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A comparative study on analgesic and non-analgesic outcomes of inter pleural analgesia compared to thoracic epidural analgesia in open pancreatico-duodenectomy

  • Lu Yao;Niroshini Rajaretnam;Natalie Smith;Lisa Massey;Somaiah Aroori
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.26 no.3
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    • pp.270-276
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    • 2022
  • Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.

Mental Health of Medical Students After Combating the COVID-19 Epidemic: A Cross-sectional Study in Vietnam

  • Duc Minh Cap;Anh Quang Nguyen;Tham Thi Nguyen
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.4
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    • pp.347-355
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    • 2024
  • Objectives: This study was conducted to investigate the prevalence of mental health (MH) symptoms and associated factors among medical students who were engaged in combating the coronavirus disease 2019 (COVID-19) epidemic in 4 provinces/cities of Vietnam. Methods: A cross-sectional study with 580 participants was conducted at a medical university in Northern Vietnam. MH was assessed using the 21-item Depression, Anxiety, and Stress Scale, which was previously standardized in Vietnam. Data were collected through a structured self-administered questionnaire. Multivariate logistic regression was employed to examine the association between MH symptoms and relevant factors. Results: Out of a total of 2703 medical students, 21.5% responded to the questionnaire. Among the 580 respondents, the prevalence rates of depression, anxiety, and stress were 43.3%, 44.0%, and 24.7%, respectively. Factors significantly associated with self-reported depression included being female and having a COVID-19 infection. Similarly, being female and having a COVID-19 infection were significantly associated with self-reported anxiety. Factors associated with self-reported stress included being female, having a personal or family history of MH symptoms, working more than 8 hr/day, and having a COVID-19 infection. Conclusions: COVID-19 has adversely impacted the MH of medical students. Our findings are valuable in their potential to motivate universities, MH professionals, and authorities to offer mental healthcare services to this group. Furthermore, there is a pressing need for training courses designed to equip future healthcare workers with the skills to manage crises effectively.

Comparison of the Awareness and Knowledge of Scrub Typhus between Case and Control Groups (쯔쯔가무시증 환자군과 대조군의 인지도와 지식 비교)

  • Lee, Kwan;Park, Byeong-Chan;Lim, Hyun-Sul;Kweon, Sun-Seog;Choi, Jin-Su;Kim, Jang-Rak;Kim, Keon-Yeop;Ryu, So-Yeon
    • Journal of agricultural medicine and community health
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    • v.37 no.1
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    • pp.1-11
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    • 2012
  • Objectives: To survey the awareness of patient to scrub typhus to provide data for education and communication concerning scrub typhus. Methods: Patients with scrub typhus (case group, n=299) and people without scrub typhus within the previous 2 years (control group, n=598) were matched for age (within 5 years), gender, and occupation (farmer or non-farmer). The participants were recruited from 15 study areas between October and December 2006. Results: The awareness rate of scrub typhus was 75.1%, and was significantly higher than in the case group (79.4% vs. 66.6%, respectively; p<0.01). The major routes of awareness were from 'past history of scrub typhus in family members or neighbors' (54.9%), 'television' (28.3%), and their past history of scrub typhus (5.5%). The average correct rate of scrub typhus was 48.4%, and the correct response rate of cases was significantly higher than controls (p<0.01). Especially, the correct rate of etiology, incubation period, route of transmission, and acquired immunity was <40%. Through conditional logistic regression test, the factor significantly associated with awareness in case group was age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.98). And the factors associated with awareness in control group were female (OR, 1.56; 95% CI, 1.03-2.36) age (OR, 0.98; 95% CI, 0.96-0.99), family history of scrub typhus (OR, 10.18; 95% CI, 1.37-75.99), history of receiving prevention education (OR, 8.47; 95% CI, 1.14-63.00). Conclusions: The rate of awareness was relatively low in study population. Thus, effective working guidelines and educational program to prevent scrub typhus must be developed, and publicity activities about the prevention of scrub typhus are needed for high-risk groups.

