• Journal of Trauma and Injury
• /
• 제30권4호
• /
• pp.113-119
• /
• 2017

Purpose: Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated. Methods: A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period. Results: Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3. Conclusions: An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.

• Journal of Gastric Cancer
• /
• 제18권1호
• /
• pp.37-47
• /
• 2018

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권14호
• /
• pp.6089-6092
• /
• 2015

Background: The prevalence of metronidazole-resistant H. pylori is almost 50% in Thailand which severely limits the use of this drug for eradication therapy. The aims of this study were to evaluate the efficacy and safety profiles of 7-day bismuth-based quadruple therapy including metronidazole as an initial treatment for H. pylori infection in a high metronidazole resistance area. Materials and Methods: This study was performed at Thammasat University Hospital and King Chulalongkorn Memorial Hospital during January 2009 to October 2010. Patients with non-ulcer dyspepsia (NUD) with active H. pylori infection were assigned to receive seven days of quadruple therapy (pantoprazole 40 mg bid, bismuth subsalicylate 1,048 mg bid, amoxicillin 1 gm bid and metronidazole 400 mg tid). H. pylori infection was defined as positive H. pylori culture or two positive tests (rapid urease test and histology). Antibiotic susceptibility test for metronidazole by Epsilometer test (E-test) was performed in all positive cultures. At least four weeks after treatment, $^{13}C$ urea breath test ($^{13}C-UBT$) was performed to confirm H. pylori eradication. Results: A total of 114 patients were enrolled in this study, 50 males and 64 females with a mean age of 49.8 years. All 114 patients had a diagnosis of NUD. Overall eradication as confirmed by negative $^{13}C-UBT$ was achieved in 94 out of 114 patients (82.5%). 44 patients had positive cultures and success for E-test. In vitro metronidazole resistance was observed in 22/44 (50%) patients. Eradication rate in patients with metronidazole resistant strains was 16/22 (72.7%) and 20/22 (90.1%) with metronidazole sensitive strains (72.7% vs 90.1%, p-value=0.12; OR=3.75 [95%CI=0.6-31.5]). Minor adverse reactions included nausea, bitter taste, diarrhea and black stools but none of the patients dropped out from the study. Conclusions: Initial treatment with 7-day bismuth-based quadruple therapy including metronidazole, amoxycillin and pantoprazole is highly effective and well tolerated for metronidazole-sensitive H. pylori infections. However, the efficacy markedly decline with metronidazole resistance. Longer duration of this regimen might be required to improve the eradication rate and larger multi-center studies are needed to confirm this hypothesis.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.9027-9031
• /
• 2014

Background: Helicobacter pylori (H. pylori) infection is an established cause of peptic ulcers and gastric cancer. The aim of this study was to identify H. pylori genotypes and to examine their associations with geographical regions and gastritis, peptic ulcers and gastric cancer in Laos. Materials and Methods: A total of 329 Lao dyspeptic patients who underwent gastroscopy at Mahosot Hospital, Vientiane, Laos during December 2010 - March 2012 were enrolled. Two biopsy specimens (one each from the antrum and corpus) were obtained for CLO testing and only CLO test-positive gastric tissue were used to extract DNA. PCR and sequencing were identified for variants of the cagA and vacA genotypes. Results: Some 119 Laos patients (36.2%) were found to be infected with H. pylori including 83 with gastritis, 13 with gastric ulcers (GU), 20 with duodenal ulcers (DU) and 3 with gastric cancer. cagA was detected in 99.2%. East-Asian-type cagA (62%) and vacA s1c (64.7%) were predominant genotypes in Laos. vacA s1c-m1b was significantly higher in GU than gastritis (53.8% vs. 24.1%; P-value=0.04) whereas vacA s1a-m2 was significantly higher in DU than gastritis (40.0% vs. 16.9%; P-value=0.03). East-Asian-type cagA and vacA s1c were significantly higher in highland than lowland Lao (100% vs. 55.8%; P-value=0.001 and 88.2% vs. 61.5%, P-value=0.03 respectively). Conclusions: H. pylori is a common infection in Laos, as in other countries in Southeast Asia. The cagA gene was demonstrated in nearly all Laos patients, cagA and vacA genotypes being possible important factors in explaining H. pylori infection and disease outcomes in Laos.

