• Title/Summary/Keyword: Critical ill patient

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Risk Factors of Delirium Among the Patients at a Surgical Intensive Care Unit (일 종합병원 외과계 중환자실 환자의 섬망 발생 요인)

  • Chun, You Kyoung;Park, Jeong Yun
    • Journal of Korean Critical Care Nursing
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    • v.10 no.3
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    • pp.31-40
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    • 2017
  • Purpose : This study examined the prevalence of delirium-related factors in a surgical intensive care unit (SICU). Methods : This retrospective study enrolled 73 patients who were admitted to an SICU from October 1, 2016 to March 20, 2017 and who had been hospitalized for more than 72 hours. Data was collected by reviewing electronic medical records. Results : Delirium occurred in 46 (63.0%) patients. Its related factors were age, education, mechanical ventilator, sleep, narcotics, physical restraint, and central line catheters. Conclusion : The results indicate that sleep and physical restraint are significant factors related to delirium occurrence. The results of this study can help in developing guidelines for the prevention of delirium.

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Laminar Cortical Necrosis (Polioencephalomalacia) caused by Postoperative Fluid Overload in a Dog with Pyometra

  • Jeong, Yoon-Soo;Kim, Ill-Hwa;Kang, Hyun-Gu
    • Journal of Veterinary Clinics
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    • v.34 no.2
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    • pp.98-102
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    • 2017
  • A 7-year-old, intact, female Siberian husky presented with vomiting and diarrhea after a fight with a dog with which it lived. The bitch was diagnosed with pyometra and severe dehydration. The patient received IV fluid therapy for 2 day pre- and post-operatively. Four days post-surgery, the patient had a decreased level of consciousness and suffered a tonic-clonic generalized seizure. On magnetic resonance imaging and histopathological findings, a diagnosis of laminar cortical necrosis caused by fluid overload was made. This case provides important information on the potential for fluid overload in a dehydrated patient giving rise to critical condition and death.

Monitoring and Interpretation of Mechanical Ventilator Waveform in the Neuro-Intensive Care Unit (신경계 중환자실에서 기계호흡 그래프 파형 감시와 분석)

  • Park, Jin
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.63-70
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    • 2018
  • Management of mechanical ventilation is essential for patients with neuro-critical illnesses who may also have impairment of airways, lungs, respiratory muscles, and respiratory drive. However, balancing the approach to mechanical ventilation in the intensive care unit (ICU) with the need to prevent additional lung and brain injury, is challenging to intensivists. Lung protective ventilation strategies should be modified and applied to neuro-critically ill patients to maintain normocapnia and proper positive end expiratory pressure in the setting of neurological closed monitoring. Understanding the various parameters and graphic waveforms of the mechanical ventilator can provide information about the respiratory target, including appropriate tidal volume, airway pressure, and synchrony between patient and ventilator, especially in patients with neurological dysfunction due to irregularity of spontaneous respiration. Several types of asynchrony occur during mechanical ventilation, including trigger, flow, and termination asynchrony. This review aims to present the basic interpretation of mechanical ventilator waveforms and utilization of waveforms in various clinical situations in the neuro-ICU.

ESTIMATING THE NUMBER OF ICU PATIENTS OF COVID-19 BY USING A SIMPLE MATHEMATICAL MODEL

  • Hyojung Lee;Giphil Cho
    • East Asian mathematical journal
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    • v.40 no.1
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    • pp.119-125
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    • 2024
  • Predicting the number of ICU patients holds significant importance, serving as a critical aspect in efficiently allocating resources, ensuring high-quality care for critically ill individuals, and implementing effective public health strategies to mitigate the impact of diseases. This research focuses on estimating ICU patient numbers through the development of a simple mathematical model. Utilizing data on confirmed COVID-19 cases and deaths, this model becomes a valuable tool for predicting and managing ICU resource requirements during the ongoing pandemic. By incorporating historical data on infected individuals and fatalities from previous weeks, we establish a straightforward equation. We found the substantial impact of the delay in infected individuals, particularly those occurring more than five weeks earlier, on the accuracy of ICU predictions. Proactively preparing for potential surges in severe cases becomes feasible by forecasting the demand for intensive care beds, ultimately improving patient outcomes and preventing excessive strain on medical facilities.

