• Acute and Critical Care
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• v.33 no.4
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• pp.252-259
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• 2018

Background: The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time ($26.7{\pm}25.1$ vs. $12.1{\pm}16.0days$, P=0.003), length of stay in the general ward ($70.6{\pm}89.1$ vs. $40.5{\pm}42.2days$, P=0.008), length of total hospital stay ($107.5{\pm}95.6$ vs. $74.7{\pm}51.2days$, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

• Knee surgery & related research
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• v.30 no.4
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• pp.348-355
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• 2018

Purpose: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. Materials and Methods: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. Results: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. Conclusions: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

• Journal of Korean Biological Nursing Science
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• v.20 no.4
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• pp.205-213
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• 2018

Purpose: The purpose of this study was to confirm the compliance of the application of a ventilator-associated pneumonia bundle and understand its effects on the decrease in the incidence of ventilator-associated pneumonia. Methods: This was a retrospective observational study with history control group design. Subjects were selected from January to June 2014, prior to the intervention using the ventilator-associated pneumonia bundle. Subjects were also selected from October 2014 to March 2015, 3 months after the intervention. The number of subjects was 112 before the intervention, and 107 after the intervention. Results: The number of nurses who followed the bundles increased from 8 out of 29 (27.6%) before the intervention to 19 out of 29 (65.5%) after the intervention (odd ratio= 4.99, confidence interval= 1.63-15.25, p= .004). There were 3 cases of ventilator-associated pneumonia before the intervention and 1 case after the intervention. The ventilator days were 2,143 days before the intervention and 2,232 days after the intervention. The ventilator-associated pneumonia rate of the 1,000 ventilator days was 1.40 before the intervention and decreased to 0.45 after the intervention. Conclusion: This study is meaningful, as there has been little research conducted regarding the application of the ventilator-associated pneumonia bundle in South Korea.

• Korean Journal of Clinical Pharmacy
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• v.28 no.4
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• pp.285-292
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• 2018

Background: Long-term levodopa therapy relieves the motor dysfunction associated with Parkinson's disease (PD), but has various effects on non-motor symptoms, including cognitive dysfunction, hallucinations, and affective disorders, and can exacerbate certain aspects of dementia-like cognitive dysfunction. Here, we investigated the relationship between levodopa treatment and development of dementia in patients with PD. Methods: This retrospective study analyzed 76 consecutive patients with PD who had taken levodopa between 2011 and 2015. The participants were initially free of dementia and had initial daily levodopa doses of below 600 mg. Patients who did and did not develop comorbid dementia were compared in terms of potential predictor variables, including PD onset age, sex, levodopa doses, and non-dementia comorbidities. Results: Of the 76 patients, 21 (27.6%) developed dementia, which was followed by hallucinations and insomnia. The independent predictors of incident dementia were PD onset age and second-year and third-year average levodopa doses that were higher than the first-year average levodopa dose. Patients who developed dementia had significantly higher average daily levodopa doses and levodopa dose increases over the 6-year treatment period than those who did not develop dementia. In addition, patients with higher levodopa doses were more likely to experience hallucinations. Conclusion: These results suggest that increases in levodopa doses may be associated with a greater risk of cognitive impairment in patients with PD. Therefore, motor and cognitive functions and levodopa dose increases should be evaluated regularly during long-term levodopa therapy in patients with PD.

• Korean Journal of Clinical Pharmacy
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• v.29 no.3
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• pp.186-192
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• 2019

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ${\geq}30$ years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31-0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

• Neonatal Medicine
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• v.25 no.4
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• pp.170-177
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• 2018

Purpose: Preterm infants frequently require red blood cell (RBC) transfusions in neonatal intensive care units (NICU). Storage RBCs undergo many changes during storage periods. We aimed to compare the hemoglobin (Hb) correction effect according to the period of RBC storage and investigate the factors influencing Hb correction. Methods: This retrospective study reviewed the medical records of 289 patients who received RBC transfusion more than once in the NICU of Kosin University Gospel Hospital between February 2006 and March 2016. The subjects were classified into two storage groups: short-term (${\leq}7days$, n=88) and long-term (>7 days, n=201), according to the period of RBC storage. We checked Hb levels by complete blood cell count tests conducted within 2 days before and 5 to 9 days after the first transfusion. We compared the Hb difference between the two groups and analyzed the factors influencing Hb correction. Results: Excluding the use of an invasive ventilator, there was no significant difference between the two groups in terms of clinical characteristics. There was no significant difference in the Hb correction effect between the two groups (P=0.537). Birth weight greater than 1,500 g, higher weight at transfusion, and larger volume of transfusion were significant prognostic factors affecting greater changes in Hb. In addition, surgery experience, higher Hb level at transfusion, and additional blood tests were found to be significantly associated with less changes in Hb. Conclusion: The RBC storage period did not affect the Hb correction effect. The Hb correction effect may be diminished in infants with lower birth weight and lower weight at transfusion under unstable clinical conditions.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.2
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• pp.53-69
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• 2021

