• Korean Journal of Occupational Health Nursing
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• v.29 no.4
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• pp.354-362
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• 2020

Purpose: This study aimed to define and clarify learning transfer in nursing. Methods: This study used a hybrid model to analyze the concept of learning transfer in nursing through three phases. For the theoretical phase, learning transfer attributes were identified through a scoping literature review. In the fieldwork phase, in-depth focus group interviews were conducted to develop attributes. Purposive sampling was performed with ten participants(five nursing students, two nurses, three nursing faculty members). In the analysis phase, the attributes and final analysis of learning transfer in nursing were extracted and integrated from the previous two phases. Results: According to the analysis, learning transfer was represented in two dimensions with eight attributes. The development of competency dimension had three attributes: 1) theory acquisition, nursing skills, professional attitude, 2) integration, and 3) analysis competency. The competency change dimension had five attributes: 1) appropriateness in patient care, 2) proficiency in patient care, 3) satisfaction, 4) achievement, and 5) confidence. Conclusion: The concept analysis might provide a basic understanding of learning transfer, a development framework toward a measurement of nursing learning transfer and effective educational nursing strategies.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.573-581
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• 2005

Breast cancer is the second leading cause of death in woman. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. This paper introduces the breast reconstruction by use of pectoralis major muscle transfer with breast implant for small size defect after skin sparing mastectomy for more satisfaction. We reviewed 24 consecutive patients who underwent breast reconstruction by pectoralis major muscle transfer with implant and only breast implant in Dong-A University from April 2002 to March 2004. The patient's age ranged between 29 and 54 years with mean of 42.3 years. We used pectorals major muscle transfer with breast implant in 12 patients and breast implant alone in 12 patients as control. The follow-up period of patients ranged from 10 months to 3 years with mean of 18.5 months. The points of comparison with control group reconstructed by breast implant alone were doctor and patient satisfaction score, operation time, duration of admission, amount of drainage, complication and satisfaction according to mass location. In conclusion, there is no difference with control group in the point of operation time, mount of drainage, duration of admission. And there is higher level of doctor's and patient's satisfaction in group reconstructed by pectoralis major muscle transfer with breast implant than implant only group. Especially, pectoralis major muscle transfer with breast implant was especially necessary for the defect in upper lateral quadrant of the breast to get more satisfaction. The advantage of pectoralis major muscle transfer with breast implant is prevention of the protruding and palpability of implant and aesthetically satisfactory result by intraoperative modification of breast shape.

• Quality Improvement in Health Care
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• v.9 no.2
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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.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.735-740
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• 2015

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

• Research in Community and Public Health Nursing
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• v.19 no.2
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• pp.196-204
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• 2008

Purpose: To examine factors affecting long-term care hospital patients' intention of transfer to a nursing home. Method: A questionnaire survey was conducted in Aug. 2007 that included 655 patients from 49 long-term care hospitals. The survey aimed to assess the patients' health status, family status, cost and intention of transfer to a nursing home. Institutional characteristics were analyzed from the nationwide database of Health Insurance Review & Assessment Service. The affecting factors were examined by employing chi-square test and logistic regression using SAS 8.2. Result: Of the subjects, 32.4% had intention of transfer to a nursing home. The intention of transfer to a nursing home was affected by moderate or severe pain, living together with the primary carer, high cost uncovered by insurance, and recognition of nursing home. Conclusion; For appropriate service utilization. a higher level of care is needed to satisfy patients at nursing homes and a balanced fee schedule is needed between long term care hospitals and nursing homes. It is desirable to encourage transfer to a nursing home at which nurses support patients and their families by giving information, coordination, and to make efforts to establish a reference system.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.97-105
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• 2012

Background: Increasing numbers of super-elderly patients (>80 years old) with cancer now require microvascular-free tissue transfer. The objectives of this study were to evaluate potential applications of microvascular tissue transfer in this patient population, and post-surgical changes in quality of life. Methods: The records of cancer patients 80 years or older who had undergone microsurgical tissue transfer were retrospectively reviewed. Structured interviews were conducted with patients and family caregivers after surgery, and the patients' quality of life was qualitatively assessed. Results: The study cohort consisted of seven patients with a mean age 87.6 years (range, 81 to 95). Wound and medically-related complications were minimal. During the patient interviews, eight of the nine respondents reported remarkable improvements in quality of life following surgery and expressed a high level of satisfaction with their surgical results. Conclusions: Our study showed that microsurgical reconstruction performed in super-elderly patient not only appropriately repairs post-oncologic defects but also significantly improves the patients' quality of life.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.163-201
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• 2019

