• Title/Summary/Keyword: Critical care unit

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Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study (항혈전스타킹과 간헐적공기압박기 적용이 중환자의 심부정맥혈전 발생 예방에 미치는 효과: 예비조사)

  • Kim, Hwasoon;Cho, Ok Min;Kim, Ji Sun;Jang, Hai Ok;Kim, Yeo Kyeong;Kim, Seol Hee;Min, Hyo Nam;Kwak, Kyung Sun;Hong, Kee Chun;Kim, Jang Yong;Chung, Joonho
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.22 no.3
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    • pp.249-257
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    • 2015
  • Purpose: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. Methods: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. Results: The mean age was 57.5 (${\pm}15.7$) and 61.4 % were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. Conclusion: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

The Predictive Value of Laser Doppler for Flap Survival (재관류손상을 받은 가토의 이개 피판에서 레이저도플러에 의한 피판 생존의 예측)

  • Kim, Seok Kwun;Park, Jung Min;Baek, Chang Yoon;Jung, Gi Hwan;Lee, Keun Cheol;Jung, Jin Suk;Park, Ju In;Park, Byung Ho
    • Archives of Plastic Surgery
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    • v.32 no.4
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    • pp.503-510
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    • 2005
  • If we could predict the necrosis of the flap caused by reperfusion injury, we can minimize the necrosis of the flap by taking appropriate action before necrosis begins. In this study, we examined whether we can predict the survival of flap under reperfusion injury or not, by measuring laser doppler flow meter values. We divided the group into the control and experimental groups corresponding to 6, 8, 9, 10, and 12hours after reperfusion(hours after ligation of auricular central artery). In each group, we examined necrotic change, perfusion unit (PU), serum superoxide dismutase (SOD), glutathione peroxidase, angiography and pathologic findings. No necrosis was observed in the 6 and 8 hours group but 8, 18, 20 hours after ligation, necrosis was observed, Also in each of 9, 10 and 12 hours group (each group consisted of 20 flaps), necrosis were noted. According to the above data, the critical time of necrosis in the auricular skin flap model lies between about 8 to 9 hours. Comparing the PU between the necrosis and non-necrosis groups, the former group showed a mean 39.57 PU increase after 60 min of reperfusion, and the latter group showed a mean increase of 21.21 PU. We can conclude that better flow can dilute oxygen free radical into systemic circulation, and this means less injuries are caused on vessels. Our study implies that if blood flow increase is less than 30 PU, intensive care is needed to save the flap. Additionally, we found significant decrease of serum SOD and glutathione peroxidase in the necrotic group. Therefore, monitoring these serum markers will be helpful in predicting reperfusion injury and supplementing these enzymes could be helpful to save the flap. The laser doppler flow meter is thought to be helpful in clinical circumstances for evaluating the circulation of the flap after the operation. However, more accumulation of clinical studies should be necessary establishing useful clinical data.

Comparison of Clinical Efficacy Between Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy (경피적 확장 기관절개술 (Percutaneous Dilatational Tracheostomy)의 시술 용이성 및 합병증)

