• Title/Summary/Keyword: patients safety

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Psychological burden for legal responsibility of 119 emergency personnels (119구급대원의 법적책임에 대한 심리적 부담감)

  • Lim, Jae-Man;Yun, Seok-Jeong;Lim, Gwan-Su;Kang, Shin-Kap;Choi, Eun-Sook;Seo, Kyung-Hee
    • The Korean Journal of Emergency Medical Services
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    • v.13 no.1
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    • pp.87-96
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    • 2009
  • Purpose : To grasp the mental burden for legal responsibility that rescue members have in the performance of job. Method : Questionnaire was presented to rescue members serving in 2 direct control safety centers of fire station located in Seoul, Daejon, Incheon, Kwangju, Busan, Daegu and Ulsan. Results : 1. Questioned whether they have mental burden for legal responsibility while performing job on the site, the rescue members responded : very burdensome in 38.0%, burdensome in 56.0%, moderate in 4.5%, not burdensome in 1.0%, no burden at all in 0.5%. 2. Questioned on the first aid treat for which they have the most mental burden, the rescue members responded : intubation into trachea laryngeal mask airway(LMA) in 40.4%, automatic external defibrillator in 16.3%, securing vein providing sap(medicine) in 10.8%, basic cardiopulmonary resuscitation in 7.2%, eliminating foreign matters inserted into body in 5.4%, stanching external bleeding and treating injury in 5.4%, fixing extremities and spine by using splint in 1.8%, measuring the symptom of vitality in 1.2%, providing oxygen in 0.0%. 3. Questioned whether experiencing legal problem or firm petition(complaint) raised by patient while serving as rescue members, they responded : experiencing a complaint in 41.6%, experiencing no complaint in 58.4%. Asked to indicate the stress level in the scale of which they suffered when lawsuit or firm petition was raised, 0(weak)-10(strong), they answered 8.8 in average. 4. Questioned whether 119 rescue members put the legal responsibility in case that they cause damage to patients intentionally in performing, they responded to the inquiry 3.66 in average(of 5.00). It represented meaningful differences (F=2.874, p=.024) whether they had license or not. 5. In future, legal action will raise against the rescue member by 99% because of people's rights improvement(63.1%), high expectations for the rescue system(29.5%), non-licensed rescue members(5.1%). Conclusion : It was found that the rescue members had severe mental burden for advanced life support which was investigated to have low enforcement rate in the preceding research, for instance, intubation into trachea securing vein management by using automatic external defibrillator. To improve the qualitative level of rescue service in the fire fighting, it may be required to construct the environment that eliminates the mental burden of rescue members for legal responsibility.

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Endoscopic Carpal Tunnel Release with Transparent Flexible Tube (유연한 투명도관을 이용한 내시경적 수근관 절개술)

  • Chae In-Jung;Park Jung-Ho;Han Seung-Beom;Oh Kwang-Jun;Lee Byung-Taek
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.2
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    • pp.120-123
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    • 2001
  • Purpose : We used transparent flexible tube which had provided the good visual field of median nerve when it was used in endoscopic release of transverse carpal ligament and evaluated the safety of that technique. Materials and Methods : We evaluated the 12 patients(20cases) who had been diagnosed as carpal tunnel syndrome and performed by endoscopic carpal tunnel release between Mar. 1997 and Mar. 2000. We used two portal technique and released the transverse carpal ligament with direct supervision of median nerve. Results : 14 cases$(70\%)$ were revealed excellent or good results and 6 cases$(30\%)$ were fair. No serious complications were shown such as nerve injury. Conclusion : We could avoid the complications of endoscopic carpal tunnel release using the transparent flexible tube which had provided tire good circumferential vision around the median nerve and it is unnecessary to maintain the wrist Joint hyperextension state during operation. Also that tube was easily obtainable in hospital so we need not to purchase the expensive operation apparatus.

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Review of Health Effects Caused by Chloromethylisothiazolinone (CMIT) and Methylisothiazolinone (MIT) - Focusing on Humidifier Disinfectant-associated Lung Injury (HDLI) - (Chloromethylisothiazolinone (CMIT)과 Methylisothiazolinone (MIT)의 건강영향에 대한 고찰 - 가습기 살균제 폐 손상을 중심으로 -)

  • Park, Dong-Uk;Kim, Jiwon;Ryu, Seung-Hun;Park, Jihoon;Kwon, Jung-Hwan;Lee, So-Yeon;Park, Soyoung
    • Journal of Environmental Health Sciences
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    • v.46 no.3
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    • pp.312-323
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    • 2020
  • Objective: This study aimed to summarize the physiochemical properties, toxicity, and legal regulation of chloromethylisothiazolinone (CMIT) and/or methylisothiazolinone (MIT), review the health effects caused by exposure to CMIT/MIT, and evaluate the individual association of lung injury with the use of humidifier disinfectants (HD) containing a mixture of CMIT and MIT. Method: A literature review was conducted by searching keywords such as CMIT, MIT, health effect, dermatitis, asthma, and lung injury, either singly or combined. Results: Both CMIT and/or MIT were found to be associated with the development of several types of adverse health effects. In particular, respiratory diseases including asthma, nasal symptoms, cough, and rhinitis were caused by the use of products including CMIT or/and MIT. The mixture of CMIT/MIT has been banned in cosmetics. As of the end of 2017, nine patients who were confirmed to have HD associated lung injury (HDLI) were found to have used only an HD brand containing CMIT and MIT. Their responses regarding the name of the HD used could be trustworthy based on the short duration of HD use (less than six months) before the onset of HDLI and frequent use of HD per day. Conclusion: According to the toxicity and HDLI cases, the use of HD containing CMIT and /or MIT can cause fatal lung injury. Further study with manufacturers' assistance is necessary in order to obtain more clear evidence on the causal relationship since HDLI cases are being reported continuously.

Comparison about adverse drug reaction report forms among Asian's countries using herbal medicine (한약을 사용하는 아시아권 국가의 유해사례 보고 양식에 관한 비교 연구)

  • Sun, Seung-Ho;Lee, Eun-Kyoung;Jang, Bo-Hyoung;Park, Sunju;Go, Ho-Yeon;Jeon, Chan-Yong;Ko, Seong-Gyu
    • Journal of Society of Preventive Korean Medicine
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    • v.19 no.3
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    • pp.91-102
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    • 2015
  • Objective : The purpose of this study is to find out the possibility of application to herbal medicine's report form for adverse drug reaction (ADR) by reviewing and analyzing Asian countries's ADR report forms. Method : We investigated, compared, and analyzed ADR report forms (ADR-RF) of Asian countries's ADR institutions (ACAI), such as, Korea institute of drug safety & risk management and Dongguk university Ilsan oriental hospital (DUIOH) in Korea, national center for ADR monintoring (NCAM) in China, pharmaceuticals and medical devices agency (PMDA) in Japan, Ministry of Health and Welfare (MOHW) in Taiwan, and drug office, department of health, the government of the Hong Kong special administrative region (GHKSAR) in Hong Kong. Results : ADR-RF for ACAI included common contents, such as, patients information (name(initial), gender, age, weight), adverse event (AE)'s report information (Recognition and report for AE occurrence, first or follow up report, Severe AE), the detailed information of AE (the title of AE, onset & closing date of AE symptoms, the progress & results detailed test of AE), the information of AE's medicine (the types of medicine, product name, ingredient name, suspected or combination drug, single dose & frequency, dosage form, administration route, dealing for AE-suspected medicine), and AE reporter's information (reporter's information, institution's information). Taiwan had ADR-RF and the department exclusively for herbal medicine (HM), but others (except DUIOH) had not only no ADR report form but also contents for HM. Conclusion : ADR-RF for HM have to include the common contents of ACAI at least, as well as HM information related to ADR, such as the title, composition and types of HM, history related to HM's ADR, and the contents of drug-induced liver injury and so on. In addition, the main department of government for HM's ADR will be needed.

