Day care center for the elderly is an alternative for community care for frail elderly who need social participation and physical cares and services outside the family. The purpose of this study was to identify the present situation of day care center for the elderly and to suggest desirable interior space plans for elderly day care center. Data were collected by two ways; a mail survey and case studies of existing day care centers. Five cases of day care centers were analyzed to find out Physical and space problems, available programs and services. Also, the staffs in 96 day care centers for the elderly in nationwide were selected for a mail survey and 68.8 percentage of all was collected and analyzed. From the result of case studies, narrow space and lack of accessibility features for wheelchair or other prosthetic devices were the major problems. From the result of a mail survey analysis, the elderly users were over 73 years old, and high proportion had suffered from dementia and apoplexy Also, staffing ration was 1:7 In other words, one staff was caring of 7 old people, and supporting staff was insufficient. Therefore, supportive, therapeutic environment Was more important issue to improve quality of care. Separate program room and outdoor space, lounging space, treatment room by gardening, separate counselling room, bedroom, a simple kitchen unit, staff office, separate physical treatment room, resting room for staff was indicated more necessarily. When priority of planning interior space was safety followed by accessability and convenience, it was also reported that sire of each room was generally narrow. The most serious problem in interior space was the lack and narrowness of space, and accessible features for mobility. Based on the literature review and the findings of this study, two types of floor plans for elderly day care center were suggested;‘a mixed type for the elderly with and without dementia’and‘a separate type for the elderly with dementia.’The main goals for designing interior space for two types of elderly day care center were to provide safe environment, encouraging environment for remaining abilities of users, sanitary environment, therapeutic environment, familiar environment, and socially-encouraging environment. The recommendations for further studies were suggested.
Journal of The Korean Society of Clinical Toxicology
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v.1
no.1
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pp.6-11
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2003
Various forms of dialytic techniques are available for detoxification. Hemodialysis, hemoperfusion and hemofiltration (hemodialfiltration) are the main treatment modalities. Because these modalities are rather invasive and expensive, it must be decided in balance of the risk and benefit to the patient. The prime consideration in the decision is based on the clinical features of poisoning; hemodialysis or hemoperfusion should be considered in general if the patient's condition progressively deteriorates despite intensive supportive therapy. The hemodialysis technique relies on passage of the toxic agent through a semipermeable membrane so that it can equilibrate with the dialysate and subsequently removed. It needs a blood pump to pass blood next to a dialysis membrane, which allows agents permeable to the membrane to pass through and reach equilibrium. Solute (or drug) removal by dialysis has numerous determinants such as solute size, its lipid solubility, the degree to which it is protein bound, its volume of distribution etc. The technique of hemoperfusion is similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. The patient's blood is pumped through a perfusion cartridge, where it is in direct contact with adsorptive material (usually activated charcoal) that has a coating material such as cellulose. This method can be used successfully with lipid-soluble compounds and with higher-molecular-weight compounds than for hemodialysis. Protein binding does not significantly interfere with removal by hemoperfusion. In conclusion, hemodialysis, hemoperfusion and hemofiltration can be used effectively as adjuncts to the management of severely intoxicated patients.
Choi, Yunjeong;Lee, Song;Kim, Ju Young;Lee, Kyung Eun
Korean Journal of Clinical Pharmacy
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v.27
no.4
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pp.276-283
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2017
Objective: Dyslipidemia is recognized as a prominent risk factor for cardiovascular and cerebrovascular diseases but it is manageable through therapeutic and lifestyle intervention. Interpreting the latest guidelines is essential for an application of recommendation from guidelines into clinical practice. Therefore, this study aimed to compare the most recent guidelines on dyslipidemia treatment recommendations in Korea and USA. Methods: This study analyzed and compared 2015 Korean guidelines for the management of dyslipidemia, 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and 2016 supportive guidelines from ACC. Results: A comparison was made focused on the following: target patients based on cardiovascular risk assessment, target goal, and treatment strategies including statin and non-statin therapies. Four target patient groups by risk were suggested in 2015 Korean guideline and cardiovascular risk factors were also considered for initiation of lipid lowering therapy. Titrated statin regimen was recommended by Korean guideline to reach LDL cholesterol and non-HDL cholesterol target level. In 2013 ACC/AHA guideline, four statin benefit group was introduced considering ASCVD risk and high intensity statin or intermediate intensity statin use were recommended without dose titration. 2016 update was to support non-statin therapy based on updated evidence and new consideration of ezetimibe, PCSK9-inhibitor and bile acid sequestrant was brought up. Conclusion: Guidelines are continuously updating as new and important clinical data are constantly released along with the advent of newly approved drugs for lipid disorder. This article provides resources that facilitates uptake of these recommendations into clinical practice.
