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Development of Community Health Center-Based Hospice Management Model: Pilot Project at a Community Health Center in Busan (보건소 중심 호스피스 운영모델 개발 - 부산지역 일개 보건소 시범사업을 중심으로 -)

  • Kim, Sook-Nam;Choi, Soon-Ock;Kim, Young-Jae;Lee, So-Ra
    • Journal of Hospice and Palliative Care
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    • v.13 no.2
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    • pp.109-119
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    • 2010
  • Purpose: This study was a part of a drive to develop a community health center-based hospice management model which is concerned with hospice care at a community health care setting and available resources of the local community. Methods: Development of a community health center-based hospice management model involved evaluation of existing hospice-related research, including literature review, and research on hospice facilities at the study site, as well as evaluation of model operation. The latter involved community health center-based hospice test operation, and evaluation of test operation by a research team, including of a nursing professor majoring in hospice care and staffs from a community health center in Busan metropolitan city, regional cancer center, and regional terminal cancer patient medical institute. The study was conducted in the 2008 calendar year. Results: The community health center-based hospice management model provides service linked with local community resources, focusing on the local community health center. Financial and administrative assistance is provided by the regional cancer center, with collaboration from academic health care professionals who guide the operation management. The community health center hospice nurse in consultation with a visiting nurse team registers terminally-ill cancer patients and, after assessment, the hospice team prioritize hospice care during team meeting. Care is delivered by staffs and volunteers. Conclusion: The developed community health center-based hospice operation management model maximally utilizes available community health resources to produce qualitative improvement of regional health and welfare policy through improving the lives of home-based cancer patients and their family who are in medical blind spot.

The Influence of Iteration and Subset on True X Method in F-18-FPCIT Brain Imaging (F-18-FPCIP 뇌 영상에서 True-X 재구성 기법을 기반으로 했을 때의 Iteration과 Subset의 영향)

  • Choi, Jae-Min;Kim, Kyung-Sik;NamGung, Chang-Kyeong;Nam, Ki-Pyo;Im, Ki-Cheon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.122-126
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    • 2010
  • Purpose: F-18-FPCIT that shows strong familiarity with DAT located at a neural terminal site offers diagnostic information about DAT density state in the region of the striatum especially Parkinson's disease. In this study, we altered the iteration and subset and measured SUV${\pm}$SD and Contrasts from phantom images which set up to specific iteration and subset. So, we are going to suggest the appropriate range of the iteration and subset. Materials and Methods: This study has been performed with 10 normal volunteers who don't have any history of Parkinson's disease or cerebral disease and Flangeless Esser PET Phantom from Data Spectrum Corporation. $5.3{\pm}0.2$ mCi of F-18-FPCIT was injected to the normal group and PET Phantom was assembled by ACR PET Phantom Instructions and it's actual ratio between hot spheres and background was 2.35 to 1. Brain and Phantom images were acquired after 3 hours from the time of the injection and images were acquired for ten minutes. Basically, SIEMENS Bio graph 40 True-point was used and True-X method was applied for image reconstruction method. The iteration and Subset were set to 2 iterations, 8 subsets, 3 iterations, 16 subsets, 6 iterations, 16 subsets, 8 iterations, 16 subsets and 8 iterations, 21 subsets respectively. To measure SUVs on the brain images, ROIs were drawn on the right Putamen. Also, Coefficient of variance (CV) was calculated to indicate the uniformity at each iteration and subset combinations. On the phantom study, we measured the actual ratio between hot spheres and back ground at each combinations. Same size's ROIs were drawn on the same slide and location. Results: Mean SUVs were 10.60, 12.83, 13.87, 13.98 and 13.5 at each combination. The range of fluctuation by sets were 22.36%, 10.34%, 1.1%, and 4.8% respectively. The range of fluctuation of mean SUV was lowest between 6 iterations 16 subsets and 8 iterations 16 subsets. CV showed 9.07%, 11.46%, 13.56%, 14.91% and 19.47% respectively. This means that the numerical value of the iteration and subset gets higher the image's uniformity gets worse. The range of fluctuation of CV by sets were 2.39, 2.1, 1.35, and 4.56. The range of fluctuation of uniformity was lowest between 6 iterations, 16 subsets and 8 iterations, 16 subsets. In the contrast test, it showed 1.92:1, 2.12:1, 2.10:1, 2.13:1 and 2.11:1 at each iteration and subset combinations. A Setting of 8 iterations and 16 subsets reappeared most close ratio between hot spheres and background. Conclusion: Findings on this study, SUVs and uniformity might be calculated differently caused by variable reconstruction parameters like filter or FWHM. Mean SUV and uniformity showed the lowest range of fluctuation at 6 iterations 16 subsets and 8 iterations 16 subsets. Also, 8 iterations 16 subsets showed the nearest hot sphere to background ratio compared with others. But it can not be concluded that only 6 iterations 16 subsets and 8 iterations 16 subsets can make right images for the clinical diagnosis. There might be more factors that can make better images. For more exact clinical diagnosis through the quantitative analysis of DAT density in the region of striatum we need to secure healthy people's quantitative values.

