• Journal of Trauma and Injury
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• 제23권1호
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• pp.6-15
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• 2010

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

• Child Health Nursing Research
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• 제8권3호
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• pp.260-271
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• 2002

This study was performed to identify the level of stress recognized by the parents as a support system for their infant patients who were hospitalized in an emergency department, thus to provide the resulting data as the basic material of care intervention for the families of infant patients. This study subjected the parents with infant patients who were hospitalized in emergency department of C University Hospital in Daejeon, and the data was collected from questionnaires for them, dating from Mar. 20, to Jun. 24, 2001 This study used the tool(30 questions) which was originally developed by Ji, Dong-ok (1992) for measuring the stress of families of infant patients in emergency room, and then was modified and complemented by this researcher suitably for infant patients. Collected data was statistically analyzed with frequency, percentage, mean, standard deviation, t-test, ANOVA, by using SPSS WIN10.0 program, and the results were as follows: 1. The stress of parents with infant patients hospitalized in emergency department averaged 3.31 on the basis of 5-point measure, which means that they felt stress beyond means. 2. The factor with high average out of stress factors the parents of infant patients recognized included the followings: 'about the pain of infant patients due to examination(3.91±1.00)'; 'about rare opportunity to be in contact with physician(3.78±1.09)'; 'delay in emergent treatment required for infant patients(3.75±1.31)'; 'delay in the general treatment of infant patients(3.72±1.32)'. Factors of the stress level includes the followings: 'care and medical treatment'(3.46±.72); 'body and diseases'(3.41±.97)'; 'lack of information and supportable resources (3.25±.77)'; and so on. 3. For the stress level according to general characteristics, there were statistically significant differences in the result of the condition of infant patients, medical treatment(P<.01), religion, the procedure of treatment(P<.05). With little preceding studies for infant patients hospitalized in emergency department, this study looked through the level of stress recognized by the parents of infant patients. Based on the comprehension on the parents with infant patients and the knowledge on stress factors recognized by the parents, it is expected that we can seek the methods of care intervention such as explanation of care and treatment procedures, unit policies, continuous interest and emotional supports as well as the provision of information to understand the responses of parents and reduce accompanied stresses.

• 대한치과의사협회지
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• 제50권12호
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• pp.763-770
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• 2012

The purposes of this work were to assess the cognition of the registered nurse(RN) on oral and maxillofacial emergency treatment and to compare cognition of the RN with that of the 119 emergency medical technician(EMT). 450 RNs who were working at each of secondary hospitals in Jeju province had responded to the questionnaire. Independent sample t-test and chi-square test were used to assess the state of RN on dental emergency treatment and to compare RN with EMT. The question 'education time on dentistry in formal education' that marked '0 hour' and '1-3 hours' were 73.3% and 20.0%, respectively. The question 'refresher training class on dentistry' that marked '0 hour' and '1-3 hours' were 92.9% and 6.7%, aggregately 99.6%. The results showed low score in the question 'reduction of temporo-mandibular joint(TMJ)'($1.67{\pm}0.857$), 'fixation of dislocated TMJ'($1.70{\pm}0.853$) and 'post-avulsed tooth treatment'($1.78{\pm}0.774$) by 5-point Likert scale. Likewise, the scores were $2.02{\pm}0.806$ in the question 'treatment of maxillofacial trauma', $2.76{\pm}1.061$ in the question 'emergent care of avulsed tooth', $2.70{\pm}1.095$ in the question 'treatment time of avulsed tooth' and $2.79{\pm}1.056$ in the question 'mouth guard', respectively. Compared to EMT, results of RN showed a statistically lower figure(p<0.05) in all items compared except the question 'medicine control', and the question 'doctor care in emergency room' was borderline(p=0.069). From this study, it is necessary for RN and student of nursing science to be educated on the oral and maxillofacial emergency treatment for the initial management of injuries. Authors suggest further co-study and nation-wide research with nursing care.

