Analysis of Operational Characteristics and Substantiality Plan of Inpatient Diets for Foreigners in Hospitals

The objectives of this study were to analyze the operational characteristics and to explore the substantiality plan of inpatient diets for foreigners in hospitals. Questionnaires were mail-delivered to 128 hospitals, and a total of 62 questionnaires were usable with a response rate of 48.4 percent. Statistical data analysis was completed using SPSS Win 11.0 for descriptive analysis, independent t-test, and χ2 test. Results can be summarized as follows. The average number of inpatient meals for foreigners in the last 6 months were 405 and 53 for general therapeutic diets and special therapeutic diets, respectively. The rates of hospitals with an exclusive department and exclusive staff for foreign inpatients were 48.4% and 53.2%, respectively. Major nationalities of foreign inpatients were China (37.5%) and Russia (31.3%), and their major medical departments were internal medicine (43.9%) and surgery (39.0%). The number of hospitals that provided inpatient diet only for foreigners was 42 (72.4%) and influencing factors were number of permitted beds (P<0.05), an exclusive department (P<0.001), and exclusive staff (P<0.01). The main type of menu was USA·European style (61.1%), and the price of inpatient meals for foreigners was mostly \10,000~\25,000 (62.0%). As 75.9% of hospitals did not possess dietary slip manuals for foreigners, the case of preparing inpatient meals for foreigners in the form of a general therapeutic diet partially-modified according to disease was the majority (55.4%). Dietitians felt the need for nutrition management guidelines and dietary slip manuals (47.3%) as a substantiality plan of inpatient diets for foreigners. There is a need for exclusive foodservice standards for foreign inpatients in the changing medical environment.

Change in Dietary Intake and Nutritional Status Using Mealworms as Hospital Meal in Postoperative Patients

The purpose of this study was to verify the validity of Mealworms as a hospital meal with increased nutrition density. We provided a meal for postoperative patients and conducted analysis of dietary intake and nutritional status of patients and assessment of acceptability of the meal. This study was carried out as a randomized control trial. Patients were supplied either a hospital meal using Mealworms (Experimental group) or a regular hospital meal (Control group). We investigated the administration amounts of parenteral nutrition (PN) and food intake of patients after surgery and measured anthropometry, body composition, and blood tests before surgery and at hospital discharge. We included 34 postoperative patients who were admitted to Gangnam Severance Hospital from March to September. In the groups of patients not supplied with PN, the experimental group (964.68±284.6 kcal, 38.82±12.9 g) had significantly higher dietary calorie and protein intake than the control group (666.62±153.7 kcal, 24.47±4.9 g)(P<0.05). Additionally in the group of patients not supplied with PN, the experimental group (1.37%) showed a significantly higher increase in fat free mass index than the control group (−3.46%)(P<0.05). In all subjects, calorie density and protein density were significantly higher in the experimental group (P<0.001), and acceptability of calorie (P=0.036) and protein (P=0.001) was also significantly higher in the experimental group. Therefore, the results of this study support the validity of the introduction of hospital meals using Mealworms.

Changes in Nutrient Intake in Patients at Nutritional Risk

The purpose of this study was to examine changes in nutrient intake in patients at nutritional risk. We included 106 malnourished patients who were admitted to Severance Hospital from March to September 2014. The average age was 59.0+/-11.6 years old and 59 patients were male (59.7%). The majority of diagnosis was cancer (94.3%). We evaluated patients' nutritional status by scored patient-generated subjective global assessment (PG-SGA), anthropometric measurement (height, weight, body composition by Bioelectrical impedance analysis), hand grip strength, biochemical and dietary assessment. The patients' daily intakes of energy and protein (1,019.5+/-706.4 kcal, 40.4+/-27.7 g) during hospitalization were significantly lower than their usual intakes (1,382.0+/-499.8 kcal, 54.4+/-25.1 g, P<0.001). Serum levels of albumin, cholesterol, and total lymphocytes were significantly reduced during hospital stay. The negatively influencing factors for reduced dietary intake were anorexia (42.5%), abdominal distention (14.2%), pain (13.2%), and others. The results of this study could be used to establish baseline data for developing new strategies for nutritional intervention in malnourished patients.