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The Study on the Measure to Improve the Event Place Guarding Operation System (행사장경호 운용시스템 개선방안에 관한 연구)

  • Lee, Sang-Chul;Kim, Tae-Min
    • Korean Security Journal
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    • no.11
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    • pp.203-226
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    • 2006
  • A highly sophisticated expertise and systematic and integrated management of security operation are essential for a crowded stadium. a special object of security guarding. Nonetheless, the recent incident in a singing concert hall reveals the overall problem like the lacking safety management system. lacking deployment of professional security personnel, absence of safety manuals and safety measures, as well as the lack of professionalism of private sector security companies. In this study, we presented three categories that needed improvement, like the legal and institutional improvement, improvement of policy and improvement of operation which are required to set up the model to operate the optimal private sector security duties. For the revision of law and institution for a better and more desirable method, we discussed the revision of related laws and regulations pursuant to the security operation at places where events are held, including the revision of law on security guarding work, regulation on common housing management, uniformity of security guarding, and law on performance. For the improvement of policies, we discussed the introduction of security consultants, strengthening the security instructor system, expansion of relevant organizations, establishment of mutual cooperation, privatization of profitable events, improvement of awareness about the security activities provided by private sector, policy for the professionalism of private security operation, expansion of security exhibition and seminar. For the improvement of operation. we discussed professional security techniques. such as the technique of security consulting, the application of CPTED technique, the technique for the integration of system, the method of operation, the establishment of a system to support public security operations and volunteers, establishment of a manual for security guarding performance, modernization and high tech-oriented equipment, organization of security guarding entity in which the industry, academic society and government participates together.

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A Study of Sex-related Problems of Old Women in Kyeonggi Province, Korea (경기도 여성노인의 성의식에 관한 조사연구)

