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Predictors of Failed Closure of Patent Ductus Arteriosus with the First Course of Indomethacin in Preterm Infants (미숙아 동맥관 개존에서 인도메타신 1차 투여 후 폐쇄 실패의 예측 인자)

  • Lee, Mong-Young;Lim, Dong-Hee;Park, Kyu-Hee;Ha, Gi-Su;Lee, Jang-Hoon;Choi, Byung-Min;Hong, Young-Sook;Yoo, Kee-Hwan;Lee, Joo-Won
    • Neonatal Medicine
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    • v.17 no.1
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    • pp.75-83
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    • 2010
  • Purpose : This study was performed to determine the predictors of failed closure of a patent ductus arteriosus (PDA) following the first course of indomethacin in symptomatic preterm infants. Methods : Forty three of 43 preterm infants, admitted to the neonatal intensive care unit diagnosed with PDA and treated with indomethacin at the Korea University Medical Center between January 1990 and October 2007, ware studied. The perinatal risk factors affecting the failed closure of PDA were retrospectively assessed. Results : The failed PDA closure group included 16 (37%) out of 43 infants three of whom underwent surgery. The closure group included 27 (63%) out of 43 infants. In the failed closure group, the Apgar scores (1 min, 5 min) were significantly higher (P<0.05) and antenatal steroid administration was significantly lower (P<0.05). In addition, dopamine administration was significantly lower (P<0.05) and the mean postnatal age at diagnosis was significantly lower (P<0.05). Multiple logistic regression for the prediction of failed PDA closure found only antenatal steroid administration (OR 0.092, CI 0,010-0.826, P=0.0331) as an associated factor. Conclusion : In patients with antenatal steroid administration the failed PDA closure rate was significantly lower. Therefore, antenatal steroid administration can be considered as an important factor for the closure of PDA in preterm pregnancies.

Pathogens and Prognotic Factors for Early Onset Sepsis in Very Low Birth Weight Infants (극소 저체중 출생아에서 조기 패혈증의 원인균과 예후인자)

  • Kim, Yi-Sun;Kim, Jin-Kyu;Yoo, Hye-Soo;Ahn, So-Yoon;Seo, Hyun-Ju;Choi, Seo-Heui;Park, Soo-Kyung;Jung, Yu-Jin;Kim, Myo-Jing;Jeon, Ga-Won;Koo, Soo-Hyun;Lee, Kyung-Hoon;Chang, Yun-Sil;Park, Won-Soon
    • Neonatal Medicine
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    • v.16 no.2
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    • pp.163-171
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    • 2009
  • Purpose: This study was conducted to determine the incidence, causative pathogens, risk factors and mortality for early onset sepsis in the first three days in very low birth weight infants. Methods: The medical records of 1,124 very low birth weight infants admitted to the neonatal intensive care unit of Samsung Medical Center between November 1994 and December 2008 were retrospectively reviewed. The incidence, causative pathogens, risk factors, and mortality for early onset sepsis in the first 3 days of life in very low birth weight infants were evaluated. Results: Early onset sepsis, as confirmed by positive blood cultures, was present in 17 of 1,124 infants (1.5%). Sixty-four percent of the isolated pathogens were gram-positive bacteria and 35% of the isolated pathogens were gram-negative bacteria. The dominant pathogens of early onset sepsis included Staphylococcus aureus (23.5%), Esherichia coli (23.5%), and Enterococcus (17.6%). Vaginal delivery (adjusted odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.3; P=0.01) was associated with early onset sepsis. The overall mortality (adjusted hazard ratio, 3.0; 95% CI, 1.4-6.5; adjusted P=0.0039) and mortality within 72 hours of life (adjusted hazard ratio, 6.5; 95% CI, 2.2-18.9; adjusted P=0.0005) of infants with early onset sepsis were higher than that of uninfected infants. Conclusion: Early onset sepsis remains an uncommon, but potentially lethal problem among very low birth weight infants. Knowledge of the likely causative organisms and risk factors for early onset sepsis can aid in instituting prompt and appropriate therapy, in order to minimize mortality.

