• Journal of Korean Academy of Nursing Administration
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• v.1 no.1
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• pp.147-211
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• 1995

Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.

• Journal of Hospice and Palliative Care
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• v.11 no.4
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• pp.181-187
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• 2008

Purpose: In order to establish efficient palliative treatment plans. It is important to estimate the survival time of a terminally ill cancer patient as accurate as possible. Proper estimation of life expectancy aids not only in improving the quality of life of the patient, it also promotes productive communication between the medical staff and the patient. The aim of this study is to determine the efficacy of neutrophil-lymphocyte ratio as a predictor of survival time in terminally ill cancer patients. Methods: Between January 2004 and June 2007, 67 terminally ill cancer patients who were admitted or transferred for palliative care, were included. Patients were categorized into three groups by Neutrophil-Lymphocyte Ratio. Demographic characteristics, clinical characteristics and blood samples were analyzed. Results: In univariate analysis, survival time of the highest Neutrophil-Lymphocyte Ratio group (${\geq}12.5$) was significantly shorter than that of the others (hazard ratio (HR)=3.270, P=0.001). After adjustment for low performance status (ECOG score 4) and dyspnea, high Neutrophil-Lymphocyte Ratio (${\geq}12.5$) was significantly and independently associated with short survival time (HR=2.907, P=0.007). Neutrophil-Lymphocyte Ratio was also significantly increased before death (P=0.001). Conclusion: Neutrophil-Lymphocyte Ratio can be useful in predicting life expectancy in terminally ill cancer patients.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.2
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• pp.207-224
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• 1998

The purposes of this study were to identify nurse's recognition and performance and to represent the factors of hindrance in the IV therapy management. The subjects were 420 nurses who worked at five general hospitals in Pusan. Tha data were collected using a questionnaire and the period of data collection was from January 1 to January 31, 1998. The instrument for this study was made by author oneself on the basis of guidelines Simmons et al', CDC' Stanley' and Kurdi' guideline, Cllinical Nurse's Association' that consist of 68 items for 5 fields ; pre-injection, just before-injection, needle-injection, during injection, post-injection field. Cron-bach Alpha coefficient of recognition and performance in the IV therapy management was .93 and .87. The datas were analized by a SPSS program using frequency, percent, paired t-test, t-test and oneway ANOVA. The results obtained were as follows : 1. The mean score of recognition in IV therapy management was significantly higher than that of performance(t=5.86, P<.001). 2. The items of lower than mean score of each fields in performance were the identification of drugs, hands washing, patient teaching about medication, disinfectional methods of the injection site and the rubber stopper in bottle, the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, use of tape and armboard, changing the IV tubing, labeling the dressing over the injection site, observation and recordings of patient's condition after medication and confirmation of the needle length at the needle removal. 3. The factors of hindrance in IV therapy were 'having no time', 'insufficiency of goods', 'unknowing of methods', 'no disadvantage', and 'factors of doctor's doing'. The most important factor was 'have no time', especially item of hands washing. The other factors of hindrance showed high frequency in the following items ; 'insufficiency of goods' in the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, 'unknowing of methods' in the certification of drugs compatibility, 'no disadvantage' in the labeling the dressing over the injection site, and 'factors of doctor's doing' in the changing the subclavian catheter dressing and checking the glucose level during the TPN infusion. In conclusion, there is necessity of educational program which can improve the nurse's knowledge of drugs, disinfection methods, comfort of patient and recordings in IV therapy management and alternative plan which are political and financial aids such as setting up the sink, giving of paper towels and necessary goods in the IV therapy for reducing the factors of hindrance for IV therapy management.

