• Journal of Hospice and Palliative Care
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• 제7권1호
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• pp.64-72
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• 2004

목적: 본 연구는 3차 의료기관에서 진행암 및 말기암 환자와 가족을 대상으로 집단 교육을 실시하여 그 효과성을 보고자 하였다. 방법: 집단교육에 참석한 환자와 가족을 대상으로 설문지를 실시했다. 응답한 설문지를 SAS 분석하고 CHISQ를 통해 유의성 검증을 하였다. 설문지 조사내용은 1) 참석자의 일반적인 특성, 2) 환자의 일반적인 특성, 3) 환자를 돌보는 어려움, 4) 교육에 대한 평가였다. 결과: 교육에 참석한 환자와 가족은 211명이었고, 이 중 응답한 설문지는 89명이었다. 응답한 설문지 결과를 보만 참석자 중 환자가 37.5%, 가족이 56.2% 참석했다. 참석자의 나이는 60대, 50대, 40대, 30대 순이었고, 가족관계는 배우자가 가장 많고, 부모, 자녀, 형제 순으로 참석했다. 환자의 진단은 위암, 폐암, 유방암, 대장암 순이었고, 진행암 환자가 48.8%, 말기가 17.4%를 차지했다. 환자와 가족이 호소하는 주된 어려움은 치료와 관련된 문제가 대부분이었고, 정서적인 문제, 식사문제, 증상관리, 통증조절, 의료문제의 어려움을 호소했다. 교육에 대한 평가는 95%가 도움이 되었다고 하였다. 특히 식사, 의료문제에 대한 교육 만족도가 높았다. 주목할 점은 환자와 가족은 치료와 관련된 문제뿐만 아니라 호스피스와 관련된 구체적인 정보를 알고 싶어했다. 결론: 이 프로그램은 진행암 및 말기암 환자와 가족을 대상으로 집단 교육을 실시하여 필요한 정보를 제공함으로써 교육이 도움이 되었다는 결과를 얻었다. 향후 프로그램은 환자와 가족이 필요로 하는 구체적인 정보와 충분한 교육시간의 확보와 보다 많은 교육의 기회의 제공이 요구된다.

• 지역사회간호학회지
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• 제15권3호
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• pp.353-364
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• 2004

Purpose: The purpose of this study was to investigate the types and frequencies of nursing intervention of home health care in Public Health Centers and its effects. Method: The data collection period for this study lasted from March 1 to December 31, 2003. The clients were sampled by a stratified randomized method among those who had been cared for at least 3 months. The data was analyzed by SPSS for description. ANOVA, paired t test, etc. Result: The types and frequencies of nursing intervention in major chronic health problems were significantly different. The main types of nursing intervention in hypertension and DM patients included education on disease management, regular exercise, stress management, diets, etc. CVA patients were intervened in pain control (ice or hot pack, massage), position changes, and ROM exercise. Cancer patients received imaginary or relaxation therapy, pain control (ice or hot pack, massage), hospice, etc. After the intervention, the drug compliance of hypertension (8.2 days per month) and DM patients (6.2 days per month) improved. Blood sugar levels (FBS 7.6, post partum 2hrs $21.4(mg/d{\ell})$ and blood pressure(systolic 9.8, diastolic 4.3 mmHg) lowered significantly. All aspects of QOL also improved (total 3.68). Conclusion: The types and frequencies of nursing intervention were determined by characteristics of the health problems, and home health care nursing intervention in Public Health Centers was effective to the elderly of the community in many aspects.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.208-212
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• 2021

Background There are currently no guidelines for the postoperative wound management of the hard-palate donor site in cases involving mucosal harvesting. This study describes our experiences with the use of an artificial dermis for early epithelialization and transparent plate fixation in cases involving hard-palate mucosal harvesting. Methods A transparent palatal plate was custom-fabricated using a thermoplastic resin board. After mucosal harvesting, an alginic acid-containing wound dressing (Sorbsan) was applied to the donor site, which was then covered with the plate. After confirming hemostasis, the dressing was changed to artificial dermis a few days later, and the plate was fixed to the artificial dermis. The size of the mucosal defect ranged from 8×25 to 20×40 mm. Results Plate fixation was adequate, with no postoperative slippage or infection of the artificial dermis. There was no pain at the harvest site, but a slight sense of incongruity during eating was reported. Although the fabrication and application of the palatal plate required extra steps before and after harvesting, the combination of the artificial dermis and palatal plate was found to be very useful for protecting the mucosal harvest site, and resulted in decreased pain and earlier epithelialization. Conclusions The combination of artificial dermis and a transparent palatal plate for wound management at the hard-palate mucosal donor site resolved some of the limitations of conventional methods.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.156-161
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• 2008

