• Journal of Korean Academy of Nursing Administration
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• v.7 no.2
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• pp.265-284
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• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.170-177
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• 2008

Purpose : The aim of this study was to evaluate whether the incidence of relapse or nephritis might be influenced by the duration of corticosteroid therapy in children with Henoch-Schonlein purpura(HSP). Methods : We retrospectively analyzed 186 children with a diagnosis of HSP in two major hospitals in Ilsan, Korea from the years 2000 to 2003. To evaluate whether renal involvement or relapse might be influenced by the duration of corticosteroid therapy in children with HSP, one pediatric nephrologist from hospital A, maintained corticosteroid therapy for at least 2 weeks(Group A, n=94). The other from hospital B used only during the symptomatic period(Group B, n=92). Results : There were no significant differences in age, sex, body weight, white blood cell count, hemoglobin, hematocrit, platelet count, serum protein and albumin levels between the two groups. The incidence of abdominal pain or arthralgia also did not differ between two groups. However, the duration of steroid therapy was significantly longer in Group A than in Group B and the cumulative dose of prednisolone was also higher in Group A than in Group B. The development of nephritis was more frequent in Group A. Conclusion : The longer duration of steroid use was not associated with the decreased rate of nephritis. Therefore, corticosteroids should be used carefully in a selected group of HSP children, and be tapered rapidly after control of the acute symptoms.

• Journal of Veterinary Clinics
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• v.27 no.4
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• pp.348-365
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• 2010

Artemisia capillaries THUNB is a perennial herb that belongs to the family compositae spp. and the most common plant among the various herbal folk remedies used in treatment of abdominal pain, hepatitis, chronic liver disease, jaundice and coughing in Korea. The object of this study is to observe the dosage-dependent anti-obestic effects of an aqueous extracts of dried aqueous extracts of stems of Artemisia capillaris Thunberg. [Artemisiae capillaris Herba, In-Jin in Korean, INJ] on 45%/Kcal high fat diet (HFD) supplied mice. 45%/Kcal rodent HFD are supplied to ICR mice from 1 week before initiation of INJ administration throughout the 12 weeks, and after the end of 12 weeks of 62.5, 125 and 250 mg/kg/day of INJ administration, the efficacy was divided into five categories 1) hypoglycemic, 2) hepato-protective, 3) nephroprotective, 4) hypolipemic, and 5) anti- obesity effects. The effects were compared to those of simvastatin (for hypolipemic activity), silymarin (for hepatoprotective and free radical scavenger effects) and metformin (for hypoglycemic and related anti-obesity effects). 7 animals per group (8 groups; total 56adapted mice on HFD were selected base on the body weight at 6 days after initiation of HFD supply) were used in this experiment. INJ and all three different reference drugs were directly suspended or dissolved in distilled water, and administered at a volume of 10 mL/kg, once a day for 84 days from 1 week after HFD supply. As results of 91 days of continuous HFD supply, mice showed marked obese states, hyperglycemia, hyperlipemia, liver damages and kidney damages. These mean the obesity, diabetes, diabetic hepatopathies, nephropathies and hyperlipemia were induced by HFD supply. After end of 84 days of continuous treatment of three different dosages of INJ, all diabetes related complications were inhibited; relatively favorable anti-obesity, hypolipemic, hepatoprotective, hypoglycemic and nephroprotective effects. These favorable effects showed relatively good dose-relations between all three different dosages of INJ treated, and INJ 250 mg/kg showed enough favorable effects on diabetes and related four complications tested as compared with one of each three different references. Otherwise, the efficacy of 62.5 and 125 mg/kg of INJ was somewhat slighter than those of all three reference drugs. Therefore, the suitable effective dosage of INJ is considered as 250 mg/kg/day in the present study. The overall anti-obesity effects of INJ 250 mg/kg-treated group was similar or more favorable than those of metformin 250 mg/kg-treated group, and INJ 250 mg/kg showed slighter hypoglycemic effects with silymarin 100 mg/kg and metformin 250 mg/kg, similar hypolipemic effects with simvastatin 10 mg/kg, and similar hepatoprotective effects with silymarin 100 mg/kg, and similar nephroprotective effects with that of silymarin 100 mg/kg and metformin 250 mg/kg, respectively. Obese, hyperglycemia, hyperlipemia, steatohepatitis and related nephropathies induced by HFD supply were dramatically inhibited by 84 days of continuous treatment of all three different dosages of INJ. It is, therefore expected that INJ extracts will be a favorable alternative agent for diet-related diabetes and complications.

