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Effect of a rapid response system on code rates and in-hospital mortality in medical wards
Hong Yeul Lee,이진우,Sang-Min Lee,Sulhee Kim,양은진,Hyun Joo Lee,Hannah Lee,류호걸,Seung-Young Oh,Eun Jin Ha,Sang-Bae Ko,조재영 대한중환자의학회 2019 Acute and Critical Care Vol.34 No.4
Background: To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards. Methods: This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups. Results: There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or brady cardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024). Conclusions: Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.
Lee Hannah,Choi Seongmi,Jang Eun Jin,Lee Juhee,Kim Dalho,Yoo Seokha,Oh Seung-Young,Ryu Ho Geol 대한의학회 2021 Journal of Korean medical science Vol.36 No.34
Background: The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥ 48 hours from 2008 to 2016. Methods: We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. Data from adult patients (aged ≥ 18) who underwent MV for ≥ 48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group. Results: A total of 158,712 patients requiring MV for ≥ 48 hours were admitted in 55 centers in Korea from 2008 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% confident interval, 0.954–0.983; P < 0.001). Benzodiazepine use, older age, lower case volume (≤ 500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and oneyear mortality. Conclusion: In critically ill patients undergoing MV for ≥ 48 hour, the use of benzodiazepines for sedation, older age, and chronic kidney disease were associated with higher in-hospital mortality and one-year mortality. Further studies are needed to evaluate the impact of benzodiazepines on the mortality in elderly patients with chronic kidney disease requiring MV for ≥ 48 hours.
( Hannah Ra ),( Seung Kak Shin ),( So Jeong Kim ),( Gyu Cheon Kyung ),( Youn-i Choi ),( Oh Sang Kwon ),( Jong-beom Shin ),( Young-joo Jin ),( Jin-woo Lee ),( Sangheun Lee ),( Ki Jun Han ),( Young Nam 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The long term data with daclatasvir (DCV)/asunaprevir (ASV) treatment for genotype 1b (GT1b) HCV-infected patients was not reported in Korea. This study investigated the efficacy in virologic response (SVR12 and SVR<sub>48~60</sub>), improvement of liver function and fibrosis markers after DCV/ASV treatment. Methods: HCV GT1b patients who had not resistant associated substitute (RAS) were enrolled in 5 tertiary Korean hospitals. A total of 287 patients treating with DCV/ASV were observed for SVR<sub>12</sub>. Virologic response was measured at 12 weeks (SVR<sub>12</sub>), and 48-60 weeks (SVR<sub>48-60</sub>) after the end of treatment. In patients with cirrhosis, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) were compared between before and after treatment (at SVR<sub>48-60</sub>). Results: SVR<sub>12</sub> was obtained in 97.6% (280/287) patients. Among them, 189 patients were observed for SVR<sub>48-60</sub>. Baseline characteristics (n=189): age (55±11 years), male 91(48%), cirrhosis 57(30.2%), treatment-naive 135(71.4%), ALT (58±53 IU/L), and HCV RNA (1,738,132±2,279,517 IU/mL) were shown. SVR<sub>48-60</sub> was obtained in 96.8 % (183/189) patients. In cirrhotic patients (n=57), changes of ALT (52±36 to 25±13 IU/L, P<0.001), total bilirubin (1.0±0.8 to 0.9±0.5 mg/dL, P=0.112), albumin (3.9±0.7 to 4.2±0.5 g/dL, P=0.003), and platelet (130±96 to 144±80 103/mm3, P=0.132) were observed. The changes of APRI score (2.1±0.3 to 0.8±0.1, P<0.001), FIB-4 index (7.2±0.9 to 3.7±0.4, P<0.001), FI (2.8±0.2 to 2.4±0.2, P=0.021), and LSM (n=16, 19.3±3.1 to 13.0±2.0 kPa, P=0.015) were observed. The characteristics of patients who failed SVR<sub>48~60</sub> (n=6) were such as: age 62(47-78) years, female 5(83%), treatment-naive 3(50%), cirrhosis 2(33%), ALT 40(14- 62) IU/L, HCV RNA 2,599,557(459,017-12,149,394) IU/mL. Conclusions: DCV and ASV treatment for HCV GT1b infected Korean patients without RAS achieved high SVR rates. However, 3% patients who achieved SVR<sub>12</sub> failed in SVR<sub>48~60</sub>. The cirrhotic patients with SVR<sub>48~60</sub> showed improvement of liver function and fibrosis markers.
Lee, Jae Young,Cho, Sun Young,Hwang, Hannah Sun Hae,Ryu, Ja Young,Lee, Jongjin,Song, In Do,Kim, Beom Jin,Kim, Jeong Wook,Chang, Sae Kyung,Choi, Chang Hwan Williams & Wilkins Co 2017 Medicine Vol.96 No.30
<P><B>Abstract</B></P><P>We aimed to investigate the diagnostic yield of stool cultures and identify predictive factors for positive cultures in patients with diarrheal illness.</P><P>A total of 13,327 patients who underwent stool cultures due to diarrheal illness were reviewed. Stool cultures were performed for enteric pathogens, including Salmonella, Shigella, Vibrio, <I>Klebsiella oxytoca</I>, and <I>Yersinia</I>. The culture-positive group was compared with the culture-negative group who were randomly selected from culture negative patients.</P><P>A total of 196 patients (1.47%) were diagnosed with positive stool culture. In 196 culture positive patients, Salmonella spp. (75.0%) was detected most commonly, followed by Vibrio (19.4%). Univariate analyses showed fever (>37.8°C), vomiting, duration and frequency of diarrhea, and high C-reactive protein (CRP) were significantly associated with positive stool culture. Multivariate analysis showed fever (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.25–4.35; <I>P</I> = .008), ≥5/day of diarrhea (OR, 3.52; 95% CI, 1.93–6.44; <I>P</I> < .001) and >50 mg/L of CRP (OR, 2.27; 95% CI, 1.18–4.36; <I>P</I> = .014) were independent predictors for positive stool culture. OR in patients with all 3 factors was 6.55 (95% CI, 2.56–16.75; <I>P</I> < .001). Vomiting (OR, 0.32; 95% CI, 0.17–0.57; <I>P</I> < .001) was a negative predictive factor.</P><P>Diagnostic yield of stool culture in patients with diarrheal illness is very low. Fever, frequency of diarrhea, and high CRP are predictors for positive stool cultures. These findings may lead to more discerning and cost-effective utilization of stool culture by clinicians.</P>