• 한국의료질향상학회지
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• 제25권1호
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• pp.43-51
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• 2019

Purpose: The time lag between the decision to initiate continuous renal replacement therapy (CRRT) and its actual initiation remains a major barrier in our intensive care units. We developed a CRRT pop-up chart on EMR for managing CRRT machines. Methods: This study measured time interval between the decision to prepare the CRRT machine and the actual use of the machine before and after using a CRRT pop-up chart. This study conducted a questionnaire of the medical staff to assess the changes in the quality of CRRT preparation. Results: A total of 95 patients on CRRT is analyzed. The time to find an available CRRT machine is decreased by 24.6%. The time to move a CRRT machine to the patient's bedside is decreased by 55.8%. Medical surveys of 44 nurses gave the following results. 1) The time to apprehend machines for 1 to 3 minutes is improved from 29.5% to 81.8%, and the time to apprehend machines over 3 minutes is decreased from 70.5% to 18.2%. 2) The number (6-all) of known machine locations is improved from 22.7% to 63.4%. 3) Interruption of a nurse's work due to telephone calls asking for the possession of movable CRRT equipment also is improved. Scores of 1-4 are improved from 15.9% to 41%. Scores of 5-7 are reduced from 52% to 15.9%. Conclusions: CRRT pop-up chart is shortened the time lag of CRRT machine preparation, reduced the nurse's phone workload and helped to improve the quality of CRRT care.

• 병원약사회지
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• 제35권4호
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• pp.418-429
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• 2018

Background : To improve medication adherence in elderly patients, the role of pharmacists in teambased services has been highlighted in the literature. However, not much is known about the role and the service elements involved in comprehensive geriatric programs in South Korea. This study was designed to describe the current status of medication adherence in geriatric patients based on the comprehensive geriatric assessment program and analyze the predictive factors for medication adherence in a tertiary teaching hospital. Methods : A retrospective cohort study was performed using electronic medical records of 247 patients from March 1st, 2015 to August 31st, 2015. Medication adherence and the types of non-adherence were also collected. Predictive factors for adherence were evaluated by including factors related to demographics, medications, illness, and patterns of medical usage. Results : The mean age of the study population was 81.2 years (range 65~98 years) and they were taking 9.7 drugs on an average (SD 5.0 drugs). The overall rate of non-adherence was 34%. About 48% of the patients had any forms of assistance in the medication administration. The most common type of non-adherence was "self-adjustment". The multivariate analyses revealed that age (adjusted odds ratio, 0.87 [95% CI, 0.80-0.96]; p 0.05) and the number of inappropriate medications (adjusted odds ratio, 0.59 [95% CI, 0.40-0.89]; p 0.05) were strong predictors for non-adherence. Conclusions : These results indicate that strategic considerations of the predictors of non-adherence should be improved in medication counseling services targeting elderly patients.

• 한국인공지능학회지
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• 제11권2호
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• pp.39-44
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• 2023

The creativity of thesis is that the significance of cyber security challenges in blockchain. The variety of enterprises, including those in the medical market, are the targets of cyberattacks. Hospitals and clinics are only two examples of medical facilities that are easy targets for cybercriminals, along with IoT-based medical devices like pacemakers. Cyberattacks in the medical field not only put patients' lives in danger but also have the potential to expose private and sensitive information. Reviewing and looking at the present and historical flaws and vulnerabilities in the blockchain-based IoT and medical institutions' equipment is crucial as they are sensitive, relevant, and of a medical character. This study aims to investigate recent and current weaknesses in medical equipment, of blockchain-based IoT, and institutions. Medical security systems are becoming increasingly crucial in blockchain-based IoT medical devices and digital adoption more broadly. It is gaining importance as a standalone medical device. Currently the use of software in medical market is growing exponentially and many countries have already set guidelines for quality control. The achievements of the thesis are medical equipment of blockchain-based IoT no longer exist in a vacuum, thanks to technical improvements and the emergence of electronic health records (EHRs). Increased EHR use among providers, as well as the demand for integration and connection technologies to improve clinical workflow, patient care solutions, and overall hospital operations, will fuel significant growth in the blockchain-based IoT market for linked medical devices. The need for blockchain technology and IoT-based medical device to enhance their health IT infrastructure and design and development techniques will only get louder in the future. Blockchain technology will be essential in the future of cybersecurity, because blockchain technology can be significantly improved with the cybersecurity adoption of IoT devices, i.e., via remote monitoring, reducing waiting time for emergency rooms, track assets, etc. This paper sheds the light on the benefits of the blockchain-based IoT market.