  • Park, Young-Soo;Choi, In-Sook
    • The Journal of Korean Society for School & Community Health Education
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    • v.5
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    • pp.71-84
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    • 2004
  • The sexual discourse has been frequent, but the subjects of it have been limited to the young, and the sex of women and that of the old people, until now, have been overlooked. According to the data in 2,000 of the Korea Statistic Service, the older-than-sixty-five-year people consist of 37.4% men and 62.6% women. Of them, the older-than-seventy-year people consist of 33.8% men and 55.2% women. The data show the fact that as the age of the old people is higher, the number of old women is enlarging. Paying attention to the above-mentioned tendency, this study conducted a survey about the aspects of the sexual consciousness of old women. The purpose of study was focused, through the survey, on discovering the ways of old women's recognization about their sexual desire, and on presenting basic data to developing the programs which could solve the problems derived from the discovery. That is to say, the purpose of it was to prevent the sexual desire's distortion and suppression of old women, if they had any, and to present basic data to developing the programs which could convert their recognization of sex. The objects of the survey were the sample group of 301 people inhabiting in Hwaseong City, Seongnam City, Yongin City, and Suwon City, chosen out of 375,298 old women of 614,316 older-than-sixty-five-year people in Kyeonggi Province (Kyeonggi Province homepage, 2002). The data were collected by the questionnairers' interviews in the fields of old men's resting house, churches, temples, old men's niversities and so like, from September 19th to September 31th in 2003. The questionnairers as volunteers were taught the prior education, being prepared for the survey about old women's sexual consciousness. The contents of education were composed of the understanding of old women, the ways of questionnairing, and the items of questionnaire. The outcomes of the survey are following; First, concerning general items, the old women of the sample group answered that they felt greatly the difficulties of health(36.5%), economy(12.0%), and loneliness(11.3%) in turn. The 48.2% of them answered that they were healthy, but the 62.3% answered that they were suffering various illnesses. The 24.4% answered they were economically rich, and the 23.9% answered they were working. The 53.5% were living alone due to divorce or death. The 71.1% had been living for more than ten years. The 83.1% believed in their own religion. Second, the 43.8% of the sample group admitted the necessity of a heterosexual friend and sexuality The 39.0% felt sexual desire, and the 33.9% were experiencing sexuality. As the obstructing factors in performing sexuality, the objects of sample group pointed out shamefulness or morality(28.7%), anxiety that such deeds might afflict their health or the problem of health itself(20.2%), weakening of sexual potency(16.9%). This outcome shows that they have ambiguous notions about their sexual alienation and manner. Third, the 33.7% of the sample group admitted sexual education and sexual counsel, and of those that admitted them, the 85.2% said that they would take part in sexual education if it were held. It shows that the demand of sexual education and sexual counsel need be fulfilled. Therefore, through this study, the following two important suggestions can be drawn: First, systematic sexual education programs should be developed, considering old people's developing steps containing their rights of health and sex. Also those should be educated through kindergartens, primary, middle and higher education institutions. Second, sexual education and sexual counsel on prospective old people and present old people should be performed.

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The Relationship of $VO_2$Max/Min in Cardiopulmonary Exercise Test and Fat Distribution (운동부하심폐기능검사상의 분당최대산소섭취량과 체내 지방분포와의 상관관계)

  • Choi, Jae-Chol;Jee, Hyun-Suk;Park, Young-Bum;Park, Sung-Jin;Yoo, Jee-Hoon;Kim, Jae-Yeol;Park, In-Won;Choi, Byoung-Whui;Hue, Sung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.4
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    • pp.495-501
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    • 2000
  • Background : Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate ($VO_2$) compared to non~obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. Methods : Maximal exercise capacity was represented by maximam maximum oxygen uptake and $VO_2$ max in the cardiopulmonary test. Obesity, total fat content and abdomina1 obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers (male 22, fema1e 20) were evaluated. Results : 1) Weight to height ratio (mean$\pm$SD) was 110$\pm$14.9% in men and 100$\pm$11.1% in women. 2) Fat ratio (mean$\pm$SD) was 23.3$\pm$5.2% in men and 27.55$\pm$3.9% in woman. 3) Waist to hip ratio (mean$\pm$SD) was 0.85$\pm$0.04 in men and 0.8$\pm$0.03 in woman. 4) In men, $VO_2$ max/min/Kg was negatively correlated with obesity, fat ratio, and abdominal fat distribution. 5) In woman, $VO_2$ max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. Conclusion : Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.

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Clinical Trial of Nasal Flumazenil Administration (플루마제닐의 경비 투여)

  • Hong, Soo-Jin;Kim, Hyun-Jung;Yum, Kwang-Won
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.3
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    • pp.441-446
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    • 2001
  • Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

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Quantitative Evaluation of Regional Cerebral Blood Flow by Visual Stimulation in $^{99m}Tc-HMPAO$ Brain SPECT ($^{99m}Tc-HMPAO$ 뇌 SPECT에서 시각자극에 의한 국소 뇌 혈류변화의 정량적 검증)

