BACKGROUND: Ventilator-associated pneumonia (VAP) is the most severe form of nosocomial infection. However the actual incidence of pneumonia associated with ventilator is not known. The purpose of this study is to examine the incidence of VAP, find out related risk factors, and establish effective preventive measures. METHODS: The medical records of 172 consecutive patients, who have been admitted to the intensive care unit (ICU) from January 2005 to October 2005 and were subjected to mechanical ventilation for more than 48 hours, have been reviewed retrospectively. VAP was defined according to the definition of CDC (1992). The statistical software SPSS (version 12.0) was used to conduct descriptive and comparative analysis including Chi-square, student's t-test, and logistic regression. RESULTS: The incidence was 163 per 1,000 persons and 19.0 per 1,000 ventilator use patient-days. The significant risk factors for VAP were type of ICU (surgical ICU, OR=5.942, 95% CI=1.894-8.644) and duration of ventilator use (OR=3.603, 95% CI=1.810-7.173). VAP developed 3.04 (+/-0.88) days after initiating mechanical ventilation. Causative agents of VAP were Acinetobacter baumanii (35.2%), MRSA (18.8%), Enterobacter aerogenes (12.4%), Klebsiella pneumonia (9.4%), Staphylococcus aureus (6.3%), Burkholderia (6.3%), Serratia marcesceus (6.3%), Stenotrophomonas (3.1%), and Pseudomonas (3.1%) spp. CONCLUSION: Type of ICU (surgical ICU, OR=5.942, 95% CI=1.894-18.644) and duration of ventilator use (OR=3.603, 95% CI=1.810-7.173) were considered to increase the incidence of VAP. Further study with larger number of cases and preventive measures would be necessary to identify risk factors related to the ventilator-associated pneumonia.
Acinetobacter ; Burkholderia ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Enterobacter aerogenes ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Klebsiella ; Medical Records ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Serratia ; Staphylococcus aureus ; Stenotrophomonas ; Tertiary Care Centers ; Ventilators, Mechanical

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death.Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. Thefactors related to attitudes toward ADs were attitudes toward dignified death (β=0.25, P=0.001), experience discussing life-sustaining treatment (β=0.17, P=0.037), preferred time to have a consultation about ADs (β=0.19, P=0.046), intention to write ADs (β= 0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (β=-0.37, P＜0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

PURPOSE: The purpose of this study was to evaluate Korean advance directives (K-AD) by examining the degree of adults' acceptance and reliability of the directive itself. METHODS: Survey was performed with 181 adults aged 20 or older who were recruited from three regions. A questionnaire used to examine the participants' acceptance of their K-AD in terms of visual analogue scale score of complexity, difficulty, necessity, satisfaction, recommendation. Then, a retest was carried out by asking participants to write up a K-AD again to confirm the reliability of the directives. RESULTS: On a scale of 100, the average acceptance score was 70 or above, which represents rather high level of acceptance in all five categories. The test-retest reliability kappa values ranged from 0.592 to 0.950, and the conformity degree was moderate or high. Regarding K-AD components such as values, treatment preference, proxy appointment, differences among age groups were observed in each component. CONCLUSION: The results of this study suggest that K-AD is a feasible instrument to analyze its acceptability and reliability for adult population. K-AD could be utilized to help people make their own decision on their end-of-life care. Further studies are needed to confirm this study results and promote widespread use of K-AD.
Adult ; Advance Directives* ; Feasibility Studies ; Humans ; Proxy ; Reproducibility of Results ; Terminal Care

PURPOSE: This study aimed to identify the effectiveness of educational Electronic Nursing Record System in terms of nursing process preparation ability and satisfaction about the system itself. METHODS: A one group pre-post experimental study design was utilized in this study. The effectiveness of the system was examined through quality of nursing diagnoses, interventions, and outcomes and electronic nursing record system satisfaction inventory. Junior and senior nursing students were the potential study respondents and evaluation instruments were applied only for the one who agreed to participated in the study. Education about nursing process and electronic nursing record system was carried out as part of regular classes and students were guided to prepare nursing process upon the scenarios developed earlier. RESULTS: 29 juniors and 33 seniors prepare nursing process documentation related to each scenario and both groups showed significant improvement upon nursing process documentation (t=7.53, p<.001, t=3.23, p=.003, respectively) compared to paper based nursing process preparation. Satisfaction about system itself was 2.78(0.81). CONCLUSION: Educational electronic nursing record system seems to be effective to train nursing students for nursing process preparation ability. Effort to enhance its utility are called in the area of education and system itself.
Education ; Humans ; Informatics ; Nursing Diagnosis ; Nursing Process ; Nursing Records* ; Nursing* ; Personal Satisfaction ; Students, Nursing* ; Surveys and Questionnaires

