• Journal of Korean Academy of Nursing Administration
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• v.8 no.1
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• pp.85-95
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• 2002

The purpose of this study was to develope a critical pathway for the chemotherapy of non-small cell lung cancer patients and to identify its effects after implementation. Critical pathway was developed through 5 steps including content and clinical validity tests with collaborative efforts of nurses, clinicians, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimizing cost to the patients. This paper was described an evaluation of the impact of a developed critical pathway on complication rate, length of stay, costs, the interval of treatment and patient satisfaction by nonequivalent control group posttest-only non-synchronized research design.Results were compared between the two groups of patients. There were no significant differences in demographic variables and the occurrence of bone marrow suppression between experimental group and control group(t=-0.01, p=0.992). There were statistically significant decreases in the average length of stay(t=-10.45, p=0.000), in the average cost(t=-2.988, p=0.004), and in the interval of treatment(t=-6.75, p=0.000) after implementation of the critical pathway compared to control group. Also, there was a statistically significant improvement of the patient satisfaction after implementation of the critical pathway compared to control group(t=4.57, p=0.000). This paper concludes that critical pathway in chemotherapy for lung cancer, implemented in the context of an general hospital, is the useful tool to shorten the hospital stay, reduce treatment costs, and improve the quality of life in cancer patients. Further study needs to be conducted to identify other clinical outcomes including job satisfaction, collaboration among health professionals and potential for use in education. Also, it is recommended that nurses should revise continuously the developed critical pathway through clinical implementation and maintain their role of patient advocacy through monitoring pathway compliance.

• Tuberculosis and Respiratory Diseases
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• v.85 no.3
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• pp.221-226
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• 2022

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation due to chronic airway inflammation and destruction of the alveolar structure from persistent exposure to oxidative stress. The body has various antioxidant mechanisms for efficiently coping with such oxidative stress. The nuclear factor erythroid 2-related factor 2 (Nrf2)-antioxidant response element (ARE) is a representative system. Dysregulation of the Nrf2-ARE pathway is responsible for the development and promotion of COPD. Furthermore, COPD severity is also closely related to this pathway. There has been a clinical impetus to use Nrf2 for diagnostic and therapeutic purposes. Therefore, in this work, we systematically reviewed the clinical significance of Nrf2 in COPD patients, and discuss the value of Nrf2 as a potential COPD biomarker.

• Tuberculosis and Respiratory Diseases
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• v.54 no.5
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• pp.551-562
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• 2003

Background : NF-${\kappa}B$ is a characteristic transcriptional factor which has been shown to regulate production of acute inflammatory mediators and to be involved in the pathogenesis of many inflammatory lung diseases. There has been some evidence that PI3K/Akt pathway could activate NF-${\kappa}B$ in human cell lines. However, the effect of PI3K/Akt pathway on the activation of NF-${\kappa}B$ varied depending on the cell lines used in the experiments. In this study we evaluated the effect of PI3K/Akt pathway on the activation of NF-${\kappa}B$ in human respiratory epithelial cell lines. Methods : BEAS-2B, A549 and NCI-H157 cell lines were used in this experiment. To evaluate the activation of Akt activation and I${\kappa}B$ degradation, cells were analysed by western blot assay using phospho-specific Akt Ab and $I{\kappa}B$ Ab. To block PI3K/Akt pathway, cells were pretreated with wortmannin or LY294002 and transfected with dominant negative Akt (DN-Akt). For IKK activity, immune complex kinase assay was performed. To evaluate the DNA binding affinity and transcriptional activity of NF-${\kappa}B$, electrophoretic mobility shift assay (EMSA) and luciferase assay were performed, respectively. Results : In BEAS-2B, A549 and NCI-H157 cell lines, Akt was activated by TNF-$\alpha$ and insulin. Activation of Akt by insulin did not induce $I{\kappa}B{\alpha}$ degradation. Blocking of PI3K/Akt pathway via wortmannin/LY294002 or DN-Akt did not inhibit TNF-$\alpha$-induced $I{\kappa}B{\alpha}$ degradation or IKK activation. Inhibition of PI3K/Akt did not affect TNF-$\alpha$-induced NF-${\kappa}B$ activation. Overexpression of DN-Akt did not block TNF-$\alpha$-induced transcriptional activation of NF-${\kappa}B$, but wortmannin enhanced TNF-$\alpha$-induced in NF-${\kappa}B$ transcriptional activity. Conclusion : PI3K/Akt was not involved in TNF-$\alpha$-induced $I{\kappa}B{\alpha}$ degradation or transcriptional activity of NF-${\kappa}B$ in human respiratory epithelial cell lines.

