A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.
The purposes of this study were to a analysis of friction relation between tennis outsole and tennis playing surfaces. Tennis footwear is an important component of tennis game equipment. It can support or damage players performance and comfort. Most importantly athletic shoes protect the foot preventing abrasions and injuries. Footwear stability in court sports like tennis is incredibly important since it is estimated that as many as 45% of all lower extremity injuries occur in the foot and ankle. The friction force is the force exerted by a surface as an object moves across it or makes an effort to move across it. The friction force opposes the motion of the object. Friction results when two surfaces are pressed together closely, causing attractive intermolecular forces between the molecules of the two different surfaces. The outsole provides traction and reduces wear on the midsole. Today's outsoles address sport specific movements (running versus pivoting) and playing surface types. Different areas of the outsole are designed for the distinct frictional needs of specific movements. Traction created by the friction between the outsole and the surface allows the shoe to grip the surface. As surfaces, conditions and player motion change, traction may need to vary. An athletic shoe needs to grip well when running but not when pivoting. Laboratory tests have demonstrated force reductions compared to impact on concrete. There is a correlation between pain, injury and surface hardness. These are a variety of traction patterns on the soles of athletic shoes. Traction like any other shoe characteristic must be commensurate and balanced with the sport. The equal and opposite force does not necessarily travel back up your leg. The surface itself absorbs a portion of the force converting it to other forms of energy. Subsequently, tennis court surfaces are rated not only for pace but also for the percentage of force reduction.
A 6-year-old, intact male maltese was presented with hindlimb ataxia of 4 day duration. Physical and neurological examinations revealed a bright, alert, and responsive dog, with no evidence of cranial nerve deficits, conscious proprioceptive deficits. Spinal reflexes of the hind and forelimbs were normal. Patellar, cranial tibial, and withdrawal reflexes were normal. Pain could not be elicited on manipulation of the neck or palpation of the spinal column. Survey radiographs of the vertebral column were unremarkable. Computed tomography (CT) scans in the transverse plane were performed. The results of CT imaging were unremarkable. Magnetic resonance imaging (MRI) in both sagittal and transverse planes was performed. The extent of the lesion was 25 mm in length by 4 mm in thickness. The spinal cord was deviated ventrally and appreared thinner. On T1-weighted and FLAIR images, a discrete hypointense lesion dorsal to the spinal cord was observed at L1-2 which was contiguous with the subarachnoid space. On T2-weighted images, this region was hyperintense, consistent with a fluid-filled structure. The signal intensity of the cysts was equivalent to cerebrospinal fluid (CSF). Surgical treatment involving dorsal laminectomy had successful outcomes.
Seo, Kyoung-Won;Ahn, Jin-Ok;Coh, Ye-Rin;Park, Chong-Woo;Chae, Ji-Sang;Hwang, Cheol-Yong;Youn, Hwa-Young
Journal of Veterinary Clinics
/
v.27
no.6
/
pp.746-750
/
2010
Three military working dogs (MWDs) were diagnosed with perianal fistulae after a complete physical examination and rectal palpation. The initial treatment protocol was used with short-term oral ciclosporine (CyA) and ketoconazole and 0.1% topical tacrolimus ointment. When lesions were nearly healed, treatment was continued with 0.1% tacrolimus ointment only at a lower frequency. The lesions improved significantly within 2-8 weeks with no noticeable side effects. Complete recovery was determined at weeks 13, 6, and 4 for cases 1, 2, and 3, respectively. This combination protocol was effective at resolving or reducing perianal fistulae (PAF) lesions even communicating with anal sacs in three dogs. The major benefit of this protocol was the rapid reduction of fistulae lesions and this could be helpful to extend the pain-free period. Moreover, this protocol appeared cost-saving as well as time-saving option for PAF dogs.
