• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.827-833
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• 2020

Objective : Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation. Methods : We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/㎠), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment. Results : Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score. Conclusion : The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.

• 농촌의학ㆍ지역보건
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• 제47권4호
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• pp.220-228
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• 2022

119 구급대원들이 사용하는 현장 검사 장비 중 하나인 자가 혈당측정기는 결과 값이 정확해야 환자에게 적절한 처치를 제공할 수 있다. 연구 최초 조사 시점 이후 현재까지도 119 구급대원 현장업무 지침에 현장 검사 장비의 작동 유무, 수량 등을 확인하는 것은 있으나, 장비의 점검에 수량, 작동 여부 등은 있으나 본 연구에서 분석한 정도관리 내용은 없다. 현장검사 장비의 질 관리가 되지 않고 있다는 것은 환자에 대한 부정확한 평가와 이로 인한 불필요한 처치와 과소, 과대처치 또는 환자 상태가 악화될 가능성을 높일 수 있다. 본 연구를 통해, 앞으로 119 구급대원의 혈당측정기를 포함한 모든 현장검사 장비의 사용실태조사가 이루어져야 하고, 119 구급대 현장 업무 지침에 현장 검사 장비 정도관리를 추가하여야 하겠다. 또한, 현장 검사 장비가 관련 지침에 따라서 적절한 질 관리가 이루어져야 하고, 지역에서 관련 업무 전문가나 응급의료지도를 담당하고 있는 지도의사에게 관리되는 것이 합당하겠다.

• 가정∙방문간호학회지
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• 제31권1호
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• pp.77-88
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• 2024

Purpose: This study aimed to develop and assess the impact of an integrated infection control education program on the awareness, attitudes, and performance of infection control among caregivers in long-term care facilities. Methods: Participants were recruited from two long-term care facilities with 25 caregivers in both the experimental group and the control group. This study used non-equivalent control group quasi-experimental pre-post design. The effectiveness of a developed Integrated Infection Control Education Program was evaluated based on infection control awareness, attitudes, and performance. Data were analyzed using SPSS/WIN 28.0 through descriptive statistics, chi-square tests, Fisher's exact tests, and independent t-tests. Results: There was a statistically significant difference in the degree of awareness (t=-5.00, p<.001), attitude (t=-4.91, p<.001), and performance (t=-6.66, p<.001) of infection control between the two groups. Conclusion: Given these results, the integrated infection control education program significantly improved infection control awareness, attitudes, and performance among caregivers in long-term care facilities. This study is noteworthy because it provided comprehensive education on infection control practices to caregivers in environments that are particularly susceptible to infections, especially following COVID-19. This educational program is actively utilized and validated in practice, it would enhance the infection control performance of caregivers, thereby reducing infection rates within facilities, shortening the length of stay for elderly residents in long term care facilities, and contributing to the reduction of healthcare costs.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

• 한국의료질향상학회지
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• 제21권2호
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• pp.12-24
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• 2015

Purpose: The need for the rapid evaluation and treatment of emergency department patients with major trauma is essential. A computerized physician order entry (CPOE) system can improve communication and provide immediate access to information with the goal of reducing ED time delays. The aim of this study was to report on the operation of a trauma CPOE program and demonstrate its usefulness by comparing time intervals from ED arrival to various evaluation steps before and after implementation of the program. Methods: This was a before-and-after observational study from a single emergency department at an academic center. The CPOE program was implemented for 6 months and compared with the data collected from the pre-CPOE implementation period. The efficacy of the program was assessed by comparing the time difference before and after CPOE implementation based on the following factors: total boarding time in ED, door-to-disposition decision time, door-to-blood-test report time, door-to-X-ray time, door-to-CT time, and door-to-transfusion time. Results: Over a period of 6 months, the CPOE was activated for a total of 17 patients. Total boarding time was reduced significantly after implementation [median, 641.5 minutes (IQR, 367.3-859.3) versus289.0 minutes (IQR, 140.0-508.0) for pre-CPOE vs. post-CPOE, respectively, p< 0.05). Time intervals for all evaluation steps were reduced after implementation of the program. The improvements in the door-to-blood-test and door-to-CT times were both statistically significant. Conclusion: This study demonstrated that a standard CPOE system can be successfully implemented and can reduce ED time delays in managing trauma patients.

