• Journal of the Korean Dietetic Association
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• v.7 no.3
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• pp.217-226
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• 2001

It is important to supply adequate nutrition to critically ill patients, whose gastrointestinal system is properly functioning, through the enteral tube feeding if oral intake is impossible. In this study we investigated the changes in nutritional status with enteral tube feeding according to the volume required. We investigated the volume ordered according to the patient's requirements, volume infused according to the volume ordered in 41 enteral tube feeding patients in intensive care unit from Jannuary to July, 2000. Body weight, serum albumin level, and total lymphocyte count were evaluated to assess nutritional status. The mean fasting period was 5 days before the enteral feeding and patients whose fasting period over 3 days were 51%. The mean enteral tube feeding period was 29 days and method of feeding was nasogastric, bolus feeding 6 times per day. The volume ordered was 69.7% of the patients' recommended calorie and volume infused was 86.6% of their volume prescribed. Accordingly, the volume infused was estimated 61.7% of their volume required. Only 44.6% of their reqiured volume was infused within 3 days after enteral tube feeding was started. It took 16 days in average to meet the patients' recommended calorie; 56% of subjects still did not fully met their requirements by the end point. Among the impeding factors in supplying enteral tube feeding, factors related to the number of feeding were high residual volume in stomach, vomiting, gastrointestinal bleeding, abdominal distension and surgery. Factors related to the acctual infused volume were diarrhea, gastrointestinal bleeding, abdominal distension, airway management and tube reinsertion. Significant correlations were shown between the volume infused and changes in both the patients' weight and serum albumin level. Deviding the subjects into two groups by their infused volume, less than 70% and more than that, we compared the two to come up with a significant difference in their serum albumin level, -0.23 vs 0.21, and their body weight, -4.52 vs 0.12. In enteral tube feeding, the volume delivered in sufficient to the pateints' energy requirement can affect their nutriitional status in critically ill patient; adequate nutritional management plan is essential. It is necessary to make every effort to educate clinical staff and to set up a unified management program to prescribe adequate ammount of energy for the patient's nutritional requirement.

• Journal of Nutrition and Health
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• v.28 no.4
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• pp.345-354
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• 1995

Blenderized diets are not recommended because of difficulties in providing a constant content of nutrients, phoblems with viscosity and osmolarity, time needed for preparation, and increased risk of contamination. To determine the possibility of substituting commercial formulas for blenderized diets, 27 unconscious patients were randomized into two different groups : blenderized diet group(n=11) and commercial formula group(n=16). Blenderized diets were composed of food sources such as rice, milk, egg, juices and others, and its energy percentage of protein, fat, and carbohydrate was 15%, 30%, and 55%, respetively. Commercial enteral formulas provided 1 kcal/ml and the energy percentage of protein, fat and carbohydrate was 25%, 20% and 55% in greenbia(G) and 20%, 20%, and 60% in Greenbia-DM(GD), repectively. In commercial formula group, five patients with diarrhea, constipation, and high blood glucose level received GD, and the other eleven patients received G. All patients received their lipuid diet for 4 weeks through 16 French rubber nasogastric tube by bolus feeding 6 times daily. The patients in commercial formula group had a similar mean daily calorie intake to the patient in blenderized diet group, 32-34kcal/kg/d and 30-35kcal/kg/d, respectively. Patients given commercial formula gained an averge of 1.7kg in weight but those given blenderized diet lost an average of 2.6kg. There was a trend toward an increase in percent ideal body weight in commercial formula group(94$\pm$5 vs 99$\pm$6%). However, blenderized diet group showed a trend toward a decrease in percent ideal body weight(106$\pm$5 vs $101\pm$6%). The initial levels of total lymphocyte counts, serum albumin and tranferrin were below the normal rante, The mean daily protein intake was significanlty higher for commercial formula group(2.0-2.1g/kg/d) than for blenderized diet group(1.1-1.3g/kg/d). Patient fed cormmercial formula for 4 weeks showed a trend toward an increase in serum albumin(8.1%) and a significant increase in serum transferrin(32.1%) without increasing the levels of blood glucose. GOT, GPT, blood urea nitrogen and serum creatinine. In the blenderized diet group, however, no significant improvement were obseved in the concentration of serum albumin and transferin, compared to initial value. There was a trend toward a decrese in the level of hemoglobin and hematocrit in blenderized deit group but no significnat change in commercial formulas goups. All patients tolerated both diets well and no significant complications were encountered. The results indicate that the commercial enteral formulas tested in this study can be an effective substitution for blenderized diet in unconscious tube-fed patients.