• 생명과학회지
• /
• 제25권9호
• /
• pp.1000-1006
• /
• 2015

α-Asarone은 동양의 전통적인 약재로 잘 알려진 석창포(Acorus gramineus)의 주된 성분이다. 석창포는 항위궤양, 항알러지, 히스타민 방출 억제 그리고 항산화 효과와 같이 다양한 효과를 나타내는 것으로 잘 알려져 있다. 그러나 석창포 역할에 대한 기전연구는 아직 부족한 실정이다. 본 연구에서는, HT1080 세포주에서 α-asarone의 항산화 효과뿐만 아니라 matrix metalloproteinase에 대한 효과를 조사하였다. 가장 먼저 α-asarone의 세포 생존에 대한 효과를 조사하기 위해 MTT assay를 이용하여 16 μM이하에서 세포독성이 없음을 나타내었다. α-asarone이 환원력과 fenton reaction에 의해 유도된 DNA 산화로부터 보호효과를 나타내는 것을 확인하였다. 더욱이, α- asarone은 collagenase 활성을 증가시키고 phorbol 12-myristate 13-acetate (PMA)로 자극된 MMP-2 및 MMP-9의 활성을 증가시켰다. 한편 phenazine methosulfate (PMS) 로 자극된 경우 MMP-9의 활성은 α-asarone의 존재하에서 증가되었으나 MMP-2 활성에는 변화가 없었다. 그러므로 우리의 연구결과는 α-asarone이 산화적 스트레스 및 MMPs와 관련된 병리학적 질환의 예방 및 치료제로 개발이 기대된다고 제안한다.

• Journal of Applied Biological Chemistry
• /
• 제54권4호
• /
• pp.265-269
• /
• 2011

뽕잎으로부터 분리한 H. pylori 억제물질이 건강기능식품으로 산업화되기 위하여 이들 유용성분이 생체 내에서 약리성을 가지는지 여부를 검토하였다. 청목노상으로부터 분리한 혼합물은 $200{\mu}g/100{\mu}L$의 농도에서 H. pylori에 대한 저해 clear zone을 형성하여 항균활성을 나타내었고, C57BL/6종 mouse에 H. pylori의 감염을 유도 한 결과 6주 이상이 되어야 H. pylori의 감염이 되는 것을 확인하였으며, 이 때 감염균수는 평균 $8{\times}10^5$ CFU/mL이었다. 경구투여를 통해 청목노상뽕잎에서 추출한 유효성분의 혼합물이 H. pylori 감염에 있어 예방 및 치료 효과를 갖는지 시험한 결과, 절개된 위속의 H. pylori colony 수가 약물투여 군에서 대조군에 비해 감소한 것을 확인하였다. 마우스의 혈청을 분리하여 immunoglobulin isotype을 측정한 결과, 대조군 보다 IgG1, IgA 등이 높게 생성되는 것이 확인되었고, 시료 혼합물에 의해 항체생성이 증가되어 H. pylori 감염을 억제하는 것으로 판단되었다. 이러한 결과로 뽕잎에서 추출한 유용성분인 caffeic acid, rosemarinic acid와 chlorogenic acid가 H. pylori의 감염에 있어서 예방 또는 치료효과가 있는 것으로 확인되었다. 따라서 H. pylori에 의해 유발되고 감염률이 증가되고 있는 위염, 위궤양, 위암의 예방과 치료가 가능할 것으로 판단되었다.

