Differences in the incidence, characteristics, and outcomes of patients with acute kidney injury in the medical and surgical intensive care units.

BACKGROUND: Though acute kidney injury (AKI) is a prevalent complication in critically ill patients, knowledge on the epidemiological differences and clinical characteristics of patients with AKI admitted to medical and surgical intensive care units (ICUs) remains limited. METHODS: Electronic medical records of patients in ICUs in Pusan National University Hospital and Pusan National University Hospital Yangsan, from January 2011 to December 2020, were retrospectively analyzed. Different characteristics of AKI between patients were analyzed. The contribution of AKI to the in-hospital mortality rate was assessed using a Cox proportional hazards model. RESULTS: A total of 7,150 patients were included in this study. AKI was more frequent in medical (48.7%) than in surgical patients (19.7%), with the severity of AKI higher in medical patients. In surgical patients, hospital-acquired AKI was more frequent (51.0% vs. 49.0%), whereas community-acquired AKI was more common in medical patients (58.5% vs. 41.5%). 16.9% and 5.9% of medical and surgical patients died in the hospital, respectively. AKI affected patient groups to different degrees. In surgical patients, AKI patients had 4.778 folds higher risk of mortality (95% confidence interval [CI], 3.577-6.382; p < 0.001) than non-AKI patients; whereas in medical AKI patients, it was 1.239 (95% CI, 1.051-1.461; p = 0.01). CONCLUSION: While the prevalence of AKI itself is higher in medical patients, the impact of AKI on mortality was stronger in surgical patients compared to medical patients. This suggests that more attention is needed for perioperative patients to prevent and manage AKI.

The role of nafamostat mesylate anticoagulation in continuous kidney replacement therapy for critically ill patients with bleeding tendencies: a retrospective study on patient outcomes and safety.

BACKGROUND: Continuous kidney replacement therapy (CKRT) is crucial in the management of acute kidney injury in intensive care units (ICUs). Nonetheless, the optimal anticoagulation strategy for patients with bleeding tendencies remains debated. This study aimed to evaluate patient outcomes and safety of nafamostat mesylate (NM) compared with no anticoagulation (NA) in critically ill patients with bleeding tendencies who were undergoing CKRT. METHODS: This retrospective study enrolled 2,313 patients who underwent CKRT between March 2013 and December 2022 at the third affiliated hospital in South Korea. After applying the exclusion criteria, 490 patients were included in the final analysis, with 245 patients in the NM and NA groups each, following 1:1 propensity score matching. Subsequently, in-hospital mortality, incidence of bleeding complications, agranulocytosis, hyperkalemia, and length of hospital stay were assessed. RESULTS: No significant differences were observed between the groups regarding the lengths of hospital and ICU stays or the incidence of agranulocytosis and hyperkalemia. The NM group showed a smaller decrease in hemoglobin levels during CKRT (-1.90 g/dL vs. -2.39 g/dL) and less need for blood product transfusions than the NA group. Furthermore, the NM group exhibited a survival benefit in patients who required transfusion of all three blood products. CONCLUSION: NM is an effective and safe anticoagulant for CKRT in critically ill patients, especially those requiring transfusion of all three blood products. Although these findings are promising, further multicenter studies are needed to validate them and explore the mechanisms underlying the observed benefits.

Reliability and Validity of Culturally Adapted Executive Function Performance Test for Koreans with Stroke.

BACKGROUND: Executive Function Performance Test was unusable in Asia because of cultural differences, although evaluating the effect that executive function has on real life is essential to people with stroke. The aims of this study were to report the development and standardization of culturally appropriate Executive Function Performance Test for Koreans (EFPT-K) and to verify its reliability and validity in the stroke population. METHODS: EFPT-K was developed by going through the process of translation, back-translation, and an expert committee's conference on cultural adaptation. Inter-rater reliability was examined and 34 people with stroke were recruited to test the internal consistency and criterion validity of EFPT-K. To verify the criterion validity, EFPT-K scores were compared with those of the Trail-Making Test, the Korean Color-Word Stroop Test, the Digit Span Test, and the Assessment of Motor and Process Skills (AMPS). RESULTS: Inter-rater reliability and internal consistency of the total score of EFPT-K supported high levels of reliability. In the criterion validity of EFPT-K, all neuropsychological tests but digits backward showed a correlation with the total score of EFPT-K, and AMPS components of initiation, notice/response, and termination showed a moderate correlation with the EFPT-K score. CONCLUSIONS: EFPT-K is a useful tool to evaluate the executive functioning of patients with stroke in real-life tasks and could be used as a sample in other Asian cultures where thorough evaluation of executive function in the performance of daily life is needed.

Happiness among Pregnant Women: A Concept Analysis.

