• 제목/요약/키워드: Admission Patient

검색결과 973건 처리시간 0.033초

청심온담탕가미방과 침구치료를 포함한 복합한의치료로 호전된 심인성 떨림 환자 1례 - 증례보고 (A Case of Psychogenic Tremor Improved by Complex Korean Medicine Treatment Including Cheongshimondam-tang-gamibang and Acupuncture Treatment - A Case Report)

  • 이지현;윤석영;전현준;주성준;이지수;임정태;한양희
    • 대한한방내과학회지
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    • 제43권6호
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    • pp.1186-1197
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    • 2022
  • Objectives: A case study about the effectiveness of integrative Korean medicine treatment in a psychogenic tremor patient. Case presentation: A 36-year-old male diagnosed with psychogenic tremor with low back pain underwent 29 days of inpatient treatment and 4 weeks of outpatient treatment. His pattern identification was a psychogenic tremor of the weakness of the heart and gall bladder (SimDamHeoGup) type. The treatments were herbal medicine and acupuncture. He took Cheongshimondam-tang for 29 days and Chunwangbosim-dan for 6 weeks when he had symptoms. He also received acupuncture for 20 minutes twice a day at GB20 (Pungji), L14 (Hapgok), HT4 (Yeongdo), PC6 (Naegwan), HT7 (Sinmun), GB34 (Yangleungcheon), ST36 (Joksamni), SP6 (Sameumgyo), and LR3 (Taechung). After 8 weeks of treatment, the Fahn Tolosa Marin rating (FTM) scale of his tremor, at rest, dropped from Grade 4 on both upper extremities, trunk, and both lower extremities at the time of admission to Grade 2 in both upper extremities and trunk, and Grade 0 in both lower extremities at the time of discharge. His Beck Anxiety Inventory (BAI) score decreased from 38 to 7, and his numerical rating scale (NRS) decreased from 8 to 1 for low back pain and from 9 to 2 for tremor. A follow-up visit to the hospital 2 months after the end of treatment confirmed continued symptom improvements and no significant side effects. Conclusions: This study suggests the possibility of treating psychogenic tremor using only Korean medicine treatments. Further studies with control groups and long-term follow-up are needed.

Current Status of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury in Korea : A Post Hoc Analysis of Korea Neurotrauma Databank Project with a Nationwide Survey

  • Youngheon Lee;Jung Hwan Lee;Hyuk Jin Choi;Byung Chul Kim;Seunghan Yu;Mahnjeong Ha;The KNTDB Investigators
    • Journal of Korean Neurosurgical Society
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    • 제66권5호
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    • pp.543-551
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    • 2023
  • Objective : This study aimed to investigate the current status of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI) in Korea and the association between ICP monitoring and prognosis. In addition, a survey was administered to Korean neurosurgeons to investigate the perception of ICP monitoring in patients with sTBI. Methods : This study used data from the second Korea Neurotrauma Databank. Among the enrolled patients with sTBI, the following available clinical data were analyzed in 912 patients : Glasgow coma scale score on admission, ICP monitoring, mortality, and extended Glasgow outcome scale score at 6 months. In addition, we administered a survey, entitled "current status and perception of ICP monitoring in Korean patients with sTBI" to 399 neurosurgeons who were interested in traumatic brain injury. Results : Among the 912 patients, 79 patients (8.7%) underwent ICP monitoring. The mortality and favorable outcome were compared between the groups with and without ICP monitoring, and no statistically significant results were found. Regarding the survey, there were 61 respondents. Among them, 70.4% of neurosurgeons responded negatively to performing ICP monitoring after craniectomy/craniotomy, while 96.7% of neurosurgeons responded negatively to performing ICP monitoring when craniectomy/craniotomy was not conducted. The reasons why ICP monitoring was not performed were investigated, and most respondents answered that there were no actual guidelines or experiences with post-operative ICP monitoring for craniectomy/craniotomy. However, in cases wherein craniectomy/craniotomy was not performed, most respondents answered that ICP monitoring was not helpful, as other signs were comparatively more important. Conclusion : The proportion of performing ICP monitoring in patients with sTBI was low in Korea. The outcome and mortality were compared between the patient groups with and without ICP monitoring, and no statistically significant differences were noted in prognosis between these groups. Further, the survey showed that ICP monitoring in patients with sTBI was somewhat negatively recognized in Korea.