Defining the Core Competencies of the Nurses in A Tertiary Hospital and Comparing Different Units based on Their Respective Characteristics (일 종합전문요양기관 간호사의 핵심역량 도출 및 근무지 특성별 중요도 인식 비교)

  • Sung, Young-Hee;Jeong, Jeong-Hee
    • Journal of Korean Academy of Nursing Administration
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    • v.12 no.1
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    • pp.76-93
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    • 2006
  • Purpose: The purpose of this study was to define the core components required of nurses to provide quality nursing care to patients and analyze the significance of these components in the hospital's various units to maintain a high level of competence among nurses. Method: The study evaluated 3 categories included 35 subcategories with 148 core components that were derived from literature review and interviews of nursing professionals. The nursing professional category included 18 subcategories with 98 components, the organizational culture category included 4 subcategories with 16 components, and the temperament-attitude category included 13 subcategories with 34 components. The study included 335 nurses with more than one year of hospital experience and measured disparities among different hospital units. The data was analyzed with SPSS-Win 10.0, differing perceptions of the importance of general traits among the participants were measured using standard deviation, and differing perceptions of the importance of professional traits among the participants were assessed using ANOVA and subsequently with the Bonferroni Test. The reliability of the aforementioned research tools were evaluated using the Cronbach's ${\alpha}$. Result: The results of the study were as follows: 1. Among the three categories, temperament-attitude category was perceived to be the most important, followed by nursing professional category and organizational culture category. Among the ten most important subcategories within the three categories, safety and infection prevention as well as responsibility were perceived to be the most important, followed by promotion of physiologic adaptation, document management and presentation, self-control, ethics, observance law, coping with emergency, humanity, and medication. 2. The relative importance of category associated with the core competencies within the hospital unit were as follows : 1) The units that rated nursing professional category as being the most significant were: internal medicine, surgical unit, mother-child unit, emergency room, intensive care unit, and operating room, in that order. 2) The units that rated the organizational culture competencies as being the most significant were: mother-child unit, internal medicine, surgical unit, emergency room, operating room, and intensive care unit, in that order. 3) The units that rated temperament-attitude category as being the most significant were: internal medicine, surgical unit, emergency room, mother-child unit, operating room, and intensive care unit, in that order.

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POSTSEDATION EVENTS IN PEDIATRIC PATIENTS SEDATED FOR DENTAL TREATMENT (진정법을 이용한 치과 치료 시 소아 환자의 진정 후 반응에 대한 연구)

  • Koo, Jung-Eun;Baek, Kwang-Woo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.36 no.2
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    • pp.209-216
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    • 2009
  • The purpose of this retrospective study was to examine twenty four hour postsedation events after discharge in children sedated for dental treatment. The sedation sheets of 355 children were selected. Selection criteria excluded no midazolam or nasal route of midazolam, no ASA class I, absent or incomplete questionnaire. Children received orally chloral hydrate and hydroxyzine, nitrous oxide was maintained during the sedation. Midazolam was injected to buccal submucosa with titration. Parents were interviewed via telephone within twenty four hours after sedation. Questionnaire included sleeping response, sleeping time, sleeping behavior, vomiting response at home. Two hundred twenty four (67.8%) children slept and twenty one(6.3%) children had abnormal sleeping behavior. One hundred four(31.0%) children had abnormal behavior after sleep and ten(3.0%) children had vomiting response. In the children took the higher dose of midazolam, there were the great tendency to sleep after discharge (p<0.05), the more negative response to sleeping behavior(p = 0.055), the longer sleeping time(p=0.054). In this study many children slept after sedation and a few children showed negative response. However there were not any considerable emergency events. Further study is required to determine the postsedation safety for the use of submucosal midazolam combination with chloral hydrate and hydroxyzine.

