Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities

( Hayne Cho Park ),( Young-ki Lee ),( Kyung Don Yoo ),( Hee Jung Jeon ),( Seung Jun Kim ),( Ajin Cho ),( Jacob Lee ),( Yang-gyun Kim ),( Sang-ho Lee ),( Sang-oh Lee ) 대한신장학회 2018 Kidney Research and Clinical Practice Vol.37 No.1

Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities. The areas of infection control covered by these guidelines include standard precautions, isolation strategies, vascular access, water treatment, cleaning/disinfecting/sterilizing, and vaccination. This special report summarizes the key recommendations from the Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.

학습자 참여형 현장방문교육을 위한 교수설계모형 개발연구

조아진(Ajin Cho),이예경(Yekyung Lee) 중앙대학교 한국인적자원개발전략연구소 2012 역량개발학습연구 Vol.7 No.4

본 연구는 ‘S’통신사에서 시행 중인 현장방문교육의 문제점을 극복하기 위하여 학습자 참여형 현장방문교육 교수설계모형을 개발하는 데 목적을 두었다. 이를 위해 현재 시행되고 있는 현장방문교육 전문가들의 검증, ISD 모형에 대한 문헌고찰과 ISD전문가를 통한 모형검증을 통하여 ‘현장 방문교육 교수설계모형’을 개발하였다. 개발된 모형은 다음의 특징을 지닌다: 1)현장 중심형 교수설계모형으로, 예비 분석, 예비 설계, 예비 개발과 현장 분석, 현장 설계, 현장 개발의 2번의 Analysis, Development, Design을 거치며, 2) 현장 방문 전 개발된 자료의 활용도를 높이기 위해 현장 방문 시 즉시 변형이 가능한 보조 자료를 개발할 수 있게 하였으며, 3) 교수설계에 학습자가 참여할 수 있는 체제를 설계함으로써 학습자의 능동적 참여가 가능한 학습 환경을 구축하도록 하였다. This study aimed at developing an instructional systems design model optimized for on-site training where trainers visit the site and conduct instruction. This study analyzed current problems of on-site visit training with instructors in the field and also analyzed literature related to ISD and on-site training to identify solutions that could be used to develop an ISD model for this situation. Verification of the ISD model was carried out by in-service training instructors for final development. The ISD model developed in this study has the following characteristics. First, it has two piloting and primary flows and each flow has its own instructional system flow of analysis, design and development. This makes the model have its strengths on in-service training focused ISD with its repeated flow display. Second, it makes use of versatile forms that can be used for different purposes regardless of goals, teaching materials, assessment items or methods. Third, it provides a learning environments where learners can actively participate and enhances their effectiveness.

Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study

( Hayne Cho Park ),( Do Hyoung Kim ),( Ajin Cho ),( Young Eun Kwon ),( Dong-ryeol Ryu ),( Jinseog Kim ),( Ki Hwa Yang ),( Ji Hyeon Shin ),( Eun Jung Son ),( Young-ki Lee ) 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.3

Background: It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; p = 0.004). Conclusion: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.

Comparison of the Neointima Inhibition Between Paclitaxel- and Sirolimus-Eluting Expanded Polytetrafluoroethylene Hemodialysis Grafts in a Porcine Model

Baek, Insu,Cho, AJin,Hwang, Jinsun,Kim, Heasun,Park, Jong-Sang,Kim, Dae Joong Korean Chemical Society 2013 Bulletin of the Korean Chemical Society Vol.34 No.6

Neointimal hyperplasia causes vascular access dysfunction in hemodialysis patients with synthetic arteriovenous (AV) grafts. Several studies have reported that paclitaxel- or sirolimus-eluting AV grafts inhibit neointimal hyperplasia and display lower rates of stenosis compared with control grafts. However, there have been few comparative studies of the efficacy of paclitaxel- and sirolimus-eluting grafts. We compared the neointimal hyperplasia of paclitaxel- and sirolimus-eluting grafts. AV grafts were implanted laterally between the common carotid artery and the external jugular vein in 12 female Landrace pigs. The animals were sacrificed six weeks after surgery. The neointimal hyperplasia at the anastomosis sites of the grafts was quantified using the ratio of the intragraft hyperplasia to the graft area (H/G ratio) at the graft-vessel interface. The area of intimal hyperplasia at the venous (paclitaxel 1.06 [0.72-1.56] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) and arterial anastomosis sites (paclitaxel 0.93 [0.57-1.48] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) was significantly different between the two groups. However, the H/G ratios for the venous anastomosis site (paclitaxel 0.25 (0.17-0.38) vs sirolimus 0.38 (0.2-0.66), P = 0.4) and the arterial anastomosis site (paclitaxel 0.19 (0.08-0.39) vs sirolimus 0.41 (0.34-0.50), P = 0.1) did not differ significantly between the groups. In conclusion, there was no significant difference in the inhibition of neointimal hyperplasia by sirolimus- and paclitaxel-eluting AV grafts.

