• Asian Pacific Journal of Cancer Prevention
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• v.15 no.24
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• pp.10879-10882
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• 2015

Objective: To investigate the effect of intraoperative glucose fluctuation and postoperative interlukin-6 (IL-6), tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$), C-reactive protein (CRP) levels on the short-term prognosis of patients with intracranial supratentorial neoplasms. Materials and Methods: Eighty-six patients undergoing intracranial excision were selected in The Second Hospital of Jilin University. According to the condition of glucose fluctuation, the patients were divided into group A (glucose fluctuation <2.2 mmol/L, n=57) and group B (glucose fluctuation ${\geq}2.2mmol/L$, n=29). Glucose was assessed by drawing 2 mL blood from internal jugular vein in two groups in the following time points, namely fasting blood glucose 1 d before operation ($T_0$), 5 min after anesthesia induction ($T_1$), intraoperative peak glucose ($T_2$), intraoperative lowest glucose ($T_3$), 5 min after closing the skull ($T_4$), immediately after returning to intensive care unit (ICU) ($T_5$) and 2 h after returning to ICU ($T_6$). 1 d before operation and 1, 3 and 6 d after operation, serum IL-6 and TNF-${\alpha}$ levels were detected with enzyme-linked immunosorbent assay (ELISA), and CRP level with immunoturbidimetry. Additionally, postoperative adverse reactions were monitored. Results: There was no statistical significance between two groups regarding the operation time, anesthesia time, amount of intraoperative bleeding and blood transfusion (P>0.05). The glucose levels in both groups at $T_1{\sim}T_6$ went up conspicuously compared with that at $T_0$ (P<0.01), and those in group B at $T_2$, $T_4$, $T_5$ and $T_6$ were significantly higher than in group A (P<0.01). Serum IL-6, TNF-${\alpha}$ and CRP levels in both groups 1, 3 and 6 d after operation increased markedly compared with 1 d before operation (P<0.01), but the increased range in group A was notably lower than in group B (P<0.05 or P<0.01). Postoperative incidences of hypoglycemia, hyperglycemia and myocardial ischemia in group A were significantly lower than in group B (P<0.05), and respiratory support time obviously shorter than in group B (P<0.01). Conclusions: The glucose fluctuation of patients undergoing intracranial excision is related to postoperative IL-6, TNF-${\alpha}$ and CRP levels and those with small range of glucose fluctuation have better prognosis.

• Journal of Korean Academy of Nursing
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• v.29 no.4
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• pp.903-916
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• 1999

The purpose of this study was to compare the ear-based rectal temperature measured with a tympanic thermometer with the rectal temperature measured with a glass mercury thermometer in order to test the accuracy of tympanic thermometer and to determine relationship among rectal, axilla, and abdominal temperature in neonates. The samples consisted of thirty four neonates admitted to the neonatal intensive care unit and nursery at an university affiliated hospital. The mean age of the subjects was 4.9 days. The ear-based rectal temperatures were taken with a tympanic thermometer in rectal mode (First Temp Genius 3000). Rectal and axilla temperatures were taken with a glass mercury thermometer, Abdominal temperature was continuously monitored with the probe connected to the servo controller of incubator. The results of the study can be summarized as follows : 1. Intrarater comparison : Agreement between the first and the second ear-based rectal temperature was 97% within 0.1$^{\circ}C$. 2. Comparison of ear-based rectal temperature and the rectal temperature from a glass mercury thermometer : ear-based rectal temperature ranged from 36.95$^{\circ}C$d to 37.95$^{\circ}C$, with a mean of 37.58$^{\circ}C$(SD＝0.22$^{\circ}C$). Rectal temperature from a glass mercury thermometer ranged from 36.2$0^{\circ}C$ to 37.2$0^{\circ}C$, with a mean 36.75$^{\circ}C$(SD＝0.29). The mean difference between both temperatures was 0.84$^{\circ}C$. The correlation coefficient between both temperatures was r＝0.77(p＝0.00). 3. Comparison of rectal and axilla temperature : Axilla temperature ranged from 35.8$0^{\circ}C$ to 37.1$0^{\circ}C$, with a mean of 36.55$^{\circ}C$. The mean absolute difference between the rectal and axilla temperature was 0.23$^{\circ}C$. The correlation coefficient between rectal and axilla was r＝0.67. 4. Comparison of axilla and abdominal temperature : Abdominal temperature ranged from 36.2$0^{\circ}C$ to 37.0$0^{\circ}C$, with a mean of 36.58$^{\circ}C$. The mean absolute difference between axilla and abdominal temperature was only -0.03$^{\circ}C$. Findings of this study suggest that ear-based rectal temperature overestimates the actual rectal temperatures in neonates. Therefore, the interchangeble use of both temperatures in clinics seems problematic. The site offset(adjustment value) programmed in rectal mode of the tympanic thermometer needs to be readjusted. Choosing one optimal site for temperature measurement for each patient, and using the specific site consistently would result in more consistent measurements of changes in body temperature, and thus can be more effective in diagnosing fever or hypothermia.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.3
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• pp.1650-1662
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• 2014

