• International Journal of Oral Biology
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• v.45 no.2
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• pp.51-57
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• 2020

Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB - postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483-8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

• Journal of Korean Clinical Nursing Research
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• v.17 no.3
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• pp.329-339
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• 2011

Purpose: The purpose of this research was to develop and train caregivers in tracheostomy tube care using a self-management program to assist patients with an 'at home' tracheostomy procedure. Caregivers' self-efficacy and knowledge of tracheostomy management before and after the training was also identified. Methods: Research participants were the main caregivers for patients with tracheostomies who were affiliated with a 'Home Healthcare Center'. Training and observation were done at 'A Hospital' and 'G Hospital' both affiliated with 'K University' in Seoul. Data were collected from May 3, 2010 to January 25, 2011 and analyzed using Wilcoxon signed rank test with SPSS program version 12.0. Results: Significant differences were found for the pre and post evaluation of the 'self-management program' for the implementation of tracheostomy care. The development and implementation of the 'self-management program' improved the main caregivers' knowledge of tracheostomy tube management (Z=-3.599, p<.001). Conclusion: Results show that this program has identified an effective nursing intervention for promoting the caregivers' knowledge of tracheostomy care and self-efficacy. We recommend that further research should be done to test primary caregivers' maintenance of knowledge and self-efficacy in tracheostomy tube management and identify factors affecting knowledge and self-efficacy in the care of these patients.

• Journal of Hospice and Palliative Care
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• v.19 no.3
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• pp.233-239
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• 2016

Purpose: Little is known regarding the factors associated with the willingness of family caregivers of terminal cancer patients to participate in a bereaved survey. This study aimed to ascertain the pre-loss factors that predict actual participation in a bereaved survey. Methods: We conducted a prospective observational study using data from two multi-center surveys at the end-of-life and after loss. In order to identify the pre-loss factors associated with participating in the bereaved survey, we used a step-wise multivariate logistic regression analysis. Results: Among 185 bereaved individuals, 30 responded to the survey (response rate: 16.2%). There were differences between the participation group and the non-participation group regarding religion, economic status, and perceived quality of care as assessed by the Quality Care Questionnaire-End of Life. A final multivariate model revealed that bereaved individuals who professed a religion (adjusted odds ratio [aOR]=5.01; P=0.008), had a high income (aOR=4.86, P=0.003), and satisfied with the care for familial relationship (aOR=4.49, P=0.003) were more likely to engage in the bereaved survey. Conclusion: Our finding suggests that improving the quality of end-of-life care may promote actual participation in a bereaved survey through easing post-loss distress. More attention should also be paid to those bereaved individuals who are hesitant to participate in a bereaved survey.

• Journal of Korean Biological Nursing Science
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• v.18 no.2
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• pp.78-86
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• 2016

Purpose: Diabetic foot ulcers are significant problems in diabetes mellitus and often result in lower extremity amputation. This study was conducted to evaluate the effects of a self-care management program on Korean patient's self-efficacy, self-care behavior, size of the wound, and wound related pain. Methods: This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The intervention strategies of the self-care management program consisted of individual intervention (education, practice and demonstration), computer animation, and face-to-face counseling. There were thirty seven patients, and 20 were assigned to the experimental group while the other 17 were assigned to the control group. The experimental group was given a self-care management program. The control group received information on diabetic mellitus care by means of a leaflet. The data was analyzed using descriptive statistics, a chi-square test, an independent t-test, and a Mann-Whitney test. Results: There were significant differences in self-care behavior and wound related pain. Conclusion: A Self-care program is an effective way to increase patient's self-care ability. This program is highly applicable to diabetic foot ulcer patients in various settings.

• Tuberculosis and Respiratory Diseases
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• v.72 no.1
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• pp.30-36
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• 2012

Background: Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture. Methods: 54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL. Results: Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant-Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037). Conclusion: Based on these data, pre-VAP samples obtained prior to 5 day onset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.

• International Journal of Advanced Culture Technology
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• v.7 no.1
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• pp.112-121
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• 2019

The purpose of the study was to determine whether a delirium educational program has a positive outcome on nurses' documentation in patient records of delirium care. A one group pre-post design was used. A convenient sample of 60 consecutive records that included documentation by participating nurses in four medical wards of one regional general hospital in South Korea was audited two months before and two months after a delirium educational program. Although an educational program in this study positively changed nurses' knowledge and attitudes, these positive effects did not translate to improvement in the documentations of delirium care. There was no significant increase in the frequency of nursing documentation of delirium assessment following participation in the educational program. Furthermore, there was no significant increase in the frequency of nursing documentation of the use of non-pharmacological management following the documentation of keywords associated with delirium after participation in the educational program. The findings indicate the need to develop, implement and record a systematic risk assessment for delirium and assessment and management of existing delirium based on evidence-based guidelines in clinical practice in South Korea.

