BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

No abstract available.
Cesarean Section* ; Female ; Myotonic Dystrophy* ; Pregnancy

INTRODUCTION: Bronchial carcinoid tumors seldom occur in children, sometimes mistaken for a minor disease and diagnosed slowly. MATERIALS AND METHODS: We report on a patient who diagnose tumors slowly because confused with asthma. RESULTS: This case describes a 14-year-old boy, presenting with asthma-like symptoms throughout 3 years. He was treated as asthma but wax and wane. Chest x-ray showed an hyperlucent left lung, so we rechecked high resolution computed tomography (HRCT) for unilateral hyperinflation diseases diagnosis. It was found 1×1cm nodule in left main bronchus. We did bronchoscopy and discovered a round mass in the left bronchus, 2∼3cm away from carina. In the biopsy, it was bronchial carcinoid tumor, so we resected tumor. DISCUSSION: Because symptoms of bronchial carcinoid tumors are various, it can often be misdiagnosed firstly. It is confused with asthma, pneumonia and foreign body. An additional examination were necessary when respiratory symptoms persist.
Adolescent* ; Asthma* ; Biopsy ; Bronchi ; Bronchoscopy ; Carcinoid Tumor* ; Child ; Diagnosis ; Foreign Bodies ; Humans ; Lung ; Male* ; Pneumonia ; Thorax

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent* ; Intensive Care Units* ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

PURPOSE: We examined the effects of a well-dying program on nursing students in terms of death preparation, death recognition and perception of well-dying perception. METHODS: The design of this study was quasi-experimental and non-synchronized with a non-equivalent control group. The study was conducted with nursing students: 32 in the experimental group and 36 in the control group. The well-dying program was consisted of five sessions: introduction, thinking about meaning of death, organizing things to do before dying, looking back on my life, and leaving a trail of my life. Descriptive analysis, t-test, chi2 test and ANCOVA were used with SPSS 18.0 program to analyze the data. RESULTS: After attending the program, a difference was observed in death preparation of the experimental group (t=2.61, P=0.014). The death recognition (F=154.15, P<0.001) score of the experimental group was significantly higher than the control group. There was no significant difference between the groups in perception of well-dying (F=0.11, P=0.747). CONCLUSIONS: The well-dying program helped nursing students build positive death recognition. Therefore, this study is expected to contribute to development of a death education program for nursing students.
Education ; Humans ; Nursing* ; Students, Nursing* ; Thinking

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.
Diagnosis, Differential ; Humans ; Liver Transplantation* ; Liver* ; Mortality ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome ; Seizures ; Status Epilepticus* ; Transplants

Brain metastases are a common cause of disability and death in patients with cancer, but their management remains a major clinical problem. They can, however, be effectively controlled by radiation therapy, possible modalities being external radiotherapy, brachytherapy(implantation), stereotactic radiosurgery(SRS), or a combination of the above modalities. It can be expected that the neurologic status of patients thus treated will remain stable or improve for most of the period during which they survive; using whole brain radiotherapy, the possible palliation index is 75-80%. Despite treatment, however, as many as 1/3 to 2/3 of patients are expected to die from complications related to the progression of brain metastases. With regard to survival, randomized trials involving dose escalation have not yet shown any advantage over the conventional dose; the same palliation index of 75-80% is expected for 40Gy/20 fractions, 30Gy/10 fractions, and 20Gy/5 fractions. It is clear, however, that a smaller daily dose of radiation(the conventional dose is 200cGy/fraction) will reduce the incidence of radiation induced dementia and improve the quality of life in long term survivors. In certain conditions such as solitary brain metastasis without extracranial disease and good performance status(KPS>or=70), a more aggressive approach, including surgical resection and stereotactic radiosurgery can be considered.
Brachytherapy ; Brain* ; Dementia ; Humans ; Incidence ; Neoplasm Metastasis* ; Quality of Life ; Radiosurgery ; Radiotherapy ; Survivors

OBJECTIVE: CDA (Clinical Document Architecture) is a markup standard for clinical document exchange. In order to increase the semantic interoperability of documents exchange, the clinical statements in the narrative blocks should be encoded with code values. Natural language processing (NLP) is required in order to transform the narrative blocks into the coded elements in the level 3 CDA documents. In this paper, we evaluate the accuracy of text mapping methods which are based on NLP. METHODS: We analyzed about one thousand discharge summaries to know their characteristics and focused the syntactic patterns of the diagnostic sections in the discharge summaries. According to the patterns, different rules were applied for matching code values of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT). RESULTS: The accuracy of matching was evaluated using five-hundred discharge summaries. The precision was as follows: 86.5% for diagnosis, 61.8% for chief complaint, 62.7%, for problem list, and 64.8% for discharge medication. CONCLUSION: The text processing method based on the pattern analysis of a clinical statement can be effectively used for generating CDA entries.
Diagnosis ; Natural Language Processing ; Semantics ; Systematized Nomenclature of Medicine