• 수면정신생리
• /
• 제6권2호
• /
• pp.126-132
• /
• 1999

목 적: 저자들은 본 연구에서 혈액투석 중인 환자들을 대상으로 불면증의 빈도, 불면증 환자들의 특성, 신체적 그리고 심인적인 증상들과의 상관관계, 수면에 대한 믿음과 태도 등을 조사하여 향후 진료에 도움을 주고자 하였다. 방 법: 부산시내 소재 4개의 혈액투석실에서 혈액투석을 받고 있는 만성 신부전증 환자 153명(남 87명, 여 66명)을 대상으로 저자들이 본 연구에 알맞게 개발한 수면관련 설문지, 벡 우울증 척도, 스필버거 상태-특성 불안 척도를 이용하여 환자들의 증상을 조사하였다. 결 과: 전체 153명의 혈액투석 환자 중 65.4%인 100명이 불면증을 호소하였다. 연령, 남녀비, 교육정도, 결혼상태, 평균 혈액투석 기간, 그리고 혈청 알부민을 제외한 조사된 혈액화학검사 소견들은 불면증군과 비불면증군 사이에 차이가 없었다. 불면증군은 비불면증군에 비해 유의하게 BDI 점수와 투석전 수축기 혈압이 높았고 혈청 알부민치는 더 낮았다. 또, 시각유도척도법을 이용한 두 군간의 주관적인 고통에 대한 조사에서 불면증군은 슬픔, 불안, 걱정, 피부 소양증, 그리고 일상생활에서의 기능장애 등의 주관적인 고통을 비불면증군보다 유의하게 더 많이 호소하고 있었다. 불면증의 심한 정도가 불량한 신체적 건강상태, 피부 소양증, 그리고 골관절 통증 등의 신체적 증상, 슬픔, 불안, 걱정 등의 심인적인 증상, 그리고 낮 동안의 졸음과 일상생활에서의 기능장애와 유의한 혈액투석 중인 만성 신부전증 환자에서의 불면증 132 상관관계가 있었다. 또, 불면증군은 비불면증군에 비해 수면에 대한 비기능적인 믿음이 더 많았다. 결 론: 혈액투석을 받고 있는 말기 신부전증 환자들은 일반 인구에 비해 불면증이 흔하였고, 이들 중 불면을 호소하는 환자들은 대조군에 비해 심인적인 증상과 신체증상 그리고 일상생활에서의 기능저하를 더 호소하였고, 수면에 대한 비기능적인 믿음이 많았다. 그리고 불면증의 심한 정도는 이러한 요인들과 밀접한 관계가 있었다. 이상의 요인들을 고려하여 수면장애를 개선한다면 이들 환자들의 진료에 도움을 주어 치료 순응도와 삶의 질을 높일 수 있으리라고 생각한다.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
• /
• 제24권3호
• /
• pp.49-57
• /
• 2018

Purpose: The increase in patients requiring hemodialysis has resulted in an increase dialysis-associated infections risk. but there are no Renal Dialysis unit design standard meet specified safety and quality standards. Therefore, appropriate Establish standards and legal regulation is important for the provision of initial certification and maintenance of facility, equipment, and human resource quality. Methods: Literature survey on the design guideline and standards of Renal Dialysis unit design in Korea, U.S, Germany, Singapore, Hongkong, Dubai. Results: There are no established standards for facilities in dialysis units in Korea. To prevent infections in dialysis patients, necessary establish standards. Considering the domestic and overseas Health-care facilities standards, the major factors to be considered in the medical environment for Renal Dialysis Unit are as follows. First, planning to separate Clean areas(treatment area) from contaminated areas(medical waste storage area). Second, ensure sufficient space and minimum separation distance. Although there may be differences depending on the circumstances of individual institutions, renal dialysis unit consider the space to prevent droplet transmission. Third, secure infrastructure of infection prevention such as sufficient amount of hand hygiene sinks. Hand washing facilities for staff within the Unit should be readily available. Hand hygiene sinks should be located to prevent water from splashing into the treatment area. Fourth, Heating, ventilation and air conditioning (HVAC) system for Renal Dialysis Unit is all about providing a safer environment for patients and staff. Implications: The results of this paper can be the basic data for the design of the Renal Dialysis Units and relevant regulations.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
• /
• 제28권2호
• /
• pp.31-38
• /
• 2022

Purpose: This study presents the results of the analysis on space utilization of kidney dialysis units in regional public hospitals, which plays a key role in local public medical services. The result aims to achieve safety from infection, allow comfort for the dialysis environment, and stability for medical support. The purpose of this study is to present fundamental data for architectural plans for the kidney dialysis unit, as well as to alleviate potential infectious diseases such as COVID-19. Methods: For research purposes, the investigation and analysis of space utilization were based on architectural floor plans, research papers and literature, related legal systems, and public statistics. Of the main 35 regional public hospitals, in regards to data accessibility, 15 facilities were selected to conduct the survey and analysis for the objective. Results: The space composition by area research results of kidney dialysis units in public hospitals are as follows: Firstly, most targets do not have required rooms in the access and support area, except for the hemodialysis beds in the treatment section. Secondly, the access area requires necessary room and space design that took into consideration of convenience and accessibility for patients. Thirdly, in regards to infection prevention and control, proper circulation and room plan is essential for storage and disposal of contaminated products and linen after use. For the treatment area, the arrangement plan needs to establish a visual connection between the isolation room, the nursing station, and the bed area. Additionally, consideration of circulation in the preparation, treatment, observation, examination, and all other rooms in the facility is required. Lastly, for the support area, the room is designed to consider adequate working and meeting spaces for the medical staff, consultation space for patients or guardians, separate storage and disposal of clean and contaminated items, and the storage of various equipment for dialysis. Implications: In preparation for the increase in chronic kidney failure patients and the spread of infectious diseases, such as COVID-19, the researched data demonstrates the basic guidelines for space composition of kidney dialysis units and the significant role of regional public hospitals.

• Nutrition Research and Practice
• /
• 제8권1호
• /
• pp.103-111
• /
• 2014

This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake ($58.86%{\pm}33.87%$ of needs) yet adequate dietary P intake ($795.52{\pm}366.94$ mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

• Journal of Korean Neurosurgical Society
• /
• 제48권4호
• /
• pp.380-382
• /
• 2010

The authors present an extremely rare case of a pseudoaneurysm of the ulnar artery as a complication of a two-portal endoscopic carpal tunnel release (ECTR). A 70-year-old man with chronic renal failure and on maintenance hemodialysis with a left arteriovenous fistula presented with paresthesia of his right hand. A clinical diagnosis of right carpal tunnel syndrome was confirmed by ultrasonography and an electro physiologic study. He underwent two-portal ECTR, and the paresthesia was much improved. However, he presented to us one month after operation with severe pain, a tender mass distal to the right wrist crease and more aggravation of the paresthesia in the ulnar nerve distribution. Doppler ultrasound was performed and revealed a hypo echoic lesion 20 mm in diameter in the right palm, with arterial Doppler flow inside connected to the palmar segment of the ulnar artery. An ulnar artery pseudoaneurysm was diagnosed and treated by ultrasound-guided percutaneous thrombin injection. Transverse color Doppler ultrasound image showed complete thrombosis of the pseudoaneurysm and flow cessation after a total injection of 500 units of thrombin. The symptoms were also improved.

• Journal of Chest Surgery
• /
• 제45권5호
• /
• pp.295-300
• /
• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.