• 대한영양사협회학술지
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• 제9권1호
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• pp.32-39
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• 2003

Although medical nutrition therapy (MNT) is considered as a cornerstone of medical treatment for hypercholesterolemia, few studies have evaluated medical and economical outcome of MNT. This study was conducted to identify whether MNT administered by registered dieticians could lead to a beneficial clinical and cost outcome in persons with hypercholesterolemia. A prospective clinical trial was carried out at outpatient clinics, which involved an initial visit with a dietitian followed by another visit at first 4 weeks during the 6 weeks study periods. Thirty-nine subjects took part in a 6 weeks nutrition intervention program. Clinical and economical outcomes were compared before and after MNT. Medical nutrition therapy lowered total serum cholesterol level 6.1% (P<0.05), low-density lipoprotein cholesterol (LDL-C) 9.4% (P<0.05) and high-density lipoprotein cholesterol (HDL-C) 3.0% (P<0.05). The cost-effective ratio was ￦ 1,520/cholesterol mg/dl and ￦ 1,441/LDL-cholesterol mg/dl, respectively. After dietitian's intervention, lipid drug eligibility was obviated in 16 of 39(41%) subjects. The cost savings from the avoidance of lipid medications was ￦ 151,107 per patient annually. In conclusion, it is suggested that provision of systemic intensive nutritional care for persons with hypercholesterolemia has significant effects on serum cholesterol reduction and clinical cost savings.

• Journal of Trauma and Injury
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• 제34권1호
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• pp.13-20
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• 2021

Purpose: Nutritional therapy in the intensive care unit is an essential factor for patient progress. The purpose of this study was to compare resting energy expenditure (REE) calculated by prediction equations (PEs) to the REE measured by indirect calorimetry (IC) in trauma patients. Methods: Patients admitted to the trauma intensive care unit who received mechanical ventilation between January and December 2015 were enrolled. REE was measured by IC (CCM Express, MGC Diagnostics) and calculated by the following PEs: Harris-Benedict, Fleisch, Robertson and Reid, Ireton-Jones, and the maximum value (25 kcal/kg/day) of the European Society for Clinical Nutrition and Metabolism (ESPEN). All patients were ventilated at a fraction of inspired oxygen (FiO2) below 60%. Results: Of the 31 patients included in this study, 24 (77.4%) were men and seven (22.6%) were women. The mean age of the patients was 49.7±13.2 years, their mean weight was 68.1±9.6 kg, and their mean Injury Severity Score was 26.1±11.3. The mean respiratory quotient on IC was 0.93±0.19, and their mean FiO2 was 38.72%±6.97%. The mean REE measured by IC was 2,146±444.36 kcal/day, and the mean REE values calculated by the PEs were 1,509.39±205.34 kcal/day by the Harris and Benedict equation, 1,509.39±154.33 kcal/day by the Fleisch equation, and 1,443.39±159.61 kcal/day by the Robertson and Reid equation. The Ireton-Jones equation yielded a higher value (2,278.90±202.35 kcal/day), which was not significantly different from the value measured using IC (p=0.53). The ESPEN maximum value (1,704.03±449.36 kcal/day) was lower, but this difference was likewise not significant (p=0.127). Conclusions: The REE measured by IC was somewhat higher than that calculated using PEs. Further studies are needed to determine the proper nutritional support for trauma patients.

• Journal of Korean Biological Nursing Science
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• 제17권3호
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• pp.228-235
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• 2015

Purpose: Although the prevalence rate of chronic diseases is rapidly increasing due to an unhealthy diet in Korea, nurses may not have enough nutritional knowledge to educate their patients. This study investigated the level of nurses' nutritional knowledge for chronic diseases as well as for strokes, and the needs for nurses' nutritional education. Methods: This research is a descriptive research conducted from April to August of 2014, on 242 nurses who work with stroke patients, in two tertiary general hospitals in the city of Seoul, South Korea. Results: The average nutritional knowledge score of our subjects was $19.9{\pm}2.51$ (range 12-24). The correct response rate was 83% which was higher than expected. However, many nurses (31-66%) answered incorrectly on items such as 'Drinking low-fat milk is better than whole milk', and 'Seasoning with a large amount of soy sauce instead of salt can reduce sodium consumption'. We also found that nurses who received continuing education regarding nutrition scored higher than those who did not (p=.020). There was no correlation between nutritional knowledge and the need for nutritional education (r=.034, p=.601). Conclusion: The level of nutritional knowledge of the nurses was relatively low and irrelevant to the completion of nutrition courses during university or duration of experience. Rather, the relevance was higher when the nurse received nutrition-related training after graduating from university. Our results imply that continuous nutritional education is necessary for hospital nurses.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권1호
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• pp.39-45
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• 2009