• Journal of Hospice and Palliative Care
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• 제7권2호
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• pp.200-213
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• 2004

목적: 호스피스 간호기록의 문제점을 개선하고 병원 U-Hospital 개념의 전자의무기록 시스템 개발 초기에 간호사의 입장과 요구사항과 특성이 고려된 호스피스 간호과정 데이터베이스를 개발하고자 함에 있다. 방법: 단계별로 나누어 조사하였는데 1단계로 3개 호스피스기관에서 사용하고 있는 간호 기록지를 종합. 분석하여 임상경력 10년 이상의 전문간호사 5인의 경험을 추출하여 합의한 후 정확하고 간편하고 기록 누락성이 보완된 전자형 간호기록지를 생성하였다. 2 단계는 생성된 간호기록지를 본 연구 목적을 적극 수용하고 협조하는 가정호스피스 3기관에 의뢰하여 2004년 4월부터 8월까지, 81명의 환자기록에 적용한 후 프로토콜의 적중률을 검증하였다. 3 단계는 적중률 검사 후 그 결과를 갖고 3개기관의 10년 이상의 임상전문가와, 호스피스 의사, 호스피스 전공 간호학교수들의 90% 이상 합의를 거쳐 최종 데이터베이스를 생성하였다. 결과: 1. 연계성이 있고, 간편하고, 기록누락성을 보완한 전자형 간호기록지를 생성하였다. 2. 가정호스피스 서비스의 표준화된 프로토콜의 적중률은 95.86%로 매우 높았다. 3. 최종 수정 보완된 호스피스 간호과정 연계목록표는 Table 7과 같다. 결론: 본 연구의 결과는 기록시간의 단축, 가정호스피스 서비스의 질적향상에 기여할 것이며, 호스피스 숫가화와 교육의 기초자료로 활용될 것이다. 또한 타호스피스 기관에서 적극 활용되어 호스피스 간호 지식체계 발전과 말기 암환자 삶의 질향상에 크게 기여할 것이다. 앞으로는 1) 호스피스 간호과정 결과가 보완된 연구가 진행되기를 바라며 2) 개발된 데이터 베이스를 이용하여 입원형이나 시설용 모델 등으로 다양하게 변형하여 활용할 수 있기를 제언한다.

• 한국산학기술학회논문지
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• 제22권3호
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• pp.679-687
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• 2021

전자의무기록 작성 시 주호소, 진단, 수술(처치) 용어는 작성자가 자유롭게 작성하는 것보다 시스템에 등재된 용어 마스터를 사용해야 의료진간의 의사소통이 원활하고, 데이터 활용을 위한 자료 추출이 가능하므로, 용어 마스터의 관리가 중요하다. 본 연구의 목적은 서울대학교 산하 4개병원(서울대학교병원, 분당서울대학교병원, 서울특별시 보라매 병원, 헬스케어시스템 강남센터)에서 개별적으로 운영하던 용어 마스터를 통합하여 표준화 및 관리 프로세스를 확립한 경험을 제시하는 것이다. 산하 4개 병원의 대표자로 구성된 서울대학교병원 용어표준화위원회는 여러 번의 논의를 거쳐 2016년 표준화 및 관리 프로세스를 확립하였고, 용어 마스터에 대한 요청을 신규 용어 등재, 용어 수정, 기존 용어 삭제와 신규 용어 등재, 그리고 용어 삭제의 4가지로 분류하였다. 요청에 대한 수용 여부는 유관 부서의 의견 조회와 그 결과를 검토한 서울대학교병원 용어표준화위원회의 의결로 결정하였다. 의결 정족수는 7명의 위원 중 5명이였으며, 참조 용어 체계에 대한 매핑은 3명의 보건의료정보관리사가 독립적으로 시행 후 이견이 있을 경우 합의하였다. 모든 과정은 온라인으로 시행하였고, 의결과 매핑 결과는 자동으로 수집되었다. 이러한 과정을 통해, 용어표준화위원회는 시스템에 등재될 용어에 대해 빠르고 명확한 의사결정을 할 수 있었고, 사용자들이 용어표준화위원회의 결정에 동의하도록 할 수 있었다. 프로세스가 정립된 후 16개월 간 126개의 신규 용어 등재, 131개의 용어 수정, 40개의 기존 용어 삭제와 신규 용어 등재, 그리고 1235개의 용어 삭제 가 처리되었다. 본 연구는 의료정보 시스템에 등재된 용어 마스터의 관리 프로세스를 정립한 최초의 시도라는 데 의의가 있다.