PURPOSE: The purpose of this study was to analyze the concept of happiness among pregnant women. METHODS: Walker and Avant's method for concept analysis was used. RESULTS: The defining attributes of happiness among pregnant women were 1) period of pregnancy, 2) emotional dimension (positive affect), and 3) cognitive dimension(existence need-satisfaction, relatedness need-satisfaction, growth need-satisfaction). The antecedents of happiness among pregnant women were 1) intrapersonal characteristics, 2) reproductive history and related characteristics, 3) interpersonal relationship, and 4) external factors. The consequences included 1) pregnant women's well-being, 2) fetal well-being, 3) maternal well-being, and 4) child's happiness. CONCLUSION: Although further studies are required to refine the diverse attributes of the concept, the results of this study contribute to explaining happiness among pregnant women. In addition, the development of adequate interventions to increase prenatal happiness is needed.

An automated information system for families of patients in the operation room based on EMR data.

When children undergo surgery, the parents waiting for them outside the room feel extreme anxiety. SNUH was a full EMR hospital. But nurses had to manually operate an electronic display board which provided information regarding the progresses of the operations. The parents had to be located in front of the board. It was a unilateral and passive system. Therefore, we were about to improve the system to provide efficient information satisfying both parents and nurses. This service, which connected to the EMR system to provide real time location of patients undergoing operations, provide information through an electronic display board outside the operating room and SMS messages. We could reduce uneasiness of patients' families, increase satisfactions, and further, not only contribute to establishing the improved service of SNUH but also lessening unnecessary duties of nurses.

Development of an early detection and monitoring system for deteriorating patients.

A number of methods of preventing cardiopulmonary arrest are currently in use. One such method is the alert response system developed by Seoul National University Children's Hospital, which is an early detection and monitoring system for deteriorating patients who are at risk of cardiopulmonary arrest. This system offers an effective means of detecting early warning signs and monitoring deteriorating patients, and its application can reduce rates of cardiopulmonary arrest.

The relationship between the fish consumption and blood total/methyl-mercury concentration of costal area in Korea.

The purpose of this study was to evaluate the relationship between fish consumption and blood THg/MeHg concentration in Korean adults by measuring MeHg concentration in blood directly. The study subjects consisted of 400 adults aged 20 or older from 30 subareas in Busan, Ulsan and Gyeongsangnam-do province in Korea from August to October, 2010. We tried to recruit the same number of male and female participants in different age groups (20s, 30s, 40s, 50s and 60s) and allocated 13-16 subjects by district to represent Hg concentration in the research areas. The geometric means of THg and MeHg concentration in blood were 5.27 µg/L (5.00-5.57) and 4.05 µg/L (3.81-4.32), respectively. The proportion of MeHg/THg concentration was 78.53% (77.09-79.97). MeHg concentration was higher in coastal areas (4.26 µg/L) than in inland areas (3.52 µg/L) and was higher in men (4.68 µg/L) than in women (3.52 µg/L). In male participants, blood MeHg concentration increased with increasing annual fish consumption, and the proportion of MeHg/THg concentration showed an upward trend as THg concentration increased. However, none of the measures of the proportion of MeHg/THg showed significant differences. This is the first report in Korea about the relationship between blood MeHg concentration and related factors. Our findings suggest that MeHg concentration is affected by fish consumption as well as by gender difference and drinking status. Since the pathological mechanism has not been clarified, additional studies are needed for explaining the biological and lifestyle differences in the risk of adverse health effects by Hg exposure.

Analysis of methylmercury concentration in the blood of Koreans by using cold vapor atomic fluorescence spectrophotometry.

BACKGROUND: Methylmercury is an organic form of mercury that is highly toxic to humans. Here, we present and establish a novel method to detect methylmercury concentrations in the blood of Koreans. METHODS: Methylmercury concentration was analyzed with an automated methylmercury analytic system (MERX, Brooks Rand Co., USA) using cold vapor atomic fluorescence spectrophotometry (CVAFS). A variety of biological materials were digested in methanolic potassium hydroxide solution. The analysis method was validated by examination of certified reference material (955c, National Institute of Standard and Technology, USA). We randomly selected 30 Korean adults (age 20 yr or older) to analyze total blood mercury and methylmercury concentrations. RESULTS: The detection limit and methylmercury recovery rate using this method were 0.1 pg/L and, 99.19% (range: 89.33-104.89%), respectively. The mean blood concentration of methylmercury was 4.54±2.15 µg/L (N=30). The mean proportion of methylmercury to the total mercury concentration was 78.27% (range: 41.37-98.80%). CONCLUSIONS: This study is the first report to analyze blood methylmercury concentration using CVAFS in Korea. We expect that this method will contribute to the evaluation of mercury exposure and the assessment of the toxicological impact of mercury in future studies.