• 대한예방의학회:학술대회논문집
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• 1995.10a
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• pp.169-170
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• 1995

• Korean Journal of Occupational Health Nursing
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• v.31 no.4
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• pp.187-197
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• 2022

Background: This study explores the pathways of nurse turnover in long-term care hospitals (LTCHs) and its underlying conditions in Korea. Although the factors of staying or leaving of nurses in LTCHs have been reported, few studies have examined the trajectory and conditions of nurses staying in and leaving LTCHs. Methods: A qualitative study design with a grounded theory approach was conducted. Data were collected in one-to-one interviews. Purposive and theoretical sampling led to the inclusion of 20 registered nurses from 15 LTCHs in South Korea. Results: Seeking work-life balance was the core category of the nurses' turnover pathway. The consequences of the nurses' turnover pathway were categorized into three groups: thriving, surviving, and leaving. Thriving nurses found meaning in their work, fostered good relationships, and saw opportunities for growth. Surviving nurses were enduring their jobs in LTCHs, having a work-life balance, and supportive nursing leaders. Leaving group nurses wished to leave LTCHs due to a lack of professional growth, unappealing work, continued conflict, and social stigma. Conclusion: This study provided the trajectory and conditions for nurses to enter, stay, move, or leave. Understanding the pathways for staying or leaving can be used as a strategy for successful retention of registered nurses in LTCHs.

• Journal of Korean Academy of Nursing Administration
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• v.6 no.1
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• pp.123-134
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• 2000

This study intended to analyze the effectiveness to obtain by developing the critical pathway presented as the method to improve the quality-betterment and cost effectiveness the through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. This study was designed to develop and effect the critical pathway for hysterectomy patients in the way to be possible the intergrated in patient management. It was adopted the process of seven phase to develop a critical pathway. To analyze the application effect of the developed critical pathway, this author offered health care service applying the critical pathway to the hysterectomy patient from July. 20 to Oct. 19. 1999. The study method had been done by investigating the experimental group and control group through the questionnaire on 40 patients who had been inpatient hysterectomy. Dependent variables were measured by modified from satisfaction, and cost and length of hospital stay. The data anlyzed by frequency, x2-test, t-test. The results of this study was as follows; 1. It was decided that the vertical line of the critical pathway was made up of eight items such as monitoring/assessment, treatment, activity, medication, consult. Lab test, diet, patient teaching and horizontal line was 7days from admission to discharge. 2. After the verifying the validity of the expert group about the critical pathway, the horizontal line was amended from hospitalization to five postoperative days and taking their consensus, some contents of the horizontal line was amended and deleted. 3. There was no significant differences in the experimental group and control group in the satisfaction, and significant differences in the cost, the length of hospital stay.

• Journal of Korean Academy of Nursing Administration
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• v.16 no.1
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• pp.59-72
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• 2010

Purpose: This study is a descriptive research to analyze prognostic factors of barbiturate coma therapy (BCT) for severe brain damage patients, to develop a critical pathway (CP) based on the results of analysis and to examine the effect of its clinical application. Method: We analyzed medical records of 76 patients who received BCT for more than three days between January 1999 to July 2005. Based on the results of the analysis, we developed a CP and applied it to 12 people during August-December of 2005. Result: By application of BCT CP, the mortality rate decreased from 31.6% to 16.7%. It was found that the period of staying at ICU and total period of hospitalization were shortened by 2.78 (13.9%) days and 16.43 (29.4%) days, respectively. The Glasgow coma scale of the recovery group by CP application was 9.03 (4.64) at 72 hours post of BCT and 14.28 (1.82) at discharge from hospital, and DRS was 6.62 (6.38) points. Conclusion: By verifying clinical validity of the suggested CP, we believe that we have obtained visible effects standardizing the treatment pathway of BCT for brain damage patients.

