• Journal of Korean Critical Care Nursing
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• v.10 no.2
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• pp.14-23
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• 2017

Purpose: The purpose of this study was to evaluate the effectiveness of a ventilator-associated pneumonia (VAP) bundle. Methods: This was a retrospective study that was carried out between June 2010 and October 2015. In this study, 3,224 intubated patients were included. The VAP bundle which was applied to Group 1 patients (n=470) included head-of-bed elevation to 30 degrees, cuff pressure monitorization, prophylaxis of peptic ulcer, and prophylaxis of deep vein thrombosis. The VAP bundle for Group 2 patients (n=1,914) included all the elements of the VAP bundle for Group 1 patients and one additional element which was oral care with 0.12% chlorhexidine. The VAP bundle for Group 3 patients (n=870) added sedative interruption and assessment of readiness to extubate to the VAP bundle for Group 2. Results: The numbers and incidences of VAP were significantly different among the three groups. Moreover, there were significant differences among groups in ICU length of stay and mortality. Conclusion: Three different VAP prevention bundles made different effects in patient outcomes.

• Clinical and Experimental Pediatrics
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• v.64 no.3
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• pp.123-129
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• 2021

Background: The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement. Purpose: To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children. Methods: The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October-December 2018), 3-month postintervention (January-March 2019), and 6-month postintervention (April-June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention. Results: The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively. Conclusion: Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.4
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• pp.423-432
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• 2014

Purpose: This study was done to evaluate effectiveness of deep breathing exercise as a postoperative intervention to prevent pulmonary complications. Methods: A search of databases from 1990 to 2012 was done including MEDLINE, EMBASE, CINAHL, Cochrane Library and eight Korean databases. Ten studies met eligibility criteria. Researchers trained in systematic review, independently assessed the methodological quality of selected studies using the Cochrane's risk of bias tool. Data were analyzed using RevMan 5.2 program. Results: Among ten RCTs in four studies, deep breathing exercise was compared with an instrument using interventions such as incentive spirometry, in the other four studies deep breathing exercise was compared with non-intervention, and in last two studies bundles of interventions including coughing and early ambulation were assessed. A significant difference was found between deep breathing exercise group and non-intervention group. The odds ratio (OR) of occurrence of pulmonary complications for deep breathing exercise versus non-intervention was 0.30. However, there was no significant difference between deep breathing exercise group and incentive spirometry group (OR=1.22). Conclusion: Deep breathing exercise is vital to improving cost-effectiveness and efficiency of patient care in preventing postoperative pulmonary complications. For evidence-based nursing, standardized guidelines for deep breathing in postoperative care should be further studied.

• Advances in biomechanics and applications
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• v.1 no.3
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• pp.169-185
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• 2014

Computational multibody models of the elbow can provide a versatile tool to study joint mechanics, cartilage loading, ligament function and the effects of joint trauma and orthopaedic repair. An efficiently developed computational model can assist surgeons and other investigators in the design and evaluation of treatments for elbow injuries, and contribute to improvements in patient care. The purpose of this study was to develop an anatomically correct elbow joint model and validate the model against experimental data. The elbow model was constrained by multiple bundles of non-linear ligaments, three-dimensional deformable contacts between articulating geometries, and applied external loads. The developed anatomical computational models of the joint can then be incorporated into neuro-musculoskeletal models within a multibody framework. In the approach presented here, volume images of two cadaver elbows were generated by computed tomography (CT) and one elbow by magnetic resonance imaging (MRI) to construct the three-dimensional bone geometries for the model. The ligaments and triceps tendon were represented with non-linear spring-damper elements as a function of stiffness, ligament length and ligament zero-load length. Articular cartilage was represented as uniform thickness solids that allowed prediction of compliant contact forces. As a final step, the subject specific model was validated by comparing predicted kinematics and triceps tendon forces to experimentally obtained data of the identically loaded cadaver elbow. The maximum root mean square (RMS) error between the predicted and measured kinematics during the complete testing cycle was 4.9 mm medial-lateral translational of the radius relative to the humerus (for Specimen 2 in this study) and 5.30 internal-external rotation of the radius relative to the humerus (for Specimen 3 in this study). The maximum RMS error for triceps tendon force was 7.6 N (for Specimen 3).