• Title/Summary/Keyword: clinical management

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Analysis of social factors influencing authenticity of suicide for patient who attempt to suicide in emergency department: Retrospective study based Post-suicidal Care Program data (응급실로 내원한 약물중독 자살시도자의 자살 진정성에 미치는 사회적 요인 분석: 응급실 기반 자살 시도자 관리시스템 자료를 이용한 후향적 연구)

  • Ji, Jae-Gu;Kim, Yang-Weon;Kang, Ji-Hun;Jang, Yun-Deok
    • Journal of The Korean Society of Clinical Toxicology
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    • v.19 no.1
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    • pp.8-16
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    • 2021
  • Purpose: This study was conducted to analyze the social factors influencing the 'authenticity of suicidal ideation' based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion: The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

An Convergence Analysis of Muscle Characteristics, Muscle Activity and Posture in Patients with Cervicogenic Headache (경추성 두통 환자의 근육 특성과 자세 및 근활성도의 융복합적 분석)

  • Yoon, Jong-Hyuk
    • Journal of Digital Convergence
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    • v.19 no.6
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    • pp.265-271
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    • 2021
  • This study aimed to define the diagnostic criteria for cervicogenic headache and propose an efficient method of clinical evaluation and physical therapy. Fifteen patients with cervicogenic headache and 15 healthy individuals were recruited and categorized into the test group and the control group, respectively. The groups were compared in terms of muscle characteristics, muscle activity and posture, and the intervariable correlations were analyzed for the test group. A significant between-group difference was found in the stiffness of the suboccipital muscle and the tone and stiffness of the upper trapezius muscle (p<.001). In posture comparison, a significant difference was noted in neck tilt angle and the T1 slope angle (p<.05). The activity of the sternocleidomastoid muscle was also significantly different between the groups (p<.001). When the correlations among the muscle characteristics, the posture, and the activity of the sternocleidomastoid muscle were analyzed for the test group, a positive correlation was found between the tone and the stiffness of the suboccipital muscle (p<.001) and between the tone and the stiffness of the upper trapezius muscle (p<.001). The findings of this study suggest a more efficient approach for the assessment and treatment of cervicogenic headache patients. It is considered that, further studies including more subjects of various job categories and comparing the outcomes.

Effect of the New Surface Treatment Method of Zirconia on the Shear Bond Strength with Resin Cement (지르코니아의 새로운 표면처리 방법이 레진 시멘트와의 전단결합강도에 미치는 영향)

  • Cho, Won-Tak;Bae, Ji-Hyeon;Choi, Jae-Won
    • Journal of Digital Convergence
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    • v.19 no.3
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    • pp.245-251
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    • 2021
  • This study was to investigate the effect of the new surface treatment method of zirconia on the shear bond strength with resin cement. The zirconia specimens were classified according to the surface treatment. CON: non-treatment, HF: 10 minutes exposure to 9% HF, ZS15: Apply 15% ZrO2 slurry, ZS30: Apply 30% ZrO2 slurry, ZS50: Apply 50% ZrO2 slurry. The resin cement was layered on the surface treated zirconia, and the shear bond strength between the zirconia and the resin cement was measured after thermo-cycling. The statistical methods for shear bond strength were Kruskal-Wallis test, Mann-Whitney U test, and Bonferroni correction(α=.05/10=.005). ZS15, ZS30, and ZS50 groups treated with zirconia slurry showed higher shear bond strength than CON and HF groups(p<.05/10=.005). Within the limits of this study, the surface treatment using zirconia slurry increased the shear bond strength with resin cement. The new surface treatment method complements and improves the limitations of the adhesion of zirconia, so that various clinical applications of zirconia can be expected.

A study on the scope of future oriented work of dental hygienists (치과위생사의 미래지향적 업무 범위에 대한 고찰)

  • Ahn, Eunsuk;Kim, Sun-Mi;Kim, Bo-Ra;Jeong, Soon-Jeong;Hwang, Soo-Jeong;Han, Ji-Hyoung
    • Journal of Korean Academy of Dental Administration
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    • v.8 no.1
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    • pp.15-23
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    • 2020
  • The aim of this study is to identify future-oriented tasks for Korean dental hygienists based on a literature review. A literature search is performed using 14 keywords related to tasks carried out by dental hygienists, and included articles published from 2000 to 2019 in the databases KISS, RISS, DBpia, NDSL, Papersearch, Pubmed, and Google Scholar. Six reviewers assessed the titles and abstracts of articles, and an article was selected if the study was considered to cover future-oriented tasks for Korean dental hygienists. Based on the results six local studies and two foreign studies were used for literature review and data extraction. In total, 38 tasks were classified as future-oriented tasks of dental hygienists according to the following criteria: 1) tasks that were specifically referred to as future-oriented tasks, and 2) tasks that could be classified as future-oriented tasks although no specific reference was made. Of these, the most frequently mentioned tasks were measuring periodontal pocket depth, dental hygiene assessment, providing dietary advice, infiltration anesthesia, and root planing. These were extracted from five of the eight studies, including both local and foreign studies. Dental hygiene planning, emergency, emergency management, and smoking cessation were the next most common tasks based on four studies. Even though some of these future-oriented tasks for Korean dental hygienists are included in the dentistry curriculum, and are currently performed as clinical practice for dental hygienists. Nonetheless, the reference to the legal scope is unclear. It is necessary to reconsider the scope of tasks of dental hygienists to reflect changes in domestic and foreign dental care delivery, thereby contributing to the oral health promotion of the public, where safety is guaranteed under legal protection.

