• 문화기술의 융합
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• 제6권3호
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• pp.125-133
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• 2020

본 연구는 중년층의 일반적 특성에 따른 치매정책인식, 치매지식, 치매태도 및 치매예방행위 차이분석을 위한 것이다. D시와 G시에 거주하는 40세에서 64세까지 중년층 217명을 대상으로 하였고, 구조화된 설문지로 자가설문조사를 수행하였다. 연구결과 대상자의 치매정책인식 정도는 75.42±8.52, 치매지식은 8.71±1.90, 치매태도는 28.55±5.10, 치매예방행위는 27.04±3.35이었다. 대상자의 일반적 특성에 따른 치매정책인식은 유의한 차이가 없었고, 치매지식은 성별, 질환 수, 치매정보 원천에서 유의한 차이가 있었으며, 치매태도는 성별, 나이, 학력, 가족 중 치매, 치매가족 동거, 직업상태, 조기검진, 치매정보 원천에서 유의한 차이가 있었다. 또한 치매예방행위는 치매가족 동거, 조기검진에서 유의한 차이가 있었다. 치매예방행위의 세부항목 순위는 '당신은 담배를 피우십니까?(역문항)'가 가장 높았고, '당신은 평상시 혈압이나 당뇨관리 등 질환관리를 하십니까?'는 가장 낮은 것으로 나타났다. 따라서 중년층의 치매정책인식을 높이고 올바른 치매지식, 긍정적 치매태도를 형성할 수 있는 전문적이고 체계적인 치매교육 프로그램 개발과 인지활동, 사회활동, 올바른 식생활 습관, 건강관리 등을 형성 및 유지할 수 있는 맞춤형 치매예방행위 프로그램 개발이 필요하다.

• Journal of Hospice and Palliative Care
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• 제11권2호
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• pp.99-105
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• 2008

목적: 본 연구에서는 호스피스 병동에 입원한 말기 암 환자들을 대상으로 임상적으로 보다 정확한 잔여 수명을 예측하고자 임종의 시기에 객관적으로 임상적 증상 및 징후들의 변화를 관찰하였다. 방법: 강남성모병원 호스피스센터를 방분한 말기 암 환자를 대상으로 입원 시부터 임종까지 말기에 흔히 나타나는 증상과 신체적 징후의 변화를 관찰하였다. 증상의 정도는 $0{\sim}3$점수화하였으며 신체적 징후는 있다 또는 없다로 구분하였다. 이밖에 활력증후와 통증 정도, 진통제 사용을 관찰하였다. 결과: 호흡곤란, 혼수의 증상은 입원 시와 비교해서 임종 $1{\sim}2$일 전에 악화되었다. 대상자의 활동 수행 능력은 임종 시간이 가까워질수록 점진적으로 감소하였고, 섭취량과 소변 배설량도 줄어들었다. 특히 임종 $1{\sim}2$2일 전부터 현저하게 혈압이 감소하였다. 임종 시점을 기준으로 시기에 따라 증상의 변화가 유의하게 나타난 임상 지표는 활동수행 능력, 수축기 혈압, 구강건조증, 식욕저하, 쇠약감, 변비, 황달, 부종, 욕창, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등이었다. 결론: 말기 암 환자에서 수축기 혈압의 감소, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등의 증상이 나타나면 임종이 임박했음을 예상하여 가족들과 환자가 준비할 수 있도록 해야 하며, 의료진도 임종에 관한 돌봄을 시행하도록 해야 한다.

• 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.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.925-928
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• 2014

Background: Gestational trophoblastic neoplasia (GTN) is a spectrum of disease with abnormal trophoblastic proliferation. Treatment is based on FIGO stage and WHO risk factor scores. Patients whose score is 12 or more are considered as at extremely high risk with a high likelihood of resistance to first line treatment. Optimal therapy is therefore controversial. Objective: This study was conducted in order to summarize the regimen used for extremely high risk or resistant GTN patients in our institution the in past 10 years. Materials and Methods: All the charts of GTN patients classified as extremely high risk, recurrent or resistant during 1 January 2002 to 31 December 2011 were reviewed. Criteria for diagnosis of GTN were also assessed to confirm the diagnosis. FIGO stage and WHO risk prognostic score were also re-calculated to ensure the accuracy of the information. Patient characteristics were reviewed in the aspects of age, weight, height, BMI, presenting symptoms, metastatic area, lesions, FIGO stage, WHO risk factor score, serum hCG level, treatment regimen, adjuvant treatments, side effects and response to treatment, including disease free survival. Results: Eight patients meeting the criteria of extremely high risk or resistant GTN were included in this review. Mean age was 33.6 years (SD=13.5, range 17-53). Of the total, 3 were stage III (37.5%) and 5 were stage IV (62.5%). Mean duration from previous pregnancies to GTN was 17.6 months (SD 9.9). Mean serum hCG level was 864,589 mIU/ml (SD 98,151). Presenting symptoms of the patients were various such as hemoptysis, abdominal pain, headache, heavy vaginal bleeding and stroke. The most commonly used first line chemotherapeutic regimen in our institution was the VAC regimen which was given to 4 of 8 patients in this study. The most common second line chemotherapy was EMACO. Adjuvant radiation was given to most of the patients who had brain metastasis. Most of the patients have to delay chemotherapy for 1-2 weeks due to grade 2-3 leukopenia and require G-CSF to rescue from neutropenia. Five form 8 patients were still survived. Mean of disease free survival was 20.4 months. Two patients died of the disease, while another one patient died from sepsis of pressure sore wound. None of surviving patients developed recurrence of disease after complete treatment. Conclusions: In extremely high risk GTN patients, main treatment is multi-agent chemotherapy. In our institution, we usually use VAC as a first line treatment of high risk GTN, but since resistance is quite common, this may not suitable for extremely high risk GTN patients. The most commonly used second line multi-agent chemotherapy in our institution is EMA-CO. Adjuvant brain radiation was administered to most of the patients with brain metastasis in our institution. The survival rate is comparable to previous reviews. Our treatment demonstrated differences from other institutions but the survival is comparable. The limitation of this review is the number of cases is small due to rarity of the disease. Further trials or multicenter analyses may be considered.