• 한국간호교육학회지
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• 제23권1호
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• pp.95-107
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• 2017

Purpose: The aim of this study was to assess the efficacy of web-based simulation and high-fidelity simulation on acute heart disease patient care. Methods: The project used a comparative study design with two simulation-based training modalities. A total of 144 nursing students participated in this study: 76 students in a web-based simulation, and 68 students in a high-fidelity simulation. Participants rated their self-efficacy, problem-solving ability, interest in learning, level of stress, satisfaction with the simulation experience, and level of difficulty of the simulation. Results: The scores for self-efficacy, problem-solving ability, and interest in learning including interest in clinical training in the high-fidelity simulation group was higher than in the web-based simulation group. However, there were no significant differences in interest in learning, including interest in nursing knowledge, and in lab training, level of stress, satisfaction with the simulation experience, and level of difficulty of the simulation. Conclusion: A high-fidelity simulation of acute heart disease patient care might be beneficial to developing many more abilities for nursing students than would a web-based simulation. Also, since the web-based simulation improved interest in nursing knowledge, it could be a viable alternative to high-fidelity simulation. Further study is needed to verify the effects of varied levels of simulation-based care with more rigorous outcomes.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.53-61
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• 2019

Background: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. Methods: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006-2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. Results: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025-162.343), low PE severity index (OR, 0.948; 95% CI, 0.917-0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040-1.307). Model II included age (OR, 0.930; 95% CI, 0.893-0.969) and aPTT (OR, 1.104; 95% CI, 1.000-1.217). Conclusion: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I-II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제16권4호
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• pp.219-224
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• 2013

Acute abdominal pain is a common complaint in childhood, and it can be caused by a wide range of underlying surgical and non-surgical conditions. The most common non-surgical condition is gastroenteritis, while the most common surgical condition is appendicitis. Abdominal pain in children varies with age, associated symptoms, and pain location. Although acute abdominal pain is usually benign and self-limiting, there are uncommon but life-threatening conditions that require urgent care. Meticulous history taking and physical examinations are essential to determine the cause of acute abdominal pain and to identify children with surgical conditions such as appendicitis.

• Journal of Chest Surgery
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• 제49권5호
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• pp.401-404
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• 2016

The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.99-105
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• 2018

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

• Tuberculosis and Respiratory Diseases
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• 제83권2호
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• pp.167-174
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• 2020

Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

• Child Health Nursing Research
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• 제6권2호
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• pp.119-131
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• 2000

The purpose of this study was to identify the trends and contents of intervention towards children using meta analysis, to support the basis for using in the field and research method about nursing intervention. We used 27 materials which was reported from 1970 to August, 1999 : dissertation study and Korean Nurses' Academic society Journals, the Journal of Korean Academic society of Adult Nursing, The Korea Journal of Maternal and Child Health Nursing. The types of intervention we used came from 3 different researchers. Snyder showed cognitive, movement, social sensory intervention. McCloskey & Bulechek categorized as the following : self-care assistance, acute care management, life-style alteration, health promotion, life support intervention, Craft & Denehy classified psychosocial intervention and biophysiological intervention. Some findings are summarized as follow : Out of the 27 researches sensory intervention had the most in there thesis, recently cognitive intervention research has a tendency to increase. 18 researches has acute care management in there theses, and health promotion was found the least. Out of the 27 thesis 15 thesis was classified as biophysiological intervention and 12 had psychosocial. 27 thesis had 11 types of interventions which originally was categorized by Snyder, therefore sensory intervention thesis had the most. 11 types of intervention which originally was classified by McClosky & Bulechek, teaching and information had the most out of acute care management. Out of 27 thesis, 14 had dealt with newborns, especially newborns with sensory intervention. Therefore school age and above had cognitive intervention which was used for teaching and information. Infants, preschool, schoolage children received acute care management the most, health promotion intervention was used towards adolescences. Depending on the characteristics of dependent variables, it was analysed using meta however 17 thesis are possible except primary experimental research. Mean effect size comparison by Snyder classification, cognitive intervention was the largest mean(1.51), sensory intervention was larger(0.71) also, movement intervention was in the middle(0.56) as shown. Comparison done by McClosky & Bulechek, the intervention leading to life style alteration was the largest mean(1.97), teaching was used the most. Comparison by Craft & Denehy classification, psychosocial intervention was larger(1.15) than biophysiological intervention (0.67). The result of nursing intervention through age classification, the largest weighted mean effect size in the research was towards infants and neonates. The research which was focused on nursing intervention, has important meaning in nursing practice and knowledge development. When we know that children's nursing intervention is necessary and overcome our biased view, efficiency of children's nursing intervention are increased and professionalized. Therefore results will be important basic data to guide a development of child nursing intervention & classification.

• Acute and Critical Care
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• 제33권4호
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• pp.206-215
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• 2018

Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.

• 한국산학기술학회논문지
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• 제14권2호
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• pp.707-712
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• 2013

급성심근경색환자에서 증상발병후 병원도착지연이 질병과 사망률에 중요한 관련이 있다. 이 연구에서는 환자의 증상 인식 등 응급의료체계 활성화 이전 단계의 의료기관 내원 지연의 원인을 연구하여, 향후 내원지연 시간 감소를 위해 적절한 보건교육 및 치료의 방향을 찾고자 하였다. 연구 샘플은 2009년 6월에서 9월까지 급성심근경색으로 입원한 환자를 대상으로 하였다. 인구통계, 의료기록 및 임상자료는 병원진료기록를 이용하였으며, 병원전 지연은 6시간이전과 이후로 분류하였다. 급성심근경색증 환자들에서 내원시간 지연에 영향을 미치는 요인으로는 고령인 경우, 낮은 사회경제적 위치, 응급의료체계의 이용하지 않고 내원 한 경우와 급성심근경색을 위한 응급처치의 지연등이다. 따라서 사회경제적 위치가 낮은 계층과 고령층에 대한 급성관상동맥 증후군의 증상에 대한 지식을 높이고 증상발생시 의료기관을 빠르게 이용하도록 교육이 필요하다.

• 기본간호학회지
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• 제24권4호
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• pp.286-295
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• 2017

Purpose: The World Health Organization identifies spiritual care as a component of health and thus nursing care. There is a need to identify how self-esteem, communication and existential well-being affects spiritual care competence in nurses. Methods: The participants were 189 nurses in G metropolitan city. The survey was conducted from March 21 to April 8, 2016, with a self-report questionnaire. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, $Scheff{\acute{e}}$ test, Pearson correlation coefficient and stepwise multiple regression analysis using SPSS version 21.0. Results: Differences in spiritual care competence were statistically significant according to education level, work department, position, having received spiritual care education, experience of providing spiritual care, experience of asking religionist to provide spiritual care for a patient and recognition of need for spiritual care. The spiritual care competence of nurses showed a significantly positive correlation with self-esteem, communication and existential well-being. Factors influencing spiritual care competence were communication, experience of providing spiritual care and existential well-being which explained about 37.5% of spiritual care competence. Conclusion: It's necessary for nurses to develop intervention programs to strengthen spiritual care competence through improving communication, providing opportunities for spiritual care and existential well-being.