BACKGROUND: Clonidine, a prototype alpha2-adrenoreceptor agonist, has been shown to be effective as a preanesthetic medication in adults. Many authors have reported the effects of intravenous clonidine pretreatment on the hemodynamic responses to tracheal intubation, on the anesthetic requirements during the operation and on postoperative analgesia in adults. The current study was designed to investigate the efficacy of two doses of intravenous clonidine as a premedicants. METHODS: In a prospective, randomized, double-blind, controlled clinical trial, 60 children, aged 5 12 years, undergoing an elective adenotonsillecctomy received saline, 1 microgram/kg clonidine or 2 microgram/kg clonidine intravenously. These agents were administered 10 minutes before the estimated time of induction of anesthesia with intravenous atropine 0.01 mg/kg. A blinded observer noted the childrens'levels of sedation, the quality of separation from parent, and degree of acceptance of mask application during the inhalation of 100% oxygen just after pentothal sodium injection. Hemodynamic changes after tracheal intubation were compared among the three groups. RESULTS: Clonidine produced significant sedation, and this effect were dose related. The clonidine administered groups provided a better quality of separation than the control group. Amnesia about mask application was significantly higher in the clonidine 2 microgram/kg administered group. These doses of clonidine did not attenuate increases in blood pressure and heart rate after tracheal intubation. No consistent differences in the blood pressure or heart rate after tracheal intubation were observed in the three groups. No clinically significant perioperative hypotension or bradycardia was observed. CONCLUSIONS: These data indicate that, the combination of intravenous 1 microgram/kg clonidine or 2 microgram/kg clonidine with atropine 0.01 mg/kg is an effective form of premedication in pediatric surgery. However, the optimal dose of clonidine for both sedation and hemodynamic stability after tracheal intubation in this setting remains to be determined.
Adult ; Amnesia ; Analgesia ; Anesthesia ; Atropine ; Blood Pressure ; Bradycardia ; Child ; Clonidine* ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Inhalation ; Intubation ; Masks ; Oxygen ; Parents ; Preanesthetic Medication ; Premedication* ; Prospective Studies ; Sodium ; Sympathetic Nervous System ; Thiopental

BACKGROUND: Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. PURPOSE: To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. METHODS: A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. RESULTS: None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. CONCLUSIONS: The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.
Workload/economics ; Program Evaluation ; Personnel Staffing and Scheduling/*economics ; Nursing Staff, Hospital/economics/*supply & distribution ; Logistic Models ; Korea ; Humans ; *Hospital Charges ; *Health Policy ; Cross-Sectional Studies ; Bed Occupancy/economics ; Analysis of Variance

Nutrition care is important for patients’ well-being. With legislation for reimbursement for nutrition support team activities from the Korea Ministry of Health and Welfare, this has increased the importance of nurses’ role in nutrition. Nutrition support nurses (NSNs) focus on the optimization of nutritional health and prevention of nutrition-related illness and injury. NSN performs as an advanced practice nurse, a core member of a nutrition support team, an educator or consultant, a policy maker in nutrition care, and a researcher or a member of quality improvement. NSNs should develop their core competency to fulfill their roles in nutrition care and the need to participate in qualified nutrition support education programs. Further, the tasks and duties of NSNs should be specifically identified so that NSNs can fulfill their roles.

No abstract available.
Craniocerebral Trauma* ; Follow-Up Studies* ; Head* ; Humans

The overall purpose of this study was to investigate the effects of level of isoflavones supplementation on bone metabolism in growing female rats. The effects of level of isoflavones supplementation on bone mineral density (BMD) and bone mineral content (BMC) were inspected in this study. Forty-five rats divided into three groups: Casein, 1/2IF, IF. The serum and urine concentrations of calcium and phosphorus were determined. BMD and BMC were estimated by using PIXImus (GE Lunar Co, Wisconsin.) in spine and femur on 3, 6, 9 weeks after feeding. This study of results were as follows: The isoflavones supplementation level did not affect weight gain, mean food intake and food efficiency ratio. The serum concentration of calcium, phosphorus were not significantly different by different level of isoflavones supplementation. The urinary calcium and phosphorus excretion were not significantly different, too. Spine and femur BMD, BMC were not significantly increased by different level of isoflavones supplementation on 3 and 6 weeks after feeding. Spine BMD and spine BMC per weight, femur BMC per weight were significantly increased in the groups 1/2IF and IF at the ninth week after feeding, but there was no significant difference by different level of isoflavones supplementation. Spine BMD per weight and femur BMD per weight were significantly higher in the group of IF than in the group of Casein and 1/2IF at the ninth week after feeding. These results suggest that the group of IF with rich isoflavones supplementation was effective to the increase of BMD spine and femur in growing female rats, respectively.
Animals ; Bone Density* ; Calcium ; Caseins ; Eating ; Female* ; Femur ; Humans ; Isoflavones* ; Metabolism ; Phosphorus ; Rats* ; Spine ; Weight Gain

