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

While there have been not a few reports on the seroepidemiological characteristics of hepatitis B virus (HBV) infection in Korea, most of them, however, have had several limitations; operational definition of HBV infection, validity of detection methods of HBV serologic markers, size of the study population, and confirmation of the vaccination history against HBV, etc. In order to avoid such limitations, authors randomly selected 1,495 healthy adults among the 217,511 insured (target population) of Korean Medical Insurance Corporation, living in seoul, and tested HBV(HBsAg, anti-HBs and anti-HBc) of all the subjects were tested, 392(26.2%) of interview failure cases 742 nonvaccinee were excluded from the actual population. Finally, the serologic markers tested of 742 nonvaccinee (study population) only were analyzed for the seroepidemiologic observation of the natural infection of HBV. The seroepidemiological characteristics of HBV infection in Korea were as follows ; 1 Point prevalence of HBs antigenemia was 11.7(9.1-14.3)% in male, which was slightly higher than that of female, 9.5(3.7-15.3)%. This level was one of the highest among those of Asian-Pacific countries. Decreasing tendency of HBsAg prevalence after the age of 50 was observed, which seems to be due to selective attrition of HBV chronic carriers among the healthy adults and/or to the limited-lasting duration of the HBs antigenemia, in part. 2. Point prevalence of anti-HBc(78.8% in male, 50.9% in female) was higher than that of anti-HBs(65.2% in male, 46.6% in female), respectively. And both of them were higher in male than in female. Increasing tendency of the prevalence of both antibodies was observed by age, which seems to be largely due to recurrent infection in adults and to some cumulative effect, in part, of their relatively longer-lasting duration. 3. The level of HBV infection defined by positive for at least one of the 3 serologic markers of HBV by RIA method was 84.7(81.8-87.6)% in male and 61.2(51.9-70.5)% in female, which was also one of the highest among those of Asian-Pacific countries. The proportion of susceptible population to HBV infection among healthy adults was 15.3% in male and 38.8% in female. 4. The relative frequency of current or past infection and chronic carrier among HBV infected person was estimated. The currently or past infected was estimated 75.7% in male and 71.8% in female, and chronic carrier state, 13.8% in male and 14.1% in female. The analysis of the geometric mean of the antibody titer in anti-HBs positive sera indicated also to be compatible with the above findings, suggesting that active, even though inapparent, infection of HBV occur so frequently among healthy adults in Korea.
Adult* ; Antibodies ; Carrier State ; Female ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Insurance ; Korea ; Male ; Prevalence ; Radioimmunoassay ; Seoul* ; Vaccination

PURPOSE: The main purpose of this study was to compare the level of satisfaction of patients with nursing care received, and of nurses with nursing care provided to their patients. Another purpose of this study was to identify the relationship between job satisfaction by the nurses and satisfaction with nursing care they provide. METHOD: A self-report questionnaire developed by Yoo & Hong (1999) was used to measure patient and nurse satisfaction. The participants were 147 patients and 133 nurses and data were collected from October 23 to October 30, 2002. Data analysis was done using SPSS WIN 11.0. RESULT: The average score for patient satisfaction was 2.47 (maximum score 5.0) and for nurses, 2.20. This difference was statistically significant. The patients gave high scores on care related personal hygiene, but they gave low scores for critical nursing areas such as following appropriate procedure for administering medications. No significant relationship was found between satisfaction with their nursing care by the nurses and satisfaction with the job. CONCLUSION: Even though the patient scores were significantly higher than nurses', the overall average score was very low and critical nursing actions received the lowest scores. It is necessary to identify areas in need of improvement and develop continuing education programs for nurses.
Education, Continuing ; Humans ; Hygiene ; Job Satisfaction ; Nursing ; Nursing Care ; Patient Satisfaction* ; Surveys and Questionnaires ; Statistics as Topic