목 적: 영양지원팀(nutritional support team, NST)은 영양부족이 위험성이 있는 환자에게 영양을 효율적으로 제공하기 위해 운영된다. 미숙아는 소화, 흡수의 미숙, 비축된 영양의 부족, 요구량의 증가, 다양한 질환에의 이환으로 인하여 영양 불균형의 위험성이 높으며 경구영양이 완전히 진행되기까지는 총정맥영양(total parenteral nutrition, TPN)에 의존하므로 적극적인 영양지원을 필요로 한다. 이에 본 연구에서는 NST 활동이 신생아중환자실에 입원하여 TPN을 투여 받는 미숙아들의 임상경과에 미치는 영향을 검토함으로써 NST의 임상적 의의를 평가하고자 하였다. 방 법: 2003년 7월에서 2006년 7월까지 분당서울대 병원 신생아중환자실에 입원하여 TPN을 시행 받은 미숙아 48명을 대상으로 하여 후향적으로 의무기록을 검토하였다. 대상 환아들을 NST 활동 여부에 따라 각각 NST 설립 이전 시기인 2003년 7월에서 2005년 2월까지 입원한 미숙아군과 NST 활동 시기인 2005년 3월에서 2006년 7월 사이에 입원한 미숙아군으로 나누어 각 군에서의 임상 지표들을 비교분석하여 NST 활동이 미치는 영향을 평가하였다. 통계학적 분석을 위해 Mann-Whitney 검정과 Fisher's exact test를 적용하였고, pvalue 0.05 미만을 통계적으로 유의하다고 판정하였다. 결 과: 대상 환아 48명(남아 27명, 여아 21명)의 재태기간은 평균 $28^{+1}$주(범위: 25주~$32^{+6}$주), 출생체중은 평균 1,008.5${\pm}$242.5 g (범위: 520~1,490 g), 재원기간은 평균 74${\pm}$40일(범위: 26~274일)이었다. 영양사, 약사 또는 NST가 환아의 TPN에 개입하기까지의 기간이 NST 활동 전에는 14.8${\pm}$21.0일 소요되었으나 NST 활동 이후 0.5${\pm}$2.0일로 유의하게 감소하였다(p=0.000). TPN 투여기간은 NST 활동 전의 41.5${\pm}$26.2일에서 NST 활동 후에는 20.5${\pm}$16.6일로 유의하게 감소하였다(p=0.001). TPN을 통해 투여된 칼로리는 NST 활동 전후로 각각 88.1${\pm}$19.0 kcal/kg/day와 98.8${\pm}$8.2 kcal/kg/day로서 유의하게 상승하였고(p=0.016), 단백 투여량은 각각 2.74${\pm}$0.50 g/kg/day와 3.36 g/kg${\pm}$0.34 g/kg/day (p=0.000), 지방 투여량은 각각 2.53${\pm}$0.86 g/kg/day와 3.40 g/kg${\pm}$0.52 g/kg/day로서 두 군 간에 유의한 차이를 보였다(p=0.000). 환아들의 금식기간이 NST 활동 전후 각각 10.5${\pm}$11.3일과 5.9${\pm}$7.3일로서 NST 활동 시작 후 유의하게 감소하였으며(p=0.017), 환자들이 완전 경장영양으로 진행하기까지 소요된 기간도 각각 44.7${\pm}$26.1일과 24.0${\pm}$17.6일로 NST 활동 후 의미 있게 감소하였다 (p=0.001). 항생제 투여기간도 NST 활동 전의 34.8${\pm}$30.8일에서 NST 활동과 더불어 15.6${\pm}$15.2일로 유의하게 감소하였다(p=0.007). 결 론: 신생아중환자실에 입원한 미숙아에게 있어 NST 활동에 의한 적극적인 영양지원은 적절한 영양을 공급하여 영양상태를 개선하는 측면과 더불어 임상적 측면에서도 장점이 있으므로 미숙아의 영양지원에 있어 NST 활동이 갖는 의의가 크다고 하겠다.