PURPOSE: With the changes to the medical environment and to the educational system, we aim to evaluate the current mission statement of the College of Medicine, Ewha Womans University, and revise it. METHODS: To establish the new mission statement, a special committee, the School Mission Revision Committee(SMRC) and an advisory group were organized in 2003. The SMRC functioned through 4 stages of action composed of: investigation, draft development, surveillance of various opinions, and announcement. RESULTS: The revised, final mission statement was: "To contribute to Korea and to the international society by producing excellent woman-leaders in healthcare, who have professional medical knowledge and are humanitarians based on Christian principles." Three key words helped in the realization of this mission: compassion, professionalism, and service. Compassion: a noble physician who practices compassion toward mankind, caring for patients with compassion and the right attitude, and contributing to health promotion. Professionalism: a responsible physician who embodies professionalism, learning the necessary knowledge and skills, having the ability for self-development, and leading in various fields of medicine. Service: a respected physician who serves society, devoting to the community with excellent woman leadership skills and an open mind, and serving Korea and the international society. CONCLUSION: We expect that this new school mission will be helpful in clarifying the whole educational process and will resolve conflicts resulting from the change to the school system within a rapidly changing educational environment.
Delivery of Health Care ; Empathy ; Female ; Health Promotion ; Humans ; Korea ; Leadership ; Learning ; Missions and Missionaries* ; Schools, Medical*

Six trials with 3 samples for each trial for external quality assessment of general chemistry and blood gas were performed in 2008. All the control materials were sent in specifically-made boxes at the same time. The response rates were 93.5% in general chemistry and 88.1% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2007), change of the methods of analysis and the peer group coefficient of variation was not remarkable and the VIS scores of general chemistry items were slightly improved.
Bilirubin ; Calcium ; Chemistry, Clinical ; Cholesterol ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea ; Peer Group ; Phosphorus ; Potassium ; Sodium ; Uric Acid

Ten trials of external quality assessment for Clinical Chemistry in general chemistry and blood gas were performed in 2004. All the control materials were sent in specifically-made boxes at the same time. The response rates were 92.0% in general chemistry and 86.0% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2003), the methods of analysis are not changed much and the coefficient of variation and VIS scores of general chemistry items are decreased.
Bilirubin ; Calcium ; Chemistry ; Chemistry, Clinical* ; Cholesterol ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea* ; Phosphorus ; Potassium ; Sodium ; Triglycerides ; Uric Acid

Six trials with 3 samples for each trial for external quality assessment of general chemistry and blood gas were performed in 2009. All the control materials were sent in specifically-made boxes at the same time. The response rates were 87.5% in general chemistry and 89.3% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2008), change of the methods of analysis was not remarkable. The peer group coefficient of variation and the VIS scores of general chemistry items were slightly improved.
Bilirubin ; Calcium ; Chemistry, Clinical ; Cholesterol ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea ; Peer Group ; Phosphorus ; Potassium ; Sodium ; Uric Acid

Ten trials of external quality assessment for Clinical Chemistry in general chemistry and blood gas were performed in 2005. All the control materials were sent in specifically-made boxes at the same time. The response rates were 90.1% in general chemistry and 84.8% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2004), the methods of analysis were changed and the coefficient of variation and VIS scores of general chemistry items were increased.
Bilirubin ; Calcium ; Chemistry ; Chemistry, Clinical* ; Cholesterol ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea* ; Phosphorus ; Potassium ; Sodium ; Triglycerides ; Uric Acid

Six trials with 3 samples for each of external quality assessment for general chemistry and blood gas were performed in 2007. All the control materials were sent in specifically-made boxes at the same time. The response rates were 92.0% in general chemistry and 95.5% in blood gas. The items included sodium, potassium, chloride, BUN, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, ALP, LD and GGT in general chemistry and pH, pCO2 and pO2 in blood gas. Compared with the previous year (2006), the methods of analysis were slightly changed and the coefficient of variation and VIS scores of general chemistry items were not significantly changed.
Bilirubin ; Calcium ; Chemistry, Clinical ; Cholesterol ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea ; Phosphorus ; Potassium ; Sodium ; Uric Acid