• Journal of Nutrition and Health
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• 제39권7호
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• pp.617-623
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• 2006

The mortality and morbidity rate of hemodialysis patients (HD) remain high. Among many factors, protein and calorie malnutrition has been shown to be a major risk factor for increased mortality in the HD patients population. Malnutrition can be caused by insufficient amino acid intake, nutrient losses in dialysate, oxidant stress and muscle catabolism. In this study, we evaluated the association of markers of nutritional status and essential amino acids intake in HD patients. We investigated nutritional status of 41 HD patients (mean age: $64.2\;{\pm}\;11.5\;y$, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24 hr recall methods. Subject's total energy intake and total protein intake were $1,648.0\;{\pm}\;397.31\;kcal/day,\;79.2\;{\pm}\;27.2\;g/day$:, respectively. The animal protein intake was $42.7\;{\pm}\;22.1\;g/day$, essential amino acids intake was $23.4\;{\pm}\;9.92\;g/day$, and the ratio of essential amino acids to total protein intake was $29.6\;{\pm}\;5.42%$. There were significantly positive correlation between muscle mass and lean body mass with serum creatinine level (r=0.435, p<0.01; r=0.435, p<0,01). There were also significant positive correlation in muscle mass and lean body mass with pre hemodialysis blood urea nitrogen (preHD BUN) (r=0.329, p<0.05; r=0.329, p<0.05). There were no significant correlation in total energy intake and total protein intake per kg ideal body weight (IBW) to muscle mass and lean body mass. However, there were significantly positive correlation between the ratio of essential amino acids and muscle mass and lean body mass (r=0.368, p<0.05; r=0.405, p<0.01). And serum hematocrit concentration was positively correlated with the ratio of essential amino acids (r=0.032, p<0.05). The results of this study indicate that strong associations exist in essential amino acid intakes with malnutrition than total protein intakes in HD patient. In conclusion, specialized nutrition education should be necessary to efficiently improve the quality of protein intakes.

• 임상간호연구
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• 제21권2호
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• pp.207-214
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• 2015

Purpose: This study was aimed to investigate the effect of an education program on inter-rater agreement of Neonatal/Infant Braden Q Scale for clinical nurses working at a neonatal intensive care unit (NICU). Methods: This was single-arm pre and post experimental study. The participants were 12 nurses and 128 hospitalized neonates at a NICU from December, 2012 to March, 2013. Twelve nurses were divided into four different groups; for two groups were assigned nurses with 3 to 5 years of clinical experiences, and for the others with less than 1 year of clinical experience. The interventions were given by one wound ostomy specialist and two NICU nurses with over 5 years of clinical experiences for 1 hour twice. The inter-rater agreement was measured by intraclass-correlation coefficient. Results: Overall inter-rater agreement was improved from .87(95% CI: .80~.92) at the pre-test to .94(.91~.96) at post-test. Each inter-rater agreement except moisture and nutrition was also improved. Conclusion: The developed education program on scoring for Neonatal/Infant Braden Q scale was effective to improve the inter-rater agreement among clinical nurses. We suggest to privide an education for NICU nurse before using the Neonatal/Infant Braden Q scale in clinical settings.