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients

  • Minjung Bak;Minyeong Kim;Boram Lee;Eun Kyoung Kim;Taek Kyu Park;Jeong Hoon Yang;Duk-Kyung Kim;Sung-A Chang
    • Korean Circulation Journal
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    • 제53권3호
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    • pp.170-184
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    • 2023
  • Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

한국형 COVID-19 흉부영상 진단 시행 가이드라인 (Korean Clinical Imaging Guidelines for Justification of Diagnostic Imaging Study for COVID-19)

  • 진광남;도경현;남보다;황성호;최미영;용환석
    • 대한영상의학회지
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    • 제83권2호
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    • pp.265-283
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    • 2022
  • 흉부영상의 적절한 활용을 위해 한국형 코로나바이러스 감염증(이하 COVID-19) 흉부영상진단 시행 가이드라인을 개발하였다. 8가지 문장형 핵심 질문을 선정하고, 근거기반 임상영상 가이드라인 수용개작 방법론에 의거하여 권고안을 작성하였다. 권고 내용은 다음과 같다. COVID-19 확진자와 접촉한 증상이 없는 사람에 대하여 COVID-19의 진단을 위하여 흉부영상검사(흉부X선검사 또는 CT)를 사용하지 않는 것이 적절하다. COVID-19가 의심되는 증상이 있으나 reverse transcription polymerase chain reaction 검사를 이용할 수 없는 경우 흉부영상검사 사용을 고려할 수 있다. COVID-19가 확인된 환자에게 병원 입원을 결정하기 위하여 임상 평가 및 검사실 검사와 함께 흉부영상검사를 고려할 수 있다. COVID-19 입원환자의 증상 경중 및 위험요인의 유무에 따라 흉부영상검사를 고려할 수 있으며, 치료 방법을 결정하거나 수정하는데 이용할 수 있다. COVID-19 환자에서 객혈 또는 폐색전증이 의심되는 경우 CT 혈관조영술을 시행할 수 있다. 증상이 호전된 COVID-19 환자의 퇴원 결정을 하는데 흉부영상검사를 사용하지 않는 것이 적절하다. COVID-19에서 회복된 환자를 추적검사할 때 폐 기능 장애가 있는 환자에서 치료 가능한 폐질환과 구별하기 위해 흉부영상검사를 고려할 수 있다.

Clinical and Imaging Characteristics of SARS-CoV-2 Breakthrough Infection in Hospitalized Immunocompromised Patients

  • Jong Eun Lee;Jinwoo Kim;Minhee Hwang;Yun-Hyeon Kim;Myung Jin Chung;Won Gi Jeong;Yeon Joo Jeong
    • Korean Journal of Radiology
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    • 제25권5호
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    • pp.481-492
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    • 2024
  • Objective: To evaluate the clinical and imaging characteristics of SARS-CoV-2 breakthrough infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Materials and Methods: This retrospective study analyzed consecutive adult patients hospitalized for COVID-19 who received at least one dose of the SARS-CoV-2 vaccine at two academic medical centers between June 2021 and December 2022. Immunocompromised patients (with active solid organ cancer, active hematologic cancer, active immune-mediated inflammatory disease, status post solid organ transplantation, or acquired immune deficiency syndrome) were compared with immunocompetent patients. Multivariable logistic regression analysis was performed to evaluate the effect of immune status on severe clinical outcomes (in-hospital death, mechanical ventilation, or intensive care unit admission), severe radiologic pneumonia (≥ 25% of lung involvement), and typical CT pneumonia. Results: Of 2218 patients (mean age, 69.5 ± 16.1 years), 274 (12.4%), and 1944 (87.6%) were immunocompromised an immunocompetent, respectively. Patients with active solid organ cancer and patients status post solid organ transplantation had significantly higher risks for severe clinical outcomes (adjusted odds ratio = 1.58 [95% confidence interval {CI}, 1.01-2.47], P = 0.042; and 3.12 [95% CI, 1.47-6.60], P = 0.003, respectively). Patient status post solid organ transplantation and patients with active hematologic cancer were associated with increased risks for severe pneumonia based on chest radiographs (2.96 [95% CI, 1.54-5.67], P = 0.001; and 2.87 [95% CI, 1.50-5.49], P = 0.001, respectively) and for typical CT pneumonia (9.03 [95% CI, 2.49-32.66], P < 0.001; and 4.18 [95% CI, 1.70-10.25], P = 0.002, respectively). Conclusion: Immunocompromised patients with COVID-19 breakthrough infection showed an increased risk of severe clinical outcome, severe pneumonia based on chest radiographs, and typical CT pneumonia. In particular, patients status post solid organ transplantation was specifically found to be associated with a higher risk of all three outcomes than hospitalized immunocompetent patients.