Analysis of risk factors of atrial fibrillation after coronary artery bypass grafting (관상동맥 우회로 조성수술후 발생하는 심 방세동의 위험요인 분석)

  • Yu, Gyeong-Jong;Go, Yeong-Ho;Im, Sang-Hyeon;Gang, Myeon-Sik
    • Journal of Chest Surgery
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    • v.29 no.6
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    • pp.599-605
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    • 1996
  • A total of 249 patients undergoing isolated coronary revascularization were studied for the occurrence of postoperative atrial fibrillation(AF). Possible associations of this arrhythmia with various preoperative, intraoperative and postoperative factors were studied by univariate and multivariate analysis. The overall incidence of postoperative AF was 15%, with the median time occurence of 48 hours(mean time : 59.1 $\pm$ 56.9 hours) after arrival to the intensive care unit. Cardiac index decreased significantly after occurence of AF(p=0.001). There were no in-hospital complications in those patients with AF. Univariate studies indicated preoperative ejection fract on(EF), triglyceride level, postoperative peak CKMB isoenzpme and atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in lower EF(p=0.025), triglyceride(p=0.006) and peak CKMB isoenzyme(p=0.002), and in patients with atrial pacing(p=0.001). Hospital stay(p=0.001) and late mortality(p=0.003) were significantly increased in patients with postoperative AF Multivariate analysis showed that body weight and postoperative atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in over- weight patients(p=0.011) and patients with atrial pacing(p=0.001). Both univariate and multivariate analy- sis showed that the age was not a significant factor but tended to promote postoperative AF respectively (p=0.053, 0.064). After 30.1 $\pm$ 11.4 months gfollow-up, those patients with AF had sinus rhythm. We think that we must try to prevent postoperative AF after ccoronary artery bypass grafting because of its deleterio s hemodynamic effect, prolonged hospital stay, and increased late mortality.

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The Role of B-type Natriuretic Peptide in Predicting Postoperative Complications and Outcomes in Patients Undergoing Coronary Artery Bypass Graft (관상동맥 우회술 환자의 술 후 합병증 예견에 대한 BNP의 역할)

  • Jung, Tae-Eun;Lee, Jang-Hoon;Do, Hyung-Dong;Han, Sung-Sae;Lee, Dong-Hyup
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.55-60
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    • 2008
  • Background: Circulating levels of brain natriuretic peptide (BNP) provide prognostic information for patients with heart failure. The aim of our study was to investigate whether preoperative and postoperative BNP levels could predict postoperative complications and outcomes in patients after coronary artery bypass graft (CABG). Material and Method: Data was collected prospectively on 30 patients (M/F=19/11, age $60.0{\pm}9.6$ years) undergoing conventional CABG during a 1-year period beginning on January 1, 2005. Patients underwent off-pump CABG, and combined surgery was excluded. The BNP assay was performed preoperatively, immediate postoperatively at the intensive care unit (ICU), and 1, 3, 5, and 7days postoperatively. Result: Preoperative BNP levels significantly correlated with preoperative echocardiographic ejection fraction and an ICU stay of 5 days or more (r=-0.4, p=0.028; r=0.39, p=0.031, respectively). A preoperative BNP cut-off value above 263 pg/mL demonstrated high specificity (90.5%) for predicting postoperative complications using the receiver operating characteristics curves. Preoperative and postoperative (7 days) BNP levels were different depending on the abscence (mean BNP=$99{\pm}23\;pg/mL$ vs. $296{\pm}74\;pg/mL$, p<0.05) and presence (mean BNP=$212{\pm}29\;pg/mL$ vs. $408{\pm}23\;pg/mL$, p<0.01). Conclusion: Preoperative BNP levels >263 pg/mL predict postoperative complications in patients receiving CABG.