A Study on the Color coordination System to fashion (섬유.패션디자인을 위한 컬러코디네이션 지원모델 개발)

  • Jung, Jae-Woo;Lee, Jae-Jung
    • Archives of design research
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    • v.18 no.1 s.59
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    • pp.167-174
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    • 2005
  • This study is to objectively support the emotional and intuitional decision making of the designer by means of developing the supporting models and tools of color coordination. Based on the color grouping system and representative vocabularies suggested in the precedent 'Study on the Grouping System of Fabric Color,' this study suggested the manufacture of the supporting model of color coordination that could be used practically through the design of coloring group. The results of this study can be summarized as below. Firstly, 687 colors in total have been collected from the four world famous collections, the street fashion of 2002 F/W 2003 S/S Season and the representative brands in each group for five years from 1999 to 2003 in order to single out the basic colors for the purpose of composing the color groups. Secondly, 687 collected colors have been grouped into 144 colors in total through the three-step process for the extraction of coloring groups. Thirdly, the final extracted colors have been divided into , , , group by the grouping system specified in the precedent study and the said four large groups have been again subdivided into 12 small groups. Fourthly, the suggested colors in each group have established a color coordination system by introducing the concept of the crossover coordination that could be matched with other groups as well as the coordination within the group. Fifthly, we have dyed 144 colors in total that have consisted of the coloring system of four representative groups (twelve subgroups) in each methodical tone as in the above in cotton yarn, one of the representative materials in fabric fashion design industry. Besides, we have specified the symbol of the Pantone Color Book and CMYK values in each color that has consisted of the system considering the industrial characteristics of fashion as a global business and the compatibility with the related design industry. Sixthly, we have packed the completed yam made of fabrics in the designed container for the easy use of cross-coordination and have completed a color coordination system that could be easily utilized for the fashion-related working-level staffs.

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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 Effect of Herding Behavior and Perceived Usefulness on Intention to Purchase e-Learning Content: Comparison Analysis by Purchase Experience (무리행동과 지각된 유용성이 이러닝 컨텐츠 구매의도에 미치는 영향: 구매경험에 의한 비교분석)

