• Korean Journal of Clinical Pharmacy
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• v.32 no.2
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• pp.116-124
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• 2022

Background: High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. Methods: We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS). We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. Results: From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. Conclusion: We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.

• The Korean Nurse
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• v.35 no.4
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• pp.51-56
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• 1996

This research was an attempt to restructure the curriculum of pediatric clinical education on the base of the analysis of the pediatric clnical experience of nursing students acquired according to the traditional hospital-based pediatric clinical education and the evaluation of its results. As the focus of health care changes, pediatric clinical education the future necessitates changes in the traditional clinical experince at all levels. The traditional concentration of clinical experience within an acute care setting must be restructured to include the expanding future roles of the nurse and the changes in the health care structure. In order to meet the need for restructuring, it is inevitably necessary to adopt an organizational design for pediatric clinical experience that is not all traditional. The additional experiences and variety of settings will enhance the quality of pediatric clinical experience. And as a matter of course this organizational change will enhance the student learning experience by giving them the opportunity to observe normal growth and development, preventive health care measures, and the role of the nurse outside the acute care setting. As the nursing's focus changes to meet the challenges of the future the faculty must apply themselves to these changes to prepare students for the future. Students must be ready to fill the many roles that nurses will hold in the future.

• Acute and Critical Care
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• v.33 no.4
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• pp.197-205
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• 2018

Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.3
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• pp.352-361
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• 2007

Purpose: The purpose of this study was to develop roles and organizational policy of advanced practice nurses (APNs) in an acute hospital setting. Method: The design of the study was to descriptive-exploratory. Sample consisted of 43 participants who included 13 nurses, 18 nurse managers and 12 physicians. Survey, interview and focus group interview were performed to obtain the data. Results: The expected roles of APNs were education and counseling, direct management patient care with advanced skills, research, and collaboration and coordination among several departments. The expected outcomes were patient satisfaction, improved access to care, decreased the rate of complications, and speedy provision of services. Based on research, a proposal of APNs roles and organizational policy in a hospital setting was developed, which included definition of APNs, qualification, roles and specific roles, specialty areas, accountability, recruitment and affiliation, privileges, and expected outcomes. Conclusion: This study gives a guideline on how to introduce and use APNs in acute care tertiary settings.

• Korean Journal of Adult Nursing
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• v.15 no.2
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• pp.287-295
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• 2003

Purpose: This descriptive study was conducted to project the number of critical care APNs needed in critical care units in an acute care hospital setting, up to the year 2020. Method: Necessary data and information were collected from various funded reports, professional literature, web-sites and personal visits to national and private institutions. The demand of critical care APNs were projected based on two critical care APNs per critical care units. Result: The projected number of critical APNs for the critical care units in acute care hospital settings as follows: 1) The total projected number of critical care APNs needed for critical care units were 1,270 in 2001. 2) By the year 2020, total number of projected critical care APNs needed in critical care units will be 1,080-1,700. Conclusion: In order to match the supply to the need, the professional organization should direct their efforts toward enacting legislation. Educational systems should identify strategies in initiation of critical care APN programs in masters level as well as standardizing curriculums across the programs.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.235-240
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• 2019

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

• Childhood Kidney Diseases
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• v.24 no.1
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• pp.19-26
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• 2020

Acute kidney injury (AKI) is common in critically ill children, and is associated with increased mortality and long-term renal sequelae. The definition of pediatric AKI was standardized based on elevation in serum creatinine levels or decrease in urine output; accordingly, epidemiological studies have ensued. Although new biomarkers appear to detect AKI earlier and predict prognosis more accurately than traditional markers, they are not frequently used in clinical setting. There is no validated pharmacological intervention for AKI, so prevention and early detection are the mainstays of treatment. For high risk or early stage AKI patients, optimization of volume status and blood pressure, avoidance of nephrotoxins, and sufficient nutritional support are necessary, and have been demonstrated to be effective in preventing the occurrence of AKI and improving prognosis. Nevertheless, renal replacement therapy is needed when conservative care fails.

• International journal of advanced smart convergence
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• v.12 no.4
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• pp.434-442
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• 2023

The relationship between acute kidney injury (AKI) prediction and nephrotoxic drugs, or drugs that adversely affect kidney function, is one that has yet to be explored in the critical care setting. One contributing factor to this gap in research is the limited investigation of drug modalities in the intensive care unit (ICU) context, due to the challenges of processing prescription data into the corresponding drug representations and a lack in the comprehensive understanding of these drug representations. This study addresses this gap by proposing a novel approach that leverages patient prescription data as a modality to improve existing models for AKI prediction. We base our research on Electronic Health Record (EHR) data, extracting the relevant patient prescription information and converting it into the selected drug representation for our research, the extended-connectivity fingerprint (ECFP). Furthermore, we adopt a unique multimodal approach, developing machine learning models and 1D Convolutional Neural Networks (CNN) applied to clinical drug representations, establishing a procedure which has not been used by any previous studies predicting AKI. The findings showcase a notable improvement in AKI prediction through the integration of drug embeddings and other patient cohort features. By using drug features represented as ECFP molecular fingerprints along with common cohort features such as demographics and lab test values, we achieved a considerable improvement in model performance for the AKI prediction task over the baseline model which does not include the drug representations as features, indicating that our distinct approach enhances existing baseline techniques and highlights the relevance of drug data in predicting AKI in the ICU setting.

• Perspectives in Nursing Science
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• v.6 no.1
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• pp.77-83
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• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• Annals of Clinical Neurophysiology
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• v.3 no.2
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• pp.115-121
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• 2001

The occurrence of muscle weakness in patients with sepsis or multiple organ failure managed in the intensive care unit has been recognized with increasing frequency in the last two decades. The difficulty in examining critically ill patients may explain why this complication has been only recently recognized. This weakness is due to an axonal polyneuropathy which is called critical illness polyneuropathy(CIP). It must be differentiated from myopathy or neuromuscular junction disturbance that can also occur in the intensive care setting. Neither the cause nor the exact mechanism of CIP has been elucidated. Electrophysiological studies demonstrated an acute axonal damage of the peripheral nerves. Before the recognition of CIP, these cases were usually misdiagnosed as Guillain-$Barr{\acute{e}}$ syndrome. Clinical recovery from the neuropathy is rapid and nearly complete in those patients who survive. Thus, neuropathy acquired during critical illness, although causing a delayed in weaning from ventilatory support and hospital discharge, does not worsen long-term prognosis.