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Comparison of Predict Mortality Scoring Systems for Spontaneous Intracerebral Hemorrhage Patients (자발성 뇌내출혈 환자의 예후 예측도구 비교)

  • Youn, Bock-Hui;Kim, Eun-Kyung
    • Korean Journal of Adult Nursing
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    • v.17 no.3
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    • pp.464-473
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    • 2005
  • Purpose: The purpose of this study was to evaluate and compare the predictive ability of three mortality scoring systems; Acute Physiology and Chronic Health Evaluation(APACHE) III, Simplified Acute Physiology Score(SAPS) II, and Mortality Probability Model(MPM) II in discriminating in-hospital mortality for intensive care unit(ICU) patients with spontaneous intracerebral hemorrhage. Methods: Eighty-nine patients admitted to the ICU at a university hospital in Daejeon Korea were recruited for this study. Medical records of the subject were reviewed by a researcher from January 1, 2003 to March 31, 2004, retrospectively. Data were analyzed using SAS 8.1. General characteristic of the subjects were analyzed for frequency and percentage. Results: The results of this study were summarized as follows. The values of the Hosmer-Lemeshow's goodness-of-fit test for the APACHE III, the SAPS II and the MPM II were chi-square H=4.3849 p=0.7345, chi-square H=15.4491 p=0.0307, and chi-square H=0.3356 p=0.8455, respectively. Thus, The calibration of the MPM II found to be the best scoring system, followed by APACHE III. For ROC curve analysis, the areas under the curves of APACHE III, SAPS II, and MPM II were 0.934, 0.918 and 0.813, respectively. Thus, the discrimination of three scoring systems were satisfactory. For two-by-two decision matrices with a decision criterion of 0.5, the correct classification of three scoring systems were good. Conclusion: Both the APACHE III and the MPM II had an excellent power of mortality prediction and discrimination for spontaneous intracerebral hemorrhage patients in ICU.

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Continuous Renal Replacement Therapy: A Survey of Practice in a Critical Care Unit (일 종합병원에서의 지속적 신대체요법 적용에 관한 실태)

  • Seo, Min-Jeong;Choi, Ang-Ja;Suh, Ji-Young;Cho, Yong-Ae;Sung, Young-Hee
    • Journal of Korean Critical Care Nursing
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    • v.2 no.1
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    • pp.58-68
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    • 2009
  • Purpose: The treatment effects and operation status of continuous renal replacement therapy (CRRT) for acute renal failure patients have been investigated. Method: Two expert nurses reviewed the records of 731 patients undergoing CRRT in an intensive care unit of a general hospital from Jan. 2002 to Dec. 2006 with the CRRT assessment sheet and situation sheet developed for this study. Results: The number of patients received CRRT increased from 90 in 2002 to 194 in 2006. The most common indication for CRRT was azotemia (40.0%). Before CRRT treatment, patients were 78.6 ($\pm55.5$) of BUN value and 5.0 ($\pm3.2$) of Cr. value. The standard values of BUN and Cr. were lowered. Compared the survival group with the death group, there were significant differences among the medical departments and the main diagnosis group. Their BUN and creatinine value, APACHE II score, mean blood pressure, and oliguria were significantly different (p<0.05). Conclusion: This survey demonstrates a trend that patients receiving CRRT has been increased. We suggest further studies are needed in some hospitals in order to generalize the results and to find how CRRT treatment affects patient’s survival and death rate.

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A Study of Anxiety, Depression and Disease Activity Index in Patients with Systemic Lupus Erythemtosus (전신 홍반성 루푸스 환자의 불안, 우울 및 질병활성도에 관한 연구)

