In order to provide more effective and personalized healthcare services to patients and healthcare professionals, intelligent active knowledge management and reasoning systems with semantic interoperability are needed. Technological developments have changed ubiquitous healthcare making it more semantically interoperable and individual patient-based; however, there are also limitations to these methodologies. Based upon an extensive review of international literature, this paper describes two technological approaches to semantically interoperable electronic health records for ubiquitous healthcare data management: the ontology-based model and the information, or openEHR archetype model, and the link to standard terminologies such as SNOMED-CT.
Aluminum Hydroxide ; Carbonates ; Delivery of Health Care ; Electronic Health Records ; Electronics ; Electrons ; Humans ; Knowledge Management ; Semantics

The purpose of this study was to investigate the effects of an oral health care education program for care providers on the nutritional status of the elderly in a long-term care facility. This study was conducted at a long-term care facility located in K metropolitan city using a nonequivalent control group non-synchronized design. Fifty-four nursing home residents aged 65 years or older were assigned either to the intervention group (n=27) or the control group (n=24). The intervention group received oral health care from the care providers' intervention group, who provided oral health care for 6 weeks after 6 weeks of oral health care education. Data were collected from the control group and intervention group at the baseline 6 and 12 weeks after oral care education and were analyzed using SPSS windows 16.0. The halitosis was lower in the intervention group than the control group at 12 weeks (P<0.01). Body mass index of the intervention group at 12 weeks was higher than that at 6 weeks. Iron intake of the intervention group at 12 weeks was lower than that at baseline. At baseline, the intakes of riboflavin, folate, and potassium were lower than 75% of dietary reference intakes. In conclusion, an oral care education program for care providers was effective in improving the oral hygiene of nursing home residents, and dietary plans are needed to improve the nutritional status of them.
Aged ; Body Mass Index ; Folic Acid ; Halitosis ; Humans ; Iron ; Long-Term Care ; Nursing Homes ; Nursing Staff ; Nutritional Status ; Oral Health ; Oral Hygiene ; Potassium ; Riboflavin

BACKGROUND: Benzodiazepines acting on the GABA receptor complex in the spinal cord are known to induce antinociception. In the present study we aimed to evaluate the effect of intrathecal midazolam with bupivacaine following hemorroidectomy. METHODS: Forty five patients were involved in this study. Patients were randomly allocated to one of 3 groups: the control group received 0.5% heavy bupivacaine 5 mg and 0.9% NaCl 0.2 ml intrathecally, group BM1 0.5% bupivacaine and midazolam 1 mg (0.2 ml), group BM2 0.5% bupivacaine 5 mg and midazolam 2 mg (0.4 ml), respectively. The analgesic effects and side effects were compared among the 3 groups. RESULTS: There was a significant difference among the 3 groups in time-to-first-pain medication and total consumption of analgesics during the 24 h after surgery. Furthermore, the analgesic effect of midazolam was dose-dependent: 2 mg of midazolam showed better results than 1 mg. All the patients showed no considerable side effects. CONCLUSIONS: We conclude that intrathecal midazolam caused a significant delay in time-to-first-pain medication and reduced utilization of analgesics within 24 h. Therefore, intrathecal midazolam can be used as an effective adjunct for spinal anesthesia for postoperative pain control.
Analgesics ; Anesthesia, Spinal* ; Benzodiazepines ; Bupivacaine* ; Hemorrhoidectomy* ; Humans ; Midazolam* ; Pain, Postoperative ; Receptors, GABA ; Spinal Cord

While constipation is a common symptom in Korea, there are no existing treatment guidelines. Although constipation may occur as a result of organic cause, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. The present paper deals with only the management of functional constipation: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, and stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents that affect peristalsis through selective interaction with 5-hydroxytryptamine-4 receptors can be effective in patients with constipation who cannot get adequate relief from current laxatives. Biofeedback can relieve symptoms in selected patients with pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation.
Biofeedback, Psychology ; Cathartics/therapeutic use ; Constipation/surgery/*therapy ; Dietary Fiber/therapeutic use ; Electric Stimulation Therapy ; Exercise Therapy ; Health Behavior ; Humans ; Laxatives/therapeutic use ; Serotonin 5-HT4 Receptor Antagonists/therapeutic use ; Surface-Active Agents/therapeutic use

