• 대한임상독성학회지
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• 제9권1호
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• pp.20-25
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• 2011

Purpose: This study was designed to analyze the contributing factors, as well as the incidence and nature of the cardiac toxicity, in patients presenting with diphenhydramine overdose. Methods: We retrospectively reviewed the medical records of the intoxicated patients who presented to the ED of Korea University Anam Hospital from January 2008 to December 2010. Those patients who visited due to a diphenhydramine overdose were selected and the following features were recorded for analysis: the general characteristics, vital signs, the amount of ingested diphenhydramine, the time interval from ingestion to presentation, the coingested drugs (if any), the toxicities and the ECG findings. Cardiac toxicity, while defined mainly in terms of the temporary ECG changes such as QTc prolongation, right axis deviation, QRS widening, high degree AV block and ischemic changes, also encompassed cardiogenic shock, which is a clinical finding. Results: A total of eighteen patients were enrolled. Of the eighteen patients, eight had ingested diphenhydramine only, while ten had ingested other drugs in addition to diphenhydramine. The most commonly observed toxicity following diphenhydramine overdose included cardiac toxicity (78%). Cardiac toxicity was observed in all the patients who presented to the emergency department 2 hours after ingestion. The patients with QTc prolongation turned out to have ingested significantly larger amounts of diphenhydramine. Conclusion: QTc prolongation and right axis deviation were common findings for the patients with a diphenhydramine overdose. QTc prolongation was more likely to occur with ingesting larger amounts of diphenhydramine. Close monitoring is mandatory for patients who have ingested large amounts of diphenhydramine to prevent such potentially lethal cardiac toxicity.

• 대한한의학회지
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• 제36권1호
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• pp.1-8
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• 2015

Objectives: This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with post-stroke spasticity. Methods: Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on post-stroke spasticity, compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions: One systematic review and 7 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of electroacupuncture treatment for post-stroke spasticity. However, it did not show any sufficient evidence to treat the patients with post-stroke spasticity with the sole acupuncture. The moderate evidence was presented that over 3 times of the electroacupuncture treatments with 1-100 Hz frequency should be performed every week on the acupoints, such as LI11, LI10, TE5, LI4, ST36, GB34, ST40, or LR3, for 20-30 minutes. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for post-stroke spasticity.

• Clinical and Experimental Pediatrics
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• 제55권8호
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• pp.286-292
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• 2012

Purpose: Continuous renal replacement therapy (CRRT) is becoming the treatment of choice for supporting critically ill pediatric patients. However, a few studies present have reported CRRT use and outcome in neonates weighing less than 3 kg. The aim of this study is to describe the clinical application, outcome, and complications of CRRT in small neonates. Methods: A retrospective review was performed in 8 neonatal patients who underwent at least 24 hours of pumped venovenous CRRT at the Samsung Medical Center in Seoul, Korea, between March 2007 and July 2010. Data, including demographic characteristics, diagnosis, vital signs, medications, laboratory, and CRRT parameters were recorded. Results: The data of 8 patients were analyzed. At the initiation of CRRT, the median age was 5 days (corrected age, $38^{+2}$ weeks to 23 days), and the median body weight was 2.73 kg (range, 2.60 to 2.98 kg). Sixty-two patient-days of therapy were reviewed; the median time for CRRT in each patient was 7.8 days (range, 1 to 37 days). Adverse events included electrolyte disturbances, catheter-related complications, and CRRT-related hypotension. The mean circuit functional survival was $13.9{\pm}8.6$ hours. Overall, 4 patients (50%) survived; the other 4 patients, who developed multiorgan dysfunction syndrome, died. Conclusion: The complications of CRRT in newborns are relatively high. However, the results of this study suggest that venovenous CRRT is feasible and effective in neonates weighing less than 3 kg under elaborate supportive care. Furthermore, for using potential benefit of CRRT in neonates, efforts are required for prolonging filter survival.

