• Journal of Physiology & Pathology in Korean Medicine
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• v.32 no.5
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• pp.347-353
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• 2018

There are some controversies about the safety of herbal medicine. In order to examine the safety of herbal medicine, this study investigated the level of liver function test(AST/ALT) in patients taking herbal medicine for more than 6 months We checked liver function in 121 patients who took herbal medicine for more than 6 months. AST/ALT were measured before treatment and every 3 months (from 3 month to 9 month). In 121 patients taking herbal medicine for more than 6 months, mean AST level after 6 months was lower than before treatment and mean ALT level after 6 months was lower than before treatment. In 20 patients with abnormal AST/ALT before herbal treatment, 18 patients's AST/ALT changed to normal after 6 month herbal treatment. 2 patients's AST/ALT was slightly higher than normal. One woman patient met the criteria for herb-induced liver injury(HILI) with RUCAM scores 4 after taking herbal medicine for 6 months. Although her RUCAM score decreased to zero after taking herbal medicine for 9 months. This study suggests that long-term herbal medicine for 6 months or longer is very unlikely to injury liver function. Individual-specific liver damage may occur, it can be recovered.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.281-286
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• 2005

Objective : The authors report our experience of urokinase thrombolysis in treating patients harboring nonaneurysmal spontanesous intraventricular hemorrhage[IVH] and evaluated complications, safety and feasibility of this procedure retrospectively. Methods : Fifty-three patients with nonaneurysmal IVH>15mL without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale[GCS]<5 were excluded. A catheter was directed into the IVH. Hematoma aspiration was followed by instillation of urokinase at the ear level of drainage bag under intracranial pressure monitoring system. This was repeated every 6hours until half of its initial volume. For analysis of prognostic factors, we classified the patients into two groups by Glasgow outcome scale[GOS]; good [$GOS\;{\ge}3$] and bad [GOS<3] prognosis group, and performed comparative analysis between two groups. Results : Mean age was 60.2years. The baseline hematoma size ranged 16 to 72mL. IVH volume reduction was done by an average of 74.2%. As complications, there were 3cases of rebleeding and 2cases of ventriculitis. No intracranial adverse effects were observed during thrombolytic theraphy. At 6months after the procedure, 29patients had achieved a good recovery, 15remained vegetative. 9patients died in hospital. The main good prognostic factors were young age, small IVH volume, and high GCS. Conclusion : The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2369-2374
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• 2014

Background and Aim: Selumetinib is a promising and interesting targeted therapy agent as it may reverse radioiodine uptake in patients with radioiodine-refractory differentiated thyroid cancer. We conduct this metaanalysis to compare the efficacy and safety of selumetinib with current therapies in patients with advanced cancer. Methods: An electronic search was conducted using PubMed/ Medicine, EMBASE and Cochrane library databases. Statistical analyses were carried out using either random-effects or fixed-effects models according to the heterogeneity of eligible studies. Results: Six eligible trials involved 601 patients were identified. Compared with current therapies, treatment schedules with selumetinib did not improve progression free survival (hazard ratio, 0.91; 95%CI 0.70-1.17, P= 0.448), but did identify better clinical benefits (odds ratio, 1.24; 95%CI 0.69-2.24, P = 0.472) and less disease progression (hazard ratio, 0.72; 95%CI 0.51-1.00, P = 0.052) though its impact was not statistically significant. Sub-group analysis resulted in significantly improved progression free survival (hazard ratio, 0.61; 95%CI 0.49-0.57, P = 0.00), clinical benefits (odds ratio, 3.04; 95%CI 1.60-5.77, P = 0.001) and reduced disease progression (hazard ratio, 0.35; 95%CI 0.18-0.67, P = 0.001) in patients administrated selumetinib. Dermatitis acneiform (risk ratio, 9.775; 95%CI 3.143-30.395, P = 0.00) and peripheral edema (risk ratio, 2.371; 95%CI 1.690-3.327, P = 0.00) are the most frequently observed adverse effects associated with selumetinib. Conclusions: Compared with current chemotherapy, selumetinib has modest clinical activity as monotherapy in patients with advanced cancer, but combinations of selumetinib with cytotoxic agents in patients with BRAF or KRAS mutations hold great promise for cancer treatment. Dermatitis acneiform and peripheral edema are the most frequently observed adverse effects in patients with selumetinib.

