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Analysis of the risk factors of acute kidney injury after total hip or knee replacement surgery

  • Lee, Yoo Jin;Park, Bong Soo;Park, Sihyung;Park, Jin Han;Kim, Il Hwan;Ko, Junghae;Kim, Yang Wook
    • Journal of Yeungnam Medical Science
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    • v.38 no.2
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    • pp.136-141
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    • 2021
  • Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m2 in the AKI group and 78.07±21.23 mL/min/1.73 m2 in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

The Study on relationship between CSV and Investment Efficiency (CSV와 투자효율성에 관한 연구)

  • Ho-Yeong Kim
    • Journal of Digital Convergence
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    • v.21 no.2
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    • pp.33-40
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    • 2023
  • In this study, we aim to examine the impact of corporate social responsibility implementation, which is a major concern in previous research, on investment efficiency. The research method will be a qualitative study with reference to existing previous research. The three main claims to be addressed in this study will be summarized, and the research variables and research models will be described. As a result of the study, based on existing previous research, this study presented three issues to examine how a high level of corporate social responsibility performance increases investment efficiency. First, we argue that a company's high level of social responsibility will be positively related to investment efficiency. Second, it is argued that investment efficiency will be positively related to individual CSR components that represent the interests of primary stakeholders. Third, it is argued that companies with too high a CSR index and companies with a too low CSR index will have less correlation with investment efficiency. The contribution of this study will be to more accurately understand the impact of CSR on corporate investment efficiency. In the future, it is hoped that additional discoveries will be made through research that adopts the three claims presented in this study as hypotheses and empirically analyzes them. The Journal of Digital Policy & Management. This space is for the abstract of your study in English.

Assessment of Heavy Metal Exposure Levels (Pb, Hg, Cd) among South Koreans and Contribution Rates by Exposure Route - Korean National Environmental Health Survey (KoNEHS) Cycle 4 (2018~2020) - (한국인의 체내 중금속(납, 수은, 카드뮴)의 노출수준 및 노출경로별 기여율 평가 - 제4기 국민환경보건 기초조사(2018~2020) -)

  • Gihong Min;Jihun Shin;Dongjun Kim;Jaemin Woo;Kyeonghwa Sung;Mansu Cho;Wonho Yang
    • Journal of Environmental Health Sciences
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    • v.49 no.5
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    • pp.262-274
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    • 2023
  • Background: Exposure levels for heavy metals such as lead (Pb), mercury (Hg), and cadmium (Cd) have increased due to human activities. They are known to be a public health concern. Objectives: This study aimed to determine the exposure levels to heavy metals in the blood and urine of South Korean adults and to present the contribution rate of exposure pathways using an exposure algorithm for men aged 19~64, women aged 19~64, and all seniors aged 65 or older. Methods: We analyzed data from the Korean National Environmental Health Survey (KoNEHS) Cycle 4 (2018~2020). A total of 2,646 participants aged ≥19 years were included. Multiple regression analysis was performed to determine the factors affecting heavy metal concentrations. The contribution rate was calculated by applying three exposure algorithms for ingestion, inhalation, and dermal exposure. Results: Factors that commonly affect heavy metal concentrations in blood and urine were gender and age. The main influencing factors for Pb and Cd were education level and smoking status, while frequency of fish consumption and of alcohol consumption were indicated to be the main influencing factors for mercury. The contribution rates of lead and cadmium from food ingestion were 78.03~79.62% and 88.39~92.89%, respectively. Additionally, the highest contribution for mercury was accounted for by food at 81.69~85.77%. As a result of the risk assessment, cadmium was found to pose a potential health risk a with total cancer risk (TCR) of more than 1×10-6. Conclusions: The KoNEHS could be an important study for determining the level of exposure to heavy metals and their influencing factors. Integrated exposure to heavy metals could assess the main exposure pathways, and this methodology could be applied to exposure management of heavy metals.

