Secondary Analysis on Pressure Injury in Intensive Care Units

Hyun, Sookyung The Institute of Internet 2021 International journal of advanced smart convergenc Vol.10 No.2

Patients with Pressure injuries (PIs) may have pain and discomfort, which results in poorer patient outcomes and additional cost for treatment. This study was a part of larger research project that aimed at prediction modeling using a big data. The purpose of this study were to describe the characteristics of patients with PI in critical care; and to explore comorbidity and diagnostic and interventive procedures that have been done for patients in critical care. This is a secondary data analysis. Data were retrieved from a large clinical database, MIMIC-III Clinical database. The number of unique patients with PI was 2,286 in total. Approximately 60% were male and 68.4% were White. Among the patients, 9.9% were dead. In term of discharge disposition, 56.2% (33.9% Home, 22.3% Home Health Care) where as 32.3% were transferred to another institutions. The rest of them were hospice (0.8%), left against medical advice (0.7%), and others (0.2%). The top three most frequently co-existing kinds of diseases were Hypertension, not otherwise specified (NOS), congestive heart failure NOS, and Acute kidney failure NOS. The number of patients with PI who have one or more procedures was 2,169 (94.9%). The number of unique procedures was 981. The top three most frequent procedures were 'Venous catheterization, not elsewhere classified,' and 'Enteral infusion of concentrated nutritional substances.' Patient with a greater number of comorbid conditions were likely to have longer length of ICU stay (r=.452, p<.001). In addition, patient with a greater number of procedures that were performed during the admission were strongly tend to stay longer in hospital (r=.729, p<.001). Therefore, prospective studies focusing on comorbidity; and diagnostic and preventive procedures are needed in the prediction modeling of pressure injury development in ICU patients.

Secondary Analysis on Pressure Injury in Intensive Care Units

Sookyung Hyun 한국인터넷방송통신학회 2021 Journal of Advanced Smart Convergence Vol.10 No.2

Patients with Pressure injuries (PIs) may have pain and discomfort, which results in poorer patient outcomes and additional cost for treatment. This study was a part of larger research project that aimed at prediction modeling using a big data. The purpose of this study were to describe the characteristics of patients with PI in critical care; and to explore comorbidity and diagnostic and interventive procedures that have been done for patients in critical care. This is a secondary data analysis. Data were retrieved from a large clinical database, MIMIC-III Clinical database. The number of unique patients with PI was 2,286 in total. Approximately 60% were male and 68.4% were White. Among the patients, 9.9% were dead. In term of discharge disposition, 56.2% (33.9% Home, 22.3% Home Health Care) where as 32.3% were transferred to another institutions. The rest of them were hospice (0.8%), left against medical advice (0.7%), and others (0.2%). The top three most frequently co-existing kinds of diseases were Hypertension, not otherwise specified (NOS), congestive heart failure NOS, and Acute kidney failure NOS. The number of patients with PI who have one or more procedures was 2,169 (94.9%). The number of unique procedures was 981. The top three most frequent procedures were ‘Venous catheterization, not elsewhere classified,’ and ‘Enteral infusion of concentrated nutritional substances.’ Patient with a greater number of comorbid conditions were likely to have longer length of ICU stay (r=.452, p<.001). In addition, patient with a greater number of procedures that were performed during the admission were strongly tend to stay longer in hospital (r=.729, p<.001). Therefore, prospective studies focusing on comorbidity; and diagnostic and preventive procedures are needed in the prediction modeling of pressure injury development in ICU patients.

Hospital-Acquired Pressure Injury: Clinical Characteristics and Outcomes in Critical Care

Hyun, Sookyung,Moffatt-Bruce, Susan,Newton, Cheryl,Hixon, Brenda The International Promotion Agency of Culture Tech 2019 International Journal of Advanced Culture Technolo Vol.7 No.2

