• Journal of Neurocritical Care
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• v.11 no.2
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• pp.110-118
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• 2018

Background: The role of clinical pharmacists in medication therapy to improve clinical and economic outcomes has been reported in the literature. This study was conducted to analyze the changes in details of medication interventions before and after the introduction of clinical pharmacists into the care of neurocritical care unit (NCU) patients, and to evaluate the economic effects of clinical pharmacists by calculating the avoidance cost. Methods: A retrospective study was conducted reviewing the electronic medical records from June 2013 to May 2014 (before), and from June 2016 to May 2017 (after). We calculated the number and rates of intervention, the acceptance rates of it, and also reviewed the list of interventions. We calculated avoidance cost if there was no intervention. Results: The monthly mean number of interventions increased from 8.0 (${\pm}5.7$) to 31.7 (${\pm}12.8$) (P<0.001) and the frequency of intervention also increased from 0.8% to 1.6% (P=0.003). The most frequently provided pharmacist intervention was nutritional support before introduction of clinical pharmacists and discussions on the medication plan after. The number of classified interventions was 14 before introduction of clinical pharmacist services and 33 after. The calculated cost avoidance associated with a clinical pharmacists' integration was 77,990,615 won per year. Conclusion: Introduction of clinicals pharmacist into the NCU was associated with increased intervention rates and expanded types of clinical interventions. The cost avoidance achieved by the pharmacists' interventions can be further explored to evaluate if similar expansions of pharmacists' services achieve similar results in other settings.

• Nutrition Research and Practice
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• v.16 no.5
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• pp.604-615
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• 2022

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1-77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01-1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08-2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49-3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27-3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36-3.87), ICU admission (HR = 1.97; 95% CI, 1.17-3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59-19.43; stage III: HR = 16.20; 95% CI, 4.99-52.59) were significantly associated with CSS. CONCLUSIONS: Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Journal of agriculture & life science
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• v.50 no.1
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• pp.117-124
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• 2016

Researches on soil microbial community are increasing to assess ecosystem responses to anthropogenic disturbances and to provide an indicator of ecosystem recovery. Microbial communities are able to respond more rapidly to environmental changes than plants and therefore they may provide an early indication of the ecosystem recovery trajectory. This study was conducted using 16S rRNA gene pyrosequencing of soil samples to compare soil bacterial community composition between artificially covered soils of the Baedudaegan ridgeline and their adjacent forest soils in two restoration project sites, Ihwaryeong and Yuksimnyeong, which were completed in 2012 and 2013, respectively. Richness of the Phylum level was 29.3 in Ihwaryeong and 32.3 in Yuksimnyeong. Significant difference in the richness between artificial restored soils and adjacent forest soils(p<0.01) was observed, however no significant difference was observed for site location and soil depth. Acidobacteria(37.3%) and Proteobacteria(31.1%) were more abundant than any other phylum in collected soil samples. Also, we found the significant difference in the relative abundance of the two abundant phyla between artificially restored soils and their adjacent forest soils (Proteobacteria, 38.1% in restored soils vs 24.2% in adjacent forest soils, p<0.01; Acidobacteria, 55.4% in restored soils vs 19.2% in adjacent forest soils, p<0.001). The results support the previous researches indicating that soil bacterial community composition is affected by nutritional status of soils and that Acidobacteria is also strongly influenced by pH, thus favoring soils with lower pH. This study could be utilized to monitor and evaluate restoration success of forest soil environment quantitatively.

• 한국노년학
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• v.30 no.3
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• pp.695-708
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• 2010

Purpose: This study was to explore the factors affecting on Dietary Behavior Change of the vulnerable elderly based on the Stage of Change. Methods: This study was a secondary analysis of the data collected from 1,262 elderly who were participated in the case management program. Total 984 participants who responded all questionnaire were included in the analysis. The variables included general characteristics, health behavior, health status, and dietary behavior stage. The data collected were analyzed by descriptive statistics, trend test and multi-variate logistic regressions. Results: about twenty four percent of the vulnerable elderly subject was pre-contemplation stage and 46.1% of them was contemplation stage of dietary behavior. Having a depressive mood, dependance of Instrumental Activity of Daily living, and being medicaid affected on starting or on maintaining healthy dietary behavior in vulnerable elderly negatively. Conclusion: The tailored nutritional intervention depending on dietary behavior stage are needed for the vulnerable elderly to improve the health. The program which can maintain the function remained of elderly and give psychological support together will be more effective.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.189-196
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• 2009