A Study on Awareness of Nuclear Power Generation and Fukushima Contaminated Water (원자력발전과 후쿠시마 오염수에 대한 인식 연구)

  • Yeon-Hee Kang;Sung Hee Yang;Yong In Cho;Jung-Hoon Kim
    • Journal of the Korean Society of Radiology
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    • v.18 no.2
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    • pp.109-117
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    • 2024
  • In order to determine the level of awareness of nuclear power generation and Fukushima contaminated water, this study conducted an online survey targeting the general public living in the Busan area and analyzed a total of 201 questionnaires. Independent samples t-test and one-way analysis of variance were conducted to verify differences in variables according to the characteristics of the study subjects, and correlation analysis was conducted to confirm the correlation between variables. First, the results of the study showed that women had a more negative perception of nuclear power generation and Fukushima contaminated water than men. In terms of age, it was found that people in their 40s and older had a high level of negative perception. In terms of political inclination, progressive respondents showed a higher negative perception toward nuclear power generation and Fukushima contaminated water. Second, information on nuclear energy was most often collected through the Internet, broadcasting, and SNS. Third, the higher the negative perception of nuclear power generation, the more negative the results were in terms of issues of concern following the discharge of contaminated water at the Fukushima nuclear power plant. Nuclear power cannot be separated from human life. Therefore, it is believed that accurate information and a knowledge delivery system are needed to ensure correct awareness of nuclear power generation.

Prediction of Damages and Evacuation Strategies for Gas Leaks from Chlorine Transport Vehicles (염소 운송차량 가스누출시 피해예측 및 대피방안)

  • Yang, Yong-Ho;Kong, Ha-Sung
    • The Journal of the Convergence on Culture Technology
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    • v.10 no.2
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    • pp.407-417
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    • 2024
  • The objective of this study is to predict and reduce potential damage caused by chlorine gas leaks, a hazardous material, when vehicles transporting it overturn due to accidents or other incidents. The goal is to forecast the anticipated damages caused by chlorine toxicity levels (ppm) and to design effective response strategies for mitigating them. To predict potential damages, we conducted quantitative assessments using the ALOHA program to calculate the toxic effects (ppm) and damage distances resulting from chlorine leaks, taking into account potential negligence of drivers during transportation. The extent of damage from toxic gas leaks is influenced by various factors, including the amount of the leaked hazardous material and the meteorological conditions at the time of the leak. Therefore, a comprehensive analysis of damage distances was conducted by examining various scenarios that involved variations in the amount of leakage and weather conditions. Under intermediate conditions (leakage quantity: 5 tons, wind speed: 3 m/s, atmospheric stability: D), the estimated distance for exceeding the AEGL-2 level of 2 ppm was calculated to be 9 km. This concentration poses a high risk of respiratory disturbance and potential human casualties, comparable to the toxicity of hydrogen chloride. In particular, leaks in urban areas can lead to significant loss of life. In the event of a leakage incident, we proposed a plan to minimize damage by implementing appropriate response strategies based on the location and amount of the leak when an accident occurs.

An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems (추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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Effects of a Self-Help Program including Stretching Exercise on Reduction of Symptom in Patients with Fibromyalgia (신장운동을 포함한 자조관리프로그램이 섬유조직염환자의 증상완화에 미치는 효과)

