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Postmastectomy Breast Reconstruction is Safe in Patients on Chronic Anticoagulation

  • Yan, Maria;Kuruoglu, Doga;Boughey, Judy C.;Manrique, Oscar J.;Tran, Nho V.;Harless, Christin A.;Martinez-Jorge, Jorys;Nguyen, Minh-Doan T.
    • Archives of Plastic Surgery
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    • v.49 no.3
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    • pp.346-351
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    • 2022
  • Background Postmastectomy breast reconstruction (PMR) increases patient satisfaction, quality of life, and psychosocial well-being. There is scarce data regarding the safety of PMR in chronic anticoagulated patients. Perioperative complications can reduce patient satisfaction; therefore, it is important to elucidate the safety of PMR in these patients. Methods A retrospective case-control study of patients who underwent PMR with implants and were on chronic anticoagulation was performed at our institution. Inclusion criteria were women ≥ 18 years old. Exclusion criteria included autologous reconstructions, lumpectomy, and oncoplastic procedures. Two controls for every one patient on anticoagulation were matched by age, body mass index, radiotherapy, smoking history, type of reconstruction, time of reconstruction, and laterality. Results From 2009 to 2020, 37 breasts (20 patients) underwent PMR with implant-based reconstruction and were on chronic anticoagulation. A total of 74 breasts (40 patients) who had similar demographic characteristics to the cases were defined as the control group. Mean age for the case group was 53.6 years (standard deviation [SD] = 16.1), mean body mass index was 28.6 kg/m2 (SD = 5.1), and 2.7% of breasts had radiotherapy before reconstruction and 5.4% after reconstruction. Nine patients were on long-term warfarin, six on apixaban, three on rivaroxaban, one on low-molecular-weight heparin, and one on dabigatran. The indications for anticoagulation were prior thromboembolic events in 50%. Anticoagulated patients had a higher risk of capsular contracture (10.8% vs. 0%, p = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, p = 0.63), thromboembolism (5% vs. 0%, p = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], p = 0.85). Conclusion Postmastectomy implant-based breast reconstruction can be safely performed in patients on chronic anticoagulation with appropriate perioperative management of anticoagulation. This information can be useful for preoperative counseling on these patients.

Job Analysis for Role Identification of Clinical Nurses with Expanded Role - Clinical Nurse with Education and Clinical Nurse with Coordination - (진료협력간호사의 역할규명을 위한 직무분석 - 교육상담간호사와 진료코디네이터간호사 중심 -)

  • Sung, Young Hee;Lim, Nan Young;Park, Kwang Ok;Jung, Jung Hee;Kwon, In Gak;Kim, Ul Soon;Hwang, Moon Sook
    • Journal of Korean Clinical Nursing Research
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    • v.15 no.2
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    • pp.139-155
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    • 2009
  • Purpose: The purpose of this study was to identify role through job analysis (duties and tasks) of nurses who work as clinical nurses with education and clinical nurse with patient coordination within the hospital. Methods: The DACUM committee was organized with 8 nurses each, clinical nurses with education and clinical nurses with coordination. The committee derived the duties and tasks of the two groups of clinical nurses from their actual work in the hospital through a DACUM workshop. Validity of the derived duties and tasks was tested by 12 nurses at each of 3 hospital. Results: For clinical nurse with education, 8 duties and 45 tasks were identified, which included patient education and consultation, patient advocacy, management of the therapeutic process, direct nursing care, activities work directed at improvement, management of health promotion events, administration work, and self-improvement. For clinical nurse with coordination, 10 duties and 54 tasks were identified, and included client consultation, client education, direct nursing care, coordination of therapeutic flow, employee education, public relations with the community, planning and operation of meetings, administration work, work directed at improvement, and self-improvement. Conclusion: The results of this study contribute to not only the work of the participants but also basic data for human resource management in the hospital.