• 종양간호연구
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• 제10권2호
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• pp.119-128
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• 2010

Purpose: This study aimed to evaluate the effectiveness of continuous nutritional education and oral mucositis management on the nutritive status of patients who received hematopoietic stem cell transplantation (HSCT). Methods: After randomly allotting 72 patients who received HSCT to either an experimental group or a control group, intensive and continuous care for preventing malnutrition was conducted in the experimental group while usual routine care was conducted in the control group. The changes of the body scale, blood chemistry profile, oral intake calories, nausea and vomitus, and oral stomatitis scores were measured at three points during their hospitalization using a oral assessment guide and nutrition analysis program: admission, HSCT, and discharge day. The differences between the scores of two groups were analyzed by repeated measures analysis of covariance. Results: The number of total lymphocytes was significantly improved in the experimental group after transplantation (p<.001). Nausea and vomiting score was significantly decreased in the experimental group during the conditioning regimen (p<.001). Conclusion: It was found that continuous nutritional education and oral mucositis control is an effective intervention by improving immune condition. Further investigations concerning direct examination of oral intake with controlling the effect of the chemotherapy are needed to ultimately discern the impact of varying oral nutrition patterns during HSCT.

• Child Health Nursing Research
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• 제9권1호
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• pp.96-106
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• 2003

Advances in neonatal care system and research have resulted in an increased survival rate among low birth weight infants in the industrialized countries. Recent Korean neonatal mortality and morbidity statistics, and current status of Korean neonatal intensive care facilities were reviewed here for the sake of future improvement and research. Morbidity statistics revealed that perinatal diseases accounted for 80％ of the death of premature infants implying the possibility of its reduction by the vigorous prenatal care service in future.On the basis of extensive studies of nutritional support and growth rate of premature infants, commercial formulas for premature infants have been developed and various aspects of feeding techniques are standardized. However, problem of growth deficit of premature infants remains unsolved as medical problem. NICU specialists are challenged with the tasks of prenatal education or provision of care that minimizes the neurodevelopmental problems seen in preterm infants, various short-term outcome researches have been reported and those are reviewed here to promote research interest in the field of neonatal nursing. Systemic long-term outcome studies are also awaited in Korea for the formulation of welfare policy in future. Nursing science has to embrace all these interdisciplinary studies as their own research field in collaboration with neonatologist, nutritionist, rehabilitation therapist, social workers and teachers.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.259-266
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• 2010

Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권6호
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• pp.521-530
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• 2020

Purpose: Malnutrition is a common feature in critically ill children. Enteral nutrition (EN) is the main strategy to nutritionally support critical ill children, but its use can be hindered by the development of intolerance. The study aimed to assess the effectiveness and safety of amoxicillin/clavulanate (A/C) to treat EN intolerance. Methods: We retrospectively evaluated patients admitted to the pediatric intensive care unit from October 2018 to October 2019. We conducted a case-control study: in the first 6 months (October 2018-April 2019) we implemented the nutritional protocol of our Institution with no drug, whereas in the second half (May 2019-October 2019) we employed A/C for 1 week at a dose of 10 mg/kg twice daily. Results: Twelve cases were compared with 12 controls. At the final evaluation, enteral intake was significantly higher than that at baseline in the cases (from 2.1±3.7 to 66.1±27.4% of requirement, p=0.0001 by Wilcoxon matched-pairs signed rank test) but not in the controls (from 0.2±0.8 to 6.0±14.1% of the requirement, p=NS). Final gastric residual volume at the end of the observation was significantly lower in the cases than in the controls (p=0.0398). The drug was well tolerated as shown by the similar safety outcomes in both cases and controls. Conclusion: Malnutrition exposes critically ill children to several complications that affect the severity of disease course, length of stay, and mortality; all may be prevented by early EN. The development of intolerance to EN could be addressed with the use of A/C. Future prospective clinical trials are needed to confirm these conclusions.

