• Archives of Plastic Surgery
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• 제47권3호
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• pp.223-227
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• 2020

Background After the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients. Methods From January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6-91 years). The average ISS was 22.01 points (range, 16-75 points). Results The most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission. Conclusions Through this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.

• Journal of Chest Surgery
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• 제48권3호
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• pp.187-192
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• 2015

Background: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. Methods: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillo-bifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. Results: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of $21.2{\pm}9.4$ months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up.. Conclusion: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

• 가정∙방문간호학회지
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• 제18권2호
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• pp.81-87
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• 2011

Purpose: The aim of this study was to estimate optimization model of stay time in EMC. Methods: Data were collected at an EMC in a hospital using medical records from June to August in 2007. The sample size was 8,378. The data were structured by stay time for doctor visit, decision making, and discharge from EMC. Descriptive statistics were used to find out general characteristics of patients. Average mean and quantile regression models were adopted to estimate optimized stay time in EMC. Results: The stay times in EMC were highly skewed and non-normal distributions. Therefore, average mean as an indicator of optimal stay time was not appropriate. The total stay time using conditional quantile regression model was estimated about 110 min, that was about 166 min shorter than estimated time using average mean. Conclusion: According to these results, we recommend to use a conditional quantile regression model to estimate optimal stay time in EMC. We suggest that this results will be used to develop a guideline to manage stay time more effectively in EMC.

• 한국병원경영학회지
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• 제15권4호
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• pp.165-190
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• 2010

Objectives : This study was supposed to investigate factors which influence to preference of medical tourism products of Japanese tourists in Seoul, Korea. Methods : Data were collected from 228 Japanese tourists who visited' Seoul Center for Culture & Tourism' in Myeong-dong, Seoul, Korea. We measured factors which influence to preference for medical tourism. The data were analyzed by T-test, ANOVA, and multiple regression analysis. Results : The major findings were as follows ; Japanese tourists preferred medical products in the order of skin care, oriental medicine treatment, health screening, and scaling & teeth whitening. They considered technical level of medical staff most importantly, followed by safety of medical products, communication during diagnosis and treatment, follow-up service, modernization of medical facilities and equipment, and the reasonable medical expenses. Japanese tourists' preferred medical institutions in the order of a university hospital, a specialty clinic, a special hospital, They said they intend to pay 50,000 to 150,000 yen for medical tourism. The preference to medical tourism products are that single women group in their twenties and thirties for skin care, married people group aged over thirties preferred oriental medicine treatment, and married men aged over forties and high income earners favored health screening. Conclusions : It should be considered carefully that the preference exists on some factors especially for Japanese tourist. Further research about preference on medical tourism products for tourists from the other countries is required appropriately to fulfill the needs.

• Clinical and Experimental Pediatrics
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• 제64권7호
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• pp.364-369
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• 2021

Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections. Purpose: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children. Methods: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients. Results: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2-14] years vs. 4 [2-6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more frequently in influenza patients than in COVID-19 patients (22.1% vs. 8.5%, P=0.029; 17.6% vs. 5.6%, P=0.013; and 13.2% vs. 5.6%, P=0.048, respectively). Both groups showed significantly elevated monocyte levels in the complete blood count (70.4% vs. 69.9%, P=0.511). Major chest x-ray findings in COVID-19 patients included mild diffuse ground-glass opacity and right lower lobe infiltrates. There were no statistically significant intergroup differences in hospitalization or mortality rates; however, the intensive care unit admission rate was higher among COVID-19 patients (2.4% vs. 0.5%, P=0.045). Conclusion: In this study, pediatric COVID-19 patients showed a wide range of clinical presentations ranging from asymptomatic/mild to severe illness. We found no intergroup differences in hospitalization rates, oxygen requirements, or hospital length of stay; however, the intensive care unit admission rate was higher among COVID-19 patients.

• 보건행정학회지
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• 제33권2호
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• pp.185-193
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• 2023

Background: This study focuses on the establishment and operation of a stroke patient hotline program to help patients and their caregivers determine when acute neurological changes require emergency attention. Method: The stroke hotline was established at the Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, in June 2016. Patients diagnosed with stroke during admission or in outpatient clinics were registered and provided with stroke education. Consulting nurses managed hotline calls and made decisions about outpatient schedules or emergency room referrals, consulting physicians when necessary. The study analyzed consultation records from June 2016 to December 2020, assessing consultation volumes and types. Outcomes and hotline satisfaction were also evaluated. Results: Over this period, 6,851 patients were registered, with 1,173 patients (18%) undergoing 3,356 hotline consultations. The average monthly consultation volume increased from 29.2 cases in 2016 to 92.3 cases in 2020. Common consultation types included stroke symptoms (22.3%), blood pressure/glucose inquiries (12.8%), and surgery/procedure questions (12.6%). Unexpected outpatient visits decreased from 103 cases before the hotline to 81 cases after. Among the 2,244 consultations between January 2019 and December 2020, 9.6% were recommended hospital visits, with two cases requiring intra-arterial thrombectomy. Patient satisfaction ratings of 9-10 points increased from 64% in 2019 to 69% in 2020. Conclusion: The stroke hotline program effectively reduced unexpected outpatient visits and achieved high patient satisfaction. Expanding the program could enhance the management of stroke-related neurological symptoms and minimize unnecessary healthcare resource utilization.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.95-97
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• 2011

Purpose: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we could improve the financial balance of the trauma center. Methods: Retrospective analysis was performed on patients visiting SNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. Results:The 31 patients in this study included 20 males and 11 females. The average ISS was $33.23{\pm}16.65$ points. We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The average hospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. Conclusion: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.

