• Title/Summary/Keyword: 중환자실 환자

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Nutritional Assessment of ICU Inpatients with Tube Feeding (경관급식을 공급한 중환자실 환자의 영양상태 평가)

  • Kim, Yu-Jin;Seo, Jung-Sook
    • Journal of the Korean Dietetic Association
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    • v.21 no.1
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    • pp.11-24
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    • 2015
  • This study investigated the general status of tube feeding for intensive care unit (ICU) inpatients and evaluated the consequent nutritional status of patients. This study was approved by the Institutional Review Board (IRB) of a general hospital located in Daegu metropolitan city. The subjects of this study were 80 adult patients who had been admitted to the ICU of a hospital, received fed tube feeding, and then been discharged. The differences in nutrition screening indicators, including percentage ideal body weight (PIBW), serum albumin, hemoglobin, total lymphocyte count, and total cholesterol, before and after tube feeding according to body mass index (BMI) or nutrient feeding levels were investigated. The ratios of actually provided amounts to calorie and protein requirements of patients were $72.8{\pm}15.8%$ and $72.6{\pm}19.8%$, respectively. The change in PIBW before and after tube feeding was significantly different among the BMI groups (P<0.01). The change in hemoglobin concentration before and after tube feeding was also significantly different among the BMI groups (P<0.01). When subjects were divided into three groups (<60%, 60~79%, ${\geq}80%$) according to the ratio of actually provided calories to required calories, there was no significant difference in nutrition screening indicators before and after tube feeding. When the subjects were divided into three groups (<60%, 60~79%, ${\geq}80%$) according to the ratio of actually provided protein to required protein, serum albumin concentration showed a significant difference among the groups before and after tube feeding (P<0.05). Therefore, an intensive nutrition intervention program would be needed for the nutritional improvement of ICU inpatients receiving tube feeding.

The Relationship among Dementia care Knowledge, Attitudes toward to dementia and Approach to dementia care of Nurses (간호사의 치매케어 관련 지식, 치매에 대한 태도 및 치매간호 접근법과의 관계)

  • Lee, Mi-Ra
    • Journal of Digital Convergence
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    • v.14 no.12
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    • pp.357-367
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    • 2016
  • The purpose of this study was to examine the relationships among dementia care knowledge, attitudes toward to dementia and approach to dementia care of nurses. The participants were 202 nurses in G hospital of P city. The mean score of dementia care knowledge was 11.02, attitude toward dementia was 40.15 and approach to dementia care was 7.90. The dementia care knowledge was significant difference for sex(t=-2.424, P<.05), education level(F=2.932, P<.05) and work unit(F=2.268, P<.05). The dementia care knowledge was positively correlated with attitude toward to dementia(r=.162,P<.05 ). The predictors of dementia care knowledge were Emergence Room(${\beta}=-1.568$, p<.05) and Intensive Care Unit(${\beta}=-1.682$, p<.05). The result suggest that it is necessary to develop convergence education program to improve dementia care knowledge and attitudes toward to dementia to give high quality nursing care for patients with dementia.

Study for the sampling method using simulation in clinical data (시뮬레이션을 이용한 임상자료의 샘플링 방법 연구)

  • Sohn, Ki-Cheul;Kim, Dal-Ho
    • Journal of the Korean Data and Information Science Society
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    • v.23 no.4
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    • pp.677-682
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    • 2012
  • There are lots of sampling design which is determined for sample survey in various fields. Especially, it is important problem for clinical data because basic characteristic variables by group which consist of experiment group and control group in population should be reflect to sample. Therefore, frequencies, center scales and dispersion scales of variables by group in population should be similar in sample. But usual sampling design is very complicate so it is difficult to use in practice for researcher. In this paper, we consider the sampling method using simulation. We applied the proposed method to colon cancer data from a hospital. We compare basic characteristic variables between population and sample with mean, frequency and statistic hypothesis test.

Risk Factors of Delirium in ICU Patients with Acute Poisoning (중환자실 급성중독환자에서 섬망의 위험인자)

  • Kim, Hee Yeon;Cha, Kyung Man;So, Byung Hak
    • Journal of The Korean Society of Clinical Toxicology
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    • v.17 no.1
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    • pp.14-20
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    • 2019
  • Purpose: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning. Methods: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis. Results: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy. Conclusion: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed.

Effects of Nurse Staffing Level on In-hospital Mortality and 30-day Mortality after Admission using Korean National Health Insurance Data (간호사 확보수준이 입원 환자의 병원사망과 입원 30일 이내 사망에 미치는 영향)

  • Kim, Yunmi;Lee, Kyounga;Kim, Hyun-Young
    • Journal of Korean Clinical Nursing Research
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    • v.28 no.1
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    • pp.1-12
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    • 2022
  • Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x2 test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

The Effectiveness of Environmental Management through Environmental Surveillance (환경감시를 통한 환경관리의 효과)