• 간호행정학회지
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• 제6권1호
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• pp.55-81
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• 2000

This study examined nursing care in a Newborn Intensive Care Unit (NICU) by reviewing nursing activities for the newborns. Through direct observation, time used for nursing care according to the nursing activity, shift, day of the week, and position of the nurses was measured. This study was done on November 15, 21, 24, 1999 at a university medical center hospital and included eight nurses and 179 newborns as the study subjects. The data were collected from the medical records, and by using a nursing activity record for the NICU, and a nursing activity time record for the NICU. The first step in the data collection process was to develop a list of nursing activities which was done through a literature review, examination of medical affairs and duty records. Content validity was measured by a panel of three professors who were experienced clinicians. In the second step two pre-training sessions were held with three sophomore student nurses who then measured the time for each nursing activity using a stopwatch. The data were analyzed using frequencies for nursing activities, averages, percentages and ANOVA for differences between shift and between days of the week, and percentages and t-test for differences according to position of the nurse. The results are as follows: 1) The total number of activities was 156, direct or indirect nursing activities. Direct nursing activity classified according to physical, educational, emotional/social/economic/spiritual needs. There were 109 direct nursing activities in 16 fields. 2) The order of nursing activities, according to time required, was record keeping, nutritional care, measurement/observation, medication, hygiene care, examination and specimen collection, and checking supplies, and according to frequency, measurement/ examination, record keeping, nutrition care, hygiene care, elimination care and medication. 3) According to shift, direct care during the night shift at 313.4 minutes was the longest time and indirect nursing care during the night shift at 252.2 minutes was the highest time. 4) For days of the week, Monday had the highest time for direct care 275.8 minutes (34.6%) and Wednessday had the highest time for indirect nursing care 269.6 minutes (36.1%). 5) For nursing time according to position of nurse, general nurses had the highest for direct care (330.7 minutes), nurse managers for indirect nursing activities (239.0 minutes) and general nurses for individual private time (63.9 minutes). The results of this study show that the major nursing time consuming activities included record keeping, nutrition care and measurement/examination. For newborns, time needs to be allowed for care to be sensitive, sophisticated and specialized rather than concentrated on indirect nursing tasks such as record keeping. Therefore, it is imperative to develop computerized systems that support a systematic approach to record keeping which is more efficient. Moreover, nursing needs according to shift, day or position of nurse can be utilized in assessing nursing resources through a computerized process.

• 임상간호연구
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• 제27권1호
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• pp.77-84
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• 2021

Purpose: Malnutrition affects all age groups, but older adults are particularly more vulnerable to nutritional deficiencies. This study evaluated the age-specific factors affecting malnutrition in hospitalized older adults. Methods: A retrospective study was conducted on inpatient elderly people who received artificial nutrition from 2010 to 2017. Data of demographics, diagnosis, type of nutrition therapy, number of comorbidity, fall risk assessment, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and intensive care unit admission were collected. Malnutrition was defined as a body mass index (BMI) of less than 18.5 kg/m². Patients were classified as the young-old (65~74 years old), the old-old (75~84 years old), or the oldest-old (85 years old or older). Results: A total of 7,130 older adults were included, and 4,028 patients were classified as the young-old, 2,506 into the old-old, and 596 into the oldest-old. Proportion of malnutrition was higher in the oldest-old compared to the other groups. In multivariate analysis, parenteral nutrition, alcohol, and high risk of falls were factors affecting malnutrition in all groups. Parenteral nutrition and alcohol in the young-old, high risk of falls in the old-old, and male sex in the oldest-old were the factors affecting malnutrition by the age group. Conclusion: Older age was the most significant factor affecting malnutrition. Specific strategies by age are needed to improve nutritional status in hospitalized older adults as influencing factors for malnutrition vary among different age groups.