This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
Critical Care Nursing/*ethics ; Humans ; *Intensive Care Units ; Nurses ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

PURPOSE : The aim of this study was to validate the effect and the feasibility of induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) on multimodality treatment. MATERIALS AND METHODS : From January 2002 to December 2003, 84 chemonaive patients with Stage III NSCLC, median age of 64 years, ECOG perfomance satus 0, 1, or 2, and without other comorbid disease were enrolled this study and received chemotherapy every 3 weeks. After two or three cycles of induction chemotherapy (gemcitabine with cisplatin), patients were reevaluated by chest CT and then underwent resection, radiotherapy, further chemotherapy, or observation. RESULTS : Overall clinical responses were seen in 43 (57%) of the 76 assessable patients. Response rates were 61% and 53% in patients with stage IIIA and IIIB disease, respectively. Twenty-eight patients out of initially unresectable 70 patients (19 of 32 stage IIIA and 9 of 38 stage IIIB) after induction chemotherapy seemed to be resectable. Operation was done in 23 out of 32 patients who achieved clinically resectable stage after induction chemotherapy and 20 (87%) resections were complete and 3 were incomplete including 1 case of open & closure. Thirty-two patients were treated with chest radiation after chemotherapy. Eighteen patients were treated with chemotherapy upto 6 cycles and 6 patients refused further treatment after induction chemotherapy. Median follow up of all patients was 16.2 months, median survival was 16 months, and estimated disease progression free interval was 11 months. Survival and disease progression free interval were different with between induction chemotherapy followed by complete resection subgroup and followed by radiation therapy subgroup (24 vs. 14 months, p=0.04). Grade 3/4 neutropenia and thrombocytopeina were noticed in 29% and 10%, respectively and one chemotherpy related death was also noticed. CONCLUSION : Induction chemotherapy followed by surgery with or without adjuvant radiation might be the recommendable management to improve the survival in locally advanced NSCLC with feasible toxicity
Carcinoma, Non-Small-Cell Lung ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Humans ; Induction Chemotherapy* ; Neutropenia ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

PURPOSE: The decrease in bone mineral density (BMD) is a major complication after kidney transplantation. This was reported to occur preferentially during the first 6 months. However, the treatment and prevention strategies against a decline of BMD are not yet clear. METHODS: The data on the pre-transplant baseline and post-transplant 1 year BMD were archived and retrieved in 125 renal transplant recipients. The post-transplant changes of the BMD were compared by the baseline status of the BMD and the types of anti-osteoporosis treatment either with a vitamin D agent (alfacalcidiol) (n=18) or alendronate (n=21). Anti-osteoporosis treatment began within 30 days after transplantation, with an oral administration of 0.5 mcg/day vitamin D or 70 mg/week alendronate, and maintained until 1 year after transplantation. RESULTS: Regardless the degree of baseline BMD status, each group (the control, vitamin D, or alendronate group) showed a significant and uniform decrease of BMD during the post-transplant 1 year. The mean change in the spine BMD in the control, vitamin D, and alendronate group was -7.1+/-7.5%, -3.3+/-7.4% and -2.6+/-6.5%, respectively. The femur BMD also changed -5.1+/-7.7%, 1.1+/-5.3% and -1.5+/-8.2%, respectively. The degree of BMD decrease in the treatment groups was significantly lower than that in the control (P=0.014 in spine, P=0.003 in femur). When the severely reduced baseline BMD (T-score of spine or femur < or =-1) subgroups were analysed separately, the treatment groups (-3.7+/-6.5% in vitamin D and -1.1+/-6.4% in alendronate group) showed a significantly less decrease in the spine BMD than the control (-8.2+/-6.2%)(P=0.036). The femur BMD also showed a less decrease in the BMD in the treatment group, but this was not statistically significant (P=0.234). There was no significant difference between the vitamin D and alendronate treatment groups. CONCLUSION: After renal transplantation, early administration of vitamin D or alendronate showed some benefit to reduce the post-transplant decrease of BMD in both spine and femur area.
Administration, Oral ; Alendronate* ; Bone Density* ; Femur ; Kidney Transplantation* ; Spine ; Transplantation ; Vitamin D* ; Vitamins*