Purpose : The pathophysiologic mechanism of nephrotic syndrome is not yet known clearly. At least in some cases, certain 'circulating factors' are thought to increase the glomerular protein permeability. Considering the systemic effect of the circulating factor on peritoneal membrane, we evaluated the loss of protein through peritoneal membrane in patients on peritoneal dialysis due to the end stage renal disease (ESRD) caused by steroid resistant nephrotic syndrome (SRNS). Methods : We retrospectively reviewed the medical records of 26 pediatric patients on peritoneal dialysis ensued during the period from 2001 to 2007 at our clinic. Twelve patients had SRNS, while 14 patients had ESRD caused by the congenital anomalies of urinary system. Results : While the other parameters including nPNA indicating the adequacy of protein intake were similar between the two groups, serum albumin was lower in SRNS patients than the non-SRNS patients ($3.7{\pm}0.3$ g/dL vs. $4.0{\pm}0.4$ g/dL, P=0.021). Peritoneal protein loss was higher in SRNS patients than in non-SRNS patients ($3,044.4{\pm}837.6\;mg/m^2$/day vs. $1,791.6{\pm}1,244.0\;mg/m^2$/day, P=0.007). The protein permeability of the peritoneal membrane measured by the ratio of total protein concentration in dialysate to plasma was twice as high in SRNS patients as the non-SRNS ($1.06{\pm}0.46%$ vs. $0.58{\pm}0.43%$, P=0.010). After 1 year, peritoneal protein loss increased in both patient groups, but to a significantly greater degree in non-SRNS patient (P=0.023). Conclusion : The results of our study support the notion that in nephrotic syndrome there are some 'circulating factors' with the systemic effect. Since the greater protein loss through peritoneal membrane in SRNS was confirmed in this study, more meticulous nutritional support and close monitoring on the nutrition are required in these patients.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.3
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Journal of the East Asian Society of Dietary Life
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• v.17 no.3
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• pp.351-363
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• 2007

Previously, we analyzed for nutrition knowledge and the use of nutrition knowledge in the everyday lives of students in order to develop nutrition education programs that focus on desirable behavior change. From this, we found that female students desired to participate in nutrition education more than male students, and regarding their concerns for nutrition education, 73.2% of the females and 50.0% of the males displayed interest in 'obesity and the regulation of body weight'. Therefore, this study showed female students give more attention to the obesity and the regulation of body weight than male students(p=.000<.001). In addition, female students had higher interests($8.63{\pm}1.67$) than male students ($7.45{\pm}2.03$) in nutrition knowledge(p=.000<.001). By investigating the use of nutrition knowledge in everyday life, our research indicated that the actual use of nutrition knowledge was less. To encourage students to persue dietary lives addressing the concerns confirmed above, the following needed to occur. 1) Provide them nutrition information for the main processed foodstuffs encountered when dining out(breads, cakes, cookies, and carbonated beverage). 2) Teach them to read food nutrition labels. 3) Help them find a lifestyle connection through lasting self-management methods and the generation of social support. Accordingly, this required developing effective and practical nutrition education programs that considered regional characteristics and gender differences. The most important factors considered during nutrition education program development were the need for motivation and ongoing education by stage of change, rather than temporal education through specific problem analysis, in order that those being educated may bring about a change of behavior by themselves. Therefore, from this study, we have suggested the use of multilateral operating strategies for successful nutrition education. In addition the phase model of behavior change should be applied. Our programs were aimed at self owned nutritional management so that students could master their own methods for acquiring skills and enjoying dietary life. The research may be summed up as follows. First, the purpose of education at the recognition stage of change was to attempt motivation for nutrition improvement, by analyzing the problems such as food buying habit and the main purchasing viewpoints when dining out. Second, the purpose of education at the action stage of change was to help students acquire of concrete methods for behavior modification by linking the program to their home as well as to teachers with various activities that suited the situation at school. This was done by analyzing the processes and decisions pertaining to dining out the main processed foodstuffs and principal components, etc. through data and experimental practice. Third, the purpose of education for changing of habits and values, or the maintenance stage, was to investigate the various reasons that undesirable behaviors were induced, and then determine a lasting self-management method as well as how to generate social support. If the nutrition education program developed in this study is utilized on site, someone in the primary role as the nutrition educator and trained specifically in nutrition, can help induce the health promotion in the community as well as lasting dietary management, by executing a link with families in parallel with educating teaching staff and students' parents. In addition, this program can playa role in the government policies related to the health promotion for our youth who are the foundation of our nation and who can enhance our national competitive power.

• Journal of Nutrition and Health
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• v.44 no.1
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• pp.49-60
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• 2011

This study was performed to develop a children's dietary life safety index required by the Special Act on Safety Management of Children's Dietary Life enacted in 2009. An analytical hierarchy process was used to obtain initial weights of dietary life safety evaluation indicators. The Delphi method was applied to develop the weights along with 98 food and nutrition professionals. Three representative policy indicators, nine strategy indicators, 11 main evaluation indicators, and 20 detailed evaluation indicators were selected for the children's dietary life safety assessment. Three policy indicators and nine strategy indicators were the following: children's food safety indicator (support level of children' safety, safety management level of children's favorite foods, and safety management level of institutional food service), children's nutrition safety indicator (management level of missing meals and obesity, nutrition management level of children's favorite foods, and nutrition management level of institutional food service), and children's perception and practice level indicator ("Dietary Life Law" perception level, perception, and practice level for dietary life safety management, perception, and practice level for nutrition management). Weights of 40%, 40%, and 20% were given for the three representative policy indicators. The relative importance of nine strategic indicators, which were determined by the Delphi method is as follows: For children’s food safety, support level of children's safety, safety management level of children's favorite foods, and safety management level of institutional food service were given weights of 12%, 9%, and 19%, respectively. For children's nutrition safety, the missing meals and obesity management level, nutrition management level of children's favorite foods, and the nutrition management level of institutional food service were given weights of 13%, 11%, and 16%, respectively. The "Dietary Life Law" perception level, perception and practice level of dietary life safety management, and perception and practice level of nutrition management were given weights of 4%, 7%, and 9%, respectively.

