• Korean Journal of Hospice Care
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• v.7 no.2
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• pp.6-14
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• 2007

Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.

• Women's Health Nursing
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• v.6 no.1
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• pp.34-45
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• 2000

The study was to find whether the educational program contributed to increase of knowledge and self-efficacy of the postpartal primiparas. This study aimed at improvement of the educational effect for postpartal primiparas. The Subjects were 34 primiparas who were admitted to the obstetric ward in a University hospital from November 15th to December 9th, 1999. The Subjects were those who had no labor pain at the admission time, had no complications during labor and delivery and, gave birth to a healthy baby. They were tested on knowledge and self-efficacy two times, one at the admission time and prior to discharge. After the first test nurses in a maternity ward taught them on postpartal care. Two tools were developed by authors based on literature review. The test tool fr knowledge of postpartal car consisted of 23 items. The test tool for self-efficacy of postpartal care consisted of 16 items. Analysis of demographic data were analyzed with calculation of percentage. Score differences between the first test and the second test were analyzed with paired t-test. The Spss (Win 8.0) program was used for data analysis. The results are as follows. 1. There were not significant influencing general characteristics of primiparous to pre-educational knowledge. There were significant influencing general characteristics of primiparous to post-educational knowledge : occupation(t=13.04, p=0.00), postpartal education(t=5.51, p=0.02). 2. There were not significant influencing general characteristics of primiparous to pre-educational self-efficacy. There were significant influencing general characteristics of primiparous to post-educational self-efficacy : antenatal education(t=5.53, p=0.02) 3. Primiparas' knowledge of postpartal care increased significantly after education(t=13.04, p=0.00). 4. Primiparas' self-efficacy of postpartal care increased significantly after education(t=5.51, p=0.02). 5. Correlation between knowledge and self-efficacy was r=.360(p=0.03). We suggest follow-up studies to find whether primiparas' self-efficacy will last after discharge or not.

• Journal of Korean Critical Care Nursing
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• v.16 no.2
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• pp.28-41
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• 2023

Purpose : This study aimed to investigate the characteristics and risk factors associated with pressure injuries related to medical devices among patients admitted to the intensive care unit (ICU). Method : A retrospective study analyzed data from 462 ICU patients. Statistical analyses, including independent t-tests, Fisher's exact tests, and logistic regression were performed to analyze the data. Results : Among the 154 subjects, there were a total of 198 medical device-related pressure injuries (MDRPI). Stage 2 and deep tissue pressure injuries were the most frequent. MDRPI occurred most frequently on the face, with nasogastric tubes being its leading cause, followed by endotracheal tubes. The risk factors for MDRPI included male sex (odds ratio [OR]=1.78, 95% confidence interval [CI]=1.12-2.83), department at the time of ICU admission (OR=4.29, 95% CI=2.01-9.15), post-surgery ICU admission (OR=0.43, 95% CI=0.25-0.73), application of extracorporeal membrane oxygenation machines (OR=2.72, 95% CI=1.06-6.95), number of medical devices (OR=1.16, 95% CI=1.05-1.30), inotropic drug administration (OR=2.33, 95% CI=1.19-4.60), and sedative use (OR=2.53, 95% CI=1.17-5.45). Conclusion : These results enable the determination of the characteristics and risk factors associated with MDRPI. It is crucial to acknowledge the risk factors for MDRPI in ICU patients and establish a prevention strategy.

• Journal of Hospice and Palliative Care
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• v.21 no.3
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• pp.75-83
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• 2018

Purpose: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. Methods: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. Results: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). Conclusion: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

• Clinical and Experimental Pediatrics
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• v.61 no.8
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• pp.239-244
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• 2018

Purpose: Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. Methods: The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above $23.0^{\circ}C$, and a check-list was used for feedback. Results: Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <$36.0^{\circ}C$) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from $35.5^{\circ}C$ to $36.0^{\circ}C$. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from $35.4^{\circ}C$ to $35.9^{\circ}C$ and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. Conclusion: Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.

• Journal of Preventive Medicine and Public Health
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• v.40 no.1
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• pp.36-44
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• 2007

Objectives : There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. Methods : To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. Results : The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. Conclusions : This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.28-35
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• 2011

Background: The aim of the study was to describe the characteristics, treatments, and outcomes of critically ill patients with pandemic Influenza A/H1N1 2009 at a major medical center in Korea. Methods: This retrospective observational study examined critically ill adult patients with pandemic Influenza A/H1N1 2009, who were admitted to the AMC between August and December 2009. Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41~67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1~4), and the median time from presentation to ICU admission was 0 days (0~1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

• Quality Improvement in Health Care
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• v.4 no.2
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• pp.260-278
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• 1997