  • Juh, Ra-Hyeong;Suh, Tae-Suk;Kwark, Chul-Eun;Choe, Bo-Young;Lee, Hyoung-Koo;Chung, Yong-An;Kim, Sung-Hoon;Chung, Soo-Kyo
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.3
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    • pp.166-176
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    • 2002
  • Purpose: The purpose of this study is to investigate the effects of visual activation and quantitative analysis of regional cerebral blood flow. Visual activation was known to increase regional cerebral blood flow in the visual cortex in occipital lobe. We evaluated that change in the distribution of $^{99m}Tc-HMPAO$ (Hexamethyl propylene amine oxime) to reflect in regional cerebral blood flow. Materials and Methods: The six volunteers were injected with 925 MBq (mean ages: 26.75 years, n=6, 3men, 3women) underwent MRI and $^{99m}Tc-HMPAO$ SPECT during a rest state with closed eyes and visual stimulated with 8 Hz LED. We delineate the legion of interest and calculated the mean count per voxel in each of the fifteen slices to quantitative analysis. The ROI to whole brain ratio and regional index was calculated pixel to pixel subtraction visual non-activation image from visual activation image and constructed brain map using a statistical parameter map (SPM99). Results: The mean regional cerebral blood flow was increased due to visual stimulation. The increase rate of the mean regional cerebral blood flow which of the activation region in primary visual cortex of occipital lobe was $32.50{\pm}5.67%$. The significant activation sites using a statistical parameter of brain constructed a rendering image and image fusion with SPECT and MRI. Conclusion: Visual activation was revealed significant increase through quantitative analysis in visual cortex. Activation region was certified in Talairach coordinate and primary visual cortex (Ba17),visual association area (Ba18,19) of Brodmann.

Effects of 12-week Combined Exercise Program on Short Physical Performance Battery, Bone Mineral Density and Parathyroid Hormone in the Elderly Women (12주간 복합운동이 여성 노인의 신체수행능력, 골밀도 및 부갑상선호르몬에 미치는 영향)

  • Kim, Jung-Sook;Kim, Ji-Hyeon;Ha, Soo-Min;Hynn, Su-Jin;Yoon, Byeong-Kon;Kim, Do-Yeon
    • Journal of the Korean Applied Science and Technology
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    • v.35 no.2
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    • pp.519-531
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    • 2018
  • The purpose of this study was to investigate the effects of combined exercise program on short physical performance battery, bone mineral density and parathyroid hormone levels in elderly women. This study subjects were 22 elderly female volunteers, aged 65-75 years and they divided into the combined exercise group(n=11) and the "no exercise" control group(n=11). The combined exercise included the line dance program performed twice per week for 60 minutes and the resistance exercise program performed once per week during 12 weeks. Exercise intensity was progressively increased from RPE "fairly light" to "slightly hard" (from 11 to 14). The findings of this study were as follows; Short physical performance battery(Balance test, gait speed, and rising from a chair five times) and bone mineral density (lumbar spine L2~L4 bone densities, and the T-score) were significantly increased after 12 weeks in the exercise group compared to the baseline. The PTH level was significantly decreased in the exercise group compared to the baseline. In conclusion, regular and continuous physical activity was effective for improving short physical performance and had a positive effect on bone mineral density and parathyroid hormone. With aging, women have decreased muscle strength and bone density and therefore, it is strongly recommended that women need to carry out continuous physical activity to prevent disease and ensure a healthy retirement.

The Effect of Long-Term Orthokeratology in Different Age Groups (장기간 굴절교정렌즈 착용자에서 연령군 별 굴절교정효과 비교)

  • Mun, Mi-Young;Lee, Koon-Ja
    • Journal of Korean Ophthalmic Optics Society
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    • v.13 no.4
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    • pp.65-73
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    • 2008
  • Purpose: The purpose of this study is to investigate the effect of age in the response to long-term overnight orthokeratology (OK) lens wearing. Methods: Among volunteers, ninety-five healthy subjects who had no eye diseases and could wear OK contact lens at least for 8 hours every day were divided into three groups children, youngsters and young adults. Unaided logMAR visual acuity, refractive error, apical corneal radius, corneal asphericity and central corneal thickness were measured with different period; before and after one day, one week, two weeks, one month, three months and six months of OK lens wear. Paired student t-test, ANOVA analysis and Pearson correlation were used with a critical p value of 0.05 for statistical analysis. Results: All groups showed statistically significant (p<0.001) improvement in unaided visual acuity, a trend for flattening in the apical corneal radius, decrease in central corneal thickness and less prolate after OK lens wear. The child group showed significantly rapid change (p<0.001) in visual acuity, and apical corneal radius showed that they reached the targeted refractive change earlier compared with youngster and adult groups. The visual effect of OK lens was significantly related with the change in central corneal thickness after long-term OK lens wear, especially in child and youngster group, and central corneal thickness were highly correlated with the targeted refractive change. Conclusions: Visual acuity change is statistically correlated with the central corneal thickness change, which is highly correlated with targeted refractive change in the long-term orthokeratology and younger lens wearers showed a rapid response to OK lens wear, suggesting a reduced epithelial response with increasing age. The results found this study extends our understanding and development in the long-term orthokeratology.