• 여성건강간호학회지
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• 제16권1호
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• pp.29-36
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• 2010

Purpose: This study aimed to identify the scores of postpartum depression(PPD) on the first day, 1st week, and 6th week after the delivery and to explore their related factors before and after delivery in postpartum women. Methods: With a survey design, 293 postpartum women were recruited from a postpartum unit, Ilsin Christian hospital in Pusan via convenience sampling and were followed at 1st week and 6th week in the outpatient clinic. Results: Results showed that the scores of PPD(EPDS score) were low at postpartum 1st day, 1st week and 6th week but prevalence of PPD(EPDS ${\geq}13$)was 3.1%at 1st day, 8.2%at 1st week and 7.5%at 6th week, respectively. The pre-delivery factors were experience of depression, and the post-delivery factors were baby's sex(1st day), no caregiver for baby(1st week), and no help and concern for taking care of baby from husband and family(1st day and 6th week). The greater satisfaction with becoming a mother and her life, and greater maternal attachment were related to lower level of PPD at the three time points. Conclusion: Regular screening for postpartum depression and supportive and informative education is needed for postpartum women visiting the outpatient clinic for follow-up.

• 한국의료질향상학회지
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• 제8권1호
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• pp.74-83
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• 2001

Background : Since a Gamma Knife had been installed on December 1997, 405 patients have been treated until December 1999 at department of neurosurgery of Seoul National University hospital. The authors analyzed results of a work to improve satisfaction of Gamma Knife surgery patients and to reduce hospital length of stay. Methods : To understand main discontent of patients, a pre-survey was performed from October 1998 to December 1999 using a questionnaire. By Analyzing 93 questionnaire received from 234 patients, pain on frame application, explanation before surgery, waiting time before surgery, waiting time before medical procedure were main discontent factor and overall satisfaction ratio was 71.0%. To improve satisfaction ratio, several quality improvement activity works were designed and applied to 123 patients during the period between January 2000 and September 2000. The same questionnaire were analyzed. Works to reduce the patient hospital LOS were devised and applied during the same period. Results : The overall satisfaction ratio of Gamma Knife radiosurgery patients was increased to 83.7%(P=0.10). The main factor to improve satisfaction ratio was to reduce waiting time(P=0.05) and improvement of discomfort during the surgery(P=0.06). The average LOS was reduced from 3.1 to 2.7 days(P=0.003). Conclusion : As a result of quality assurance activities, the overall satisfaction ratio of patients was improved and LOS was reduced. The pain during frame application was remained as a main discontent factor and a further study is required to reduce this pain.

• Tuberculosis and Respiratory Diseases
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• 제81권4호
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• pp.274-280
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• 2018

Background: The risk of tuberculosis (TB) infection among health care workers (HCWs) is higher than as noted among workers in the general population. The prevalence and risk factors of TB infection among HCWs were assessed in a tertiary hospital in South Korea, resulting in a conclusion of an intermediate TB burden within the country. Methods: This cross-sectional study enrolled HCWs who underwent a QuantiFERON-TB Gold In-Tube (QFT-GIT) test to detect the presence of a latent TB infection (LTBI), in patients admitted to a tertiary hospital in South Korea in 2017. The departments of the hospital were divided into TB-related and TB-unrelated departments, which were based on the risk of exposure to TB patients. In this sense, the risk factors for LTBI, including current working in the TB-related departments, were analyzed. Results: In this case, a total of 499 HCWs (54 doctors, 365 nurses and 80 paramedical personnel) were enrolled in this study. The median age of the subjects was 31 years (range, 20-67 years), 428 (85.8%) were female, and 208 (41.7%) were working in the TB-related departments. The prevalence of LTBI was 15.8% based on the QFT-GIT. Additionally, the prevalence of experience of exposure to pre-treatment TB patents was higher among HCWs working in the TB-related departments, than among HCWs working in the TB-unrelated departments (78.8% vs. 61.9%, p<0.001). However, there was no significant difference in the prevalence of LTBI between the two groups (17.3% vs. 14.8%, p=0.458). On a review of the multivariate analysis, only the factor of age was independently associated with an increased risk of LTBI (p=0.006). Conclusion: Broadly speaking, the factor of age was associated with an increased risk of LTBI among the HCWs in South Korea. However, those workers current working in the TB-related departments was not associated with an increased risk of LTBI.