Elastofibroma is a rare benign tumor-like condition manifesting as firm and spherical mass with poorly circumscribed margins of fibroelastic tissue, occuring in the subscapular region or the chest wall of elderly persons. It is not a true neoplasm but rather a reactive or degenerative process causing abnormal elastogenesis. It is unilateral in the majority of cases and the right side is affected more commonly than the left. We report a case of bilateral elastofibromas removed from both subscapular regions of a 73-year-old female farmer. She was presented with tender masses on the bilateral subscapular areas for seven years. Microscopically, it consisted of a mixture of intertwining broad eosinophilic collagen bundles and elastic fibers associated with a few fibroblasts and mature fat cells. The elastic fibers had a degenerated beaded appearance or were fragmented into serrated globules in a linear arrangement.
Adipocytes ; Aged ; Collagen ; Elastic Tissue ; Eosinophils ; Female ; Fibroblasts ; Humans ; Thoracic Wall

The leading cause of death of massive hemoptysis is the aspiration of blood into the contralateral normal lung resulting in asphyxia. The management of massive hemoptysis can be performed by the evacuation of the blood, and the protection and ventilation of the uninvolved lung from aspiration. Double-lumen endotracheal tubes provide lung isolation, the ability to ventilate one or both lungs, and suction in case of acute endobronchial hemorrhage. We report a case of blood aspiration and hypoxemia which occurred during one lung ventilation using single lumen endotracheal tube for left pneumonectomy. The patient was treated with a supplement of 100% oxygen, continual suctioning, and positive-pressure ventilation. If we had used a double-lumen endotrachal tube, it would have enabled us to separate both lungs, to clear the left lung, and to apply ventilatory support on the contralateral lung.
Anoxia* ; Asphyxia ; Cause of Death ; Hemoptysis ; Hemorrhage ; Humans ; Lung* ; One-Lung Ventilation* ; Oxygen ; Pneumonectomy ; Positive-Pressure Respiration ; Suction ; Ventilation

PURPOSE: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. METHODS: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. RESULTS: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. CONCLUSION: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.
Adult ; Aged ; Blood Pressure ; Chronic Disease ; Cost-Benefit Analysis/*methods ; Databases, Factual ; Female ; Humans ; Hypertension/economics/*therapy ; Male ; Middle Aged ; *Models, Statistical ; Program Evaluation

A total of 47 preoperative CT scans in patients with renal cell carcinoma were retrospectively reviewed and compared with surgical findings to assess the accuracy of CT for determining the perinephric tumor extension. CT criteria for perinephric extension were hazy ill-defined tumor margin, perirenal nodule and fascial thickening. Regardless of the tumor stage, the accuracy of CT in detecting perinephric extension was 76.6%(36/47), with a sensitivity of 88.9% (16/18) and specificity of 68.9% (20/29). The cause of understaging (n=2) was microscopic infiltration of the perinephric space. The causes of overstaging were tumor infiltration to the renal capsule (n=5), partial adhesion with the perinephric fat (n=3) and renal vein thrombosis (n=1). A smooth clear tumor margin is highly reliable sign for stage I but infiltrative findings onto renal capsule and perirenal fat could be considered stage I.
Carcinoma, Renal Cell ; Humans ; Renal Veins ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed

A total of 47 preoperative CT scans in patients with renal cell carcinoma were retrospectively reviewed and compared with surgical findings to assess the accuracy of CT for determining the perinephric tumor extension. CT criteria for perinephric extension were hazy ill-defined tumor margin, perirenal nodule and fascial thickening. Regardless of the tumor stage, the accuracy of CT in detecting perinephric extension was 76.6%(36/47), with a sensitivity of 88.9% (16/18) and specificity of 68.9% (20/29). The cause of understaging (n=2) was microscopic infiltration of the perinephric space. The causes of overstaging were tumor infiltration to the renal capsule (n=5), partial adhesion with the perinephric fat (n=3) and renal vein thrombosis (n=1). A smooth clear tumor margin is highly reliable sign for stage I but infiltrative findings onto renal capsule and perirenal fat could be considered stage I.
Carcinoma, Renal Cell ; Humans ; Renal Veins ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed