• Journal of Korean Critical Care Nursing
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• v.11 no.3
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• pp.45-57
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• 2018

Purpose : This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission. Methods : The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014. Results : The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at $1^{st}$ ICU admission, severity at $1^{st}$ ICU admission (CPSCS and APACHE II), duration of applying ventilator application during $1^{st}$ ICU admission, severity at $1^{st}$ discharge from ICU (CPSCS, APACHE II, and GCS), and application of $FiO_2$ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at $1^{st}$ ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, $FiO_2$ with oxygen therapy at $1^{st}$ ICU discharge, and major symptoms at $1^{st}$ ICU admission) were shown to be significant. Conclusions : Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.156-162
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• 2001

Objective : The purpose of this study is to review our experience with spontaneous thalamic hemorrhage. Clinical outcome of patients was brought about by comparing stereotactic aspiration and conservative medical therapy. Methods : The study consists of seventy-three cases with spontaneous thalamic hemorrhage which were treated from the period of Jan. 1993 to Dec. 1999. Thirty-eighty patients were treated with computed tomography (CT) guided stereotactic aspiration and thirty-five patients were treated conservatively. We compared the factors affecting treatment and the factors are as follows : age & sex, conscious level on admission, hematoma volume, hematoma sites, presence of ventricular penetration. Results : The results in the thirty eight stereotactic aspirated cases for the 6 months from oneset are as follows : good recovery or moderate disability in 43%, severe disability in 32%, vegitative state in 11%, dead in 13% respectively. The clinical result was more favorable in stereotactic aspiration, with 11-30cc hematoma volume, extend to internal capsule of hematoma, poor conscious level on admission than conservative medical therapy. But age & sex, conscious level on admission, presence of ventricular penetration were not influential in the statistical outcome between stereotactic aspiration and conservative medical therapy. Conclusion : Treatment modality of spontaneous thalamic hemorrhage is still controversial. But stereotactic aspiration is more recommended for improvement therapeutic results than conservative treatment or open craniotomy in case of 11-30cc hematoma volume, extend to internal capsule of hematoma and poor conscious level on admission.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.173-178
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• 2007

Objective : Hydrocephalus is one of the major complications following spontaneous subarachnoid hemorrhage (SAH). However, the risk factors of the hydrocephalus after SAH are not still well known. This study was focused on verification of the causal relationships between the development of hydrocephalus and SAH. Methods : The patients who developed hydrocephalus after rupture of aneurysms were studied. To obtain prognostic factors regarding to hydrocephalus, several parameters such as age, sex, hypertension, location of aneurysm, existence of intraventricular hemorrhage (IVH) and intracerebral hemorrhage (ICH), Glasgow coma scale (GCS), Hunt-Hess SAH classification & Fisher Grade on admission and the ratio of frontal harn of lateral ventricle diameter to skull inner table diameter at this level (FH/ID) were studied retrospectively. Results : The development of hydrocephalus following SAH is multifactorial. The age, IVH, FH/ID ratio were related to hydrocephalus in analysis. There is a low clinical correlation between sex, hypertension, location of aneurysm, existence of ICH, GCS, Hunt-Hess SAH classification, Fisher Grade on admission and hydrocephalus. Conclusion : Knowledge on risk factors related to the occurrence of hydrocephalus may help guide neurosurgeons in the long-term care of patients who have experienced aneurysmal SAH.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.15 no.1
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• pp.6-13
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• 2008

Purpose: This research was conducted to identify major factors that influence competency for nursing students in basic nursing skills. Method: Data were collected by questionnaires from 290 first year students in one college of nursing. The instrument tools included motivation for admission to nursing, concern about fundamentals of nursing, perceived importance of fundamentals of nursing, level of active participation in fundamentals of nursing, number of times to use open Lab, Lab class satisfaction, self-efficacy, self-evaluation and student attitude. Results: There was no significant correlation between competency in basic nursing skills and motivation for admission to nursing, concern about fundamentals of nursing, perceived importance of fundamentals of nursing, or number of times to use open Lab. Competency in basic nursing skill in these students showed a significantly positive correlation to Lab class satisfaction, self-efficacy, self-evaluation, student attitude and level of active participation in fundamentals of nursing. The major factors that influenced competency in basic nursing skills for nursing students were student attitude, self-efficacy and number of times to use open Lab. These factors explained 15.5% of the variance in competency. Conclusion: Basic nursing skill practice education programs should be developed to improve self-efficacy and active participation.

• Korean Journal of Biological Psychiatry
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• v.13 no.1
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• pp.26-31
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• 2006

Object : To evaluate how the therapeutic factors affect post-discharge course of patients with schizophrenia, we analyzed relationship between each therapeutic factor and outcome of inpatients with schizophrenia in Hanyang University Hospital. Methods : This study is a retrospective report. Subjects were schizophrenic inpatients who were discharged from Hanyang University Hospital from January 1, 2003 through December 31, 2004. We obtained demographic and clinical data from review of inpatient and outpatient charts. Results : We analyzed the records of 104 patients with schizophrenia(44 males and 60 females). Patients who had longer first admission days have fewer number of readmission. There were no significant correlation between psychiatric rehabilitation and course of schizophrenia. Courses, such as duration of outpatient department follow-up and number and duration of rehospitalization, did not differ according to the existence of extrapyramidal symptoms or types of antipsychotics prescribed. Conclusion : Among the therapeutic factors, longer duration of the first admission only affected better post-discharge course of patients with schizophrenia.

• Journal of Korean Clinical Nursing Research
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• v.19 no.2
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• pp.265-274
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• 2013

Purpose: The aim of this study was to determine the risk factors contributed to unplanned readmission to intensive care unit (ICU) and to investigate the prediction model of unplanned readmission. Methods: We retrospectively reviewed the electronic medical records which included the data of 3,903 patients who had discharged from ICUs in a university hospital in Seoul from January 2011 to April 2012. Results: The unplanned readmission rate was 4.8% (n=186). The nine variables were significantly different between the unplanned readmission and no readmission groups: age, clinical department, length of stay at 1st ICU, operation, use of ventilator during 24 hours a day, APACHE II score at ICU admission and discharge, direct nursing care hours and Glasgow coma scale total score at 1st ICU discharge. The clinical department, length of stay at 1st ICU, operation and APACHE II score at ICU admission were the significant predictors of unplanned ICU readmission. The predictive model's area under the curve was .802 (p<.001). Conclusion: We identified the risk factors and the prediction model associated with unplanned ICU readmission. Better patient assessment tools and knowledge about risk factors could contribute to reduce unplanned ICU readmission rate and mortality.

• Tuberculosis and Respiratory Diseases
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• v.66 no.1
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• pp.27-32
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• 2009

Background: The management of patients with lung cancer has improved recently, and many of them will require admission to the medical intensive care unit (MICU). The aim of this study was to examine the clinical characteristics and to identify risk factors for mortality in patients with lung cancer admitted to the MICU. Methods: We conducted retrospective analysis on 88 patients with lung cancer admitted to the MICU between April 2004 and March 2008. Results: Of the 88 patients (mean age, 66 years), 71 patients (80.7%) had non-small cell lung cancer and 17 patients (19.3%) had small cell lung cancer. Distant metastasis were present in 79 patients (89.8%). The main reasons for MICU admission were acute respiratory failure (77.3%), sepsis (11.4%), and central nervous system dysfunction (4.5%). Mechanical ventilation was used in 54 patients (61.4%). Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of MICU stay, need for mechanical ventilation, source of MICU admission were correlated with MICU mortality. The type of lung cancer and metastasis were not predictive factors of death in MICU. Conclusion: Most common reason for ICU admission was acute respiratory failure. Mortality rate of lung cancer patients admitted to the MICU was 65.9%. APACHE II score, length of ICU stay, need for mechanical ventilation, source of MICU admission were predicted factors of death in the MICU.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.113-119
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• 2020

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26-3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.15 no.4
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• pp.522-530
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• 2008

Purpose: In this study active surveillance culture for ICU patients, in whom the risk of VRE infection was high were conducted, and through this the VRE colonization rate and the characteristics of the colonization were examined and risk factors involved in VRE colonization and acquisition were analyzed. Method: This research was performed with 635 patients admitted to ICU between July 1 and December 31, 2006. Results: On admission to ICU, the VRE colonization rate was 2.36%, 93% identified from active surveillance culture. The VRE colonization rate was significantly higher in those patients with cancer (OR=9.43; 95% CI=1.38${\sim}$62.50; P=.022), liver cirrhosis (OR=55.5; 95% CI=7.29${\sim}$500; P=.005), transferred from other hospitals (OR=200; 95% CI=22.73${\sim}$1000; P=.000), high APACHE II score (OR=1.107; 95% CI=1.010${\sim}$1.213; P=.029), or antibiotics within the last 3 months (OR=15.87; 95% CI=2.27${\sim}$111.11; P=.005). The VRE acquisition rate was 5.2%. It was significantly higher in those who were using a ventilator (OR=26.31; 95% CI=5.13${\sim}$142.86; P=.000), three or more kinds of antibiotics during admission (OR=58.82; 95% CI=16.13${\sim}$200; P=.000), or high APACHE II score (OR=1.16; 95% CI=1.08${\sim}$ 1.24; P=.000). Conclusion: The results of this study show that active surveillance culture can detect VRE colonization on admission to ICU and those who have acquired VRE in ICU. The analyzed VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in ICU.