  • Ahn, Jong-Joon;Koh, Youn-Suck;Chin, Jae-Yong;Lee, Ki-Man;Park, Wann;Hong, Sang-Bum;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Lim, Chae-Man
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1277-1283
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    • 1998
  • Background : Surgical tracheostomy(ST) is usually performed by surgeons in operating room. For a patient with mechanical ventilation, however, transportation to operating room for ST could be dangerous for patients. In addition, ST is often delayed due to unavailability of operating room or surgeon. Percutaneous dilatational tracheostomy(PDT), although novel in Korea, is gaining popularity as a bedside procedure in the hospitals of western countries. We evaluated the technical ease and safety of PDT in comparison with ST. Method : Thirty-eight patients in medical intensive care unit (ICU) who were either under mechanical ventilation for more than 7 days or required airway protection, were randomly assigned to ST(18 patients) or PDT(20 patients). Between two groups, there was no significant clinical difference except that female to male ratio was higher in the ST group. ST was performed by second year residents of the department of otolaryngology while PDT was performed by third grade medical resident and pulmonologist under bronchoscopic guide using Ciaglia Percutaneous Tracheostomy Set(Cook Critical Care, Bloomington, USA) in medical ICU. The following factors were compared between two groups : number of delayed cases after the decision for tracheostomy, procedural time, complications related to tracheostomy. Results : Delayed cases were 11 in ST group and 3 in PDT group (P<0.05). Procedural time was significantly shorter in PDT group ($15.6{\pm}7.1min$) than in ST group ($29.1{\pm}11.6min$, P<0.0001). Complications related to tracheostomy occurred in 5 cases in ST group : accidental decannulation (1), subcutaneous emphysema (2) and minor bleeding (2), and in 4 cases in PDT group : minor bleeding (2), subcutaneous emphysema (1) and premature extubation (1) (P>0.05). Conclusion : Since percutaneous dilatational tracheostomy was easy to practice and its complications were not different from surgical tracheostomy, PDT can be a useful bedside procedure for mechanically ventilated patients.

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"Critical Application of Witness Commentaries: The Case of Guerrilla Warfare in the Korean War" ("증언자료의 비판적 활용 - 6.25전쟁 시기 유격대의 경우")

  • Cho, Sung Hun
    • The Korean Journal of Archival Studies
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    • no.12
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    • pp.137-178
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    • 2005
  • The anticommunist guerrillas' activities that aretheconcern of this article took place largely in North Korea or behind the enemy-held lines. Verifying their history is accordingly difficult and requires careful attention, but despite their active operations the military as well as the scholarly community have been lax in studying them. The Korean War came to be perceived as a traditional, limited war with regular battles, so that the studies addressed mostly the regular operations, and guerrilla warfare is remembered as an almost 'exclusive property' of the communist invaders; a small wonder that the anticommunist guerrillas have not been studied much and the collection of materials neglected. Therefore, in contrast with the witness accounts concerning regular battles, witness resources were of a small volume about these "patriots without the service numbers." For the above reasons the guerrilla participants and their later-organized fellowships took to the task of leaving records and compiling the histories of their units. They became active preservers of history in order to inform later generations of their works and also to secure deserved benefits from the government, in a world where none recognized their achievements. For instance, 4th Donkey Unit published witness accounts in addition to a unit history, and left video-recordings of guerrilla witnesses before any institute systematized the oral history of the guerrillas. In the case of Kyulsa ("Resolved to Die") Guerrilla Unit, the unit history was 10 times revised and expanded upon for publication, contributing substantially to the recovery of anticommunist guerrilla history which had almost totally lacked documented resources. Now because the guerrilla-related witness accounts were produced through fellowship societies and not individually, it often took the form of 'collective memory.' As a result, though thousands of former guerrillas remain surviving, the scarcity of numerous versions of, or perspectives upon, an event renders difficult an objective approach to the historical truth. Even requests to verify the service of a guerrilla member or to apply for decoration or government benefits for those killed in action, the process is taken care of not at the hands of the first party but the veteran society, so that a variety of opinions are not available for consideration. Moreover, some accounts were taken by American military personnel, and since some historians, unaware of official documents or evaluation of achievements, tended to center the records around their own units and especially to exaggerate the units' performances, they often featured factual errors. Thefollowing is the means to utilize positively the aforementioned type of witness accounts in military history research. It involves the active use of military historical detachments (MHD). As in the examples of those dispatched by the American forces during the Korean War, experts should be dispatched during, and not just after, wartimes. By considering and investigating the differences among various perspectives on the same historical event, even without extra documented resources it is possibleto arrive at theerrors or questionable points of the oral accounts, supplementing the additional accounts. Therefore any time lapses between witness accounts must be kept in consideration. Moreover when the oral accounts come from a group such as participants in the same guerrilla unit or operation, a standardized list of items ought to be put to use. Education in oral history is necessary not just for the training of experts. In America wherethefield sees much activity, it is used not only in college or graduate programs but also in elementary and lifetime educational processes. In comparison in our nation, and especially in historical disciplines, methodological insistence upon documented evidences prevails in the main, and in the fields of nationalist movement or modern history, oral accounts do not receive adequate attention. Like ancient documents and monuments, oral history also needs to be made a regular part of diverse resource materials at our academic institutes for history. Courses in memory and history, such as those in American colleges, are available possibilities.

