• Journal of Korean Neurosurgical Society
• /
• 제61권1호
• /
• pp.35-41
• /
• 2018

Objective : Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH). Methods : Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses. Results : Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005-7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029-1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094-10.155; p=0.034). Conclusion : Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.

• Journal of Korean Neurosurgical Society
• /
• 제61권4호
• /
• pp.474-477
• /
• 2018

Objective : From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search. Methods : We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm". Results : There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court. Conclusion : Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.

• Journal of the Korean Society of Physical Medicine
• /
• 제13권3호
• /
• pp.49-60
• /
• 2018

PURPOSE: This study was conducted to investigate the intervention effect obtained by applying an ICF tool to improve the dressing in a patient with rotator cuff syndrome to schematize the problems and approaching with PNF to solve the problems. METHODS: The subject of this study was a 44-year-old patient who underwent surgery after complete right rotator cuff tear. To treat his symptoms, the processes of clinical practice were implemented in the order of examination, assessment, diagnosis, prognosis, intervention, and outcome. During examination, patient information was collected using the ICF core set. In the assessment, the problems were schematized, and an ICF assessment sheet was used to identify the interaction of the problems. The diagnosis was made by clearly describing the causal relationship derived from the assessment in ICF terms. To solve the problems, the intervention was given in the order of indirect, direct, and task based on the philosophy of PNF. To evaluate the outcome, the differences before and after the intervention were compared. Additionally, the comparison for the ICF qualifier is presented with the ICF evaluation display. RESULTS: The results of the study showed clinical advantages in shoulder strength, eccentric control, range of motion, scapular stability, and shoulder pain. Overall, our patient with rotator cuff syndrome showed improvement in dressing and undressing activity in response to the PNF strategy. CONCLUSION: Application of the PNF intervention strategy after complete rotator cuff tear would have a positive effect on patient upper extremity function.

• Journal of Korean Neurosurgical Society
• /
• 제29권10호
• /
• pp.1345-1351
• /
• 2000

Objective : Around the sellar area, there are many important structures. But, the optimal radiation dosage for minimal toxicity to surrounding neural tissue has not been firmly established. The purpose of this study is to evaluate the radiosurgical outcome of juxtasellar tumors and to investigate the relationship between radiation dosage and toxicity to neural tissue. Method : Between May 1992 and June 2000, we treated 65 juxtasellar tumors by using the Leksell Gamma Knife. Among them, 52 patients who could be followed more than 1 year were included in this study. The radiosurgical dosage to the optic pathway, cavernous sinus, Meckel's cave, hypothalamus, pituitary gland and stalk, and brain stem was analyzed and correlated with clinical outcome. The mean follow-up period was 33.5 months(range 12.2- 99.0 months). Result : The clinical response rate was 69.2%. The volume response rate was 61.0% and the radiologic control rate was 92.7%. There were 4 complications(7.7%) of 2 trigeminal neuropathy, 1 abducens nerve palsy, and 1 trigeminal and transient abducens nerve palsy. The optic apparatus appeared to tolerate doses greater than 10Gy. The risk of cranial nerve complications in cavernous sinus seemed to be related to doses of more than 16Gy. In 3 of 4 patients who received more than 16Gy to cavernous sinus, the abducens or trigeminal neuropathy occurred. Also, one patient who received more than 15Gy to the Meckel's cave, trigeminal neuropathy developed. The hypothalamus, pituitary gland and stalk, and brain stem were relatively tolerable to radiation. Conclusion : Gamma Knife radiosurgery seems to be an effective method to control the growth of juxtasellar tumors. To avoid injury to surrounding important neural tissue, careful dose planning and further study for radiation toxicity to neural tissue were needed.