  • Han, Sang-Sook
    • Journal of muscle and joint health
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    • v.5 no.1
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    • pp.39-56
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    • 1998
  • This study was an quasi-experimental study, done to identify factors Influencing the reduction of symptoms in patients with fibromyalgia. The primary purpose of the study was to develop a Self-Help Program suitable for patients with fibromyalgia in Korea. The secondary purpose was to identify the effects of a Self-Help Program which included stretching exercise. This study was carried out between Feb. 24 and July 8, 1997 and patients in the study Included out patient diagnosed with fibromyalgia based on the criteria developed by the American College of Rheumatology(1990) and H, University which is a tertiary patient care clinic for Rheumatism. The experimental group included 38 patients who were residents of Seoul or Kyungi province, and a control group of 38 patients who were residents of other areas. The control patients were matched to the experimental group patients and they were selected considering the number of tender points on the Fibromyalgia Impact Questionnaire score and a score of self-efficacy. The experimental group participated in a Self-Help Program based on the American Arthritis Foundation(1995) guidelines. The program participants participated in a small group which consisted of 12-15 members attending the program once a week, for 6 weeks with each program lasted two to two and a half hours. The stretching exercise was carried out in each patient's home every day following the video tape exercise provided by the researcher, and the researcher provided encouragement and concern to the patients by calling them once a week. The number times the exercise was performed was divided by the number of participants to calculate the percentage of performance and determine the amount of exercise. Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al. (1989) for arthritis patients. The degree of pain was converted to scores based on the Visual Analog Scale, the number of tender points was converted to scores based on the criteria of the ACR(1990) and of Yunus. Depression was measured by CES-D and physical disability, sleep disturbance, fatigue, and anxiety of patients with fibromyalgia were measured by the Fibromyalgia Impact Questionnaire. The level of the exercise performance was converted to scores using the number of times the exercise was performed following the video tape prepared by Association of Rheumatology Health Professionals. Data were analyzed by SPSS windows and the results ire described below. 1. The experimental group which participated in the Self-Help Program showed higher efficacy scores than the control group when both groups were analyzed for depression and the number of tender points as common variables(F=9.146, p=.003). 2. The experimental group which participated in the Self-Help Program showed lower scores than the control group, for pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety. These symptoms of fibromyalgia can all be seen to have subsided(F=9.483, p=.003 : F=32.680, p=.001 ; F=11.104, p=.001, F=5.344 : p=.024, F=7.630 : P=.007, F=15.6512, p=.003 : F= 7.5412, p=.008). 3. In the experimental group, the self-efficacy score for the first three weeks showed a positive correlation with the exercise-performance score for four to six weeks (r=.387, p=.043). 4. In the experimental group, the relationship between the level of exercise-performance and the reduction of symptoms showed a significant correlation only to physical disability(r= -.500, p=.001). 5. In the experimental group, the relationship between the self-efficacy score and pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety score showed inverse correlations and thus, a reduction of symptoms occured when the self-efficacy score increased(r=-.325, p=.004 ; r= -.253, p=.027, r=-.452, p=.001 : r=-.434, p=.001 ; r=-.316, p=.005 ; r=-.460, p=.001 ; r=-.397, p=.014). Therefore, self-efficacy improved following the Self-Help Program including the stretching exercise. It was also found that physical symptoms (pain, number of tender points, level physical disability) and psychological symptoms (depression, fatigue, sleep disturbance, anxiety) were reduced. Moreover, It was found that the higher the self-efficacy, the the higher the degree of achievement of goals set for the stretching exercises. In addition, the level of exercise-performance influenced the level of physical disability, one of the symptoms of fibromyalgia. Accordingly, the conclusions from this study are that exercise-performance and the reduction of symptoms is achieved through promotion of self-efficacy. Therefore, it is proposed that are the Self-Help Program including stretching exercises is an appropriate nursing intervention for the reduction of symptoms of fibromyalgia.

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Determination of Target Clean-up Level and Risk-Based Remediation Strategy (위해성에 근거한 정화목표 산정 및 복원전략 수립)

  • Ryu, Hye-Rim;Han, Joon-Kyoung;Nam, Kyoung-Phile
    • Journal of Soil and Groundwater Environment
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    • v.12 no.1
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    • pp.73-86
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    • 2007
  • Risk-based remediation strategy (RBRS) is a consistent decision-making process for the assessment and response to chemical release based on protecting human health and the environment. The decision-making process described integrates exposure and risk assessment practices with site assessment activities and remedial action selection to ensure that the chosen actions are protective of human health and the environment. The general sequences of events in Tier 1 is as follows: initial site assessment, development of conceptual site model with all exposure pathways, data collection on pollutants and receptors, and identification of risk-based screening level (RBSL). If site conditions do not meet RBSL, it needs further site-specific tier evaluation, Tier 2. In most cases, only limited number of exposure pathways, exposure scenarios, and chemicals of concern are considered the Tier 2 evaluation since many are eliminated from consideration during the Tier 1 evaluation. In spite of uncertainties due to the conservatism applied to risk calculations, limitation in site-specific data collections, and variables affecting the selection of target risk levels and exposure factors, RBRS provides us time- and cost-effectiveness of the remedial action. To ensure reliance of the results, the development team should consider land and resource use, cumulative risks, and additive effects. In addition, it is necessary to develop appropriate site assessment guideline and reliable toxicity assessment method, and to study on site-specific parameters and exposure parameters in Korea.

Effects of Different Physical Frequency on Food-Dependent Exercise Induced Allergy Anaphylaxis (FDEIA) and Related Mechanisms (운동빈도의 차이가 식이유도 운동알레르기 질환과 관련기전에 미치는 영향)