Usefulness of Cardiac Troponin I as a Prognostic Marker in Noncardiac Critically Ill Patients (비순환기계 중환자의 예후인자로서 Cardiac Troponin I의 유용성)

  • Kim, Hwi Jong;Ham, Hyoun Seok;Cho, Yu Ji;Kim, Ho Cheol;Lee, Jong Deok;Hwang, Young Sil
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.1
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    • pp.53-61
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    • 2005
  • Background : Cardiac troponin I (cTnI) is a specific marker of myocardial injury. It is known that a higher level of cTnI is associated with a poor clinical outcome in patients with acute coronary syndrome. An elevation in cTnI is also observed in various noncardiac critical illnesses. This study evaluated whether cTnI is useful for predicting the prognosis in noncardiac critically ill patients. Methods : From June 2003 to July 2004 at Gyeongsang National University Hospital, we enrolled 215 patients (male:142, female:73, mean age:$63{\pm}15$ years ) who were admitted for critical illness other than acute coronary syndrome at the medical intensive care unit(ICU). The severity score of critical illness (SAPS II and SOFA) was determined and serum cTnI level was measured within 24 hours after admission to the ICU. The mortality rate was compared between the cTnI-positive (${\geq}0.1{\mu}g/L$) and cTnI-negative ($cTnI<0.1{\mu}g/L$) patients at the $10^{th}$ and $30^{th}$ day after admission to the ICU. The mean cTnI value was compared between the survivors and non-survivors at the $10^{th}$ and $30^{th}$ day after admission to the ICU in the cTnI-positive patients. The correlation between cTnI and the severity of the critical illness score (SAPS II and SOFA) was also analyzed in cTnI-positive patients. Results : 1) The number of cTnI-negative and positive patients were 95(44%) and 120(56%), respectively. 2) The mortality rate at the $10^{th}$ and $30^{th}$ day after admission to the ICU was significantly higher in the cTnI-positive patients (29%, 41%) than in the cTnI-negative patients (12%, 21%)(p<0.01). 3) In the cTnI-positive patients, the mean value of the cTnI at the $10^{th}$ and $30^{th}$ day after admission to the ICU was significantly higher in the non-survivors ($4.5{\pm}9.2{\mu}g/L$, $3.5{\pm}7.9{\mu}g/L$) than in the survivors($1.8{\pm}3.6{\mu}g/L$, $2.0{\pm}3.9{\mu}g/L$) (p < 0.05). 4) In the cTnI-positive patients, the cTnI level was significantly correlated with the SAPS II score (r=0.24, p<0.001) and SOFA score (r=0.30, p<0.001). Conclusion : The cTnI may be a useful prognostic marker in noncardiac critically ill patients.

Development of Practical Problem-focused teaching plans for Teenagers' 'Preparation for Successful aging' in the 'Family life in old age' unit (고등학생의 '성공적인 노후생활 준비교육'을 위한 실천적 문제 중심 가정과 수업의 교수 설계와 개발)

