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

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

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

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

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

PURPOSE: The purpose of this study was to identify factors affecting health promotion behavior among workers with high risk of metabolic syndrome. This study was based on the planned behavior theory. METHODS: The participants were 167 workers at high risk of metabolic syndrome. Data were collected using a structured questionnaire. Surveyed variables were attitude, subjective norm, perceived behavioral control, intention, and health promotion behavior. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and hierarchical regression analysis with SPSS/WIN 22.0. RESULTS: Perceived behavioral control affected the intention of health promotion behavior among the workers with high risk of metabolic syndrome. It explained 62% of variance in the intention of health promotion behavior (F=40.09, p<.001). Perceived behavioral control and occupation affected health promotion behavior among the risk workers with high risk of metabolic syndrome. The two factors explained 16% of variance in health promotion behavior (F=4.95, p<.001). CONCLUSION: The findings of this study suggest that perceived behavioral control is the only factor affecting health promotion behavior when the theory of planned behavior was applied. Therefore, intervention programs for improving health promotion behavior should be focused on strengthening perceived behavioral control.
Health Behavior ; Health Promotion* ; Intention ; Metabolic Syndrome X ; Occupations ; Surveys and Questionnaires

A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Adie Syndrome ; Emergencies ; Female ; Hepatic Encephalopathy ; Humans ; Intensive Care Units ; Intracranial Hemorrhages ; Liver Transplantation* ; Liver* ; Middle Aged ; Nervous System Diseases ; Peripheral Nervous System Diseases* ; Pupil ; Reflex* ; Reflex, Pupillary ; Thromboembolism