• Journal of Preventive Medicine and Public Health
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• v.30 no.4 s.59
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• pp.669-685
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• 1997

Previous studies, reporting the inverse relationship between osteoarthritis and osteoporosis suggest the existence of possible pathophysiologic mechanisms between them. To examinine the hypothesis that 'bone mineral densities of women with osteoarthritis are significantly higher than that of women without osteoarthritis in Korea', subjects from the health and nutritional examination survey in Kuri city were sampled. Samples were selected through multi-stage sampling frame using established clusters in Kuri city. From August 18 to September 10,1997, the survey was conducted. Among the. total number of selected sample population (1,656 people), response .ate was 52.4 percent (348 men and 519 women). 420 women who took BMD measurement, radiologic exam, and anthropometric exam were selected for the analysis. The analytic results are as follows. 1. General characteristics: Mean BMD was $0.493g/cm^2$, mean age was 43.0, mean BMI was $23.9kg/m^2$. The number of women who experienced menopause was 106, hysterectomy was 19. There were 0 case of osteoarthritis of hip, 64 cases of osteoarthritis of knee, and 2 cases of osteoarthritis of hand. 2. Univariate analysis results: Mean BMD of women with the osteoarthritis of knee was significantly lower than that of women without the osteoarthritis of knee(0.4269 vs. $0.5057g/cm^2$). But, there were too few cases of osteoarthritis of hip and hand, so comparative studies of BMD in osteoarthritis of hip and hand could not be conducted. There were significant differences of BMD among pre-menopause group(0.5204), post-menopause group(0.4206), and hysterectomy group(0.4881). Additionally, there were significant differences of BMD among diabetes group(0.4297), impaired glucose tolerance group(0.4874), and normal group(0.5057). Furthermore, age, parity, BMI, bioimpedance were significantly related with BMD. 3. Multivariate analysis results: To examinine the relationship between osteoarthritis and BMD while controlling the other variables' effects which were significant in the univariate analyses, multiple linear regression analysis was done. But, it was found that osteoarthritis of knee was not a significant variable to BMD anymore. While age and menopause had significant negative relationship with BMD. Diabetes, parity, BMI, and bioimpedance did not have significant relationships with BMD. After stratification of subjects according to menopause, multiple linear regression analyses were done to each strata. Consequently, age in post-menopause group, age and osteoarthritis of knee in hysterectomy group showed significant negative relationship with BMD. The results did not support the many results of other previous studies done with white men and women. further studies of biological plausibility to Korean women are recommended. Also it is suggested that longitudinal study to verify the relationship between osteoarthritis and BMD will be valuable.

• Radiation Oncology Journal
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• v.13 no.2
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• pp.157-162
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• 1995

Lung cancer study group at Asan Medical Center has conducted the second prospective study to determine the efficacy and feasibility of MVP chemotherapy with concurrent hyperfractionated radiotherapy for Patients with stage III unresectable non-small cell lung cancer(NSCLC). All eligible Patients with stage III unresectable NSCLC were treated with hyperfractionated radiotherapy(120 cGy/fx BID. 6480 cGy/54fx) and concurrent 2 cycles of MVP(Mitomycin C $6mg/m^2,$ d2 & d29.Vinblastine $6mg/m^2,$ d2 & d29, Cisplatin $60mg/m^2,$ dl & d28) chemotherapy. Between Aug. 1993 and Nov. 1994, 62 patients entered this study; $6(10\%)$ had advanced stage IIIa and $56(90\%)$ had IIIb disease including 11 with pleural effusion and 10 with supraclavicular metastases. Among 62 patients, $48(77\%)$ completed planned therapy. Fourteen patients refused further treatment during chemoradiotherapy. Of 46 patients evaluable for response, $34(74\%)$ showed major response including $10(22\%)$ with complete and $24(52\%)$ with partial responses. Of 48 patients evaluable for toxicity, $13(27\%)$ showed grade IV hematologic toxicity but treatment delay did not exceed 5 days Two patients died of sepsis during chemoradiotherapy. Severe weight loss(more than $10\%)$ occurred in 9 patients$(19\%)$ during treatment. Nine patients$(19\%)$ developed radiation pneumonitis Six of these patients had grade 1 (mild) Pneumonitis with radiographic changes within the treatment fields Three other patients had grade 11 Pneumonitis, but none of these patients had continuous symptoms after steroid treatment. Concurrent chemoradiotherapy for patients with advanced NSCLC was well tolerated with acceptable toxicity and achieved higher response rates than the first study, but rather low compliance $rate(77\%)$ in this study is worrisome. We need to improve nutritional support during treatment and to use G-CSF to improve leukopenia and if necessary. supportive care will be given as in patients, Longer follow-up and larger sample size is needed to observe survival advantage.