종합병원 입원 환자의 정신 건강 평가 (A Study on Anxiety-Depression and Psycnoticism in Hospitalized Patients)

  • 김진성
    • Journal of Yeungnam Medical Science
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    • 제9권1호
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    • pp.54-67
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    • 1992
  • 1991년 10월부터 1992년 3월까지 부산시에 소재하는 세개 종합병원 임상 각 과의 비정신과 환자 497명과 DSM-III-R진단 기준에 의거하여 정신장애로 진단되어 입원중인 정신과 환자 42명을 대상으로 신불안 우울척도(NADS)와 정신증 척도(PSCS)를 사용하여 평가한 결과는 다음과 같다. 비정신과 환자군의 불안 우울 점수의 평균은 $34.4{\pm}10.4$, 정신과 환자의 점수는 $50.5{\pm}18.3$으로 정신과 환자군이 유의하게 높았다(P<0.001). 비정신과 환자의 정신증 점수 평균은 $3.9{\pm}4.4$, 정신과 환자군은 $20.3{\pm}9.8$로 정신과 환자군이 유의하게 높았다(P<0.001). 사회정신의학적 요인들중 불안 우울 및 정신증 성적에 공통적으로 유의한 영향을 끼친것은 가정분위기 및 가족과의 친숙도에 불만족인 경우(각각 P<0.001, P<0.001) 및 미래 현재 과거의 자아상에 대한 태도에 있어서 비관적인 경우(각각 P<0.001, P<0.001, P<0.001), 과거 정신과적 치료 및 입원 경험이 있었던 경우(각각 P<0.01, P<0.01)등이었다. 불안 우울 척도와 정신증(${\gamma}$ = 0.74), 과거 자아상과 현재 자아상에 대한 태도(${\gamma}$ = 0.45), 현재 자아상과 미래 자아상에 대한 태도(${\gamma}$ = 0.45), 과거 자아상과 미래 자아상(${\gamma}$ = 0.34) 가정 분위기 및 가족과의 친숙도 (${\gamma}$ = 0.49) 사이에 상관관계가 있었다. 희귀분석결과 불안 우울 정도를 설명 예측할 수 있는 변수들의 중요도는 현재 자아상에 대한 태도, 가족과의 친숙도, 미래의 자아상에 대한 태도, 과거 자아상에 대한 태도, 가정 분위기 순이었다. 불안 우울 및 정신증 성적 결과에 따라서 판별 분석 결과, 집단이 잘못 분류된 사례는 비정신과 환자군 중 22명, 정신과 환자군중 2명이었다.

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불완전 가와사끼병에서 NT-proBNP의 진단적 역할 (NT-proBNP as a useful tool in diagnosing incomplete Kawasaki disease)

  • 이동원;김여향;현명철;권태찬;이상범
    • Clinical and Experimental Pediatrics
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    • 제53권4호
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    • pp.519-524
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    • 2010
  • 목 적: 지속적인 발열과 3개 이하의 가와사끼병 진단 기준을 만족하는 환자군에서 불완전 가와사끼병을 감별하는데 있어 NT-proBNP가 가지는 진단적 의미를 살펴보고자 하였다. 방 법: 2008년 1월부터 2009년 6월까지 가와사끼병으로 진단 및 치료 받은 환자 96명을 대상으로 하였다. 진단은 입원 당일 열을 포함한 가와사끼병의 고전적인 진단 기준에 따랐고, 진단 기준의 만족 정도에 따라서 완전 가와사끼병 환자군과 불완전 가와사끼병 환자군으로 구분하였으며, NT-proBNP를 포함한 혈액검사를 시행하였다. 지속되는 열과 함께 3개 미만의 진단 기준을 만족하였지만 임상 경과와 여러 검사들을 통해 환자 19명을 대조군으로 하여 분석하였다. 결 과: 96명의 가와사끼병 환자 중 고전적인 진단 기준을 3가지 이하로 만족한 불완전 가와사끼병 환자는 33명으로 전체 가와사끼병 환자의 34% 였다. 임상 양상으로 구강 점막의 변화와 안검 충혈이 가장 많았는데 완전 가와사끼병에 비해 발생 빈도는 적었다(76% vs 98%, 76% vs 90%). 불완전 가와사끼병 환자의 NT-proBNP는 대조군에 비해 유의하게 높았으며($1407.7{\pm}1633.5pg/mL$ vs $126.2{\pm}135.5pg/mL$, $P$<0.001), cutoff value를 158 pg/mL으로 하였을 때 민감도 81%, 특이도 74% 로 C 반응성 단백 ${\geq}3mg/dL$의 민감도 74%, 특이도 68% 보다 높았지만, 적혈구 침강 속도 ${\geq}40mm/hr$의 민감도 70%, 특이도 84%로 특이도에서 적혈구 침강 속도보다 낮았다. 결 론: 지속되는 열, 안검 충혈, 구강 점막의 변화가 있어 불완전 가와사끼병으로 의심해야 하는 환자에서 NT-proBNP 검사를 시행하고 진단에 이용하는 것이 가와사끼병의 빠른 진단과 치료에 도움이 될 것이다.