Doctor has the duty of an inter-hospital transfer, known as inter-facility or secondary transfer, when the diagnostic and therapeutic facilities required for a patient are not available at the given hospital. Also, the decision to transfer the patient to an another facility is rely on whether ill patient is the benefits of care, including clinical and non-clinical reasons, available at the another facility against the potential risks. Crucial point to note is that issues about 'inter-hospital transfer' is limited to questions occurred in the course of transfer between emergency medicals (facilities). 'emergency medical (facility)' is specified by Medical Law, article 3 and the duty of an inter-hospital transfer includes any possible adverse events, medical or technical, during the transfer. Because each medical facility has an different ability to care for a patient in an emergency condition, coordination between the referring and receiving hospitals' emergency medicals would be important to ensure prompt transfer to the definitive destination avoiding delay at an emergency. Simultaneously, transfer of documents about the transfer process, medical record and investigation reports are important materials for maintaining continuity of medical care. Although the duty of an inter-hospital transfer is recognized as one of duty of doctor and more often than not it occurs, there is constant legal conflict between a doctor and a patient related to the duty of the inter-hospital transfer. Therefore, we need clear and specific legal standard about the inter-hospital transfer. This paper attempts to review the Supreme Court's cases associated to the inter-hospital transfer and to compare opinion of the cases with guideline for an inter-hospital transfer already given. Furthermore, this article is intended to broaden our horizons of understanding the duty of an inter-hospital transfer and I wish this article helps to resolve the settlement and case dealt with the duty of inter-hospital transfer.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.10 no.12
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• pp.2243-2250
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• 2006

When a patient is positioned at insulated bed and practitioner is positioned at insulated floor, that condition could be a cause of lessening effect in acupuncture practice. We investigated how Ground connection and Insulation could influence on the electrical meridian potential between practitioner and patient during acupuncture practice. We treated 30 normal healthy subjects with acupuncture and measured changes in the electrical potential between the stomach meridian points ST-39 and ST-37 in response to light touch after insertion of a needle at ST-36. At first, we stimulated non-insulated needle and measured electrical potentials for non ground, patient ground only, practitioner ground only, all ground respectively. Then we used insulated needles and measured same as above. Non-insulated all ground subject elicited positive mean potential $44.6{\pm}19.2{\mu}V$ and showed $181.4{\pm}59.7{\mu}V$ peak to peak potential. Practitioner ground only showed negative mean potential of $51.5{\pm}9.3{\mu}V$ and $367.4{\pm}27.8{\mu}V$ of peak to peak potential. Patient ground only revealed no mean potential of $2.9{\pm}1.3{\mu}V$, $16.4{\pm}11.9{\mu}V$ of peak to peak potential. All ground showed no mean potential of $1.6{\pm}0.7{\mu}V$, $3.3{\pm}1.9{\mu}V$ of peak to peak potential. In case of Insulated condition, there elicited no mean potential. Non ground and Practitioner only showed weak value of peak to peak potential as $7.8{\pm}2.6{\mu}V$ and $8.4{\pm}2.5{\mu}V$ each. But patient only and all ground showed no potential as $4.7{\pm}2.2{\mu}V$, $3.4{\pm}2.2{\mu}V$, respectively. Therefore, Ground connection modulate the energy transfer course between practitioner and patient. Insulation block energy transfer but static electrical impulse between practitioner and patient.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• The Korean Journal of Food & Health Convergence
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• v.8 no.6
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• pp.11-17
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• 2022

Emergency transport is directly related to the life of the patient, and rapid transport to the hospital is crucial. However, external environmental factors such as traffic or weather, interfere with hospital transport. In this study, we investigated the external environment affecting hospital transport time. We examined the transfer time and patient treatment time of emergency patients in an area of northern Gyeonggi-do from 2018 to 2020. Diagnosis after arrival at the hospital was used, and on-site treatment time was measured from paramedic arrival time at the scene to departure. Furthermore, we examined whether there was a correlation between the time paramedics left the scene and hospital arrival time through the reason for the delay as recorded in the emergency log. Traffic jams had the greatest impact on patient transport, while transport delays occurred due to heavy rain, but not snow. Among injured patients, electrical accidents were the most problematic in terms of on-site treatment time. This was because a lot of first aid is needed in electrical accidents. It must be necessary to mobilize two ambulances in an emergency through the expansion of infrastructure, prepare a plan for rapid transport in heavy rain, and implement strong laws against transport obstruction.