  • Song, Byung-Eun;Sohng, Kyeong-Yae;Yoo, Yang-Sook
    • Journal of muscle and joint health
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    • v.7 no.2
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    • pp.258-268
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    • 2000
  • The purpose of this study is to describe anxiety, depression and disease activity index(SLEDAI) and correlations among these variables, to provide the basic information developing apporiate nursing interventions for the lupus patients. In this study, authors evaluated anxiety, depression and SLEDAI from 39 lupus patients at one university hospital in Seoul. Data were collected by using questionnaires and reviewing medical records. Frequencies, t-test, Duncan's multiple range test after ANOVA were evaluated with SAS program. The key results were as follows : 1. The average age of the subjects was 31.0 years and ranged from 20 to 51. Female comprised 70.9% and 79.5% were unemployed and housewife. Fifty one point nine percent of the sample had a spouse and above junior college graduates. 74.4% of the sample had a religion and average length of suffering from lupus was 66.59 months. Majority(94.9%) of the subjects had experience of hospitalization, and 55.3% had experience of learning about lupus and average number of learning was 3.9. 2. The average anxiety score of the subjects was 44.53, showing significant relationship with educational background(t=2.27, p< .05), monthly income(F=4.56. p< .05). 3. The depression score was 41.85, showing significant relationship with monthly income(F=3.81 p=0.0236) experience of learning about lupus(t=2.09, p< .05). 4. The SLEDAI score was 12.36, showing no significant relationship with demographical variables. 5. Anxiety showed positive correlations with depression(r=0.76, p< .001), SLEDAI(r=0.48, p< .01), and depression showed positive correlations with SLEDAI(r=0.42, p< .001).

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Changes in Korean Knee Score and Range of Motion after the Implementation of Structured Nursing Exercise Programs for Patients underwent Total Knee Arthroplasty: A Retrospective Study (슬관절 전치환술 환자를 위한 구조화된 운동교육 프로그램 후 한국형 슬관절 점수와 슬관절 운동범위 변화: 후향적 조사연구)

  • Park, Yu Ra;Park, Wanju
    • Journal of muscle and joint health
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    • v.25 no.2
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    • pp.61-74
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    • 2018
  • Purpose: The purpose of this study was to examine the factors affecting changes in Korean Knee Score (KKS) and ranges of motion (ROM) of the knee after the structured exercise programs for the patients with total knee arthroplasty. Methods: This was a retrospective study using electronic medical records from January 2015 to February 2017, and the subject of this study was a total of 124 out of 434 patients underwent total knee replacement operation. They took part in a structured step-by-step exercise program conducted by orthopedic nurses, and then were evaluated for KKS and Knee ROM for 12 weeks after operation. Results: Post-intervention scores increased significantly in the KKS subdomains including pain and symptoms (t=-22.31, p<.001), function (t=-20.68, p<.001), evaluation of floor life (t=-14.18, p<.001), socioemotional function (t=-28.94, p<.001) over time. As for the change in the ROM, knee extension (t=9.23, p<.001) and knee flexion (t=4.04, p<.001) showed a statistically significant changes over time. Conclusion: This study illuminated the factors affecting the changes in pain and symptom, physical function, evaluation of floor life, socioemotional function and range of motion after structured exercise training programs for knee arthritis patients.

Reduction of Length of Stay in Emergency Room by Using Critical Pathway for Stroke Patients (Critical pathway 적용을 통한 급성 뇌졸중 환자의 응급실 체류시간 단축 효과)

  • Yun, Yeo-Ok;Kim, Min-Young;Kim, Woo-Jeong;Kang, Young-Joon;Park, Ju-Ok;Park, Kyung-Hye
    • Journal of Korean Academy of Nursing Administration
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    • v.17 no.1
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    • pp.66-73
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    • 2011
  • Purpose: The purpose of this study was to demonstrate effects of a critical pathway (CP) for stroke patients seen in emergency rooms (ER). Method: The CP developed by the CP committee consisted of 8 criteria: behavior of doctors and nurses, laboratory tests, Image testing, medication, treatment, activity, and nutrition. According to application of CP, a control group (n=17) and experimental group (n=17) were defined. Time was checked by the electronic medical records. Result: Use of CP for stroke patients in the ER, resulted in a decreased length of stay in ER (t=2.341, p=.026), and time required for image testing (t=2.623, p=.021), and an increased number of patients using rtPA ($x^2$=4.802, p=.049). Time required for neurology doctor contact, for neurology doctor to see patient in the ER, and for report of blood tests decreased, but there were no statistical significance. Conclusion: Quick responses are most important in the ER, so CP for these patients is a very effective patient management tool. To reduce delay in stroke diagnosis, continuous education programs for similar symptoms are necessary. CPs for other patients in the ER should be developed, and studies on cost and satisfaction, as well as length of stay, should be done.

