• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.198-206
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• 2000

Background : Pulmonary complications following bonemarrow transplantation (BMT) are common and associated with a high mortality rate. We investigated the yield, safety, and impact of fiberoptic bronchoscopy (FOB) for diagnosis of postBMT pneumoniae. Methods : From May 1997 to April 2000, 56 FOBs were performed in 52 post BMT patients for clinical pneumoniae. BMT patients with respiratory symptoms and/or pulmonary infiltrates had a thoracic HRCT(high resolution computed tomography) and bronchoscopic examination including BAL (bronchoalveolar lavage), TBLB (transbronchial lung biopsy), PSB (protected specimen brush). Results : The characteristics of the subjects were as follows : 37 males, 15 females, mean age of 31.3 years(l7-45), 35 sibling donor allogenic BMTs, 15 nonrelated donor allogenic BMTs, and 2 autologous BMTs. Fiftynine percent of FOBs (33 FOBs, 31 patients) were diagnostic. Isolated pathogens included the following : 12 cytomegalovirus (CMV) (21.4 %), 7 pneumocystis carinii (PC) (12.5 %), 11 CMV with PC (19.6 %), 2 Mycobacaterium tuberculosis (3.6%), and 1 streptococcus (1.8%). Most of the radiographic findings were diffuse interstitial lesions. CMV pneumoniae had mainly diffuse interstitial nodular lesion, and PC pneumoniae had diffuse, interstitial ground glass opacity(GGO). When CMV was accompanied by PC, a combined pattern of nodular and GGO was present. Of the 56 cases (23.2%), 13 died of CMV pneumoniae (n=2), PCP (n=2),mixed infection with CMV and PC (n=3), underlying GVHD (n=1), underlying leukemia progression (n=1), or respiratory failure of unknown origin (n=4). There was no major complication by bronchoscopy. Only 3 cases developed minor bleeding and 1 episode temporary hypoxemia. Conclusion : Based on our findings, CMV and PC are the major causes of postBMT pneumoniae. In addition, BAL can be considered a safe and accurate procedure for the evaluation of pulmonary complications after BMT.

• Tuberculosis and Respiratory Diseases
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• v.53 no.6
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• pp.612-618
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• 2002

Background : Bronchoscopy is an important diagnostic and a therapeutic tool in chest medicine. However, most patients feel that a bronchoscopy is an unpleasant procedure, and it is important to sedate the patients appropriately, particularly where repetitive examinations are required. Midazolam is a sedative drug with amnestic qualities and a rapid 2 hour half-life. This study have attempted to determine the safety, appropriate dosage, and the effect of midazolam premedication in patients who underwent a bronchoscopy. Methods : One hundred and eighty consecutive patients undergoing bronchoscopy were enrolled in this study. The patients received a midzolam doses of 0.03 mg/kg, 0.06 mg/kg, or a placebo. An additional dose of lidocaine, the total number of coughs, and the duration of the procedures were recorded with monitoring the the blood pressure, heart rate, and oxygen saturation. The level of satisfaction was assessed by the patient, bronchoscopist, and the nurse. Results : The blood pressure, pulse rates, oxygen saturation, number of coughs, lidocaine dose, and procedure time in the 3 groups were similar. There was a trend for the midazolam 0.03 mg/kg group to satisfy bronchoscopists more than the other two groups. The nurses' acceptability was lower in the midazolam 0.06 mg/kg group than the other groups. The patients' acceptablity was greater in both the midazolam 0.03 mg/kg and 0.06 mg/kg groups than in the control group. Conclusion : Sedation with low doses of intravenous midazolam is a safe technique for fiberoptic bronchoscopy with a low morbidity and high acceptable to patients and bronchoscopists.

• Tuberculosis and Respiratory Diseases
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• v.58 no.5
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• pp.498-506
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• 2005

Background : This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules ($18{\mu}g$ once daily) with a ipratropium metered dose inhaler (2 puffs of $20{\mu}g$ q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). Method : After the initial screening assessment and a two-week run-in period, patients received either tiotropium $18{\mu}g$ once daily or ipratropium $40{\mu}g$ four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second ($FEV_1$) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. Result : In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted $FEV_1$ of 42 (12)% were analyzed. The trough $FEV_1$ response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. Conclusion : This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.