• The Korean Society of Law and Medicine
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• v.12 no.1
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• pp.177-225
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• 2011

Verdicts related to major medical litigation given by the Seoul Central District Court, the Seoul High Court and the Supreme Court in 2010 were analyzed. It's shown that in cases of the medical negligence regarding the occurrence of neonatal cerebral palsy, the plaintiff claims were dismissed using criteria proposed by associations of Obstetrics and Gynecology and Pediatrics in US, and thereof the burden of plaintiffs to prove the medical negligence has increased. In addition, in case of that the expected survival period of infants gets longer, payments for treatment and nursing after survival period determined by judges are made and it was judged to compensate it as a periodical indemnity. In case for the explanation obligation the most frequently mentioned in the medical litigation, in addition to cases of invoking the existing theory of explanation obligation, verdicts to mention the instructions of theory regarding instruction explanation obligation and the possibility of compensation for damages on property are given. Particularly, in cases for a liability of reparation by exaggerating the effects and not disclosing the risks related to treatment with stem cells, even if the treatment not approved by Food and Drug Administration is in violation of the Pharmaceutical Affairs Law, it's not illegal as violation in Pharmaceutical Affairs Law itself. But there is a certain verdict to present the possibility of an extension of the theory of explanation obligation by acknowledging the liability of reparation caused by illegal acts with no explanations of effects and risks of treatment with stem cell by doctors and pharmaceutical companies. In an incident in which a mental patient fell and died through the opened door of the roof at the hospital, a liability of reparation was acknowledged due to defects in structure installation management and this verdict drew an attention since the overall management responsibility about patients including structures was acknowledged to the hospital besides the obligations on medical practice. In case of the verdict without giving the opportunity to state the opinion with respect to the main legal issues, the responsibility of the court was emphasized since the court did not fulfill the explanation obligations. There were some cases in which payments for nursing and caring to a patient in vegetative state during the plastic surgery was admitted. However, in dental-related incidents, the proportion of cases in which plaintiff won was low since the difficulty of proving may be reflected. In the area of administrative litigation, unlike the existing position regarding arbitrary medical charge cover collected from patients in hospital, the verdict to admit the legitimacy of collection of medical treatment was given and attracted the attention of people. Verdict in which the expression related to medical advertisement was not exaggerated disposed the original verdict and pointed out the problem of excessive regulations on medical advertisement. The effort to analyze the trend of verdicts of court through reviewing the decisions and to organize should be continued, but the full decision should be disclosed as a base, and people and systems to enable the all time monitoring should be prepared.

• The Korea Journal of Herbology
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• v.31 no.2
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• pp.7-12
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• 2016

Objectives : Secondary amenorrhoea is the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhoea. It can be caused by stress, extreme weight loss, and excessive exercise. The purpose of this study was to report the clinical effects of herbal medicine on secondary amenorrhoea.Methods : We employed oriental medical treatments; herbal - medication (Hyunburikyungtang gamibang), acupuncture and moxibustion. We treated the patients one or two times a month with oriental therapy method. They took medicine three times a day after a meal. During taking medicine, we let the patients avoid fatty food, flour based food and alcohol. We evaluated the status of the patient, on the basis of the state of menstration and F2 level of Yangdorak. Because we diagnosed the condition of patients with the pattern of liver depression and qi stagnation, so F2 level of Yangdorak was an important point of the diagnosis. Yangdorak machine was Tormeter Iw - zen at Towatech Co.,Ltd.Results : After taking treatment - several times acupuncture and moxibustion during some period and taking herbal-medicine, they had menstrain naturally without taking any hormone drug. Also the amount of menstration has gradually increased. The F2 level of Yangdorak returned to normal range. The feeling of cold on hands, feet and lower abdomen was much improved.Conclusions : Herbal medicine (Hyunburikyungtang gamibang) with oriental medical treatments, acupuncture and moxibustion was effective in the treatment of secondary amenorrhoea.