• Journal of Preventive Medicine and Public Health
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• v.49 no.6
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• pp.394-405
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• 2016

Objectives: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. Methods: The present study used data from 139 679 HIV patients aged ${\geq}15$ years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. Results: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for < $100cells/mm^3$ vs. > $350cells/mm^3$), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients. Conclusions: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.843-849
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• 1999

The prevalence of nonspecific interstitial pneumonitis(NSIP) in HIV-positive patients with pulmonary disease has varied from 11 to 38%. But NSIP in HIV-positive patients is indistinguishable from Pneumocystis carinii pneumonia(PCP) clinically and radiologically. The number of HIV-positive patients is less in Korea than in western developed countries, so little attention has been paid to the differential diagnosis between NSIP and PCP. We report a case of NSIP in HIV-positive, 61-year-old man which mimicked PCP. He presented with cough, sputum and mild exertional dyspnea. Lung sound was clear. But, chest X-ray and HRCT demonstrated diffuse patch and bilateral ground-glass opacities in central and perihilar area of both lung. Microbial pathogens were not found on sputum, BAL fluid and tissues taken by TBLB. In transbronchial lung biopsy specimen, interstitial infiltrates with lymphocytes were distributed on peribronchiolar regions. A pathologic diagnosis of NSIP was suggested, he received symptomatic treatment. The follow-up chest X-ray showed near complete resolution.

• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.105-114
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• 2001

This study was conducted to analyze the change of sex-related knowledges and attitudes of female students after sex education intervention at rural high school. After conducting a pre-survey on 119 subjects of 1st and 2nd grade female students in two rural high schools in November 1999, 150 minute-sex education was provided for the students by health professional from health center. Two follow-up survey were conducted in one month and six months later to evaluate the effect of sex education. The score of knowledge of AIDS was increased from 8.46 in pre-education to 11.90 in one month and 11.87 in six month later. The positive attitude toward the pre-marage sexual relationship was changed from 16.9% in pre-education to 14.4% in one month and 23.5% in six month later. The opinion for the heterosexual intercommunion during school age was not changed by sex education intervention and the subjects were pro for the making male friends during their school period. The subjects were more understood that AIDS patient should be treated humanly and they recognized that the mode of disease transmission and how to prevent the disease. To maintain the effect of sex education, the continuous and regular educational intervention and team approach from school and health professional should be necessary.

• Journal of the Korean Society of Radiology
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• v.18 no.2
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• pp.153-159
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• 2024

In X-ray projection, Unskilled radiologists become skilled through fail exam. This causes the patient to be exposed to unnecessary radiation. In this study, pre-position unskilled radiologic technologist presented ways to improve clinical proficiency. presented a skull lateral x-ray projection practice method using visual, spatial, and assistive devices. In addition, the accuracy and usefulness of the use of assistive devices were evaluated. When X-ray images were taken based on learning, the rotational spacing, which indicates image distortion, was 7.85 ± 1.45 mm and the tiliting spacing was 4.84 ± 0.5 mm. When practicing using visual aids, the rotational spacing is 4.4 ± 0.76 mm and the inclination spacing is 3.01 ± 0.87 mm. using a spatial compensation device, the rotational spacing is 5.2 ± 0.69 mm and the tiliting spacing is 3.33 ± 0.61 mm. Skull lateral X-ray Image distortion caused by empirical photography practice decreased by 5.4%, but image distortion caused by tilting increased by 1.2%. When practicing using a visual assistive devices, the degree of rotational spacing by 40.1% and the tiliting spacing decreased by 30.7% compared to the empirical x-ray exposure practice. When using spatial assistive devices, the rotation interval was reduced by 41.7% and the tilting interval by 23.7% compared to conventional empirical x-ray exposure practice. Therefore, if an unskilled radiologist practices using visual and spatial aids,the accuracy will be improved in skull lateral x-ray projection.

• Journal of the Korean Society of Radiology
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• v.9 no.7
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• pp.529-533
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• 2015