• Journal of the Korean Data and Information Science Society
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• 제28권2호
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• pp.407-419
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• 2017

본 연구는 간호학생을 대상으로 SBAR (situation, background, assessment, and recommendation) 적용에 중점을 둔 시뮬레이션 교육의 효과를 확인하여 간호사와 의사 간의 의사소통능력 향상을 위한 간호교육 개발의 기초자료를 제공하고자 시행되었다. 간호대학 3학년을 대상으로 호흡곤란 주제의 시나리오에 SBAR를 적용하는 사전, 사후시뮬레이션 진행 중 녹화된 25개의 동영상을 분석한 결과 SBAR 점수는 사후시뮬레이션에서 B단계의 '가장 최근에 측정한 활력징후 보고' 항목 (Z=-2.448, p=.014)과 '간호사가 판단한 상황' 항목 (Z=-3.464, p=.001)이 통계적으로 유의하게 증가하였다. SBAR 단계별 진행빈도는 사전시뮬레이션에서 SBA나 SBAR 단계로 진행된 경우가 없었으나 사후시뮬레이션에서는 48%로 증가하였다. 사후시뮬레이션에서 언급된 SBAR 평가항목별 빈도는 S단계의 환자이름 (96%), 간호사이름 (80%), B단계의 가장 최근에 측정한 산소포화도 (76%), S단계의 주증상 (60%)의 순서였다. 그러나 A단계에서 추가사정을 통한 간호사의 판단결과를 제시하는 것과 R단계의 추가처방 요청이나 의사의 직접 환자방문 요청은 언급되지 않았다. 따라서 SBAR 적용이 포함된 시뮬레이션교육이 간호사와 의사간의 의사소통교육에 긍정적 효과를 보여 추후 의사와의 협력을 통한 문제해결이 필요한 시뮬레이션교육에서 SBAR 적용을 적극적으로 고려하는 것이 필요하다.

• 대한간호학회지
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• 제17권3호
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• pp.204-217
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• 1987

It is generally accepted that the delivery of health care is undergoing many changes specially those related to acute, contagious disease care and to the increase of chronic illnesses which can not be cured but are controlable. The health care practitioner can not be soley responsible for the control of their clients' care. Because the clients will play a vital role in controlling their illnesses, long term participation by both the health care provider and the client is necessary. Since most individuals with hypertension do not experience signs or symptoms, the disease is difficult to detect and even when diagnosed, clients do not comply well with their hypertension regimens. The noncompliant client is at increased risk for compliants involving the heart, brain, kidney and other organs. In an effort to explore methods of increasing patient participation in and adherence to treatment programs for hypertension, the researcher used health contracting to promote self care. The research questions are; 1) Will the health contracting increase compliance in health behavior and reduce the blood pressure\ulcorner 2) If clients comply with their regimens will this reduce their blood pressure\ulcorner The research design utilized in this study was a quasi-experimental design. A purposive sample, was abtained from two churches in the 1. area, consisting of 64 clients with hypertension. The data was collected from the middle of January to the 1st of September 1985. Randomization was only of the two church groups into experimental and control groups. Compliance with health behavior related to the hypertensive regimen, blood pressure and body weight were measured, compared and analyzed. In the experimental group measurements were made 6 times; one month before the education program after education program when health contracting was done and 4 more times once a month for 4 months. In the control group measurements were made 3 times; one month before the education program after the education program, and once 4 months later. There was no health contracting. The data were analyzed by t-test, Pearson correlation and ANOVA according to purpose of the study. The result of this study may be summarized as follows: The result related to the hypothesis on the effect of health contracting are as follows: H$_1$; “The hypothesis that the experimental group, with a health contractual agreement will demonstrate increased compliance levels for health behavior than the control group” was supported(t＝-5.29, df＝62, p＝.000). H$_2$; “The hypothesis that the experimental group, with a health contractual agreement, will demonstrate a greater reduction in blood pressure than the control group” was supported (for systolic blood pressure t＝2.72, df＝62, p＝.009, for diastolic blood pressure t＝1.95, df＝62, p＝.050). H$_3$; The hypothesis that the greater the compliance of the client with health behavior the lower the client's blood pressure will be was partially supported (for systolic pressure r＝-.2981, p＝.008, for diastolic pressure r＝-.1720, p＝.087). From the examination of the results of this study it can be concluded that the interaction between the nurse and the client, contracting to define goals and reinforcing compliant behavior, leads to improved compliance with health care behaviors and thus to an increase in the effectiveness of nursing care. Further consideration need to be given to the inclusion of the concept of health contracting in primary nursing and to further research in this area.

