• Journal of Trauma and Injury
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• 제28권1호
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• pp.9-14
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• 2015

Purpose: The aim of this study was to estimate the seropositive prevalence of blood-borne infection in neurotrauma patients who underwent emergent surgical intervention, especially patients with hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human immunodefIciency virus (HIV). Methods: A retrospective review identified 559 patients with traumatic brain injury and spinal trauma who underwent emergent surgery between 2007 and 2014. We reviewed the medical records and extracted data, including age, sex, location of lesion, result of serologic tests, time interval of admission and surgery after presenting to emergency room. Serologic tests for HBV, HCV, syphilis and HIV were performed and analyzed to determine whether the seropositive results were confirmed by the surgeon before surgery. Results: The majority of the patients were male (74.6%), and the mean age was $55.4{\pm}20.2years$. Most patients underwent surgery due to traumatic brain injury (90.0%). Fifty-three patients (10.0%) showed a positive result on at least one serologic test. Seropositive rates according to pathogens were 0.5% for syphilis, 5.2% for HBV and 3.9% for HCV. No positive results were noted on the serologic tests for HIV. HBV in patients with spinal cord injury and age from 40 to 49 years were associated with high serologic positive rate, and that result was statistically significant. However, no statistically significant differences were found in the other variables. Serologic results could not confirmed before surgery in the majority of the cases (62.1%), and 10.4% of these patients showed seropositive results. Conclusion: The results of this study emphasize the importance of taking precautions and conducting rapid serologic testing in preventing the occupational transmission of blood-borne viruses to health-care workers.

• 한국의료질향상학회지
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• 제9권2호
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• pp.116-133
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• 2002

Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.

• 한국문헌정보학회지
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• 제56권2호
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• pp.133-155
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• 2022

본 연구는 2021년도 경기도 책꾸러미 정기배송 사업에서 양육자의 독서 육아의 효과를 분석함에 그 목적이 있다. 이를 위해 지표를 개발하고 효과성을 분석한 뒤 향후 경기도 독서문화 진흥 정책 수립 시 활용하고자 하였다. 이 사업은 소외 지역에 거주하는 유아 대상의 독서 복지를 위해, 기관과 가정이 연계하여, 가정에 책꾸러미를 정기 배송하고, 유아와 양육자를 대상으로 맞춤형으로 개별적인 교육을 실시하였다. 양육자의 독서 육아 효과 분석을 위한 측정지표는 가정 문식성, 부모 효능감 이론에 대한 문헌 검토를 바탕으로 설정되었고, 이후 17개 설문 문항을 개발하여 전문가를 통해 델파이로 타당도를 검증하였다. 이후 경기도 7개 시군(포천시, 양평군, 여주시, 동두천시, 가평군, 연천군, 양주시)의 양육자 105명을 대상으로 효과성 검증을 위하여 사전/사후조사를 실시하였다. 결과적으로 사전/ 사후 효과성을 조사한 결과, 유아 책꾸러미 정기배송 사업의 양육자는 독서 상호작용과 독서 육아 효능감 면에서 향상을 가져왔다. 이러한 사업 효과를 고려할 때, 이 정책은 특정 지역을 넘어서 보편적인 조기 유아 독서 복지 정책으로 가정과 기관이 연계한 형태로 지속적인 사업으로 실시될 필요가 있다.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.151-154
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• 2016

Purpose: To evaluate the association between time to surgery and injury severity score (ISS). Methods: Medical charts and records were reviewed for polytrauma patients who underwent trauma surgery from November 2014 to March 2016. The patients were divided into two groups based on the ISS. Results: Among the 217 operated patients, 22 patients underwent first and second surgery. The patients with an ISS over 17 (mean 13.0 days) had a longer interval between surgeries than patients with an ISS of 17 or less (mean 7.5 days) (p=0.031). One hundred and twenty-one patients only underwent elective surgery and there is a positive correlation between ISS and time to elective surgery (p<0.028, Pearson's correlation coefficient=0.224). Seventy-four patients underwent emergent surgery only. Among these, the patients with an ISS of 17 or less underwent general surgery (86%) but the patients with an ISS more than 17 underwent neurological surgery (47%). Conclusion: Patients with high ISS need critical care during the preoperative and postoperative period.