• 중환자간호학회지
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• 제14권3호
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• pp.26-36
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• 2021

Purpose : This study aimed to present the incidence of pressure ulcers and identify different associated factors according to the time of occurrence of pressure ulcers in intensive care unit (ICU) patients. Methods : The participants were 313 patients who reported pressure ulcers among 2,908 patients in ICUs at a large tertiary hospital in Gyeonggi-do. Among them, 220 patients (70.3%) had a pressure ulcer before admission, and 93 patients (29.7%) reported newly developed pressure ulcers after admission to the ICU. Data were collected between August 2018 and April 2019. Along with the time of occurrence and characteristics of pressure ulcers, diverse associated factors were gathered through electronic medical records. Data were analyzed using descriptive statistics, independent t-tests, and 𝑥²-tests. Results : Different risk factors associated with pressure ulcers in ICU patients according to the time of occurrence were main diagnosis, score of acute physiology and chronic health evaluation, score of Richmond agitation sedation scale, level of consciousness, administered sedatives, use of a ventilator, insertion of a feeding tube, and the duration of fasting period. Conclusion : Based on the results of this study, healthcare providers, especially ICU nurses, should try to detect early signs and symptoms of pressure ulcers, taking into account the derived factors associated with pressure ulcers in ICU patients. Practical intervention programs and strategies considering the factors associated with pressure ulcers must be developed to prevent and alleviate such ulcers in ICU patients in the future.

• Annals of Pediatric Endocrinology and Metabolism
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• 제23권4호
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• pp.210-214
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• 2018

Purpose: Premature adrenarche (PA) often leads to polycystic ovary syndrome (PCOS). Higher anti-mullerian hormone (AMH) levels are reported in PCOS. We studied the androgen profile and AMH profiles in Hispanic girls with PA (aged 5-8 years) and age and body mass index (BMI) matched controls. Methods: Retrospective review of electronic medical records of girls who met the inclusion criteria for premature adrenarche were done. Results: PA girls (n=76) were matched to control girls (n=12) for age (mean${\pm}$standard deviation) ($6.7{\pm}1years$ vs. $6.2{\pm}1.3years$) and BMI ($20{\pm}10kg/m^2$ vs. $17.8{\pm}2.7kg/m^2$). Dehydroepiandrostenedione sulfate ($63.3{\pm}51.3{\mu}g/dL$ vs. $29.8{\pm}17.3{\mu}g/dL$, P<0.001) and testosterone levels ($11.4{\pm}4.8ng/dL$ vs. $8.2{\pm}2.9ng/dL$, P=0.001) were significantly higher in the PA group than controls. AMH values (<14 years: reference range, 0.49-3.15 ng/mL) were $3.2{\pm}2.2ng/mL$ vs. $4.6{\pm}3.2ng/mL$ respectively in the PA and control groups and were not different (P=0.4). AMH did not show a correlation with bone age (P=0.1), and testosterone (P=0.9) in the PA group. 17-hydroxyprogesterone levels (17-OHP ng/dL) were $39.5{\pm}30.5ng/dL$ vs. $36.8{\pm}19.8ng/dL$ in PA versus control girls. The concentration of 17-OHP was not statistically different between the control and PA groups. Conclusion: Higher AMH was not observed in PA girls and no correlation with BA and androgen levels was observed.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.573-581
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• 2023

Objective : Due to the implementation of vaccinations and the development of therapeutic agents, the coronavirus disease 2019 (COVID-19) pandemic that started at the end of 2019 has entered a new phase. As a result, neurosurgeons should reconsider the way they treat their patients. As the COVID-19 situation prolongs, the change in neurosurgical emergency patients according to the number of confirmed cases is no longer clear. Outpatient treatment by telephone was permitted according to government policy. In addition, visits to caregivers in the intensive care unit were limited. Methods : The electronic medical records of patients who had been treated over the phone for a month (during April 2020, while the hospital was closing) were reviewed. Meanwhile, according to the limited visits to the intensive care unit, a video meeting was held with the caregivers. After the video meeting, satisfaction was evaluated using a questionnaire. Results : During April 2020, 1021 patients received non-face-to-face care over the telephone. Among the patients, no critical medical problem occurred due to non-face-to-face care. From July 2021 to December 2021, 321 patients were admitted to the neurosurgical intensive care unit and 107 patients (33.3%) including their caregivers agreed to video visits. Twice a week, advance notice was given that access would be made through a mobile device and the nurse explained to caregivers how to use the mobile device. The time for the video meeting was approximately 20 minutes per patient. Based on the questionnaire, 81 respondents (75.7%) answered that they agreed, and 26 respondents (24.3%) answered that they strongly agreed that was easy to communicate through video meetings. Fifty-two (48.6%) agreed and 55 (51.4%) strongly agreed that they were easy to understand the doctor's explanation. For overall satisfaction with this video meeting, three respondents (2.8%) gave 4/5 points and 95 respondents (88.8%) gave 5/5 points, and nine (8.4%) gave 3/5 points. Their reason was that there was not enough time. Conclusion : In situations where patient visits are limited, video meetings through a mobile device can provide sufficient satisfaction to caregivers. Telemedicine will likely become common in the near future. Health care professionals should prepare and respond to these needs and changes. Therefore, establishing a system with institutional support is necessary.