• Molecules and Cells
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• v.41 no.4
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• pp.282-289
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• 2018

Interleukin-17A (IL-17A) is a pro-inflammatory cytokine mainly derived from T helper 17 cells and is known to be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Cigarette smoke (CS) has been considered as a primary risk factor of COPD. However, the interaction between CS and IL-17A and the underlying molecular mechanisms have not been clarified. In the current study, we investigated the effects of cigarette smoke extract (CSE) on IL-17A-induced IL-8 production in human bronchial epithelial cells, and sought to identify the underlying molecular mechanisms. IL-8 production was significantly enhanced following treatment with both IL-17A and CSE, while treatment with either IL-17A or CSE alone caused only a slight increase in IL-8 production. CSE increased the transcription of IL-17RA/RC and surface membrane expression of IL-17R, which was suppressed by an inhibitor of the phosphoinositide 3-kinase (PI3K)/Akt pathway (LY294002). CSE caused inactivation of glycogen synthase $kinase-3{\beta}$ ($GSK-3{\beta}$) via the PI3K/Akt pathway. Blockade of $GSK-3{\beta}$ inactivation by overexpression of constitutively active $GSK-3{\beta}$ (S9A) completely suppressed the CSE-induced up-regulation of IL-17R expression and the CSE-induced enhancement of IL-8 secretion. In conclusion, inactivation of $GSK-3{\beta}$ via the PI3K/Akt pathway mediates CSE-induced up-regulation of IL-17R, which contributes to the enhancement of IL-17A-induced IL-8 production.

• Journal of Society of Preventive Korean Medicine
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• v.26 no.1
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• pp.11-23
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• 2022

Objectives : The aim of this study was to develop a clinical pathway (CP) model for the integrative treatment of non-invasive breast cancer, with western medicine and Korean traditional medicine. Methods : The checklist model was composed in four types according to the target patients: DCIS inpatients, DCIS outpatients, LCIS inpatients, LCIS outpatients. The vertical axis of the pathway consists of 11 categories of actions applied to the patient. The horizontal axis was in accordance with the flow of time, comprising three periods during inpatient care and seven periods during outpatient care. In addition, CP was also composed in flow chart form. The pathway model was developed through a literature review of clinical practice guidelines, conference publications, papers, books, and websites. Results : The integrative CP model for non-invasive breast cancer was developed. Conclusions : The goal of the CP suggested in this study was to improve non-invasive breast cancer patients' quality of life and to supplement conventional treatment, by alleviating the side effects. The model developed through this study could serve as the basis when developing CPs in a real-world integrative medical environment. This could lead to a reduction in cost and time for CP development, thus bringing about efficiency in the clinical setting.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.27-36
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• 2012

Objectives : A protocol called "critical pathway" was developed to standardize the management of hospital patients the day after they underwent gamma knife radiosurgery. The quality of improvement in patient outcomes was evaluated. Methods : Critical pathway was developed, according to the regulations of the I hospital, by analyzing the medical records of 22 inpatients who underwent gamma knife surgery within the period from January to April 2011 on the day of the surgery. The study included a group of 22 patients admitted to the hospital the day after they underwent gamma knife radiosurgery, between July and September 2011. The control group included 22 patients who had surgery employing the same method within the period from May to June 2011. To measure the effects on quality improvement, the average length of stay, the execution rate of the hospital discharge notice system, daily hospital revenue, and the satisfaction of the patients and the medical team were assessed. The patient questionnaire employed a four-point Likert scale while the medical-staff questionnaire employed a five-point Likert scale. Result : The average length of stay was significantly shorter in the study group compared to the control group (2.3 days vs. 3.8 days, P<0.05). The execution rate of the hospital discharge notice system was higher in the study group (100% vs. 72%) than in the control group. Daily hospital revenues were higher by 264,178 Korean won in the study group when compared to the control group. The study group showed greater satisfaction of patients compared to the control group based on a four-point Likert scale (P<0.05). The study group showed greater satisfaction in medical team compared to the control group based on a five-point Likert scale (P<0.05). Conclusion : The development and implementation of a critical pathway protocol for hospital admission the day after gamma knife radiosurgery is an effective care process that improves the clinical quality.