Cho Kwang-Hyun;Kwon Young-Min;Han Il-Yong;Jun Hee-Jae;Lee Yang-Haeng;Hwang Youn-Ho;Yoon Young-Chul
Journal of Chest Surgery
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v.38
no.10
s.255
/
pp.721-724
/
2005
Aortocaval fistula is a rare complication of abdominal aortic aneurysm, involving less than $1\%$ of all abdominal aortic aneurysms. A 64-years old man with a long history of hypertension and abdominal aortic aneurysm had chest pain, dyspnea, epigastric discomfort and palpable abdominal pulsating mass. Physical examination revealed hypotension with a systolic blood pressure of 70 mmHg, a large pulsatile mass and a systolic abdominal bruit. Laboratory data revealed a hemoglobin values of 11.0 g/dL, blood urea nitrogen (BUN) value of 5 mg/dL, and creatine value of $2.5 mg\%$. Abdominal Angio CT showed a 10cm infrarenal abdominal aortic aneurysm with dilatation of the IVC and aortocaval fistula from the aortic aneurysm, which was confirmed at emergency surgery. When the aneurysm was opened and the thrombus was removed, a 1 cm communication was identified between the aorta and IVC. This was controlled with Foley catheters ballooning, and the fistula was closed by continuous suture placed outside the aneurysm. A bifurcated aorto-iliac graft was used to restore arterial continuity. The patient was discharged home after uncomplicated postoperative course.
The Delivery Process can be viewed as one of the developmental crisis that forces the majority of women. During the labor and delivery process the women may face a variety of problems and pain with all its subjectivity. This developmental crisis may lead a pregnant women to have a negative experience in delivery. For nurses, to help to pregnant women check with the crisis and perceived support and to positive experience. This study intended to analyze the pregnant women's delivery experience according to supporter during labor. The subjects for this study were 45 pregnant women who had normal delivery without complications, within 37 to 42 weeks of pregnancy. Data Collection was done from April 24th to May 20th 1995 by two instruments, a support measurement scale and a delivery experience measurement scale which were consisted it 18-items scale developed by researcher. The data was analyzed by SPPS program using descriptive statistic Kruskal-Wallis one way analysis and Spearman Correlation Coefficient. The result of this study are as follows. 1. Support distribution by support contents is shown is order of holding the hands (97.8%), help to urination(86.7%), bed arrangement(57.8%), massaging the arms and legs(55.6%), changes in posture(44.4%), teaching how to produce power(44.4%), while emotional support is disclosed in order of sympathy(97.8%), encouragement(82.2%), hearing the needs(60.0%), However, information support was as low as less than 33.3%. 2. The extent of delivery experience a Pregnant woman perceives is revealed in order of a sense of comfortableness(44%), satisfaction(43.2%), reduction of fear(43.2%), familiarity (42.8%), self-confidence (42.5%), decrease of laborpain(39.9%). 3. The extent of delivery support a pregnant woman perceives reveals that physical support($x^2$=22.4452, P=.000) and information support($x^2$=7.5187, P=.0233) Show a significant difference among the mothers group, the mothers-in-law group, the husbands group, but to significant difference was found in emotional support among them. 4. The extent of delivery experience a pregnant woman perceives represents a significant difference in order of the mothers group, the mothers in-law group, and the husbands group($x^2$=13.4255, P=.0012). 5. A positive correlation was manifested between the extent of support and delivery experience a pregnant woman perceives(r=.8643, P=.000). This information can be utilized as data to further the understanding delivery experience according to supporter. In Consequence, it is recommended that the range of family support limited to husband should be expended including mother and mother-in-law.
Purpose: The purpose of this study is to evaluate the result of arthroscopic excision of painful Os subtibiale and Os subfibulare. Materials and Methods: Sixteen patients who had accessory bone in the ankle joint were treated by arthroscopy. Os subtibiale was four cases and os subfibulare twelve. The average follow-up period was 9 months$(range:6{\sim}42months)$. All patients were evaluated clinically with physical examination and radiologically with simple X-ray and for further evaluation, eight with bone scan, three with computed tomography and twelve with magnetic resonance image. We estimated the result of resection with Ogilvie-Harris's criteria. Results: All parameters of subjective and functional evaluation were improved with statistical significance(p<0.05). At final evaluation, eight patients still complained of mild pain and among them, three patients for synovitis, three for tendinitis on MRI and two for incomplete resection. Conclusion: The arthroscopic resection is a very effective method for painful os subtibiale and subfibulare using small incisions and for treatment of associated lesion. The preoperative radiological evaluation is essential and magnetic resornance image is useful for detecting of associated lesion.