Comparison of the Neointima Inhibition Between Paclitaxel- and Sirolimus-Eluting Expanded Polytetrafluoroethylene Hemodialysis Grafts in a Porcine Model

Insu Baek,AJin Cho,Jinsun Hwang,김혜선,박종상,김대중 대한화학회 2013 Bulletin of the Korean Chemical Society Vol.34 No.6

Neointimal hyperplasia causes vascular access dysfunction in hemodialysis patients with synthetic arteriovenous (AV) grafts. Several studies have reported that paclitaxel- or sirolimus-eluting AV grafts inhibit neointimal hyperplasia and display lower rates of stenosis compared with control grafts. However, there have been few comparative studies of the efficacy of paclitaxel- and sirolimus-eluting grafts. We compared the neointimal hyperplasia of paclitaxel- and sirolimus-eluting grafts. AV grafts were implanted laterally between the common carotid artery and the external jugular vein in 12 female Landrace pigs. The animals were sacrificed six weeks after surgery. The neointimal hyperplasia at the anastomosis sites of the grafts was quantified using the ratio of the intragraft hyperplasia to the graft area (H/G ratio) at the graft–vessel interface. The area of intimal hyperplasia at the venous (paclitaxel 1.06 [0.72-1.56] vs sirolimus 2.40 [1.72-3.0] mm2, P = 0.04) and arterial anastomosis sites (paclitaxel 0.93 [0.57-1.48] vs sirolimus 2.40 [1.72-3.0] mm2, P = 0.04) was significantly different between the two groups. However, the H/G ratios for the venous anastomosis site (paclitaxel 0.25 (0.17-0.38) vs sirolimus 0.38 (0.2-0.66), P = 0.4) and the arterial anastomosis site (paclitaxel 0.19 (0.08-0.39) vs sirolimus 0.41 (0.34-0.50), P = 0.1) did not differ significantly between the groups. In conclusion, there was no significant difference in the inhibition of neointimal hyperplasia by sirolimus- and paclitaxel-eluting AV grafts.

Serum alkaline phosphatase and γ-glutamyl transferase in acute pyelonephritis

( Chaehoon Han ),( Young-ki Lee ),( Hayne Cho Park ),( Ajin Cho ),( Sun Ryoung Choi ),( Jong-woo Yoon ),( Ja Ryong Koo ),( Hyung Jik Kim ),( Jung-woo Noh ),( Min-jeong Park ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.2

Background: Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes. Methods: We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FE_γ-GT) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined. Results: We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08-4.19; P = 0.029). FE_γ-GT was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP. Conclusion: Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FE_γ-GT levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.

Case Report : Two cases of idiopathic membranous nephropathy treated with rituximab

( Jae Young Yoon ),( Seung Tae Han ),( Ajin Cho ),( Hye Ryoun Jang ),( Jung Eun Lee ),( Woo Seong Huh ),( Dae Joong Kim ),( Ha Young Oh ),( Yoon Goo Kim ) 대한신장학회 2013 Kidney Research and Clinical Practice Vol.32 No.3

Idiopathic membranous nephropathy is a common cause of nephrotic syndrome, and has been reported as a cause of idiopathic primary glomerulonephropathy in up to 90% of patients. However, the treatment options remain controversial. We report two cases of idiopathic membranous nephropathy that were treated with rituximab. A 54-yearold man and a 64-year old man were admitted for rituximab therapy. They had previously been treated with combinations of immunosuppressive agents including cyclophosphamide, cyclosporine, mycophenolate, and steroids. However, the patients` heavy proteinuria was not resolved. Both patients received rituximab therapy, 2 weeks apart. After several months of follow-up and a second round of rituximab treatment for each patient, their proteinuria decreased and partial remission of disease was achieved in both patients.

메가시티에서의 스마트 모빌리티를 위한 디자인 기초 방향 연구

이지혜(Jihye Lee),양희람(Heeram Yang),이보경(Bokyung Lee),조아진(Ajin Cho),오이담(Idam Oh) 한국디자인학회 2016 디자인학연구 Vol.29 No.3

Effects of the route of erythropoietin administration on hemoglobin variability and cardiovascular events in hemodialysis patients

( Do Hyoung Kim ),( Young-ki Lee ),( Juhee Kim ),( Hayne Cho Park ),( Kyu Sang Yun ),( Ajin Cho ),( Jong-woo Yoon ),( Ja-ryong Koo ),( Jung-woo Noh ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.4

Introduction: Despite of the routine use of erythropoietin in hemodialysis patients to correct anemia, its administration route’s effects on hemoglobin variability and cardiovascular events remain elusive. Herein, we determined different erythropoietin administration routes’ effects on hemoglobin variability in hemodialysis patients and the associated factors of hemoglobin variability and cardiovascular events. Methods: This is a post hoc analysis of a prospective, controlled, randomized, unblinded study with 78 Korean hemodialysis patients receiving intravenous (n = 40) or subcutaneous (n = 38) erythropoietin therapy. We evaluated hemoglobin variability by calculating the frequency of hemoglobin measurements outside the target range during all visits. The high-frequency group was defined by those with hemoglobin variability over the median value (25%) while the low-frequency group was defined by those with hemoglobin variability of <25%. Results: In this analysis, 37 patients (51.1%) were male, and the mean age was 50.6 ± 12.5 years. The frequency of the value being outside the target hemoglobin range was higher in the subcutaneous group compared to the intravenous group (p = 0.03). The low-frequency group required significantly lower erythropoietin doses compared to the high-frequency group. In the adjusted Cox analysis, the parameter high group was a significant independent risk factor for cardiovascular events (p = 0.03). Conclusion: The risk out of the target hemoglobin range increased with subcutaneous administration compared with intravenous erythropoietin administration in hemodialysis patients. An increased frequency of the value being outside the target hemoglobin range was also associated with an increased risk of cardiovascular events.

Evaluation of maternal rhesus blood type as a risk factor in adverse pregnancy outcomes in Korea: a nationwide health insurance database study

( Yihua Jin ),( Meari Dong ),( Seung Woo Yang ),( Kyu-min Lee ),( Sung Won Han ),( Shin Hee Seo ),( Ajin Lee ),( In Sook Sohn ),( Han Sung Kwon ),( Geum Joon Cho ),( Han Sung Hwang ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4

Objectives The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. Methods The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. Results In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81-1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98-1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46-1.37; and placenta previa: OR, 1.08, 95% CI, 0.78-1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. Conclusion Maternal Rh status is not associated with adverse outcomes in primigravida women.