PURPOSE: The main purpose of this study was to compare the clinical competency in different instructio nal methods for funda- mentals of nursing practicum, standardized patients methods story as text method ,and traditional lecture/model method. METHOD: The study was designed as a quasi-experimental, nonequivalent control group post-test design with three separate classes of sophomore students attending fundamentals of nursing classes at one baccaleureate nursing school located in metropoli tan Seoul area. Control group was taught by traditiona lecture/ model method and two experimental groups were taught by standardized patients method and story as text method. Data were collected from September, 1999 to June 2001. There were 36 students in the standardized patient method group, 38 students in story as text group, and 40 students in the control group. Data analysis was done using SPSS WINDOW 9.0. RESULT: The results showed that the standardized patients method and story as text method groups were significantly better in clinical judgement and communication skills than the traditional lecture/model method group. The standardized patients method group was significantly better in clinical nursing skills performance than two other groups. However, there was no significant difference among the three groups in student satisfaction. CONCLUSION: The standardized patients method is an effective in teaching clinical cometency for student nurses. It is necessary to explore more efficient way to develop standardized patients cases for wider areas of nursing education. Also, it is recommended to develop more research projects with many nursing programs.
Education, Nursing ; Humans ; Nursing* ; Schools, Nursing ; Seoul ; Statistics as Topic ; Triacetoneamine-N-Oxyl

The study was designed to observe the correlation between the eating habits and growth development in 1,574 children(3 - 6 years old) in Kyunggi-do and Seoul, Korea. The eating habits and nutrient intake were determined by mini dietary assessment and food frequency questionnaire (FFQ). 35.6% children had been practicing an unbalanced diets. Children with unbalanced diet consumed less amount of protein source foods (meat, fish, egg, soy products), vegetables and fruits and had irregular meal time, but more of them preferred sweet foods (ice creme, cookies) and carbonated drinks as snack compared with children in balanced diet. 24 - 35% children consumed energy, iron (Fe), calcium (Ca), Niacin, Zinc (Zn) less than 75% RDA. Energy intake of children with unbalanced diet was not significantly different from those with balanced diet, but they consumed less amount of niacin, Fe, Ca and Zn than those with balanced diet. By using the relative percentage of standard weight-length-index (WLI), 65.7% children was normal weight, 12.9% was underweight, 13.4% was overweight and 7.9% was obese. However, 11.9% of underweight and normal weight children was so called thin obese since their body fat content was greater than 20%. There were 16.8% underweight in children with unbalanced diet and 12.6% underweight in those with balanced diet. Compared to normal weight, the underweight children significantly consumed less amount of milk and its product, high protein foods, fried foods and fruits, but obese children consumed more high protein source foods (meat, fish, egg, etc) and sweet foods. In conclusion, the eating habits of unbalanced meal was prevalent problem in preschool children which resulting in their health risks. Therefore, it would be needed that new approach for nutrition education to improve eating habits in preschoolers.
Adipose Tissue ; Calcium ; Carbonated Beverages ; Child ; Child, Preschool* ; Diet ; Eating* ; Education ; Energy Intake ; Fruit ; Gyeonggi-do ; Humans ; Iron ; Korea ; Meals ; Milk ; Niacin ; Overweight ; Ovum ; Seoul ; Snacks ; Surveys and Questionnaires ; Thinness ; Vegetables ; Zinc

No abstract available.

PURPOSE: The aim of this study was to investigate nursing students' awareness of biomedical ethics and attitudes toward death of terminal patients. METHODS: A structured questionnaire was developed to examine nursing students' biomedical ethics. Their attitudes toward terminal patients' death were measured by using the Collett-Lester Fear of Death Scale. Surveys were conducted with 660 nursing students enrolled at a three-year college located in Daejeon, Korea. Data were analyzed using descriptive statistics, Wilcoxon rank sum test and Kruskall Waills test. RESULTS: Students who have experienced biomedical ethics conflicts, agreed to prohibition of cardiopulmonary resuscitation (CPR) and have no religion exhibited more negative attitudes toward death compared to students without the above characteristics. Of the participants, 81.2% answered that life sustaining treatment for terminal patients should be discontinued and 76.4% replied that CPR on terminal patients should be prohibited. The majority of the correspondents stated that the two measures above are necessary "for patients' peaceful and dignified death". CONCLUSION: Study results indicate the need to establish a firm biomedical ethics value to help nursing students form a positive attitude toward death. It also seems necessary to offer students related training before going into clinical practice, if possible. The training program should be developed by considering students' religion, school year, experience with biomedical ethics conflicts and opinion about CPR on terminal patients. The program should also include an opportunity for students to experience terminal patient care in advance via simulation practice on standardized patients.
Attitude to Death ; Bioethics ; Cardiopulmonary Resuscitation ; Humans ; Korea ; Patient Care ; Students, Nursing ; Surveys and Questionnaires