• Nutrition Research and Practice
• /
• 제7권2호
• /
• pp.132-138
• /
• 2013

The food choices in childhood have high a probability of being carried through into their adulthood life, which then contributes to the risk of many non-communicable diseases. Therefore, there is a need to gather some information about children's views on foods which may influence their food choices for planning a related dietary intervention or programme. This paper aimed to explore the views of children on foods and the types of foods which are usually consumed by children under four food groups (snacks, fast foods, cereals and cereal products; and milk and dairy products) by using focus group discussions. A total of 33 school children aged 7-9 years old from Selangor and Kuala Lumpur participated in the focus groups. Focus groups were audio-taped, transcribed and analyzed according to the listed themes. The outcomes show that the children usually consumed snacks such as white bread with spread or as a sandwich, local cakes, fruits such as papaya, mango and watermelon, biscuits or cookies, tea, chocolate drink and instant noodles. Their choices of fast foods included pizza, burgers, French fries and fried chicken. For cereal products, they usually consumed rice, bread and ready-to-eat cereals. Finally, their choices of dairy products included milk, cheese and yogurt. The reasons for the food liking were taste, nutritional value and the characteristics of food. The outcome of this study may provide additional information on the food choices among Malaysian children, especially in urban areas with regard to the food groups which have shown to have a relationship with the risk of childhood obesity.

• Journal of Korean Neurosurgical Society
• /
• 제30권3호
• /
• pp.319-324
• /
• 2001

Objectives : The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. Methods : This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. Results : The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions : The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.

• Journal of Korean Neurosurgical Society
• /
• 제52권2호
• /
• pp.80-84
• /
• 2012

Objective : This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment. Methods : Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale. Results : Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway. Conclusion : Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.

• Journal of Labour Economics
• /
• 제30권2호
• /
• pp.87-118
• /
• 2007

Using KRIVET's Graduates Economic Activities Survey for 2005, this article examines the relationship between university ranking and labor market outcome, with a focus on wage differentials existing between provincial and Seoul metropolitan area university graduates. According to the analysis results, the average monthly wage for provincial university graduates was 1,747.7 thousand Korean won, which is 11.5% lower than that for graduates of universities in the Seoul metropolitan area. School effects on individual wage were estimated to about 12.2% after applying Hierarchical Linear Model technique, which means that university explains only an insignificant part of the total variance in wage among graduates. After controlling for the selection bias, the ability difference between the two areas, by applying the Heckman type 2SLS wage function and Neumark wage differential decomposition technique, the wage gap resulting from the segregation was not identified. This implies that, to a significant extent, the wage gap between provincial and Seoul metropolitan university graduates is attributed to the difference in productivity among individual graduates, rather than to the wage segregation. Also, the estimated wage function by applying Quantile Regression technique indicates that there does not exist any significant wage segregation difference by wage quantile.

• Journal of Korean Academy of Nursing
• /
• 제6권1호
• /
• pp.23-28
• /
• 1976

This study was undertaken to obtain information about selected characteristics and the degree of physical disability of patients with a diagnosis of cerebrovascular accident upon their discharge from a general hospital. It was hoped that this information would contribute to the assessment of their needs for follow-up nursing care. Nurse's and Physician's Progress Notes of all stroke patients discharged from five general hospitals in Seoul from January to December 1975 were analysed using a prepared check list. Patients with other complicating diagnosis such as diabetes, tuberculosis or heart disease were excluded from the sample. According to six factors used to grade the total sample of 334 stroke victims degree of physical ability at discharge, 144 (43%) of the Survivors had good functional ability, 72 (22%) fair, 62 (18%) poor, and 57(17%) very Poor. Certain clinical diagnosis correlated with the degree of physical ability. Intra cranial Hemorrhage and Subarachnoid Hemorrhage tended to be related to poor and very poor outcome categories. There was no significant correlation between nae and ability outcome, women had revealed a significantly positive correlation with poor and very poor ability outcomes. The hospitalization period was less than three days for 37.5% of the total group, and more than one month for 4.7%. Those patients with less than three days hospitalization accounted for the highest relationship with poor and very poor ability outcomes. Of the total groups 175(50.99%), were discharged with a diagnosis of condition improved (though not necessarily with good physical ability). The results suggest serious need for comprehensive follow- up nursing care for stroke survivors discharged a from general hospitals in Seoul.

• Journal of Korean Academy of Nursing
• /
• 제47권1호
• /
• pp.14-24
• /
• 2017

Purpose: The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective. Methods: Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed. Results: The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (${\beta}=.84$), hope and cognitive illness representation (${\beta}=.37$ and ${\beta}=.27$) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome. Conclusion: This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.