Blood mercury concentration and related factors in an urban coastal area in Korea.

OBJECTIVES: This study was carried out for the purpose of evaluating the blood mercury concentration of the residents of Busan, Korea, as well as the relationship between the mercury concentration and the pattern of fish consumption along with other epidemiological factors. METHODS: Two hundred ninety-three subjects (147 men and 146 women), who were aged 40 years or more, were recruited into this study between June and October 2009. The mean age of the subjects was 54.3 years (with a range of 40-70 years). Mercury concentrations in blood samples were measured using a gold-amalgam collection method. RESULTS: The geometric mean concentration of mercury in the total subjects was 8.63 µg/L [range: 1.48~45.71 µg/L]. The blood mercury concentration of the men (9.55 µg/L) was significantly higher than that of the women (7.76 µg/L). The blood mercury concentration of those who eat fish more than 4 times per week was higher than others, and was statistically significant (male p = 0.0019, female p = 0.0002). According to the multiple analysis, the blood mercury concentration was significantly affected by the consumed fish but other epidemiological factors were not related. CONCLUSIONS: It was found that the subjects who have consumed a large amount of fish may have high blood mercury concentration. It appears that fish consumption can influence blood mercury concentration. Therefore, guidelines for fish consumption that will decrease blood mercury concentration might be necessary in Korea.

Case study: analysis of end-user requests on electronic medical record and computerized physician order entry system of Seoul National University Hospital in Korea.

Seoul National University Hospital (SNUH) in Korea has utilized the full Electronic Medical Record (EMR) system since October 2004. Unlike other countries, most EMR systems in Korean teaching and general hospitals are in-house development systems. Therefore, we can actively respond to user requests on EMR. Here, based on 5 years of experience in EMR system operation, we analyzed 2,339 SNUH EMR user requests from 2006 to 2008 for improvement of EMR system operation and management. We classify user requests into 9 criteria based on guidelines from the SNUH medical information management team. In conclusion, the most common requests (73%) are for improvement of improving quality of care. However, requests associated with hospital enterprise, public policy, and customer service are gradually increased every year. Therefore, we suggest that suitable EMR management criteria are necessary for reliable EMR operation and management.

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare.

OBJECTIVES: Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. METHODS: THE HOSPITAL INFORMATION SYSTEM IN SEOUL NATIONAL UNIVERSITY HOSPITAL CONSISTS OF COMPONENT APPLICATIONS: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. RESULTS: Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. CONCLUSIONS: Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system.

Anomalous electrokinetic dispersion of carbon nanotube clusters in liquid crystal under electric field.

An anomalous electrokinetic dispersion after contraction of carbon nanotube (CNT) cluster suspended in a vertically aligned nematic liquid crystal (LC) cell is demonstrated. CNT aggregates were firstly aligned toward the field line by dielectrophoretic (DEP) torque and secondly they were elongated above a certain threshold field due to interaction between the induced dipole moment of CNTs and external ac electric field. Below a certain breakdown field, the original morphology of the CNT aggregates was restored after the removal of the field where the elongation was fully reversible. Above breakdown electric field, CNT aggregates were ruptured and fragmented into small pieces and consequently CNTs were well dispersed in LC medium.

Classification of nursing statements based on the ICNP, the HHCC, and the nursing process for use in electronic nursing records.

The purposes of this study were to identify nursing-phenomena-related statements and nursing-action- related statements for use in nursing records, to link nursing statements for the nursing process, to develop integrated nursing terms using the ICNP, to identify new terms for inclusion, and to group statements using the HHCC in a user interface. We extracted 5,133 nursing-phenomena-related statements and 3,844 nursing-action-related statements, with the former including 233 nursing diagnoses. A total of 2791 nursing terms were mapped and 287 new terms were developed. Synonyms of 827 standard nursing terms were extracted. We developed trees of nursing statements using the HHCC for the user interface in an electronic nursing record. The quality of nursing documentation and the nursing performance improved with the standardization process.

Mapping nursing statements with the ICNP and its practical use in electronic nursing records.

This study analyzed the usage of nursing statements and the frequencies of mapped nursing statements using the ICNP in electronic nursing records. A total of 9,200 statements were analyzed, comprising 5,135 related to nursing assessments, 215 related to nursing diagnoses, and 3,850 related to nursing interventions. Nurses used 3,744 (72.9%) of the respective statements in assessments, 149 (69.3%) in diagnoses, and 2,641 (68.6%) in interventions. There were 11,499 (56.8%) completely mapped nursing statements, 7,548 (37.3%) partially mapped statements, and 1,203 (5.9%) unmapped statements.