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약물부작용 감시정보시스템의 도입과 평가 : pilot study
황수희,김은영,이용석,정선영,이영미,손기호,최경업,이숙향,김윤 韓國病院藥師會 2005 병원약사회지 Vol.22 No.2
A computerized surveillance system is the most recent tool to monitor, identify and prevent ADEs, based on alerts generated by matching signals such as abnormal lab data with electronic medical records (EMRs). Since this system has been proven to be simple and cost-effective in detecting ADEs, there is a growing trend towards routine application. The objectives of this study were to implement the system in Samsung Medical Center (SMC), a 1300-bed tertiary hospital, and evaluate its applicability and validity in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The retrospective analysis was performed using 1-month EMRs in 598 discharged patients from 2 ICUs and 5 general wards. Alerts as potential indicators of ADEs were generated by this system using our modified signals. Patient charts were carefully reviewed by clinical pharmacists to detect ADEs and to verify whether these ADEs were also recognized by the signals. A total of 718 alerts were generated by the system and 187 ADEs were detected by chart review. One hundred forty eight alerts were found to be associated with ADEs. The sensitivity of the modified signals for identifying ADEs was estimated to be 79.1 (95% confidence interval [CI], 73.3~85.0) percent, and the estimated specificity was 29.2 (95% CI, 26.1~32.3) percent. The PPV and the NPV were 20.6 (95% CI, 17.7~23.6) percent and 85.8 (95% CI, 81.6~89.9) percent, respectively. Our computerized surveillance system showed that the sensitivity value was higher (79.1% vs. ca 50%) and the specificity was lower (29.2% vs. ca 70~80%) than those reported in the literature. It would be necessary to further modify the signals to improve the specificity and rate of ADE detection. More studies will be needed to confirm the usefulness and cost-effectiveness of this system.
황수희,김명화,박춘선,Hwang, Soo-Hee,Kim, Myung-Hwa,Park, Choon-Seon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.2
Purpose: The aims of this study were to assess the presence of core patient safety practices in Korean hospitals and assess the differences in reporting and learning systems of patient safety, infrastructure, and safe practices by hospital characteristics. Methods: The authors developed a questionnaire including 39 items of patient safety staffing, health information system, reporting system, and event-specific prevention practices. The survey was conducted online or e-mail with 407 tertiary, general and specialty hospitals. Results: About 90% of hospitals answered the self-reporting system of patient safety related events is established. More than 90% of hospitals applied incidence monitoring or root cause analysis on healthcare-associated infection, in-facility pressure ulcers and falls, but only 60% did on surgery/procedure related events. More than 50% of the hospitals did not adopted present on admission (POA) indicators. One hundred (80.0%) hospitals had a department of patient safety and/or quality and only 52.8% of hospitals had a patient safety officer (PSO). While 82.4% of hospitals used electronic medical records (EMRs), only 53% of these hospitals adopted clinical decision support function. Infrastructure for patient safety except EMRs was well established in training, high-level and large hospitals. Most hospitals implemented prevention practices of adverse drug events, in-facility pressure ulcers and falls (94.4-100.0%). But prevention practices of surgery/procedure related events had relatively low adoption rate (59.2-92.8%). Majority of prevention practices for patient safety events were also implemented with a relatively modest increase in resources allocated. Conclusion: The hospital-based reporting and learning system, EMRs, and core evidence-based prevention practices were implemented well in high-level and large hospitals. But POA indicator and PSO were not adopted in more than half of surveyed hospitals and implementation of prevention practices for specific event had low. To support and monitor progress in hospital's patient safety effort, national-level safety practices set is needed.
Spiral Vein Graft를 이용한 상대정맥 우회로 조성술-치험 1례-
황수희,김병준,정성운,Hwang, Su-Hui,Kim, Byeong-Jun,Jeong, Seong-Un 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.3
상대정맥 증후군을 가진 49세 여자환자에 spiral vein graft를 이웅한상대정맥 우회로 조성술을 실시 하여 좋은 결과를 얻었다. 이 복합 나선형 이식 편은 폐쇄된 상대정 맥을 우회하여 우측 무명동맥과 우심 이간에 이식되었다. 이식편은 환자 자신의 대복재정 맥을 세로로 절개하여 스탠트에 나선형으로 감은 후 정맥의 가장자리들을 봉합하여 하나의 큰직경을 가진 도관으로 만든 것이다. 환자는 증세 호전되었고 수술 후 21일째 합병증 없이 퇴원하였다. A 49-year-old female patient who had obstruction of superior vents cave(SVC) with SVC syndrome was successfully managed by bypass operation of superior vents cava with spiral vein graft. A composite spiral vein graft was placed between the right innominate vein and the right atrium to bypass the occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion and the edges of the vein were sutured together to form a large autogenous conduit. The patient was relieved o SVC obstructive symtoms and signs and discharged 21 days postoperatively without any complication.