• Title/Summary/Keyword: early interventions

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The Psychosocial Aspects of the Patients with Chronic Hepatitis B (만성 B형 간질환 환자의 정신사회적 측면)

  • Kim, Jin-Sung
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.3-10
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    • 2000
  • Objectives : The author wanted to summarize the psychiatric and social aspects of the patients with hepatitis B virus infection. Methods : The author reviewed all pertinent citations in the Medline database from 1966 to 1999. Results : Psychiatric problems in this population include delirium, psychotic disorder due to general medical condition(especially mania), anxiety, depression, adjustment disorder, alcohol abuse/dependence, and drug abuse/dependence. Social aspects of the patients with hepatitis B viral infection relate to the stigma of being a carrier, guilty feeling about infection, guilty feeling about increased family burden, impacts of having hepatitis on interpersonal relations, sexual difficulties, and job loss with increased financial burden, and health care worker's refusal. Conclusions : Appropriate early educational counseling interventions regarding the expected course and psychosocial intervention should be tailored to the sociocultural needs of special populations. Those interventions will increase compliance of treatment and prevent progression to hepatocellalar carcinoma from hepatitis.

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Complementary and Alternative Medicine for Oral Health : a Literature Review of Randomized Controlled Clinical Trials (구강건강에 이용되는 보완대체의학 치료: 무작위대조임상연구를 통한 문헌적 고찰)

  • Kim, Da-Hee;Choi, Gwang-Ho;Hwang, Eui-Hyoung;Heo, Kwang-Ho;Kim, Yong-Deok;Shin, Byung-Cheul
    • Journal of Society of Preventive Korean Medicine
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    • v.18 no.3
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    • pp.23-39
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    • 2014
  • Objective : This review aims at analyzing Complementary and Alternative Medicine (CAM) therapies, using for oral health to know current use of CAM in dental area by analyzing randomized controlled clinical trials (RCTs). Method : We searched the following 6 electronic databases until 1 July 2014. : Pubmed, Medline, Embase, Allied and Complementary Medicine Database(AMED), Cumulative Index to Nursing and Allied Health Literature(CINAHL), the Cochrane Library. We included parallel RCTs and cross-over RCTs that assessed the efficacy of CAM regardless of blinding and language. Results : A total of 154 RCT articles were included. There were 2-arm parallel study design(69.5%), 3-arm parallel study design(20.8%), 4-arm parallel study design(4.5%) and Cross-over design(5.2%). Complementary and alternative medicine RCTs in oral health tend to increase in the early-2000s and in the mid-2010s. In addition, 154 citations were classified according to diseases and interventions that categorized Natural Products studies(68.2%), Mind and Body Practices studies(31.8%). We classified in detail that vitamin and mineral therapies(29.9%), dietary supplements(24.7%), acupuncture(23.3%), Herbal medicine(13.6%), homeopathy (2.6%), energy therapies(2.6%), Massage(1.9%), biofeedback(0.6%), traditional medicine(0.6%). Conclusion : Increasing publications and diverse interventions regarding CAM for oral health is observed by analyzing RCTs from the literature review. Further studies are needed to be performed as systematic reviews to verify their effectiveness and the research to inquire into side effect.

Risk Factors, Symptoms, and Intervention Analysis of Delirium Subtypes in Hospitalized Patients (입원환자에게 나타나는 섬망 아형별 위험요인과 증상 및 중재 분석)

  • Ryu, Ahyun;Kang, Young-Ok;Song, Rhayun
    • Journal of the Korea Convergence Society
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    • v.12 no.10
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    • pp.353-363
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    • 2021
  • This study aimed to investigate subtypes, risk factors, symptoms and the interventions to inpatients with delirium. The data of 108 inpatients who had the diagnosis of delirium during their hospital stay were collected from Electronic Medical Record at a university hospital and were analyzed by SPSS for Windows V. 26.0 program. As a results, Patients had a high proportion of elderly, male, orthopedic, and with fractures or amputations. The subtypes of delirium were hyperactive (51.9%), hypoactive (6.5%), and mixed (41.7%). Among the risk factors, depression and use of psychotropic agent were more common in those with hypoactive delirium. Among delirium interventions, behavioral symptom management and aggressive behavioral intervention were mainly implemented for those with hyperactive or mixed types, and emotional support was mainly implemented for those with hypoactive or mixed types. The delirium related intervention was more likely given immediately when the patients showed aggressive behaviors. Therefore, intervention strategies and protocol development are required for early detection of delirium in inpatients.