A Study on the Quality of Healthcare Services for Four Critical Illnesses and the Maintenance of Right to Protection and Dignity in a Senior General Hospital (상급종합병원의 4대 중증질환 의료 서비스 품질과 보호받을 권리 및 존엄성 유지에 관한 연구)

  • Woojin Lee;Minsuk Shin
    • Journal of Korean Society for Quality Management
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    • v.51 no.4
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    • pp.531-550
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    • 2023
  • Purpose: The unique nature of life-and-death healthcare services sets them apart from other service industries. While many studies exist on the relationship between healthcare services and customer satisfaction, most of them focus on mildly ill patients, ignoring the differences between critically ill and non-seriously ill patients. This study discusses the actual quality of healthcare services for patients who are facing life-threatening illnesses and are on life support, as well as their right to protection and dignity. Methods: The survey conducted to 149 patients with the four major illnesses: cancer, heart disease, brain disease and rare and incurable disease, those who have experiences with senior general hospitals. Results: The basic statistics of this study are adequate to represent the four major critical illnesses, and the reliability and validity of this study's hypotheses, which were measured by multiple items, were analyzed, and the internal consistency was judged to be high. In addition, it was found that the convergent validity was good and the discriminant validity was also secured. When examining the goodness of fit of the hypotheses, the SRMR, which is the standardized root mean square of residuals that measures the difference between the covariance matrix of the data variables and the theoretical covariance matrix structure of the model, met the optimal criteria. Conclusion: The academic implications of this study are differentiated from other studies by moving away from evaluating the quality of healthcare services for mildly ill patients and focusing on the rights and dignity of patients with life-threatening illnesses in four senior general hospitals. In terms of academic implications, this study enriches the depth of related studies by demonstrating the right to protection and dignity as a factor of patient-centeredness based on physical environment quality, interaction quality, and outcome quality, which are presented as sub-factors of healthcare quality. We found that the three quality factors classified by Brady and Cronin (2001) are optimized for healthcare quality assessment and management, and that the results of patients' interaction quality assessment can be used to provide a comprehensive quality rating for hospitals. Health and human rights are inextricably linked, so assessing the degree to which rights and dignity are protected can be a superior and more comprehensive measurement tool than traditional health level measures for healthcare organizations. Practical implications: Improving the quality of the physical environment and the quality of outcomes is an important challenge for hospital managers who attract patients with life and death conditions, but given the scale and economics of time, money, and human inputs, improving the quality of interactions and defining them as performance indicators in hospital quality management is an efficient way to create maximum value in the short term.

Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital (일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정)

  • Kim, Kyeong-Uoon
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.3
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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Experiences on Transfer of Critically Ill Patients from Intensive Care Units to General Wards - Focus Group Interview on Nurses' View - (간호사가 인식하는 중환자실 환자의 병동으로의 전실경험 - 포커스 그룹 연구방법 적용 -)

  • Son, Youn-Jung;Suh, Yeon-Ok;Hong, Sung-Kyung
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.16 no.1
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    • pp.92-102
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    • 2009
  • Purpose: Relocation stress is a common phenomenon in patients discharged from an intensive care unit(ICU) to a ward. Therefore, nurses need to be aware of the problems that can arise during the transfer process. The aim of this study was to identify nurses' experiences in transferring critically ill patients from the ICU to a ward. Method: Focus group interviews were done with 13 nurses from wards and ICU, which participated in receiving and sending of ICU patients. The debriefing notes and field notes were analyzed using the consistent comparative data analysis method. Result: Seven major categories were identified in the analysis of the data. These were 'mixed feeling about transfer', 'lack of transfer readiness', 'increase in family burden', 'uncertainty with unfamiliar environment', 'difficulty in decision making', 'difference of perception of the relationships between patients and health care providers', 'need for continuity of nursing care'. Conclusion: Transferring out of the critical care area should be presented to the patient and family as a positive step in the recovery process. However, a more universal method of passing information from nurse to nurse is needed to assist in a smooth transition.

