The increase in size and numbers of general hospitals in the process of conspicuous development of modem medicine has been accompanied by a serious increase in hospital acquired infections. Hospital aquired infections cause pain and discomfort, may threaten life, adds an economic burden, and delays recovery and return to society. Even though respiratory hospital infection rates resulting for tracheostomy and respiratory inhalation therapy, may be low, they are serious because of their bad prognosis and high mortality rates. This study was designed to assess certain aspects of respiratory infections of patients with a tracheostomy and thus provide baseline data for further research related to preventive or therapeutic nursing interventions. The specific objectives were to determine the incidence of colonization in the trachea, clinical signs, type of colonized bacteria and sensitivity to antibiotics. Data were collected from July 1 to December 10, 1989 at two university Hospital in Seoul. Subjects were 20 patients with a tracheostomy admitted to the Intensive Care Unit or Cerebral Vascular Accident Center. Clinical signs related to respiratory infection were observed using a checklist based on previous study outcomes. Bacterial culture, sensitivity test to antibiotics, WBC counts and chest X-ray were also performed. Cultures were done on the day of tracheostomy, and on the third, fifth and seventh day. Cultures were then done on seventh days after the first colonization. The results were as follows : 1. The incidence of bacteria colonization in a week was 90%(18 patients) 50% (10/20 patients) on the day of tracheostomy, 70%(7/10 patients) on the third day, and 0% on the fifth day, and 33%(1/3 patient) on the seventh day. 3 of 18 patients (16.7%) were colonies of mixed growth isolated. 2. The observed clinical signs related to respiratory infection were high fever 38.9%(7 patients), prulent secretion 16.7%(12 patients) and infiltration seen on chest X-ray 33.3%(6 patients). 3. The total number of types of bacteria isolated among the 18 subjects was 21 ; gram negative 71.4%, gram postive 28.6%. The dominant bacteria type was Staphylococcus aureus(5 cases) for gram(equation omitted) and Pseudomonas aeruginosa(3 cases), Klebsiella (4 cases), Enterobacter(3 cases) for gram (equation omitted). The results of culture on 7th day after the first colonization, 6 cases showed same type of bacteria, 3cases showed different type of bacteria and 1 cases showed no growth. 4. The sensitivity tests to antibiotics showed that Pseudomonas aeruginosa and Staphylococcus were strongly resistant to most kinds of antibiotics, but Klebsiella and the rest of gram negative bacteria were moderately sensitive to antibiotics.
The traditonal inpatient acute hospital setting is organized primarily for the intensive management of disease, but not well-suited for continuity of care for the chronically ill patients after being discharged from hospital. For the planning of the continuity of care, firstly, it is necessary to assess the home care needs of the discharged pateints in the context of the nursing diagnosis. Therefore, this study is designed to identify the home nursing care need trajectory of the patients with chronic illness after discharged from one of the the General Hospitals in Seoul, Korea. The subjects are the patients with chronic illness such as stroke, musculoskeletal disease, hypertension, cancer etc., in average age of 52. 2 years old. The findings of this study are as follows : 1) The limitaion of ADL has been constantly facing to the subjects and has not been changed 4 weeks after being discharged. And the sense of with-drawal was getting worse at 4th weeks than the 1st week after being discharged. 2) The lists of the patient's problems are the impairment of mobility, elimination pattern, inactivity, impairment of skin integrity, ineffective airway clearance, and potential anxiety, self concept deficit, ineffective family coing, etc. Those problems were diminished in quantity at the first week after discharged, but at the 4th week, those problems were getting worse. 3) The need of specialized nursing care such as tube feeding, ostomy care, $O_2$ inhalation, IV therapy, teaching and exercise are considered as the most consisting problems facing to the subjects. 4) In general, the chronically ill patients and their caregivers have not been adapted well even at the 4th weeks after being discharged. 5) Considering those findings, the basic care for patients should be given and the trainging for process of the adaptation after discharged should be encouraged prior being discharged from hostital. For this suggestion, the systematic discharge planning should be carried and the hospital based home nursing model should be implemented at the general hospital for the chronically ill patients.
Breathlessness is a frequent and distressing symptom in terminal cancer patients. Refractory breathlessness is defined as a state that does not respond to conventional disease-specific therapy with an exclusion of reversible underlying causes, and the main classes of symptomatic drug treatments include opioids and benzodiazepines. Korean Family Medicine Palliative Medicine Research Group discussed two terminal cancer patients in whom severe breathlessness with different causes were treated with inhalation of nebulized furosemide, which is an emerging option of palliative treatment. It still remains unclear how it becomes effective or how much it is effective, therefore, its routine use seems to be somewhat early. Nevertherless, if a patient with intractable breathlessness does not have a marked obstructive airway lesion, its use should be considered. Based on the discussion in the seminar, we want to share our experience of the application of inhaled furosemide with other palliative care practitioners and strongly recommend further research on this topic in the future.
Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.
The purpose of this study is to determine the effect of aromatherapy, showing how the composition handling of aromatherapy and abdominal massage treatment reaches body ingredient transformation. The subjects for this research were total 18 middle-aged females in Seoul; aroma massage group of 7 females, aroma inhalation and water bathe group of 5 females, abdominal massage group of 6 females by jojoba oil without any medical effect. This clinic trial was held from July 1, 2008 to Aug.14, 2008. I held this clinic trial under the same condition after and before this clinic. A standard tape and OLYMPIA 3.5 of S hospital were used at the body measuring for subjects after and before clinic trials. I got Average and standard deviation by data analysis by SPSS Win. Ver.14.0. I did paired t-test for the comparison of before and after, and repeated measure ANOVA for between two groups or among three groups'. The verification was held Duncan Test. The results of this study were as follows: 1. Body mass quotient (F=2.86, p= .063) and Body region (F=1.34, p= .279) among three groups showed no meaningful difference, but weight meaningful difference and aroma massage group showed the greatest difference of body measure change quantity. 2. In change quantity of abdomen girth, Waist circumference and WHR, abdomen girth (F=4.56, p= .012) and Waist circumference (F=4.37, p= .031) showed a meaningful statistical difference. The result of subsequent inspection showed that there was a meaningful difference among three groups and aroma massage group was best. 3. In Cell quantity, Body region quantity and Muscle volume, Body region quantity (F=2.76, p= .182) and Muscle volume (F=3.12, p= .054) showed no difference, but Cell quantity (F=3.79, p= .040) showed a meaningful difference. In the comparison of three groups there was no difference, but aromatherapy group showed more change quantity than any other group. According to the result of this study, the composition handling of aromatherapy and body massage was effective in the decrease of Abdominal fatness and Waist circumference, Weight and the increase of Cell quantity. so I suggest that woman use this therapy in the program of obesity management for her health improvement.
BOOP is a clinopathologic entity consisting of a flu-like illness, late inspiratory crackles, and pathologically granulation tissue plugs within lumens of small airways sometimes with complete obstruction of small airways and granulation tissue extending into alveolar ducts and alveoli with a variable degree of interstitial infiltration of mononuclear cells and accumulation of foamy macrophages in alveolar spaces in a patch distribution, and preservation of background architecture of the lung. It has patch infiltrates roentgenographically, and restrictive ventilatory defect pysiologically such as decreased vital capacity. and diffusing capacity. The BOOP has been observed in the context of collagen vascular disease, and other autoimmune disease secondary to treatment with penicillamine, bleomycin, acebutolol and amiodarone, following the inhalation of toxic fumes, after several infections including measles, pertussis and influenza and idiopathic. Clinically, response to coricosteroid therapy is good and relapse dose not occur if sufficient theraphy is good. A flu-like illness occurs in one third, cough in one third, cough with dyspnea in the remaining patients. Hemoptysis are rare. The physical examination reveales dry crackles in the majority of the patients with BOOP but rarely associated with wheezing. The duration of illness is less than 2 months in 75% of patients. With a brief review of literature, we report a case of the BOOP which is good response to steroid, but frequent relapse and assoicated with wheezing.
Lee, Hyun Su;Choi, Chansoo;Kim, Chan Hyeong;Han, Min Cheol;Yeom, Yeon Soo;Nguyen, Thang Tat;Kim, Seonghoon;Choi, Sang Hyoun;Lee, Soon Sung;Kim, Jina;Hwang, JinHo;Kang, Youngnam
Journal of Radiation Protection and Research
/
v.44
no.3
/
pp.103-109
/
2019
Background: Four-dimensional computed tomographic (4DCT) images are increasingly used in clinic with the growing need to account for the respiratory motion of the patient during radiation treatment. One of the reason s that makes the dose evaluation using 4DCT inaccurate is a change of the patient respiration during the treatment session, i.e., intrafractional uncertainty. Especially, when the amplitude of the patient respiration is greater than the respiration range during the 4DCT acquisition, such an organ motion from the larger respiration is difficult to be represented with the 4DCT. In this paper, the method to generate images expecting the organ motion from a respiration with extended amplitude was proposed and examined. Materials and Methods: We propose a method to generate extra-phase images from a given set of the 4DCT images using deformable image registration (DIR) and linear extrapolation. Deformation vector fields (DVF) are calculated from the given set of images, then extrapolated according to respiratory surrogate. The extra-phase images are generated by applying the extrapolated DVFs to the existing 4DCT images. The proposed method was tested with the 4DCT of a physical 4D phantom. Results and Discussion: The tumor position in the generated extra-phase image was in a good agreement with that in the gold-standard image which is separately acquired, using the same 4DCT machine, with a larger range of respiration. It was also found that we can generate the best quality extra-phase image by using the maximum inhalation phase (T0) and maximum exhalation phase (T50) images for extrapolation. Conclusion: In the present study, a method to construct extra-phase images that represent expanded respiratory motion of the patient has been proposed and tested. The movement of organs from a larger respiration amplitude can be predicted by the proposed method. We believe the method may be utilized for realistic simulation of radiation therapy.