• Journal of dental hygiene science
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• v.7 no.3
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• pp.113-119
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• 2007

This study attempts to find factors contributing to the use pattern of prosthetics by investigating the current condition of prosthetics for the aged of over 65 years old by place of practice. Among those of over 65 years old who live in Gangnam-gu, Seocho-gu, Seongbuk-gu, and Gwanak-gu of Seoul and use the apartment senior's center, those having prosthetics were selected as subjects of this study, and this study was conducted in forms of interview and record. Findings of this study are summarized as follows: First, in regard of the state of prosthetics and relevant symptoms in the mouth according to the place of prosthetics practice, there was significant difference in the questions except the medical benefit of prosthetics between unlicensed facilities and dental clinics and hospitals. Second, regarding difference in satisfaction according to the place of prosthetics practice, dental clinics and hospitals showed a higher level of aesthetic satisfaction than unlicensed facilities. For difference in satisfaction at pronunciation, chewing, pain, a sense of foreign body, and holding power, dental clinics and hospitals showed a higher level than unlicensed facilities, Third, after factor analysis on the perception factors of unlicensed treatment and dental treatment, unlicensed facilities showed the highest level of reliability, and then convenience, word of mouth, and modernity in order. Dental clinics and hospitals also showed the highest level of reliability, however, and then convenience, modernity, and word of mouth in order. Fourth, as a consequence of analyzing the factors to influence the use pattern of prosthetics, regarding residential pattern, there were higher possibilities to use dental clinics and hospitals when the subjects lived together with their children and in Gangnam, and the more were the number of pyeong for the residence, pocket money, medical expense, and property in their name, compared to unlicensed facilities. In conclusion, economic factors appear to be the most important factors in selecting facilities for denture prosthodontics. Therefore, it is important to ensure the denture prosthodontics for the elderly are reimbursable so that they can enjoy a healthier life.

• Journal of dental hygiene science
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• v.13 no.4
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• pp.386-392
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• 2013

The purpose of this study was to evaluate the factors related to xerostomia in patients with systemic diseases, and the results were analyzed through t-test, ANOVA, and multiple linear regression analysis. There were 62 respondents (56.9%) who reported dry mouth and the season of the most severe dry mouth was reported to be the highest during winter. According to the analysis made in the relationship of xerostomia with the awareness of general health and health behavior, the group that understood their own health poorly, had more than two kinds of diseases, and had been administered more than two kinds of daily medication showed higher xerostomia. Also, those who experienced desperation, had high dryness in other parts of the body, and heavy snoring were more aware of xerostomia (p<0.05). According to the analysis made in the relationship between xerostomia and awareness of oral health state, the group that understood their oral health poorly and had pain in the oral mucous membrane and halitosis was more aware of xerostomia (p<0.05). According to the analysis made in the relationship between quality of life and xerostomia, the group that showed high level of problem in daily living and stress and were self-conscious and felt tense due to halitosis reported more xerostomia (p<0.05). Finally, xerostomia was most correlated with consciousness of the eyes of others due to halitosis followed by the number of transferred systemic diseases and stress level. Based on such results, xerostomia was understood to be an obstacle in maintaining favorable social life and health. Since xerostomia was shown to be related to the number of transferred systemic diseases, the dental professions are asked to further improve their understanding not only on oral health but also systemic diseases. Therefore, these efforts are expected to prevent xerostomia and reduce various complications caused by xerostomia.