Ethanolic leaf extract of Bauhinia variegata has been tested for its possible antioxidant potentials against sodium arsenite induced toxicity in mice. Mice were randomized into two groups of five and fifty mice. Group I consisting of 5 mice without any treatment with food and water ad libitum which served as normal control. Group II mice were fed with sodium arsenite in drinking water at 100 ppm concentration for two monthsthen they were segregated into five groups which were treated differently. Group II a mice received only arsenic as sodium arsenite with drinking water, Group II b were fed chronically 1 : 20 alcohol to distilled water (vehicle), Group II c, d, e mice were orally fed 50 mg/kg, 150 mg/kg and 250 mg/kg of B. variegata leaf extract of once daily for 15 and 30 days respectively along with arsenic. Several toxicity marker enzymes such as gamma glutamyl transferase, lactate dehydrogenase, aspartate and alanine aminotransferase, acid and alkaline phosphatase, catalase and superoxide dismutase along with haematological variables such as glucose 6-phosphate dehydrogenase, creatinine, bilirubin, haemoglobin and sugar in different groups of treated and control mice were studied. Results obtained from the in vivo experiment revealed that administration of sodium arsenite caused a significant increase in some enzymes while decrease in some. A similar trend was also observed with haematological variables. In contrast B. variegata treatment at 150 mg/kg favourably modulated these alterations and maintained the antioxidant status than other two doses i.e. 50 mg/kg and 250 mg/kg thereby making it a good candidate to be used as supportive palliating measures in arsenic induced toxicity.
We report a case of a full-term neonate with persistent pulmonary hypertension who developed asphyxia after birth and was treated with iloprost. The neonate had persistent hypoxia and did not respond to supportive treatment. Because inhaled nitric oxide (iNO) was not available in our hospital, inhaled iloprost was administered via an endotracheal tube. This resulted in an immediate elevation of oxygen saturation. Echocardiography revealed the conversion of the right-to-left ductal shunt to the left-to-right one and a decrease of the right ventricular pressure. The use of inhaled iloprost did not cause any significant side effects. Here, we describe our experience where iloprost was used in a neonate with persistent pulmonary hypertension because the standard therapy with inhaled nitric oxide was not available.
Background: In this study, we tried to comprehensively explore clinical dental hygienist's experience of a prevention-based incremental oral health care program, which was pilot-operated by dental clinics, define prevention-based incremental oral health care as experienced in the field, and identify factors to be considered. Methods: This study conducted a focus group interview with five dental hygienists who participated in an ongoing oral management pilot project in 2016. The interview was conducted by a researcher, and the co-research team attended as progress assistants and recorded characteristics of the participants, main dictations, and non-verbal characteristics. All interviews were recorded and underwent thematic analysis to examine the questions of the study as the main axis. Results: As a result of the study, 65 meaningful statements were extracted by code, integrated into 24 sub-categories, and structured into 11 categories. Finally, four keywords were drawn: characteristics, facilitating factors, conflicting factors, and improvement measures for prevention-based incremental oral health care. Regarding prevention-based incremental oral health care in dental clinics, dental hygienists were highly aware of the physical and mental burdens of personalized treatment and education for each individual. They were responsible for the patient and for facilitating changes in the behavior of the client, leading to professional satisfaction. The dental team's cooperation and supportive attitude were found essential to continue oral health care in the dental clinic. Conclusion: Through dental team-based treatment philosophy sharing and collaboration, it is possible to provide prevention-based incremental oral health care in dental clinics. In future, it is necessary to develop a system for establishing a sustainable preventative management system for public health promotion.
The authors, over the last 6 months, have treated 2 patients with perforated typhlitis complicating acute lymphocytic leukemia (ALL) with good outcome. The first patient was a 13-year-old male who developed intermittent high fever, abdominal pain, abdominal distention and diarrhea during the course of maintenance chemotherapy. The peripheral leukocyte ranged from 230-470/$mm^3$. Serial ultra sonograms and CT scans demonstrated irregular thickening of the cecal and ascending colonic walls and subsequent ragged perforation of the posterior wall of the cecum. He survived after treatment by right hemicolectomy and aggressive supportive measures. The patient case was a 3 year-old female who developed intermittent high fever, right lower abdominal pain, a mass, and watery diarrhea during the course of maintenance chemotherapy. Serial ultra sonograms and CT scans demonstrated irregular thickening of the cecal wall (6-15mm in thickness) and subsequent small perforation of the posterior wall of the cecum with thick-walled localized abscess. She has recovered completely after aggressive medical management. We learned two lessons from our experience treating these patients:1) early diagnosis provided by a high index of suspicion and the use of ultra sonogram or CT scan is essential. And 2) although perforation is one of the surgical indications for the treatment of typhlitis, it is possible to manage the perforation nonoperatively in selected cases with localized abscess.