Journal of the Korea Academia-Industrial cooperation Society
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v.20
no.5
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pp.300-310
/
2019
This study is a systematic review of randomized experimental and non-randomized studies on the effects of lavender scent therapy on pain and a meta-analysis to provide evidence-based data. The data included in the meta-analysis are 18 studies published from 2000 to 2018, with interventional subjects being surgical, maternal, arthritis and dialysis patients, and the types of interventions were massage, application, hot-pack, and taking medication. RESULTS: The effect size (Hedges' g) for pain was -0.16 [95% CI:-1.40: -0.72], which was statistically significant. The effect size according to intervention type was -1.36 [95% CI: -1.96, -0.77], local application -1.11 [95% CI:-1.57-0.66], inhalation -1.05 [95% CI:-1.54, -0.56 ], and massage -0.92 [95% CI:-1.62, -0.23], all of which were statistically significant. To explore the possible causes of heterogeneity ($I^2=88%$), meta-ANOVA was conducted with covariates of intervention type or study design, and the results revealed it was statistically insignificant (intervention type Q=0.25, df=3, p=.968, study design Q=0.22, df=1, p=.642).
Background: Korean Red Ginseng has been widely used in traditional oriental medicine for a prolonged period, and its pharmacological effects have been extensively investigated. In addition, Angelica gigas and deer antlers were also used as a tonic medicine with Korean Red Ginseng as the oriental herbal therapy. Methods: This study was conducted to evaluate the potential toxicological effect of KGC-HJ3, Korean Red Ginseng with angelica gigas and deer antlers, on reproductive and developmental functions including fertility, early embryonic development, maternal function, and embryo-fetal development. KGC-HJ3 was administered by oral gavage to Sprague-Dawley rats (22 animals per sex per group) at dose levels of 0 mg/kg (control), 500 mg/kg, 1000 mg/kg, and 2000 mg/kg to evaluate the potential toxicological effect on fertility and early embryonic development. In addition, KGC-HJ3 was also administered by oral gavage to mating-proven Sprague-Dawley rats (22 females per group) during the major organogenesis period at dose levels of 0 mg/kg (control), 500 mg/kg, 1000 mg/kg, and 2000 mg/kg to evaluate the potential toxicological effect on maternal function and embryo-fetal development. Results and conclusion: No test item-related changes in parameters for fertility, early embryonic development, maternal function, and embryo-fetal development were observed during the study period. On the basis of these results, it was concluded that KGC-HJ3 did not have toxicological potential on developmental and reproductive functions. Therefore, no observed adverse effect levels of KGC-HJ3 for fertility, early embryonic development, maternal function, and embryo-fetal development is considered to be at least 2000 mg/kg/day.
Background: While inhalation therapy efficacy hinges on attaining proper peak inspiratory flow rate (PIFR), the prevalence of inappropriate PIFR among patients with chronic obstructive pulmonary disease (COPD) remains unstudied in Korea. This study aimed to assess the prevalence of inappropriate PIFR, its correlation with COPD assessment test (CAT) scores, and factors associated with suboptimal PIFR. Methods: We enrolled 108 patients with COPD who had been using the same inhaler for at least 1 year without exacerbations. PIFR was measured using an inspiratory flow meter (In-Check DIAL G16). Demographic, clinical, pulmonary function, and CAT score data were collected. Inappropriate was defined as PIFR <60 L/min for dry power inhaler (DPI) users, and >90 L/min for aerosol device users. Results: The cohort comprised 87 (80.6%) men, mean age 71.0±8.5 years, with mean post-bronchodilator forced expiratory volume in 1 second of 69.1%±1.8% predicted. Twenty-nine (26.9%) used aerosol devices only, 76 (70.4%) used DPIs only, and three (2.8%) used both. Inappropriate PIFRs were found in 17.2% of aerosol device users, and 42.1% of DPI users. CAT scores were significantly higher in the inappropriate PIFR group than in the appropriate PIFR group (11.2±7.7 vs. 7.5±4.9, p=0.003). In DPI users, female, shorter height, lower body weight and maximal voluntary ventilation (MVV) were associated with inappropriate PIFR. Conclusion: The prevalence of inappropriate PIFR among patients with COPD is 17.2% for aerosol device users, and 42.1% for DPI users. Suboptimal PIFR correlates with female gender, shorter stature, lower weight and MVV in DPI users.
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