  • Mi Hyang Lee;Jae Yeun Kim;Sang Ha Kim
    • The Journal of the Convergence on Culture Technology
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    • v.9 no.6
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    • pp.557-561
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    • 2023
  • This study aims to assess how effective environmental management can be accomplished through monitoring of environmental conditions in patient discharge rooms within healthcare facilities through direct observation and the use of fluorescent markers. From March to July 2013, this study evaluated 448 check-out beds in wards and intensive care units before and 494 after intensive environmental monitoring activities. The collected data were analyzed using the SPSS 21.0 program. According to the study's findings, direct observation increased from 95.2% prior to the implementation of intensive environmental monitoring activities to 98.9% following the implementation, which was statistically significant. The non-detection rate of fluorescent markers exhibited an increase from 96.1% prior to the commencement of intensive environmental monitoring activities to 98.0% following their implementation. However, it should be noted that this observed increase was not deemed statistically significant. In light of the results of this research, it is imperative to evaluate the effectiveness of environmental management by employing a variety of assessment methods, including direct observation and fluorescent markers.

Review of Music Interventions for Family Caregivers of Patients in Medical Settings (국내·외 의료 환경 내 가족 참여 음악 중재 연구 고찰)

  • Choi, Da In
    • Journal of Music and Human Behavior
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    • v.14 no.1
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    • pp.17-39
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    • 2017
  • This study aimed to review Korean-written and English-written studies on music interventions for family caregivers of patients in medical settings. Electronic databases were searched for studies published through 2016, using the keywords of music intervention, family caregivers, and specified settings. A total of 43 studies, five Korean-written and 38 English-written studies, were selected. The results showed that caregivers were the sole participants in five studies (family-only), and caregivers and patients co-participated in 38 studies (family-patient). While diversified types of family participation were included in the English-written studies dating back to the late 1980s, the Korean-written studies were the only ones to include patients as co-participants with their caregivers. Studies with family-only participation tended to be conducted in palliative care units and usually included the spouses of the patients. Meanwhile, studies with family-patient participation tended to be conducted in NICU or cancer units and usually included the parents of the patients. Furthermore, studies with family-only participation tended to apply passive music activities, and those with family-patient participation tended to use active music activities. The results of this study present baseline data on how family-centered care can be included in music interventions in medical settings in Korea, suggesting future studies to systematically analyze music interventions for family caregivers in terms of diversified patient- and caregiver-related factors.

Flow Analysis of Vacuum Oral Cleaner Developed for Serious Patient (중증환자를 위한 진공 구강 세정기에 대한 유동해석)

  • Shin, Hyeon seok;Kim, Nam Woong;Kim, Kug Weon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.1
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    • pp.121-126
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    • 2018
  • The oral hygiene of patients admitted to the ICU (Intensive Care Unit) is very important. Critically ill patients are basically immunocompromised ones because of the high risk of infection by various pathogenic bacteria. The mouth is not only the primary site of infection, but also the site of systemic infections. The purpose of this study was to design a mouthpiece type vacuum oral cleaner for the oral care of seriously ill patients. A 3D CAD modeling and flow analysis model were established for a double structure type cleaner and standard tooth model, and their pressure and flow characteristics were analyzed. The pressure inside the oral cleaner was almost constant, but the velocity distribution showed a large difference between the inside and outside of the teeth. The velocity at the center region inside of the teeth was the highest, and the speed decreased as the distance from the center increased. In the analysis of the case where the suction tube was replaced by the drainage tube, the velocity at the center of the outer portion of the teeth was the highest. In order to increase the effectiveness of the oral cleaner, alternating between suction and drainage is proposed, and a design complement to increase the speed of the molar region is required.

Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care (섬망의 돌봄: 완화의료 영역에서의 진단, 평가 및 치료)

  • Seo, Min Seok;Lee, Yong Joo
    • Journal of Hospice and Palliative Care
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    • v.19 no.3
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    • pp.201-210
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    • 2016
  • Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

Clinical Reviews of Spontaneous Hemopneumothorax (자연성 혈기흉의 임상 양상)

  • Kim, Jung-Tae;Chang, Woon-Ha
    • Journal of Chest Surgery
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    • v.40 no.9
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    • pp.613-616
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    • 2007
  • Background: Spontaneous hemopneumothorax is a rare disease and can be life threatening; it occurs in $1{\sim}12%$ of patients with spontaneous pneumothorax. We analyzed clinical reviews and treatments, as well as complications of spontaneous hemopneumothorax patients that were treated to aid in the optimal management. Material and Method: We studied retrospectively 30 cases with spontaneous hemopneumothorax for 11 years, from 1995 to 2006, at our hospital. Result: All the patients were male and most of the patients were under 30 years. The sides with the disorder were as follows: right in 15 cases and left in 15 cases. Patients showed mostly initial symptoms of chest pain, dyspnea and hypovolemic shock. All patients underwent a closed thoracostomy and 27 patients underwent surgery. Chemical pleurodesis was peformed because of postoperative persistent air leakage and one case was treated in the ICU due to re-expansion pulmonary edema, There were no other complications such as fibrothorax seen during the follow-up periods. Conclusion: The most important finding is proper initial management, as the spontaneous hemopneumothorax can potentially lead to a life-threatening condition. Recently, video assisted thoracoscopic surgery (VATS) is common procedure for general thoracic surgery and overcomes the weak points of performing a thoracotomy. The results of VATS are encouraging.