This study aimed to develop smartphone application contents for the medication reconciliation of high-alert medications and to evaluate the satisfaction for this application. The xcode 4.5 and ios 6.1 SDK(software development kit) were used for constructing screen of the system. After implementation during 4 weeks, thirty five ICU(Intensive Care Unit) nurses were asked function related, contents related, and usage related satisfaction using 12 items. And differences of satisfaction according to the number of daily use and the frequency of use were evaluated. Data were analyzed using descriptive analysis, ANOVA with the SPSS 18.0. We developed the formula for drug dosage calculation, the alarming procedure, and the information of the high alert medication. In the satisfaction items, the mean score of 'This application is helpful to perform drug dosage calculation' was 3.14. However, 'I satisfy this application' was relatively low as 2.94. There were no differences in satisfaction according to the daily use and frequency of use. Based on the results of this study, more advanced smartphone application for medication reconciliation of high-alert medications will provide an important platform for patient safety.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.12
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• pp.212-223
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• 2019

The purpose of this study was to investigate how attitude, subjective norm, and perceived behavioral control affect nurses' pressure ulcer (PU) prevention behavior among general hospital nurses based on the theory of planned behavior. A total of 111 nurses in four general hospitals in Korea participated in this study and replied to a survey on attitude, subjective norm, perceived behavioral control, and behavior regarding PU prevention. Data were analyzed with multiple regressions by all participants, education level, working department, and hospital size group. In all participants, the more positive attitude and the higher subjective norm, the more PU prevention behavior. However, in the group of 'more than bachelor degree' and 'tertiary hospital', the more clinical experience, the more behavior. In the group of 'surgical ward & intensive care unit', the higher attitude, the more behavior. In the group of 'more than bachelor degree', the higher subjective norm, the more behavior. Therefore, personalized and tailored intervention for nurses may be provided depending on nurses' education level, work department, and hospital size to enhance PU prevention behavior by means of improving nurses' attitude, subjective norm toward PU prevention.

• Clinical and Experimental Pediatrics
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• v.58 no.11
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• pp.421-426
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• 2015

Purpose: The vancomycin dosage regimen is regularly modified according to the patient's glomerular filtration rate (GFR). In the present study, we aimed to assess the usefulness of serum cystatin C (Cys-C) concentration, compared with serum creatinine (SCr) concentration, for predicting vancomycin clearance (CLvcm) in neonates. Methods: We retrospectively analyzed the laboratory data of 50 term neonates who were admitted to the neonatal intensive care unit and received intravenous vancomycin, and assessed the pharmacokinetic profiles. Creatinine clearance (CLcr) and GFR based on Cys-C (GFRcys-c) were estimated using the Schwartz and Larsson formulas, respectively. Results: The mean CLvcm (${\pm}$standard deviation) was $74.52{\pm}31.17L/hr$, the volume of distribution of vancomycin was $0.67{\pm}0.14L$, and vancomycin half-life was $9.16{\pm}17.42hours$. The SCr was $0.46{\pm}0.25mg/dL$ and serum Cys-C was $1.43{\pm}0.34mg/L$. The peak and trough concentrations of vancomycin were $24.65{\pm}14.84$ and $8.10{\pm}5.35mcg/mL$, respectively. The calculated GFR based on serum creatinine concentration (GFR-Cr) and GFRcys-c were $70.2{\pm}9.45$ and $63.6{\pm}30.18mL/min$, respectively. The correlation constant for CLvcm and the reciprocal of Cys-C (0.479, P=0.001) was significantly higher than that for CLvcm and the reciprocal of SCr (0.286, P=0.044). GFRcys-c was strongly correlated with CLvcm (P=0.001), and the correlation constant was significantly higher than that for CLvcm and CLcr (0.496, P=0.001). Linear regression analysis showed that only GFRcys-c was independently and positively correlated with CLvcm (F=41.9, P<0.001). Conclusion: The use of serum Cys-C as a marker of CLvcm could be beneficial for more reliable predictions of serum vancomycin concentrations, particularly in neonates.