A Study on the Deactivating Factors of System for Compulsory Treatment and Rehabilitation of Drug Abusers in Korea (한국 마약류 중독자 치료보호제도 활성화 저해요인에 관한 연구)

  • Jun Hyeok Kang;Seong Jun Maeng;Young Ho Kim
    • Studies on Life and Culture
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    • v.52
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    • pp.129-152
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    • 2019
  • This study aims to identify hinderance factors impeding a invigoration of treatment and protection system for drug abusers and provide an alternative plan to solve it from a viewpoint of alcoholism treatment experts. To achieve the goal, a research and service report on treatment and protection work was secondarily obtained and 58 cases of alcoholism treatment experts were extracted and analysed. The collected data were analysed with deducted content analysis proposed by Elo and Kynga(2008), and hinderance factors impeding a invigoration of treatment and protection system for drug abusers were discovered by 8 categories including 'cognition of a patient problem', 'condition of a patient problem', 'worker problem', 'agency problem', 'treatment program problem', 'budget problem', 'selection of test object problem', 'system problem'. According to the result, alternatives including plenty information and prior education for a recipient, a management on a patient's supportive system, an operation of independent hospital ward for drug, a provision of an incentive pay on treatment experts and agencies, an establishment of rehabilitation institute, a development of systematic program offering treatment, rehabilitation and self support, a budget increase and effective ways to utilize, strengthening a communication between the prosecution and treatment ad protection institutions, an assurance of enough treatment and protection period, an introduction of mandatory treatment system and a development of integrated manual for workers were suggested.

Effects of Wholistic Hospice Nursing Intervention Program on Pain and Anxiety for In-patient of Hospice Palliative Care Unit (전인적 호스피스간호중재 프로그램이 입원한 호스피스환자의 통증과 불안에 미치는 효과)

  • Choi, Sung-Eun;Kang, Eun-Sil;Choe, Wha-Sook
    • Korean Journal of Hospice Care
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    • v.8 no.1
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    • pp.55-67
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    • 2008
  • Purpose: This study was to test the effects of wholistic hospice nursing intervention program on pain and anxiety for in-patient of hospice palliative care unit. This study's design was one-group pre-post test quasi- experimental research. Methods: The subjects of study were 27 patients who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The experimental group subjects participated in holistic hospice nursing program took 120 minutes per session, a total of 1,200 minutes altogether for 10 sessions. The period of data collection was from April 6, 2004 to April 20, 2005. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. A Wholistic Hospice Nursing Intervention Program (named ‘Rainbow Program’) was used as a experimental tool in this study. This was developed by the authors. It was provided by interdisciplinary hospice team (nurses, medical doctors, social worker, pastors, art therapists, and volunteers). In addition, Korean Version of Brief Pain Inventory (BPI-K) by Young-Ho Yun(1998) was used to test degree of pain in physical aspect. And State-Anxiety Inventory was developed by Spielberger(1975) and translated by Kim, Jung-Tack & Shin, Dong-Gyun(1978) was used to test the degree of state-anxiety in emotional aspect. Results: (1) Hypothesis No. 1 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of pain than before" was supported (t=-10.585, P= .000). (2) Hypothesis No. 2 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of state-anxiety than before" was supported (t=-8.234, P= .000). Conclusion: Our results testified that this Wholistic Hospice Nursing Intervention Program was effective to decrease pain and state-anxiety of the in-patients of hospice palliative care unit. Therefore it can be used and applied actively in practice as a useful model of interdisciplinary team approach by hospice professionals in hospice palliative care unit.

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A Study on the Protection of Personal Information in the Medical Service Act (의료법의 개인정보보호에 관한 연구)

