Text Network Analysis of Newspaper Articles on Life-sustaining Treatments

PURPOSE: This study tried to understand discourses of life-sustaining treatments in general daily and healthcare newspapers. METHODS: A text-network analysis was conducted using the NetMiner program. Firstly, 572 articles from 11 daily newspapers and 258 articles from 8 healthcare newspapers were collected, which were published from August 2013 to October 2016. Secondly, keywords (semantic morphemes) were extracted from the articles and rearranged by removing stop-words, refining similar words, excluding non-relevant words, and defining meaningful phrases. Finally, co-occurrence matrices of the keywords with a frequency of 30 times or higher were developed and statistical measures—indices of degree and betweenness centrality, ego-networks, and clustering—were obtained. RESULTS: In the general daily and healthcare newspapers, the top eight core keywords were common: “patients,” “death,” “LST (life-sustaining treatments),” “hospice palliative care,” “hospitals,” “family,” “opinion,” and “withdrawal.” There were also common subtopics shared by the general daily and healthcare newspapers: withdrawal of LST, hospice palliative care, National Bioethics Review Committee, and self-determination and proxy decision of patients and family. Additionally, the general daily newspapers included diverse social interest or events like well-dying, euthanasia, and the death of farmer Baek Nam-ki, whereas the healthcare newspapers discussed problems of the relevant laws, and insufficient infrastructure and low reimbursement for hospice-palliative care. CONCLUSION: The discourse that withdrawal of futile LST should be allowed according to the patient's will was consistent in the newspapers. Given that newspaper articles influence knowledge and attitudes of the public, RNs are recommended to participate actively in public communication on LST.

Comparison of several dosing schedules of intravenous dexmedetomidine in elderly patients under spinal anesthesia

BACKGROUND: Many clinicians have probably used subjective, unscientific methods for dose reduction to avoid overdose in elderly patients. The aim of this study was to compare several dosing schedules of intravenous dexmedetomidine (DEX) to identify the appropriate dosing schedule within the therapeutic dose range for adequate sedation of elderly patients under spinal anesthesia. METHODS: After administration of spinal anesthesia, a loading dose of DEX was injected over 10 min in three groups with the following dosages: group A, 1.0 μg/kg of actual body weight; group B, 1.0 μg/kg of ideal body weight (IBW); and group C, 0.8 μg/kg of IBW. Then, a maintenance infusion (0.5 μg/kg of each BW/h) was administered. The bispectral index score (BIS), the time required to reach BIS 80, airway obstruction score, and the occurrence of bradycardia were recorded. RESULTS: The changes in the BIS among the groups over time were found to have statistically significant differences (P < 0.001). The times required to reach BIS 80 were 6.1 ± 5.3 min, 5.0 ± 3.6 min, and 11.0 ± 8.6 min in groups A, B, and C, respectively (P < 0.001). The airway obstruction score and the frequency of bradycardia did not have statistically significant differences among the groups. CONCLUSIONS: An initial loading dose of DEX that is 0.8 μg/kg of IBW over 10 min, followed by an infusion rate of less than 0.5 μg/kg of IBW/h may be adequate for sedation in elderly patients receiving spinal anesthesia.

Comparison of several dosing schedules of intravenous dexmedetomidine in elderly patients under spinal anesthesia

BACKGROUND: Many clinicians have probably used subjective, unscientific methods for dose reduction to avoid overdose in elderly patients. The aim of this study was to compare several dosing schedules of intravenous dexmedetomidine (DEX) to identify the appropriate dosing schedule within the therapeutic dose range for adequate sedation of elderly patients under spinal anesthesia. METHODS: After administration of spinal anesthesia, a loading dose of DEX was injected over 10 min in three groups with the following dosages: group A, 1.0 μg/kg of actual body weight; group B, 1.0 μg/kg of ideal body weight (IBW); and group C, 0.8 μg/kg of IBW. Then, a maintenance infusion (0.5 μg/kg of each BW/h) was administered. The bispectral index score (BIS), the time required to reach BIS 80, airway obstruction score, and the occurrence of bradycardia were recorded. RESULTS: The changes in the BIS among the groups over time were found to have statistically significant differences (P < 0.001). The times required to reach BIS 80 were 6.1 ± 5.3 min, 5.0 ± 3.6 min, and 11.0 ± 8.6 min in groups A, B, and C, respectively (P < 0.001). The airway obstruction score and the frequency of bradycardia did not have statistically significant differences among the groups. CONCLUSIONS: An initial loading dose of DEX that is 0.8 μg/kg of IBW over 10 min, followed by an infusion rate of less than 0.5 μg/kg of IBW/h may be adequate for sedation in elderly patients receiving spinal anesthesia.

A loading dose of 1 µg/kg and maintenance dose of 0.5 µg/kg/h of dexmedetomidine for sedation under spinal anesthesia may induce excessive sedation and airway obstruction

BACKGROUND: For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical. METHODS: Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 µg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 µg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients' vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection. RESULTS: The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60-80 at 30 and 50 min. CONCLUSIONS: A loading dose of DEX 1 µg/kg for 10 min, and a maintenance dose of DEX 0.5 µg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.

Vesicoureteral Reflux Managed with Gil-Vernet Technique / 대한비뇨기과학회지

Vesicoureteral reflux (VUR) is common disease found in up to 70% of children who have urinary tract infection, and the various type of antireflux surgerys were used to correct the problem. Among them, Gil-Vernet antireflux technique is a useful method and it has many advantages such as procedure of simplicity, shorter operative time, and lower complication rate along with maintaining high success rate. We present six cases of vesicoureteral reflux who had been managed with Gil-Vernet antireflux technique, and review the advantages, disadvantages, complications, and usefulness of the procedure.

Experience of Extracorporeal Shock Wave Lithotripsy (ESWL) with EDAP-LT01: A Report of 660 Cases / 대한비뇨기과학회지

PURPOSE: Since ESWL had been developed, many experiences of the treatments to urinary stones with various type of lithotriptors were reported. We evaluated the efficacy of EDAP-LT01 piezoelectric lithotriptor according to the size, location of the stone, number of the treatment session, adjuvant therapy and cause of failure. MATERIALS AND METHODS: We retrospectively analyzed the data of 660 cases who had been treated with ESWL. Among the patients, the renal stones were 122, the ureteral stones were 452, and combined with renal and ureteral stones were 43 cases. The mean size of stones was 13mm (range: 4-38mm). ESWL was performed to all the patients with urinary stones except complete staghorn calculi. No anesthesia was performed except in one child (5 years old). RESULTS: Overall success rate was 94.7%, and there were close correlations between the success rate and the size. The mean number of sessions was 2.4. There was no significant complication, but 35 cases were failed by ESWL monotherapy, and auxiliary procedures were done in 21 cases. Efficiency quotient was 0.59. CONCLUSIONS: The ESWL with EDAP-LT01 seems to be effective and safe to treat the urinary stones of various location and size, even compared to the lithotriptors of other type. We also propose that ESWL monotherapy with this machine is efficient for the treatment of the partial staghorn calculi and stones larger than 30mm.

A Case of Male Urethral Diverticulum with Giant Calculi / 대한비뇨기과학회지

We present one case report of anterior urethral diverticulum in a male with giant calculi. The patient was a 56-year-old male with the complaints of base-ball sized palpable scrotal mass and post-void dribbling for 15-16 years. The diverticulum was filled with multiple whitish-yellow stones. The largest one was 8X7X6cm in size.