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare but significantly imperative in inducing chronic pulmonary hypertension. Clinically, it is difficult to distinguish between IPAH and CTEPH. However, the treatment of pulmonary hypertension is different depending on the disease. The present study was performed to analyze the similarities and differences in clinical features between IPAH and CTEPH. METHODS: During a nine-year period, thirty-three patients with IPAH and twenty-two patients with CTEPH were enrolled. Symptoms, physical findings, chest radiograph, electrocardiograph, pulmonary function test, echocardiograph, perfusion lung scan, right heart catheterization results were analyzed between both the groups. RESULTS: The median age of IPAH group was 33 (6~70) years that was lower than that (52(27~80) years) of CTEPH group. Amongst the IPAH patients, there was female predominance (76 %) and there was no sex difference between the patients with CTEPH. Both the groups exhibited similarity in the results of chest radiograph, electrocardiograph, pulmonary function test, and echocardiograph. In the perfusion lung scan, all IPAH patients exhibited findings with normal (28%) or low probability (72%) of pulmonary embolism and all CTEPH patients exhibited findings with high probability of pulmonary embolism. CONCLUSION: Although IPAH and CTEPH bear similarities in terms of symptoms, physical signs and general investigation results, there were differences in age distribution, sex predominance and results of perfusion lung scan.
Age Distribution ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis, Differential ; Electrocardiography ; Female ; Humans ; Hypertension* ; Hypertension, Pulmonary* ; Lung ; Perfusion ; Pulmonary Embolism ; Radiography, Thoracic ; Respiratory Function Tests ; Sex Characteristics

PURPOSE: The purpose of this study was to compare changes in learning objectives in Fundamentals of Nursing which were established between 2000 and 2004. METHOD: 2000, 2004 learning objectives were analyzed with frequencies and percents. RESULTS: There was an increase in the total number of learning objectives used in 2004(n=534) over 2000(n=527). In 2004 compared to 2000, there was an increase in learning objectives related to nursing process, need of oxygenation, need of nutrition, need of temperature regulation, need of activity and exercise, need of comfort, medication, preoperative care. According to Bloom's taxonomy, learning objectives established in 2004, mainly consisted of three domains, 35.5% for comprehension, 23.6% for synthesis, 20.4% for knowledge. Changes in learning objectives established in 2004 compared to 2000 decreases in the comprehension domain and increases in the synthesis domain. CONCLUSION: The learning objectives established in 2004 showed remarkable change when compared to those established in 2000. But the learning objective domains in Bloom's taxonomy were distributed unevenly. For better learning objectives in Fundamentals of Nursing, constant revision will be needed.
Classification ; Comprehension ; Learning* ; Nursing Process ; Nursing* ; Oxygen ; Preoperative Care