PURPOSE: The purpose of this study was the development of a comprehensive nursing intervention program for the client with acute lymph stasis and stage I lymphedema. METHOD: The Quasi-experimental design using a non-equivalent control group was used. The subjects were 22 stroke patients with lymph stasis in the control group and 23 patients in the experimental group. The complex physical therapy of Casley-Smith was carried out to the control group for 10 hours, and comprehensive nursing intervention for the experimental group was carried out for 60 minutes. The data for this study was gathered from Feb. 2002 until June 2002 and pertains knowledge about lymphedema, self-care for managing lymphedema, and circumferences of affected limbs. Data was analyzed by mean, standard deviation, x2-test, and t-test. RESULT: The changes in knowledge about lymphedema, self-care practices, and circumference of affected limbs after nursing intervention did not show significant differences between control group and experiment group. CONCLUSION: It can be concluded that comprehensive nursing intervention had more efficiency than complex physical therapy in the treatment of edema for stroke patients because of it's simplicity and time saving. Thereby, the comprehensive nursing intervention program developed in this study would be a useful therapy for the clients with lymph stasis and early stage lymphedema.
Edema ; Extremities ; Humans ; Lymphedema* ; Nursing* ; Self Care ; Stroke

PURPOSE: The purpose of this descriptive study was to gain basic data to develop a self-care protocol for the lymphedema patients. METHOD: The subjects of this study consisted of 115 patients with lymphedema from 8 hospitals and two community health and welfare centers in Busan and Seoul. The data was collected with questionnaire by self reporting of patients between March 2001 and December 2001. Data was analyzed by mean and percentage. RESULT: For self-care activities in daily life, compliance of 'use skin care preparations', 'use heat and cold', 'protect from local compression on affected limbs', 'protect from insect biting', 'use aids to protect affected limbs', 'take diuretics and take protein diet' did not reach to 50%. For self-care activities related to complex physical therapy, 28.7% of subjects complied with compression garment, 14.8% with manual lymph drainage, and 13.0% with exercise. 20.0% of subjects tried to treat with acupuncture and 13.9% with heat therapy. CONCLUSION: From this study, it is suggested that patients need to get a self-care education with correct information about self care activities and health care professionals need to develop more convenience self-care techniques of massage and exercise.
Acupuncture ; Busan ; Compliance ; Delivery of Health Care ; Diuretics ; Drainage ; Education ; Hot Temperature ; Humans ; Insects ; Lymphedema* ; Massage ; Self Care* ; Self Report ; Seoul ; Skin Care ; Surveys and Questionnaires

X-linked recessive bulbospinal muscular atrophy (Kennedy's syndrome) is a variant of the spinal muscular atrophies caused by mutation of androgen receptor gene on X-chromosome. A 69-year-old man had suffered from slowly progressive lower extremity weakness and gynecomastia. Muscle weakness was more severe in proximal muscles and showed symmetrical features. He had fascicular contraction on his face and tongue. All tendon reflexes were absent and pyramidal signs were not detected. Nerve conduction studies were normal except low amplitude of sensory nerve action potential in median nerve. Needle electromyography revealed widespread chronic denervation potentials in all sampling muscles of extremities, facial and tongue muscles. Histopathologic findings showed chronic denervation atrophy. DNA analysis showed abnormal expansion of CAG repeats in the androgen receptor gene and we confirmed this case as Kennedy's syndrome. If an adult patient has slowly progressive muscle weakness, bulbar symptoms and signs of male genital failure, DNA analysis should be taken to differentiate Kennedy syndrome from other motor neuron disease or myopathy.
Action Potentials ; Adult ; Aged ; Atrophy ; Bulbo-Spinal Atrophy, X-Linked ; Denervation ; DNA ; Electromyography ; Extremities ; Gynecomastia ; Humans ; Lower Extremity ; Male ; Median Nerve ; Motor Neuron Disease ; Muscle Weakness ; Muscles ; Muscular Atrophy* ; Muscular Diseases ; Needles ; Neural Conduction ; Receptors, Androgen ; Reflex, Stretch ; Tongue ; Trinucleotide Repeats