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DEVELOPMENTAL DISTURBANCES OF SUCCESSIVE PERMANENT TEETH BY TRAUMA TO THE PRIMARY TEETH (유치의 외상에 의한 계승 영구치의 발육 장애)

  • Kim, Ji-Young;Kim, Young-Jin;Kim, Hyun-Jung;Nam, Soon-Hyeun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.37 no.2
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    • pp.260-266
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    • 2010
  • Trauma to the primary teeth may have an effect on the successive permanent teeth. Thus, the treatment plans should be focused on safety of their permanent teeth. The degree of developmental disturbances in those permanent teeth depends upon many factors including the age of the children, developmental conditions of the affected teeth, types and severities of trauma and time interval from the moment of trauma to the initial treatment the patients received. The complications of the effected permanent teeth vary from the mild enamel hypoplasia to the premature finishing of teeth development. In this study, children whose ages were 33 months, 5 years, and 26 months presented the developmental disturbances to their permanent teeth, which resulted from the trauma to the primary teeth: the intrusion, the avulsion, and the subluxation. There showed a mild complication in the case of subluxation resulting in enamel hypoplasia, but, the more severe complication of the root dilacerations occurred in the case of intrusion. Furthermore, the 5-year-old patient whose primary dentition was near in transition period to the permanent one, the more complicated problem such as stop of root development of the permanent teeth was resulted from the avulsion. Thus, one should assume that the types of trauma and the age of the children at the moment of trauma have different effects on those successive permanent teeth. In conclusion, when the trauma that causes changes in the position of primary teeth happened, it is important to arrange an appropriate treatment procedure considering the types of trauma and the developmental conditions of the permanent teeth.

A Performance Evaluation of Diagnostic X-ray Unit Depends on the Hospitals Size (병원 규모별 진단용 X선 발생장치의 성능 평가)

  • Park, Ju-Hun;Im, In-Chul;Dong, Kyung-Rae;Kang, Se-Sik
    • Journal of Radiation Protection and Research
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    • v.34 no.1
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    • pp.31-36
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    • 2009
  • The purpose of this study is to measure the tube voltage, the tube current/volume, exposure time and exposure dose of diagnostic X-ray unit in each doctor offices, hospitals and general hospitals for evaluating the performance of such device, to learn the method and technology of its measurement and to suggest its importance. Research subjects were total 30 X-ray units and divided into groups of 10 X-ray units each. The tube voltage, the tube current/volume, exposure time and exposure dose were measured using percentage average error, and then reproducibility of exposure dose was measured through calculating coefficient of variation. The results are like followings; The tube voltage correctness examination showed that incongruent devices among total 30 X-ray units were 5 devices (16.7%). The tube current correctness examination showed that incongruent X-ray units were 3 devices (10.0%). The tube current volume correctness examination showed that incongruent X-ray units were 4 devices (13.3%). Finally, according to exposure time correctness examination, incongruent X-ray units were 5 devices (16.7%) and according to reproducibility examination of exposure dose, incongruent X-ray units were 7 devices (23.3%). Above results showed serious problem in performance management based on management regulation of diagnostic X-ray unit; it means that regular checkout and safety management are required, and as doing so, patients will be able to receive good quality of medical service by the reduction of radiation exposure time, image quality administration, unnecessary retake and etc. Therefore, this study suggests that the performance of diagnostic X-ray units should be checked regularly.

