• 제목/요약/키워드: Medical-surgical nursing

검색결과 279건 처리시간 0.024초

수술전과 수술중 피부가온요법 적응이 고관절 전치환술 환자의 수술 주기 고막체온 변화에 미치는 영향 (The Effect of Pre and Intra-Operative Warming Therapy on Tympanic Temperature Changes during Perioperative Phase in Receiving Patients with Total Hip Replacement)

  • 권영숙;김은희
    • 기본간호학회지
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    • 제7권1호
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    • pp.86-96
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    • 2000
  • The purpose of the study was to investigate the effects of Warming Therapy used with patients consistantly before and during surgery to on changes in their body temperatures. The data were collected from patients in a university hospital in Taegu between December 1, 1998 and May 31, 1999. The subjects were selected from patients who were hospitalized for total hip replacement surgery. Thirty participants were assigned to two groups : experimental(Warming Therapy) group and control group. Each group consisted of 15 patients. The research design was a repeated measurement design, using a nonequivalent control group. The Warming Therapy, using a forced-air warming blanket, that is a, 'Bair Hugger' was applied to subjects in the experimental group. The subjects in the group were treated with the 'Bair Hugger' to warm up the whole body for 40 minutes before surgery and upper body and face during the operation. The core temperature was measured using a tympanic thermometer. The body temperature of the patients was measured 13 times every 15 minutes during the surgery. After the operation the body temperature of the patients was measured 4 times every 15 minutes, from the time of arrivial in the recovery room to the time of leaving the recovery room. The SPSS Win 9.0 program was used for data analysis. Specific methods tested were done using ${\chi}^2-test$, t-test, repeated measures ANOVA. The findings of the study are as follows. 1. The first hypothesis, 'The level of tympanic temperature for the experimental group which received Warming Therapy will be higher than that of the control group during the operation', was supported (F=32.16, p=.000). 2. The second hypothesis, 'The level of tympanic temperature for the experimental group which received Warming Therapy will be higher than that of the control group after the operation', was supported.(F=33.36, p=.000) 3. During recovery, shivering was observed one patient in the experimental group and seven patients in the control group. In summary, the findings of the study suggest that the 'Warming Therapy' applied before and during the surgery was a very effective treatment for surgical patients in maintaining the core temperature during surgery

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중환자 중증도 평가도구의 타당도 평가 - APACHE III, SAPS II, MPM II (Comparing the Performance of Three Severity Scoring Systems for ICU Patients: APACHE III, SAPS II, MPM II)

  • 권영대;황정해;김은경
    • Journal of Preventive Medicine and Public Health
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    • 제38권3호
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    • pp.276-282
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    • 2005
  • Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).

Contemporary Koreans' Perceptions of Facial Beauty

  • Rhee, Seung Chul;An, Soo-Jung;Hwang, Rahil
    • Archives of Plastic Surgery
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    • 제44권5호
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    • pp.390-399
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    • 2017
  • Background This article aims to investigate current perceptions of beauty of the general public and physicians without a specialization in plastic surgery performing aesthetic procedures. Methods A cross-sectional and interviewing questionnaire was administered to 290 people in Seoul, South Korea in September 2015. The questionnaire addressed three issues: general attitudes about plastic surgery (Q1), perception of and preferences regarding Korean female celebrities' facial attractiveness (Q2), and the relative influence of each facial aesthetic subunit on overall facial attractiveness. The survey's results were gathered by a professional research agency and classified according to a respondent's gender, age, and job type ($95%{\pm}5.75%$ confidence interval). Statistical analysis was performed using SPSS ver. 10.1, calculating one-way analysis of variance with post hoc analysis and Tukey's t-test. Results Among the respondents, 38.3% were in favor of aesthetic plastic surgery. The most common source of plastic surgery information was the internet (50.0%). The most powerful factor influencing hospital or clinic selection was the postoperative surgical results of acquaintances (74.9%). We created a composite face of an attractive Korean female, representing the current facial configuration considered appealing to the Koreans. Beauty perceptions differed to some degree based on gender and generational differences. We found that there were certain differences in beauty perceptions between general physicians who perform aesthetic procedures and the general public. Conclusions Our study results provide aesthetic plastic surgeons with detailed information about contemporary Korean people's attitudes toward and perceptions of plastic surgery and the specific characteristics of female Korean faces currently considered attractive, plus trends in these perceptions, which should inform plastic surgeons within their specialized fields.

임상간호사의 병원감염관리에 대한 중요성 인지도, 실천정도 및 만족도에 관한 연구 (A Study on Clinical Nurses Level of Perception of Importance, Performance and Satisfaction in the control of Nosocomial Infection.)

