• 한국임상약학회지
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• 제21권2호
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• Journal of Chest Surgery
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• 제49권6호
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• pp.435-442
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• 2016

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.

• 대한한방내과학회지
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• 제40권6호
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• pp.1268-1277
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• 2019

Objective: The purpose of this study was to report the effectiveness of Korean medicine in the treatment of functional dyspepsia in a fibromyalgia patient with a history of long-term NSAIDs use. Methods: The patient was diagnosed as a Soeumin, one of the four constitution types in Korean medicine, and treated with herbal medicines such as Seungyangikgibuja-tang and Pyeongjinsunjeom-san. Acupuncture and moxibustion treatment were also performed. The severity of symptoms was assessed using the Numerical Rating Scale (NRS) of epigastric pain, daily oral intake changes, the Korean Gastrointestinal Symptom Rating Scale (KGSRS), the Gastrointestinal Symptom Score (GIS), and the Functional Dyspepsia-Quality of Life (FD-QOL) score. Results: After treatment for 48 days, the severity of epigastric pain decreased from NRS 8 to NRS 0, and daily oral intake was increased. The KGSRS score decreased from 55 to 43, the GIS score was reduced from 18 to 10, and the FD-QOL score also decreased from 69 to 55. Conclusions: This study suggests that Korean medical treatment could be an effective option for treating functional dyspepsia in fibromyalgia patients with a history of long-term NSAIDs use.

• 한국산학기술학회논문지
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• 제13권11호
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• pp.5238-5246
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• 2012

본 연구는 신경계 중환자에 적용한 간호행위에 따른 중환자 중증도 분류도구를 신경계 중환자에게 적용하여 그 결과를 분석하고 그에 따른 중환자 중중도 분류도구에 미치는 영향을 규명하여 신경계 중환자의 간호중재를 위한 기초자료를 파악하고자 시도되었으며 2008년 1월부터 2009년 5월, 2011년 10월부터 2011년 12월까지 서울시 소재 C 대학 병원 중환자실에 입원한 만 18세 이상의 신경계환자 203명의 의무기록지를 분석하였다. 신경계 중환자의 일반적 특성 및 임상관련 특성에 따른 중환자 중증도 분류도구 차이는 사망, 생존(p=<.001), 혈색소(p=<.001), 중탄산(p=<.001), 백혈구(p=<.001), 기관 내 삽관 유무(p=<.001), 중심 정맥관 삽입 유무(p=<.001), 중증도(p=<.001)가 통계적으로 유의한 차이를 보였다. 본 연구의 대상자 203명 중 64명이 사망하여 사망률은 31.5%였다. 중환자 중중도 분류도구로 측정된 신경계 중환자의 평균 점수는 $112.09{\pm}18.91$로 나타났고 중중도가 높아질수록 중환자 중중도 분류도구 점수도 유의하게 높아지는 경향을 보였다. 각 영역별로는 활력징후 측정 $3.74{\pm}2.15$, 감시 측정 $28.97{\pm}4.31$, 일상 활동 $34.99{\pm}3.66$, 영양 $.19{\pm}.98$, 정맥 주입 및 약물요법 $18.20{\pm}8.27$, 치료 및 시술 $16.93{\pm}4.90$, 호흡치료 $8.61{\pm}7.07$로 확인되었다. 감시 측정, 일상 활동, 정맥 주입 및 약물요법, 치료 및 시술, 호흡치료영역이 포함된 모형은 유의한 것으로 나타났으며(F=678.789, p<.001) 이들이 중환자 중증도 분류도구를 설명하는 설명력은 98.1%를 나타내어 신경계 중환자의 중중도를 예측하는데 유용한 영역이라 사료된다.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.138-143
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• 2007

Purpose: $S100{\beta}$, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. $S100{\beta}$, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S 10019, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum $S100{\beta}$, and neurologic outcome, and severity in traumatic brain injury. Methods: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for $S100{\beta}$, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). Results: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum $S100{\beta}$, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups ($0.74{\pm}1.50\;{\mu}g/L$ vs $7.62{\pm}6.53\;{\mu}g/L$ P=0.002). A negative correlation existed between serum $S100{\beta}$, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum $S100{\beta}$, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlation between serum $S100{\beta}$, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of $S100{\beta}$, was $7.62\;{\ss}{\partial}/L$ (SD=${\pm}6.53$) in the expired patients, $1.15\;{\mu}g/L$ in the mildly disable patient, and $0.727\;{\mu}g/L$ (SD=${\pm}0.73$) in the recovered patients. These differences are statistically significant (p<0.001). Conclusion: In traumatic brain injury, a higher level of serum concentration of $S100{\beta}$, has a poor prognosis for neurologic outcome.

