• Archives of Plastic Surgery
• /
• v.49 no.2
• /
• pp.227-239
• /
• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

• Korean Journal of Clinical Pharmacy
• /
• v.32 no.2
• /
• pp.125-132
• /
• 2022

Background: Fixed-dose combinations have the advantage of improving patient compliance, but may increase the risk of duplicate prescriptions. As the use of fixed-dose combination antihypertensives increases, it is necessary to investigate the current status of class duplication prescriptions (CDP) in patients taking fixed-dose combination antihypertensives in Korea and to identify factors associated with CDP. Methods: We conducted a retrospective observational study using nationally representative claim data. Hypertensive patients aged 20 years or older taking fixed-dose combination antihypertensives were extracted. Among these patients, patients with CDP were identified. A chi-square test was applied to determine the differences between patients with CDP and non-CDP. The associated factors of CDP were identified through multiple logistic regression. Results: Of the 74,165 patients who were prescribed fixed-dose combination antihypertensives, 426 patients (0.6%) with CDP were identified. The most common antihypertensive class associated with CDP was calcium channel blockers (194 patients, 45.5%), followed by angiotensin II receptor blockers (136 patients, 31.9%). Patients aged 75 years or older (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.02-3.52), chronic kidney disease (OR 4.45, 95% CI 2.15-8.25), chronic heart failure (OR 2.71, 95% CI 1.93-3.72), coronary artery disease (OR 2.22, 95% CI 1.60-3.03) and Medical Aid/Patriots and Veterans Insurance (OR 1.49, 95% CI 1.04-2.07) were significantly associated with increased CDP. Conclusions: The factors associated with CDP were the elderly, comorbidities, and low socioeconomic status. Since CDP can result in negative clinical outcomes, active intervention by the pharmacist is warranted.

• Clinical Pain
• /
• v.16 no.1
• /
• pp.20-25
• /
• 2017

Objective: To find that the patients who conducted home self-exercise in conjunction with intra-articular corticosteroid injection will have better improvement in subacromial subdeltoid (SASD) bursitis symptoms than those who received only an injection. Method: A prospective, nonrandomized, comparison study was conducted in outpatient rehabilitation clinic in a tertiary university hospital. Patients diagnosed with SASD bursitis with physical examination and ultrasound evaluation were included and received ultrasound guided injection (UGI). Patients were divided into two groups according to the compliance of self-exercise: UGI-exercise group and UGI only group. Visual analog scale (VAS) was checked before, at 3 weeks, 3 months, and 6 months after the UGI. A patient's global impression of change (PGIC) survey was made at 3 months after the UGI. Results: A total of 82 patients with SASD bursitis were included. At 3 weeks after the injection, the mean VAS for the UGI-exercise group was 2.6 ± 1.7 and for UGI only group was 1.9 ± 1.3 (p=0.030). At 3 months after the injection, the mean VAS for the UGI-exercise group was 4.0 ± 1.3 and for UGI only group was 5.4 ± 1.4 (p<0.001). Conclusion: We concluded that home-based self-exercise of the shoulder provides an additional benefit for pain alleviation possibly with prolonging the effect of injection in SASD bursitis.

• Journal of Biomedical Engineering Research
• /
• v.44 no.6
• /
• pp.428-442
• /
• 2023

In this study, we have a goal to develop usability evaluation guidelines for heuristic-based artificial intelligence-based Software as a Medical Device (SaMD) in the medical field. We conducted a gap analysis between medical hardware (H/W) and non-medical software (S/W) based on ten heuristic principles. Through severity assessments, we identified 69 evaluation domains and 112 evaluation criteria aligned with the ten heuristic principles. Subsequently, we categorized each evaluation domain into five types, including user safety, data integrity, regulatory compliance, patient therapeutic effectiveness, and user convenience. We proposed usability evaluation guidelines that apply the newly derived heuristic-based Software as a Medical Device (SaMD) evaluation factors to the risk management process. In the discussion, we also have proposed the potential applications of the research findings and directions for future research. We have emphasized the importance of the judicious application of AI technology in the medical field and the evaluation of usability evaluation and offered valuable guidelines for various stakeholders, including medical device manufacturers, healthcare professionals, and regulatory authorities.

• Anxiety and mood
• /
• v.19 no.2
• /
• pp.37-47
• /
• 2023

This review article explores the psychological characteristics, comorbid mental disorders, and psychosocial assessments throughout the solid organ transplant journey, spanning the pre-transplant, peri-transplant, and post-transplant phases for transplant recipients. The psychological burden and anxiety in the pre-transplant phase are high for organ failure patients with complex physical difficulties who are deciding to undergo transplantation and are on the waiting list. The pre-transplant psychosocial evaluation covers various aspects, including the patient's readiness, awareness of, and commitment to transplant treatment, medical compliance, psychopathological conditions such as cognitive function and personality disorders, lifestyle factors, including substance abuse, as well as various psychosocial factors like social support. During the peri-transplant phase, mental health problems such as postoperative delirium should be carefully recognized and addressed. After transplantation, it is essential to assist patients in coping with the various stressful experiences they encounter, manage psychiatric symptoms such as depression, anxiety, and insomnia, and improve treatment adherence and quality of life during long-term care for the transplanted organ. Managing psychiatric problems in post-transplant patients requires a deep understanding of immunosuppressant medications and a keen awareness of associated risks, including adverse effects and potential drug interactions. This comprehensive review emphasizes the significance of proactive mental health care and psychosocial evaluation, highlighting the necessity of a multidisciplinary approach to enhance the quality of life and overall success of transplant patients throughout all phases of transplantation.