• 한국항해항만학회지
• /
• 제30권6호
• /
• pp.551-559
• /
• 2006

상선승무원들의 승선근무로 인한 질병 발생 실태를 조사하여 승선근무로 인해 발생되는 질병예방 및 건강증진을 위한 기초 자료를 제공하기 위한 목적으로 1049명의 상선승무원들을 대상으로 설문 및 면접을 통해 조사 분석한 결과는 다음과 같다. 최근 12개월 동안 승선 중 당직근무에 지장을 받을 정도의 질병을 경험한 선원은 69.0%였으며, 질병경험분포에 유의성을 나타낸 변수는 연령(p<0.05), 소득수준(p<0.01), 승선경력(p<0.01), 직급(p<0.01), 건강인식도(p<0.01), 건강염려도(p<0.01), 피로도(p<0.01), 직업만족도(p<0.05), 휴식시간(p<0.05) 등이었으며, 질병경험은 치주질환 7.3%>무좀 6.6%>위궤양 6.4%>외상 5.3% 순이었다. 질병군별 질병발생은 근골격계질환이 17.8%로 가장 많았고 구강계질환 13.6%> 피부계질환 12.4%> 소화계질환 12.1% 순이었으며, 발생 질병의 불편기간은 31일 이상이 35.7%, 입원기간과 치료기간은 각각 7일 이하가 50.2%, 42.8%였고 의료시설 이용은 의원급이 27.9%로 가장 높게 조사되었다.

• 기본간호학회지
• /
• 제2권2호
• /
• pp.115-130
• /
• 1995

The incidence of oral complications among adult cancer patients undergoing chemotherapy varies from 12 to 80%. Adequate oral hygiene has been shown to be important in prevention of oral complication and an essential role is reserved for the nursing staff. These considerations prompted the decision to survey by means of a questionaire, the nurses who give care to cancer patients. The Questions were included multidisciplinary treatment, inspection skill, nursing intervention, nursing education, problem in mouth care, solution for problem solving. - Results are fellow : 1. A total of 116 of the nurses returned the questionaire 2. According to 88.2% of the respondents, the policy with regard to oral-hygine is determined by the physician and the nurse. 62.1% of nurses do not consult the dentist When oral complication is occured. 3. In only 34.5% of case was a penight used to provide the necessary extra illumination nursing Inspection of oral cavity. 4. Frequency of oral complications observed by the respondents is that they observed complications in < 25% of patients. The nature of the complication varied from ulcer, stomatitis, infection, dry mouth, candidiasis, herpes simplix, bleeding. 5. Percentages of respondents who use the intervention indicated 1) to prevent oral complication : 0.9% normal saline gargling(44%), 0.02% chlorhexidine gargling, oral dressing(38.8%), observation, nutrition, restriction of alcohol and tabaco(23.2%) 2) to deal with the early symptoms 0.9% normal saline gargling (47.4%), cryotherapy(37.9%), 0.02% chlorhexidine gargling(20.7%) 3) to help alleviate severe complications : dental consult, holding the chemotherapy(34.5%), 0.9% normal saline gargling(31.1%), cryotherapy(18.0%) 6. According to 70% of the respondents, insufficient attention is given to oral complication during nursing education classes only 8.6% said that both the theory and the practical aspects had been deal with in sufficient detail during their training. The results of the survey indicate thatoral care in cancer patients undergoing chemothrapy has a number of problem. There are not enough dentist to provide the necessary care for patients undergoing chemotherapy. The expertise of the nurses with respect to the pathogenesis of the complication is limited. In the training of nurses, additional attention to oral examinations and oral hygine is warranted. The care of patients should be the responsibility of a multidisciplinary team approach. The nurse occupies a key position with in this team, which includes the medical oncologist, a dentist.