• 대한화상학회지
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• 제19권1호
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• pp.12-15
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• 2016

Purpose: Firefighters are vulnerable to burn injury during firefighting. In extensive fires, conducted heat and radiant heat can cause burn injury even though firefighters are not directly exposed to fire. There has been increasing interest in the health problems of firefighters considerably since Hongje-dong fire of 2001, which claimed the lives of six fireman. However, there have been no studies done on the characteristics of firefighter burn injuries in South Korea. Therefore, we investigated the characteristics of firefighter burn injuries in a burn center. Methods: A retrospective, single-center research was performed between Jan 2006 to Dec 2015. 24 firefighters came to the burn center. The electronic medical records of patients were reviewed. Results: Flame burns (87.5%) were the major cause of burn in firefighter. All the patients suffered second-degree or third-degree burns. Mean burn size was 6.1±6.7%. 22 of 24 patients were hospitalized and 2 of 22 hospitalized patients admitted to intensive care unit. Mean length of hospitalization was 29.1±23.7 days and mean length of intensive care unit hospitalization was 6.0±1.4 days. The face was the site most commonly burned, representing 25.8% of injuries. The hand/wrist, upper extremity, and neck were the next largest groups, with 19.4, 12.9, 11.3% of the injuries, respectively. Conclusion: Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. The burn size was small but, admitted patients need about 30 days of hospitalization.

• Journal of Nutrition and Health
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• 제48권3호
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• pp.211-220
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• 2015

본 연구는 지속적 신대체요법을 받은 급성 신손상 환자 239명을 대상으로 영양공급 충족률이 환자의 임상적인 결과에 미치는 영향을 알아보고자 수행하였으며 대상자의 영양요구량 및 실제공급량을 조사하여 영양공급 충족률에 따른 임상결과를 비교하였다. 대상자의 평균 에너지 충족률이 68.06%, 평균 단백질 충족률이 43.13%로 나타났고 체중 당 에너지 공급량은 16.62 kcal/kg/일, 단백질 공급량은 0.63 g/kg/일로 지침에서 권장하는 요구량에 미치지 못하는 수준이었다. 에너지 충족률 70%, 단백질 충족률 50% 기준으로 두 군간 임상결과의 차이를 관찰한 결과 에너지 충족률이 높은 군에서 총 재원일수, 중환자실 재원일수와 지속적 신대체요법 적용일수, APACHE II score가 유의하게 감소하는 것으로 분석되었고 단백질 충족률이 높은 군에서는 총 재원일수, 중환자실 재원일수, 지속적 신대체요법 적용일수, APACHE II score 이외에 사망률도 유의하게 감소한 것으로 분석되었다. 생화학적 검사 결과의 경우 에너지 충족률 70% 이상 충족군에서는 헤마토크릿 수치가, 단백질 충족률 50% 이상 충족군에서는 총 임파구수, 헤마토크릿 수치가 유의하게 개선된 것으로 나타났다. 사망환자를 제외하고 영양공급량과 임상결과를 나타내는 항목의 상관관계를 분석한 결과 에너지 공급량과 중환자실 재원일수가 의미 있는 음의 상관관계를 가지는 것으로 나타났으며 영양공급량과 생화학적 검사 결과의 상관관계를 파악한 결과 에너지 공급량에 따라서는 유의한 상관계수가 도출되지 않았고 단백질 공급량과는 따라서는 헤마토크릿과 칼슘이 유의한 양의 상관관계를 가지는 것으로 나타났다. 본 연구 결과 영양공급 충족률이 높은 군에서 임상적인 결과 및 영양상태와 관련한 생화학적 검사결과가 개선되는 것으로 나타나 요구량에 적정한 영양공급이 환자의 치료에 긍정적인 영향을 준다는 것을 확인할 수 있었다. 이를 위해서 의료진의 타당한 영양처방이 중요하겠으며 영양지원의 체계적인 관리를 위해 다학제적인 접근과 함께 영양공급의 적정성을 지속적으로 모니터링하는 것이 중요하겠다.