• 병원약사회지
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• 제35권4호
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• pp.391-399
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• 2018

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

• 임상간호연구
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• 제15권1호
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• pp.133-147
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• 2009

Purpose: This study was conducted to construct evidence based clinical guidelines and to develop nursing process based performance measures for prevention and management of pressure ulcers, falls and pain. Method: Clinical guidelines were drafted through a comprehensive review of relevant literature, national guidelines and hospital protocols. The proposed guidelines were reviewed by a panel of experts and 90 hospital nurses, and refined on the basis of their suggestions. Nursing process based performance measures were developed based on the clinical guidelines and content validity was examined by surveys from 90 hospital nurses. Results: All items, except timetable for position change and pressure ulcer nursing record, in the guidelines for prevention and management of pressure ulcer were appropriate. Most items, except fall risk assessment tools, were appropriate for the guidelines of fall prevention. All other items, except the purpose of pain management, were appropriate for the guidelines of pain management. Performance measures developed in this study were acceptable as a tool to evaluate quality of nursing care. Conclusion: Nursing process based performance measures provide important indicators to monitor whether necessary nursing care is implemented and can be used as the primary resources to improve quality of nursing services.

• 대한치과의사협회지
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• 제37권3호통권358호
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• pp.197-204
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• 1999

서울대학교 치과병원에서는 지난 1월 '국민과 함께하는 21세기 초일류 치과병원'이라는 21세기 비전을 제시했다. 서울대학교 치과병원 외에도 각 대학의 치과병원에서는 경영의 합리화를 꾀하고 진료의 질을 높이며 지역사회와 함께 하기 위한 21세기 비전을 준비중이다. 이에 11개 치대병원의 21세기 비전에 대해서 살펴본다.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권3호
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• pp.180-185
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• 2018

Background/Aims: We aimed to compare the outcomes of Helicobacter pylori eradication in patients receiving sequential therapy (ST) depending on the use of ecabet sodium (ES). Materials and Methods: Between January to December 2015, 176 patients randomly received either ST alone (n=72) or 10-day ES therapy combined with ST (n=104). After applying the exclusion criteria, 56 patients were finally assigned to the ST-only group and 84 to the ST with ES group. We retrospectively reviewed and analyzed the H. pylori eradication rate and adverse events between the two groups. Results: Among the 140 patients, 121 (86.4%) achieved successful H. pylori eradication and 24 (17.1%) had adverse events. Eradication was achieved in 50 patients (89.3%) in the ST-only group and in 71 patients (84.5%) in the ST with ES group (P=0.420). No significant difference in the incidence of adverse events was found between the ST-only and ST with ES groups (12.5% vs. 20.2%, respectively; P=0.234). However, the ST with ES group tended to have a higher prevalence of nausea or vomiting than the ST-only group (11.9% vs. 1.8%; P=0.050). Conclusions: ST showed a good H. pylori eradication rate without deteriorating the adverse events regardless of adding ES.

• 한국임상약학회지
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• 제30권4호
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• pp.243-249
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• 2020

Background: Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. Methods: We developed "WafarinTalk" as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. Results: We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. Conclusion: This study showed that warfarin-related information could be provided to patients through a messenger application-based chatbot.

• 임상간호연구
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• 제17권3호
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• pp.411-420
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• 2011

Purpose: The purpose of this study was to develop and evaluate a new-nurse education program utilizing both e-learning and instructor demonstration. Methods: From August to December in 2009, the e-learning education program about insulin injection was developed. The control (C) group was educated via instructor demonstration from April 15 to October 6 in 2009, and the experimental (E) group was educated via both e-learning and instructor demonstration from January 5 to October 13 in 2010. After each education, knowledge and educational effectiveness were checked. Results: Satisfaction with the education contents in the E group was significantly higher than those of the C group (Z=-3.72, p<.001), and satisfaction with the education method in the E group was higher than those of the C group (Z=-2.98, p=.003). Usefulness (Z=-3.33, p=.001), application (Z=-2.62, p=.009), and confidence (Z=-2.61, p=.009) in the E group were all higher than those of the C group. 78.9% in the E group reused the e-learning program after the experimental education. Conclusion: Combined educational program with e-learning and instructor demonstration had both merits of online efficiency and face-to-face education. It would be useful especially for new-nurses to improve their nursing skills in accomplishing their roles.