PURPOSE: The aim of this study was to investigate the satisfaction of newly graduated nurses with educational programs and their experiences in role transition. METHODS: Data were collected from November 1 to December 15, 2018 and 483 new graduate nurses working at 15 tertiary hospitals and 10 general hospitals participated. For data collection, self-report questionnaires including the Casey-Fink Graduate Nurse Experience Survey tool and satisfaction with education were used. Data were analyzed using descriptive statistics, t-test, and one-way analysis of variance. RESULTS: Satisfaction with education ranged from 3.09 to 3.27, and satisfaction with preceptors was 3.45(maximum 4). The skill that new nurses ranked as most difficult during the first 3 months was charting/documentation, and throughout a whole year, the top 4 difficult skills were cardiopulmonary resuscitation/emergency response, ventilator care, end-of-life care, and prioritization/time management. In comfort/confidence, new graduates felt most comfortable with support and least comfortable with patient safety. More than 50 percent of new graduates experienced stress during role transition, and the most frequently experienced stressors were related to job performance and personal life. Levels of satisfaction with education and comfort/confidence differed according to the hospital type and number of preceptors for new nurses. CONCLUSION In order to facilitate the transition of new graduate nurses to professional nurse, an extended period of education, systematic and standardized transition programs, and continuous support during the first year of practice are required.

BACKGROUND: The expansion and strengthening of primary care is approved as the only method to revise the ineffective health care system in Korea. In such a system, we intended to analyze the functional and regianal distribution of specialists by investigating and classifying the hospitals where residents who completed their training in a university hospital located in Seoul for seven years are working and by acquiring the distribution of the subjects who are practicing as primary care physicians by year, specialties and location. METHODS: We selected 384 specialists, all of whom were trained as residents at a university hospital located in Seoul from 1987 to 1993. The hospitals they worked at were classified as primary, secondary and tertiary care hospitals according to the classification in the health care administration. The location of primary care hcspitals among them was plotted an two maps; one of Seoul, the other of Korea. RESULTS: The number of females in the subjects was 68(17.7%) and that of males 316(82.3%). The number of practitianers was 156(40.6%) and that of specialists working at the secondary care hospitals was 55(14.3%), and 147 specialists were working at the tertiary care hospitals(38.3%). With regard to the pereentage of practitioners, dermatologic specialists presented with 60%, and relatively high group included obstetrics and gynecology(59.2%), family medicine(54.5%), plastic surgery(52.6%), otolaryngology (52.0%), pediatrics(51.7%), and orthopedics(48.6%).In tertiary care hospital, chest surgery showed 72.7% as highest. Radiologic ancology presented with 66.7% and anatamical pathology with 66.7%. As to the location of primary care hospitals, 41.0% were in Seoul and 38.5% in Kyungkido. And the rest of the 20. 5% were located in other areas of Korea. CONCLUSIONS: Considering the results of the study that show a great number of specialists are actually practicing as primary care physicians after their specialists training, the present training system of specialists needs to be revised and cantrolled in structure.
Classification ; Delivery of Health Care ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Obstetrics ; Otolaryngology ; Pathology ; Physicians, Primary Care ; Primary Health Care ; Secondary Care ; Seoul ; Specialization ; Tertiary Healthcare ; Thorax

BACKGROUNDS: Recent studies of population trends demonstrate massive increases in both absolute numbers and percentage of our aging population. A large proportion of the population older than 65 years has age-related sensory losses that impair food intakes, overall health, self-sufficiency, and quality of life. Thus, this study was performed investigate the subjective and objective changes of taste perception in Korean elderly. METHODS: The subjects were 22 male and 109 female normal elderly persons aged 55 to 81(mean: 70+4.5) years without diabetes mellitus. They were recruited from senior citizen centers in Northern area of Seoul. The agents used for taste measurements are; sodium chloride for salt taste ; sucrose, for sweet; Glacial acetic acid, for sour; and Quinine hemisulfate for buffer. Taste threshold was measured by determining detection and recognition thresholds for all 4 taste qualities by a forced-choice, three-stimulus drop technique. Taste threshold was obtained by dropping solutions on the right sides of the tip of the tongue for salt taste, anterior lateral side for sweet, posterior lateral side, for sour taste, and back of the tongue for buffer taste. RESULTS: Among subjects, 52(40%) had hypertension, 12(9%) heart disease, and 18(14%) hypercholesterolemia. Male subjects had lower detection threshold for salt taste compared to that of females. The subjects with hypercholestrolemia had higher detection threshold for buffer taste(p<0.05). Male subjects had higher recognition threshold for buffer taste compared to that of females(p<0.05). The subjects with hypertension, heart problems, history of smoking, drinking, or medication had no significant changes in detection and recognition taste threshold of 4 different taste. Twenty one(16%) subjects experienced symptoms of dysgeusia, thirty(23%) hypogeusia. None of them reported symptoms of phantogeusia, cacogeusia, or heterogeusia. The subjects with dysgeusia had higher detection threshold for sweet taste(p<0.05). CONCLUSION: Male subjects had lower detection threshold for salt taste and higher recognition threshold for buffer taste compared to those of females in Korean elderly(p<0.05). The subjects with hypercholesterolemia had higher detection threshold for buffer taste(p<0.05), and the subjects with dysgeusia had higher detection threshold for sweet taste(p<0.05). Thus, sex-related salty and buffer taste perception were observed in the elderly and dysgeusia had an effect on sweet taste. These results suggest that these taste perception changes seem to have an influence on nutritional and health status of the elderly and we should consider these taste perception changes to prepare the dietary guidelines for healthy life of the elderly.
Acetic Acid ; Aged* ; Ageusia ; Aging ; Diabetes Mellitus ; Drinking ; Dysgeusia ; Female ; Heart ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Nutrition Policy ; Quality of Life ; Quinine ; Seoul ; Smoke ; Smoking ; Sodium Chloride ; Sucrose ; Taste Perception* ; Taste Threshold ; Tongue

BACKGROUND: Myasthenia gravis is an autoimmune neuromuscular disorder that shows increased sensitivity to nondepolarizing muscle relaxants. Atracurium is eliminated by Hofmann elimination and ester hydrolysis. We studied the onset and duration of atracurium in patients with myasthenia gravis. METHODS: Ten patients undergoing thymectomy for myasthenia gravis and ten patients of ASA Class I-II without liver, kidney and neuromuscular disease for orthopedic surgical procedures were assigned. Anesthesia was induced with thiopental (4~5 mg/kg) and maintained with inhalation of N2O:O2 (1:1) and enflurane (1.0~2.0 vol%). Atracurium (0.5 mg/kg) was given as a muscle relaxant and then intubation was performed after twitch response was depressed more than 80%. Neuromuscular relaxation was assessed by TOF (T1) at the adductor pollicis with supramaximal stimulation of ulnar nerve at 2 Hz every 12 seconds. The onset and the duration of 5, 25, 50, 75% recovery time of T1 and the recovery index were recorded. RESULTS: Onset of block was shortened and recovery time of 5, 25, 50, 75% and recovery index were prolonged in patients with myasthenia gravis. Conlusions: In patients with myasthenia gravis, atracurium induced rapid onset time and prolonged recovery time of 5, 25, 50, 75% and recovery index.
Anesthesia ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Inhalation ; Intubation ; Kidney ; Liver ; Myasthenia Gravis* ; Neuromuscular Diseases ; Orthopedic Procedures ; Relaxation ; Thiopental ; Thymectomy* ; Ulnar Nerve

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
Female ; Granuloma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pyrazines ; Retrospective Studies ; Seroma ; Urinary Retention

PURPOSE: This study was to determine the effects of abdominal breathing training using biofeedback on stress, immune response, and quality of life. METHOD: The study design was a nonequivalent control group pretest- posttest, quasi-experimental design. Twenty-five breast cancer patients who had completed adjuvant chemotherapy were enrolled. The experimental group(n=12) was provided with abdominal breathing training using biofeedback once a week for 4 weeks. State anxiety, cancer physical symptoms, serum cortisol, T cell subsets(T3, T4, T8), NK cell and quality of life were measured both before and after the intervention. RESULT: Though state anxiety, cancer physical symptoms, and serum cortisol were reduced after 4 weeks of abdominal breathing training using biofeedback, there was no statistical significance. It showed, however, improvement in quality of life (p=.02), and T3(p=.04). CONCLUSION: Abdominal breathing training using biofeedback improves quality of life in breast cancer patients after a mastectomy. However, the mechanism of this beneficial effect and stress response requires further investigation with special consideration in subject selection and frequency of measurement. Nurses should consider this strategy as a standard nursing intervention for people living with cancer.
*T-Lymphocyte Subsets ; Stress, Psychological/psychology/therapy ; *Quality of Life ; Middle Aged ; Mastectomy/*psychology/rehabilitation ; Hydrocortisone/blood ; Humans ; Female ; *Breathing Exercises ; Breast Neoplasms/immunology/*psychology/surgery ; *Biofeedback (Psychology) ; Adult