• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.338-342
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• 2012

Objective : The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods : From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results : The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference ($p{\leq}0.000$). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion : Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.

• Women's Health Nursing
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• v.5 no.3
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• pp.265-276
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• 1999

Female nurses in Korea have historically experienced discrimination on the basis of their gender as part of the traditional society views on woman and as a result of the male dominated hospital environments. This discrimination may interfere with the ability of female nurses to promote the health of their patients. To better understand this bias, we collected and analyzed 16 cases of alleged sexual discrimination reported by female nurses with more than 5 years work experience. The cases were classified into 10 subjects and further into 4 categories: personnel administration, daily working environment, female gender bias, and health care delivery. There were 7 cases (11.3%) of unjust personnel changes consisting of demotion(1), termination(4), and reallocation of position(3). Twenty three (37.1%) of cases related to problems in the daily workplace including biases in communication between female nurses and male physicians(12), daily work(8), and responsibility for adverse outcomes(3). We noted 17 cases (27.4%) of female gender bias as reported by female nurses(7), female physicians(7), and female patients(3). Lastly, there were 15 (24.3%) cases of problems with health care delivery due to sexual discrimination, including enrollment in the health care system(4),and decisions regarding medical care(4). These results suggest that sexual discrimination towards women is pervasive in the Korea hospitals, not only towards female nurses but also towards female physicians and patients. More discriminatory practices in a timely fashion such that better nursing care can be provided to patients and their families.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9615-9619
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• 2014

Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer which is more likely to be her-2/neu amplified. While the her-2/neu status has been utilised to predict prognosis, the published data are inconsistent. The present meta-analysis was conducted to determine whether the her-2/neu status predicts outcomes. Papers were selected from the PubMed database based on defined inclusion and exclusion criteria. Parameters such as total patients, follow-up time and outcome statistics (i.e. overall survival (OS), relapse-free survival (RFS) were collected. The analysis included 6 studies with 2,838 IBC patients. The summary hazards ratio (HR) estimating the association of OS with HER-2-positive disease was 0.96 (95% confidence interval (95%CI: 0.85-1.10)), with similar findings for RFS (HR=0.81, 95%CI: 0.61-1.09). No obvious statistical heterogeneity was detected. This meta-analysis suggests that HER-2-positive status is not an independent adverse prognostic factor for survival among IBC patient cases.

• Journal of Acupuncture Research
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• v.35 no.2
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• pp.95-100
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• 2018

Background: The aim of this study is to assess the feasibility of acupuncture treatment for the management of subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures. Methods: A total of 30 participants who have undergone thoracotomy after traumatic multiple rib fractures will be recruited. Participants will be invited and equally randomised into acupuncture plus usual care and usual care alone groups. A computer-generated random number sequence will be used and concealed using opaque, sealed, sequentially numbered envelopes. Twelve sessions of manual and electrical acupuncture performed by Korean medicine doctors will be provided over a span of 3 months to participants allocated to the acupuncture group. Participants in the usual care group will continue pain medication, exercise and physical therapy as required. Study feasibility will be measured based on the proportion of patients who complete the measurement of pain at 12 or 24 weeks after baseline. The clinical outcomes will include; the average pain intensity over the recent week at rest, movement and cough, quality of life, patient's global assessment of recovery, respiratory function measured by the pulmonary function test and use of pain medication at 4, 8, 12 and 24 weeks after enrolment. Adverse events will be recorded for all participants. Written informed consent will be obtained from all participants. The local ethics committee has approved the study. This pilot trial will inform further studies investigating the potential role of acupuncture for subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures.

• Journal of Acupuncture Research
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• v.35 no.3
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• pp.120-128
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• 2018

Background: Adhesive capsulitis (AC) is a common condition that includes shoulder pain and limited movement. Despite more than 100 years of AC treatment, the most efficacious treatment remains unclear. The aim of this study was to evaluate the feasibility of a randomized controlled trial (RCT) using acupuncture for AC. Methods: Thirty participants with AC were randomly assigned to acupuncture (A) or sham acupuncture (SA) groups. The participants received 15 acupuncture sessions over 6 weeks, and follow-up occurred for an additional 4 weeks thereafter. The primary clinical outcome was the numeric rating scale (NRS) for shoulder pain 6 weeks from the baseline. Secondary outcomes included range of motion (ROM) in the shoulder, the shoulder pain and disability index (SPADI), the EuroQol-5 dimensions (EQ-5D), the Pittsburgh sleep quality index (PSQI), and the patient global impression of change (PGIC). Results: Thirty participants were enrolled out of 37 screened individuals. Recruitment was conducted between August 2014 until May 2015. A total of 28 participants (93%) completed the 6-week intervention, and 26 participants (87%) completed the study. NRS, ROM, SPADI, EQ-5D, PSQI, and PGIC scores improved in both the experimental group and the sham group after 6 weeks, but the difference between the groups was not statistically significant. Adverse events were reported by 12 participants, although these events were not associated with acupuncture. Conclusion: A future RCT for AC may be feasible with some modifications to the recruitment plan and the secondary outcome measurement methods.