목 적 : 막창자염은 면역기능이 저하되고 호중구가 감소된 소아암 환자에서 호발하는 괴사성 장염으로 사망률이 매우 높은 것으로 알려져 있다. 저자들은 항암치료 중 발생한 막창자염에 대하여 적극적인 내과적 치료와 항생제 치료를 시행하여 그 치료성적을 분석하고자 본 연구를 시행하였다. 방 법 : 2002년 8월부터 2007년 7월까지 영남대학교병원 소아과에 입원하여 항암화학요법을 받은 소아암 환자 207명 중 막창자염으로 진단받은 12명을 대상으로 의무기록을 분석하였다. 진단은 임상증상과 신체검진소견, 복부단순촬영검사, 복부초음파검사와 복부전산화단층촬영으로 하였다. 항암화학요법 시행 후 증상 발생일, 백혈구수, 절대호중구수, 치료항생제의 종류 및 치료기간과 치료결과를 분석하였다. 결 과 : 막창자염으로 임상적 진단을 받은 환자는 12명(5.7%)이었으며, 임상증상은 복부통증 및 압통 12명(100%), 발열 12명(100%), 설사 9명(75%), 구토 5명(41%), 반발압통 3명(25%) 등이었다. 항암화학요법 종료일로부터 증상 발생일까지의 기간의 중앙값은 12일(범위 3-18일)이었다. 백혈구수의 중앙값은 340 / L$(30-1,270/{\mu}L)$이었으며, 절대호중구수의 중앙값은 $116/{\mu}L(0-648/{\mu}L$)이었다. 치료는 항생제 요법과 충분한 수분 공급 및 장의 휴식 등 보존적 요법을 시행하였으며 환자 12명 모두 증상이 호전되었고, 수술적 치료를 받은 경우는 없었다. 항생제 조합의 선택에 따른 항생제 사용기간의 통계적인 차이는 없었다(P=0.74). 결 론 : 항암화학요법을 받는 소아암 환자에서 발열, 우하복부 압통, 호중구감소증이 있을 때는 막창자염을 의심하여야 하며, 조기진단 및 적극적인 내과적 치료와 항생제 요법을 시행하여 좋은 결과를 얻을 수 있다고 생각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권2호
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• pp.157-165
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• 2008

The aim of this study was to evaluate the efficacy of a topical 0.2% hyaluronic acid (HA) preparation in the management of wound after removal of arch bar for facial bone fracture and a suture site after orthognatic, oral cancer or oral surgery. Forty patients participated in a randomized, placebo controlled, double-blind trial to evaluate the efficacy of the topical HA and preparation. HA topically applied to the wound after removal of arch bar or stitch out, 3 times a day for 4 weeks. Evaluation is performed once a week for 4 weeks. For subjective evaluation, relative pain reduction in visual analog scale (VAS) and existence of heat sensation was accessed. For objective evaluation, gross evaluation, papilla index, existence of wound dehiscence, redness and swelling was checked. The same evaluation was performed in each arch bar group and suture group. For whole subject, 0.2% HA group resulted higher reduction than placebo group in pain of site in first week with significancy. Same findings were seen other weeks but there was no significancy. 0.2% HA group had better result than placebo in objective evaluation (papilla index, wound dehiscence, redness and swelling), but in gross evaluation placebo had better result than 0.2% HA group with no significancy. Subject was divided into suture group and arch bar group. Same aspect was seen, but only suture group had significancy not arch bar group in pain reduction score. 0.2% HA group resulted higher reduction than placebo group in pain of site in first week with significancy, especially in suture group. It reveals topical application of HA in wound especially suture site reduced pain in early stage. And 0.2% HA group had better result than placebo in papilla index, redness and swelling with no statistical significancy. In conclusion, HA has effect of pain reduction and healing promotion in the mucosal wound after oral surgery.

• 임상간호연구
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• 제18권2호
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• pp.317-328
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• 2012

Purpose: This study was done to provide oncology nurses systemic guidelines designed to perform telephone counseling in outpatient settings treating patients with chemotherapy. Methods: Symptoms which are frequently questioned were identified through case reports recorded by 4 clinical nurse specialists from January 4 to December 31. 2010. Fifteen clinical experts and two hemato-oncologists reviewed the developed draft. Their opinions were synthesized to arrive at consensus on the ideal guidelines. This process confirmed content validity. The two hemato-oncologists also verified the face validity. Results: The six symptoms which were most frequently asked about were identified through 4,644 case reports and concerned pain, fever, skin alteration, nausea/vomiting, stomatitis and diarrhea. Evidence-based telephone triage guidelines for the 6 major symptoms in patients receiving chemotherapy were developed. Conclusion: These guidelines will help oncology nurses from novice to expert incorporate evidence-based telenursing into their practice.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.459-461
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• 2009

Polycythemia vera is one type of myeloproliferative disorder which occurs due to the clonal proliferation of hematopoietic stem cell related to the production of leukocyte and megakaryocyte which produces a little less than erythrocyte. Polycythemia vera has a peak incidence in the sixth decade of life with males affected slightly more frequently than females. Vasquez first described polycythemia vera as an autonomous erythrocytosis in 1892, and a further description, delineation of the disease process and a complete course outline were made in 1899, 1903 and 1938, respectively. Symptoms include pruritus, tinnitus, vertigo, gastrointestinal (GI) pain, and bleeding gums. Hyperuricemia and hyperuricosuria are present in about 40% of these patients. Complications are hemorrhage, thrombosis, post-polycythemic myeloid metaplasia, and leukemic transformation. In case of surgery, complications such as hemorrahge and thrombosis are highly likable to happen. We report a case of preoperative and postoperative of a 63-year-old male, who was diagnosed as oral cavity cancer in the mouth floor, with known history of hypertension and polycythemia vera. We considered that conservative management would be an advisable treatment for patients with uncontrolled systemic disease.