  • Yoo, Chul-Woo;Kim, Yang-Jin;Moon, Jung-Hoon;Choe, Young-Chan
    • Asia pacific journal of information systems
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    • v.18 no.4
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    • pp.105-130
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    • 2008
  • Consumers of e-learning market differ from those of other markets in that they are replaced in a specific time scale. For example, e-learning contents aimed at highschool senior students cannot be consumed by a specific consumer over the designated period of time. Hence e-learning service providers need to attract new groups of students every year. Due to lack of information on products designed for continuously emerging consumers, the consumers face difficulties in making rational decisions in a short time period. Increased uncertainty of product purchase leads customers to herding behaviors to obtain information of the product from others and imitate them. Taking into consideration of these features of e-learning market, this study will focus on the online herding behavior in purchasing e-learning contents. There is no definite concept for e-learning. However, it is being discussed in a wide range of perspectives from educational engineering to management to e-business etc. Based upon the existing studies, we identify two main view-points regarding e-learning. The first defines e-learning as a concept that includes existing terminologies, such as CBT (Computer Based Training), WBT (Web Based Training), and IBT (Internet Based Training). In this view, e-learning utilizes IT in order to support professors and a part of or entire education systems. In the second perspective, e-learning is defined as the usage of Internet technology to deliver diverse intelligence and achievement enhancing solutions. In other words, only the educations that are done through the Internet and network can be classified as e-learning. We take the second definition of e-learning for our working definition. The main goal of this study is to investigate what factors affect consumer intention to purchase e-learning contents and to identify the differential impact of the factors between consumers with purchase experience and those without the experience. To accomplish the goal of this study, it focuses on herding behavior and perceived usefulness as antecedents to behavioral intention. The proposed research model in the study extends the Technology Acceptance Model by adding herding behavior and usability to take into account the unique characteristics of e-learning content market and e-learning systems use, respectively. The current study also includes consumer experience with e-learning content purchase because the previous experience is believed to affect purchasing intention when consumers buy experience goods or services. Previous studies on e-learning did not consider the characteristics of e-learning contents market and the differential impact of consumer experience on the relationship between the antecedents and behavioral intention, which is the target of this study. This study employs a survey method to empirically test the proposed research model. A survey questionnaire was developed and distributed to 629 informants. 528 responses were collected, which consist of potential customer group (n = 133) and experienced customer group (n = 395). The data were analyzed using PLS method, a structural equation modeling method. Overall, both herding behavior and perceived usefulness influence consumer intention to purchase e-learning contents. In detail, in the case of potential customer group, herding behavior has stronger effect on purchase intention than does perceived usefulness. However, in the case of shopping-experienced customer group, perceived usefulness has stronger effect than does herding behavior. In sum, the results of the analysis show that with regard to purchasing experience, perceived usefulness and herding behavior had differential effects upon the purchase of e-learning contents. As a follow-up analysis, the interaction effects of the number of purchase transaction and herding behavior/perceived usefulness on purchase intention were investigated. The results show that there are no interaction effects. This study contributes to the literature in a couple of ways. From a theoretical perspective, this study examined and showed evidence that the characteristics of e-learning market such as continuous renewal of consumers and thus high uncertainty and individual experiences are important factors to be considered when the purchase intention of e-learning content is studied. This study can be used as a basis for future studies on e-learning success. From a practical perspective, this study provides several important implications on what types of marketing strategies e-learning companies need to build. The bottom lines of these strategies include target group attraction, word-of-mouth management, enhancement of web site usability quality, etc. The limitations of this study are also discussed for future studies.

Effect of Frequency of Using Forest Environment on Workers' Stress: a Comparative Study on Workers in Medical and Counseling Service Institution (산림환경 이용 빈도가 근로자의 스트레스에 미치는 영향: 의료 및 상담서비스기관 종사자에 대한 비교 연구)

  • Jung, Won Hee;Woo, Jong-Min;Ryu, Jee Soo
    • Journal of Korean Society of Forest Science
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    • v.103 no.1
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    • pp.129-136
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    • 2014
  • This study aims to investigate the effect of frequency of using forest environment on workers' stress. Workers in medical and counseling industry, which is recently known to require heavy emotional burden and thus cause a lot of stress and burnout syndrome, participated in the study. We classified 370 subjects, who were working at medical and counseling service institutions in Seoul metropolitan area, into two groups according to frequency of using forest environment by conducting a screening survey. 69 subjects submitted written consent and were recruited for either forest therapy program or control-group test; the "high" group (n=27) at the high frequency of using forest environment and the "low" group (n=42) at the low level. We measured the level of stress by using psychosocial indicators such as Worker's Stress Response Inventory (WSRI), Recovery Experience Questionnaire (REQ), and Maslach Burnout Inventory-General Survey (MBI-GS) and biological ones such as heart rate variability (HRV), cortisol, and Natural Killer cell (NK cell). The results suggested that the level of stress differed by frequency. The "high" group showed significantly low scores in the depression and work sub-scale and the total score of WSRI, emotional exhaustion, professional efficacy and total score of MBI-GS, and high scores in the total score of REQ. Similar tendencies were observed in the most of other indicators of psychosocial measures. Regarding the biological indicators, the "high" group showed the highest SDNN, RMSSD and TP measures of HRV and NK Cell activity and the low cortisol, although the statistical power did not reach the significant level. Our results suggest that the subjects who use forest environment frequently show favorable stress level both psychologically and biologically.

