skills development in children with ASD.
The aim of this study is to evaluate plan quality and dose accuracy for Volumetric Modulated Arc Therapy (VMAT) on the TG-119 and is to investigate the effects on variation of the selectable optimization parameters of VMAT. VMAT treatment planning was implemented on a Varian iX linear accelerator with ARIA record and verify system (Varian Mecical System Palo Alto, CA) and Oncentra MasterPlan treatment planning system (Nucletron BV, Veenendaal, Netherlands). Plan quality and dosimetric accuracy were evaluated by effect of varying a number of arc, gantry spacing and delivery time for the test geometries provided in TG-119. Plan quality for the target and OAR was evaluated by the mean value and the standard deviation of the Dose Volume Histograms (DVHs). The ionization chamber and $Delta^{4PT}$ bi-planar diode array were used for the dose evaluation. For treatment planning evaluation, all structure sets closed to the goals in the case of single arc, except for the C-shape (hard), and all structure sets achieved the goals in the case of dual arc, except for C-shape (hard). For the variation of a number of arc, the simple structure such as a prostate did not have the difference between single arc and dual arc, whereas the complex structure such as a head and neck showed a superior result in the case of dual arc. The dose distribution with gantry spacing of $4^{\circ}$ was shown better plan quality than the gantry spacing of $6^{\circ}$, but was similar results compared with gantry spacing of $2^{\circ}$. For the verification of dose accuracy with single arc and dual arc, the mean value of a relative error between measured and calculated value were within 3% and 4% for point dose and confidence limit values, respectively. For the verification on dose accuracy with the gantry intervals of $2^{\circ}$, $4^{\circ}$ and $6^{\circ}$, the mean values of relative error were within 3% and 5% for point dose and confidence limit values, respectively. In the verification of dose distribution with $Delta^{4PT}$ bi-planar diode array, gamma passing rate was $98.72{\pm}1.52%$ and $98.3{\pm}1.5%$ for single arc and dual arc, respectively. The confidence limit values were within 4%. The smaller the gantry spacing, the more accuracy results were shown. In this study, we performed the VMAT QA based on TG-119 procedure, and demonstrated that all structure sets were satisfied with acceptance criteria. And also, the results for the selective optimization variables informed the importance of selection for the suitable variables according to the clinical cases.
The purpose of this study was to find out various problem behaviors of children who were not diagnosed with any disability, but instead, engaged in problem behaviors. This study also intended to review the difficulties of children with problem behaviors, their teachers' difficulties and needs, to suggest support for child care and education teachers. This study conducted semi-structured qualitative interviews with eight child care and education teachers. The interviews were transcribed into text and analyzed by contents. The results of this study are as follows. Problem behaviors of children described by teachers were classified into external and internal types. In addition, children with problem behaviors had experienced difficulties in maintaining relationships with their teachers, peers and parents. Many teachers were not successful to provide appropriate support for preschoolers who demonstrated problem behaviors in classrooms or some teachers provided individualized support. Teachers adapted the behavioral and the psychological approaches to problem behaviors of preschoolers. However, teachers reported difficulties with children with problem behavior and brought up the following issues on teaching children with problem behaviors; managing troubled matters happening in the class, difficulty in controlling teacher's emotions on problem behaviors, the lack of time, the integrated child care time without teacher in charge of child, the interruption in activity progress, the lack of a special way to deal with problem behaviors, and difficulty in cooperation with families through parents-teacher counseling sessions. Teachers counseled with parents who had a child with problem behaviors and revealed that parents reacted to problem behaviors in various ways such as embarrassment, acceptance, ignorance, or avoidance. Most teachers received assistance and support for teaching children with problem behaviors, from families, local communities and in-service training. Lastly, teachers with preschoolers with problem behaviors needed the support of experts on managing behavior problems, assistant teaching personnel, education for parents and teachers, respects for teachers, psychological counseling or play therapy from professional service agencies, diagnosis service at child care and education centers which children attended, and support networking with agencies. Teachers also required the family support of medical diagnosis and psychological counseling and financial support from the government.
The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.
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