• Journal of Trauma and Injury
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• 제32권1호
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• pp.1-7
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• 2019

Purpose: The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region. Methods: We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups. Results: No significant differences were found in the annual patients' average age ($54.1{\pm}20.0$ vs. $52.8{\pm}18.2$, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: -0.358, -0.271 vs. post-trauma group: 1.071, 0.958). Conclusions: There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

• 한국의료질향상학회지
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• 제7권2호
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• pp.138-155
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• 2000

3차 의료기관 응급의료센터의 총 진료소요시간을 단축하여 업무의 효율성을 높이고 환자적체를 해소하는 방안을 마련하기 위하여 l997년 4월 1개월 동안 대구광역시 소재 영남대학교병원 응급의료센터 내원환자 1,742명을 대상으로 환자의 특성, 응급진료와 관련된 내용 및 응급진료시간, 그리고 상호관련성을 분석하였다. 평균 초진소요시간은 83.3분이었고, 남자 83.1분, 여자 84.9분여였으며, 평균 총 진료소요시간은 전체 698분이었고, 남자 718.0분 여자 670.5분이었다. 총 진료소요시간은 고령일수록 증가하였으며 의료보호환자에서 초진 및 퇴실시간이 가장 많이 소요되었고 산재환자는 가장 적게 소요되었다. 전원시 소견서를 구비하지 않은 경우에 초진소요시간어이 많았으며, 총 진료소요시간은 외래어에서 전과된 경우, 타병원으로부터 전원된 경우, 전원시 소견서를 구비한 경우와 OCS를 부분적으로 사용한 경우에 많았다. 약물중독환자, 심폐소생술을 시행한 환자, 내과환자 수혈을 받은 환자 및 복합진료 여부가 3개과 이상이었던 환자에서 총 진료소요시간이 많았으며 당직인턴수가 4명이었던 경우가 총 진료소요 시간이 5명이었던 경우에 비해 더 많이 걸렸다. 입원한 경우, 입원명령후 공실이 없었던 경우에서 역시 총 진료소요시간이 증가하였으며 총 진료소요시간과 유의한 상관관계를 갖는 연속변수로는 환자의 연령, 방사선검사수 및 일반검사수였다. 초진소요시간에 대한 중회귀분석결과, 응급의학과 환자, 응급환자, 내원시 심폐소생술 시행환자유무, 내원시 기관내삽관 여부 등이 유의한 독립변수였다. 총 진료소요시간에 대한 중회귀분석결과, 공실유무, 일반검사수, 최종진료과, 타병원 전원유무, 방사선검사수, 퇴원약 유무, 입원실 종류, 입원유무, 담당전공의 연차, 내원원인, 내원시 심폐소생술 시행환자 유무, 수술여부, 병원직원 지인유무 및 특수검사수가 유의한 독립변수였다. 이상의 결과로 보아 응급의료센터내의 환자적체현상을 해결하기 위한 방안으로는 응급환자와 비응급환자를 분류하는 제도적 장치가 필요하며, 필수적인 경우에 한해 일반검사 및 방사선검사를 실시하도록 하며, 병동내의 과별 지정병상을 유동적으로 운영하여 응급의료센터 환자가 우선적으로 입원될 수 있도록 각과의 협조가 필요할 것으로 사료된다.

• 한국콘텐츠학회논문지
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• 제15권7호
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• pp.330-342
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• 2015

의료관광은 많은 지역에서, 특히 아시아 국가들에서 수익성이 매우 높은 관광의 영역으로 간주되어지고 있다. 이와 같은 의료관광은 유희의 목적의 관광활동과 헬스케어 서비스가 강조되어 결합된 관광으로서 전 세계적으로 빠르게 성장추세를 보이고 있다. 본 연구에서는 의료관광 서비스 종사자들 가운데 간호사들을 대상으로 그들이 인지하고 있는 서비스 지향성과 이직의도의 영향관계에서의 직무몰입과 직무만족간의 매개효과를 실증분석을 실시하였다. 분석결과, 첫째, 간호사들이 인지하고 있는 서비스 지향성은 이직의도에 부(-)의 영향관계를 미치고 있었으며, 둘째, 서비스 지향성과 이직의도의 관계에서 간호사들의 직무몰입은 매개효과를 보이고 있었고, 셋째, 간호사들이 지각하고 있는 서비스 지향성과 이직의도의 관계에서 그들의 직무만족 또한 매개효과를 나타내고 있었다. 이와 같은 실증분석 결과들은 향후 의료관광 관리자들에게 의료관광 활성화를 위한 전략수립에 유용한 정보를 제공할 수 있을 것이다.

