Biomedical subjects
Publications and source records attributed to Youn Seon Choi.
Up to recently, a few cases of myocarditis in the cardiac manifestations of scrub typhus have been reported. However, acute myocardial infarction (AMI) associated with scrub typhus has not been previously reported. We presented a case of AMI ensued on scrub typhus, which were successfully treated by percutaneous coronary intervention (PCI).
Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.
Appropriate pain assessment is very important for managing cancer pain. This study was designed to evaluate the utility of the Korean Cancer Pain Assessment Tool (KCPAT) by assessing changes in the management of cancer pain. The changes in pain intensity, the pattern of drug prescriptions, and the patients' satisfaction with pain control were analyzed after using the KCPAT. The results indicated that pain medicine prescriptions were changed in 194 (51.5%) cases after using the KCPAT, and 69.5% of these changes were affected by the KCPAT. After using the KCPAT, pain intensity as assessed by the Visual Analogue Scale (VAS, 0-10cm) decreased (4.31+/-2.35 vs. 3.60+/-2.45, P<0.0001), and the presence of associated symptoms and psychosocial items was significantly reduced. The patients' satisfaction with pain control was improved. Forty-four physicians (89.8%) thought that the KCPAT was useful. The KCPAT improved patients' satisfaction with pain control and was a useful tool for evaluating and managing cancer pain.
Inflammation and thrombogenesis have been suggested as possible causes for cardiovascular events in patients suffering from metabolic syndrome (MS). The primary objective of this study was to determine the relationship between red blood cell (RBC) or white blood cell (WBC) subtypes and MS. The secondary objective was to reveal any gender differences inherent to this association. Body mass index (BMI), blood pressure, serum high-density lipoprotein cholesterol, triglycerides, and glucose were measured. The numbers of WBC subtypes and RBCs were determined in healthy adults. In male subjects, the numbers of total leukocytes, neutrophils, and lymphocytes was elevated in the MS patients (P<0.05). In the male subjects, the numbers of total leukocytes, neutrophils, and lymphocytes were elevated in accordance with the metabolic component count (P<0.05). RBC, monocyte, eosinophil, and basophil counts did not differ in accordance with metabolic component counts (r = 0.406, r = 0.304, r = 0.366; P<0.05). In the female subjects, we determined there to be no differences in the numbers of RBC and WBC subtypes in the MS patients, in accordance with metabolic component counts. The numbers of total leukocytes, neutrophils, and lymphocytes were elevated in the male MS subjects in this study, and these counts increased in accordance with the metabolic component counts. In the female subjects in this study, we determined there to be no association between RBC and WBC subtype counts with MS.
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The Korean Cancer Pain Assessment Tool (KCPAT), which was developed in 2003, consists of questions concerning the location of pain, the nature of pain, the present pain intensity, the symptoms associated with the pain, and psychosocial/spiritual pain assessments. This study was carried out to evaluate the reliability and validity of the KCPAT. A stratified, proportional-quota, clustered, systematic sampling procedure was used. The study population (903 cancer patients) was 1% of the target population (90,252 cancer patients). A total of 314 (34.8%) questionnaires were collected. The results showed that the average pain score (5 point on Likert scale) according to the cancer type and the at-present average pain score (VAS, 0-10) were correlated (r=0.56, p<0.0001), and showed moderate agreement (kappa=0.364). The mean satisfaction score was 3.8 (1-5). The average time to complete the questionnaire was 8.9 min. In conclusion, the KCPAT is a reliable and valid instrument for assessing cancer pain in Koreans.
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Relapsing polychondritis is a multisystemic disease of unknown etiology that mainly involves the cartilaginous portions of the ear, nose, and trachea. Occasionally, there is involvement of the cardiovascular system, which usually results in severe morbidity and mortality. The most common manifestation of cardiovascular involvement is aortic root dilation resulting in aortic regurgitation. We describe the first case in Korea, a 51-year-old woman with relapsing polychondritis with aortitis, but without aortic valve involvement. She presented only with complaints of abdominal pain, and was successfully treated with corticosteroids and methotrexate.
Opioid antagonists have well-established indications in the reversal of life-threatening opioid toxicity, but also hold considerable promise for other applications in palliative care practice, particularly management of opioid-related constipation. We briefly review current understanding of opioid receptors, focusing on their complex role in gastrointestinal physiology. We summarize the pharmacology, conventional indications, and clinical usage of three major groups of opioid antagonists, including a promising new peripherally acting agent, methylnaltrexone, which is not commercially available. We suggest an approach to administering opioid antagonists for reduction of life-threatening opioid toxicity in patients with pain. The literature on opioid-induced constipation and its treatment with opioid-antagonists is reviewed in detail. Finally, other potential uses of opioid antagonists in palliative care are described, especially strategies for reducing such opioid side effects as nausea and pruritus and for improving analgesia or reducing tolerance by concomitantly administrating both an opioid agonist and low dosages of an antagonist.
In the United States, hospice and palliative care are two distinct expressions of the hospice interdisciplinary team approach to end-of-life care, which originated in Great Britain in the 1960s. The hospice movement developed largely as a home-care program and alternative to conventional care. Hospice regulations and reimbursement allowances limit services to patients who are expected to die within 6 months and who forego many common oncologic treatments. On the other hand, palliative care is a more recent academic, medically mainstream discipline that attempts to integrate the hospice approach into oncology and other areas of clinical medicine from the earliest phases of diagnosis and treatment. Palliative care entertains all appropriate forms of care at any phase of an illness. In this review, we describe the key goals of palliative care, which include excellent pain and symptom control, psychosocial and spiritual support for the patient and family, informed decision-making, and coordinated services across the continuum of care. We focus on selected recent developments that are important to oncology practice: the role of artificial nutrition; management of malignant small bowel obstruction; communication tasks, such as information sharing, recognition of patient preferences, advanced-care planning, and bereavement care; and ethical principles related to the hastening of death.