• Journal of Korean Critical Care Nursing
• /
• v.8 no.1
• /
• pp.71-79
• /
• 2015

Purpose: The purpose of this study was to compare the applicability of the Charlson Comorbidity Index (CCI) and Acute Physiology, Age, Chronic Health Evaluation III (APACHE III) to the prediction of the healthcare outcomes of intensive care unit (ICU) patients. Methods: This research was performed with 136 adult patients (age>18 years) who were admitted to the ICU between May and June 2012. Data were measured using the CCI score with a comorbidity index of 19 and the APACHE III score on the standard of the worst result with vital signs and laboratory results. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under an ROC curve (AUC). Calibration was performed using logistic regression. Results: The overall mortality was 25.7%. The mean CCI and APACHE III scores for survivors were found to be significantly lower than those of non-survivors. The AUC was 0.835 for the APACHE III score and remained high, at 0.688, for the CCI score. The rate of concordance according to the CCI and the APACHE III score was 69.1%. Conclusion: The route of admission, days in ICU, CCI, and APACHE III score are associated with an increased mortality risk in ICU patients.

• Journal of Korean Critical Care Nursing
• /
• v.8 no.1
• /
• pp.41-49
• /
• 2015

Purpose: The purpose of this study was to measure the noise levels in intensive care units (ICUs) and to analyze the causes of the noise and patient perceptions of the noise. Methods: Noise levels were recorded in adult ICUs for 24 h over a week from the patients' bedside with a sound level meter. Noise sources were categorized into three groups: medical equipment, health care providers, and the environment. Noises from the environment were recorded in an empty ICUs side room. Perceptions of the noise of 125 patients admitted to the ICUs were recorded using a questionnaire. Results: The mean level of noise in the ICUs was 58.5 dBA (range: 34.2-80.2 dBA). The causes of noise higher than 70 dBA were nebulizers and infusion/syringe pumps among medical equipment, and drawer slamming, phone ringing, and stripping packages of medical fluids among environmental noises. According to the questionnaire, 64.0% of the patients responded that the ICUs were noisy and that they suffered from sleep disturbance because of the noise. Conclusion: Noise is considerably high in ICUs and is an annoying factor for the patients. Most noise sources are adjustable, and we should try to reduce noise whenever possible to make the ICUs environment more pleasant.

• Journal of Korean Critical Care Nursing
• /
• v.4 no.1
• /
• pp.51-63
• /
• 2011

Purpose: This study aimed to examine the effects of extended family visiting hours in the intensive care unit (ICU). Methods: The subjects were 168 ICU patients and their family members. Two 30-minute visits a day were allowed to the control group according to current policy, while four 30-minute visits a day were allowed to the experimental group. Patients' state anxiety was measured at the first day of ICU admission, and on the third day of ICU admission patients' anxiety and family satisfaction were measured. For the infection rate, comparison was made between the experimental and control data-collecting periods. Results: The patients' state anxiety significantly decreased in the experimental group. Family satisfaction of experimental group was significantly higher than that of control group. There was no significant difference in the infection rate. Nurses positively evaluated extension of visiting hours because it could stabilize patients, reduce the number of arrangements for additional visits, and help establish trust relationship with families. Conclusion: Extended family visiting hours in the ICU reduced patients' anxiety and improved family satisfaction but had no effect on the infection rate. Extended family visiting hours in the ICU is expected to improve the quality of critical care.

• Journal of Korean Critical Care Nursing
• /
• v.11 no.3
• /
• pp.1-11
• /
• 2018

Purpose : This study compares experiences of ethical dilemma between nurses working in intensive care units and those in general units under specific situations of treatment decisions and confidentiality. Method : This cross-sectional descriptive study utilizes the self-report survey method. The survey questionnaires were completed by 50 and 52 nurses working in intensive care units and general units, respectively. The instrument, which consisted of 16 items of ethical dilemma situations about treatment decision and confidentiality, was used. The mean scores for each item were compared between the two groups. Results : The study found no differences in terms of age, gender, education level, clinical experience in years, and being educated on healthcare ethics. For 9 out of 16 items, the mean scores of nurses in intensive care units were significantly higher than those of nurses in general units. Conclusions : Nurses in intensive care units experienced ethical dilemmas regarding treatment decisions and confidentiality more often than those in general units. This study emphasizes the need to establish strategies for improving the ethical competence of critical care nurses.

• Journal of Korean Critical Care Nursing
• /
• v.12 no.1
• /
• pp.36-45
• /
• 2019

Purpose : The purpose of this study was to identify status and characteristics of patients who have been readmitted to ICU, and to analyze risk factors associated with the readmission to ICU within 48hours. Method: Data were collected from patient's electronic medical reports from one hospital in B city. Participants were 2,937 patients aged 18 years old or older admitted to the ICU. Data were analyzed using odd ratios (ORs) from multivariate logistic regressions. Results: 2.2% of the 2,937 patients were early readmitted to ICU. Risk factors for early readmission to ICU were existence of respiratory disease, use of mechanical ventilator, and duration of hospitalization (longer). Conclusion: The assessment on the respiratory system of the patient who will be discharged from the ICU was identified as an important nursing activity. Therefore, the respiratory system management and education should be actively conducted. In addition, early ICU readmission may be prevented and decreased if a link was built to share the information on patient condition between the ICU and general wards.