Objectives: The purpose of this study is to investigate preliminarily for development of the Korean medicine clinical practice guideline (CPG) for pancreatic cancer through the analysis of existing CPGs. Methods: Through searching the medical database such as Pubmed, SCOPUS, CNKI, Google Scholar, etc. The global CPGs within recent three years were collected and analyzed. In particular, recommendations related to the Korean medicine or Chinese medicine were made primarily in the Guidelines of Diagnosis and Therapy in Oncology with Traditional Chinese Medicine. Results: The six CPGs were mentioned in this study. The academic societies and organizations developing the CPGs were located in China, Japan, Europe and America. The contents of the CPGs were the clinical questions and statements, surgical therapy, adjuvant therapy, radiation therapy, chemotherapy, palliative medicine, risk assessment, palliation and supportive care, follow-up and recurrence, Tumor-Node-Metastasis (TNM) staging. In the Guidelines of Diagnosis and Therapy in Oncology with Traditional Chinese Medicine, the etiology, mechanisms, herbal drugs, Chinese medicine assessment, complication, syndrome differentiation (SD), Chinese medicine treatment were described. Conclusions: In order to develop the proper Korean medicine CPG for pancreatic cancer and to adapt the correct integrative treatment program on the pancreatic cancer, institutional arrangements for cooperation with Korean medical communities and standardization of SD should be performed.
Journal of Dental Rehabilitation and Applied Science
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v.30
no.2
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pp.176-183
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2014
Severely absorbed edentulous ridge cannot bear mechanical stress, causes undesired transformation of oral environment and makes patients difficult to adapt to dentures. Nowadays implant overdenture can be a treatment of choice in order to relieve patients' discomfort and improve stability and retention of the denture. Placement of implant on maxilla is difficult because of its bone quality and anatomic structure. It also has wide supportive tissue and convenience of border sealing, which provides sufficient support and stabilization with conventional complete denture. Mandible, on the other hand, is difficult to obtain sufficient support, retention and stabilization with conventional complete denture. Therefore, implant overdenture is recommended on mandible. Locator attachment has been improved for convenience of use and male parts of various retention enabled it to replace ball type attachment clinically. In this study, we restored maxillary arch with conventional denture, and mandibular arch with implant and tissue-supported overdenture and Locator attachment system.
Reports on the comparison of clinical effect between non-surgical and surgical therapy, and the change of the clinical parameters during maintenance phase have been rarely presented in Korea. This study was to observe the clinical changes during maintenance phase of 6 months in patients with chronic periodontitis treated by non-surgical or surgical therapy in Department of Periodontics, Chonnam National University Hospital. Among the systemically healthy and non-smoking patients with moderate to severe chronic periodontitis, twenty eight patients (mean age: 47.5 years) treated by non-surgical therapy (scaling and root planning) and nineteen patients (mean age: 47.3 years) treated by surgical therapy (flap surgery) were included in this study. The periodontal supportive therapy including recall check and oral hygiene reinforcement was started as maintenance phase since 1 month of healing after treatment. Probing depth, gingival recession. clinical attachment level and tooth mobility were recorded at initial, baseline and 1, 2, 3 and 6 month of maintenance phase. The clinical parameters were compared between the non-surgical and surgical therapies using Student t-test and repeated measure ANOVA by initial probing depth and surfaces. Surgical therapy resulted in greater change in clinical parameters than non-surgical therapy. During the maintenance phase of 6 months, the clinical effects after treatment had been changed in different pattern according to initial probing depth and tooth surface. During maintenance phase, probing depth increased more and gingival recession increased less after surgical therapy, compared to non-surgical therapy. The sites of initial probing depth less than 3 mm lost more clinical attachment level, and the sites of initial probing depth more than 7 mm gained clinical attachment level during maintenance phase after non-surgical therapy, compared to surgical therapy. Non-surgical therapy resulted in greater reduction of tooth mobility than surgical therapy during maintenance phase. These results indicate that the clinical effects of non-surgical or surgical therapy may be different and may change during the maintenance phase.
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