• Journal of Korean Society for Quality Management
• /
• v.51 no.4
• /
• pp.531-550
• /
• 2023

Purpose: The unique nature of life-and-death healthcare services sets them apart from other service industries. While many studies exist on the relationship between healthcare services and customer satisfaction, most of them focus on mildly ill patients, ignoring the differences between critically ill and non-seriously ill patients. This study discusses the actual quality of healthcare services for patients who are facing life-threatening illnesses and are on life support, as well as their right to protection and dignity. Methods: The survey conducted to 149 patients with the four major illnesses: cancer, heart disease, brain disease and rare and incurable disease, those who have experiences with senior general hospitals. Results: The basic statistics of this study are adequate to represent the four major critical illnesses, and the reliability and validity of this study's hypotheses, which were measured by multiple items, were analyzed, and the internal consistency was judged to be high. In addition, it was found that the convergent validity was good and the discriminant validity was also secured. When examining the goodness of fit of the hypotheses, the SRMR, which is the standardized root mean square of residuals that measures the difference between the covariance matrix of the data variables and the theoretical covariance matrix structure of the model, met the optimal criteria. Conclusion: The academic implications of this study are differentiated from other studies by moving away from evaluating the quality of healthcare services for mildly ill patients and focusing on the rights and dignity of patients with life-threatening illnesses in four senior general hospitals. In terms of academic implications, this study enriches the depth of related studies by demonstrating the right to protection and dignity as a factor of patient-centeredness based on physical environment quality, interaction quality, and outcome quality, which are presented as sub-factors of healthcare quality. We found that the three quality factors classified by Brady and Cronin (2001) are optimized for healthcare quality assessment and management, and that the results of patients' interaction quality assessment can be used to provide a comprehensive quality rating for hospitals. Health and human rights are inextricably linked, so assessing the degree to which rights and dignity are protected can be a superior and more comprehensive measurement tool than traditional health level measures for healthcare organizations. Practical implications: Improving the quality of the physical environment and the quality of outcomes is an important challenge for hospital managers who attract patients with life and death conditions, but given the scale and economics of time, money, and human inputs, improving the quality of interactions and defining them as performance indicators in hospital quality management is an efficient way to create maximum value in the short term.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.15 no.1
• /
• pp.31-39
• /
• 2017

Purpose: Despite the clinical and socio-economic impact of acute poisoned patients, many of the treatments are not standardized in Korea. Moreover, no formal training that is specifically focused on clinical toxicology exists. Rather, training and education are conducted case by case in various institutions. This study was conducted to develop a standardized simulation-based clinical toxicology training curriculum for healthcare providers. This program will focus on specific assessment and treatment of critical toxicology patients, specifically those who have been poisoned with organophosphate. Methods: The study was performed using a pre- and post-design to determine the effects of implementation of this program. The study was conducted at eight different urban teaching hospitals in a simulated room in the clinical area. The study was targeted to 19 groups composed of emergency residents and nurses. Simulation-based learning was conducted for each group. Results: All 19 groups achieved the minimum passing score of 75%. Implementation of the program led to improved performance rates for overall management and cooperative moods competency (p<0.01). Inter-rater agreement between the two evaluators was excellent. In general, the participants thought the program was realistic and were able to recognize and improve the competencies needed to care for organophosphate poisoned patients. Conclusion: Simulation-based learning is an effective educational strategy that can be applied to improving and understanding proper care for rare but critical patients. This program was effective at improving team performance and cooperative moods when managing an organophosphate poisoned patient in the Emergency Department.

• Journal of Yeungnam Medical Science
• /
• v.1 no.1
• /
• pp.13-23
• /
• 1984

Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Post-renal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as $FENa^+$ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilyzing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.894-900
• /
• 1989

