• The Korean journal of internal medicine
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• v.39 no.3
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• pp.477-487
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• 2024

Background/Aims: Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19. Methods: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital-acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness. Results: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality. Conclusions: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.

• Journal of the Korean Applied Science and Technology
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• v.41 no.1
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• pp.83-95
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• 2024

The purpose of this study was to identify factors influencing the acceptance of disabilities among adults with acquired disabilities based on ecological theory, utilizing raw data from the 4th Disability and Life Dynamics Panel in 2021. The results of hierarchical multiple regression analysis indicated that individual factors such as 'gender,' 'type of disability,' 'severity of disability,' 'marital status,' 'education,' 'employment status,' 'depression,' 'self-esteem,' and 'overall health in the past six months,' interpersonal factors like 'emotional support and assistance,' and organizational and environmental factors including the 'level of difficulty in using disability-related services' and 'overall satisfaction with disability welfare services' were found to impact the acceptance of disabilities among adults with acquired disabilities. Based on these research findings, it is suggested that efforts in the community to enhance the acceptance of disabilities among adults with acquired disabilities should go beyond individual dimensions, increasing opportunities for social interactions and fostering a disability-friendly environment.

• Korean Journal of Adult Nursing
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• v.18 no.2
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• pp.213-222
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• 2006

Purpose: This study was designed to construct a structural model for explaining model health-related quality of life in acquired people with physical disabilities. Method: The hypothetical model of this study was consisted of 6 latent variables and 14 observed variables. Exogenous variables included in this model were physical status and economical level. Endogenous variables were social attitudes, family function, self-esteem, and health-related quality of life. Data were collected from 226 acquired people with physical disabilities residing in Seoul and Kyunggi-do from January to February, 2005. The collected data were analyzed using SAS 8.2 version and LISREL 8.32 version program. Results: The results of the fitness test of the modified model were follow as; ${\chi}^2=67.479$ (df=50, p=.05), GFI=.959, AGFI=.914, SRMR=.049, NFI=.961, NNFI=.979, CN=249.244. Health-related quality of life was influenced directly by physical status, economic level, and social attitudes and accounted for 88.8% of the variance by these factors. Conclusion: These results suggest that physical status is the most significant effect on health-related quality of life, and social attitudes and economic level are important factors having influences on health- related quality of life. Therefore improving physical status and economic level, and modifying negative attitudes are necessary to increase health-related quality of life of acquired people with acquired physical disabilities.

• The Korean Journal of Emergency Medical Services
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• v.22 no.2
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• pp.67-77
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• 2018

Purpose: This study was conducted to identify the factors influencing performance confidence by knowledge and experience of respiratory-assistant therapy in paramedic students. Methods: A descriptive survey study used a convenience sample comprising 387 students from September 15 to October 31, 2016. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and regression analysis. Results: Knowledge was statistically significant by college(3-year), acquired certification, and observation experience in respiratory-assistant therapy. Performance confidence was statistically significant by sex, academic grade($3.0{\leq}$), acquired certification, and observation and performance experience in respiratory-assistant therapy. There was a significant correlation between knowledge and acquired certification, clinical practice, and major satisfaction. There was a significant correlation between performance confidence and acquired certification, clinical practice, major satisfaction, and knowledge. Regression analysis revealed that performance confidence accounted for 22.9% of the variance by academic grade(3.0~3.99), acquired certification, and major satisfaction. Conclusion: For paramedic students in clinical practice and in-school classes, it is important to improve performance confidence by combining training instruction with experience and education of respiratory-assistant therapy.

• Neonatal Medicine
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• v.18 no.1
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• pp.23-33
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• 2011

The etiology of thrombosis is multifactorial and involves the interaction of inherited and acquired risk factors. Many neonatal thromboembolic disorders are iatrogenic and their incidence is likely to increase as advancements are made in neonatal care. Among pediatric populations, neonates have the highest risk for thrombosis secondary to the unique developmental hemostatic system, inherited prothrombotic disorders, and perinatal clinical conditions. Central venous and arterial catheters present the greatest risk for developing thromboembolisms in neonates. Both venous and arterial thromboses have been reported in a variety of anatomic locations. Prompt identification and appropriate management of thromboembolisms is critical for avoiding life-threatening complications. To date, few data are currently available regarding the contribution of inherited and acquired prothrombotic disorders in the pathogenesis of neonatal thromboembolism. In particular, a lack of information about neonatal thromboembolism in Korea has inhibited the development of appropriate guidelines for diagnosing thromboembolisms in neonates. An overview of the current knowledge about the role of inherited and acquired risk factors for neonatal thromboembolism in the West and a detailed description of common neonatal thromboembolic diseases is reviewed.

• Clinical and Experimental Pediatrics
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• v.63 no.11
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• pp.447-450
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• 2020

Background: Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown. Purpose: We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists. Methods: The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed. Results: Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy. Conclusion: The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.

• Journal of Korean Public Health Nursing
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• v.35 no.1
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• pp.149-164
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• 2021

Purpose: To identify the factors associated with poor self-rated health in individuals with acquired visual impairment through classification of such individuals into severe and mild visual impairment groups. Methods: This descriptive, cross-sectional, survey-based study analyzed data from 563 individuals with visual impairment due to acquired causes who had been recruited in the 2017 Korean National Survey on Persons with Disabilities. Results: Individuals with severe visual impairment reported poorer self-rated health. Mild depression (p=.003), and low smartphone use (p=.045) were associated with poorer self-rated health in those with severe visual impairment. The factors associated with poor self-rated health in those with mild visual impairment were comorbidities, low smartphone use (p=.006), needed health information (p=.020), unbalanced diet (p<.001), low weight (p=.024), and lack of health checkups (p=.001). Conclusion: Depression was found to be a predictor of poor self-rated health in individuals with severe visual impairment, which highlights the need for nursing and related healthcare intervention to lower depression in this specific population. Further, promoting social network building and providing health information using smartphones may serve to encourage appropriate health behavior in people with severe visual impairment who have reduced mobility and health literacy.

• Journal of the Korean Data and Information Science Society
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• v.22 no.3
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• pp.389-400
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• 2011

This study was carried out to analysis factors related to in-hospital mortality of community-acquired peumonia using administrative database. The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge Injury Survey 2004-2006 data. The data were analyzed using chi-squared test and decision tree model in the data mining technique. Among the decision tree model, C4.5 had the best performance. The critical factors on in-hospital mortality of communityacquired pneumonia are admission route, respiratory failure, congenital heart failure including age, comorbidity, and bed size. This study was carried out using the administrative database including patients' characteristics and comorbidity. However further study should be extensively including hospital characteristics, regional medical resources, and patient management practice behavior.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.120-126
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• 2020

Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions: Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.

• Tuberculosis and Respiratory Diseases
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• v.70 no.2
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• pp.105-112
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• 2011

Pneumonia is frequently encountered in the clinical fields, both as a cause for admission and as a complication of the underlying disorder or as the course of treatment. Pneumonia is the second most common hospital-acquired infection and is associated with the highest morbidity and mortality rates among hospital-acquired infections. The guidelines for the management of hospital-acquired pneumonia by the American Thoracic Society include identifying individuals who have recently received antibiotics therapy or have been in medical facilities; these individuals are at higher risk for infection with multiple drug resistant organisms. Individuals, who have acquired pneumonia according to this clinical scenario, have what is known as healthcare-associated pneumonia (HCAP). Patients with HCAP should be considered to have potentially drug-resistant pathogens and should receive broad spectrum empiric antibiotic therapy directed at the potentially resistant organisms. In this paper, the diagnosis, risk factors, and treatment of HCAP are discussed.