DETECTION OF METHICILLIN OR VANCOMYCIN-RESISTANT STAPHYLOCOCCUS AUREUS FROM DENTAL HOSPITAL (치과병원 진료실 내에서 메티실린 또는 반코마이신 저항성 Staphylococcus aureus의 검출)

  • Min, Jung-Hee;Park, Soon-Nang;Hwang, Ho-Keel;Min, Jung-Beum;Kim, Hwa-Sook;Kook, Joong-ki
    • Restorative Dentistry and Endodontics
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    • v.32 no.2
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    • pp.102-110
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    • 2007
  • The purpose of this study was to obtain the basic information for the improvement of dental environment by investigating the presence of methicillin- or vancomycin-resistant Staphylococcus aureus (MRSA or VRSA) isolated from dental health care workers (DHCWs) and environment of the Chosun University Dental Hospital (CUDH) and a private dental clinic (control group). Staphylococcus aureus (S. aureus) was isolated from anterior nares of 42 DHCWS and 38 sites, unit chairss, x-ray devices, computers, etc., at 10 departments of the CUDH and 20 DHCWs and 11 sites at the private dental clinic. S. aureus was isolated on mannitol salt agar plate and confirmed by PCR with S. aureus species-specific primer. Antimicrobial susceptibility test of clinical isolates of S. aureus against several antibiotics including methicillin (oxacillin) was performed by investigating minimum inhibitory concentration (MIC) using broth microdilution assay. In addition, PCR was performed to detect the methicillin- or vancomycin-resistant gene. The data showed that one strain of S. aureus was isolated from DHCWs of the CUDH and three strains of S. aureus was isolated from 3 samples of the private dental clinic, respectively. All of the isolates from the CUDH and the private dental clinic had resistance to penicillin G, amoxicillin and vancomycin and susceptibility to oxacillin and ciprofloxacin. The S. aureus strains were already obtained the resistance to penicillin G and amoxicillin. These results suggest that two dental clinics were under relatively safe environment.

The Etiological Role of Legionella Pneumophila in Patients with Community-Acquired Pneumonia in Korea (입원한 지역사회획득 폐렴 환자에서 요중 레지오넬라항원 검사를 통해 본 Legionella Pneumophila 감염의 비중)

  • Song, Hong-Seok;Suh, Ji-Hyeon;Ahn, Jong-Ho;Yoon, Byeong-In;Lee, Seung-Joon;Lee, Myung-Goo;Jun, Man-Jo;Kang, Min-Jong;Lee, Jae-Myung;Kim, Dong-Gyu;Son, Jee-Woong;Park, Myung-Jae;Hyun, In-Gyu;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.4
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    • pp.409-414
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    • 2001
  • Background : Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluate the etiological importance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. Method : The CAP patients over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age $63.8{\pm}15.3$) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. Result : The average Fine's PORT score was 99.7(${\pm}44.9$). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pnewnophila serogroup 1 were not detected. Conclusion : Legionella pnewnophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.

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Effect of Synagis (palivizumab) prophylaxis on readmission due to respiratory syncytial virus in very low birth weight infants (극소 저체중 출생아에서 Synagis (palivizumab) 접종이 respiratory syncytial virus 감염으로 인한 재입원에 미치는 영향)

  • Park, Soo Kyoung;Jung, Yu Jin;Yoo, Hye Soo;Ahn, So Yoon;Seo, Hyun Joo;Choi, Seo Hui;Kim, Myo Jing;Jeon, Ga Won;Koo, Soo Hyun;Lee, Kyung-Hoon;Chang, Yun Sil;Park, Won Soon
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.358-364
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    • 2010
  • Purpose : The aim of this study was to determine the efficacy of $Synagis^{(R)}$ (palivizumab) in reducing the respiratory syncytial virus (RSV) readmission rate in very low birth weight infants (VLBWI ) and the subgroup that showed the most effective vaccination. Methods : We enrolled 350 VLBWI who had been discharged alive from the neonatal intensive care unit of Samsung Medical Center from January 2005 to December 2007 and were followed up for at least one year. A retrospective study based on medical records was performed for a period of one year after discharge. RSV readmission rate was investigated according to BPD (bronchopulmonary dysplasia, requiring oxygen at postnatal day 28) and $Synagis^{(R)}$ prophylaxis. We categorized the subgroups by the severity of BPD gestational age, and birth weight and compared the RSV readmission rates between subgroups. Results : Eleven VLBWI were readmitted. $Synagis^{(R)}$ prophylaxis resulted in a 86% reduction in the rate of readmission due to RSV infection (prophylaxis group, 0.7% and no prophylaxis group, 5.0%; P =0.02). Readmission rate in BPD patients was also reduced in the prophylaxis group (0.7% in the prophylaxis group vs. 5.2% in the no prophylaxis group, P =0.03). The readmission rate in patients without BPD was reduced in the prophylaxis group (0% in the prophylaxis group vs. 4.9% in the no prophylaxis group, P =1.00), but this was not statistically significant.Conclusion : $Synagis^{(R)}$ prophylaxis was effective at reducing RSV readmission in VLBWI. Its efficacy was verified irrespective of BPD, gestational age, or birth weight.