  • Sung, Soo-Yeon
    • The Korean Society of Law and Medicine
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    • v.21 no.2
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    • pp.75-103
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    • 2020
  • There is a growing voice that medical information should be shared because it can prepare for genetic diseases or cancer by analyzing and utilizing medical information in big data or artificial intelligence to develop medical technology and improve patient care. The utilization and protection of patients' personal information are the same as two sides of the same coin. Medical institutions or medical personnel should take extra caution in handling personal information with high environmental distinct characteristics and sensitivity, which is different from general information processors. In general, the patient's personal information is processed by medical personnel or medical institutions through the processes of collection, creation, and destruction. Still, the use of terms related to personal information in the Medical Service Act is jumbled, or the scope of application is unclear, so it relies on the interpretation of precedents. For the medical personnel or the founder of the medical institution, in the case of infringement of Article 24(4), it cannot be regarded that it means only medical treatment information among personal information, whether or not it should be treated the same as the personal information under Article 23, because the sensitive information of patients is recorded, saved, and stored in electronic medical records. Although the prohibition of information leakage under Article 19 of the Medical Service Act has a revision; 'secret' that was learned in business was revised to 'information', but only the name was changed, and the benefit and protection of the law is the same as the 'secret' of the criminal law, such that the patient's right to self-determination of personal information is not protected. The Privacy Law and the Local Health Act consider the benefit and protection of the law in 'information learned in business' as the right to self-determination of personal information and stipulate the same penalties for personal information infringement such as leakage, forgery, alteration, and damage. The privacy regulations of the Medical Service Act require that the terms be adjusted uniformly because the jumbled use of terms can confuse information subjects, information processors, and shows certain limitations on the protection of personal information because the contents or scope of the regulations of the Medical Service Law for special corporations and the Privacy Law may cause confusion in interpretation. The patient's personal information is sensitive and must be safely protected in its use and processing. Personal information must be processed in accordance with the protection principle of Privacy Law, and the rights such as privacy, freedom, personal rights, and the right to self-determination of personal information of patients or guardians, the information subject, must be guaranteed.

The Effect of the Degree of Competition of the Hospital Market Regions on Clinic's Rate of Antibiotics Prescription (병원시장지역 내 경쟁 정도가 의원급 의료기관의 항생제 처방률에 미치는 영향)

  • Jo, Changik;Lim, Jae-Young;Lee, Soo Yeon
    • KDI Journal of Economic Policy
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    • v.30 no.2
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    • pp.129-155
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    • 2008
  • The rate of antibiotics prescription for an acute airway infection significantly varies depending upon the diagnosis type, specialty, and the location of the hospital along with many other related factors. The objective of this study is to empirically investigate the possible relationship between the antibiotics prescription rates for an acute airway infection and the degree of competition in the hospital market regions of mainly the providers of primary medical care services such as clinics, internal medicines, pediatrics and otorhinolaryngology department. Using the data from Health Insurance Review and Assessment Service (HIRA) regarding the hospitals' antibiotics prescription rates for the acute airway infection and controlling for selected variables of demand and supply sectors, this study tries to figure out that the degree of competition in the hospital market, regardless of what type of competition indexes we employed, has a statistically significant effect on the variations of antibiotics prescription rate of the clinics in local areas. This result implies that as an economic consideration itself, the change in the degree of competition in the hospital market can play a crucial role influencing the treatment behaviors of the medical doctors. More specifically, this study reveals that as the degree of competition increases the antibiotics prescription rate goes up. This result means that if the market becomes more competitive in a specific region so that it might cause a reduction in doctor's income, doctors with rational decision-making process, recognize that the benefit created from inducing patients' seemingly unnecessary demand for medical care (income effect) would be higher than the costs associated with sustaining their targeted income (substitution effect). It is because that the doctors are more likely to prescribe antibiotics which create relatively higher margins than other medical care services in order to sustain their targeted income when the hospital market competition becomes tighter. Even though this study empirically confirms that antibiotics prescription can be affected by the economic incentives, it still raises following issues as limitations of the study: first issue is about the representativeness of the hospital regions segregated for this study, which might be weak in explaining whether these regions are mutually exclusive in reality. Patients actually consider the quality of services, transportation cost, time costs, and any other related factors choosing the doctors or hospitals, and in that sense, this study rules out 'border-crossing' in using the medical care services. Second issue arises in capturing the data of antibiotics prescription rate. Since we use the average rate for each medical institution, we cannot figure out the average rate for each patient so that we are not able to control for the variation of patients' medical conditions. It is because of the unavailability of data regarding each patient's medical condition from HIRA. Thirdly, since this study mainly analyzes the medical institutions providing primary care such as clinics, internal medicines, pediatrics, and otorhinolaryngology department, it is skeptical of whether those institutions can represent the hospital market in respective regions and truly reflect the degree of competition. It needs to extend the study areas and disease types as well as any micro data for future studies.

