vidence-Based Nursing Practice Guideline: Ostomy Care / 임상간호연구

Purpose@#The aim of this study was to develop an evidence-based guideline for stoma management providing institutional policy, assessment, complications and follow-up care. Methods: The guideline adaptation manual consisting of 23 steps developed by the National Evidence-Based Healthcare Collaborating Agency was used for this study. It presents an overview of the process used to develop the guideline and lists specific recommendations from the guideline. @*Results@#It provides 55 recommendations that include the following 8 topics: 1) Organization and policy recommendations, 2) Preoperative nursing; Ostomy education, stoma site marking, 3) Ostomy formation, 4) Postpoperative nursing; education, assessment, high output stoma management, 5) Selection of ostomy products, 6) Colostomy irrigation, 7) Stomal and peristomal complications, 8) Follow-up care after discharge. @*Conclusion@#The guideline can be used to address stoma management in hospital settings. The intent of the guideline is to provide information that will assist healthcare providers to manage adult patients with ostomies, prevent or decrease complications, and improve patients’ outcomes.

Survival of in-hospital cardiac arrest patients before and after the implementation of the act on decisions on life-sustaining treatment: the well-dying law

OBJECTIVE: The act on decisions on life-sustaining treatment, the well-dying law (WDL), has been implemented in Korea since February of 2018 so that a patient may die with dignity in his or her death bed. On the other hand, there has been an increase in in-hospital cardiac arrest patients, resulting in poor outcomes due to strict regulations of withdrawal of life support. This study examined the survival of in-hospital cardiac arrest patients before and after implementation of the WDL. METHODS: The in-hospital cardiac arrest data registry from the authors' in-hospital cardiac arrest committee and electronic medical records were reviewed retrospectively. The baseline characteristics, cardiac arrest variables, and cardiac arrest outcomes were compared before and after implementation of the WDL. Multivariate logistic regression was conducted to analyze the association of the implementation of the WDL and return of spontaneous circulation (ROSC) of in-hospital cardiac arrest patients. RESULTS: This study analyzed 183 patients before and 346 patients after the implementation of the WDL. The ROSC (115 [62.8%] vs. 158 [45.7%]), 24-hour survival (53 [29.0%] vs. 60 [17.3%]), and survival discharge (25 [13.7%] vs. 29 [8.4%]) were higher in the before period than in the after period. Multivariate logistic regression analysis showed that the WDL was associated with a lower ROSC (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.37–0.85; P<0.01) and lower survival at 24 hours (OR, 0.53; 95% CI, 0.31–0.93; P=0.03), but not a lower survival discharge (OR, 0.84; 95% CI, 0.39–1.83; P=0.67). CONCLUSION: The implementation of the WDL has been associated with a lower ROSC and lower survival at 24 hours in in-hospital cardiac arrest patients.

Unilateral noncystic renal dysplasia in a Sprague Dawley rat / 동물의과학연구지

Renal dysplasia is a developmental disorder of the renal parenchyma involving anomalous differentiation. It is characterized by persistent metanephric ducts surrounded by primitive mesenchyme, fetal or immature glomeruli, fetal or immature tubules, interstitial fibrosis, and dysontogenic metaplasia involving tissues such as cartilage. Renal dysplasia has been rarely reported in rats. Here, we observed a small left kidney in a rat used in a short-term repeat toxicity study. The rat showed no clinical signs throughout the study. All parameters, including those reflecting kidney functions, were normal upon hematological examination and urinalysis. Grossly, the kidney was small (5 x 8 mm) and its surface appeared normal. Histological examination revealed that the cortex and medulla were poorly demarcated and contained immature/atrophic glomeruli, immature renal tubules, and mesenchymal cells. The cortex contained immature glomeruli, atrophic glomeruli with cystic dilatation of Bowman's capsular space, and some atypical tubules. Primitive metanephric tubules in the medulla were larger in diameter than normal collecting ducts, lined by a tall columnar epithelium with pale cytoplasm and basal nucleus, and surrounded by loose mesenchymal cells. Occasional tubules contained pale eosinophilic homogenous material in the lumen. Thus, this was diagnosed as a case of renal dysplasia on the basis of histologic features and is the first reported case of renal dysplasia in Sprague Dawley rats.