Background : Quality of professional nursing care is the most essential factor for survival and growth of nursing profession. Then, nursing professionals have responsibility for the evaluation of quality of professional nursing care. The purpose of this study was to develope an evaluation tool of nursing care for patients received gastrointestinal surgery with general anesthesia. This study was a primary work for the developement of a computer program for the evaluation of nursing care. Methods : This study was done through some consecutive steps. They were (1) Developement of items for the tool (2) Developement of an evaluation tool of nursing care quality for the G-I surgery patient (3) Test of reliability and validity of the tool. Two groups of experts and expert pannels who had much experience of the QA and the care of G-I surgery patients participated for developement of the items. 85 nursing records were used for the test of reliability and validity of the developed tool. The evaluation tools were developed with two types of scoring, norm-referenced tool and criterion-referenced tool. Results The system of items for tool was evaluation area evaluation item-indicator. There were 7evaluation areas which contained 32evaluation items which contained 7lindicators. Evaluation areas 1, 2, 3, 4 were for the evaluation of process and 5, 6, 7 were for the evaluation of outcome of nursing care for G-I surgery patient. For the test of interrator reliability, correlation coefficients of each scores of items and intragroup correlation coefficients were calculated. The average correlation coefficients between two rators were 0.65, 0.54 and the intragroup correlation coefficient were 0.99 and 1.00 by the types of scoring. The Cronbach alpha coefficients of the tools were 0.54 and 0.46 by the types of scoring. The average content validity index of the items was 0.95 from 4 pairs of experts. Because there were significant differences between some scores of quality of nursing care of 3 general hospitals regardless of the types of scoring, the tools could be thought to have some construct validity. And also, there were significant correlations between some scores of quality of nursing care and admission days and admission days after surgery regardless of the types of scoring, the tools could be thought to have predictive validity. Conclusion In this study, the evaluation tool of nursing care was developed for the very specified group of patient, G-I surgery patient. And the items were developed and tested by the experts of nursing practice. Because of these reasons, it was supposed that the tool could be used effectively in nursing pratice. And the procedures for the development and the test of the evaluation tool of nursing care in this study were supposed to be used for the developement of other tools.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.13 no.3
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• pp.351-358
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• 2006

Purpose: The purpose of this study was to compare the effects of oral hygiene with 0.1% chlorhexidine or with normal saline on the incidence of pathogens in the oral cavity of patients in Intensive Care Units (ICU). Method: A quasi experimental design with non-equivalent control group and non-synchronized design was used. For the study 46 patients were recruited from a university hospital (24 for the experimental group, 22 for the control group). patients in the experimental group received mouth care with 0.1% chlorhexidine gluconate and those in the control group received mouth care with normal saline twice a day for 7 days in a row. Oral samples were taken for bacterial cultures on admission day, the 4th day and the 7th day for both groups. Results: The incidence of oral pathogens decreased in the experimental group, and increased in the control group. There was no significant difference in the incidence of oral pathogens between the two groups. However oral hygiene using 0.1% chlorhexidine gluconate decreased the incidence of oral pathogens significantly for patients who already had pathogenic bacteria in their mouths on the admission day. Conclusion: The results suggest that mouth care with 0.1% chlorhexidine is effective for decreasing the incidence of oral infection for ICU patients who have oral infections.

• Journal of Korean Academy of Nursing Administration
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• v.3 no.2
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• pp.137-150
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• 1997

This study was done to evaluate patient satisfaction with nursing care. The study subjucts were 164 patients admitted in a general hospital in Incheon province. The instrument used in this study was developed by Risser (1975) and Lim Hae Kyoung (1980) based on classification of nursing care area and modified by Chow Kwang Nam (1995). The relaiability alpha of this tool was 0.93695. The survey method was applied to collect data and the period of data collection was total 30 days from April Ist to April 30th in 1997. The data was analyzed by statistical method of %, mean, t-test and ANOVA through SAS program. 1. The highest scores of satisfaction were shown in the area of reliance, area of treatment, area of environment and area of education in order. 2. The crossed analysis of patient general characteristics and satisfaction of nursing care showed a signficance in the department of patient's admission and the highest satisfaction score was found in the general surgery ward (p<0.05). 3. General characteristics of patients which influence on the satisfaction showed a significant response according to the department of patient's admission in the treatment area, education area and environment area of nursing.(p < 0.05). Recommendation The followings are deriven from the above study results. 1. Area of nursing education which showed the lowest satisfaction should be empathized by making improvement of nursing care approach because the area in the basis to achieve nursing goal. 2. The development of systematic and objective instrument is necessary for evaluation of nursing quality and the evaluation should be performed in the area of patient satisfaction, hospital facility and hospital environment as well.