The Multi-door Courthouse: Origin, Extension, and Case Studies (멀티도어코트하우스제도: 기원, 확장과 사례분석)

  • Chung, Yongkyun
    • Journal of Arbitration Studies
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    • v.28 no.2
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    • pp.3-43
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    • 2018
  • The emergence of a multi-door courthouse is related with a couple of reasons as follows: First, a multi-door courthouse was originally initiated by the United States government that increasingly became impatient with the pace and cost of protracted litigation clogging the courts. Second, dockets of courts are overcrowded with legal suits, making it difficult for judges to handle those legal suits in time and causing delays in responding to citizens' complaints. Third, litigation is not suitable for the disputant that has an ongoing relationship with the other party. In this case, even if winning is achieved in the short run, it may not be all that was hoped for in the long run. Fourth, international organizations such as the World Bank, UNDP, and Asia Development Bank urge to provide an increased access to women, residents, and the poor in local communities. The generic model of a multi-door courthouse consists of three stages: The first stage includes a center offering intake services, along with an array of dispute resolution services under one roof. At the second stage, the screening unit at the center would diagnose citizen disputes, then refer the disputants to the appropriate door for handling the case. At the third stage, the multi-door courthouse provides diverse kinds of dispute resolution programs such as mediation, arbitration, mediation-arbitration (med-arb), litigation, and early neutral evaluation. This study suggests the extended model of multi-door courthouse comprised of five layers: intake process, diagnosis and door-selection process, neutral-selection process, implementation process of dispute resolution, and process of training and education. One of the major characteristics of extended multi-door courthouse model is the detailed specification of individual department corresponding to each process within a multi-door courthouse. The intake department takes care of the intake process. The screening department plays the role of screening disputes, diagnosing the nature of disputes, and determining a suitable door to handle disputes. The human resources department manages experts through the construction and management of the data base of mediators, arbitrators, and judges. The administration bureau manages the implementation of each process of dispute resolution. The education and training department builds long-term planning to procure neutrals and experts dealing with various kinds of disputes within a multi-door courthouse. For this purpose, it is necessary to establish networks among courts, law schools, and associations of scholars in order to facilitate the supply of manpower in ADR neutrals, as well as judges in the long run. This study also provides six case studies of multi-door courthouses across continents in order to grasp the worldwide picture and wide spread phenomena of multi-door courthouse. For this purpose, the United States and Latin American countries including Argentina and Brazil, Middle Eastern countries, and Southeast Asian countries (such as Malaysia and Myanmar), Australia, and Nigeria were chosen. It was found that three kinds of patterns are discernible during the evolution of a multi-door courthouse model. First, the federal courts of the United States, land and environment court in Australia, and Lagos multi-door courthouse in Nigeria may maintain the prototype of a multi-door courthouse model. Second, the judicial systems in Latin American countries tend to show heterogenous patterns in terms of the adaptation of a multi-door courthouse model to their own environments. Some court systems of Latin American countries including those of Argentina and Brazil resemble the generic model of a multi-door courthouse, while other countries show their distinctive pattern of judicial system and ADR systems. Third, it was found that legal pluralism is prevalent in Middle Eastern countries and Southeast Asian countries. For example, Middle Eastern countries such as Saudi Arabia have developed various kinds of dispute resolution methods, such as sulh (mediation), tahkim (arbitration), and med-arb for many centuries, since they have been situated at the state of tribe or clan instead of nation. Accordingly, they have no unified code within the territory. In case of Southeast Asian countries such as Myanmar and Malaysia, they have preserved a strong tradition of customary laws such as Dhammthat in Burma, and Shriah and the Islamic law in Malaysia for a long time. On the other hand, they incorporated a common law system into a secular judicial system in Myanmar and Malaysia during the colonial period. Finally, this article proposes a couple of factors to strengthen or weaken a multi-door courthouse model. The first factor to strengthen a multi-door courthouse model is the maintenance of flexibility and core value of alternative dispute resolution. We also find that fund raising is important to build and maintain the multi-door courthouse model, reflecting the fact that there has been a competition surrounding the allocation of funds within the judicial system.