Folk Remedies used by Patients with Breast Cancer (유방암 환자의 민간요법)

  • 박진미;정복례
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.419-430
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    • 1995
  • There is a need to investigate folk remedies used by patients with breast cancer because there is little information about the subject, even though many Korean women with breast cancer have used folk remedies during and after their treatment. The purpose of this study was to investigate and describe the phenomena and the meaning of folk remedies in order to better understand patients with breast cancer and to suggest directions for comprehensive nursing care. The Questions for the study were as follows What kinds of folk remedies do patients with breast cancer use\ulcorner What are the routes of knowing about folk remedies in patients with breast cancer\ulcorner What are the patterns of the usage of the folk remedies\ulcorner Why do patients with breast cancer use folk remedies\ulcorner What are the meanings of folk remedies to patients with breast cancer\ulcorner To answer these questions, a qualitative research method was used. Thirty-nine patients were recruited from university teaching hospitals from March, 1993 to November 1994. Many of them underwent either modified radical mastectomy or received various adjuvant therapy including chemotherapy, radiation therapy, and hormonal therapy. Data were collected by in-depth interviews, observations, medical records, and analyzed step-by-step using qualitative analysis. The results were as follows : 1. Patients with breast cancer have used many different kinds of folk remedies. 2. Patients with breast cancer did not know the exact effects of the folk remedies. Also the effects could not be exactly proven by the patients. 3. Patients with breast cancer received information about many kinds of folk remedies through various communication systems, such as other patients, their families and relatives, friends, and many types of mass media. 4. To use the folk remedies was one kind of illness behavior that was used by these patients. 5. Folk remedies were used to deal with not only anxiety by the patients themselves but also as the expression of affection and concern by families and relatives. 6. The use of folk remedies was one of the adaptation behaviors in patients with breast cancer whose disease was in the terminal stage. Based on the above findings, one suggestion was made : To continue further studies on folk remedies used by other patients with cancer in order to further explain health and illness behavior of Korean people.

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The Effects of Self-Efficacy Promoting Cardiac Rehabilitation Program on Self- Efficacy, Health Behavior, and Quality of Life

  • Song, Kyung Ja
    • Journal of Korean Academy of Nursing
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    • v.33 no.4
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    • pp.510-518
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    • 2003
  • Background. Ischemic heart disease results from athesclerotic changes of the coronary artery. These changes are aggravated by hypercholesterolemia, smoking, obesity, lack of exercise, coronary-prone personality, and stress. Because these risk factors affect not only the prevalence of the ischemic heart disease but also recurrence of the disease, cardiac rehabilitation programs were introduced to help patients with ischemic heart disease reduce risk factors. Diverse cardiac rehabilitation programs are needed to motivate participation in cardiac rehabilitation and to enhance patients' quality of life. Objectives. To examine the effect of a self-efficacy promoting cardiac rehabiltation program on self-efficacy, health behavior and quality of life of patients with ischemic heart disease. Methods. Data were collected from 45 hospitalized ischemic heart disease patients. Medical records were reviewed to obtain demographic and clinical characteristics. Data regarding self-efficacy, health behavior, and quality of life were obtained from interviews using structured questionnaires. The nonequivalent control group non-synchronized design was used to conduct this study. One session of conventional group education was given to patients in the control group while they were in the hospital. Patients in the experimental group participated in a newly developed cardiac rehabilitation program. It focused on strengthening self-efficacy with four self-efficacy sources-performance accomplishment, vicarious experiences, verbal persuasion and physical status using two individualized in-hospital education sessions and four weekly telephone counseling follow-up calls after discharge. Results. Four weeks after discharge, the increment of total self-efficacy score was significantly higher in the experimental group than in the control group (p<.0l). There was also a significant difference in the total quality of life scores increments between the two groups (p<.0l). However, no significant changes were noted in the increments of total health behavior scores between the two groups. Conclusion. A cardiac rehabilitation program focusing on promoting self-efficacy was effective in improving self-efficacy, and quality of life of patients with ischemic heart disease.