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Evaluation of Prescription Data for Development of Warfarin Nomogram in Korean Patients with Cerebral Infarction (뇌졸중 환자군의 Warfarin Nomogram 설정을 위한 실제 처방전 평가)

  • Jang, Ju-Young;Ko, Kyung-Mi;Yoon, Ji-Yeon;Han, Ok-Yeon;Lim, Sung-Cil
    • YAKHAK HOEJI
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    • v.53 no.2
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    • pp.83-88
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    • 2009
  • Warfarin is the most widely used oral anticoagulant in the world but maintenance of proper therapeutic range and prevention of adverse drug events always need to be careful. Especially, in Korea, warfarin dosing for patients with cerebral infarction is currently based on the nomogram which is done by foreign clinical trials not for the Korean. Therefore we evaluate warfarin dose of patients in the neurology and eventually get the base data of warfarin nomogram for Korean with stroke. We performed this study retrospectively on reviewing the medical charts to evaluate the prescribed loading dose (LD) and maintenance dose (MD) of warfarin and each responding International Normalized Ratio (INR) with any bleeding adverse drug reaction including of patient's characteristics for total 75 patients with stroke in the department of neurology of Kangnam ST. Mary's Hospital from January 2005 to June 2008. All evaluated patients should not be treated with warfarin in the past at all and should be initiated warfarin therapy first.ly at this time. All evaluated patients were divided as two classes by wafarin LD which is; 1) HDG - a high loading dosing group prescribed over 5mg, and 2) LDG - a low loading dosing group prescribed 5mg or below. As a result, average LD was $9.34{\pm}0.22$ mg (p=0.000) in HDG and $4.25{\pm}0.39$ mg (p=0.000) in LDG. Average baseline INR was $0.91{\pm}0.05$ (p=0.161) in HDG and $1.26{\pm}0.14$ (p=0.002) in LDG. On the first and second week, daily MD was $4.21{\pm}0.14$ mg (p=0.000) and $2.96{\pm}0.19$ mg (p=0.696) in HDG and also in LDG, $2.95{\pm}0.29$ mg (p=0.000) and $3.14{\pm}0.36$ mg (p=0.696). Also average reacting daily INR was respectively $2.53{\pm}0.12$ (p=0.141) and $2.51{\pm}0.16$ (p=0.678) in HDG, and in LDG, $2.11{\pm}0.17$ (p=0.141) and $2.42{\pm}0.14$ (p=0.678). After the second week, INR was not measured in regularly. Also most of underlying diseases were hypertension (n=38), diabetes mellitus (n=14), dyslipidemia (n=8) in order. Four ADRs with simple hemorrhage were occurred and those were due to drug interaction by comedication. In the conclusion, proper starting LD for Korean with stroke is 10 mg if baseline INR is around 1.0 or 5 mg if over 1.3. Proper MD need to be more evaluated in the future for setting up warfarin nomogram to make prospective study.

A Study on the Perception Changes of Physicians toward Duty to Inform - Focusing on the Influence of the Revised Medical Law - (설명의무에 대한 의사의 인식 변화 조사 연구 -의료법 개정의 영향을 중심으로-)