• Journal of the Korean Dietetic Association
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• v.7 no.1
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• pp.65-71
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• 2001

The purpose of this study was to produce proper nutrition and foodservice through positive intervention for diet-refusal patients who has difficulties in adaptation to hospital diet, and to contribute to hospital management with the focus of fast recovery. The survey was conducted using questionnaires between July 18 and August 17, 2000. The subjects were consisted of 24 diet-refusal patients who were hospitalized in St. Mary's Hospital except the patients hospitalized for the purpose of operation or pre-therapy tests. Also chart reviews were conducted. The statistical analysis of data was done by SAS/win 6.11 package to determine descriptive analysis and paired t-test and Pearson's correlation. The summary of study results is as follows : 1. Most of the subjects was receiving chemotherapy. The leading place for offering private food was from patient's home. Subjects worried about delayed recovery from illness due to nutritional problems caused by extreme fasting. The problems were in order of anorexia, nausea and vomiting during therapy process. 52.4% of subjects ate hospital diet after positive intervention. 2. Major reasons of hospital diet-refusal patients' dissatisfaction were in order of expenses, dissatisfaction, serum total protein levels were significantly lower(p<.05). 3. Serum Alb(p<.05), Hb(p<.05), Hct(p<.05) and TLC(p<.001) levels showed significantly negative correlations with fasting duration. With these results, it is concluded that a major cause of malnutrition among patients is to last fasting.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.647-651
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• 2012

Aim: An epidemiological study was conducted based on an esophageal cancer patient's cohort to investigate the association of folate intake and MTHFR C677T polymorphism with the prognosis of esophageal cancer in a Chinese population. Methods: 167 patients aged 37-75 years who had histological confirmed diagnosis of esophageal squamous cell cancer were collected from Jan. 2006 to Jan. 2008. MTHFR genotypes at the C677T site were analyzed by PCR-based RFLP methods, and the folate intake was computed by multiplying the food intake (in grams) and the folate content (per gram) of food in our questionnaire. Results: We found associations between the prognosis of esophageal cancer and smoking status, T and N stages. Individuals carrying the MTHFR 677CT and TT genotypes showed a shorter survival time than with the CC genotype, with adjusted HRs (95% CI) of 1.20 (0.56-2.15) and 2.29 (1.30-4.28), respectively. Similarly, those carrying MTHFR 677T allele had a 1.86-fold risk of death. A higher folate concentration showed a significant decreased risk of death, with an HR (95% CI) of 0.45 (0.18-0.87). Individuals with high folate intake and the MTHFR 677CC genotype showed a significant decreased risk of esophageal cancer (0.43, 0.25-0.89).Conclusion: Our findings supports the hypothesis that high folate intake and active MTHFR C677T polymorphism may exert protective roles in the prognosis of esophageal cancer in the Chinese population.

• Journal of Periodontal and Implant Science
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• v.25 no.1
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• pp.56-66
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• 1995

It is very important to understand the chief complaint of a patient prior to evaluation of prognosis and establishment of treatment plan. The purpose of this study was to prepare the basic data available for dental practitioners in establishing the treatment plan of periodontal patients. The chief complaints were statistically analyzed according to age and sex from 5.843 periodontal cases(age range: $20{\sim}70,male$: 3,048, female: 2,795) by means of Chi-Square Test in Microstat program. The results were as follows : 1.The proportion of each chief complaint, except routine check was in the following order: pain(32.84%) ; gingival swelling(13.35%); tooth mobility(13.2S%); hypersensitivity(12.53%) ; gingival bleeding(8.45%) ; pus discharge(8.33%) ; food impaction(3.80%); gingival recession(3.59%); halitosis(2.70%) ; itching sensation(1.90%); spacing(O.48%) ; implant(O.39%) ; gingival discoloration(0.38%). 2. The pain was the predominant chief complaint of periodontal patients regardless of age and sex(p

• Journal of the Korean Society of Food Science and Nutrition
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• v.27 no.6
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• pp.1236-1243
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• 1998