It has been suggested that mixed venous $O_{2}$ tension is a predicor of cardiac output especially in a critically ill patient after an open heart surgery. From April 1988 through September 1989, we monitored mixed venous $O_{2}$ tension and pulmonary arterial pressure in 48 patients with acyanotic congenital heart disease at postoperative 1 hour, 6 hour, 12 hour, 24 hour, and 48 hour respectively. They were divided into Group I, with severe pulmoary hypertension, and Group II, without severe pulmonary hypertension. In Group I, mixed venous $O_{2}$ tension and cardiac index showed significant increase with time (p<0.05), but the ratio of pulmonary-aortic systolic pressure didn't show significant change. The increase was significant only 24 hour after operation, and so this low cardiac performance in early postoperative period should be considered when postoperative management is being planned in the risky patient. In Group II, all of the three variables didn't show any significant change with time. The correlation coefficient between mixed venous $O_{2}$ tension and cardiac index was significantly different from zero in both Group I (p<0.001) and group II (p<0.05) at each imeperiod, but the ratio of pulmonary-aortic systolic pressure didn't correlated well with the other 2 variables. Our study showed that serial determination of mixed venous $O_{2}$ tension in acyanotic congenital heart disease could be used as a guide in estimating the cardiac index postoperatively.

• Tuberculosis and Respiratory Diseases
• /
• v.77 no.3
• /
• pp.141-144
• /
• 2014

Invasive pulmonary aspergillosis (IPA) is rarely reported in patients who have normal immune function. Recently, IPA risk was reported in nonimmunocompromised hosts, such as patients with chronic obstructive pulmonary disease and critically ill patients in intensive care units. Moreover, influenza infection is also believed to be associated with IPA among immunocompetent patients. However, most reports on IPA with influenza A infection, including pandemic influenza H1N1, and IPA associated with influenza B infection were scarcely reported. Here, we report probable IPA with a fatal clinical course in an immunocompetent patient with influenza B infection. We demonstrate IPA as a possible complication in immunocompetent patients with influenza B infection. Early clinical suspicion of IPA and timely antifungal therapy are required for better outcomes in such cases.

• The Korean Journal of Physiology and Pharmacology
• /
• v.28 no.2
• /
• pp.121-127
• /
• 2024

Vancomycin is a frequently used antibiotic in intensive care units, and the patient's renal clearance affects the pharmacokinetic characteristics of vancomycin. Several advantages have been reported for vancomycin continuous intravenous infusion, but studies on continuous dosing regimens based on patients' renal clearance are insufficient. The aim of this study was to develop a vancomycin serum concentration prediction model by factoring in a patient's renal clearance. Children admitted to our institution between July 1, 2021, and July 31, 2022 with records of continuous infusion of vancomycin were included in the study. Sex, age, height, weight, vancomycin dose by weight, interval from the start of vancomycin administration to the time of therapeutic drug monitoring sampling, and vancomycin serum concentrations were analyzed with the linear regression analysis of the mixed effect model. Univariable regression analysis was performed using the vancomycin serum concentration as a dependent variable. It showed that vancomycin dose (p < 0.001) and serum creatinine (p = 0.007) were factors that had the most impact on vancomycin serum concentration. Vancomycin serum concentration was affected by vancomycin dose (p < 0.001) and serum creatinine (p = 0.001) with statistical significance, and a multivariable regression model was obtained as follows: Vancomycin serum concentration (mg/l) = -1.296 + 0.281 × vancomycin dose (mg/kg) + 20.458 × serum creatinine (mg/dl) (adjusted coefficient of determination, R² = 0.66). This prediction model is expected to contribute to establishing an optimal continuous infusion regimen for vancomycin.

• Tuberculosis and Respiratory Diseases
• /
• v.67 no.3
• /
• pp.205-211
• /
• 2009

Background: Serum procalcitonin level has been considered prognostic during sepsis and septic shock. We investigated the significance of procalcitonin in critically ill patients with respiratory infections. Methods: The patients who had radiographically diagnosed diffuse lung infiltrations were enrolled on a prospective basis. Bronchoalveolar lavage (BAL) fluid for the purpose of quantitative cultures (${\geq}10^4$ cfu/mL) was obtained from all patients. Serum procalcitonin levels determined by PCT-Q kit were measured on BAL day and classified as follows; <0.5 ng/mL, 0.5~2.0 ng/mL, 2.0~10.0 ng/mL and >10.0 ng/mL. We analyzed the patient's characteristics according to outcome; favorable or unfavorable, defined as death. Results: Patients from the following categories were included: medical 17 (47.2%), surgical 9 (25%), and burned 10 (27.8%). APACHE II scores on admission to intensive care unit were 11.5${\pm}$6.89 and 11 (30.6%) had unfavorable outcomes. A procalcitonin level ${\geq}$0.5 ng/mL was in 17 (47.2%) of all. On univariate analysis, the frequencies of burn injury, mechanical ventilation, multiple organ failure, and a procalcitonin level ${\geq}$0.5 ng/mL were more often increased in patients with unfavorable outcomes than in those with favorable outcomes (p<.05). Also, a higher procalcitonin range and ventilator-associated pneumonia (VAP) were more closely associated with an unfavorable outcome (p<.05). However in multivariate analysis, a strong predictor of unfavorable outcome was burn injury (p<.05). A procalcitonin level ${\geq}$0.5 ng/mL was more sensitive in predicting VAP than unfavorable outcome. Conclusion: A higher procalcitonin level seems to be associated with VAP, but further study is required to know that procalcitonin would be a prognostic marker in critically ill patients with respiratory infections.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.19 no.1
• /
• pp.121-126
• /
• 2018