• Journal of Veterinary Clinics
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• v.20 no.1
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• pp.33-41
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• 2003

The cardiopulmonary and anesthetic effects of tiletamine/zolazepam(TZ, 10 mg/kg IV), xylazine-tiletamine /zolazepam(XTZ, X: 1.1 mg/kg IM, TZ: 10 mg/kg IV) and medetomid-ine-tiletamine/zolazepam(MTZ, M: 30$\mu\textrm{g}$/kg IM, TZ: 10 mg/kg IV) were evaluated to 15 healthy mongrel dogs (4.16$\pm$0.65 kg). These dogs were randomly assigned to the three treatment groups(Control, XTZ, MTZ) with 5 dogs in each group. All experimental animals were premedicated with atropine(0.03 mg/kg, IM). Xylazine or medetomidine were administered to dogs in XTZ group and MTZ group 10 minutes after atropine injection. TZ was administered 20 minutes after atropine injection in all groups. The loss of pain response at pedal reflex and ear pinching tests in XTZ and MTZ groups were much longer compared with those of Control group(P < 0.01). All dogs in this study showed head rocking and hypersalivation during recovery time. Body temperature decreased progressively during experimental period in all groups, but it was not significant. After TZ injection, heart beat rate significantly increased 10 and 20 minutes in Control group, and 20 and 40 minutes in XTZ group(P < 0.05). Respiratory rate significantly decreased 0,10,20 and 40 minutes after 72 injection in XTZ and MTZ groups. In Control group, systolic arterial pressure (SAP) 20 minutes. diastolic arterial pressure(DAP) 10 minutes and mean arterial pressures (MAP) 10 and 20 minutes after 72 injection significantly decreased(P < 0.05). In XTZ group, SAP, DAP and MAP significantly decreased 20 and 40 minutes after 72 injection(P < 0.05). Thus, it was considered that XTZ and MTZ were useful in a canine surgical treatment that requires long anesthetic duration and deep analgesia.

• The Journal of Korean Medicine
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• v.17 no.1 s.31
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• pp.374-406
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• 1996

