• Journal of Hospice and Palliative Care
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• 제24권3호
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• pp.135-143
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• 2021

End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress, listening to and interacting with patients remains essential for understanding their psychological condition. The most important tool, though difficult to implement in practice, is end-of-life discussion (EOLD). EOLD has been shown to have positive effects on end-of-life treatment choices, achievement of patients' life goals, improvements in the quality of life of patients and their families, and the prevention of depression and complicated grief among bereaved family members. EOLD is not often undertaken in clinical practice, however, due to hesitancy among medical personnel and patients for various reasons. In order to conduct an EOLD, the patient's judgment, psychiatric illnesses such as delirium and depression, and psychological issues such as the side effects of psychotropic drugs, denial, and collusion must be evaluated. Open and honest conversation, treatment goal setting, the doctor's familiarity with the patient's background, and attentiveness when providing information are important elements for any dialogue. Meaning-centered psychotherapy was developed to alleviate the existential distress of cancer patients, and its application may promote EOLD. The future development of meaning-centered psychotherapy in practice and in research is expected to further promote EOLD.

• Journal of Chest Surgery
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• 제18권2호
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• pp.232-240
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• 1985

Preoperative and postoperative psychiatric evaluation were done for 51 patients who were undergoing open-heart surgery. The incidence of postoperative psychopathological complications following open-heart surgery was 27.5%. This rate is comparable to that of previous studies. Neurotic reactions occurred in eight patients, delirium in five, and acute psychotic reaction in one. Of those variables which were previously suggested to influence the high incidence, the demographic factors and the severity of preoperative illness were correlated with postoperative psychopathologic dysfunctions. No somatic variable associated with intraoperative or postoperative procedures has been proven to correlate. By preoperative psychiatric evaluations, the patients could be divided into three groups: the Anxiety group, the Denial group, and the Adjusted group. The most important psychological finding was that in patients who demonstrated a high degree of preoperative anxiety or who could not express preoperative anxiety, postoperative psychological complications developed more frequently. With these findings, the preoperative psychiatric interview was recommended for prevention and reduction of postoperative psychiatric complications.

• 한국의료질향상학회지
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• 제23권2호
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• pp.69-78
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• 2017

Background: The purpose of this study was to examine associations between classification of the Geriatric Screening for Care-10 (GSC-10) and the Morse Fall Scale (MFS) among elderly inpatients. Methods: Among elderly inpatients aged over 65 admitted to hospital (from November 1, 2016 to July 31, 2017), the data for 5,780 patients (who were evaluated using the Morse Fall Scale and the Geriatric Screening for Care-10) were analyzed using x2-tests and t-tests to examine differences between the GSC-10 and MFS, according to general characteristics of elderly inpatients (i.e., gender) using IBM SPSS Statistics 24. Results: : Scores for the GSC-10 were significantly higher in women than men for depression (p<.001), delirium (p=.048), functional decline (p<.001), incontinence (p<.001), and pain (p<.001). Statistically significant differences in all domains of the GSC-10 for elderly hospitalized patients were found for the classification of fall risk. Conclusion: The findings of this study, as supported by the GSC-10, indicate that the most common problems experienced by the elderly are related to the risk of falling. In order to reduce the incidence of falls in elderly inpatients, customized fall prevention based on the GSC-10 results is necessary.

• 중환자간호학회지
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• 제16권2호
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• pp.1-14
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• 2023

Purpose : Sleep disturbances in patients in the intensive care unit (ICU) are related to health problems after discharge. Therefore, active prevention and management are required. Hence, identification of the factors that affect sleep in patients who are critically ill is necessary. Methods : The PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science databases were searched. Selection criteria were observational and experimental studies that assessed sleep as an outcome, included adult patients admitted to the ICU, and published between November 2015 and April 2022. Results : A total of 21,136 articles were identified through search engines and manual searches, and 42 articles were selected. From these, 22 influencing factors and 11 interventions were identified. Individual factors included disease severity, age, pain, delirium, comorbidities, alcohol consumption, sex, sleep disturbance before hospitalization, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and high diastolic blood pressure (DBP), low hemoglobin (Hb), and low respiratory rate (RR). Environmental factors included light level, noise level, and temperature. Furthermore, treatment-related factors included use of sedatives, melatonin administration, sleep management guidelines, ventilator application, nursing treatment, and length of ICU stay. Regarding sleep interventions, massage, eye mask and earplugs, quiet time and multicomponent protocols, aromatherapy, acupressure, sounds of the sea, adaptive intervention, circulation lighting, and single occupation in a room were identified. Conclusion : Based on these results, we propose the development and application of various interventions to improve sleep quality in patients who are critically ill.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.113-119
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• 2017

Purpose: Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated. Methods: A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period. Results: Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3. Conclusions: An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.