Outcome Analysis of Cochlear Implantation in Elderly Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical indications and effect of auditory rehabilitation have not been established in elderly deaf patients who received cochlear implant (CI). The aim of this study is to analyze the outcomes of CI with respect to auditory performance and surgical complication in elderly deaf patients. SUBJECTS AND METHOD: Nineteen postlingually deafened patients who were 60 years and older at the time of implantation were included in the study from April 1992 to October 2006. They were compared to a group of 53 younger patients (<60 years) at the time of implantation. Surgical complications were identified and speech performance was evaluated preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year and 2 years. RESULTS: In the etiology, progressive hearing loss was most common in both groups. Perioperative complications such as temporary dizziness, wound problem, tinnitus, and temporary facial weakness showed no significant differences between elderly and control groups despite higher incidence of underlying disease in elderly patients. Preoperative speech performance (audiologic K-CID) was significantly better in control group than in elderly group, but there were no significant differences in postoperative period. CONCLUSION: The outcomes of CI in the elderly patients have been comparable with those of younger adults. Advanced age alone could not preclude anyone from being candidates of CI.

Cost, Benefit Analysis of Operation System Change in the Hospital Foodservice

Environmental pressures from such sources an economic condition, the government and inter-institutional competition create managerial challenges. Economic pressures may be forcing dietetic dept, in hospital to utilize cost, benefit analysis to assist them in their problem solving. Cost, benefit analysis have been widely used in business, industry and many other fields with only limited application to foodservice. Due to the lack or this information the purposes of this study were to identify use of cost, benefit analysis in hospital foodservice system to evaluate the economic efficiency of alternatives, and to make recommendation for operation system change. Using the cost?benefit method, cash flows are separated into cost and benefits. For an alternative to be selected, indicators, such as NPV, benefit-cost ratio (B/C ratio) with 5% discount rate per annum. The sensitivity analysis was also conducted with difference rate 3%, 7% respectively and reduced employee payroll change. The result of this study can be summarized as follows : 1. The total cost of investment for operation system change was 390,570 thousand won and the total benefit through operation system change was 865,808 thousand won. 2. Net present value(NPV) for 5 years was 475,239 thousand won and benefit-cost ratio was 2.22. 3. In sensitivity analysis with different discount rate 3%, 7%, benefit-cost ratio was 2.25, 2.18 respectively, with total reduced employee payroll change, benefit-cost ratio was 2.86. In conclusion, total benefits were exceeded total costs. Therefore, the project of operation system change in hospital foodservice was found to be economically efficient.

The Effect of Diazepam and Midazolam Pretreatment on Succinylcholine Induced Fasciculation , Muscle Relaxation and Serum Potassium and Creatine Phosphokinase Changes / 대한마취과학회지

It has been already reported that diazepam pretreatment attenuated succinylcholine(Sch)-induced myalgia, fasciculation and potassium elevation. The effect of midazolam, a benzodiazepine derivative like diazepam, on Sch has not been investigated. So Midazolam, d-Tubocurarine and diazepam pretreatment were studied to determine the effect on subsequently administered Sch in 36 female patients. The patients were divided into 4 groups. Group 1 received no pretreatment, only Sch 1mg/kg(control). While Group 2 received d-Tubocurarine 0.05mg/kg, Group 3 received diazepam 0.05 mg/kg, and Group 4 received midazolam 0.025 mg/kg. After the pretreatment 4 minutes before Sch administration, the time to abolition and recovery of twitch height, the degree of fasciculation, the adequacy of relaxation for intubation, the changes in serum potassium and creatine pliosphokinase(CPK) were measured. The results are as follows: I) Group 2 showed increased time to abolition of twitch and decreased time to recovery of twitch. Group 3 showed increased time to recovery of twitch. 2) The incidence of fasciculation was decreased in Groups 2, 3 and 4. 3) Serum potassium was increased in Groups 1 and 2 but not in Groups 3 and 4. 4) Serum creatine phosphokinase was in- creased in all groups at post-Sch. 24 hours. It is concluded that diazepam and midazolam pretreatment attenuate Sch-inducedifasciculation and potassium increase.