Electronic health records (EHRs) enable us to use and re-use electronic data for various multiple purposes, such as public reporting, quality improvement, and patient outcomes research. Current hospital-acquired pressure injury (HAPI) risk assessment instruments have not been specifically developed for intensive care unit (ICU) patients and showed false positive rates in this specific populations. Previous research studies report a number of risk factors; however, it is still not clear what factors influence ICU HAPI in this population. As part of a larger research study, we performed an exploratory analysis by using a large electronic health record data. The aims of this study were to compare characteristics of patients who developed HAPIs during their ICU stay with those who did not, and to determine whether the two groups were different in the aspects of length of ICU stay, discharge disposition, and discharge destinations. We conducted chi-square test and t-test for group comparison. Association was examined by using bivariate analyses. Pearson correlation coefficients were used to examine correlation between LOS and number of medications. Our findings suggest a number of consistent and potentially modifiable risk factors, such as sedation, feeding tubes, and the number of medications administered. The mortality of the HAPI group was significantly higher than the non-HAPI group in our data. Discharge disposition was significantly different between the groups. 67% of the HAPI group transferred to intermediate or long-term care hospitals whereas 57.7% of the non-HAPI group went home after discharge. Awareness of these risk factors can lead to clinical interventions that can be preventative in the ICU setting.

Tree-based Approach to Predict Hospital Acquired Pressure Injury

Hyun, Sookyung,Moffatt-Bruce, Susan,Newton, Cheryl,Hixon, Brenda,Kaewprag, Pacharmon The International Promotion Agency of Culture Tech 2019 International Journal of Advanced Culture Technolo Vol.7 No.1

Despite technical advances in healthcare, the rates of hospital-acquired pressure injury (HAPI) are still high although many are potentially preventable. The purpose of this study was to determine whether tree-based prediction modeling is suitable for assessing the risk of HAPI in ICU patients. Retrospective cohort study has been carried out. A decision tree model was constructed with Age, Weight, eTube, diabetes, Braden score, Isolation, and Number of comorbid conditions as decision nodes. We used RStudio for model training and testing. Correct prediction rate of the final prediction model was 92.4 and the Area Under the ROC curve (AUC) was 0.699, which means there is about 70% chance that the model is able to distinguish between HAPI and non-HAPI. The results of this study has limited generalizability as the data were from a single academic institution. Our research finding shows that the data-driven tree-based prediction modeling may potentially support ICU sensitive risk assessment for HAPI prevention.

Comorbidity Analysis on ICU Big Data

Hyun, Sookyung,Newton, Cheryl The International Promotion Agency of Culture Tech 2019 International Journal of Advanced Culture Technolo Vol.7 No.2

Comorbidity isthe simultaneous presence of two chronic diseases or conditions in a patient. As part of a larger research study, the aims of this study were to explore comorbid conditions in intensive care unit (ICU) patients and to compare the comorbidity across different demographic groups, and to determine what comorbid health problems coexisted in the patients with hospital-acquired pressure injury (HAPI). The average number of comorbid conditions was 6.4 with range from 0-20 in the ICU patients. African American patients had significantly more comorbid health problems than other race/ethnicity groups. Asian and Hispanic female patients showed higher comorbidity than male patients across age. The patients with HAPIs had significantly more comorbid health problems than the patients without HAPIs -- the average numbers were almost two-fold. We found comorbid health problems that existed with HAPI in ICU patients. 'Other diseases of lung' and 'Disorders of fluid, electrolyte, and acid-base balance' were most frequently coexisting health problems in the ICU patients with HAPI. Exploratory plots are helpful to discover patterns or hypotheses relevant to clinical management in critical care. Inclusion of patients' comorbid health problems to ICU HAPI risk assessment may be helpful. Identification of patients at a high risk for the development of HAPI and the early preventative interventions can help reduce length of stay as well as costly complications.

Secondary Analysis on Ventilator-Associated Pneumonia and Pressure Injury

Hyun, Sookyung,Moffatt-Bruce, Susan,Newton, Cheryl,Kaewprag, Pacharmon The International Promotion Agency of Culture Tech 2018 International Journal of Advanced Culture Technolo Vol.6 No.3

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

Brief Summary on Nursing Studies regarding COVID-19

Hyun, Sookyung The International Promotion Agency of Culture Tech 2021 International Journal of Advanced Culture Technolo Vol.9 No.2