• 대한한방내과학회지
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• 제10권1호
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• pp.65-80
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• 1989

About Oui-Ga-Sil(胃家實) in order to considerate the contents recorded in Nai-Gyung Sang-Han-Lon and latter literature, definition, etiopathology, syndrome, differential diagnosis, therapy, Prognosis and prevention were classified. And the results were as follows: 1. Oui-Ga(胃家)was a term which indicated the whole digestive system such as stomach, small intestine, large intestine, rectum and anus. Sil(實)could be defined as the peculiar concept pertaining to the acute and last stage which was invaded to inside bowels because of abundance with evil influence. 2. Eliology of Oui-Ga-Sil was abunt gastric fever originally, injured mucus because of mistreatment, the invasion to inside of outside evil influence through meridian. Pathology was the opening and shutting appearance of gastric abundance with intestinal emptiness, and intestinal abundance with gastric emptiness, Oui-Ga-Sil could be occurred because of gastric abundant dryness and splenic humidifying capacity decrease. 3. Symptom of Oui-Ga-Sil was classified as for the sunlight outside syndrome and the inside abundant syndrome. The sunlight outside syndrome was body fever, sweating, no chilling, on the contrary hatred of fever. The chief complaint of inside abundant syndrome was daily fever, talking in delirium, hand and foot sweating, abdominal distention, difficult defection and those could be pertained to sunlight bowel syndrome. 4. Diagnostic views of Oui-Ga-Sil were that pulse was descending abundant large strong and smooth quick, a coated tongue was yellow, deep yellow, old yellow, thick, scorching dry rough or gray black. On abdominal diagnosis, pressing by hand, patient was conscious of pain, excessive pain, rejection against press, impossible press or intermittent abdominal pain and bowel cutting pain without press. 5. Differential diagnosis was that the sunlight of Nai-Gyung-Fever-Theory was outside desease making meridian the prime object, Baik-Ho-Tang syndrome was making figureless abundant fever the pivotal point. And important differential standard of splenic shrink syndrome was that a daily fever, an irritation with fever were not occurred. 6. Theory of Oui-Ga-Sil was that Seng-Gi-Tang classes had been used in attacking downward or making balance, and moxibustion on Jung-Wan, honey boiling induction theory had been also used. Attacking downward therapy was invigorating method to preserve mucus, and if mucus had been exausted with complicating emptiness prognosis had been appeared badly. 7. Preventing from Oui-Ga-Sil diet by rule, fitness to cold and warmth may be needed to prevent outside evil influence attack and inside evil influence occurrence. Prudence with being very busy, fatigue, wine and woman may be also needed not to be an injury to splanic and gastric spirit.

• Journal of Chest Surgery
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• 제36권7호
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• pp.472-482
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• 2003

심폐바이패스의 재가온 시기 동안 뇌산소 탈포화가 수술 후 신경학적 합병증 발생의 원인 중 한가지라고 보고된 바 있다. 따라서 심폐바이패스 동안 뇌산소 탈포화를 예방해 줌으로써 수술 후 신경학적 합병증 발생을 줄일 수 있으리라 생각된다. 본 연구는 심폐바이패스 동안 뇌산소 탈포화를 예방해주는 방법인 고탄산분압과 고관류가 뇌대사에 미치는 영향을 비교하기 위해 실시되었다. 대상 및 방법: 심장수술을 시행할 36명의 성인 환자들을 대상으로 심폐바이패스의 재가온 시기 동안 동맥혈액의 고탄산분압군(Pa$CO_2$ 45~50mmHg, n＝18)과 고관류군(2.75 L/ $m^2$/min, n＝18)으로 나누었다. 전체 환자들에 대해 중대뇌동맥 혈류 속도, 뇌동정맥혈 산소함량 차이, 뇌산소 대사율, 뇌산소 운반율, S-100 $\beta$ 농도 증가율, 뇌정맥혈 산소 탈포화도 등을 심폐바이패스 전, 심페바이패스 실시 10분, 재가온-1기(비인두 온도: 33$^{\circ}C$), 재가온-2기(비인두 온도; 37$^{\circ}C$), 심폐바이패스 종료 직후 등의 다섯 시기에 측정하였다. 그리고 수술 후 섬망 발생률과 지속시간 역시 조사하여서 위의 모든 변수들과 함께 양 그룹간에 비교하였다. 결과: 고탄산분압군이 고관류군 보다 재가온 시기 동안 중대뇌동맥 혈류 속도(157.88$\pm$10.87 vs 120.00$\pm$6.18%, p＝0.006), 뇌정맥혈 산소분압(41.01$\pm$2.25 vs 32.02$\pm$1.67 mmHg, p＝0.03) 및 포화도(68.01$\pm$2.75 vs 61.28$\pm$2.87%, p＝0.03), 뇌산소 운반비율(110.84$\pm$7.41 vs 81.15$\pm$8.11%, p＝0.003)이 유의하게 더 높았다. 재가온 동안 뇌동정맥 산소함량 차이(4.0$\pm$0.30 vs 4.84$\pm$0.38mg/dL, p＝0.04), S-100 $\beta$ 증가율(391.67$\pm$23.40 vs 940.0$\pm$17.02%, p＝0.003), 뇌정맥혈 산소 탈포화도(2명 vs 4명, p＝0.04), 수술 후 섬망증의 지속시간(18 vs 34 hr, p＝0.02)은 고탄산분압군이 고관류군에 비해 상대적으로 낮았다. 결론: 상기한 결과들을 비교 분석한 바 심폐바이패스 시 고탄산분안법이 고관류법 보다 뇌조직에 산소공급을 더 많이 해줌으로써 뇌대사가 상대적으로 원활하여 신경학적 합병증 발생률이 낮은 것으로 사료된다.