• 대한소아치과학회지
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• 제42권1호
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• pp.80-86
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• 2015

진정법을 시행하는 치과의사는 반드시 발생할 수 있는 응급상황에 적절히 대처할 수 있는 능력과 환경을 갖추어야 한다. 2010년 치의학회에서 발간한 진정법 가이드라인에서 진정법을 준비하고 책임지는 치과의사는 기본생명구조술과 전문심장구조술 자격을 유지할 것을 요구하고 있다. 국내에서는 대한심폐소생협회가 2004년부터 기본생명구조술 및 전문심장구조술을 위한 Provider, Instructor 양성 과정을 진행하고 있다. 저자는2014년에 이 과정들을 이수하면서 과정에 대한 소개와 경험한 내용을 공유하고자 하였다. 기존 교육이 응급의료를 담당하는 사람들에게 초점이 맞추어 졌기에, 향후 치과의사의 특수성에 보다 적합한 교육 과정 개발이 필요하다고 사료된다.

• Clinical and Experimental Pediatrics
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• 제48권5호
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• pp.557-560
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• 2005

재태 연령 38주, 출생체중 3,040 g, 제왕절개로 출생하여 단 일제대동맥이 동반되고 첫 울음 없이 전신에 청색증, 심한 호흡 곤란이 발생하여 기관내삽관을 시행하였으나 실패 한 후 후두내시경을 통해 확진된 선천성 후두폐쇄증 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 성인간호학회지
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• 제12권4호
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• pp.497-506
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• 2000

The purpose of this phenomenological study was to explore and describe the experience of people with HIV/AIDS. Three men and three women with HIV/AIDS participated in the study. They were asked open-ended and descriptive questions in order for them to talk about their experience in their own terms. Interviews were audiotaped and transcribed to maintain data integrity and to reduce perceptual bias. The transcripts were analyzed by the Colaizzi method. Member checks from the participants were used to validate the emergent themes. Seven themes emerged from the analysis. 1. People with HIV/AIDS have a strong impact and emotional reaction when receiving positive HIV test results. 2. All people with HIV/AIDS attempt to conceal HIV infection because of fear of stigma or rejection. 3. After the initial brief traumatic reaction to HIV/AIDS diagnosis, all participants feel lonely because they had no one to express or share their own experiences. 4. People with HIV/AIDS reflect on their life, think about the death and dying process and they become depressed. 5. Most participants feel that the family members who know his/her diagnosis are a big source of support. 6. According to the normativeness of infection route of HIV, the degree of guilty feeling differs among participants. 7. Although all participants think medication is a lifeline, the adherence to medication is not maintained because of side effects, denial and concealment of HIV/AIDS. The results of this study may help nurses and other health care workers to implement more efficient nursing strategies for people with HIV/AIDS by more deeply understanding their experience.

• 과학기술학연구
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• 제12권2호
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• pp.117-157
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• 2012

이 글은 최근 국내에 크게 증가하고 있는 우울증(depression)이 생의학적(biomedical) 차원에서 의료화(medicalization)되는 과정을, 질병의 진료 메커니즘을 통해 고찰한 것이다. 우울증은 근래까지 병원(病原)의 실체가 명확히 규명되지 못함에 따라 다양한 요인들이 복합되어 발병하는 정신질환으로 인식되어왔다. 따라서 우울증에 대한 치료 역시 약물과 심리적 사회적 처치를 병행해왔다. 그러다 1990년대 들어 서구를 중심으로 뇌과학이 출현하고 최첨단 뇌 진단장비 및 정신질환 치료 신약의 개발 등이 급속히 진전되면서, 우울증은 일상적 관리와 완치가 가능할 뿐만 아니라 누구나 걸릴 수 있는 '뇌 신경계 질환'으로 급속히 재정의되었다. 이러한 질병 개념 및 인식과 치료법의 영향으로 최근 국내에서는, 해마다 평균 8% 이상의 우울증 환자가 정신의학계의 적극적인 치료 대상으로 '출현하고(emergent)' 있다. 그러나 정신의학계는 현재의 우울증 치료율은 10%선에 불과하며, 치료 범주에서 벗어나 있는 우울증 환자가 전체의 80% 이상이라고 추산한다. 그렇다면 이러한 추정치는 어떠한 의미를 갖는 것일까? 이 논문은 이러한 의문을 가지고 우울증의 생의학적 의료화 과정을 비판적으로 탐색하였다.