VCUG(Voiding Cystourethrography) study is being performed to check urinary reflex symptom from bladder to ureter or kidney in the method of filling the bladder with radiation opaque contrast agent. However, VCUG study have been performed impersonally, patients have to be naked and open their legs and then void. This method is so impersonal that it is immediately needed to improve the way of testing and crete new aid. Therefore, this study through producing underwear for VCUG, analysis and compares the test time of VCUG, patient radiation dose and patient satisfaction. The target of this study was 79 Male and Female patients who visited genitourinary clinic of PNUYH for their VCUG tests AXIUM Iconos R200(Siemens Medical System : Germany) and self-produced plastic underwears made by vinyl and plasic molding machine were used. The 79 patient were divided into two groups : experiment of patient and comparison group of we patient (using aid) in order to compare, testing time, DAP (dose area product) and patient satisfaction. There was time reduction, from 35.3min of comparison group to 27.8min experimentation group by 7.5min decrease. And comparison group of $4566.6{\mu}Gym^2$(DAP) decreased experimental group (using aid) of $3411.9{\mu}Gym^2$ by $1154.7{\mu}Gym^2$. In the case of patients satisfaction study, anxiety had a drop by 3.45 of comparison group to 2.51 experimentation group by 0.94 decrease. in experimental group. And shame had a drop by 4.02 of comparison group to 3.08 experimentation group by 0.94 increase. in experimental group. Difference of the smooth voiding had a drop by 1.90 of comparison group to 2.84 experimentation group by 0.94 increase. in experimental group. In addition satisfaction had a rise by 1.19 in experimental group. There were also other opinions of uncomfortableness on it and troublesome to wear. VCUG is one of the sensitive care required test. Therefore staff and the aid can give patients such comfortable and the aid can consentive on voiding. As a result test time and DAP can be reduced. It is needed to make testing at more comfortable for patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.2
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• pp.171-179
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• 1995

The conservative treatment of the condylar fracture has been used for a long time because of its simplicity, good prognosis and less complication. Traditionally the conservative treatment has been carried out by maxillomandibular fixation using arch bar and wire. But a simplified technique of maxillomandibular fixation introduced here is a procedure that 4 bone screws are placed above the apecies of the maxillary and mandibular canines and then ipsilaterally placed maxillary and mandibular bone screws are linked by a loop of wire each other. This procedure has several advantages compared with the traditional maxillomandibular fixation method. 1) it provides simplicity for the operators. 2) it sustains maxillomandibular fixation more rigidly compared with arch bar technique. 3) it keeps stable maxillomandibular fixation in the region of the anterior teeth so that anterior open bite tendency can be remarkably minimized. 4) it does not injure the periodontal tissue because the teeth are not engaged and causes less discomfort to the patient. 5) it decreases the possibility of operator's AIDS infection through inadvertent skin puncture. 6) it is highly recommended for the patients whose teeth are available for maxillomandibular fixation. The two male patients were diagnosed as bilateral condylar and symphyseal fracture of the mandible. They restored stable occlusion and functional mandibular movement only by a simplified technique of maxillomandibular fixation.

• The Journal of Korean Society of Virology
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• v.26 no.2
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• pp.259-267
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• 1996

In order to evaluate the effect of viral load on the prognosis of human immunodeficiency virus-1 (HIV-1)-infected individuals, immune complex dissociated (ICD) serum p24 antigen (p24) by acid treatment was retrospectively measured for 50 HIV-infected patients for 60 months. Among them, 27 patients were p24 positive (p24+) above 25pg/ml for $40.4{\pm}12$ months and 23 patients were negative (p24-). Follow-up periods from HIV diagnosis were $63.0{\pm}19$ months (range; 40-112) for the p24+ and $68.4{\pm}19$ months (range; 38-106) for the p24-, respectively (P>0.05)Mean CD4+T cell counts in the p24+ group decreased from $473{\pm}$277/ul (median;373) to $157{\pm}150/ul$ (median; 111) for $60{\pm}16$ months (5.3/month P280/ul (median; 476) to $432{\pm}285/ul$ (median;382) for $63{\pm}19$ months (2.5/month, P<0.01). From CD4+T cell count >200/ul, the patient who progressed to AIDS of <200/ul were 13 of 23 (56%) in the p24+ and 4 of 22 (18%) in p24-, respectively (p<0.01). And the number of death in two groups were 6 (22%) and 1 (4%), respectively (p<0.01). Presumed survival in two groups were about 12 and 24.5 years. These data suggest that viral load itself be very important for the prognosis of HIV-infected patients.