Nonsurgical endoscopic or percutaneous dilatation and insertion of an endoprosthesis is the treatment of choice in the majority of patiens with incurabie malignant biliary obsturction. But these palliative treatment of extrahepatic cholestasis with an endoscopic or percutaneous biliary endoprosthesis is limited by clogging. One of the factors thought to be of importance is the diameter of the stent. So in order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. Wallstent is braided in the form of a tubular mesh from surgical grade stainless alloy. This prosthesis is geometrically stable, pliable and self expanding. Its elastic properties are such that its diameter can be substantially reduced by moderate elongation. The stent is constrainded on a small diameter delivery catheter(total outside diameter: 9 French). During the implantation procedure the final position of the partially released endoprosthesis can be adjusted by gradual removal of the delivery catheter. If full expansion to 30 French occurs, the stent will be shortened by approximately 30% to their normal length range between 34-102mm. Now in this article we report a new method for endoscopic retrograde placement of biliary Wallstent in a patient with obsturctive jaundice due to periampullary choangiocacrcinoma.
Alloys ; Catheters ; Cholestasis, Extrahepatic ; Dilatation ; Endoscopes ; Humans ; Jaundice ; Palliative Care ; Prostheses and Implants ; Stents

Background: Nivolumab and pembrolizumab are antagonists of the programmed death-ligand 1 (PD-L1) receptor that function as immuno-oncological agents. This study aimed to evaluate the safety and efficacy of nivolumab and pembrolizumab in elderly patients in outpatient settings. Methods: The safety and efficacy of nivolumab and pembrolizumab were compared retrospectively among patients at the Veterans Health Service (VHS) Medical Center in Seoul, South Korea, from September 1, 2017 to August 25, 2018. Results: Eighty-seven patients were selected for the study. The median progression-free survival was 63 days for nivolumab (95% confidence interval (CI), [14 to 282]) vs. 243 days for pembrolizumab (95% CI, [22 to 348]) (p =0.04). The objective response rate (ORR) was 0% in the nivolumab group vs 5.6% in the pembrolizumab group (p =0.310). All the patients exhibited treatmentrelated adverse effects. More than 89% of the patients exhibited diseases of the gastrointestinal (GI) tract. Pneumonia, of grades three or higher, was the most common adverse effect, followed by weakness and anorexia. Conclusions There was no statistically significant difference between the nivolumab group and the pembrolizumab group with respect to the ORR. The incidence and severity of the adverse effects in this study were higher than those of previous studies; however, these adverse effects are generally manageable in a real-world clinical setting. Further randomized controlled studies will be necessary to confirm these results in elderly patients.

Background: Nivolumab and pembrolizumab are antagonists of the programmed death-ligand 1 (PD-L1) receptor that function as immuno-oncological agents. This study aimed to evaluate the safety and efficacy of nivolumab and pembrolizumab in elderly patients in outpatient settings. Methods: The safety and efficacy of nivolumab and pembrolizumab were compared retrospectively among patients at the Veterans Health Service (VHS) Medical Center in Seoul, South Korea, from September 1, 2017 to August 25, 2018. Results: Eighty-seven patients were selected for the study. The median progression-free survival was 63 days for nivolumab (95% confidence interval (CI), [14 to 282]) vs. 243 days for pembrolizumab (95% CI, [22 to 348]) (p =0.04). The objective response rate (ORR) was 0% in the nivolumab group vs 5.6% in the pembrolizumab group (p =0.310). All the patients exhibited treatmentrelated adverse effects. More than 89% of the patients exhibited diseases of the gastrointestinal (GI) tract. Pneumonia, of grades three or higher, was the most common adverse effect, followed by weakness and anorexia. Conclusions There was no statistically significant difference between the nivolumab group and the pembrolizumab group with respect to the ORR. The incidence and severity of the adverse effects in this study were higher than those of previous studies; however, these adverse effects are generally manageable in a real-world clinical setting. Further randomized controlled studies will be necessary to confirm these results in elderly patients.

BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.
Cross Infection ; Humans ; Incidence ; Income ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Nursing ; Odds Ratio ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Prospective Studies* ; Respiration, Artificial ; Risk Factors ; Seoul ; Ventilation ; Ventilators, Mechanical

Background: Interprofessional education (IPE) is important for collaboration between professionals in the team-based practices of the healthcare field. Objectives: This study aimed to examine pharmacy students across in Korea on the experience of IPE and the perceptions of the importance of interprofessional collaboration (IPC) and the need of IPE. Methods: A cross-sectional survey using a 20 questionnaire to pharmacy students nationwide was conducted from March to May 2019. Results: A total of 555 students from 32 pharmacy schools participated. They recognized that the importance of close pharmacist-medical doctor collaboration was an average of 5.38 points (out of 6 points), but the current level of pharmacist-to-medical doctor collaboration was an average of 2.51 points (out of 6 points), and the reasons for the insufficient IPC were the lack of an environment encouraging mutual cooperation (79.5%) and the psychological distance to the other professional (35.3%). They perceived the necessity of IPE between pharmacistmedical doctor was 4.95 points (out of 6 points), with the curriculum including how to cooperate with medical doctors (78.2%), communication skills (51.0%), and understanding of medical doctors’ functions (44.5%), etc. Only 52 respondents (9.4%) had experience in IPE. Respondents who recognized the importance of IPC (≥5 points) showed 4.44-fold higher agreement on the need for IPE than those who did not (≤4 points) (OR 4.44, 95% CI 2.56, 7.68). Conclusions Further attention and discussion to add IPE program in the pharmacy school curriculum is necessary in order to cultivate pharmacists with sufficient professional collaboration capabilities.

Background: Medication’s benefits and harms require careful management. Laws mandate pharmacists to provide essential med-ication details since inadequate counseling may pose risks. This study explores public expectations for pharmacist-provided side effect information to enhance safety. Methods: A self-developed questionnaire was created for participant to self-report, refined through pilot surveys with experts and laypersons. Nineteen items were categorized into four sections, using closed-ended ques-tions. Adults over 20, having obtained prescription medications within the past year, were surveyed via convenience sampling.Data analysis employed descriptive statistics and T-tests using IBM SPSS Statistics 21 and Microsoft Excel. Results: The study involved 189 participants, with a slightly higher proportion of females (59.3%) than males (40.7%), predominantly in their 20s (45.0%) and college graduates (57.1%). Health professionals represented 76.2% of respondents. Over half visited pharmacies at least 5 times yearly for prescriptions. Indirect experience with side effects was more common (30.2%) than direct experience (17.5%). Most (82.0%) showed interest in media-reported side effect events. Satisfaction with pharmacist-provided side effect explanations was low (59.7%), but importance was high (98.9%). Preferences favored combined verbal and written explanations (65.1%), with a majority desiring explanations for common but less serious side effects (82.5%). Healthcare professionals found explanations significantly more sufficient than non-professionals did. Older individuals, those living with elderly, and frequent pharmacy visitors attributed greater importance to pharmacist-provided explanations. Conclusion Koreans view pharmacist-pro-vided medication side effect explanations as vital but find current services lacking. Enhancements in content and delivery meth-ods are needed in pharmacy counseling to meet public expectations.

Background: Medication’s benefits and harms require careful management. Laws mandate pharmacists to provide essential med-ication details since inadequate counseling may pose risks. This study explores public expectations for pharmacist-provided side effect information to enhance safety. Methods: A self-developed questionnaire was created for participant to self-report, refined through pilot surveys with experts and laypersons. Nineteen items were categorized into four sections, using closed-ended ques-tions. Adults over 20, having obtained prescription medications within the past year, were surveyed via convenience sampling.Data analysis employed descriptive statistics and T-tests using IBM SPSS Statistics 21 and Microsoft Excel. Results: The study involved 189 participants, with a slightly higher proportion of females (59.3%) than males (40.7%), predominantly in their 20s (45.0%) and college graduates (57.1%). Health professionals represented 76.2% of respondents. Over half visited pharmacies at least 5 times yearly for prescriptions. Indirect experience with side effects was more common (30.2%) than direct experience (17.5%). Most (82.0%) showed interest in media-reported side effect events. Satisfaction with pharmacist-provided side effect explanations was low (59.7%), but importance was high (98.9%). Preferences favored combined verbal and written explanations (65.1%), with a majority desiring explanations for common but less serious side effects (82.5%). Healthcare professionals found explanations significantly more sufficient than non-professionals did. Older individuals, those living with elderly, and frequent pharmacy visitors attributed greater importance to pharmacist-provided explanations. Conclusion Koreans view pharmacist-pro-vided medication side effect explanations as vital but find current services lacking. Enhancements in content and delivery meth-ods are needed in pharmacy counseling to meet public expectations.