안정된 만성 폐쇄성 폐질환환자와 급성 악화상태의 혈중 Osteopontin 농도 비교 (Comparison of Serum Osteopontin Levels in Patients with Stable and Chronic Obstructive Pulmonary Disease and Exacerbation)

  • 마정은;이승훈;김유은;임수진;이승준;정이영;김호철;이종덕;황영실;조유지
    • Tuberculosis and Respiratory Diseases
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    • 제71권3호
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    • pp.195-201
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    • 2011
  • Background: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. Methods: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. Results: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects ($62.4{\pm}51.9ng/mL$, $36.9{\pm}11.1ng/mL$, $30{\pm}11ng/mL$, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission ($45{\pm}52.1ng/mL$, $62.4{\pm}51.9ng/mL$, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker ($23{\pm}5.7ng/mL$, $35.5{\pm}17.6ng/mL$, $58.6{\pm}47.8ng/mL$, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second ($FEV_1$%) predicted in healthy controls and stable COPD patients (r=-0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). Conclusion: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.

한 대학병원 내과계 중환자실에서 장기간 기계환기를 받은 노인 환자들의 특징 및 예후 (Clinical Characteristics and Prognosis of Elderly Patients Receiving Prolonged Mechanical Ventilation in the Medical Intensive Care Unit at a University Hospital)

  • 한민수;문경민;이양덕;조용선;나동집
    • Tuberculosis and Respiratory Diseases
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    • 제64권6호
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    • pp.445-450
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    • 2008
  • 연구배경: 최근 노인 인구가 급격히 증가하면서 중환자실로 입원하는 노인 환자도 증가하는 추세이다. 내과계 중환자실에서 30일 이상 장기간 기계환기를 받은 노인 환자들의 임상적 특징 및 예후에 대하여 알아보고자 하였다. 방 법: 2004년 4월부터 2007년 3월까지 을지대학병원 내과계 중환자실에 입원했던 환자들 중에서 연속해서 30일 이상 기계환기를 받았던 65세 이상 환자 41명을 대상으로 임상적 특징과 예후에 대하여 후향적으로 조사하였다. 결 과: 대상 환자 41명의 평균 연령은 $74.6{\pm}6.0$세이었고, 남자가 27명(65.9%)이었다. 중환자실로 입원한 주된 이유는 급성호흡부전 30명(73.2%)으로 가장 많았고 패혈증 5명(12.2%), 신경계장애 4명(9.8%), 위장관출혈 2명 (4.9%) 순이었다. 평균 APACHE II 점수는 $26.9{\pm}4.5$이었다. 중환자실 평균 입원 기간은 $49.3{\pm}23.0$일 이었으며 기계환기의 평균 기간은 $57.5{\pm}32.8$일이었다. 사망한 환자는 25명(60.9%)이었으며 사망과 관련있는 인자는 APACHE II 점수(p=0.038)와 수혈(p=0.007) 등이었다. 결 론: 장기간 기계환기 치료를 받은 노인 환자들에서 호흡부전이 가장 흔한 중환자실 입원 이유이었으며 사망률은 60.9%이었고 사망에 영향을 주는 인자는 APACHE II 점수와 수혈 등이었다.