The purpose of this study is to evaluate the nutritional status of protein and lipids in the patients with alcoholic liver disease, to find an effective way of dietary management for patients with alcoholic liver disease and to obtain the materials for nutritional education for alcoholics. The subjects consist of 80 patients with alcoholic liver cirrhosis(ALC) and 12 patients with alcoholic fatty liver(AFL). The control group included 57 alcoholics without liver disease(A), 32 patients with viral liver cir rhosis(VLC) and 194 normal(NL). Biochemical evaluation of nutritional status was performed by ana lyzing the profiles of protein and lipids in blood samples. The results are summarized as follows: 1) The frequency of subjects below the normal range of serum total protein was 26.3% in ALC, 16.7% in AFL and 3.5% in A. Serum albumin was lower in 41.3% of ALC. 2) The alcoholics without liver disease showed significantly higher level of serum triglycerides, total cholesterol and LDL cholesterol than the other groups. The alcoholic subjects had lower HDL cholesterol than normal subjects. Overall, the protein and lipids status of the alcoholic subjects in this study was evaluated to be very poor on the basis of biochemical assessments. The results suggest that alcohol abuse and poor dietary intake could cause malnutrition. An extensive nutritional education should be emphasized for the alcohol consuming population. High quality of protein and other dietary intakes from early stage of the disease may be effective in nutritional therapy for the patient with alcoholic liver disease.

• Journal of Preventive Medicine and Public Health
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• v.33 no.3
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• pp.349-363
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• 2000

Objectives : Generally, it seemed that the therapeutic result in diabetic patients was changed by compliance. This study was conducted on the basis of assumption that the therapeutic result id diabetic patients could control according to compliance. This study was conducted to analyze the related factors in association with compliance to drug, diet and exercise therapy. Methods : 224 diabetic patients in Kyungpook National University Hospital were selected through the interviews and HbA1c values from 1 Jan. to 28 Feb.1997. The drug compliance was tested by regularity of drug administration, the diet compliance was tested by restriction of food, exactly allocation, balance of nutrient, measuring food and the exercise compliance was tested by regularity of exercise per day. We assessed compliance by percentage, $x^2-test$ and generalized logit regression model(method:enter). Results : The significant variable was the satisfaction to medical personnels in drug, the knowledge to disease in diet, the participation of the diabetic education in exercise therapy and the satisfaction to medical personnels in HbA1c. Using the generalized logit model(method : enter) in compliance change, the significant variables were the satisfaction to medical personnels and the complication in drug; the significant variables were the age at the first diagnosis, the family history, the concern of health, the knowledge of disease, the self-exertion for therapy and the complication in diet: the only significant variable was the gender in exercise therapy. Conclusions : The degree of glycemic control in diabetic patients was influenced by compliance. In order to improve patient's compliance, we must foster the knowledge on the diseases, lead participation for diabetic education. Because the satisfaction to medical personnels was the important variables, we must build up good relationship between doctors and patients.

• Korean Journal of Clinical Pharmacy
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• v.13 no.2
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• pp.72-81
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• 2003

Adverse drug reaction (ADR) may increase hospital admission, morbidity and mortality and adding extra cost to healthcare expenditures. AIMS: This study was performed to identify the types of ADR being reported in a tertiary hospital, and to find out the ways to improve current ADR monitoring system. To investigate the attitudes of hospital pharmacists towards, and their understanding of ADR reporting. METHODS: Of 117 reports submitted to the pharmacy department during 3 months survey period, A questionnaire survey of 75 randomly selected hospital pharmacists was conducted. RESULT: Of the report was from patients aged between 60 and 70. The medical department with the high frequency in ADR reporting was Internal Medicines $(60\%)$. The most common ADR manifestations were gastrointestinal complaints $(47.8\%)\;and\;80\%$ of the reported cases were mild in their severity. The most common drugs suspected of causing ADR were CNS drugs which accounted for $38.4\%.\;55.5\%$ of respondent were aware of the need to education and information about ADR monitoring. The important reasons for unreporting ADR were unknown of how to report ADRs $(94.6\%)$. CONCLUSIONS: An ADR reporting system based on reporting by staff pharmacists has been effective increasing the number of reported reactions and pharmacist involvement in monitoring patients for ADRs. Pharmacists have the knowledge and responsibility to contribute to ADR reporting program. A great opportunity exists for pharmacists to contribute in this area of patient care.