The oral hygiene of patients admitted to the ICU (Intensive Care Unit) is very important. Critically ill patients are basically immunocompromised ones because of the high risk of infection by various pathogenic bacteria. The mouth is not only the primary site of infection, but also the site of systemic infections. The purpose of this study was to design a mouthpiece type vacuum oral cleaner for the oral care of seriously ill patients. A 3D CAD modeling and flow analysis model were established for a double structure type cleaner and standard tooth model, and their pressure and flow characteristics were analyzed. The pressure inside the oral cleaner was almost constant, but the velocity distribution showed a large difference between the inside and outside of the teeth. The velocity at the center region inside of the teeth was the highest, and the speed decreased as the distance from the center increased. In the analysis of the case where the suction tube was replaced by the drainage tube, the velocity at the center of the outer portion of the teeth was the highest. In order to increase the effectiveness of the oral cleaner, alternating between suction and drainage is proposed, and a design complement to increase the speed of the molar region is required.

• Childhood Kidney Diseases
• /
• v.15 no.2
• /
• pp.107-115
• /
• 2011

Acute kidney injury (AKI) is associated with mortality and may lead to increased medical expense. A modified criteria (pediatric RIFLE [pRIFLE]: Risk, Injury, Failure, Loss, and End-stage renal disease) has been proposed to standardize the definition of AKI. The common causes of AKI are renal ischemia, nephrotoxic medications, and sepsis. A majority of critically ill children develop AKI by the pRIFLE criteria and need to receive intensive care early in the course of AKI. Factors influencing patient survival (pediatric intensive care unit discharge) are known to be low blood pressure at the onset of renal replacement therapy (RRT), the use of vasoactive pressors during RRT, and the degrees of fluid overload at the initiation of RRT. Early intervention of continuous RRT (CRRT) has been introduced to reduce mortality and fluid overload that affects poor prognosis in patients with AKI. Here, we briefly review the practical prescription of pediatric CRRT and literatures on the outcomes of patients with AKI receiving CRRT and associations among AKI, fluid overload, and CRRT. In conclusion, we suggest that an increased emphasis should be placed on the early initiation of CRRT and fluid overload in the management of pediatric AKI.

• Journal of Nutrition and Health
• /
• v.44 no.5
• /
• pp.384-393
• /
• 2011

The objective of this study was to determine the nutritional support in patients treated in medical intensive care units (MICUs) by evaluating the extent of current nutritional support using the patient care plan and considering the association between nutritional status and the amount of nutrition supplied. From April to December 2010, 114 patients (age ${\qeq}$ 18 years) admitted to the MICU and who underwent nutritional support for > 5 days were included. Descriptive statistics showed that the 114 patients received nutritional support within 1.2 ${\pm}$ 0.7 days and for 16.2 ${\pm}$ 11.7 days in the MICUs. The total delivered/required caloric ratio was 81.08 ${\pm}$ 27.31%, and the protein ratio was 80.32 ${\pm}$ 28.93%. Patients who received > 80% of required calories and protein showed improved nutritional status (p < 0.05). The results showed that adequate nutritional support is crucial to critically ill patients. We suggest early nutritional screening using simple tools such as periodic monitoring and management to recalculate nutritional status and nutritional requirements and nutritional support using a multidisciplinary method. Systematic nutritional support teams are needed to provide adequate nutritional support for patients in the MICU.