Outcomes of Patients with COPD Requring Mechanical Ventilation (만성폐쇄성폐질환 환자의 기계호흡시 생존 예측 인자 분석)

  • Baik, Jae-Joong;Kim, Sang-Chul;Lee, Tae-Hoon;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.2
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    • pp.179-188
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    • 2000
  • Background : The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate information regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD. Methods : The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined. Results : Weaning sucess was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes. previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, $PaO_2$, $PaCO_2$, $FEV_1$ duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success. Conclusion : While weaning success from mechanical ventilation can be predicted by APACHE II score in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.

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Outcomes in Relation to Time of Tracheostomy in Patients with Mechanical Ventilation (기계호흡환자의 기관절개 시행 시기에 따른 결과 분석)

  • Shin, Jeong-Eun;Shin, Tae-Rim;Park, Young-Mi;Nam, Jun-Sik;Cheon, Seon-Hee;Chang, Jung-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.3
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    • pp.365-373
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    • 1999
  • Background: Despite widespread use of tracheostomy in intensive care unit, it is still controversial to define the best timing from endotracheal intubation to tracheostomy under prolonged mechanical ventilation. Early tracheostomy has an advantage of easy airway maintenance and enhanced patient mobility whereas a disadvantage in view of nosocomial infection and tracheal stenosis. However, there is a controversy about the proper timing of tracheostomy. Methods: We conducted a retrospective study of the 35 medical and 15 surgical ICU patients who had admitted to Ewha Womans University Mokdong Hospital from January 1996 to August 1998 with the observation of APACHE III score, occurrence of nosocomial infections, and clinical outcomes during 28 days from tracheostomy in terms of early (n=25) vs. late (n=25) tracheostomy. We defined the reference day of early and late tracheostomy as 7th day from intubation. Results: The number of patients were 25 each in early and late tracheostomy group. The mean age were $48{\pm}18$ years in early tracheostomy group and $63{\pm}17$ years in late tracheostomy group, showing younger in early tracheostomy group. The median duration of intubation prior to tracheostomy was 3 days and 13 days in early and late tracheostomy groups. Organs that caused primary problem were nervous system in 27 cases(54%), pulmonary 14(28%), cardiovascular 4(8%), gastrointestinal 4(8%) and genitourinary 1(2%) in the decreasing order. Prolonged ventilation was the most common reason for the purpose of tracheostomy in both groups. APACHE m scores at each time of intubation and tracheostomy were slightly higher in late tracheostomy group but not significant statistically. Day to day APACHE III scores were not different between two groups with observation upto 7th day after tracheostomy, Occurrence of nosocomial infections, weaning from mechanical ventilation, and mortality showed no significant difference between two groups with observation of 28 days from tracheostomy. The mortality was increased as the APACHE m score upto 7 days after tracheostomy increased, but there were no increment for the mortality in terms of the time of tracheostomy and the days of ventilator use before tracheostomy, Conclusion: The early tracheostomy seems to have no benefit with respect to severity of illness, nosocomial infection, duration of ventilatory support, and mortality. It suggests that the time of tracheostomy is better to be decided on clinical judgement in each case. And in near future, prospective, randomized case-control study is required to confirm these results.

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