산욕부 안위에 영향을 미치는 병원환경 요인에 관한 연구 (Study on Hospital Environmental Causes Affected the Mother′s Comfort After Her Child Birth)

  • 변수자
    • 대한간호학회지
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    • 제8권1호
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    • pp.1-15
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    • 1978
  • The Purpose of this study is to examine closely the causes influenced upon the comfort and recovery of the woman delivered of a child in the hospital at the same time to understand environmental status of hospitals in order to promote mother's health recovery, and to improve hospital environment by emphasizing the meaning of environment and health before the medical staff and hospital administrative authority. In the method of servery of the research, 165 post paestum patients have been randomly selected who were accommodated and delivered their babies at OB(obstetric ) & GY (Gynecologic) unit the 7 general hospitals for the period of 6 December 1976 through 17 December 1976. As for the survey, it has been used of Questionnaire where we have 65 items in the respect of personal environment in the hospital such as trusting nurse, ability, reliability, kindness and etiquette of nurse and tile character of nurse the relationship with patients the other respect of physical environment included 9f temperature, moisture. air-ventilation lightening noise, cleanness. facilities, and the third realm being of mother's hearth ground to have the following conclusion 1. The feature of the collected personnel they are from OB or GY sects of from OB unit of the other 5 hospitals except the two general hospitals of the college or school Otherwise the rate of the patients to nurses would be 9 : 1. As for the nurses'ground it would be appeared of 20-25 years of age as the 76%. either 3 year course or 4 year course in the education would be each 50% and less than 2 year experience case would record as of 60 %. In the respect of hospital physical environmental status, there we have two hospitals without any thermometers, on the other han4 nowhere there's hygrometer, otherwise, the lightening is normal or over than normal As for the structure of noise protection the corridors're, generally speaking worse than rooms, nerver hueless, there's no ventilating system in the hospitals. The rooms'repainted in white and yellow, light green white, or green color. The patient's clothing were in green pink blue, light green or in white co for. There're not anything special in both decoration and equipments. Most of them used tall beds except in one hospital 2. To the extent of perception of patient's hatch 9round and hospital environment it is presented that they perceived nurse's ability in highest in total human variable, though perceived kindness or etiquette in the lowest otherwise, comparatively high in total average. 3. In the respect of physical environment it is highest perceived of lightening terms, otherwise, lowest perceived of air ventilation and total average became lowest than the one of the original record 4. To ages, in the respect of hatch ground rather old aged mother than the younger one has perceived that nurse would be trusting, in good service character, able, at the same time, liable, Otherwise, in physical environment regardless of age, they perceived lightening in high and remarkably lower in ventilation As a result of the examination of the difference in hospital environment to each age it is appeared of statistical difference at 5% level of ability in the personal environment otherwise little difference as for physical environment 5. In the respect of perceiving level to educational standard it is highly perceived of personal environment for higher ranking group rather than lower group in the educational standard. In case of physical environment it is highly perceived for lower level group rather than higher level group in educational background. The variables which have statistical significance at 5% level are from trusting kindness, etiquette and total kindness, etiquette and total all significance at 5% level are from trusting, kindness, etiquette and total human environment variable in personal environment, otherwise, there's little difference in the physical environment. 6. The perceiving level due to times of admission and accommodation at the hospital would be cleared out as gradual higher perception both physical and personal environment in the hospital. At 5% significant level of the ventilation condition in physical environmental variable it is presented of meaningful difference otherwise, there we have little difference both in Personal variable and other one. 7. In accordance with living standard, the perception degree of personal environment in tee hospital would be inclined to increase to higher living standard on the other hand, in case of the physical environment, the perception level world increase to lower living standard At 5 % level, the trustuariable and total scores in the personal eicuironmectal variable there appeared a meaningful/ significant difference otherwise, there presented little difference both in physical environmental and other variable to the living standard 8. Pertaining to family unit, the mother of an independent family unit perceived highly in all respect of the personal and the physical environment in the hospital rather than the woman of succeeding family unit. At 5 % level there appeared a difference in the respect of kindness and etiquette both in personal environment variable, on the other hand, there hardly marked a difference between other variable and physical environmental one. 9. The degree of perception to comforting level has little connection with a statistical difference the age, educational level hospital admitting times, living standard or family unit. 10. The most effective variable to mother's comforting level will be nurse's ability, reliability, trusting manner, and total physical environment variable in order.

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