• Korean Journal of Environment and Ecology
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• v.15 no.4
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• pp.361-368
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• 2002

The valley forests located at the east-facing slope and the west facing slope in Hambaeksan area were studied to investigate forest structure in relation to aspect and altitude of the slope. There was little difference in density. mean DBH and basal area of the tree layer between east-facing slope and west-facing slope. The importance percentages of Tilia amurensis and Betula costata in west-facing slope were higher than those in east-facing slope. However, the importance percentages of Quercus mongilica and Fraxinus rhynchophylla in the west facing slope were lower than those in east-facing slope. Species diversity of the west-facing slope was 1.415 and that of the east-facing slope was 1.328. Elevation trends were also found for forest structure. As elevation Increased basal area and mean height of the tree layer decreased in both of east-facing slope and west-facing slope. There was a tendency that number of species, species diversity and evenness decreased with increasing elevation. The importance percentage of Quercus mongolica increased with increasing elevation while those of Betula costata and Maackia amurensis decreased. The result of cluster analysis for the tree and subtree layer indicated that the studied forests were classified into the mixed forest community of broad-leaved tree species at west-facing slope and the low and middle elevation belts of east-facing slope and Quercus mongolica community at the high elevation belt of east-facing slope. Quercus mongolica was significantly and positively correlated with Symplocos chinensis for. pilosa, Acer tschonoskii var. rubripes and deutzia glabrata. Betula costata was significantly and negatively correlated with Quercus mongolica and Acer pseudo-sieboldianum.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1296-1307
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• 1997

Background : Erdosteine is a thiol derivative developed for the treatement of chronic obstructive bronchitis, including acute infective exacerbation of chronic bronchitis. Erdosteine has mucomodulating and antioxidant properties and especially exhibits excellent gastrointestinal tolerability. Methods : The study was conducted as a prospective evaluation, with 2 comparative groups orally treated with erdosteine 300mg (bid.) or ambroxol 30mg (b.i.d.) for 7 days and the design of trial was double-blind. The treatments have been assigned randomly to patients (n=80) with acute or chronic bronchitis. The primary end-point used to determine efficacy in this study was subjective symptoms including expectorating frequence, expectoration volume, expectorating difficulty, expectoration viscosity, cough intensity and dyspnea. The secondary end-points of efficacy was the result of arterial blood gas analysis and pulmonary function test. Safety was evaluated with adverse drug reactions and laboratory tests monitoring. 61 patients was included in the efficacy analysis, due to the fact that 19 patients drop-out for different reasons. The obtained values have been analyzed with paired Hest., ANOVA test., multivariate $t^2$-test, repeated measures analysis of covariance, two sample t-test, loglinear-logit model analysis, Fisher's exact test. Results : 1) There was no significant difference on demographic data and vital signs between erdosteine and ambroxol treated groups. 2) The comparison between erdosteine and ambroxol treated groups showed no significant difference in improvement of each symptom in spite of the more favorable efficacy obtained with erdosteine. No difference on the contrary was observed for arterial blood gas analysis and pulmonary function test. 3) As safety is concerned, no clinical significant changes in laboratory test and symptom were induced in erdosteine and ambroxol treated group and two patients in ambroxol treated group drop-out for adverse reactions in symptom. 4) In the evaluation of final clinical efficacy, erdosteine improved more effectively patient's overall symptoms {very good effect (11/31), good effect (12/31), moderate effect (6/31), no effect (2/31), aggravation (0/31)} than ambroxol {very good effect (6/30), good effect (14/30), moderate effect (5/30), no effect (4/30), aggravation (2/30)}. And the probability of symptomatic improvement by erdosteine compared to ambroxol was 2.5 times. (p<0.05). Conclusion : This study showed that erdosteine was clinically effective and safe drug for treatment of acute and chronic bronchitis.

• Korea Journal of Hospital Management
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• v.18 no.3
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• pp.27-42
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• 2013

Purpose: This study is aimed to provide the fundamental data for building the patient safety culture by identifying the perceptions of patient safety culture of hospital nurses. Methods: this study was a cross-sectional survey. For this study, 816 nurses participated from three general hospital and one university hospital located in Gwangju and Chonnam. The data were collected from April to June, 2012 by self-administrated questionnaires. The 'Hospital Survey on Patient Safety Culture'developed AHRQ(2004) and translated in Korean and edited by Je(2006), was used to measure the patient safety culture which the nurses were perceived. The collected data were analyzed with descriptive statistics, t-test, ANOVA, Scheffe test using SPSS window 18.0. Results: With a possible score of 5 points, the average score for nurses'perceived patient safety culture 3.32. In the sub dimension of patient safety culture, the score hospital-level aspects was the highest level of 3.27(0.50) and reporting system medical errors was the lowest of 3.08(0.40). The difference of perception level on patient safety culture were statistically significant depending on demographic and job-related characteristics such as age, hospital level, work experience in present hospital, work experience in present unit, work experience in present area, positions, work hours of week. Conclusion: The scores of perception of which were shown to be relatively low in this study, needed to be improved through continuous education, evaluation and researches. We suggest developing a new tool on patient safety culture fit our country which will help to manage ongoing patient safety culture.

