The Role of Patient and Parents Education in the Management of Pediatric Asthma / 소아알레르기및호흡기학회지

PURPOSE: Patient education is an important part of asthma management. This study was designed to evaluate the role of education program for asthmatic children and their parents. In the western countries, the effectiveness of patient education on improving self-management of asthma has been well documented. However, data from Korean population is lacking. METHODS: We performed the study to evaluate the efficacy of a hospital based education program aimed at improving self-management skills and reducing morbidity. Twenty patient and their parents attending Korea University Ansan Hospital allergy clinic were enrolled in the study. They were instructed 4 times of 10-15 minutes session with every 3 month interval on the pathophysiology of asthma, treatment and the appropriate use of medication including proper inhaler technique and the self-management of their diseases. The instructions were reinforced by three more education session at subsequent outpatient clinic attendance. RESULT: After twelve months, morbidity was assessed by the numbers of hospitalization, emergency department attendance and outpatient clinic attendance, use of oral steroids and steroid inhalation and impairment of quality of life. The efficacy of the education was demonstrated by significant reduction in the number of hospitalization(P<0.005), emergency department visit(P<0.005), outpatient clinic visit(P<0.05) and reduction of oral steroid use(P<0.001). There were also reduction of outpatient department attendance and improvement in steroid inhalation and quality of life. CONCLUSION: The result of this study suggest that a proper patient education is essential in reduction of asthma morbidity and improving in quality of life.

A Model of Education Program for Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: The size of the burden placed on all concerned, the chronicity of the disorder, and the importance of patient compliance in optimal management make asthma an excellent target for the development of patient education programs. Despite the usefulness and the need of the asthma education programs, there is no asthma education programs developed in Korea. In order to develop the education programs for childhood asthma, we offer a model for educating parents, as the first step. METHODS: Most1y, adult education programs consist of 3 components-planning, implication, evaluation. At first, we are going to p1an the asthma education programs for parents of the patients. 2O Volunteers in mothers will be gathered in one c1ass. The curiculum is made of four 1-hour sessions. During the each session, mothers wi1l be taught about the asthma, discuss the shared experiences and practice the skins. RESULTS: This model consists of 4 sessions such as the definition of asthma, the treatment-medicines and correct use of inhalation devices, prevention and the management of acute episodes. CONCLUSIONS: Use of this education model wi1l achieve better control of childhood asthma by leading the parents and patients to participate actively in their asthma treatment. The effects of this program will be assessed by a formal objective evaluation using a pretest, posttest experimental research design.

ED OVERCROWDING AND SPECIAL UNIT FOR OBSERVATION

Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. Overcrowding in ED results in many patients not receiving needed care and impairs the ability of the ED provider to meet the needs of those patients that are treated. The effect of the critically ill patients on the overcrowded emergency department make emergency physicians frustrated. So we created 'the special unit for observation' of critically ill patients and managed them continuously and closely. The special unit for observation have 4 physical beds and monitors and 2 ventilators. One nurse and senior ED residents were asigned to the management of the patients in the special unit. 160 patients(3.4% of all ED visits) admitted to special unit during the period of March 1, 1996 to May 31, 1996. we could continue assessment and management of critically ill patients without psychologic strain or burnout generated by overcrowding. We think that special unit for critically ill patients is a very effective alternative to overcrowded ED.

Triflupromazine , Methoxyflurane and Alcuronium for Pheochromocytoma Anesthesia / 대한마취과학회지

A 21 year-old female underwent resection of a pheochrocytoma under general anesthesia. The patient was treated with phenoxybenzamine for 5 days preoperatively and premedicated with triflupromazien, Librium, Seconal, pethidine, hydroxyzine and atropine in combination. Following indution of anesthesia with intravenous morphine and thiopental sodium, succinylchoine was administered intravenously and endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and methoxyflurane, using a semiclosed carbon dioxide absorption circle system, and alcuronium was injection intermittently. Blood pressure during manipulation of tumor was increased up to 190/130 torr without arrhythmia and transiently dropped to 70/50 torr immediately after removal. Blood pressure was controlled by i.v. Hartmann's solution and whole blood with Solucortef and Effortil but not norepinephrine was needed. There was no marked tachycardis or arrhythmia during anesthesia, so a beta-adrenergic blocker(Inderal) was not used. The importance of preoperative preparation, premedication and selction of anesthetics is discussed.

Clinical Evaluation of Anesthesia for Cesarean Section / 대한마취과학회지

To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicates regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar score and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows: 1) The incidence of cesarean action was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 < p < 0.025). 3) Blood loss in spinal anesthesia (566+/-146 ml) is less than in general anesthesia(796+/-388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anesthesia (3.9%) is more than spinal anesthesia (1.9%). Even though clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above observation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anesthetic method should not be exclusively used.