  • Kim, Cheol-Woo;Kwak, Yi-Sub
    • Journal of Life Science
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    • v.22 no.7
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    • pp.897-903
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    • 2012
  • Food allergies have become a serious health concern in the past two decades, especially in developed countries. Foods associated with allergies include vegetables, some fruits, shellfish, wheat, egg, chicken, and nuts. To describe the specific fundamentals, etiological factors, and clinical manifestations, we analyzed the different physical frequency on spleen index in sensitized and regular exercise-trained mice. We also conducted a proliferation assay of lymphocytes to OVA, ROS, ASAS, and we determined the cytokine levels. Female BALB/c mice were bred in the animal laboratory of the P and D university under controlled conditions ($22{\pm}2^{\circ}C$, RH 45-55%, and a 12-hour photoperiod). The animals were 6 weeks old at the start of the study and were fed a standard commercial chow diet from 09:00 to 15:00 for the 8-week study period. All animals had access to distilled deionized water ad libitum. They were divided into four groups: a control group (S; control sensitized, n=25), a low-frequency training group (F2, n=25), a mid-frequency training group (F3, n=25), and a high-frequency training group (F5, n=25) following the treatment of exercise time per week. The results were as follows: The mice spleen index showed the highest grade in the F5 group compared with the other groups; this level showed in an exercise frequency-dependent manner. In the proliferation assay of OVA, the F5 group showed the highest grade compared with the other groups; this level was also showed in an exercise frequency-dependent manner. Peritoneal ROS and ASAS showed a statistically significant increase in the F5 group and decreased in the F2 group compared with the S group. However, there were no significant differences in the F3 group. The highest level of IL-4 was found in the F5 group compared with the other groups. However, the highest level of INF-${\gamma}$ was in the F2 group. The results suggest that FDEIA is positively correlated with the frequency of exercise due to the direct effect of physical exercise on peritoneal ROS and the cytokine profile. Further research is needed on the specific mechanism underlying the combined effects of exercise intensity and frequency on physical-induced allergy anaphylaxis.

An Effect of the Self-Regulation Program for Hypertensives -Synthesis & testing of Orem and Bandura's theory- (본태성 고혈압 환자의 자가간호증진을 위한 자기조절 프로그램 효과 -Orem이론과 Bandura이론의 합성과 검증-)

  • Park, Young-Im;Hong, Yeo-Shin
    • Research in Community and Public Health Nursing
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    • v.5 no.2
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    • pp.109-129
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    • 1994
  • Chronic health problems has become a major concern and challenge to the health care professionals today. Especially hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Self-care is an essential factor that keeps chronic patients in control of their health and wellness. Thus this study was conducted to identify the effect of the comprehensive self-regulation program as a nursing intervention on the promotion self-care performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi-experimental research with pre and post test design was used. The subjects of the study was consisted of thirty persons with mild or moderate essential hypertension from two companies in Cheong-ju city. The whole program was carried out from October, 1993 to February, 1994. The self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The instruments used for data collection in this study were as follows : 1) Instruments used for measuring the knowledge about hypertension, multiple health locus of control, and perceived benifits and barriers were adapted from previous studies and modified by author to be fit for the subjects. 2) Self-efficacy scale and self-care performance record were developed by the author. 3) Physiological parameters included systolic / diastolic blood pressure, body weight, level of blood cholesterol, and 24hour ambulatory blood pressure. The post-experimental Cronbach's Alpha as the reliability test of scales were 0.703-0.897, an appropriate level of confidence. The effect of the program was analyzed by experimental stages ; the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t-test and t-test, repeated measure ANOVA, and pearson's correlation to de termine the effect of program. The results were as follows : 1) After the self-regulation program, scores on knowledge(t=-2.41, p=.011), perceived self-efficacy (F=5.60, p=.001), self-care performance(F=22.31, p=.0001) were significantly higher than those before the program. 2) After the program, both systolic and diastolic blood pressure were significantly lower than those before the program(F=10.89 -13.11, p=.0001). However in 24hour ambulatory blood pressure, systolic mean pressure was nearly significantly lower, but not in diastolic mean pressure. 3) After the program, the body weight was significant decresed(t=5.53, p=.0001), but the blood cholesterol level was not decreased significantly except in those cases with higher cholesterol level. 4) There were significant relationships between changes in self-care performance and diastolic pressure at 1st week (r=.3389, p=.033) and changes in self-care performance and systolic pressure at 9th week(r=.3651, p=.024). 5) There were significant relationship between perceived self-efficacy and self-care performance at 5th week(r=.5313, p=.001) and 9th week (r=.3026, p=.052). 6) After the program, internal health locus of control and perceived benefits did not show significant change, but perceived barriers was significantly lower than those before the program (t=3.57, p=.0001). From the above results, it can be concluded that 1) The self-regulation program is an effective nursing strategy to promote self-care performance of hypertensives and to lower the blood pressure. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings. 2) The synthesis of Orem's self-care theory and Bandura's self-regulation & self-efficacy theory in this study was proved to enhance explanation and prediction of the change of self-care behavior. Thus the result of the study would contribute in development of the self-care theory and an expansion of practice-theory.

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