Influential Factors of Post-Traumatic Stress Disorder in Survivors of Intensive Care Units (중환자실 생존자의 외상 후 스트레스장애 발생정도와 영향요인)

  • Kim, So Hye;Ju, Hyeon Ok
    • Journal of Korean Clinical Nursing Research
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    • v.26 no.1
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    • pp.97-106
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    • 2020
  • Purpose: This study was conducted to investigate the incidence and associated factors with post-traumatic stress disorders (PTSD) in patients with intensive care units (ICU) admission experience. Methods: This study is a retrospective observational study using self-reporting questionnaire. Patients who were admitted to ICU more than 72 hours and agreed to participate were enrolled in this study. PTSD were assessed by Korean version of post-traumatic diagnosis scale, and PTSD was defined as 20 points or more. Medical records of participants were reviewed to identify influencing factors of PTSD. To analyzed the data, descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test and gamma regression were utilized using SPSS/WIN 23.0 program. Results: A total of 128 patients participated in the study. Mean age of participants was 58.3±11.7 years and 50 patients (39.1%) were female. Mean duration of ICU stay was 8.43±8.09 days and PTSD was diagnosed in 12 patients (9.4%). In the results of a Gamma regression analysis, Psychiatric history (B=1.09, p=.002), APACHEII score (B=.04, p=.005), CPR experience (B=1.65, p=.017) and physical restraint (B=.68, p=.049) were independently associated with PTSD occurrence. Conclusion: The results of this study suggest that a various factors influencing PTSD should be identified to prevent PTSD in patients who requires ICU care. In addition, post-ICU care programs are required to assess and reduce PTSD.

Risk Factors and Clinical Outcomes of Unplanned Reintubation after Planned Extubation in Adult Patients admitted to the Intensive Care Unit after Cardiac Surgery (성인 심장수술 후 중환자실에 입실한 환자의 계획된 발관 후 비계획적 기관 재삽관 위험요인과 임상결과)

  • Lee, Ju-Hee;Choi, Hye-Ran
    • Journal of Korean Critical Care Nursing
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    • v.15 no.3
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    • pp.88-100
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    • 2022
  • Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥2-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO2 before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥2=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

Influencing Factors of Behavior of Reducing Exposure to Endocrine Disrupting Chemicals in Pregnant Women (임부의 내분비계 장애물질 노출저감화행동의 영향요인)

  • Um, Jiyoun;Jun, Eun-Young
    • Journal of Home Health Care Nursing
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    • v.30 no.2
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    • pp.202-215
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    • 2023
  • Purpose: This study attempted to determine the factors related to behaviors of reducing exposure to endocrine disrupting chemicals (BRE to EDCs) in pregnancy, based on the PRECEDE model. Methods: A cross-sectional survey was conducted with participants (N=239) who met the medical records and eligibility criteria from the Women's Hospital and Public Health Center. Data were collected using a specially-designed questionnaire based on the PRECEDE model and included BRE to EDCs predisposing factors, reinforcing factors, and enabling factors. The data were analyzed using the chi-square test, independent t-test, one way ANOVA, Pearson's correlation coefficients and a hierarchical multiple regression analysis. Results: In Model I it was found that participation in prenatal education influenced the BRE to EDCs significantly; and a regression showed that the determinant variables accounted for 3.4%. In Model II, the predisposing factors of perceived barriers of BRE to EDCs and environmental self-efficacy were added. It was shown that they significantly influenced BRE to EDCs in the order named, and a regression revealed that increases in the determinant variables accounted for 22.5%. In Model III, to which enabling factors were added, the information acquisition experience of BRE to EDCs interacted significantly with BRE to EDCs and a regression showed an increase in the determinant variables accounting for 25.3%. Conclusion: The results of this study, the content of endocrine disruptors must be included in the prenatal care education program for pregnant women, and it should be composed of contents that can reduce the perceived obstacle to BRE to EDCs, enhance the environmental self-efficacy, and provide the information in regard to reducing exposure to EDCs.