SMART Careplan System for Continuum of Care / 대한의료정보학회지

OBJECTIVES: This paper describes the integrated Careplan system, designed to manage and utilize the existing Electronic Medical Record (EMR) system; the system also defines key items for interdisciplinary communication and continuity of patient care. METHODS: We structured the Careplan system to provide effective interdisciplinary communication for healthcare services. The design of the Careplan system architecture proceeded in four steps-defining target datasets; construction of conceptual framework and architecture; screen layout and storyboard creation; screen user interface (UI) design and development, and pilot test and step-by-step deployment. This Careplan system architecture consists of two parts, a server-side and client-side area. On the server-side, it performs the roles of data retrieval and storage from target EMRs. Furthermore, it performs the role of sending push notifications to the client depending on the careplan series. Also, the Careplan system provides various convenient modules to easily enter an individual careplan. RESULTS: Currently, Severance Hospital operates the Careplan system and provides a stable service dealing with dynamic changes (e.g., domestic medical certification, the Joint Commission International guideline) of EMR. CONCLUSIONS: The Careplan system should go hand in hand with key items for strengthening interdisciplinary communication and information sharing within the EMR environment. A well-designed Careplan system can enhance user satisfaction and completed performance.

Effect of Kegel Exercise to Prevent Urinary and Fecal Incontinence in Antenatal and Postnatal Women: Systematic Review

PURPOSE: The aim of this study was to review the literature to determine whether intensive pelvic floor muscle training during pregnancy and after delivery could prevent urinary and fecal incontinence. METHODS: Randomized controlled trials (RCT) of low-risk obstetric populations who had done Kegel exercise during pregnancy and after delivery met the inclusion criteria. Articles published between 1966 and 2012 from periodicals indexed in Ovid Medline, Embase, Scopus, KoreaMed, NDSL and other databases were selected, using the following keywords: 'Kegel, pelvic floor exercise'. The Cochrane's Risk of Bias was applied to assess the internal validity of the RCT. Fourteen selected studies were analyzed by meta-analysis using RevMan 5.1. RESULTS: Fourteen RCTs with high methodological quality, involving 6,454 women were included. They indicated that Kegel exercise significantly reduced the development of urinary and fecal incontinence from pregnancy to postpartum. Also, there was low clinical heterogeneity. CONCLUSION: There is some evidence that for antenatal and postnatal women, Kegel exercise can prevent urinary and fecal incontinence. Therefore, a priority task is to develop standardized Kegel exercise programs for Korean pregnant and postpartum women and make efficient use of these programs.

Comparison of a Waterless, Brushless Chlorhexidine/Ethanol Emollient with Povidone-Iodine Surgical Scrubs / 병원감염관리

BACKGROUND: The purpose of this study was to compare a 1% chlorhexidine gluconate/6l% ethanol (CHG/Ethanol) emollient and 7.5% povidone-iodine (PVI) scrub for antibacterial efficacy and effect on skin condition. METHODS: Twelve healthy newly employed nurses were recruited for this clinical study to evaluate the two hand cleansing agents. The CHG/Ethanol emollient hand preparation was applied without scrubbing and 7.5% PVI was applied using a scrub brush in 5-minute surgical scrubbing. Subjects used one method for 5 days and switched to the other method for another 5 days. Samples were taken for bacterial counts using the glove juice technique before and one minute after hand cleansing and again at the end of surgical operation on Day 1, 2, and 5. The VSS (Visual Scoring of Skin condition) scores and HSA (Hand Subject Assessment) scales were used to evaluate skin condition. RESULTS: Log reduction in bacterial counts by CHG/Ethanol emollient was greater than by PVI immediately after hand cleasing (log3.73 vs log1.66) and at the end of surgical operation (log3.49 vs log1.93) on Day 1. But there were no significant difference on Day 2 and 5. CHG/Ethanol emollient caused fewer skin problems than PVI; the VSS scores of the CHG/Ethanol emollient were better than those of PVI on Day 2, 3, 4, and 5 (P24.5 vs 23.0-->19.3). CONCLUSION: Compared to PVI, the CHG/Ethanol emollient hand preparation was shown to be more antibacterial and less irritation to skin. The results showed the possibility of using the waterless, scrubless agent for surgical hand scrub in Korea.