Background: Medication’s benefits and harms require careful management. Laws mandate pharmacists to provide essential med-ication details since inadequate counseling may pose risks. This study explores public expectations for pharmacist-provided side effect information to enhance safety. Methods: A self-developed questionnaire was created for participant to self-report, refined through pilot surveys with experts and laypersons. Nineteen items were categorized into four sections, using closed-ended ques-tions. Adults over 20, having obtained prescription medications within the past year, were surveyed via convenience sampling.Data analysis employed descriptive statistics and T-tests using IBM SPSS Statistics 21 and Microsoft Excel. Results: The study involved 189 participants, with a slightly higher proportion of females (59.3%) than males (40.7%), predominantly in their 20s (45.0%) and college graduates (57.1%). Health professionals represented 76.2% of respondents. Over half visited pharmacies at least 5 times yearly for prescriptions. Indirect experience with side effects was more common (30.2%) than direct experience (17.5%). Most (82.0%) showed interest in media-reported side effect events. Satisfaction with pharmacist-provided side effect explanations was low (59.7%), but importance was high (98.9%). Preferences favored combined verbal and written explanations (65.1%), with a majority desiring explanations for common but less serious side effects (82.5%). Healthcare professionals found explanations significantly more sufficient than non-professionals did. Older individuals, those living with elderly, and frequent pharmacy visitors attributed greater importance to pharmacist-provided explanations. Conclusion Koreans view pharmacist-pro-vided medication side effect explanations as vital but find current services lacking. Enhancements in content and delivery meth-ods are needed in pharmacy counseling to meet public expectations.

Background: Medication’s benefits and harms require careful management. Laws mandate pharmacists to provide essential med-ication details since inadequate counseling may pose risks. This study explores public expectations for pharmacist-provided side effect information to enhance safety. Methods: A self-developed questionnaire was created for participant to self-report, refined through pilot surveys with experts and laypersons. Nineteen items were categorized into four sections, using closed-ended ques-tions. Adults over 20, having obtained prescription medications within the past year, were surveyed via convenience sampling.Data analysis employed descriptive statistics and T-tests using IBM SPSS Statistics 21 and Microsoft Excel. Results: The study involved 189 participants, with a slightly higher proportion of females (59.3%) than males (40.7%), predominantly in their 20s (45.0%) and college graduates (57.1%). Health professionals represented 76.2% of respondents. Over half visited pharmacies at least 5 times yearly for prescriptions. Indirect experience with side effects was more common (30.2%) than direct experience (17.5%). Most (82.0%) showed interest in media-reported side effect events. Satisfaction with pharmacist-provided side effect explanations was low (59.7%), but importance was high (98.9%). Preferences favored combined verbal and written explanations (65.1%), with a majority desiring explanations for common but less serious side effects (82.5%). Healthcare professionals found explanations significantly more sufficient than non-professionals did. Older individuals, those living with elderly, and frequent pharmacy visitors attributed greater importance to pharmacist-provided explanations. Conclusion Koreans view pharmacist-pro-vided medication side effect explanations as vital but find current services lacking. Enhancements in content and delivery meth-ods are needed in pharmacy counseling to meet public expectations.

OBJECTIVE: The purposes of this study were to investigate the factors influencing life satisfaction and quality of life (QOL) of the disabled persons and to help the planning and evaluation of Community Based Rehabilitation (CBR). METHOD: Data were collected through personal interviews of 503 registrated disabled persons in Uiwang City. Demographic variables and scores of modified Barthel index (MBI), modified Lambeth disability screening questionnaire (MLDSQ), Craig handicap assessment and reporting technique (CHART) and life domain satisfaction measure (LDSM) were obtained. RESULTS: The score of LDSM was 4.0+/-1.0. Life satisfaction was related to the age, sex, employment status, severity of disability, educational level, housing and residence, level of instrumental activities of daily living and social integration. MLDSQ score was the most strong predictor of life satisfaction (p=0.00) followed by social integration (p=0.001) and total CHART scores (p=0.017). And the factors influencing the handicap were monthly income, severity of disability, employment, level of education and age. CONCLUSION: Based on our study, we suggest that the CBR program of Uiwang City need to focus on improving functional ability and social skill of disabled individual and housing, and also promoting their vocational and educational status.
Activities of Daily Living ; Disabled Persons* ; Education ; Educational Status ; Employment ; Gyeonggi-do* ; Housing ; Humans ; Mass Screening ; Quality of Life* ; Surveys and Questionnaires ; Rehabilitation