The Effect of MgSO4 on the Duration of Epinephrine - induced Arrhythmia Compared to the Effect of Lidocaine in Halothane Anesthetized Rabbits / 대한마취과학회지

The effect of mgSO4 on epinephrine-induced arrhythmia were evaluated in twenty male rabbits anesthetized with halothane. Epinephrine was given intravenously at a rate of 5 mcg/Kg/min by a constant volume infusion pump until two or more premature ventricular contractions occured. The arrhythmogenic dose of epinephrine was determined to be the dose at which the onset of arrhythmia occured. Thirty seconds after the onset of arrhythmia, either mgSO4 8mg/kg(group 1, n=10) or lidocaine 1.5mg/kg(group 2, n=10) was injected and repeated at 30 second intervals up to 4 times until normal sinus rhythm returned. Intravenous injection of mgSO4 decreased the duration of arrhythmia. The arrhythmia duration of group 1(78.5+/-23.9 sec) was shorter than group 2(92.5+/-46.1 sec) but which was statistically insignificant. Two cases of group 1 and four cases of group 2 did not treated by antiarrhythmic agents, but there were not statistically significant. The results of this study show that compared to lidocaine, mgSO4, had a shorter duration of epinephrine-induced cardiac tachyarrhythmia although it was not statistically significant. However malignant ventricular tachyarrhythmia not controllable with lidocaine and other conventional drugs, mgSO4 infusion is recommended.

A Case Report of Transfusion Associated Acute Graft - Versus - Host Disease / 대한마취과학회지

A 46 year old woman was admitted to the Korea University Gynecology department for the resection of a myoma uteri. Upon admission, preoperative laboratory findings revealed a low hemoglobin level of 8.6 gm/dl, Two units of fresh whole blood donated by her two sons were transfused and her post transfusion hemoglobin was corrected to 10,5 gm/dl. On April 22, she received a transabdominal hysterectomy under general anesthesia during which no significant events occured. Aside from fever and coughing, the postoperative course was uneventful She was discharged seven days after surgery. The patient was readmitted on May 3, with chilling, diarrhea, generalized ache, skin rash, diffuse abdominal pain and tenderness. She was send to ICU, but her condition deteriorated rapidly and her skin rash progressed to generalized erythroderma and icterus was noted. Thereafter she became confused, hypotensive and oligurie. Her blood studies revealed pancytopenia and atypical lymphocytes. The patient was died on May 22, despite all efforts. Although the exact causes of death are still unknown, the presumed diagnosis is acute transfusion associated graft-versus-host disease based on clinical symptoms, signs and laboratory data.

The Effects of Depolarizing and Nondepolarizing Muscle Relaxants on Postoperative Sore Throat , Hoarseness , and Myalgia / 대한마취과학회지

The relationship between different muscle relaxants(vecuronium, pancuronium, succinyl- choline) and postoperative sore throat, hoarseness, and myalgia was evaluated in 46 adult ASA class I women undergoing general anesthesia with endotracheal intubation. All patients were anesthetized with thiopental-N2O-O2 and enflurane. The patients were divided into 3 groups. Patients in group 1(n=15) were given vecuronium, group 2(n= 16) pancuronium, and group 3(n =15) succinylcholine. Patient interviews were conducted at 6~10 hours(h) and 24~30 h postoperatively. Evaluation for severity of sore throat, hoarseness and myalgia was accomplished by scoring according to specific criteria. In groups 1, 2, and 3, 6~10 h postoperatively, the incidence of sore throat was 40%, 50%, and 33%; hoarseness was 40%, 31% and 27%; myalgia was 13%, 6% and 20% respectively. In groups 1, 2, and 3, 24-30 h postoperatively, the incidence of sore throat was 7%, 25%, and 53%; hoarseness was 13%, 31%, and 33%; myalgia was 13%, 19%, and 33% respectively. The use of succinyleholine(Sch) resulted in higher incidence of postoperative sore throat at 24-30 h compared with 6-10 h(p<0.05). These results suggest that administration of SCh may contribute to the occurence of postoperative sore throat.

A report of hypercarbia during general anesthesia / 대한구급학회지

No abstract available.

Effects of Radiant heat and Meperidine on Oxygen Consumption in Postanesthesia Shivering / 대한마취과학회지

Radiant heart(RD) and Meperidine(MEP) have been used to suppress postanesthesia shivering. However their efficacies to date have only been assessed by observation of visible shivering. We measured the effects of RH and MEP on oxygen consumption (VO2), minute volume(VE) in sixteen otherwise healthy patients(two groups of eight each) shivering after general anesthesia. RH successfully supressed visible shivering in all patients and was associated with significant decrease in VO2(16% of baseline) and VE(13% of baseline, p<0.05). In the reshivering patients, the effect of RH on VO2 was less than initial RH therapy owing to sustained invisible shivering. MEP suppressed visible shivering in seven patients and was associated with 13% decrease in VO2. In conclusion, RH and MEP are effective methods of reducing the elevated oxygen consumption by shivering.