• Journal of Korean Biological Nursing Science
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• 제23권2호
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• pp.138-150
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• 2021

Purpose: This retrospective study aimed to investigate nursing interventions in patients with severe thoracic injury in trauma bay of a regional trauma center. Methods: Of the 1,780 patients admitted to the trauma bay of a regional trauma center in a university hospital in the Gyeonggi Province between January 1, 2019 and December 31, 2019, 120 adult patients with severe thoracic injury who met the inclusion criteria were enrolled. Participants' clinical characteristics and nursing interventions were collected from electronic medical records after receiving ethical approval. Nursing interventions were classified using the terminology in the Nursing Intervention Classification. Results: The mean age of participants was 52.25 years and 72.5% of participants were male. The main areas of thoracic injury included lung parenchyma and pleura (95.8%). The mean Abbreviated Injury Scale (AIS) for thoracic injury was 3.13 and the mean Injury Severity Score (ISS) was 17.81. Fluid resuscitation, invasive hemodynamic monitoring, chest tube care, respiratory monitoring, artificial airway management, gastrointestinal tube care, mechanical ventilation management: airway insertion and stabilization, blood product administration, allergy management, and surgical preparation were performed significantly more frequently in thoracic injury patients with unstable vital signs or a higher AIS score. Conclusion: This study is significant as it investigated the types of nursing interventions given to patients with severe thoracic injury in the trauma bay. These results would contribute to developing more detailed educational materials for initial nursing interventions in trauma bay.

• 한국임상수의학회지
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• 제38권4호
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• pp.204-209
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• 2021

A seven-month-old castrated male Chihuahua weighing 1.6 kg presented with generalized tonic-clonic seizure following ingestion of isoniazid. Emergency treatment with three doses of diazepam (total 1.5 mg/kg, intravenous [IV]) and phenobarbital (15 mg/kg IV) was administered. The seizure stopped after administration of propofol (constant rate infusion [CRI]; 0.2 mg/kg/min). Blood analyses showed mildly increased serum blood glucose concentration, hyperkalemia, and hyperphosphatemia. On suspicion of isoniazid toxicity, activated charcoal (1 g/kg, orally), lipid emulsion (CRI; 9 mL/hr), and pyridoxine hydrochloride (70 mg/kg IV) were added to the treatment regimen. Twelve hours after presentation, the dog showed increased serum liver enzyme activities, serum blood urea nitrogen, and creatinine concentrations indicating hepatic and renal failure. Twenty-two hours after presentation, blood analysis still revealed increased liver enzyme activities, blood urea nitrogen, and creatinine concentrations with low blood glucose concentration. Twenty-six hours after presentation, the dog's vital signs deteriorated and the owner elected for the dog to be euthanized. This is the first report of the clinical course of isoniazid toxicosis in a dog in South Korea. Furthermore, to our best knowledge, this is the first report where secondary multiple organ failure was observed due to isoniazid toxicosis. Clinicians should be aware of the possibility of isoniazid toxicosis in dogs. Rapid initiation of treatment after clinical recognition is warranted in such cases.

• 대한간호학회지
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• 제51권6호
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• pp.758-768
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• 2021

Purpose: This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job. Methods: A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators' jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task. Results: From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, 'assess the patient's general health status' was carried out most frequently. Nurse care coordinators perceived that 'check vital signs' and 'strengthen patient competence to promote health behaviors' were more important than all other tasks. The most difficult task was 'develop professionalism as a nurse care coordinator'. Conclusion: The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.181-188
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• 2022

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients. Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University Hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase. Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%). Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.189-194
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• 2022

Purpose: The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations. Methods: A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis. Results: When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014). Conclusions: Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.

• Journal of Chest Surgery
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• 제55권2호
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• pp.108-117
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• 2022

Background: The efficacy of telemedicine among cancer survivors is uncertain. The Smart After-Care Program (SAP), which is an interactive, smartphone-based remote health monitoring system, was developed to help patients manage their health after leaving the hospital. This study was designed to evaluate the efficacy of our remote health care program for lung cancer patients. Methods: We enrolled 50 patients with lung cancer. Self-monitoring devices were supplied to all patients, who were instructed to enter their daily vital signs and subjective symptoms to the Smart After-Care app. The app also provided information about rehabilitation exercises and a healthy diet for lung cancer patients. All patients received health counseling via telephone once a week and visited an outpatient clinic during weeks 6 and 12 to assess satisfaction with the SAP and changes in quality of life and physical performance. Results: Overall satisfaction with the SAP was very high (very good, 61.9%; good, 26.2%). In the multivariate analysis to identify factors affecting satisfaction, the distance between the patient's residence and the hospital was the only significant independent factor (p=0.013). Quality of life improved along all functional scales (p<0.05). Muscle strength significantly improved in the lower limbs (p=0.012). Two-minute walk distance also significantly improved (p=0.028). Conclusion: This study demonstrated that the SAP was acceptable for and supportive of patients with reduced pulmonary function after lung cancer treatment. The SAP was found to be particularly useful for patients living far from the hospital.