• 대한골관절종양학회지
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• 제1권1호
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• pp.52-59
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• 1995

Metastatic cancer is the most common tumor of the skeleton. The prevalence of pathologic fracture may increase as patient survival is prolonged by improved cancer therapy. With recent advances in orthopaedic procedure and medical management of terminal cancer patients, it is generally agreed that aggressive treatment should be undertaken for patient with pathologic fracture secondary to metastatic disease, and a team approach should be utilized. The authors have reviewed twenty cases of pathologic fracture of the long bone due to metastatic tumor treated in the Department of Orthopedic Surgery, Yonsei University College of Medicine, from April 1989 to April 1994 and the following results were obtained. 1. The mean age at surgery was 58.4 years (ranged from 24years to 86years) and among 20 cases, 10 cases were male and the others were female. 2. The most frequent site of pathologic fracture in long bone is femur(15 cases, 75%), and followed by humerus(4 cases, 20%), tibia(1 case). 3. The frequently encountered primary tumors that metastases to long bone are those of the lung(7 cases, 35%), breast(4 cases, 20%), and prostate(2 cases, 10%). 4. The operative procedure was performed by resection of the tumor mass extensively, and we used polymethylmetacrylate for filling the dead space after resection, in all cases. 5. The mean survival period after operation is 9.2 months(ranged from 1 month to 4 years and 9 month). 6. The results of postoperative pain relief status were graded as fair to excellent in 17 cases(85%).

• 대한간호학회지
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• 제47권5호
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• pp.600-612
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• 2017

Purpose: This study aimed to identify and compare hospice care research topics between Korean and international nursing studies using text network analysis. Methods: The study was conducted in four steps: 1) collecting abstracts of relevant journal articles, 2) extracting and cleaning keywords (semantic morphemes) from the abstracts, 3) developing co-occurrence matrices and text-networks of keywords, and 4) analyzing network-related measures including degree centrality, closeness centrality, betweenness centrality, and clustering using the NetMiner program. Abstracts from 347 Korean and 1,926 international studies for the period of 1998-2016 were analyzed. Results: Between Korean and international studies, six of the most important core keywords-"hospice," "patient," "death," "RNs," "care," and "family"-were common, whereas "cancer" from Korean studies and "palliative care" from international studies ranked more highly. Keywords such as "attitude," "spirituality," "life," "effect," and "meaning" for Korean studies and "communication," "treatment," "USA," and "doctor" for international studies uniquely emerged as core keywords in recent studies (2011~2016). Five subtopic groups each were identified from Korean and international studies. Two common subtopics were "hospice palliative care and volunteers" and "cancer patients." Conclusion: For a better quality of hospice care in Korea, it is recommended that nursing researchers focus on study topics of patients with non-cancer disease, children and family, communication, and pain and symptom management.

• Experimental and Molecular Medicine
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• 제50권11호
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• pp.6.1-6.12
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• 2018

Morphine tolerance remains a challenge in the management of chronic pain in the clinic. As shown in our previous study, the dopamine D2 receptor (D2DR) expressed in spinal cord neurons might be involved in morphine tolerance, but the underlying mechanisms remain to be elucidated. In the present study, selective spinal D2DR blockade attenuated morphine tolerance in mice by inhibiting phosphatidylinositol 3 kinase (PI3K)/serine-threonine kinase (Akt)-mitogen activated protein kinase (MAPK) signaling in a ${\mu}$ opioid receptor (MOR)-dependent manner. Levo-corydalmine (l-CDL), which exhibited micromolar affinity for D2DR in D2/CHO-K1 cell lines in this report and effectively alleviated bone cancer pain in our previous study, attenuated morphine tolerance in rats with chronic bone cancer pain at nonanalgesic doses. Furthermore, the intrathecal administration of l-CDL obviously attenuated morphine tolerance, and the effect was reversed by a D2DR agonist in mice. Spinal D2DR inhibition and l-CDL also inhibited tolerance induced by the MOR agonist DAMGO. l-CDL and a D2DR small interfering RNA (siRNA) decreased the increase in levels of phosphorylated Akt and MAPK in the spinal cord; these changes were abolished by a PI3K inhibitor. In addition, the activated Akt and MAPK proteins in mice exhibiting morphine tolerance were inhibited by a MOR antagonist. Intrathecal administration of a PI3K inhibitor also attenuated DAMGO-induced tolerance. Based on these results, l-CDL antagonized spinal D2DR to attenuate morphine tolerance by inhibiting PI3K/Akt-dependent MAPK phosphorylation through MOR. These findings provide insights into a more versatile treatment for morphine tolerance.