Objectives : The purpose of this study is to analyze the effects of treatment between Western medicine and Korean medicine on Allergic rhinitis patients using national population-based claim data from the Health Insurance Review and Assessment Service. Methods : The subjects of the study were 30,024 patients in the Korean medicine group and 30,024 in the Western medicine group who were diagnosed with Allergic rhinitis from September 1, 2018 to December 31, 2018. Propensity score analysis was used for matching age, sex, etc. at a ratio of 1:1. Cox regression and subgroup analysis were used to estimate the adjusted hazard ratio of recurrence, Asthma, and Atopic dermatitis in Korean medicine group and Western medicine group. In addition, the total treatment period, total treatment cost, and average cost per day of visit were compared and analyzed. Results : Compared to Korean medicine, Western medicine had a significantly higher risk of recurrence at 1.701 times, Asthma occurrence risk at 1.609 times and Atopic dermatitis occurrence risk at 1.098 times. Compared to Western medicine, the total treatment period of Korean medicine was 14.27 days longer, the total treatment cost was 53,591 won more, and the average cost per day was 7,539 won more. Conclusions : This study is a retrospective cohort study using the propensity score matching in Korea to compare the outcomes of Allergic rhinitis between Western medicine and Korean medicine. Further research is needed by considering patients characteristics, and linking with additional data.

• Journal of Pharmacopuncture
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• v.23 no.4
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• pp.201-211
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• 2020

Objectives: The purpose of this study is to comprehensively review Korean domestic studies and investigate the research trends of pharmacopuncture therapy on cervical pain caused by traffic accidents. Methods: Domestic studies between February 1999 and May 2020 from four Korean databases were searched with combinations of keywords 'cervical pain', 'traffic accident', 'whiplash injury', and 'pharmacopuncture'. Results: 17 studies were selected for review, including 7 randomized controlled trials, 5 retrospective observational studies, 3 case reports, and 2 non-randomized controlled trials. Each study was reviewed by published year, study type, types of pharmacopuncture solutions, selected acupuncture points, dosage of pharmacopuncture solutions, frequency of treatment, concurrent treatments, outcome measurements, and the effectiveness of pharmacopuncture therapy. The results are as follows: (1) It showed that the total number of published studies had increased slightly in the last 10 years compared to the previous decade. (2) The pharmacopuncture solutions used in the studies were in the following order: Bee-Venom (蜂毒), Jungsongouhyul (中性瘀血), Hwangryunhaedoktang (黃連解毒湯) and Soyeom (消炎). Frequently used acupuncture points were GB20, GV21, A-shi point, GV16, EX-B2, and SI15 in order. (3) The most commonly used total injection dosage was 1.0 cc at a time, and the frequency of treatment was twice a week. (4) Concurrent treatments such as acupuncture, herbal medication, physical therapy and Chuna manual therapy were performed in all 17 studies. (5) Pharmacopuncture therapy showed positive effects on cervical pain caused by traffic accidents in all 17 studies reviewed. Conclusion: Pharmacopuncture therapy was effective in cervical pain caused by traffic accidents in all 17 studies selected. Further studies will be needed using more larger scales and more objective data to confirm the effectiveness of pharmacopuncture therapy and to generalize its application.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.24-28
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• 2021

Background and Objectives Vocal polyp is one of the most common benign diseases of vocal fold caused by overuse of voice. Laryngeal microsurgery is the first treatment of choice for vocal polyp. However, surgery has many risks such as side effects of general anesthesia, injury of tooth and psychological burden. And we often experience reduction of vocal polyps without surgical procedure. The purpose of study is to evaluate the effect of non-surgical treatment such as vocal hygiene education and proton pump inhibitor (PPI) in patients with vocal polyp. Materials and Method We performed retrospective study for seventy-three patients of vocal polyp who treated with non-surgical modalities such as vocal hygiene education and PPI over three months. Treatment outcomes and risk factors such as age, sex, polyp size, position, symptom duration, presence of laryngopharyngeal reflux (LPR) symptoms, smoking history, voice abuse history and vocal hygiene education were evaluated by comparison between polyp size improved group and non-improved group. Results 5.5% of enrolled patients showed complete response and 23.3% showed partial response without surgery. Polyp size improved group significantly carried out more practice of vocal hygiene education treatment than the non-improved group (p=0.040). And the presence of LPR symptoms [hazard ratio (HR) 3.368, confidence interval (CI) 1.055-10.754, p=0.040] and not performing of vocal hygiene education (HR 3.664, 95% CI 1.078-12.468, p=0.038). Conclusion Vocal hygiene education can be a useful treatment option when making a decision to treat with vocal polyp.