• 생물정신의학
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• 제3권1호
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• pp.102-108
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• 1996

본 연구는 한국인의 우울증 환자에서 moclobemide가 효과적이며 안전하게 사용될 수 있음을 입증하였으며, 투약 방법으로 초기 권장량인 1일 300mg을 2회 분복시키는 방법이 추천될 수 있음을 확인하였다.

• 대한간호학회지
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• 제25권3호
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• pp.441-456
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• 1995

This study was done to determine direct and in-direct nursing time in nursing units in hospital to ap-plied computer system and expect that those results contribute to measure efficiency of nursing practice and planning of nursing manpower. The design for study was a descriptive study. The study results are as follows. 1. Patients admitted to the Internal Medicine and General Surgery units were grouped into four. Group Ⅰ, 32.9% of the total patients, consisted patients whose condition was considered minor Group Ⅱ, 26.1%, was of those whose condition was considered moderate, Group Ⅲ, 41. 8%, moderate severe and Group Ⅳ, 29.2% the most severe. 2. Nursing intervention times by care type were as follows four minutes spent for suction eight minutes, for simple position change, ten minutes, for sheet change, seven minutes for a hot or cool compress, six minutes for dressing change, four minutes for Ⅰ.M. injection, six minutes for patient health education and five minutes for body temperature check. 3. Direct care time by patient group revealed the following : Group Ⅰ rquired 191.4 minutes, Group Ⅱ required 331.1 minutes, Group Ⅲ rquired 499.4 minutes, and Group Ⅳ rquired 1328.0 minutes. 4. The ratio of time for adequate nursing care and direct care time in the Internal Medicine and Goneral Surgery units was 67.4%-83.4% and 94.7%-99.3% in the Intensie Care Unit. 5. Average daily direct care time per patient was 5.5 hours in the Internal Medicine unit and 11.5 hours in the Intensive Care Unit. 6. Time spent in indirect care was 48.3 minutes for computer recording,34.8 minutes for giving and receiving patient information for shift duty, 28.0 minutes for eating and resting time, 26.6 minutes for transfering and identifying patients, 25.6 minutes for identifying Doctor's order, 23.9 minutes for recording vital signs. 7. Time spent in indirect care was 282.2 minutes by head nurses (charge nurses), 258.7 minutes by nurses and 261.6 minutes by nurse aids. 8. The average nurse's workload was 9.3 hours and daily indirect nursing time required 46.3%-50. 5% of above mentioned workload time. .9. The average daily indirect care time per patient was expected to be 57.7 minutes in the Internal Medicine unit and 3.3 hours in the Intensive Care Unit.

• 전자공학회논문지SC
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• 제48권4호
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• pp.1-9
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• 2011

쇼크(shock)란 조직에 필요한 산소 요구량과 공급 간의 불균형에 의해 유발되는 임상증후군을 말한다. 환자의 치료효과와 생존율 향상을 위해서 쇼크의 조기 진단은 매우 중요하다. 그러나 현재 쇼크 진단에 사용되는 맥박, 혈압 등 생체 징후의 경우 출혈 정도를 제대로 반영하지 못하여 환자에 대한 처치가 늦어질 수 있다. 따라서 쇼크의 조기 진단을 위한 많은 연구들이 진행되어 왔으며, 조직의 저산소증, 대사성 산증을 반영해주는 지표인 젖산 농도와 관류 측정의 유용성이 입증된 바 있다. 본 연구에서는 흰쥐를 대상으로 정량적 출혈을 유도한 후, 젖산 농도 측정과 laser Doppler flowmeter를 통해 관류를 측정하였으며, 지혈 후 젖산 농도/관류의 비(ratio)를 생존 예측을 위한 새로운 지표로써 제안하였다. 새로 제안된 지표를 통한 생존예측을 ROC 커브 방법에 적용한 결과, 민감도 90.0%, 특이도 96.7%, 정확도 94.0%를 보였으며, 생존군과 사망군 간 새로운 지표의 유의한 차이도 가장 조기에 보여주었다. 향후 임상 적용 연구를 통해 새롭게 제안한 지표의 임상 적용이 가능하다면, 쇼크 환자를 조기 진단하고 치료효과를 높일 수 있을 것으로 생각된다.