Clinical effectiveness of different types of bone-anchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis

  • Wang, Jiangwei;Yang, Yingying;Wang, Yingxue;Zhang, Lu;Ji, Wei;Hong, Zheng;Zhang, Linkun
    • The korean journal of orthodontics
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    • v.52 no.5
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    • pp.313-323
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    • 2022
  • Objective: This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis. Methods: We searched seven databases for randomized and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction, and quality assessment, we calculated the mean differences, 95% confidence intervals, and surface under the cumulative ranking scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework. Results: Six interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-Nasion-Supramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups. Conclusions: Bone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of a facemask.

Introduction of Child and Adolescent Mental Health Services in Korea and Their Role During the COVID-19 Pandemic: Focusing on the Ministry of Education Policy

  • Seo Jung Kim;Jongha Lee
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.34 no.1
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    • pp.4-14
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    • 2023
  • This study aimed to discuss mental health services for children and adolescents that are being implemented as initiatives of the Korean government and to review the functions and roles of these projects during the COVID-19 pandemic. Three government departments are in charge of providing mental health services for children and adolescents: Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare. The Ministry of Education has implemented several policies to facilitate the early detection of mental health issues among school students (from preventive interventions to selective interventions for high-risk students). The Ministry of Gender Equality and Family additionally serves out-of-school children and adolescents by facilitating early identification of adolescents in crises and providing temporary protection or emergency assistance (as required) through the Community Youth Safety-Net Project. Furthermore, the Ministry of Health and Welfare operates relevant mental health agencies for individuals of all ages including children and adolescents. Any high-risk students who have been screened through the projects of the Ministry of Education are supported through referrals to the following institutions for appropriate treatment of their symptoms: specialized hospitals, the Youth Counseling and Welfare Center operated by the Ministry of Gender Equality and Family, the National Youth Healing Center, the Mental Health Welfare Center operated by the Ministry of Health and Welfare, the Suicide Prevention Center, and the Child Welfare Center. To assist students who are facing any psychological difficulties because of the COVID-19 pandemic, the Ministry of Education has established a psychiatric support group for providing emergency mental health care; furthermore, schools are promoting psychological surveillance (e.g., provision of non-face-to-face counseling services that are centered around the Wee Center). The Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare have provided varied mental health support services in order to address the challenges faced by children and adolescents during the pandemic. Nevertheless, the mental health services operated by each ministry do show some limitations because their service provision system is insufficiently collaborative. The present study discussed the positive effects of each initiative as well as its limitations; furthermore, it suggested improvements for facilitating the healthy development of children and adolescents' mental health.

Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care (섬망의 돌봄: 완화의료 영역에서의 진단, 평가 및 치료)

  • Seo, Min Seok;Lee, Yong Joo
    • Journal of Hospice and Palliative Care
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    • v.19 no.3
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    • pp.201-210
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    • 2016
  • Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

Literature Review Nursing Intervention for Developmental Support on Preterm Infants (미숙아의 발달지지를 위한 간호중재에 관한 문헌연구)

  • Kim, Tae-Im;Sim, Mi-Kyung
    • Korean Parent-Child Health Journal
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    • v.4 no.1
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    • pp.35-55
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    • 2001
  • Recently attention has been focused on the effects of early intervention, or its lack, on both normal and preterm infants. Particularly numerous studies suggest that premature infants are not necessarily understimulated but instead are subjected to inappropriate stimulation. Developmental support and sensory stimulation have become clinical opportunities in which nursing practice can impact on the neurobehavioral outcome of premature infants. Developmental care has been widely accepted and implemented in neonatal intensive care units across the country. Increasingly, attention and concern in caring for low-birth-weight infants and premature infants has led clinicians in the field to explore the effects of a complex of interventions designed to create and maintain a developmentally supportive environment; to provide age-appropriate sensory input; and to protect the infant from inappropriate, excessive and stressful stimulation. The components of developmental care include modifications of the macro-environment to reduce NICU light and sound levels, care clustering, nonnutritive sucking, and containment strategies, such as flexed positioning or swaddling. Sensory stimulation of the premature infants is presented to standardize the modification of a developmental intervention based on physiologic and behavioral cues. The most appropriate type of stimuli are those that are sensitive to infant cues. Evaluation of infant physiological and behavioral responds to specific intervention stimuli may help to identify more appropriate interventions based on infants' cues. A critical question confronting the clinician is that of determining when the evidence supporting a change in practice is sufficient to justify making that change. There are acknowledged limitations in the current studies. Many of the studies examined had small sample sizes; used nonprobability sampling; and used a phase lag design, which introduces the possibility of threats to internal validity and limits the generalizability of the results. Although many issues regarding the effects of developmental interventions remain unresolved, the available research base documents significant benefits of developmental care for LBW infants in consistent outcomes, without significant adverse effects. Particularly, although the individual studies vary somewhat in the definition of specific outcomes measured, instrumentation used, time and method of data collection, and preparaion of the care providers, in all studies, infants receiving the full protocol of individualized developmentally supportive care had improvements in some aspect of four areas of infant functioning: level of respiratory or oxygen support, the establishment of oral feeding; length of hospital stay, and infant behavioral regulation. In summary, based on the available literature, individualized developmental intervention should be incorporated into standard practice in neonatal intensive care. And this implementation needs to be coupled with ongoing research to evaluate the impact of an individualized developmental care programs on the short- and long-tenn health outcomes of LBW infants.