This study has been carried out to investigate the types of differential diagnosis of amnesia. The results are as follows; 1. Amnesia has various types of differential diagnosis(辨證分型) ; deficiency of both the heart and spleen(心脾兩虛型), deficiency of the heart(心虛型), deficiency of the kidney(腎虛型), breakdown of the coordination between the heart and the kidney(心腎不交型), mental confusion due to phlegm(痰迷心竅型), accumulation of stagnant blood(蓄血型), internal injury by seven emotion (七情所傷型). 2. The type of deficiency of both the heart and spleen(心脾兩虛型) occurs when the heart and spleen is injured by overthinking(思慮過度), The symptoms are heart palpitation(心悸), continuous palpitation(??), insomnia(少寐), hypochondric discomfort(心煩), dream disturbed sleep(多夢), being easy to be scared(易驚), dizziness(眩暈), these are caused by blood deficiency of the heart(心血不足), poor appetite(飮食不振), loss of appetite(納?), short breath(氣短), sense of turgid abdormen(腹部膨滿感), loose stool(泥狀便), these are caused by deficiency of the spleen(脾虛), lassitude and weakness (身倦乏力), lassitude of the extremities (四肢無力), dim complexion (面色少華), pale lips(舌質淡), thready and feeble(脈細弱無力), these are caused by deficiency of both qi and the blood(氣血虛損). The remedy is nourishing the heart-blood(養心血) and regulating the spleen(理脾土). I can prescribe the recipes such as Guibitang(歸脾湯), Gagambosimtang(加減補心湯), Seongbitang(醒脾湯), Insin-guisadan(引神歸舍丹), Insamyangyoungtang(人蔘養榮湯), Sojungjihwan(小定志丸), Yungjigo(寧志膏), Palmijungjihwan(八味定志丸), etc., 3. The type of deficiency of the heart(心虛型) occurs when the heart-blood is injured by the mental tiredness(神勞) and so blood cannot nourish the heart. The symptoms are amnesia(健忘), short breath(氣短), heart palpitation(心悸), perspire spontaneously(自汗), facial pallidness(顔面蒼白), pale lips (舌質淡白), feeble pulse and lassitude(脈虛無力), intermittent pulse(結代脈). The remedy is nourishing the hart and blood and allaying restlessness(補心益血安神). I can prescribe the recipes such as Chenwangbosimdan(天王補心丹), Jeongji-hwan(定志丸), Gaesimhwan(開心丸), Youngjigo(寧志膏), Chilseonghwan(七聖丸), Baegseogyoungtang(白石英湯), Oseohwan(烏犀丸), Yangsinhwan(養神丸), Guisindan(歸神丹), Bogsinsan(茯神散), Jinsamyohyangsan(辰砂妙香散), Cheongeumboksinsan(千金茯神散), Samjotang(蔘棗湯), jangwonhwan(壯元丸), Sa gunjatang(四君子湯) minus rhizoma atractylodis macrocephalae(白朮) plus rhizoma acori graminei(石菖蒲), radix polygalae(遠志), cinnabaris(朱砂), etc. 4. The type of deficiency of the kidney(腎虛型) occurs when the kidney-qi and kidney-essence is deficient(腎氣腎精不足) and so it cannot nourish the brain. The symptoms arc amnesia(健忘), ache at the waist and lassitude in the lower extremities(腰산腿軟), dizziness and tinnitus(頭暈耳嗚), emmission and premature ejaculation(遺精早泄), burning sensation of the five centres(五心煩熱), flushed tongue(舌紅), rapid and small palse(脈細數). The remedy is nourishing the kidney and strengthen the essence(補腎益精). I can prescribe the recipes such as Gagamgobonhwan(加減固本丸), Jeongjihwan(定志丸), Gongseongchlmjungdan(孔聖枕中丹), Yugmigihwanghwan(六味地黃丸) plus ra-dix polygalae(遠志), fructus schizandrae(五味子), Yugmigihwanghwan(六味地黃丸) plus radix polygalae(遠志), fructus schizandrae(五味子), rhizoma acori graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), Palmihwan(八味丸) plus fructus schizandrae(五味子), semen zizyphi spinosae(酸棗仁). etc., 5. The type of breakdown of the coordination between the heart and the kidney (心腎不交型) occurs when the heart-fire(心火) and kidney-fluid(腎水) are imbalanced. The symptoms are amnesia(健忘), hypochondric discomfort(心煩), insomnia(失眠), dizziness and tinnitus(頭最耳嗚), feverish sensation m the palms and soles(手足心熱), emmision(遺精), ache at the waist and lassitude in the lower extremities(腰?腿軟), flushed tongue(舌紅), rapid pulse(脈數). The remedy is coordinating each other(交通心腎). I can prescribe the recipes such as Gangsimdan(降心丹), Jujaghwan(朱雀丸), Singyotang(神交湯), Simsinyang- gyotang(心腎兩交湯), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), rhizoma acari graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), etc., 6. The type of mental confusion due to phlegm(痰迷心竅型) occurs when the depressed vital energy(氣鬱) create phlegm retention(痰飮) and phlegm stagnancy(痰濁) put the heart and sprit(心神) out of order. The symptoms arc amnesia(健忘), dizziness(頭暈), chest distress(胸悶), nausea(惡心), dull(神思欠敏), dull and slow facial expression(表情遲鈍), tongue with yellow and greasy fur(舌苔黃?), sliperry pulse(脈滑). The remedy is removing heat from the heart to restore consciousness and dispersing phlegm(淸心化痰開竅) I can prescribe the recipes such as Gamibogryeongtang(加味茯?湯), Goa-rujisiltang(瓜蔞枳實湯), Jusaansinhwan(朱砂安神丸), Dodamtang(導痰湯) plus radix saussurea(木香), Yijintang(二陳湯) plus succus phyllostachyos(竹瀝), rhizoma zingiberis(生薑) Ondamtang(溫膽湯) plus rhizoma acori graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc., 7. The type of accumulation of stagnant blood(蓄血型) occurs when the blood is accumulated in the lower part of body. The symptoms are amnesia(健忘), chest distress(胸悶), icteric skin(身黃), rinsing the mouth but don't wanting eat(漱水不欲燕), madness(發狂), black stool(屎黑), pain in the lower abdomen(小腹硬痛). The remedy is dispersing phlegm and absorb clots (化痰化瘀), I can prescribe the recipes such as Jeodangtang(抵當湯), Daejeodanghwan(代抵當丸), Hyeolbuchugeotang (血府逐瘀湯) plus rhizoma acori graminei (石菖蒲), rhizoma curcumae aromaticae(鬱金), Jusaansinhwan(朱砂安神丸) plus rhizoma curcumae aromaticae(鬱金), radix polygalae(遠志), semen persicae(桃仁), cortex moutan radicis(收丹皮), etc., 8. The type of internal injury by seven emotion(七情所傷型) occurs when the anger injures the will stored in the kidney(腎志). The symptoms are amnesia(健忘), heart palpitation(心悸). hot temper(易怒), being easy to be scared(善驚), panic(易恐). The remedy is relieving the depressed liver and regulating the circulation of qi(疏肝解鬱). I can prescribe the recipes such as Tongultang(通鬱湯), Sihosogantang(柴胡疏肝湯) plus rhizoma acari graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc.

