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- 저자 : 申京華 (검색결과 82 건)
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신경화,목정하,이상희,김은정,석나리,류선석,하명남,이광하 대한중환자의학회 2014 Acute and Critical Care Vol.29 No.3
Background: Many terminally ill patients die while receiving life‐sustaining treatment. Recently, the discussion of life‐sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients. Methods: The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively. Results: Eighty-nine patients were enrolled. Their mean age was 65.8 ± 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 ± 1.0 days after the decision for removal of life-sustaining treatment. Conclusions: The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.
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부산대학교병원에서 시행된 혈전혈소판감소자반증-용혈요독증후군 혈장교환술(2003∼2011)
신경화,이현지,김신영,장철훈,박기형,이은엽,손한철,김형회 대한수혈학회 2012 大韓輸血學會誌 Vol.23 No.1
Background:Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are related diseases with high rates of fatality. Plasma exchange therapy improves survival rates in patients with TTP and HUS. The aim of this study is to evaluate our experience in conduct of plasma exchange procedures for treatment of patients with TTP-HUS over the past nine years, and to identify risk factors for poor response to this treatment. Methods:Between January 2003 and August 2011, 230 plasma exchange procedures were performed for treatment of 22 TTP-HUS patients at Pusan National University Hospital. We conducted a retrospective analysis of data from clinical records and plasma exchange records for these patients. Results:Fourteen female patients and eight male patients were included in the study. The majority of patients (86%) had neurologic symptoms; and 41% of patients had a fever. Eight patients presented with an additional disorder; three patients presented with Systemic Lupus Erythematosus. The mean number of plasma exchange procedures was 10.5 per patient. The overall rate of mortality following plasma exchange therapy was 27% and relapse was observed in only one patient. Rate of mortality varied with different comorbid diseases. Female patients and patients who underwent fewer plasma exchange procedures tended to be unresponsive to plasma exchange therapy, but the results are not statistically significant. Aggressive treatment involving two plasma exchange procedures within 24 hours of diagnosis and choice of any replacement fluid did not show an association with improved mortality. Conclusion:No association of the factors analyzed with mortality rate and responsiveness to plasma exchange was observed.
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신경화,이선민,이현지,김혜림,송두열,양유진,김인숙,김형회,장철훈 대한수혈학회 2017 大韓輸血學會誌 Vol.28 No.2
Background: Blood transfusions are complicated procedures, and are highly sensitive to mistakes that could seriously endanger the life of patients. The failure mode and effect analysis (FMEA) can be used to inspect and improve high risk processes. Here, we aimed to identify the risk factors of a blood transfusion process and to improve its safety by optimizing the process. Methods: We conducted a weekly meeting from March to April 2014. We investigated the frequency of events for 2013 (before FMEA) and 2015 (after FMEA). The FMEA process was performed in eight steps and the improvement priorities were determined in accordance with the magnitude of calculated fatalities (multiplied by severity, occurrence, and detection scores). Results: The whole process of blood transfusion was analyzed by detailed steps: Decision of blood transfusion, blood transfusion request, pre-transfusion test, blood product discharge, delivery, and administration process. Then, we identified the types of failures and likelihood of occurrence, discovery, and severity. Based on the calculated risk priority number, strategies to improve the highest failure modes were developed. Eleven transfusion-related events occurred before FMEA, and three events occurred after FMEA. Conclusion: In this study, we analyzed the failure modes that may occur during a transfusion procedure. The FMEA was a useful tool for analyzing and reducing the risks associated with a blood transfusion procedure. Continuous efforts to improve the failure modes would be helpful to further improve the safety of patients undergoing blood transfusion.
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디에고와 밀텐버그 항원이 포함된 비예기항체 선별검사 시약간 비교
신경화,김형회,이현지,김혜림 대한수혈학회 2022 大韓輸血學會誌 Vol.33 No.1
The Dia and Mia antigens have been detected in Koreans with a frequency of 6.4∼14.5% and 0.9%, respectively. This study evaluated the effectiveness of different screening cells using the cells with Dia and Mia antigens for unexpected antibody screening. An unexpected antibody-screening test was performed separately using different screening cells, including the Dia antigen (Panel D) and Mia antigen (Panel M). A total of 2,077 specimens from 1,847 patients were collected, among which 49 (2.32%) and 43 (2.08%) were positive using Panel D and Panel M, respectively. Twenty-seven patients were positive with both panels, 2012 were negative with both panels, and thirty-eight patients showed a discordant result. The suspected anti-Dia and anti-Mia were detected in 4 (0.19%) and 5 (0.24%) patients, respectively. Therefore, the frequency of anti-Dia and anti-Mia antibodies in this study may be helpful for selecting unexpected antibody screening reagents. (Korean J Blood Transfus 2022;33:46-49)
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Economic and Workflow Analysis of a Blood Bank Automated System
신경화,김형회,장철훈,이은엽 대한진단검사의학회 2013 Annals of Laboratory Medicine Vol.33 No.4
Background: This study compared the estimated costs and times required for ABO/Rh(D)typing and unexpected antibody screening using an automated system and manual methods. Methods: The total cost included direct and labor costs. Labor costs were calculated on the basis of the average operator salaries and unit values (minutes), which was the handson time required to test one sample. To estimate unit values, workflows were recorded on video, and the time required for each process was analyzed separately. Results: The unit values of ABO/Rh(D) typing using the manual method were 5.65 and 8.1min during regular and unsocial working hours, respectively. The unit value was less than 3.5 min when several samples were tested simultaneously. The unit value for unexpected antibody screening was 2.6 min. The unit values using the automated method for ABO/Rh(D) typing, unexpected antibody screening, and both simultaneously were all 1.5 min. The total cost of ABO/Rh(D) typing of only one sample using the automated analyzer was lower than that of testing only one sample using the manual technique but higher than that of testing several samples simultaneously. The total cost of unexpected antibody screening using an automated analyzer was less than that using the manual method. Conclusions: ABO/Rh(D) typing using an automated analyzer incurs a lower unit value and cost than that using the manual technique when only one sample is tested at a time. Unexpected antibody screening using an automated analyzer always incurs a lower unit value and cost than that using the manual technique.
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