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An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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Growth- and Breed-related Changes of Fetal Development in Cattle

  • Mao, W.H.;Albrecht, E.;Teuscher, F.;Yang, Q.;Zhao, R.Q.;Wegner, J.
    • Asian-Australasian Journal of Animal Sciences
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    • v.21 no.5
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    • pp.640-647
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    • 2008
  • Breed differences in adult animals are determined during fetal development. If interventions are to be developed that influence growth of muscle and fat, it is important to know at which time during gestation breed differences appear and are fixed. The objective of this study was to characterize fetal development in cattle of different breeds. Pregnant cows of 4 cattle breeds with different growth impetus and muscularity were slaughtered under normal processing conditions and the fetuses were removed. German Angus, a typical beef cattle; Galloway, a smaller, environmentally resistant beef type; Holstein Friesian, a dairy type; and Belgian Blue, an extreme type for muscle growth were used. Fetuses of each breed were investigated at 3, 6, and 9 mo of gestation. Fetuses were weighed and dissected into carcass, organs, and muscles. Body fat weight was obtained using the Soxhlet extraction method. Fetal weight increased most rapidly in the third trimester of gestation mainly due to the accelerated muscle and fat deposition. The organ weight to body weight (BW) ratios decreased and the muscle and fat weight to BW ratios increased. At 3 mo of gestation, Galloway fetuses had the significantly smallest BW, half-carcass weight, leg weight, organ weight, muscle weight and shortest leg length. In contrast, Holstein fetuses had the significantly greatest BW, liver, kidney, and lung weights and significantly longest leg length among the 4 breeds, but no differences between Holstein Friesian and Belgian Blue were detected in half-carcass and leg weight. Indeed, Belgian Blue fetuses had the significantly greatest half-carcass weight, leg weight, and muscle weight at 9 mo of gestation, and Galloway had a significantly greater body fat to BW ratio than Holstein Friesian and Belgian Blue. These differences were not evident at 3 and 6 mo of gestation. These data show that the profound increase of tissue and organ weights occurred in later gestation in cattle fetuses even though breed differences were evident as early as 3 mo of gestation. Depending on the tissue of interest, impacting fetal growth likely needs to occur early in gestation before the appearance of breed-specific differences.

Advantages of Distal Subtotal Gastrectomy over Total Gastrectomy in the Quality of Life of Long-Term Gastric Cancer Survivors

  • Kwon, Oh Kyoung;Yu, Byunghyuk;Park, Ki Bum;Park, Ji Yeon;Lee, Seung Soo;Chung, Ho Young
    • Journal of Gastric Cancer
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    • v.20 no.2
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    • pp.176-189
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    • 2020
  • Purpose: This study evaluated differences and shifting patterns in the health-related quality of life (HRQoL) of 5-year gastric cancer survivors after either a distal subtotal gastrectomy (DSG) or total gastrectomy (TG). Materials and Methods: We analyzed the prospectively collected HRQoL data of 528 patients who survived 5 years without recurrence using the European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Quality of Life Questionnaire-Stomach module according to the type of surgery. The purpose was to identify the proportion of patients with deteriorating HRQoL and to assess the clinical significance of these changes. Results: Deteriorating HRQoL was prevalent in both groups, including a large proportion of the DSG group. Decreased overall health status and scores on several function scales were less in the DSG group, while increases on the symptom scales were higher in the TG group. For most of the scales, gaps in HRQoL during the early postoperative period did not merge within the 5 years. Scores on the diarrhea and body image scales revealed "moderate changes" in both groups. Conclusions: During the 5-year period after surgery, the TG group suffered from inferior HRQoL compared to the DSG group. However, a large proportion of the DSG group also suffered HRQoL deterioration. In general, the TG group experienced more HRQoL decline, with diarrhea and body image being the major concerns for both groups. To improve HRQoL after gastrectomy, patients must be better informed about post-gastrectomy symptoms. These symptoms must be vigorously investigated, and medical interventions should be available parallel to nutritional support. Favorable evidence of function-preserving gastrectomy should be established and disseminated to improve the HRQoL of early gastric cancer patients.