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

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

One author's affiliation is misspelled in original article.

Purpose: : This study was designed to determine the impact of the ‘Respect Together Program’ for nursing students on their attitudes, awareness, empathy, and interpersonal communication competence toward people with disabilities. Methods: : Among the students participating in the program, data were collected from 28 students who participated in both pre- and post-surveys. The collected data were analyzed using the SPSS/WIN 23.0 program. Results: : Compared to before the implementation of the ‘Respect Together’ program for direct interaction with the disabled, the subjects’ attitude scores toward the disabled, awareness scores toward the disabled, empathy toward the disabled, and interpersonal communication competence scores significantly improved statistically. Conclusion : The ‘Respect Together Program’, which involves meeting disabled people in person and carrying out the program together, improved participants’ attitudes, awareness, empathy, and interpersonal communication competence. This suggests that through the direct experience, trial and error, and role composition included in this program, it is possible to effectively prepare in advance to approach disabled people visiting the hospital in a more humane manner.

Purpose: : This study was designed to determine the impact of the ‘Respect Together Program’ for nursing students on their attitudes, awareness, empathy, and interpersonal communication competence toward people with disabilities. Methods: : Among the students participating in the program, data were collected from 28 students who participated in both pre- and post-surveys. The collected data were analyzed using the SPSS/WIN 23.0 program. Results: : Compared to before the implementation of the ‘Respect Together’ program for direct interaction with the disabled, the subjects’ attitude scores toward the disabled, awareness scores toward the disabled, empathy toward the disabled, and interpersonal communication competence scores significantly improved statistically. Conclusion : The ‘Respect Together Program’, which involves meeting disabled people in person and carrying out the program together, improved participants’ attitudes, awareness, empathy, and interpersonal communication competence. This suggests that through the direct experience, trial and error, and role composition included in this program, it is possible to effectively prepare in advance to approach disabled people visiting the hospital in a more humane manner.

Purpose: : This study was designed to determine the impact of the ‘Respect Together Program’ for nursing students on their attitudes, awareness, empathy, and interpersonal communication competence toward people with disabilities. Methods: : Among the students participating in the program, data were collected from 28 students who participated in both pre- and post-surveys. The collected data were analyzed using the SPSS/WIN 23.0 program. Results: : Compared to before the implementation of the ‘Respect Together’ program for direct interaction with the disabled, the subjects’ attitude scores toward the disabled, awareness scores toward the disabled, empathy toward the disabled, and interpersonal communication competence scores significantly improved statistically. Conclusion : The ‘Respect Together Program’, which involves meeting disabled people in person and carrying out the program together, improved participants’ attitudes, awareness, empathy, and interpersonal communication competence. This suggests that through the direct experience, trial and error, and role composition included in this program, it is possible to effectively prepare in advance to approach disabled people visiting the hospital in a more humane manner.

Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.
Hypnotics and Sedatives ; Intensive Care Units* ; Propofol*

Purpose: : This Study is designed to identify factors related to ethical values that can help medical students preparing to become healthcare professionals make better ethical judgments in the face of conflicting opinions. Methods : This study is based on 114 Nursing students in University, preparing and studying to become healthcare professionals. The Data obtained from questionnaires to research perceptions of physical restraints use and attitudes regarding use of restraints, nursing professional values, and scale affect ethical values were analyzed using the SPSS/WIN 21.0. Results: : To research the effects of perceptions of physical restraints use, attitudes regarding use of physical restraints and nursing professional values on ethical values, a hierarchical regression analysis is conducted with three models. In Model 3, as the last step, the perceptions of physical restraints is not a significant predictor of ethical values. However, the attitudes regarding use of restraints and the nursing professional values are related to ethical values. Conclusion : The formation of deontological ethics, which begins with the proposition that life is important, can be approached through education related to nursing professional values and education related to physical restraints.

Obesity is consistently increasing in prevalence and can trigger insulin resistance and type 2 diabetes. Many lines of evidence have shown that macrophages play a major role in inflammation associated with obesity. This study was conducted to determine metformin, a widely prescribed drug for type 2 diabetes, would regulate inflammation through down-regulation of scavenger receptors in macrophages from obesity-induced type 2 diabetes. RAW 264.7 cells and peritoneal macrophages were stimulated with LPS to induce inflammation, and C57BL/6N mice were fed a high-fat diet to generate obesity-induced type 2 diabetes mice. Metformin reduced the production of NO, PGE2 and pro-inflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) through down-regulation of NF-kappaB translocation in macrophages in a dose-dependent manner. On the other hand, the protein expressions of anti-inflammatory cytokines, IL-4 and IL-10, were enhanced or maintained by metformin. Also, metformin suppressed secretion of TNF-alpha and reduced the protein and mRNA expression of TNF-alpha in obese mice as well as in macrophages. The expression of scavenger receptors, CD36 and SR-A, were attenuated by metformin in macrophages and obese mice. These results suggest that metformin may attenuate inflammatory responses by suppressing the production of TNF-alpha and the expressions of scavenger receptors.
Animals ; Cytokines ; Diet, High-Fat ; Dinoprostone ; Down-Regulation ; Hand ; Inflammation ; Insulin Resistance ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Macrophages, Peritoneal ; Metformin ; Mice ; Mice, Obese ; NF-kappa B ; Obesity ; Prevalence ; Receptors, Scavenger ; RNA, Messenger ; Tumor Necrosis Factor-alpha

PURPOSE: Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directed therapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. MATERIALS AND METHODS: We performed a systematic review that included a meta-analysis. We used electronic search engines including PubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis. RESULTS: A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observational studies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631-0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75-1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found. CONCLUSION: The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
Humans ; *Observational Studies as Topic ; *Randomized Controlled Trials as Topic ; Resuscitation/*methods ; Shock, Septic/mortality/*therapy