• Journal of Korean Critical Care Nursing
• /
• v.12 no.1
• /
• pp.57-70
• /
• 2019

Purpose : The purpose of this study was to identify the risk factors for falls in tertiary hospital inpatients and to suggest data for developing a nursing intervention program for preventing falls. Methods: Data were collected between January 1, 2017, to December 31, 2017. Kaplan-Meier estimation was used to measure the survival rate, and the log-rank test was used for the differences between the fall group and the non-fall group. The Cox proportional hazards model was used to identify the risk factors for falls. Results: The incidence rate of falls for the inpatients was 1.2 cases per 1,000 days of hospitalization. The risk factors for falls were more likely to be found among those who were aged ${\geq}81$, had not undergone surgery, had poor joint motion, had unsteady gait, needed help or supervision, used assistive devices, had comorbidity, and took at least two drugs. Conclusion: For the inpatients, the risk factors for falls included age, surgery, comorbidity, medication that could change mobility, joint motion, and use of patient care equipment. It is necessary to give special attention to inpatients who have any of these risk factors and to develop a falls risk assessment tool.

• Tuberculosis and Respiratory Diseases
• /
• v.41 no.5
• /
• pp.537-545
• /
• 1994

Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

• Neonatal Medicine
• /
• v.15 no.1
• /
• pp.44-53
• /
• 2008

Purpose : Epidemic keratoconjunctivitis (EKC) caused by adenovirus is a highly contagious disease, which has been reported as outbreaks involving adults in the community. However, there has been no report on EKC outbreak by adenovirus in a neonatal intensive care unit (NICU) in Korea. Aims of this study were to investigate the EKC outbreak by adenovirus type 8 in NICU and to confirm an effectiveness of polymerase chain reaction (PCR) for diagnosis. Methods : Conjunctival swab or nasopharyngeal aspirate specimens were taken from all patients and tested by viral culture and PCR. Adenovirus serotype was determined by sequencing of PCR product of selected region of hexon gene using the virus isolates or specimens. Results : An outbreak of EKC occurred which was involving 12 preterm infants in the NICU of the Seoul National University Children's Hospital between July 12th and August 1st, 2005. Three hospital staffs and one family member of the neonate were also affected. Adenovirus was detected in 12/12 (100%), 6/11 (54.5%) by PCR and virus culture, respectively. Eleven PCR-positive neonates were identified as serotype 8 by sequencing. The first affected 4 babies have had routine ROP (retinopathy of prematurity) examinations one week ago. While previous outbreaks were sustained for a few months, the event in our unit was controlled without complications in 3 weeks. Conclusion : We analyzed the EKC outbreak by adenovirus type 8 in NICU. Adenovirus serotype was identified by PCR and sequencing with high sensitivity for the first time in Korea, so we suggest this method can be very useful for rapid diagnosis and infection control.

• Tuberculosis and Respiratory Diseases
• /
• v.60 no.2
• /
• pp.228-234
• /
• 2006

Background : Acinetobacter baumannii is an important pathogen associated with nosocomial infections in intensive care units, and is responsible for nosocomial pneumonia, UTI, bacteremia, etc. The main concern is that this pathogen is often resistant to many antimicrobial agents, particularly to carbapenem. This study compared the clinical those of ICU admitted patients with the carbapenem resistant A. baumannii isolated from the sputum with characteristics of patients with carbapenem sensitive A. baumannii. Methods : A total of 49 patients with A. baumannii from a sputum culture who were admitted to the ICU from January to December 2003 were enrolled in this study. This study evaluated the demographic variables, mortality, APACHE II score, comorbidity, antibiotics used, hospital and ICU stay, Clinical Pulmonary Infection Score, and mechanical ventilation. A retrospective analysis was made by a review of the patients' medical records. Results : Carbapenem sensitive and resistant A. baumannii was isolated from 23 patients and 26 patients respectively. Univariate analysis revealed renal disease, the use of carbapenem and aminoglycoside to be statistically significant factors for carbapenem resistance. Multivariate analysis revealed carbapenem use(p=0.024; OR, 8.17; CI 1.32 to 50.68) to be positively associated with carbapenem resistance, and aminoglycoside use(p=0.026; OR, 0.18; CI, 0.04 to 0.82) to be negatively associated with carbapenem resistance. There was no significant difference in mortality between the carbapenem sensitive and resistant group(30 vs 42%. P=0.39). Conclusion : The occurrence of carbapenem resistant A. baumannii is positively associated with carbapenem use and negatively associated with aminoglycoside use. Carbapenem resistance in the sputum culture did not affect the mortality rate.

• Journal of Gastric Cancer
• /
• v.2 no.3
• /
• pp.117-122
• /
• 2002

전통적으로 수술 전 평가는 수술 전날 밤에 시행되는 것이 일반적이었다. 그러나 외래수술을 받는 환자의 증가로 인하여 많은 환자들이 수술 당일 아침에 마취과 의사를 처음 만나게 되는 경우가 많고 심지어는 심각한 내과적 문제를 가진 환자들도 충분한 수술 전 평가가 이루어지지 않은 사태에서 수술실로 들어오게 되는 경우가 있다. 그러나 이러한 상황에서도 마취과의사는 주술기(perioperative)의 환자 상태를 관리하는 주된 역할자로서 수술 전 환자에 대한 평가를 충실히 해야 한다. 수술 전 평가는 환자의 현재 상태를 평가하는 것이고, 수술 중 발생할 수도 있는 상황에 대비하며, 수술실을 넘어서 중환자실, 통증치료실에서의 마취의사의 역할로 이어지도록 하는 것이다. 최근 발전하고 있는 수술 전 평가 클리닉은 환자의 수술준비의 기초적인 정보를 제공한다. 이는 마취의사에게는 상당한 장점과 편리성을 제고하는 것이고, 환자 관리의 질적 향상과 급변하는 병원관리정책의 요구에 부합하는 것이다.