Purpose: In this study, we tried to develop the technique of osteotomy for hallux valgus. The new modified technique of osteotomy was accomplished with even more greater stability, accurate correction of the deformity and more effective than 'chevron' osteotomy in terms of correction of the deformity. Materials and Methods: Between March 1998 and December 2001, 55 cases of new modified osteotomy for hallux valgus were performed for 39 patients, 16 of whom underwent operation of both feet. Operations were made for 34 women and 5 men whose average age was 46 years old (range, $20{\sim}71$ years). Average follow up period was three years (range, $2{\sim}5$ years), and during the follow up, the patients underwent physical examination and assessment with use of the American Orthpaedic Foot and Ankle Society's hallux-metatarso-phalangealinterphalangeal scale and standard foot radiographic measurements. Results: 37 patients (53 cases) out of 39 patients (55 cases) had no pain, good cosmesis, and all of the patients were satisfied with the results of the operation. Two had occasional mild discomfort. The average score according to the hallux-metatarso-phallangeal-interphalangeal scale was 93.2 points (range, $78{\sim}100$ points). The average preoperative intermetatarsal angle was $14.4^{\circ}$, which was decreased to $7.9^{\circ}$ after the osteotomy with an average correction of $6.5^{\circ}$ and The average preoperative hallux valgus angle was $34.1^{\circ}$, which was decreased to $11.1^{\circ}$ after the osteotomy with an average correction of $23^{\circ}$. This new modified technique would prevent the angulation or shortening at the osteotomy site and it was also even more stable at osteotomy site, and could do even more effective and accurate correction of the deformity than conventional Chevron osteotomy. Conclusion: New modified chevron osteotomy for the treatment of symptomatic hallux valgus was done in 55 cases, and the results were satisfactory in all cases. This method was more stable at the osteotomy site than conventional Chevron osteotomy and was also possible to do more accurate and more effective correction of the deformity. It was also easy to control the distal fragment of first metatarsal bone.
Meningococcal infections can be associated with abnormalities of the complement system, which contains 5 terminal complement proteins. Furthermore, deficiencies in 1 of these 5, complement component 7 (C7), leads to the loss of complement lytic function, and affected patients show increased susceptibility to recurrent meningococcal meningitis and systemic Neisseria gonorrhoeae infection. In September 2003, an 11-year-old female patient presented at our outpatient department with high fever, lower leg pain, headache, and petechiaes. She rapidly progressed to coma but later achieved full recovery due to prompt treatment. Her final diagnosis was meningococcal sepsis and arthritis. Her elder brother also had a similar bacterial meningoencephalitis history, which encouraged us to perform analyses for complement component and gene mutations. Resultantly, both the brother and sister were found to have the same mutation in the C7 gene. Subsequently, vaccinations of the meningococcal vaccine meningococcal vaccine ($Menomune^{(R)}$) were administered. However, in September 2006, the brother expired due to acute micrococcus meningoencephalitis. At present, the 16-year-old female patient is healthy. Here, we report a Korean family with a hereditary C7 deficiency with susceptibility to meningococcal infections due to C7 gene mutation.
The purpose of this study was try to check the change of a subjective evaluation about the life function fitness and health-related quality of life by executing the home support exercise program three times a week for total 16 weeks with elderly women that are order than 70 years old. The experiment group(total : 17 people, mean age : 79.4) and the control group(total : 17 people, mean age : 80.7) live Yeonje-gu in Busan city, and they don't have any physical injury and any inconvenience to move. and they are all composed of elderly women who agree to participate in this study. We carried out an analysis of covariance with SAS 9.2 statistics package. These are the results from it. First, the experiment group showed statistically significant increase(p<.001) in lifting dumbbells, repeatedly standing up and sitting down, 2.24m shuttle running, walking at the same place for 2 minutes. Second, there was no particular effect with the experiment group in flexibility(catching hands with their backs leaned against each other). This result point out that there is a need of supplementation like adding exercise item which can improve flexibility to home support exercise program. Third, there was no particular difference between the experiment group and the control group in 8 sub-factors with the subjective evaluation about health-related quality of life through SF-36. However, there the bodily pain and vitality sub-factors of experiment group was better than that of the control group with p<.10 level, so we considered this result showed us the positive effect slightly.
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