• The korean journal of orthodontics
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• v.27 no.4 s.63
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• pp.607-621
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• 1997

GRP was known as the modulator of Pain transmission in central nervous system and local effector to peripheral tissue causing vasodilation, increased blood flow, modulation of immune sysem, stimulation of endothelial cell proliferation, and stimulation of bone formation. Numerous study, therefore, were done to elucidate involvement of CGRP to tooth movement. To investgate the response of CGRP immunoreactive nerve cells according to cell size in trigeminal ganglion during tooth movement, immunohistochemical study was performed using rat. Experimental rats(9 weeks old, 210 gm) were divided as six groups(normal(n=6), 3 hour group(n=5), 12 hour group(n=4), 1 day group(n=5), 3 day group(n=5), 7 day group(n=5)), and were applied orthodontic force (approximately 30 gm) to upper right maxillary molar. After frozen sections of trigeminal ganglions were immunostained using rabbit antisera, the changes of CGRP immunoreactive cells in regard to cell size distribution(small cell(upto $20{\mu}m$), medium cell($20-35{\mu}m$), large cell(above $35{\mu}m$)) were observed. The results were as follows 1. The percentage of CGRP immunoreactive cells to all nerve cells in trigeminal ganglion was 33.0% in normal control group, was decreased to 24.5% in 1 day group, and was increased to 41.8% in 7 day group. 2. The percentage of small, medium, and large cells expressing CGRP immunoreactivity in normal trigeminal ganglion to all CGRP immunoreactive cells were 51.3%, 44.0%, 4.7%, respectively. 3. The percentage of small cells with CGRP immunoreactivity to all CGRP immunopositive cells was increased in 3 hour and 12 hour groups. 4. The percentage of medium cells with CGRP immunoreactivity was increaed in 3 day and 7 day groups. 5. The percentage of large cells with CGRP immunoreactivity was increaed in 7 day group. Conclusively, the small cells with CGRP immunoreactivity in trigeminal ganglion respond to orthodontic force during initial phase of tooth movement, and later the medium and large cells with CGRP immunoreactivity respond

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.356-361
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• 2008

Background: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. Methods: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. Results: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. Conclusion: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.67-77
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• 1990

This study was intended to analyse the relation between the psychic traumatic experience and the psychological health of the aged. The authors carried out this study by means of the combined anxiety-depression scale(CADS) and the preadolescence traumatic experience scale(PTES) with 278 aged men and women residing in Taegu from September to October 1988. The results were as follows : 1. Based on the scores avaluated by CADS, the scores of the both groups showed that comparative group was accounted for $40.15{\pm}6.19$, while the experimental group for $57.75{\pm}6.37$, which showed significantly higher score in the experimental group(p<0.001). 2. The experimental group showed significantly higher early experience score than the comparative group in the dietary difficulty, alcoholism among family members, disunion between husband and wife, trouble between mother and children, early mother loss, parent's indifference and unwanted birth(p<0.001). 3. The experimental group showed higher early experience score than the comparative group by sex, age, marital status and grown location(p<0.001). 4. When the subjects were included in the unemployed and in the middle or low classes and their parents were engaged in agriculture and commercial business and believing in buddhism or non-religion, showed higher experience score (p<0.001).