PURPOSE: The purpose of this study was to explore the content related to nosocomial infection control in the course on Fundamentals of Nursing. METHOD: Participants were 49 faculty who were teaching courses in Fundamentals of Nursing in universities and colleges in Korea. The questionnaire was composed of 55 items related to nosocomial infection control. RESULTS: Eighteen items out of 55 items were taught in more than 80% of the universities and colleges. These included principles of infection control, principles and effect of hand washing, method of hand washing, hand scrubs, and donning sterile gown and gloves. CONCLUSION: The most effective interventions for infection control, including asepsis, hand washing, infection control for urinary catheterization, and infection control for IV sites were taught in most universities and colleges. However, the time assigned for teaching these items and the importance placed on practice were not considered sufficient.
Asepsis ; Cross Infection* ; Education* ; Hand ; Hand Disinfection ; Infection Control ; Korea ; Nursing* ; Surveys and Questionnaires ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is an uncommon pulmonary disease. It could be occurred by diverse causes with the different response to the treatment. However, the clinical features of DAH have not been well known in Korea. METHODS: Twenty cases identified as DAH between March of 1990 and July of 2000 at a university affiliated hospital were retrospectively reviewed. RESULTS: The median age was 45 yr (range: 18~73 yr) with 11 females. Diagnosis was made by clinical and radiologic findings including hemoptysis, newly developed anemia, and diffuse bilateral lung opacities with the continuous bloody lavage fluid or bloody bronchial aspirate on bronchoscopy. The mean APACHE III score was 50.8 (+/-26.7) points. Hemoptysis prior to admission was observed in 8 (40%) patients. Diffuse crackles were heard on the bilateral lung fields in 18 cases. On chest radiographs, diffuse ground glass appearance and/or confluent air space consolidation with ill defined irregular margin were mainly observed. In patients with DAH the hemoglobin level fell a mean of 2.0 (+/-0.8) g/dL. Fourteen (70%) patients received mechanical ventilation due to the respiratory failure. Six patients (30%) were dead during admission. Among these patients, 4 patients were dead due to refractory respiratory failure with continuous DAH. The bleeding tendency such as disseminated intravascular coagulation or low platelet count was higher in dead patients than the survivors (p=0.018). The survivors of DAH with noninfectious causes showed better responses to immunosuppressive drugs with/without plasmapheresis compared to nonsurvivors (p=0.003). CONCLUSION: DAH was prone to develop acute respiratory failure and needed mechanical ventilation frequently. However, DAH of non-infectious causes showing a good response to the immunosuppresive therapy would have a better prognosis. In addition, DAH would have a worse prognosis in cases of combined bleeding tendency.
Anemia ; APACHE ; Bronchoscopy ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Glass ; Hemoptysis ; Hemorrhage* ; Humans ; Korea ; Lung ; Lung Diseases ; Plasmapheresis ; Platelet Count ; Prognosis ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Sounds ; Retrospective Studies* ; Survivors ; Therapeutic Irrigation

BACKGROUND: The heat shock protein (HSP) 70 families are known to protect cells against the irreversible tissue injury induced by stress and to induce the recovery of cell function during stress. Heat pretreatment was reported to decrease the acute lung injury(ALI) of rats induced by lipopolysaccharide (LPS). However the role of heat shock with LPS co-treatmenton ALI is unclear. The purpose of this study was to investigate the effect of heat treatment, which was given immediately after the beginning of ALI induced by LPS intratracheally administered in rats. METHODS: Either saline (saline group) or LPS was intratracheally instilled without heat treatment (LPS group). In addition, heat was conducted 18 hours prior to the instillation of LPS (pre-treatment group) and conducted immediately after instillation of LPS (co-treatment group). Six hours after the LPS or saline treatment, blood, bronchoalveolar lavage (BAL) fluid and lung tissue samples were obtained. The myeloperoxidase (MPO) activity and the heat shock protein expression in the lung tissue, the differential counts of the polymorphonuclear leukocytes (PMN) in the BAL fluids, and the LDH, protein, IL-1beta, TNF-alpha and IL-10 levels in BAL fluid and serum were measured. RESULTS: 1)The MPO activity, the differential PMN counts in the BAL fluid, BAL fluid and serum cytokines were higher in the LPS, the heat pre-treatment and co-treatment group than those of the saline group (p value <0.05). 2)The MPO activity and the protein level in the BAL fluid from the heat co-treatment group were similar to those of the LPS group. 3) The serum TNF-alpha level of the heat co-treatment group was significantly higher than that of the LPS group (p=0.01) . CONCLUSIONS: Heat shock response administered immediately after a LPS instillation did not attenuate the ALI in this model.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Cytokines ; Heat-Shock Proteins ; Heat-Shock Response ; Hot Temperature* ; Humans ; Interleukin-10 ; Lung ; Neutrophils ; Peroxidase ; Rats* ; Shock ; Tumor Necrosis Factor-alpha

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