• 대한통합의학회지
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• 제7권2호
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• pp.111-119
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• 2019

Purpose : The aim of this study was to investigate patterns of medical use among juveniles and adolescents, including for chronic disease, in Korea. The study sought to do the following: (a) investigate the extent to which chronic diseases account for medical expenditures, (b) investigate and the socio-demographic characteristics associated with medical use, and (c) identify the differences in medical use between juveniles and adolescents. Methods : We used data from the 2015 Korean Health Panel and selected 12 variables. The socio-demographic characteristics investigated included, growth period (juvenile, adolescents), gender, family income, national basic livelihood act status, disability registration, and degree of disability. There were five medical factors that were considered: emergency room use, hospitalization use, hospital outpatient use, chronic disease, and medical expenditure. Data were analyzed using stepwise multiple and logistic regression. Results : The prevalence of chronic disability in juveniles and adolescents was 31.1 % and 1 %, respectively. The factors affecting medical expenditures included hospitalization use, hospital outpatient use, family income, disability, gender, chronic disease, and emergency room use ($R^2=.160$, p<.05). For national basic livelihood act recipients, the probability of having chronic disease was about 1.6 times higher (OR=1.597, 95 % CI=1.092-2.335, p=.016), compared with non-national basic livelihood act recipients. People with disabilities were 6.6 times more likely than those without disabilities to suffer from chronic disease (OR =6.571, 95 % CI=2.776-15.556, p<.001). Hospital outpatient user was 2.3 times higher than non-user (OR=2.260, 95 % CI=1.702-3.001, p<.001). Juveniles had a 1.7 times and 6.2 times higher likelihood of emergency rooms user (OR=1.654, 95 % CI=1.270-2.155, p<.001), and hospital outpatient user than adolescents (OR=6.208, 95 % CI=4.443-8.676, p<.001). Conclusion : The findings of this study suggest that health care services for juveniles is needed to manage chronic diseases that have an effect on medical expenditures.

• 한국임상수의학회지
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• 제40권6호
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• pp.399-407
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• 2023

Chronic kidney disease (CKD) occurs in more than 15% of the dogs over 10 years of age and causes irreversible renal function deterioration. Therefore, it is important to diagnose CKD early and treat the disease properly. The purpose of this study aimed to to evaluate the clinical utility of urine albumin/creatinine ratio (ACR) using POC (point-of-care) device as an early detection urinary biomarker in CKD dogs and to confirm the correlation between ACR and other known CKD biomarkers. Urine and serum samples were obtained from 50 healthy dogs and 50 dogs with CKD. Serum blood urea nitrogen (BUN), creatinine, and symmetric dimethylarginine (SDMA) concentrations, and urine protein creatinine ratio (UPC) were measured. Urine specific gravity (USG) was evaluated using refractometer, and ACR was measured using an i-SENS A1Care analyzer. The ACR values of dogs with CKD were significantly different from those of healthy dogs (p < 0.001), as with other renal biomarkers. ACR showed significant differences between healthy dogs and dogs with CKD at every IRIS stage (p < 0.005), whereas no significant differences were observed between dogs with CKD IRIS stage I and healthy dogs with UPC. There are significant positive correlation between ACR and BUN (r = 0.611, p < 0.001), creatinine (r = 0.788, p < 0.001), SDMA (r = 0.747, p < 0.001), and UPC (r = 0.784, p < 0.001), and significant negative correlation between ACR and USG (r = -0.700, p < 0.001). In receiver operator characteristic curve analysis, the area under the curve (AUC) was 0.982 (95% CI 0.963-1.000, p < 0.001), with an optimal cut-off value of 64.20 mg/g (94% sensitivity and 94% specificity). Thus, ACR is a useful urinary biomarker for the early diagnosis of proteinuria in CKD and combined use of ACR and other renal biomarkers may be helpful for early diagnosis and prevention of CKD in dogs.

• 대한의용생체공학회:의공학회지
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• 제40권5호
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• pp.197-205
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• 2019

The existing Extracorporeal membrane oxygenation(ECMO) and Cardiopulmonary bypass system(CPB) have been developed and applied to various devices according to their respective indications. However, due to the complicated configuration and difficult usage method, it causes inconvenience to users and there is a risk of an accident. Therefore, smart all-in-one cardiopulmonary circulation device is being developed recently. The smart all-in-one cardiopulmonary assist device consists of a blood pump for cardiopulmonary bypass, a blood oxidizer for cardiopulmonary bypass, a blood circuit for cardiopulmonary bypass, and an artificial cardiopulmonary device. It is an integrated cardiopulmonary bypass device that can be used for a variety of purposes such as emergency, intraoperative, post-operative intensive care, and long-term cardiopulmonary assist, combined with CPB used in open heart surgery and ECMO used when patient's cardiopulmonary function does not work normally. The smart all-in-one cardiopulmonary assist device does not exist as a standard and international standard applicable to advanced medical devices. Therefore, in this study, we will refer to the International Standard for Blood Components, the International Standard for Blood, the Guideline for Blood Products, and prepare applicable performance and safety guidelines to help quality control of medical devices, and contribute to the improvement of the health of people. The guideline, which is the result of conducted a survey of the method of safety and performance test, is based on the principle of all-in-one cardiopulmonary aiding device, related domestic foreign standards, the status of domestic and foreign patents, related literature, blood pump(ISO 18242), blood oxygenator (ISO 7199), and blood circuit (ISO 15676) for cardiopulmonary bypass.The items on blood safety are as follows: American Society for Testing and Materials ASTM F1841-97R17), and in the 2010 Food and Drug Administration's Safety Assessment Guidelines for Medical Assisted Circulatory Devices. In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers / importers, testing inspectors, academia, etc. the final guideline was established through revision and supplementation process. Therefore, we propose guidelines for evaluating the safety and performance of smart all-in-one cardiopulmonary assist devices in line with growing technology.