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A Study on Changes of Serum $fT_3\;and\;rT_3$ Concentration in Nonthyroidal Critical Illness (비갑상선 중증 질환에서 혈청 $fT_3$$rT_3$의 변화에 관한 연구)

  • Lee, Jong-Wha;Kim, Ju-Ock;Yu, Cheol-Jae;Moon, Youn-Sung;Shin, Young-Tae;Ro, Heung-Kyu
    • The Korean Journal of Nuclear Medicine
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    • v.19 no.1
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    • pp.103-111
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    • 1985
  • Recently changes in thyroid physiology during acute and chronic medical illness were demonstrated. The serum $fT_3,\;rT_3,\;T_4,\;T_3,\;fT_4$, and TSH concentration were measured by radioimmunoassay method in 49 patients with critical illness and 10 normal subjects to assess the change of thyroid function in critical illness. The results were as follows; 1) The mean serum $fT_3$ concentration was $6.68{\pm}1.05pmol/ml$ in normal subjects while in patients with critical illness the serum $fT_3$ concentration was significantly lowered to $1.55{\pm}1.15pmol/ml$(p<0.001). 2) The mean serum $rT_3$ concentration was $0.22{\pm}0.44ng/ml$ in normal subjects and $0.42{\pm}0.37ng/ml$ in patient with critical illness. There was increment in critically ill patients as compared to normal subjects but no statistically significant difference(p>0.05). 3) The mean serum $T_3$ concentration was $1.24{\pm}0.25ng/ml$ in normal subjects and $0.56{\pm}0.56ng/ml$ in patients with criticial illness and there was significant difference in each other(p<0.005). 4) The mean serum $T_4,\;fT_4$, and TSH concentrations were $7.80{\pm}1.02{\mu}g/dl,\;1.26{\pm}0.39ng/dl,\;1.87{\pm}0.45{\mu}U/ml$ in normal subjects respectively and $6.02{\pm}3.06{\mu}g/dl,\;1.46{\pm}0.80ng/dl,\;1.74{\pm}0.79{\mu}U/ml$ in patients with critical illness and there was no significant difference between critically ill patients and normal subjects. 5) The ratio of mean serum concentration of $fT_3$ and $rT_3(fT_3/rT_3)$, $30.42{\pm}5.58$ in normal subjects was significantly higher(p<0.005) than the coresponding patients with critical illness. 6) The mean serum $fT_3$ concentration in expired cases(n=12) during admission was significant difference between expired and survived cases(p<0.005). The mean serum $rT_3$ centration was $0.67{\pm}0.58ng/ml$ in expired cases and $0.34{\pm}0.22ng/ml$ in survived cases with significant difference(p<0.005). Half of the cases who showed less than $3{\mu}g/dl$ of serum $T_4$ level were expired.

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Trend of Intensive Care Unit Admission in Neurology-Neurosurgery Adult Patients in South Korea : A Nationwide Population-Based Cohort Study

  • Saeyeon Kim;Tak Kyu Oh;In-Ae Song;Young-Tae Jeon
    • Journal of Korean Neurosurgical Society
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    • v.67 no.1
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    • pp.84-93
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    • 2024
  • Objective : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.

Evaluation of Clinical Usefulness of Critical Patient Severity Classification System(CPSCS) and Glasgow coma scale(GCS) for Neurological Patients in Intensive care units(ICU) (신경계 중환자에게 적용한 중환자 중증도 분류도구와 Glasgow coma scale의 임상적 유용성 평가)

  • Kim, Hee-Jeong;Kim, Jee-Hee
    • Proceedings of the KAIS Fall Conference
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    • 2012.05a
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    • pp.22-24
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    • 2012
  • The tools that classify the severity of patients based on the prediction of mortality include APACHE, SAPS, and MPM. Theses tools rely crucially on the evaluation of patients' general clinical status on the first date of their admission to ICU. Nursing activities are one of the most crucial factors influencing on the quality of treatment that patients receive and one of the contributing factors for their prognosis and safety. The purpose of this study was to identify the goodness-of-fit of CPSCS of critical patient severity classification system(CPSCS) and Glasgow coma scale(GCS) and the clinical usefulness of its death rate prediction. Data were collected from the medical records of 187 neurological patients who were admitted to the ICU of C University Hospital. The data were analyzed through $x^2$ test, t-test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and ROC curve. In accordance with patients' general and clinical characteristics, patient mortality turned out to be statistically different depending on ICU stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Homer-Lemeshow goodness-of-fit tests were CPSCS and GCS and the results of the discrimination test using the ROC curve were $CPSCS_0$, .734, $GCS_0$,.583, $CPSCS_{24}$,.734, $GCS_{24}$, .612, $CPSCS_{48}$,.591, $GCS_{48}$,.646, $CPSCS_{72}$,.622, and $GCS_{72}$,.623. Logistic regression analysis showed that each point on the CPSCS score signifies1.034 higher likelihood of dying. Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.

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