• Korean Journal of Psychosomatic Medicine
• /
• v.28 no.1
• /
• pp.53-62
• /
• 2020

Objectives : This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. Methods : A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. Results : The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). Conclusions : Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient-doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.3
• /
• pp.258-269
• /
• 2017

This study was conducted to examine the predictive factors for health promotion behaviors of breast cancer patients, focusing on Pender's health promotion model (1996). Data were collected from 121 patients using a structured questionnaire from September 18 to October 26 in 2015. The data were analyzed with a t-test, ANOVA, Pearson's correlation coefficients, and hierarchical multiple regression analysis using SPSS 20.0 for Windows. The predictive factors for the health promotion behavior of the participants were social support, commitment to a plan of action, prior behavior, activity related effects, perceived self-efficacy, family function, perceived benefits of action, and situational influences. The total explanatory power of these factors was 57.8%. Development and application of a nursing intervention plan that enhances patient compliance with health promotion behavior is needed to enable breast cancer patients undergoing rehabilitation to maintain their optimal health and live a high-quality life. Patients who showed a low degree of predictive factors identified in this study are in particular need of attention.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.34 no.4
• /
• pp.685-693
• /
• 2007

Class I malocclusion without skeletal problem results from tooth size/arch-size discrepancies, either evidenced by crowding, or spacing problems. Treatment method can be chosen according to dentition, the amount of arch discrepancy, patient compliance, or patient demands. We report of clear aligner and spring aligner that can be applicated in cases of permanent dentition with minimal arch discrepancy in anterior segment. There are some limits of application, but these are very useful appliances in the selective case. When crowding exists, definitive analysis and diagnosis should be made before starting treatment because certain amount of space must be obtained somewhere in the dentition to resolve the crowding. Therefore, appliance should be applied when lacking space is small. Also, in cases with spacing arch circumference is reduced after alignment so no problem in intermaxilla occlusal relationship must be confirmed. In case with crowding, judicious removal of interproximal enamel is indicated.

• Journal of the Korean Society of Radiology
• /
• v.9 no.7
• /
• pp.445-448
• /
• 2015

Recently there has been increasing interest in the filter to reduce the proportion of low-energy photons in the polychromatic X-ray, affect the quality of the image quality by X-ray hardening effect is a situation that has been overlooked. In this study, by evaluating the change in FSR based on the filter and it was quantitatively discuss scatter dose affecting the medical image quality. The results of the experiment, as the thickness of the filter is increased, up to 13.9%p, that tends to FSR increases appearance were evaluated. Based on these results, in compliance with the thickness of the filter that has been recommended in KS standard, even while reducing the radiation dose of the patient, in addition to the noise to about 1%p within the FSR only medical image the contribution to it is conceivable. Therefore, even while reducing radiation dose of the patient, in order to improve the quality of the medical image, the use of appropriate filter is considered important.

• Journal of Nutrition and Health
• /
• v.33 no.8
• /
• pp.813-823
• /
• 2000

The purpose of this study was to investigate the effects of the nutrition therapy and drug(simvastatin) treatment on the levels of blood lipids for the hyperlipidemic patients according to genetic polymorphism of apo CIII. Subjects of the study consisted of 43(male: 9, female: 34 )hyperlipidemic patients registered to Kyung Hee Medical Center, Intakes of nutrients for the subjects were determined by 24-hr recall method through a personal interviews. The subjects were instructed to take the hypolipidemic and hypocholesterolemic diets. Compliance was monitored through food records, personal interview, and body-weight measurements. The patients changed their basal diet containing 40. 1g fat(182.7mg cholesterol./day) to a diet containing 30.7g fat(139.2mg cholesterol/day) after 12 weeks of nutrition therapy. The distribution of genotypes for apo CIII by Msp I was 32.5% of TT, 50.0% of TC, and 17.5% of CC. aT the beginning of the study, the level of blood triglyceride was the highest for patients with TT and TC. Following the nutrition therapy, patients with CC exhibited the largest drop of blood triglyceride. Following simvastatin treatment with nutrition therapy, blood LDL-cholesterol decreased in most of the patiens with TT. Meanwhile the distribution of genotypes for apo CII by the Fok I was 10.0% of TT, 47.5% of TC, and 42.5% of CC. The level of blood triglyceride was the highest for patients with CC. Following the nutrition therapy, patients with TC exhibited a significant drop for the blood triglyceride. Following simvastatin treatment with nutrition therapy the level of blood LDL-cholesterol decreased in most of the patients with CC. We concluded that dietary habits and food have been changed by nutrition therapy. And blood lipid levels have been decreased by the restriction of intakes of energy, fat and cholesterol. There was variation in the levels of blood lipids according to apo CII polymorphisms. The level of blood lipids responded to nutrition therapy and drug treatment in different was according to genetic polymorphisms. Accordingly, the choice of individualized therapy based on the patient\\`s genetic polymorphism is very important for effective therapy(Korean J Nutrition 33(8) : 813-823, 2000)