The Evaluation of Teicoplanin Usage in a University Hospital (대학병원에서의 Teicoplanin의 사용 현황 조사 및 실태 평가)

  • Kim, Eun A;Oh, Jung Mi
    • Korean Journal of Clinical Pharmacy
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    • v.11 no.1
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    • pp.19-29
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    • 2001
  • Teicoplanin, a glycopeptide antibiotic, has potential for use as an alternative to vancomycin in the treatment of gram-positive bacterial infections. However, unlike vancomycin, there is a lack of study on teicoplanin's efficacy and safety and the guideline for its use is not available, yet. The objective of this study was to investigate and evaluate the pattern of teicoplanin usage in a university hospital. A retrospective study was performed on 72 adult patients, who took teicoplanin for 3 continuous days at D. University hospital from 1 January 1999 to 30 June 2000. The microorganisms treated with teicoplanin were methicillin-resistant Staphylocorcus aureus $(69\%)$, coagulase-negative Staphylococci $(12\%)$, Enterococcus $(4\%)$, vancomycin-resistant Enterococci $(2\%)$, Streptococci $(2\%)$, and Bacillus $(1\%)$. The types of infection treated with teicoplanin were surgical wound infection $(58\%)$, lower respiratory infection $(11\%)$, bactremia $(7\%)$, urinary tract infection $(5\%)$, pleural fluid infection $(4\%)$, and peritoneal fluid infection $(2\%)$. The mean duration of teicoplanin usage was 16.5 days and teicoplanin was used with 1.4 other antibiotics, which were aminoglycosides (isepamicin, amikacin, netilmicin, astromicin) or quinolones (ciprofloxacin, tosufloxacin) or the third generation cephalosporin (ceftazidime). Only 24 cases $(28.6\%)$ met with the criteria for the justification of use, and the rest of 60 cases $(71.4\%)$ did not meet the criteria. In 84 cases $(100\%)$, blood culture tests were performed prior to the initial dose of teicoplanin. In 83 cases $(99\%)$, serum creatinine were conducted before the initial doses. In 45 cases $(53.6\%)$, serum creatinine was monitored at least twice weekly. In 55 cases $(65.5\%)$, WBC was tested at least twice weekly. In 84 cases $(100\%)$, body temperature was monitored at least once per nursing shift. In 15 cases out of 56 cases, maximum temperature decreased at least 1 degree within 3 days of teicoplanin use. In 15 case out of 35 cases, WBC values were within the normal range after treatment. In 23 cases $(27.4\%)$, dosage regimen was appropriate. Drug-related adverse effects were reported in 13 cases. Nephrotoxicity (progressively increasing SCr. or sustained SCr increase of $\geq$0.5 mg/dl from baseline) was noted in five cases. Neutropenia (absolute neutrophil count <1,500 $cells/mm^3$) was noted in one case and eosinophilia (total eosinophil count >350 $cells/mm^3$) was noted in seven cases. A more strict control on use of teicoplanin is required, considering that teicoplanin is categorized as one of restricted antibiotics.

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Clinical Efficacy of Repetitive Transcranial Magnetic Stimulation for Treatment of Depression and Latest Trends in TMS Techniques (반복 경두개자기자극술의 우울증 치료효과 및 최신동향에 대한 고찰)

  • Kim, Shin Tae;Kim, Hae Won;Kim, Se Joo;Kang, Jee In
    • Korean Journal of Biological Psychiatry
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    • v.24 no.3
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    • pp.95-109
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    • 2017
  • Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique which can change cortical excitability in targeted area by producing magnetic field pulses with an electromagnetic coil. rTMS treatment has been used to treat various neuropsychiatric disorders including depression. In this review, we evaluate the literature on rTMS for depression by assessing its efficacy on different subtypes of depression and different technical parameters. In particular, we focus on the results of randomized clinical trials and meta-analyses for depression after the US Food and Drug Administration approval in 2008, which acknowledged its efficacy and acceptability. We also review the new forms of rTMS therapy including deep TMS, theta-burst stimulation, and magnetic seizure therapy (MST) that have been under recent investigation. High frequency rTMS over left dorsolateral prefrontal cortex (DLPFC), low frequency rTMS over right DLPFC, or bilateral rTMS is shown to be effective and acceptable in treatment for patients with non-psychotic, unipolar depression either as monotherapy or adjuvant. Deep TMS, theta-burst stimulation and MST are promising new TMS techniques which warrant further research.