• Journal of Korean Academy of Nursing Administration
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• v.21 no.3
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• pp.243-253
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• 2015

Purpose: The purpose of this study was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). Methods: Intra-operative findings and care plans were documented and shared between staff members on a daily basis from the day of operation to the day of general ward transfer. Incidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with incidence of AEs one year after establishment of PCS. Results: The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. Incidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (${\chi}^2=7.23$, p=.010). Incidence of other major complications decreased from 4.2% (9/216) to 0.6% (${\chi}^2=6.66$, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (${\chi}^2=20.31$, p<.001). Conclusion: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcome research about communication strategies for patient safety should be further studied.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.4031-4035
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• 2016

Background: In the adjuvant treatment of breast cancer, anthracycline and taxane based regimens can be used concomitantly or sequentially. The best order in the sequential regimens has yet to be well established. This study evaluated the feasibility of 4 cycles of adjuvant taxotere ($100mg/m^2$) every 3 weeks followed by 4 cycles of doxorubicin ($60mg/m^2$) and cyclophosphamide ($600mg/m^2$) every 3 weeks. The primary outcome was the safety profile. Secondary outcomes were disease free survival (DFS) and overall survival (OS). Materials and Methods: This non-randomize prospective phase II stud was performed at Jordan University of Science and Technology and its affiliated King Abdulla Teaching Hospital between July 2009 and August 2010. Data collection was closed on May $31^{th}$, 2015 giving a median follow up period of 62 months. The study was approved by the institutional review board and a written informed consent was obtained for each patient. Results: Fifty patients were enrolled. The median age was 53.1 years (range 34-76). One patient (2%) had stage I disease, 17 (34%) stage II, and 32 (64.0%) stage III. Forty-six patients were evaluable for efficacy analysis. The completion rate was 95.7%. No dose modifications were needed. The incidences of grade 3-4 neutropenia and febrile neutropenia were 14 % and 10%. No grade 3-4 non-hematological adverse events were encountered. At a median follow up time of 62 months the OS and the DFS rates were 76.1% and 56.5%. Those for stages I and II combined were 100% and 75%. Conclusions: Taxotere first followed by doxorubicin-cyclophosphamide appears a feasible regimen as evidenced by an acceptable completion rate, a satisfactory safety profile, and an OS and DFS rates comparable to other studies.

• Journal of Environmental Health Sciences
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• v.38 no.4
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• pp.277-290
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• 2012

Objectives: Diesel engine exhaust (DE) accounts for a significant percentage of air pollutants that are associated with various health outcomes including mortality, asthma, chronic bronchitis, respiratory tract infection, etc. In June, 2012, the International Agency for Research on Cancer (IARC) released the assessment results that classified DE as "carcinogenic to humans" (Group 1). This review is therefore focused on the lung cancer risks of DE. Methods: Literatures were searched using PubMed with key words of "diesel exhaust", "lung cancer", and other related terms for the period between 1990 and 2012. A total of 295 articles were searched and sixteen epidemiologic studies were identified as potentially relevant. Results: Sixteen epidemiologic studies about the lung cancer risks of workers exposed to DE in various occupations were summarized in two tables, 1) retrospective cohort studies and 2) case-control studies. Increased lung cancer risk, although not always smoking adjusted, was observed in 6 out of 8 retrospective cohort studies and 4 of 8 case-control studies. Conclusions: Diesel fuel is widely used in Korea. Exposure to DE is confirmed to be a human carcinogen by IARC. Noncancer health risks of DE also need careful attention as DE is a major source of fine-particle pollution. Along with the efforts for reducing the DE emission through improvements of diesel engines and fuel, and the use of alternative fuels, comprehensive health risk assessment of DE should be conducted to minimize the adverse health effects.

• Journal of Preventive Medicine and Public Health
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• v.48 no.3
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• pp.151-169
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• 2015

Objectives: The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels. Methods: Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter ${\leq}2.5{\mu}m$ [$PM_{2.5}$], nitrogen dioxide [$NO_2$], ozone [$O_3$], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and ${\gamma}$-glutamyltranspeptidase [${\gamma}$-GTP)]) were evaluated using generalized additive and linear mixed models. Results: Interquartile range increases in the concentrations of the pollutants showed significant associations of $PM_{2.5}$ with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and ${\gamma}$-GTP (5.0% increase, p=0.0051) levels; $NO_2$ with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and $O_3$ with ${\gamma}$-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers. Conclusions: Short-term exposure to air pollutants such as $PM_{2.5}$, $NO_2$, and $O_3$ is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.1
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• pp.51-60
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• 2000

Background and Objectives : Quality of life(QOL) is a construct representing physical, mental and social well-being. QOL has been used as a device for measuring the severity of health-related condition and treatment outcomes. As the social welfare system develops, the attention to QOL increases as well. The aims of this study was to examine whether the patients with voice disorder perceived significantly more the effects of voice disorder on QOL than nonpatient group did and if any, identify the sociodemographic risk factors influencing QOL of patients. Materials and Methods : This study asked 113 adults with voice disorders who were enrolled in Voice Clinic in the Department of Otolaryngology, Kangbuk Samsung Hospital between lune 1998 and January 1999 and 111 nonpatients to complete a questionnaire designed to elicit information about the effete of voice disorders on quality of lift. The questionnaire included items concerning sociodemographic areas, voice symptoms, job, effects of voice disorders on QOL domains(work, social, psychological, physical, and communication areas), potential risk factors to exposures, familial and medical history of voice disorders. Results : The sociodemographic characteristics of the patient group are as follows : (1) 75.2% of total patient group were female and the rest were male. (2) Age of total patient group ranged from 20 to 65 years. Hoarseness was the most commonly reported complaints, followed by complaints of high note difficulties during singing and voice fatigue. The patient group perceived effects of voice disorders on the areas of work, social, psychological, physical and communication more adversely than the comparison group did (p＜0.05). QOL impairments were evaluated as a function of age, gender, education, and income, controlling other independent effects. The results were that (1) age was significantly associated with work problems and (2) gender and income were significantly associated with psychological problems. Conclusions : The findings indicated that the patients with voice disorders would perceive markedly adverse effect on all QOL domains, that is, work, social, psychological, physical, communicational areas. Therefore, the results of study suggest that lurker investigations about the nature of voice disorders, the prevention, treatment, and coping strategies are needed in the future.