• 한국보육지원학회지
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• 제19권4호
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• pp.29-52
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• 2023

Objective: This research aims to examine the effect of a young children's engineering-focused STEAM program based on the project approach - a program that constructs components aligned with children's interests in their play through an engineering design process - on their scientific inquiry ability, mathematical problem-solving ability, and creativity. Methods: In this research, 42 five-year-old children from a public kindergarten in S district, I city, were randomly divided into experimental and comparative groups, each with 21 children. The engineering-focused STEAM program was conducted from April 18 to June 10, 2022, with the experimental group exploring the 'car' theme and the comparison group focusing on a different theme. The study employed an independent sample t-test and analysis of covariance(ANCOVA), using the pretest as a covariate to control variables. Results: The children-selected 'cars' themed engineering-focused STEAM program was effective in enhancing their scientific inquiry ability, mathematical problem-solving ability and creativity. Conclusion/Implications: The engineering-focused STEAM program, which emerges from young children's interesting daily play, had positive effects on enhancing their scientific inquiry ability, mathematical problem-solving ability, and creativity. This research can serve as fundamental data for developing education programs focused on engineering within the STEAM framework, guided by children's emergent play.

• 임상간호연구
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• 제20권2호
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• pp.223-235
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• 2014

Purpose: Resuscitation rooms in emergency department are places for time-critical tasks. This study aimed 1) to develop a resuscitation protocol for dyspneic patients and 2) to evaluate the effect of the resuscitation protocol for dyspneic patients in improving clinical performances. Methods: A panel of experts including emergency physicians and nurses developed a resuscitation protocol for dyspneic patients which included a list of critical interventions and time-limits. The resuscitation protocol was implemented in a emergency medical center for two months. Clinical performances of health care providers were compared by analyzing video-recorded clinical performances. Results: The resuscitation protocol consisted of four steps: Initial treatments within 5 minutes, main treatments within 15 minutes, diagnostic tests within 30 minutes, and disposition within 60 minutes. A total of 43 dyspneic patients (23 patients experimental group, 20 patients control group) were included for the analysis of the clinical performance change. Clinical performance rates were improved significantly from control group (66.71%) to experimental group (82.41%) after implementing the resuscitation protocol (Z=-3.09, p=.004). Conclusion: The resuscitation protocol developed for dyspneic patients improved clinical performance rates of health care providers. Further development of clinical protocols for other emergent cases at resuscitation rooms are strongly recommended.

• Tuberculosis and Respiratory Diseases
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• 제56권1호
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• pp.85-90
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• 2004

Rasmussen 동맥류는 공동성 폐결핵에 동반되어 종종 대량객혈을 일으킬 수 있어 임상적으로 중요하다. 그동안 이의 존재나 치료에 대한 보고는 간헐적으로 있어왔으나 본 증례와 같이 기관지내시경으로 직접 병변을 관찰하고 나선식 CT로 Rasmussen 동맥류의 존재를 확인한 경우는 없어 이에 보고하는 바이다. 또한 기관지 내시경 검사시 발견되는 종양 형태의 병변에는 이와 같은 혈관성병변도 있을 수 있으므로 생검 등의 침습적 검사시에 보다 신중해질 필요가 있으며, 기존 질환이 진행된 공동성 폐결핵일 경우에는 더욱 주의를 필요로 한다.

• 한국가족복지학
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• 제57호
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• pp.183-215
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• 2017

본 논문은 돌봄민주주의 관점에서 중앙정부의 보육정책을 규범적 접근으로 분석했다. 저출산 고령화로 인한 돌봄공백이 신사회 위험으로 등장하면서 경제성장 중심에서 돌봄가치 중심으로의 패러다임 전환이 필요하다는 사회적 인식이 이루어졌다. 하지만 돌봄윤리가 개별 정책에 어떤 방식으로 반영되어야 하는가에 대한 구체적인 정책연구는 많이 이루어지지 못해왔다. 이에돌봄민주주의 관점의 '자유', '평등', '정의' 가치를 적용해서 보육정책을 분석하고 새로운 정책지향을 제시하고자 했다. 분석결과는 다음과 같다. 먼저, 자유 관점에서, 현재 보육정책은 자유선택의 제약으로 인해 공공성과 사회연대성이 담보되지 못하고 있다. 둘째, 평등관점에서 성별및 소득불평등으로 인한 계층화는 인종과 세대의 축이 더해지면서 더욱 복잡하고 다층적인 불평등을 초래했으며, 사적 돌봄의 악순환이 나타나고 있다. 셋째, 정의관점에서 과거로부터 축적되어 온 부정의는 조정을 통해 교정되지 못하면서 구조적 불평등이 오히려 심화되는 것으로 나타난다.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.86-92
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• 2018

Background: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. Methods: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm were selected. Results: During the observation period, 225 patients were treated under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P<0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. Conclusion: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.161-171
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• 2005

Background: The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality.(p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.