• Environmental Analysis Health and Toxicology
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• 제27권
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• pp.13.1-13.10
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• 2012

Objectives: We aimed to investigate the acute effects of heat stress on body temperature and blood pressure of elderly individuals living in poor housing conditions. Methods: Repeated measurements of the indoor temperature, relative humidity, body temperature, and blood pressure were conducted for 20 elderly individuals living in low-cost dosshouses in Seoul during hot summer days in 2010. Changes in the body temperature, systolic blood pressure (SBP) and diastolic blood pressure (DBP) according to variations in the indoor and outdoor temperature and humidity were analyzed using a repeated-measures ANOVA controlling for age, sex, alcohol, and smoking. Results: Average indoor and outdoor temperatures were $31.47^{\circ}C$ (standard deviation [SD], $0.97^{\circ}C$) and $28.15^{\circ}C$ (SD, $2.03^{\circ}C$), respectively. Body temperature increased by $0.21^{\circ}C$ (95% confidence interval [CI], 0.16 to $0.26^{\circ}C$) and $0.07^{\circ}C$ (95% CI, 0.04 to $0.10^{\circ}C$) with an increase in the indoor and outdoor temperature of $1^{\circ}C$. DBP decreased by 2.05 mmHg (95% CI, 0.05 to 4.05 mmHg), showing a statistical significance, as the indoor temperature increased by $1^{\circ}C$, while it increased by 0.20 mmHg (95% CI, -0.83 to 1.22 mmHg) as outdoor temperature increased by $1^{\circ}C$. SBP decreased by 1.75 mmHg (95% CI, -1.11 to 4.61 mmHg) and 0.35 mmHg (95% CI, -1.04 to 1.73 mmHg), as the indoor and outdoor temperature increased by $1^{\circ}C$, respectively. The effects of relative humidity on SBP and DBP were not statistically significant for both indoor and outdoor. Conclusions: The poor and elderly are directly exposed to heat waves, while their vital signs respond sensitively to increase in temperature. Careful adaptation strategies to climate change considering socioeconomic status are therefore necessary.

• Journal of Chest Surgery
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• 제34권12호
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• pp.937-943
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• 2001

배경 : 본 연구의 목적은 흉골골절에서 심혈관계 동반 손상의 예측인자를 알아내고 응급 심장 초음파검사의 적응증을 제시하고자 하였다. 대상 및 방법 : 1994년 3월부터 5년간 이화여자대학교 부속 목동병원 응급실을 통해 입원한 흉골골절로 입원한 40명의 환자들을 대상으로 후향적 분석을 시행하였다. 예측인자로서는 1) 안전띠 착용의 유무, 2) 동반 손상의 유무, 3) 심혈관계 질환의 병력 유무, 4) 내원시 환자의 RTS(Revised Trauma Score) 4가지를 대상으로 분석하였다. 또한 심혈관계 손상의 동반 유무를 파악하기 위하여 일반적으로 사용하는 심전도와 흉부 단순 촬영 및 심근 효소의 분획을 조사하였으며, 그 결과에서, 흉골골절에서 응급 심장 초음파 검사의 적응증을 추론하였다. 결과 : 흉골골절에서 심혈관계 손상의 동반 유무를 나타내는데 통계적으로 의미가 있다고 나온 인자로는 심혈관계 과거 병력이 있는 경우와 입원시 RTS의 이상을 들 수 있다. 응급 심장 초음파검사의 시행은 예측인자들과 심전도와 흉부 단순 촬영 및 심근 효소의 분획 같은 일반적으로 사용하는 검사 결과에 따라 시행하였다. 흉골골절 환자에서 응급 심장 초음파검사의 적응으로 1) 의미 있는 예측 인자의 변화가 없더라도 두 개 이상의 검사에서 이상소견을 보이던가, 2) 예측인자의 의미있는 변화가 하나 이상 나오는 경우를 들 수 있다. 결론 : 흉골골절 환자에서 심혈관계의 과거 병력과 초기활력 징후가 심혈관 동반 손상 유무를 중요하게 나타날 수 있으며, 필요한 경우, 응급 심장 초음파 검사를 시행하여 조기에 확진을 내리는 것이 중요하다고 생각한다.