• 간호행정학회지
• /
• 제11권4호
• /
• pp.449-467
• /
• 2005

Purpose: This study aims to offer the fundamental data in order to cost the nursing service on the basis of the NIC and a close examination of the interventions that are contained in the health insurance cost list under the system of the current health insurance. Methods: The data is handled with the SPSS 10.0 program. The participants' general peculiarity is calculated in terms of the real number and the percentage, and the performing frequency of the nursing interventions is calculated in terms of the mean and the standard deviation. the correlation between the participants' general peculiarity and the performing frequency of the nursing interventions is analysed with t-test or one way ANOVA of SPSS. Results: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" was the highest as 2.69${\pm}$1.21, the domain of "the behavioral" was the lowest as 2.11${\pm}$1.12. There were 50 core interventions in the medical unit, 48 in the surgical unit, 24 in the MICU and 33 in the SICU. The health insurance cost items contained commonly in the core interventions of each unit were 12, and the health insurance cost items except 12 items contained commonly in the core interventions of each unit were appeared 14 items in the medical unit, 6 in the surgical unit, 7 in the MICU and 2 in the SICU. The core interventions contained commonly in four units of the medical unit, the surgical unit, the MICU & the SICU are 18. And among these, the core interventions contained in the health insurance cost items are 10; pain management, hyperglycemia management, analgegic administration, medication administration: intravenous, oxygen therapy, pressure ulcer prevention, fluid management, fluide monitoring, intravenous(IV) insertion, intravenous(IV) therapy. As the result of the comparison & analysis between the core interventions of the NIC and the health insurance cost items, the core interventions contained in the health insurance cost list are 21(29 as the health insurance cost items). Conclusion: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" is being performed most frequently, and in the performing frequency of the core interventions, the interventions of the domain of "the physiological: complex" is being performed most frequently. On the basis of these results, the writer hopes that the attempts to interlink the nursing interventions into the nursing cost by using of standard terms and the efforts to cost the nursing services would also be made in the future constantly.

• 한국식품과학회지
• /
• 제36권5호
• /
• pp.779-783
• /
• 2004

P. pentosaceus CBT SL4균이 생산하는 항균물질 농축건조물은 H. pylori균에 대하여 평판 및 액상배양 조건에서 생육억제 활성이 확인되었고, 사막모래쥐를 사용한 감염실험에서는 감염방어 및 제균작용이, 보균자 인체실험에서는 제균작용이 확인되었다. 최근 3제 요법이나 신규 약물 등에 의하여 자각증세가 있는 위염증 환자에서의 제균율은 크게 향상되었으나, 국내의 경우에는 전체국민의 감염율이 매우 높은 것과 식습관 등의 요인에 의하여 단체 및 사회생활을 통한 신규감염이나 재감염을 방어할 효과적 수단은 없는 상태에 있다. 따라서, 일상적인 섭취가 가능하고, 병원균의 내성개발 우려나 인체에 대한 부작용이 없으며, H. pylori균에 대한 감염방어 및 제균작용을 동시에 지닌 유산균 및 그 항균활성물질을 이용한 식품소재는 국민전체의 H. pylori 감염율을 낮추고, 신규감염과 재감염의 악순환을 방지하기 위한 유용한 방어수단이 될 수 있을 것으로 판단된다. 한편, 유산균 배양액에 의한 H. pylori균에 대한 생육억제 현상은 모든 유산균에서 보편적인 현상은 아닌 것으로서 특정한 균주의 배양액에서만 관찰되고 있어 단순히 젖산 등 유기산에 의한 효과로 보기에는 어려움이 있으며 Gram 음성의 병원균들은 외막의 보호작용에 의하여 분자량이 큰 박테리오신 성분에 의해서는 생육이 억제되지 않는 것으로 판단되고 있다. 저자들은 당 균주가 생성하는 H. pylori 생육 억제 물질을 산성의 저분자 물질로 추정하고, 물질 및 작용기작 규명을 위하여 활성물질의 분리 및 구조분석 작업을 진행 중에 있으며, 이러한 연구가 완료되면 분리정제 물질을 활용한 추가적인 산업화 용도 개발이 가능할 것으로 기대하고 있다.