  • 김순옥;조수현
    • 대한간호학회지
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    • 제27권4호
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    • pp.765-776
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    • 1997
  • Hospitals accomodate patients who have a high risk of infection due to reduced immunity as well as people who require surgical, medical or other treatments. Consequently, the role of clinical nurses, who come into close contact with these patients is very important in the control of nosocomial infection. This study was done to investigate and compare the level of perception of the importance of the control of nosocomial infections as well as the level of actual performance, and the level of satisfaction with the control of nosocomial infection by the clinical nurses. Thus, the purpose of this study is to contribute basic data for improving policies and educational programs to control nosocomial infection. A summary of the survey results is as follows. 1) The means of scores on all categories of the inquiry were 4. 51 for awareness 4.42 for actual performance, and 3.20 for satisfaction, of a possible high score of 5.00. 2) Correlations of the level of perception of importance between characteristics of nurses and hospital control of nosocomial infection differed significantly according to the type of hospital establishment type (p=.005), age(p=.000), career(p=.000), position (p=.002), and regular conferences on infection control in working departments(p=.003), Correlation of the level of actual performance between characteristics of nurses and hospital control of nosocomial infection diffesed significantly according to type of hospital(p=.000), hospital size (p=.009), working department(p=.000), age(p=.000), career (p=.000), school career(p=.040), position (p=.000), education experience on nosocomial infection(p=.020), and regular conferences on infection control in working department(p=.000). Correlation of degree of satisfaction between characteristics of nurses and hospital control of nosocomial infection also differed significantly according to the type of hospital establishment (p=.003), working department(p=.000), age (p=.000), and regular conferences on infection control in working department (p=.000). 3) Correlation between clinical nurses, level of perception of importance and actual level of performance for the control of nosocomial infection was relatively positive (r=.57, p=.000). Correlation between clinical nurses degree of satisfaction and level of actual performance for control of nosocomial infection was relatively positive (r=.47, p=.000). Correlation between clinical nurses, level of perception of importance and degree of satisfaction degree with the control of nosocomial infection was also relatively positive (r=.27, p=.000).

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로봇을 이용한 심장수술이 환자의 통증, 수면 및 자가간호수행에 미치는 영향 (Effects of pain, sleep and self-care behavior in patients underwent robotic minimally invasive cardiac surgeries)

  • 박수현;장인실
    • 디지털융복합연구
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    • 제17권7호
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    • pp.265-274
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    • 2019
  • 본 연구는 로봇을 이용한 최소침습절개술 접근과 기존의 정중흉골절개술 접근을 이용한 심장판막수술환자를 대상으로 통증, 수면, 자가간호수행을 파악하고 이를 비교분석하기 위한 조사연구이다. 대상자는 서울시 일개 상급종합병원에서 심장수술을 시행한 대상자 중 정중흉골절개술군 64명, 최소침습절개술군 64명을 대상으로 하였다. 자료분석은 SPSS 22.0 프로그램을 이용하여 기술적 통계, ${\chi}^2$ 검증, paired t-test를 시행하였다. 수술 후 2일째, 5일째 모두 통증은 로봇을 이용한 최소침습절개술군이 정중흉골절개술군에 비해 높았다. 통증발생부위는 두 군 모두 수술접근부위로 크게 나타났다. 수면은 수술 후 2일째 정중흉골절개술군에서 높게 나타났으며, 자가간호수행은 최소침습절개술군에서 높게 나타났다. 그러므로 로봇 수술의 재원기간 단축과 빠른 회복 등의 장점에도 불구하고 대상자의 통증관리를 위해 정확한 통증 사정 및 차별화된 프로토콜의 적용이 필요시 된다. 또한 성별, 연령 및 수술방법의 차이를 고려하여 안위를 증진시키기 위한 체계화된 교육 프로그램 중재가 요구되어진다.

중환자의 욕창 예방 연구 : 욕창 예방 QI팀을 중심으로 (CQI Action Team Approach to Prevent Pressure Sores in Intensive Care Unit of an Acute Hospital Korea)

  • 강소영;최은경;김진주;주미정
    • 한국의료질향상학회지
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    • 제4권1호
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    • pp.50-63
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    • 1997
  • Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

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Impact of the Interval between Previous Endoscopic Exam and Diagnosis on the Mortality and Treatment Modality of Undifferentiated-Type Gastric Cancer

  • Lee, Ayoung;Chung, Hyunsoo;Lee, Hyuk-Joon;Cho, Soo-Jeong;Kim, Jue Lie;Ahn, Hye Seong;Suh, Yun-Suhk;Kong, Seong-Ho;Choe, Hwi Nyeong;Yang, Han-Kwang;Kim, Sang Gyun
    • Journal of Gastric Cancer
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    • 제21권2호
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    • pp.203-212
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    • 2021
  • Purpose: The impact of the interval between previous endoscopy and diagnosis on the treatment modality or mortality of undifferentiated (UD)-type gastric cancer is unclear. This study aimed to investigate the effect of endoscopic screening interval on the stage, cancer-related mortality, and treatment methods of UD-type gastric cancer. Materials and Methods: We reviewed the medical records of newly diagnosed patients with UD gastric cancer in 2013, in whom the interval between previous endoscopy and diagnosis could be determined. The patients were classified into different groups according to the period from the previous endoscopy to diagnosis (<12 months, 12-23 months, 24-35 months, ≥36 months, and no history of endoscopy), and the outcomes were compared between the groups. In addition, patients who underwent endoscopic and surgical treatment were reclassified based on the final treatment results. Results: The number of enrolled patients was 440, with males representing 64.1% of the study population; 11.8% of the participants reported that they had undergone endoscopy for the first time in their cancer diagnosis. The percentage of stage I cancer at diagnosis significantly decreased as the interval from the previous endoscopy to diagnosis increased (65.4%, 63.2%, 64.2%, 45.9%, and 35.2% for intervals of <12 months, 12-23 months, 24-35 months, ≥36 months, and no previous endoscopy, respectively, P<0.01). Cancer-related mortality was significantly lower for a 3-year interval of endoscopy (P<0.001). Conclusions: A 3-year interval of endoscopic screening reduces gastric-cancer-related mortality, particularly in cases of UD histology.

만성통증 환자의 통증 조절 (Chronic pain control in patients with rheumatoid arthritis)

  • 은영
    • 근관절건강학회지
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    • 제2권1호
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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응급의료센터 내원환자 진료시 소요시간과 관련된 요인 (Factors Related to Waiting and Staying Time for Patient Care in Emergency Care Center)

  • 한남숙;박재용;이삼범;도병수;김석범
    • 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.

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