  • Kim, Rosa
    • The Korean Society of Law and Medicine
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    • v.19 no.2
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    • pp.235-261
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    • 2018
  • The Medical law stipulates regulations about the physician's duty to inform to contribute to patient's self-determination. This law was most recently revised on December 20, 2016, and came into effect on June 21, 2017. There has been much controversy about this, and it has been questioned whether or not it will be effective for physicians to comply with the duty to inform. Therefore, this study investigated perceptions of physicians of whether they observed the duty to inform and their legal judgment about that duty, and analyzed how the revision of the medical law may have affected the legal cognition of physician's duty to inform. This study was conducted through an online questionnaire survey involving 109 physicians over 2 weeks from March 29 to April 12, 2018, and 108 of the collected data were used for analysis. The questionnaire was developed by revising and supplementing the previous research (Lee, 2004). It consisted of 41 items, including 26 items related to the experience of and legal judgment about the duty to inform, 6 items related to awareness of revised medical law, and 9 items on general characteristics. The data were analyzed using SAS 9.4 program and descriptive statistics, Chi-square test, Fisher's exact test and Binary logistic regression were performed. The results are as follows. • Out of eight situations, the median number of situations that did not fulfill the duty to inform was 5 (IQR, 4-6). In addition, 12 respondents (11%) answered that they did not fulfill the duty to inform in all eight cases, while only one (1%) responded that he/she performed explanation obligations in all cases. • The median number of the legal judgment score on the duty to inform was 8 out of 13 (IQR, 7-9), and the scores ranged from a minimum of 4 (4 respondents) to a maximum of 11 (3 respondents). • More than half of the respondents (n=26, 52%) were unaware of the revision of the medical law, 27 (25%) were aware of the fact that the medical law had been revised, 20(18%) had a rough knowledge of the contents of the law, and only 5(5%) said they knew the contents of the law in detail. The level of awareness of the revised medical law was statistically significant difference according to respondents' sex (p<.49), age (p<.0001), career (p<.0001), working type (p<.024), and department (p<.049). • There was no statistically significant relationship between the level of awareness of the revised medical law and the level of legal judgment on the duty to inform. These results suggest that efforts to improve the implementation and cognition of physician's duty to inform are needed, and it is difficult to expect a direct positive effect from the legal regulations per se. Considering the distinct characteristics of medical institutions and hierarchical organizational culture of physicians, it is necessary to develop a credible guideline on the duty to inform within the medical system, and to strengthen the education of physicians about their duty to inform and its purpose.

The Effect of Tai Chi Self Help Group Program for Hemophilic Arthritis Patients (혈우병관절염 수술환자를 위한 타이치자조관리 프로그램 효과)

  • Bak, Won-Sook;Yoo, Myung-Chul;Kang, Hyun-Sook
    • Journal of muscle and joint health
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    • v.19 no.1
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    • pp.71-83
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    • 2012
  • Purpose: The purpose of this study was to develop and evaluate the effects of Tai Chi Self-help program for Hemophilic Arthritis Patients. Method: A quasi-experimental design was used. The subjects were 48 patients who underwent orthopedic surgery (24 experimental group, 24 control group). The subjects of experimental group were participated in the Tai Chi self-help group program in which 16 times for 8 weeks. The program consisted of health education on hemophilia, Tai Chi exercise, and workshop and its outcomes have been evaluated on WOMAC(Western Ontario and McMaster scale), mobility, pain, fatigue, muscle strength, depression, and quality of life(SF-36). The obtained data were analyzed by using the t-test or Fisher's exact test of PASW 18.0. Results: 1) The score of WOMAC, pain, fatigue, and depression decreased significantly in the experimental group as compared to the control group. 2) The score of mobility, muscle strength, and quality of life increased significantly in the experimental group as compared to the control group. Conclusion: Considering these research results, the program could be useful to improve joint movement, strength and psychological condition for patient with hemophilic arthritis, particularly in those who underwent orthopedic surgery.

Achievements of Nursing Students among Simulation and Traditional Education of Bleeding Patients (출혈환자 간호 시뮬레이션 실습에 따른 간호학생의 학업성취)

  • Choi, Eun Hee;Kwon, Kyung Nam;Lee, Eun Ju
    • The Journal of Korean Academic Society of Nursing Education
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    • v.19 no.1
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    • pp.52-59
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    • 2013
  • Purpose: This study was performed to identify in nursing students the effects of simulation practice for hemorrhagic patients. Methods: Subjects were sophomore nursing students in Daegu (n=133). A self describing performance questionnaire which included knowledge, skill and attitude towards bleeding patients was given. Consent was received from students. The data was analyzed by ANOVA with Scheffe's test and Mann-Whitney U test using the SPSS 12.0 Program. Result: Subjective and objective knowledge and skill showed significant improvement in the control group, especially in assessment, correct medication administration, explaination of NPO and preparing the crash cart for a cardiac arrest. Objective knowledge and skill was significantly higher in the control group although attitude was not. Conclusion: Simulation practice was an effective education method for improving knowledge, skill and attitude in nursing students.