• Clinical and Experimental Pediatrics
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• 제65권3호
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• pp.136-141
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• 2022

Background: High-flow nasal cannula (HFNC) is a noninvasive respiratory support that provides the optimum flow of an air-oxygen mixture. Several studies demonstrated its usefulness and good safety profile for treating pediatric respiratory distress patients. However, the cost of the commercial HFNC is high; therefore, the modified high-flow nasal cannula was developed. Purpose: This study aimed to compare the effectiveness, safety, and nurses' satisfaction of the modified system versus the standard commercial HFNC. Methods: This prospective comparative study was performed in a tertiary care hospital. We recruited children aged 1 month to 5 years who developed acute respiratory distress and were admitted to the pediatric intensive care unit. Patients were assigned to 2 groups (modified vs. commercial). The effectiveness and safety assessments included vital signs, respiratory scores, intubation rate, adverse events, and nurses' satisfaction. Results: A total of 74 patients were treated with HFNC. Thirtynine patients were assigned to the modified group, while the remaining 35 patients were in the commercial group. Intubation rate and adverse events did not differ significantly between the 2 groups. However, the commercial group had higher nurses' satisfaction scores than the modified group. Conclusion: Our findings suggest that our low-cost modified HFNC could be a useful respiratory support option for younger children with acute respiratory distress, especially in hospital settings with financial constraints.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.332-340
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• 2022

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period. Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation. Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292). Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

• 대한본초학회지
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• 제34권1호
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• pp.13-21
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• 2019

Objectives : This clinical trial is performed to investigate the effect of improving the hypersensitivity reaction and the safety of powdered ethanol extract Codonopsis lanceolata (S. et Z.) Trautv. for allergic patients. Methods : This study was randomized, double blinded, placebo-controlled clinical trial. 60 allergic rhinitis subjects were randomly assigned to Treatment group(n=30) and Control group(n=30). They were received the test substance or placebo in their $1^{st}$ and $2^{nd}$ visit, and took it once a day, 1 powder bag per 1 time, for 8 weeks. The freeze dried powder of Codonopsis lanceolata (S. et Z.) Trautv. was mixed with 30% ethanol and the filtrate was collected thrice with constant stirring of the mixture. The placebo was prepared in the same form as the test substance by replacing with corn starch. Total Nasal Symptom Score(TNSS) questionnaires and laboratory tests were performed at the screening and last visit to evaluate the efficacy. And to assess safety, vital signs and adverse events were confirmed at every visit. Statistical analysis about the result was performed using SAS 9.4. Results : In treatment group, there was a significant decrease in B cell after taking the test substance(p<0.005). And there was a statistically significant difference between groups(p<0.005). Changes in nasal symptoms were not statistically significant between groups, and both groups showed statistically significant differences before and after the test(p<0.0001). Also there were no adverse events associated with the clinical trial product. Conclusions : This clinical trial showed that Codonopsis lanceolata (S. et Z.) Trautv. extract was helpful in improving the hypersensitivity reaction in allergic patients without significant side effects.

• 대한간호학회지
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• 제52권4호
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• pp.391-406
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• 2022

Purpose: The purpose of this study was to provide foundational knowledge on nursing tasks performed on patients with COVID-19 in a nationally-designated inpatient treatment unit. Methods: This study employs both quantitative and qualitative approaches. The quantitative method investigated the content and frequency of nursing tasks for 460 patients (age ≥ 18 y, 57.4% men) from January 20, 2020, to September 30, 2021, by analyzing hospital information system records. Qualitative data were collected via focus group interviews. The study involved interviews with three focus groups comprising 18 nurses overall to assess their experiences and perspectives on nursing care during the pandemic from February 3, 2022, to February 15, 2022. The data were examined with thematic analysis. Results: Overall, 49 different areas of nursing tasks (n = 130,687) were identified based on the Korean Patient Classification System for nurses during the study period. Among the performed tasks, monitoring of oxygen saturation and measuring of vital signs were considered high-priority. From the focus group interview, three main themes and eleven sub-themes were generated. The three main themes are "Experiencing eventfulness in isolated settings," "All-around player," and "Reflections for solutions." Conclusion: During the COVID-19 pandemic, it is imperative to ensure adequate staffing levels, compensation, and educational support for nurses. The study further propose improving guidelines for emerging infectious diseases and patient classification systems to improve the overall quality of patient care.