  • Lee, Jong-Hui;Cho, Byung-Eun
    • Journal of Korean Home Economics Education Association
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    • v.23 no.3
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    • pp.161-183
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    • 2011
  • This study aims to design, develop the impact of a high school course in practical problem- focused teaching plan which will enable students to deal with an aging society, and prepare well for the aging by looking at issues the elderly face. This study set a target of analyzing the 2007 revised curriculum manual to develop instructor-led teaching and learning plans for 'Successful aging preparation'. Five common subjects were reframed on a practical problem basis through factor analysis of preliminary research regarding aging education for teenagers and the 2007 revised curriculum and textbooks of Technology Home Economics, and Human Development. The practical problem was 'What do we need to do to Successfully live an independent life in aging?', and the subjects studied to answer this question were the aging society and population changes. the nature of the elderly, aging preparation, care of the elderly, and welfare services for the elderly. These five subjects were grouped under the main categories of The Aging Society. Understanding the Elderly, and aging Preparation. The ultimate objective of the lessons was, through critical reasoning, to inquire into the causes of current problems the elderly face so that teenagers can understand aging societies and the elderly, and prepare for a Successful aging. Another objective was to seek reasonable alternatives for teenagers as they prepare for Successful and independent aging, and increase their problem-solving abilities in choosing the best course of action by considering the ripple effect of consequences of each of those alternatives. The practical problem-teaching lesson plans consisted of five classes on practical reasoning instruction. This study suggests that new high school curricula should include lessons on preparation for aging so that students can deal successfully with our aging society.

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Pollen-Food Allergy Syndrome in Korean Pollinosis Patients: A Nationwide Survey

  • Kim, Mi-Ae;Kim, Dong-Kyu;Yang, Hyeon-Jong;Yoo, Young;Ahn, Youngmin;Park, Hae-Sim;Lee, Hyun Jong;Jeong, Yi Yeong;Kim, Bong-Seong;Bae, Woo Yong;Jang, An-Soo;Park, Yang;Koh, Young-Il;Lee, Jaechun;Lim, Dae Hyun;Kim, Jeong Hee;Lee, Sang Min;Kim, Yong Min;Jun, Young Joon;Kim, Hyo Yeol;Kim, Yunsun;Choi, Jeong-Hee;Work Group for Rhinitis, the Korean Academy of Asthma, Allergy and Clinical Immunology
    • Allergy, Asthma & Immunology Research
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    • v.10 no.6
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    • pp.648-661
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    • 2018
  • Purpose: Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergy in pollinosis patients caused by raw fruits and vegetables and is the most common food allergy in adults. However, there has been no nationwide study on PFAS in Korea. In this study, we investigated the prevalence and clinical characteristics of PFAS in Korea. Methods: Twenty-two investigators participated in this study, in which patients with allergic rhinoconjunctivitis and/or bronchial asthma with pollen allergy were enrolled. The questionnaires included demographic characteristics, a list of fruits and vegetables, and clinical manifestations of food allergy. Pollen allergy was diagnosed by skin prick test and/or measurement of the serum level of specific IgE. Results: A total of 648 pollinosis patients were enrolled. The prevalence of PFAS was 41.7% (n = 270). PFAS patients exhibited cutaneous (43.0%), respiratory (20.0%), cardiovascular (3.7%) or neurologic symptoms (4.8%) in addition to oropharyngeal symptoms. Anaphylaxis was noted in 8.9% of the PFAS patients. Seventy types of foods were linked to PFAS; e.g., peach (48.5%), apple (46.7%), kiwi (30.4%), peanut (17.4%), plum (16.3%), chestnut (14.8%), pineapple (13.7%), walnut (14.1%), Korean melon (12.6%), tomato (11.9%), melon (11.5%) and apricot (10.7%). Korean foods such as taro/taro stem (8.9%), ginseong (8.2%), perilla leaf (4.4%), bellflower root (4.4%), crown daisy (3.0%), deodeok (3.3%), kudzu root (3.0%) and lotus root (2.6%) were also linked to PFAS. Conclusions: This was the first nationwide study of PFAS in Korea. The prevalence of PFAS was 41.7%, and 8.9% of the PFAS patients had anaphylaxis. These results will provide clinically useful information to physicians.