Extended Adaptation Database Construction for Oriental Medicine Prescriptions Based on Academic Information (학술 정보 기반 한의학 처방을 위한 확장 적응증 데이터베이스 구축)

  • Lee, So-Min;Baek, Yeon-Hee;Song, Sang-Ho;CHRISTOPHER, RETITI DIOP EMANE;Han, Xuan-Zhong;Hong, Seong-Yeon;Kim, Ik-Su;Lim, Jong-Tea;Bok, Kyoung-Soo;TRAN, MINH NHAT;NGUYEN, QUYNH HOANG NGAN;Kim, So-Young;Kim, An-Na;Lee, Sang-Hun;Yoo, Jae-Soo
    • The Journal of the Korea Contents Association
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    • v.21 no.8
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    • pp.367-375
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    • 2021
  • The quality of medical care can be defined as four types such as effectiveness, efficiency, adequacy, and scientific-technical quality. For the management of scientific-technical aspects, medical institutions annually disseminate the latest knowledge in the form of conservative education. However, there is an obvious limit to the fact that the latest knowledge is distributed quickly enough to the clinical site with only one-time conservative education. If intelligent information processing technologies such as big data and artificial intelligence are applied to the medical field, they can overcome the limitations of having to conduct research with only a small amount of information. In this paper, we construct databases on which the existing medicine prescription adaptations can be extended. To do this, we collect, store, manage, and analyze information related to oriental medicine at domestic and abroad Journals. We design a processing and analysis technique for oriental medicine evidence research data for the construction of a database of oriental medicine prescription extended adaption. Results can be used as a basic content of evidence-based medicine prescription information in the oriental medicine-related decision support services.

Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

  • Ri, Motonari;Nunobe, Souya;Ida, Satoshi;Ishizuka, Naoki;Atsumi, Shinichiro;Hayami, Masaru;Makuuchi, Rie;Kumagai, Koshi;Ohashi, Manabu;Sano, Takeshi
    • Journal of Gastric Cancer
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    • v.21 no.4
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    • pp.325-334
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    • 2021
  • Purpose: Although dumping symptoms are thought to involve postprandial glycemic changes, postprandial glycemic variability without dumping symptoms remains poorly understood due to the lack of a method that allows the easy and continuous measurement of blood glucose levels. Materials and Methods: Patients having undergone distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY), total gastrectomy with RY (TG-RY) and pylorus preserving gastrectomy (PPG) for gastric cancer 3 months to 3 years prior, diagnosed as pathological stage I or II, were prospectively enrolled from March 2018 to January 2020. The interstitial tissue glycemic levels were measured every 15 min, up to 14 days by continuous glucose monitoring. Moreover, using a diary recording the diet and symptoms, asymptomatic glucose profiles without sugar supplementation within 3 h postprandially were compared among the four procedures. Results: A total of 40 patients were enrolled, 10 patients for each of the four procedures. There were 47 glucose profiles with DG-BI, 46 profiles with DG-RY, 38 profiles with TG-RY, and 46 profiles with PPG. PPG showed the slowest increase with a subsequent gradual decrease in glucose fluctuations, without hyperglycemia or hypoglycemia, among the four procedures. In contrast, TG-RY and DG-RY showed spike-like glycemic variability, sharp rises during meals, and rapid drops. The glucose profiles of DG-BI were milder than those of RY. Conclusions: The asymptomatic glycemic changes after meals differ among the types of surgical procedures for gastric cancer. Given the mild glycemic fluctuations in PPG and the glucose spikes in TG-RY and DG-RY, pylorus preservation and physiological reconstruction without changes in food pathways may optimize postprandial glucose profiles after gastrectomy.

Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution

  • Jang, Joonyong;Koo, So-My;Kim, Ki-Up;Kim, Yang-Ki;Uh, Soo-Taek;Jang, Gae-Eil;Chang, Wonho;Lee, Bo Young
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.3
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    • pp.249-255
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    • 2022
  • Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22-76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2-14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30-32 minutes) in survivors (n=2) and 65 minutes (range, 33-482 minutes) in non-survivors (n=7). Conclusion: High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

Rehabilitation of a patient by converting poorly maintained fixed implant prosthesis into implant overdenture: a case report (기존 임플란트 보철물의 불량한 유지관리를 개선하기 위해 임플란트 피개의치로의 상부 보철물 전환 증례)

  • Kim, Yeong-Kyu;Jeong, Chang-Mo;Yun, Mi-Jung;Lee, So-Hyoun;Huh, Jung-Bo
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.1
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    • pp.127-134
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    • 2022
  • Among many contributing factors of implant failure, excessive loading and inflammation contribute mainly to increasing implant failure rate. Especially, poor oral hygiene around implants is one of the most common reasons for implant failure. When implant prosthesis fails to function, the clinician should re-diagnose and plan treatment using the remaining implants. Additional implantation may be needed to make a new type of prosthesis or either implant-assisted RPD and implant overdenture treatment may be performed using the remaining implants. In this article, a patient whose fixed implant prosthesis in the maxilla had failed of poor oral hygiene maintenance was reported to be recovered with removable implant overdenture by using remaining implant abutments and a milled bar with additional retentive elements. Through this treatment, the clinical results were satisfactory in terms of esthetics, masticatory function recovery and oral hygiene management.

Herbal Medicine for Liver Cancer: A Protocol for Systematic Review and Meta-Analysis (간암에 대한 한약치료: 체계적 문헌고찰 및 메타분석의 프로토콜)

  • Kwon, Seungwon;Song, Ga Yeon;Yang, Seung-Bo
    • The Journal of Internal Korean Medicine
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    • v.43 no.4
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    • pp.559-566
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    • 2022
  • Introduction: The aim of this systematic review is to provide evidence confirming the efficacy and safety of herbal medicines used in the treatment of liver cancer. Methods: The review will include randomized clinical trials that compared herbal medicines used as treatments for liver cancer with other therapies, such as placebos and Western medicine. Only randomized controlled trials will be included in this review, and all types of herbal medicine will be evaluated. Eleven electronic databases will be searched from the inception date: the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, AMED, CINAHL, one Chinese database (CNKI), and five Korean databases (OASIS, DBpia, RISS, KISS, and NDSL). The selection of studies, data extraction, and management will be performed independently by four researchers. Methodological quality, including the risk of bias, will be assessed using the Cochrane risk-of-bias assessment tool. Results: The review of current evidence for the effectiveness of herbal medicine for liver cancer will be summarized and quantitatively analyzed. Conclusions: Our systematic review will provide evidence of the efficacy of herbal medicines as treatments for liver cancer. This evidence will provide useful information for practitioners and patients in the fields of oncology and complementary medicine.

Efficacy of Living Donor Liver Transplantation in Patients with Methylmalonic Acidemia

  • Jang, Jae Guk;Oh, Seak Hee;Kim, Yu Bin;Kim, Seo Hee;Yoo, Han-Wook;Lee, Beom Hee;Namgoong, Jung-Man;Kim, Dae Yeon;Kim, Ki-Hun;Song, Gi-Won;Moon, Deok-Bog;Hwang, Shin;Lee, Sung-Gyu;Kim, Kyung Mo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.24 no.3
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    • pp.288-294
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    • 2021
  • Purpose: Despite aggressive medical and nutritional management, patients with methylmalonic acidemia (MMA) often suffer from multi-organ damage. Early deceased donor liver transplantation (DDLT) has emerged as an intervention to prevent disease progression. We investigated the efficacy of living donor LT (LDLT) with a potential carrier of MMA and a small volume of graft in patients with MMA as an alternative to DDLT. Methods: Of five patients (three male, two female; median age 5.7 years; range, 1.3-13.7 years), four underwent carrier LDLT, while one underwent non-carrier auxiliary LDLT. All patients received pre- and post-LT continuous renal replacement therapy and were provided with minimal restriction diet according to serum MMA level after LT. MMA levels in the serum and urine, the incidence of metabolic crisis, and clinical findings before and after LT were compared. Results: The survival rate was 100% during 2.2 years of follow up period after LT. In all five cases, MMA titer in the serum after transplantation decreased with less restrictive diet. Metabolic crisis was not observed during the follow-up period. In addition, no patient showed progression of severe renal impairment requiring hemodialysis. Progression of delayed cognitive development was not observed. Social functioning with improved neuropsychiatric development was observed. Conclusion: This study showed that LDLT achieved improved quality of life with less restrictive diet, therefore it could be a feasible alternative option to DDLT for the treatment of patients with MMA, even with an auxiliary LT.