• Quality Improvement in Health Care
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• v.21 no.1
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• pp.80-95
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• 2015

Objectives : A safety culture is the bedrock for all patient safety improvement initiatives; thus, many resources have been invested in measuring hospital culture. However, many of these endeavors have failed to yield meaningful results. This article proposes a practical checklist to ensure successful administration of a safety culture survey and describes current methodologies for analyzing survey results to develop safety improvement programs. Methods : We reviewed currently used safety culture surveys and summarized their strengths and weaknesses. We also reviewed studies using safety culture surveys and found several pitfalls leading to failure in survey administration. With this information, we developed a checklist that covers critical items in the survey process. We also reviewed newly developed methodologies for survey results analysis and application and described them using the Korean version of the Safety Attitudes Questionnaire as an example. Results : The checklist consists of three steps: survey preparation, administration, and analysis and application. Each step contains clear action items. The content even describes how to get buy-in from hospital executives and manage communication channels with them. Also, common misunderstandings regarding survey scores are described and possible solutions are suggested. In the analysis section, we demonstrate new methods for obtaining more accurate survey results and how to utilize these methods to develop and implement hospital-wide safety improvement programs. Conclusion : A successful safety culture survey is the foundation of all future safety improvement projects. This review is intended to guide hospitals in enhancing safety.

• Quality Improvement in Health Care
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• v.22 no.2
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• pp.75-90
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• 2016

Objectives: This study measures the level of cognition of employee's patient safety culture and evaluates the current level through comparing the results to external levels. Ultimately it is performed to construct a strategic improvement plan through the basic database for patient's safety culture. Methods: A questionnaire survey of self reporting type was carried out using structured questionnaire of the patient's safety culture for employees currently employed in a hospital. Total responders was 1,129 and a response rate was 54.6%. The survey results were calculated with a percent positive response, and the current level was evaluated by comparing with the survey results of a hospital (2009 and 2014) and the survey result of The Agency for Healthcare Research and Quality(2014). Results: Sub-dimension of high percent positive response for each area were 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%) and 'supervisor/manager expectations & actions promoting safety' (67%). Meanwhile, 'teamwork across hospital units' (31%), 'hospital management support for patient safety' (29%), 'staffing' (27%) and 'non-punitive response to error' (17%) were relatively low percent positive response. Compared to the survey results of AHRQ (2014) for each area, 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%), 'frequency of event reporting' (66%) were at the top 50% percentile level and the remaining sub-dimensions showed a very low level in the lower 10% percentile area. Conclusion: In order to establish a system for patient safety culture within the hospital and evaluate the effect on this, it is necessary to periodically evaluate the patient's safety culture and establish regulations on hospital safety culture to comply with this.

• Korean Journal of Occupational Health Nursing
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• v.31 no.4
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• pp.157-166
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• 2022

Purpose: The purpose of this study was to identify factors influencing fall-prevention behaviors of nurses working in long-term care hospitals. Methods: Participants included 147 nurses working in 10 long-term care hospitals in B city. Data were collected from September 20-October 12, 2016. SPSS/WIN 21.0 was used for analysis with t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression. Results: It was found that attitude toward fall (r=.29, p<.001) and patient safety culture (r=.25, p=.002) had a significant positive correlation with fall-prevention behaviors of nurses working in long-term care hospitals. The factors influencing fall-prevention behaviors in participants were clinical career and patient safety culture (β=.21, p=.012), contributing to 19% of the total variance in fall- prevention behaviors. Conclusion: The findings showed that systematic delivery of differentiated fall prevention education is preferred to nurse's clinical career as a private factor to improve fall-prevention behaviors of nurses in long term care hospital. Particularly, it is imperative to conduct periodical and practical fall-prevention education for nurses to prevent career discontinuity. An independent report system and open communication system as well as a scheme that can disseminate patient safety culture in individual departments to implement patient direct nursing are required to encourage patient safety culture in organizations.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.161-172
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• 2022

Purpose : The study was to promote patient safety by analyzing the effect of dental hygienist's perception of patient safety culture on infection control activities. Methods : The study is based on a survey of 210 dental hygienists in total working in dental settings. To find out infection control activities according to patient safety culture awareness, there were 6 general characteristics, 3 teamwork within the department, 2 infection control systems, 4 surface management, 9 equipment washing, disinfection, and laundry management, 4 infectious wastes, and 3 personal protection phrases.The data was analyzed using the SPSS version 20.0, and p<.05 was adopted to decide on significance. Results : The longer dental hygienists have worked n the dental settings, the more active they become in infection control activities. Among the different types of dental care settings, general (university) hospitals had the largest number of infection control activities, followed by dental clinics, and network dental clinics, in descending order. The dental settings possessing a higher number of dental hygienists were found to conduct more infection control activities than other dental settings. In addition, it was found that when a dental setting adopts a patient safety policy across all the units in the hospital, more systems and procedures for patient safety tend to be established, and that stricter management response to error leads to improvement of infection control activities. Conclusion :In order to enhance infection control activities, infection control activity programs should develop and implement periodic reinforcement of infection control education. regular monitoring of infection control activities.