• 한국산학기술학회논문지
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• 제22권3호
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• pp.679-687
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• 2021

전자의무기록 작성 시 주호소, 진단, 수술(처치) 용어는 작성자가 자유롭게 작성하는 것보다 시스템에 등재된 용어 마스터를 사용해야 의료진간의 의사소통이 원활하고, 데이터 활용을 위한 자료 추출이 가능하므로, 용어 마스터의 관리가 중요하다. 본 연구의 목적은 서울대학교 산하 4개병원(서울대학교병원, 분당서울대학교병원, 서울특별시 보라매 병원, 헬스케어시스템 강남센터)에서 개별적으로 운영하던 용어 마스터를 통합하여 표준화 및 관리 프로세스를 확립한 경험을 제시하는 것이다. 산하 4개 병원의 대표자로 구성된 서울대학교병원 용어표준화위원회는 여러 번의 논의를 거쳐 2016년 표준화 및 관리 프로세스를 확립하였고, 용어 마스터에 대한 요청을 신규 용어 등재, 용어 수정, 기존 용어 삭제와 신규 용어 등재, 그리고 용어 삭제의 4가지로 분류하였다. 요청에 대한 수용 여부는 유관 부서의 의견 조회와 그 결과를 검토한 서울대학교병원 용어표준화위원회의 의결로 결정하였다. 의결 정족수는 7명의 위원 중 5명이였으며, 참조 용어 체계에 대한 매핑은 3명의 보건의료정보관리사가 독립적으로 시행 후 이견이 있을 경우 합의하였다. 모든 과정은 온라인으로 시행하였고, 의결과 매핑 결과는 자동으로 수집되었다. 이러한 과정을 통해, 용어표준화위원회는 시스템에 등재될 용어에 대해 빠르고 명확한 의사결정을 할 수 있었고, 사용자들이 용어표준화위원회의 결정에 동의하도록 할 수 있었다. 프로세스가 정립된 후 16개월 간 126개의 신규 용어 등재, 131개의 용어 수정, 40개의 기존 용어 삭제와 신규 용어 등재, 그리고 1235개의 용어 삭제 가 처리되었다. 본 연구는 의료정보 시스템에 등재된 용어 마스터의 관리 프로세스를 정립한 최초의 시도라는 데 의의가 있다.

• Journal of Medicine and Life Science
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• 제21권2호
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• pp.40-48
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• 2024

Understanding the effectiveness of statin treatment is essential for developing tailored stroke prevention strategies. We aimed to evaluate the efficacy of statin treatment in preventing recurrent stroke among patients with various ischemic stroke subtypes. Using data from the Clinical Research Collaboration for Stroke-Korea-National Institute for Health (CRCS-K-NIH) registry, we included patients with acute ischemic stroke admitted between January 2011 and July 2020. To evaluate the differential effects of statin treatment based on the ischemic stroke subtype, we analyzed patients with large artery atherosclerosis (LAA), cardio-embolism (CE), and small vessel occlusion (SVO). The primary outcomes were recurrent ischemic stroke and recurrent stroke events. The hazard ratio for outcomes between statin users and nonusers was compared using a Cox proportional hazards model adjusted for covariates. A total of 46,630 patients who met the inclusion criteria were analyzed. Statins were prescribed to 92%, 93%, and 78% of patients with LAA, SVO, and CE subtypes, respectively. The hazards of recurrent ischemic stroke and recurrent stroke in statin users were reduced to 0.79 (95% confidence interval [CI], 0.63-0.99) and 0.77 (95% CI, 0.62-0.95) in the LAA subtype and 0.63 (95% CI, 0.52-0.76) and 0.63 (95% CI, 0.53-0.75) in CE subtype compared to nonusers. However, the hazards of these outcomes did not significantly decrease in the SVO subtype. The effectiveness of statin treatment in reducing the risk of recurrent stroke in patients with LAA and CE subtypes has been suggested. Nonetheless, no significant effect was observed in the SVO subtype, suggesting a differential effect of statins on different stroke subtypes.

• The Korean Journal of Medicine
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• 제93권6호
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• pp.560-564
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• 2018

자가면역 췌장염 환자에서 드물지만 가성낭종이 동반될 수 있다. 자가면역 췌장염에 동반된 가성낭종은 대부분 스테로이드 투여만으로 소실된다고 알려져 있다. 하지만 본 증례에서는 스테로이드 투여에도 불구하고 가성낭종의 크기가 증가하였고, 이차적으로 낭종내 감염이 발생하였다. 이에 초음파내시경을 이용하여 낭종 배액술을 시행하였으며, 이를 통하여 가성낭종이 완전히 소실되었다.

• 가정∙방문간호학회지
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• 제29권3호
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• pp.263-277
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• 2022

Purpose: This descriptive study examined the management status of the home health care visiting vehicles and the nurse bags, by the home health care center of hospitals (at the hospital level or higher) in Korea, and identified the relevant factors. Methods: Of 120 managers or home health care nurses from medical institutions at hospital level or higher that provide home nursing, 93 individuals participated in the study in July 2021. Results: Hospitals that followed standard guidelines were more likely to perform internal disinfection of home health care visiting vehicles, and distinguished between clean and contaminated areas inside the visiting vehicles. Further, hospitals that followed standard guidelines were more likely to use more barrier surfaces to protect the surfaces of nurse bags to prevent infection. In addition, hospitals supporting the washing cost of the interior of home health care visiting vehicles were more likely to conduct the washing, and hospitals supporting nurse bags were more likely to use barrier surfaces to protect the bags' surfaces. Conclusion: This study only investigated home health care centers at hospital level or higher. Therefore, to generalize the results of the study, it is necessary to conduct a qualitative study involving additional investigation of home health care visiting vehicles and nurse bags and interviews with nurses from all domestic home health care centers.