• Journal of Hospice and Palliative Care
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• v.6 no.1
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• pp.34-44
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• 2003

Purpose : The purpose of this study was to elucidate the effects of hospice care on pain management of the terminal cancer patients. Method : The subjects of the study were 37 terminal cancer patients hospitalized in the general hospital in JeonJu with the hospice care nit. The data were collected using the questionaire with interviews from July to Nov. in 2000. The severity and interference of pain were examined with the self reported survey based on the Korean version of Brief Pain Inventory (BPI-K). The data were analyzed with the mean, SDs, paired t-test. The hospice care to provide for three weeks. Results : 1) The mean scores of the worst pain for the last 24-hours measured with the pain severity of BPI-K were pre-intervention (6.35) and post (4.76). The pain interference of BPI-K in pre-intervention was enjoy (8.22), work (7.46), walk (7.08) and activity (7.08), while post was of enjoy (6.62), work (6.43), walk (6.11) and activity (5.78), respectively. 2) In pain severity, significant difference was found between the pre-intervention and post in all of followings. - worst pain for last 24 hours (t=4.085, P=.000) - least pain for last 24 hours (t=4.020, P=.000) - average pain for last 24 hours (t=4.254, P=.000) - pain right now (t=4.017, P=.000) 3) In pain interference, significant difference was found between the pre- intervention and the post in all of followings. - activity (t=3.137, P=.003) - mood (t=6.713, P=.000) - walk (t=2.027, P=.050) - work (t=2.132, P=.040) - relate (t=4.143, P=.000) - sleep (t=4.071, P=.000) - enjoy (t=3.881, P=.000) Conclusion : The terminal cancer patients who were offered hospice care had significantly lower hospice care pain and pain interference than those without hospice care. According to these results, hospice care can be regarded as an effective modality in relief of pain in the terminal ill-patients.

• Proceedings of the Korean Society of Computer Information Conference
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• 2011.01a
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• pp.127-130
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• 2011

사회가 고령화, 초핵가족화 및 재난취약계층이 늘어나면서 요구호자에 대한 고품질 맞춤형서비스가 필요하게 되었고, 급성진환, 심뇌혈관 고위험 환자 및 자살 등 예방가능 사망률이 선진국에 비해 높음에 따라 신속하고 전문적인 구조 구급서비스가 요구된다. 따라서 본 논문에서는 응급환자가 발생하였을 때 병원 도착 전 환자의 정보를 이용하여 응급처치가 가능하도록 하고, 응급의료기관에서는 환자 진료준비를 사전에 할 수 갖출 수 있도록 하여 응급환자 진료의 효율성을 극대화하였다. 또한 사회적 인지도가 높은 119번호를 이용한 다양한 복합 응급신고 접수 시 유관기관과 통합적 대응체계를 구축하는 효율적 응급의료서비스 고도화 전략을 제시하고자 한다.

• The Korean Journal of Emergency Medical Services
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• v.16 no.3
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• pp.29-43
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• 2012

Purpose : The goal of the present study is to provide the basic information to medical control which is the most important improving factor of pre-hospital medical treatment. Method : A total of 749 records of direct medical control were collected from 119 EMTs in emergency medical information center of Daejeon, Chungcheongnam-do and Chungcheongbuk-do from March 1, 2010 to February 28, 2011. Results : The 119 EMTs should record the level of qualification of EMT and general patient history taking precisely when they receive direct medical controls. The doctors should take medical controls within the task range of qualification of EMTs. Conclusion : It is necessary to establish the guideline of medical direction and protocol of prehospital emergency care. The quality improvement of pre-hospital emergency services will be possible by the guideline and protocol.

• The Korean Society of Law and Medicine
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• v.9 no.1
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• pp.319-382
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• 2008

As a withdrawing care's study, the purpose of this study is searching about withdrawing care's acceptance and circumstances through Bora-mae hospital case(chapter 1). Withdrawing life-sustaining treatment has various forms. Though the meaning of euthanasia, death with dignity, natural death, physician assisted suicide are duplicated, the meaning of those are different slightly. Firstly, this study looks about the difference of the those meaning and acceptance range(condition) by withdrawing care's forms(chapter 2). Bora-mae hospital case sentenced guilty about physician who discharged incompetent patient who was after surgery by patient's wife determination. This Bora-mae case that sentenced guilty about discharge against medical advise(DAMA) that is regarded to custom has brought intensive confliction of legal, social, medical aspect, Bora-mae hospital case has many legal problems. First, as to criminal law rule 250(murder), the problem is whether discharge and withdrawing life-sustaining treatment is commission or omission. this study concluded omission(district court: omission, appeal, supreme court: commission). Because legal denounce point of discharge and medical treatment withdrawing is omission that physician who is obligatory on patient to cure. If physician's act is regarded omission, it is necessary to determine whether he has guardian status and obligation. Without guardian status and obligation, omission crime can't exist. This study decided that physician had guardian status and obligation and foundation of guardian status was pre-action or acceptance of emergency patient. Physician's medical treatment duty finished when patient(or patient's guardian) demands discharge. But when patient death is foreseen and other possible treatment does not exist, his duty of life prolonging treatment does not finish. This originate from physician's social responsibility and public status that limits patient's private liberty. This study regarded physician's action as accomplice about whether physician's discharging action is accomplice or the principal offender(district court: the principal offender, appeal, supreme court: accomplice). Though the principal offender needs criminal determination and action, there is no this common determination and functional action control of physician in Bora-mae case(chapter 3). Bora-mae hospital case partly originated from deficiency of legal, institutive system including medical security system shortage, the instruction is 1. medical security system strengthening, 2. hospital ethical committee's activity strengthening, 3. institutionalization of withdrawing life-sustaining treatment, 4. acceptance of pre-decision making system, 5. sufficient persuasion of physician for patient and faithful writing of medical paper, 6. respect for patients' self-determination and rights, 7. consciousness's changing for withdrawing life-sustaining treatment and persistent education about medical ethics(chapter 4). Considering Bora-mae case, medical sector is not the dead ground of a criminal punishment. Intervention of criminal law in medical sector give rise to ill effect, that is, excess medical examination and treatment, safeguard treatment, delay of discharge from a hospital. Because sufficient guarantee of life becomes mere empty slogan under situation that impose a burden of heavy cost to family or hospital, public and systematic solution should be given(chapter 5).