• Clinical and Experimental Pediatrics
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• v.54 no.6
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• pp.246-252
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• 2011

Purpose: The outcomes of small for gestational age (SGA) infants especially in extremely low birth weight infants (ELBWIs) are controversial. This study evaluated the mortality and morbidity of ELBWIs, focusing on whether or not they were also SGA. Methods: The medical records of 415 ELBWIs (birth weight<1,000 g), who were inborn and admitted to the Samsung Medical Center neonatal intensive care unit from January 2000 to December 2008, were reviewed retrospectively. Mortality and morbidities were compared by body size groups: very SGA (VSGA), birth weight ${\leq}$3rd percentile; SGA, 3rd to 10th percentile; and appropriate for gestational age (AGA) infants, >10th percentile for gestational age. For gestational subgroup analysis, groups were divided into infants with gestational age ${\leq}24^{+6}$ weeks (subgroup I), $25^{+0}$ to $26^{+6}$ weeks (subgroup II), and ${\geq}27^{+0}$ weeks (subgroup III) Results: Gestational age was $29^{+2}{\pm}2^{+6}$ weeks in the VSGA infants (n=49), $27^{+5}{\pm}2^{+2}$weeks in the SGA infants (n=45), and $25^{+4}{\pm}1^{+4}$ weeks in AGA infants (n=321). Birth weight was $692{\pm}186.6$ g, $768{\pm}132.9$ g, and $780{\pm}142.5$ g in the VSGA, SGA, and AGA groups, respectively. Cesarean section rate and maternal pregnancy-induced hypertension were more common in the VSGA and SGA than in AGA pregnancies. However, chorioamnionitis was more common in the AGA group. The mortalities of the lowest gestational group (subgroup I), and also of the lower gestational group (subgroup I+II) were significantly higher in the VSGA group than the SGA or AGA groups (P=0.020 and P=0.012, respectively). VSGA and SGA infants showed lower incidence in respiratory distress syndrome, ductal ligation, bronchopulmonary dysplasia, intraventricular hemorrhage than AGA group did. However, by multiple logistic regression analysis of each gestational subgroup, the differences were not significant. Conclusion: Of ELBWIs, extremely SGA in the lower gestational subgroups, had an impact on mortality, which may provide information useful for prenatal counseling.

• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.121-130
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• 2019

Purpose: To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors. Materials and Methods: This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis. Results: The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent. Conclusion: The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• Pediatric Infection and Vaccine
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• v.27 no.1
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• pp.45-52
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• 2020

Purpose: This pilot study aimed to evaluate the efficacy of high dose ampicillin-sulbactam and colistin combination therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in the pediatric intensive care unit of Pusan National University Children's Hospital. Methods: We retrospectively reviewed 17 pediatric patients with VAP caused by CRAB from June 2017 to August 2018. Ten (58.8%) patients were treated with high dose ampicillin-sulbactam and colistin combination therapy (combination therapy group), whereas 7 were treated with colistin only or with various combinations with or without colistin (other antibiotics group). Clinical and bacteriological outcomes were compared between the groups. Results: The mean duration of fever after antibiotic use was 1.30±1.70 days in the combination therapy group and 1.71±1.49 days in the other antibiotics group. The mean duration of days for negative conversion of endotracheal aspirate bacterial culture after antibiotic therapy was 3.40±1.71 days in the combination therapy group and 11.80±8.86 days in the other antibiotics group. The mortality rate within 30 days of antibiotic therapy was 1/10 (10%) in the combination therapy group and 3/7 (42.9%) in the other antibiotics group. Conclusions: High dose ampicillin-sulbactam and colistin combination therapy as early antibiotic treatment in VAP caused by CRAB in children could improve clinical outcomes.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.1-6
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• 2017

Purpose: We investigated the effectiveness of the delta neutrophil index (DNI) for the prediction of neonatal bacteremia and compared it to other indices. Methods: A total of 146 pediatric patients, aged less than 31 days, admitted to the neonatal intensive care unit of Wonju Severance Christian Hospital with fever before or during hospitalization were enrolled in this study. We divided the patients into two groups based on the existence of neonatal bacteremia and performed blood culture tests on both groups. We examined white blood cell count, absolute neutrophil count, DNI, platelet count, and C-reactive protein (CRP) test. We used a receiver operating characteristic (ROC) curve to evaluate their diagnostic significance. Results: Seventy-seven patients were diagnosed with neonatal bacteremia. The mean gestational age was 38.74 weeks and the mean birth weight was 3.20 kg. The mean gestational age of the control group was 33.34 weeks and the mean birth weight was 2.20 kg. Causative organisms of bacteremia included Staphylococcus aureus (n=22), Staphylococcus epidermidis (n=18), and Streptococcus agalactiae (n=8). Both DNI and CRP were significantly associated with neonatal bacteremia after adjusting for gestational age and birth weight. The area under the ROC curve (AUC) for DNI (0.70) was higher than that for CRP (0.68). Conclusions: The DNI can be used to effectively predict neonatal bacteremia. The prediction will be more accurate if DNI is used in conjunction with other indices. In future, it will be useful to compare DNI with other indices and investigate its relationship with prognosis.