The coronavirus disease 2019 (COVID-19) pandemic continuously influences on the health and well-being of people and communities worldwide. The purpose of this study was to explore the published research articles in the fields of nursing and health during the COVID-19 pandemic. The research design is an exploratory study. Samples are the abstracts of the articles from a literature database, PubMed, that were published from January 1st, 2020 to April 15th, 2021. We used a MeSH term, 'nursing' and "COVID-19" to retrieve articles that are related to COVID-19. Five hundred and fifty-five articles were retrieved. Two hundred and sixteen articles were excluded as they were not met the inclusion criteria. The total number of articles used in this study was three hundred and thirty-nine. The average number of articles published during the data collection period was 21.9. Seven topics were discovered from the abstracts of the articles: COVID-19 management and guidance; Perinatal COVID-19 and breastfeeding; Nurse; Health service and support; Patient care; Research; and Education and experience. This study revealed some interesting topics from the articles related to COVID-19 and provided some sense of research areas that may be interesting and allow us to develop important research questions about nursing science and nursing practice.

Secondary Analysis on Ventilator-Associated Pneumonia and Pressure Injury

Sookyung Hyun,Susan Moffatt-Bruce,Cheryl Newton,Pacharmon Kaewprag 국제문화기술진흥원 2018 International Journal of Advanced Culture Technolo Vol.6 No.3

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

Northern distribution limits and future suitable habitats of warm temperate evergreen broad-leaved tree species designated as climate-sensitive biological indicator species in South Korea

Shin Sookyung,Kim Jung-Hyun,Kang Duhee,Kim Jin-Seok,Kang Hong Gu,Jang Hyun-Do,Lee Jongsung,Han Jeong Eun,Oh Hyun Kyung 한국생태학회 2022 Journal of Ecology and Environment Vol.46 No.4

Background: Climate change significantly influences the geographical distribution of plant species worldwide. Selecting indicator species allows for better-informed and more effective ecosystem management in response to climate change. The Korean Peninsula is the northernmost distribution zone of warm temperate evergreen broad-leaved (WTEB) species in Northeast Asia. Considering the ecological value of these species, we evaluated the current distribution range and future suitable habitat for 13 WTEB tree species designated as climate-sensitive biological indicator species. Results: Up-to-date and accurate WTEB species distribution maps were constructed using herbarium specimens and citizen science data from the Korea Biodiversity Observation Network. Current northern limits for several species have shifted to higher latitudes compared to previous records. For example, the northern latitude limit for Stauntonia hexaphylla is higher (37° 02’ N, Deokjeokdo archipelago) than that reported previously (36° 13’ N). The minimum temperature of the coldest month (Bio6) is the major factor influencing species distribution. Under future climate change scenarios, suitable habitats are predicted to expand toward higher latitudes inland and along the western coastal areas. Conclusions: Our results support the suitability of WTEB trees as significant biological indicators of species’ responses to warming. The findings also suggest the need for consistent monitoring of species distribution shifts. This study provides an important baseline dataset for future monitoring and management of indicator species’ responses to changing climate conditions in South Korea.

Predicting the potential distribution of the subalpine broad-leaved tree species, Betula ermanii Cham. under climate change in South Korea

Shin, Sookyung,Dang, Ji-Hee,Kim, Jung-Hyun,Han, Jeong Eun The National Institute of Biological Resources 2021 Journal of species research Vol.10 No.3

Subalpine and alpine ecosystems are especially vulnerable to temperature increases. Betula ermanii Cham. (Betulaceae) is a dominant broad-leaved tree species in the subalpine zone and is designated as a 'Climate-sensitive Biological Indicator Species' in South Korea. This study aimed to predict the potential distribution of B. ermanii under current and future climate conditions in South Korea using the MaxEnt model. The species distribution models showed an excellent fit (AUC=0.99). Among the climatic variables, the most critical factors shaping B. ermanii distribution were identified as the maximum temperature of warmest month (Bio5; 64.8%) and annual mean temperature (Bio1; 20.3%). Current potential habitats were predicted in the Baekdudaegan mountain range and Mt. Hallasan, and the area of suitable habitat was 1531.52 km², covering 1.57% of the Korean Peninsula. With global warming, future climate scenarios have predicted a decrease in the suitable habitats for B. ermanii. Under RCP8.5-2070s, in particular, habitat with high potential was predicted only in several small areas in Gangwon-do, and the total area suitable for the species decreased by up to 97.3% compared to the current range. We conclude that the dominant factor affecting the distribution of B. ermanii is temperature and that future temperature rises will increase the vulnerability of this species.