• YAKHAK HOEJI
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• v.58 no.1
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• pp.40-46
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• 2014

Drugs with a narrow therapeutic index (NTI) require very precise dosing. Warfarin and digoxin are the examples of NTI-drugs and dosing of them varies widely for different patients. However, in South Korea, only two strengths of warfarin and one of digoxin are commercially available. This is a big barrier for the precise dispensing and has potential safety risks to patients, particularly to elderly patients. To find a potential solution to the problem, an analysis of the prescribed doses and dispensing patterns of those drugs was performed. Data were collected by computer-facilitated prescription review in a university hospital. The period screened was from May 1st, 2012 to April 30th, 2013. All the prescriptions with either warfarin or digoxin tablets were selected for this study and dispensing patterns were analyzed according to the prescribed doses. A total of 17,017 warfarin prescriptions were analyzed; 8,148 for inpatient prescriptions, 8,869 for outpatient prescriptions, respectively. Of the 23 kinds of prescribed doses, 2 mg (19.9%) was most frequent, followed by 3 mg (13.2%) and 2.5 mg (11.7%). By analyzing the dispensing patterns, 60.3% (10,253) of the prescriptions required pill splitting and 72.0% of them were for the patients 65 years old and over. On the other hand, 4,350 digoxin prescriptions were included in this study. Of the 6 kinds of prescribed doses, 0.125 mg (71.2%) was most frequent, followed by 0.0625 mg (20.2%). Among the prescriptions for digoxin, 92.0% (3,998) should be split and 65.7% of them were for the patients aged 65 years and over. Despite limitations of strengths, various doses of warfarin and digoxin were prescribed. Furthermore, more than half of the prescriptions that required pill splitting were for elderly patients. The results from this study suggest that different strengths of warfarin and digoxin should be provided for accuracy of dispensing and safety for patients receiving them.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.336-345
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• 2023

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.

• The Journal of Korean Academic Society of Nursing Education
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• v.24 no.4
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• pp.347-357
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• 2018

Purpose: The purpose of this study was to identify patient safety awareness and emergency response ability and affecting factors perceived by nursing homes and home visiting caregivers. Methods: This study was a descriptive study that conveniently extracts nursing caregivers who care for elderly patients in S and G provinces, Korea. Data collection was done by structural questionnaires from April to May 2018. A total of 204 responses consisting of 103 nursing homes and 101 home visiting caregivers were used for data analysis in SPSS Win 22.0. Results: Patient safety awareness and emergency response ability of nursing homes caregivers with each $4.24{\pm}0.50$, $74.26{\pm}09.57$ was each higher than that of the home visiting caregivers with $3.68{\pm}0.49$, $68.02{\pm}12.12$ (p<.001). The affecting factors of the patient safety awareness were working place, safety education, and daily average working hours with 12 or more (F = 27.30, p<.001) and that of emergency response ability were number of patients per personnel with 9 or more and emergency situation experience (F=14.00, p<.001). Conclusion: These results suggest that it is necessary to develop a safety education program that can share indirectly experience emergency situations that occur on the job site.

• Proceedings of the Korea Institute of Fire Science and Engineering Conference
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• 2005.05a
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• pp.160-168
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• 2005

• Journal of East-West Nursing Research
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• v.19 no.1
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• pp.46-54
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• 2013

Purpose: An objective of this study was to investigate nurses' perceptions toward patient safety culture and to examine the factors affecting safety care activities. Methods: The participants were 429 nurses, at 6 hospitals located in regions, which have 150 to 300 beds, and HSOPSC (AHRQ, 2009) and questionnaire on safety care activities were used as measurement tools. Descriptive statistics, independent t-test, one way ANOVA, and stepwise multiple regression with SPSS/WIN version12.0 were used to analyze the data. Results: Supervisor manager expectations and actions promoting patients safety and frequency of events reported were the highest as positive responses, whereas staffing and nonpunitive response to errors showed the lowest scores as positive responses. Scores of medication surveillance is the highest while firefighting surveillance is the lowest in terms of safety care activities. Significant predictors influencing safety care activities were frequency of events report, handoffs and transitions, work unit a patient safety grade, organizational learning-continuous improvement, and teamwork across units. These predictors account for 23% of the variance. Conclusion: These results suggest that hospital policies and systems should be built to settle patient safety culture effectively. Development of standard manuals for safety care activities is another critical element for promoting patient safety.

• Journal of the korean academy of Pediatric Dentistry
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• v.51 no.2
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• pp.109-131
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• 2024

This review aims to examine safety concerns in pediatric dental care and underscore the need for comprehensive patient safety initiatives within the Korean Academy of Pediatric Dentistry. Drawing insights from the prevailing patient safety policies of the American Academy of Pediatric Dentistry, case reports, and systematic reviews, this review elucidates issues such as dental fires during sedation, ocular complications from local anesthesia, and surgical emphysema. This review highlights the significance of safety toolkits encompassing infection control, medical error reduction, dental unit waterline infection, and nitrous oxide safety in pediatric dental settings, underscoring the need to foster a safety culture. Furthermore, this study explores the curriculum for pediatric dentistry residency programs, emphasizing concepts such as high-reliability organizations and mortality and morbidity conferences. The study suggests the need for initiatives to enhance patient safety, including establishing safety committees, expanding reporting systems, policy development, and supporting research related to patient safety. In conclusion, this study underlines key messages, emphasizing the utmost priority of patient safety, acknowledging the inevitability of human error, promoting effective communication, and cultivating a patient safety culture. These principles are vital for advancing patient safety in pediatric dental care and improving outcomes among pediatric patients.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.37-47
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• 2024

Purpose: This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma. Methods: This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images. Results: When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm. Conclusions: Using the sternum length as a tube thoracostomy indicator might be feasible.