• 성인간호학회지
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• 제14권1호
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• pp.125-134
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• 2002

Purpose: The objectives for this study were to identify the factors that correlate with appraisal of illness and to explore what variables are predictive of cancer patients primary caregivers' cognitive appraisal for stress. Method: The subjects were selected by convenient sampling and 130 caregivers who completed a questionnaire. Measures used in this study included the Family Inventory of Resources for Management, Social Support Index, Family Crisis Oriented Personal Evaluation Scales and Family Coping Coherence Index. Pearson correlation was used to identify the relationship among factors and multiple regression was used to determine the individual and cumulative effect of potential predictors on the caregivers' appraisal. Results: Patient's level of activity, severity of the disease, quality of relation between patient and caregiver, caregiver's subjective health status, economic status, family resources and coping were significantly correlated. Among the variables, coping, family resources, economic status and quality of relation between caregiver and patient predicted 49.2 percent of the variance in appraisal of caregivers' stress condition. Conclusion: These findings suggest that coping mechanisms and family resources are important for positive appraisal. Nurses should provide adequate nursing care for the primary caregiver about professional care information and supportive counseling.

• 대한한방내과학회지
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• 제40권2호
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• pp.173-180
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• 2019

Objective: In this case report, we address the case of a 47-year-old man with anemia due to chronic kidney disease. Methods: A patient was treated with Korean medicine including an herbal medication, Shipjeondaebo-tang. We evaluated the improvement of symptoms by biochemical examination of blood, complete blood cell count and total score of Fatigue Severity Scale (FSS). Results: After 15 days of Korean medicine treatment, there was an increase in hemoglobin states, even after intervention ended, for over 30 days with improvement of the patient's fatigue. Conclusions: This study suggested that Shipjeondaebo-tang might be effective in patient's renal anemia and fatigue recovery.

• 한국응급구조학회지
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• 제26권2호
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• pp.73-85
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• 2022

Purpose: The purpose of this study is to understand currently active Korean paramedics' disaster response abilities, including immediate response, severity classification, patient treatment, and patient transfer, in a disaster situation with multiple casualties. Methods: A structured questionnaire consisting of a total of 25 questions was used, including 5 questions on the subject's general characteristics and 20 questions on disaster-related emergency response abilities. Results: Among the disaster response abilities of the participants, the patient transport ability scores were high and the cooperative support ability scores were low. In terms of general characteristics, there was a significant difference in age, and it was high in the 40s, and there was a significant positive correlation between each competency. Conclusion: These results suggest that there is an urgent need to develop a systematic and specialized educational system with components inside and outside fire departments related to multiple casualty disasters to improve overall abilities.

• Journal of Trauma and Injury
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• 제29권3호
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• pp.68-75
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• 2016

Purpose: The purpose of this study was to analyze the effectiveness of regional trauma center's management. Methods: Data collected between January 2013 and December 2015 from a regional trauma center registry was retrospectively reviewed. The patients who had injury severity score (ISS) greater than 15 and over the age of 18 were included. We compared annual general characteristics, the injury mechanism, the pathway of transportation, the injury severity score, the length of stay in emergency department (ED) and hospital, the in-hospital mortality. Results: The annual numbers of enrolled patients were 337, 334 and 278, respectively. No significant differences were found in the annual patient's median ages, injury mechanism, ISS and in-hospital mortality. The annual proportions of coming from other hospital and the median length of stay in hospital were increased after establishment of regional trauma center. The annual median lengths of stay in ED were decreased remarkably. Conclusion: Through the establishment of regional trauma center, the length of stay in ED can be reduced but not in-hospital mortality. More multidisciplinary cooperation and well-organized study is needed to reduce mortality of major trauma patients and maximize effect of regional trauma center.

• 간호행정학회지
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• 제13권1호
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• pp.5-16
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• 2007

Purpose: This study is to verify the validity and reliability of classified items and criteria of the patient classification system(PCS) based on Park's definition of nursing intensity. Methods: An expert group of 8 persons verified the content validity of the tools. The 1817 inpatients at a tertiary hospital in Seoul, Korea were classified into 4 groups according to two tools for verifying concurrent validity and interraters' reliability. These verifications were performed from September to October, 2004. Results: Nursing domains of the tools have been divided into 12 items: hygiene, nutrition, elimination, exercise & activity, education & counseling, emotional support, communication & consciousness, treatment & examination, medication, measurement & observation, coordination of multidisciplinary team, admission & discharge & transfer management. Content validity was verified by the content validity index(above 0.75 in all 12 areas). Interraters' reliability was no significant difference in the results of the patient classification between the two raters(A group 93.75%. B group 88.24%). Concurrent validity was also verified by the agreement of two tools(73.7%). Conclusion: These results showed that the reliability and validity of the PCS based on the nursing intensity were verified. These will use an data for nursing productivity in the future.