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A Study on the Effect of Cold Application Using a Sponge Bath in Healthy Adults (냉요법 적용방법에 따른 냉요법 효과에 관한 연구-건강한 성인 여성에서 스폰지 목욕방법을 중심으로)

  • Chung, Hyun-Sook;Kang, Kyu-Sook;Hwang, Ae-Ran
    • The Korean Nurse
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    • v.28 no.3
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    • pp.68-82
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    • 1989
  • This study was a quasi-experimental research study to test the characteristics of temperature regulation according to sponge bath methods of cold application. Thirteen volunteers were selected from among nursing college students according to an established criteria using a purposive sampling technique. Four different cold application methods were used: $\circled1$ tepid water sponge bath at $28^{\circ}C$, $\circled2$ 20% alcohol sponge bath at $28^{\circ}C$, $\circled3$ 40% alcohol sponge bath at $28^{\circ}C$ and $\circled4$ tepid water sponge bath at 28$^{\circ}$C plus an ice bag to the head. Changes in rectal temperature, mean skin temperature, mean body temperature, heat content change and thermal discomfort during the cold application were measured at 5 minute intervals over a 120 minute period. The data collection period was from Dec. 20, 1988 to Feb. 3, 1989. The data were analyzed using descriptive statistics, simple regression, ANOVA, Duncan's multiple range test and Pearson correlation coefficient using the SPSS-X Program. The results of the study are summarized as follows. Five general hypothesis were tested. Hypothesis 1 that "Change in heat content will be decreased for each cold application method according to the cold application time" was rejected. (tepid water sponge bath: after 10 minutes of cold application, 20% alcohol sponge bath: after 25 minutes of cold application: 40% alcohol sponge bath: after 45 minutes of cold application, tepid water sponge bath plus an ice bag to the head: after 80 minutes of cold application) Hypothesis 2 that "Thermal discomfort will be changed for each cold application method according to the cold application time" was rejected after 5minutes of cold application. Hypothesis 3 that "Change in heat content will differ among the cold application methods" was accepted except 0~5, 0~10, 0~65, 0~105 and 0~120 minute. This difference showed significance only between sponge bath methods and tepid water sponge bath plus an ice bag to the head. Hypothesis 4 that "Thermal discomfort will differ among the cold application methods" was accepted at 15, 20, 35, 45, 75, 80, 90, 95, 100, 105, 110, 115 and 120 minute of cold application time. This difference showed significance only between sponge bath methods and tepid water sponge bath plus an ice bag to the head. Hypothesis 5 that "The higher the change in heat content, the higher the thermal discomfort during the cold application time" was accepted for between 10~60 and 75 minute of cold application. In conclusion, this study showed that in sponge bath at $28^{\circ}C$, 10~80 minute was a effective cold application time in the view of heat loss through the skin. Concerning the effects of evaporation and thermal discomfort, it was found that there was no difference with regard to the solutions; tepid water sponge bath; 20% alcohol sponge bath or 40% alcohol sponge bath at a $28^{\circ}C$ controlled solution temperature. So it was thought that the type of solution itself did not have a big influence on the heat loss through skin. The combined effect of sponge bath with an ice bag to the head showed a significant difference and also showed a slight increase in thermal discomfort. On the basis of this research it can be concluded that cold application, for example, an ice bag to the head during a tepid water sponge bath is a good method as it increase heat loss through conduction, although fit can also cause a slight increase in thermal discomfort. The correlation between changes in heat content and thermal discomfort were not high. So factors other than change in heat content are considered to have an effect on the cognition of thermal discomfort.

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