Tumorigenesis after Injection of Lung Cancer Cell Line (SW-900 G IV) into the Pleural Cavity of Nude Mice (누드마우스의 흉강에 폐암세포주의 주입에 의한 종양형성과 HER2/neu와 TGF-${\beta}_1$의 발현)

  • Park, Eok-Sung;Kim, Song-Myung;Kim, Jong-In
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.588-595
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    • 2010
  • Background: Base on types of tumor, the types of expressed tumor is diverse and the difference in its expression rate is even more various. Due to such reasons an animal model is absolutely needed for a clinical research of lung cancer. The author attempted oncogenesis by cultivating a cell line of non-small cell carcinoma and then injecting it inside thoracic cavities of nude mice. The author conducted quantitative analyses of HER2/neu tumor gene - an epidermal growth factor receptor (EGFR) related to lung cancer, and TGF-${\beta}_1$, which acts as a resistance to cell growth inhibition and malignant degeneration. In order to investigate achievability of the oncogenesis, histological changes and the expression of cancer gene in case of orthotopic lung cancer is necessary. Material and Method: Among 20 immunity-free male BALB/c, five nude mice were selected as the control group and rest as the experimental group. Their weights ranged from 20 to 25 gm (Orient, Japan). After injection of lung cancer line (SW900 G IV) into the pleural cavity of nude mice, They were raised at aseptic room for 8 weeks. HER2/neu was quantitatively analyzed by separating serum from gathered blood via chemiluminiscent immunoassay (CLIA), and immunosandwitch method was applied to quantitatively analyze TGF-${\beta}_1$. SPSS statistical program (SPSS Version 10.0, USA) was implemented for statistical analysis. Student T test was done, and cases in which p-value is less than 0.05 were considered significant. Result: Even after lung cancer was formed in the normal control group or after intentionally injected lung cancer cell line, no amplification of HER2/neu gene showed reaction. However, the exact quantity of TGF-${\beta}_1$ was $28,490{\pm}8,549pg/mL$, and the quantity in the group injected with lung cancer cell was $42,362{\pm}14,449pg/mL$, meaning 1.48 times highly Significant (p<0.483). It proved that HER2/neu gene TGF-${\beta}_1$ had no meaningful interconnection. Conclusion: TGF-${\beta}_1$ gene expressed approximately 1.48 times amplification in comparison to the control group. The amplification of TGF-${\beta}_1$ meant somatic recuperation inhibition mechanism due to carcinogenesis in nude mice was definitely working. It may be implemented as a quantitative analysis that allows early detection of lung cancer in human body.

Study on Implementation Measures of Provincial Self-governing Police System : Focusing on the Implication from Enlargement of Work Scope of Self-governing Police of Jeju Province (광역자치경찰제의 정착방안에 관한 연구 - 제주자치경찰의 사무확대에 대한 시사점을 중심으로 -)

  • Kim, Seong-Hee
    • Korean Security Journal
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    • no.59
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    • pp.37-69
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    • 2019
  • According to viewpoints of researchers and stakeholders, various opinions can be suggested on self-governing police system. Therefore, success of Korean self-governing police system will be defending on how to balance among conflicting values such as Empowerment, Political neutrality, Financial issues, Comprehensive competence in maintaining public safety. Before the launching of self-governing police system nation-wide, the experience of Jeju provincial police will be valuable model case. In specific, enlargement of work scope of self-governing police in Jeju province which has been introduced since last year will be a useful reference. There is more pessimism about self-governing police of Jeju province so far. However, this perspective is mostly based on the issue regarding hardwares such as manpower, equipment, law and organization. Issues regarding softwares such as organizational culture, operation system and work process need more attention to evaluate self-governing police system properly. To mark the first year after enlargement of work scope of Jeju police, this study demonstrate the overall result and implications of self-governing police of Jeju province based on documents, statistics, reports and media reports. In result, several preconditions are needed to implement the self-governing police system nation-wide successfully. 1. Strengthen the link between local government and local police 2. Establish the foundation for collaboration of state and local police 3. Enhance the aspect of citizen autonomy in local level 4. Reinforcing the capability of handling situation of state and local police 5. Invigorating the inter-organizational working group to operate self-governing police system effectively. The self-governing police system is unclosed topic to discuss. After this study, in-depth studies should be followed with more resources. Particularly, additional perspective including redundancy and equity need to be considered regarding self-governing police. By getting with the changes of macroscopic trends - lowbirth and aging, the fourth industrial revolution and possible reunification of north and south Koreas - these studies should suggest the long-term blueprint of self-governing police system of Korea.

A Study of Job Satisfaction and Related Factors of the National Hospital Nurses (국립병원 간호사의 직무만족과 관련요인 연구)

  • Suh Gil-Hee;Kim Ok-Hee
    • Journal of Korean Public Health Nursing
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    • v.7 no.2
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    • pp.53-66
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    • 1993
  • By this time, a few of previous studies of factors related to separation from their jobs and job satisfaction only have dealt with the separation rate. the cause of separation and related factors that induce job satisfaction and incentive factors, the actualities of morale some suggestions for reduction of the separation rate. This study is attempted to determine factors that have effect on job satisfaction of national hospital nurses. and to proide information and materials for the development of the administration of nursing through the appreciation of factors influencing on job satisfaction between isolated ward nurses and general ward nurses working at national hospitals. 185 nurses of national hospitals responsed th this study, and were divided into two groups. Group 1: 57 nurses working at isolated wards for tuberculosis patients and Group 2 : 128 nurses at general wards. Relevant data were collected from August, 5, 1992 through August 20, 1992. The questionnaire consisted of 8 genalized items and 4 items concerning job satisfaction. The collected data were processed with SPSS, and the relationship among vaviables was analyzed by means of $X^2-test$, Pearson Correlation, Multiple Regression. The results of this study are as follows: 1. There is no significant difference between two groups in terms of generalized items. Age distributions show $44.3\%$ under the category of less than 34. and $55.7\%$ under the category more than 35, $19.3%$ was single and $74.6\%$ was married respectively. 2. $79.4\%$ of the nurses have the desire to have in-service education under the satisfactory physical environments such as welfare system, accommodating structures and facilities, instruments or management systems of the hospital, but under the category of unsatisfactory circumstances, $60.3\%$ have the intention of having in- service education. The concern in terms of in-service education shows statistically significant difference between two groups $(X^2=8.85,\;p<0. 05)$. This result accepts the hypothesis that good physical environments could intensify interests in service education. 3. The extent of satisfaction related to psychological environments is heightend according to good physical environments. In result, the hypothesis that the extent of satisfaction in terms of physical environments could raise satisfaction about psychological environment is accepted. 4. In the light of the extent of satisfaction about physical environments, $33.3\%$ of isolated ward nurses are satisfied with physical environments, but only $11.7\%$ of general ward nurses are satisfied. $(X^2=10.88,\; p<0.01)$. This result shows that the satisfaction degree about phusicalenvironments of isolated war nurses was higher than that of general ward nurses in spite of high physical and psychological risks due to exposure to infection. Consequently. the hypothesis was rejected that the satisfaction degree about physical environments would be lower in isolated ward nurses than in general ward nurses. 5. The fact that $87.7%$ of isolated ward nurses took interest in service education and $53.19\%$ of general ward nurses took interest in service education demonstrats that isolated ward nurse have more interest in service education than gerneral ward nurses. The result shows that the hypothesis is accepted that isolated ward nurses would have mor interests in service education than general ward nurses. 6. In the extent of satisfaction about physical environments such as morale human relationship promotion, there is no significant difference between two groups in terms of statistics. The hypothesis is rejected that satisfaction about psychologic environments would be high in isolated ward nurses than in general ward nurses. In conclusion. factors influencing on job satisfaction are considered to have effect on. another, and also interdisciplinary amelioration of factors accompanied with systematic inter cooperative investigation is necessary.

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