• Journal of Chest Surgery
• /
• v.21 no.1
• /
• pp.169-174
• /
• 1988

Thoracic esophageal rupture caused by blunt trauma is often not recognized until late because of the vague symptoms in the initial state as well as its rare incidence, which can easily lead to fulminant mediastinitis with frequent fatal outcome. Once extensive mediastinitis occurs, the primary surgical repair of the esophageal tear is considered to be practically impossible. Various methods have been proposed for the management of these desperately ill patients, but no one provides an acceptable good result yet. The purpose of this article is to report the successful result obtained in the treatment of a patient with fulminant mediastinitis from traumatic esophageal rupture by continuous transesophageal irrigation. A 27 year-old male patient was brought to the emergency room of our hospital complaining of dyspnea and chest pain after blunt trauma. The diagnosis of esophageal rupture in the thorax was made late, about 46 hours after the initial injury, when mediastinitis had already progressed. The transesophageal irrigation method was immediately instituted which consisted of profuse transesophageal irrigation of the mediastinum with orally ingested fluid and/or by Levin tube, positioned proximal to the site of the rupture, and drainage of the irrigation fluid by thoracoscopically accurately positioned chest tubes connected to a well suctioning system. With subsiding inflammatory signs and symptoms, the esophagogram, obtained 54 days after the treatment, showed no evidence of the mediastinal leakage of contrast material which contrasted previous esophagograms with definitive dye collections in the mediastinum. Additional endoscopic finding confirmed complete healing of the esophageal mucosa, previously ruptured. He has been followed up without any problem until recently, 6 months after discharge.

• Health Policy and Management
• /
• v.13 no.4
• /
• pp.115-130
• /
• 2003

Reperfusion delay in patients with acute myocardial infarction leads to increased morbidity and mortality. We sought to measure the rates of reperfusion delay and to identify factors associated with reperfusion delay after arrival to hospitals. We included 360 patients who had acute myocardial infarction with ST-elevation or left bundle branch block on electrocardiogram and received reperfusion therapy from the three participating academic medical centers from 1997 to 2000. Through retrospective chart review, we collected data about time to reperfusion therapy, patient and hospital factors potentially associated with reperfusion delay. Factors independently associated with reperfusion delay were determined by logistic regression analysis. Median door­to­needle time was 60.0 minutes, and median door­to­balloon time was 102.5 minutes. According to recommendation of the American College of Cardiology/American Heart Association Guidelines, 226 out of 264(85.6％) of thrombolytic patients and 43 out of 96(44.8％) percutaneous transluminal coronary angioplasty(PTCA) patients experienced reperfusion delay. The significant factors associated with delay were type of reperfusion therapy, patient factors including hypertension and delayed symptom onset to presentation(>4 hours), and hospital factors including nocturnal presentation(6pm∼8am), weekend, and an individual hospital. A significant proportion of patients experienced reperfusion delay. The identified predictors of reperfusion delay may help design a hospital system to reduce the delay in reperfusion therapy

• The Korean Journal of Health Service Management
• /
• v.12 no.1
• /
• pp.81-93
• /
• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• Health Policy and Management
• /
• v.10 no.4
• /
• pp.75-98
• /
• 2000

This study applied Data Envelopment Analysis(DEA) and Ratio Analysis and Regression Analysis to a set of Korean Public Corporation Medical Centers to evaluate their relative human resource efficiencies. The output measure used in this study was based on health insurance system which was used in both in-patient departments and out-patient departments. Inputs included working time of the doctors, nurses, technicians, and managerial department staff. Based on the data provided on the inputs and outputs, the analysis showed 23 of the 34 hospitals to be relatively inefficient. Each hospital with an efficiency rating of less than 1 was considered relatively inefficient. In addition, managerial strategies based on dual variables were constructed to indicate the manner In which inefficient hospitals may be made efficient. A subsequent analysis of t-test revealed that the bed occupancy rate, medical revenue per 100beds, value added revenue per staff, medical revenue per staff were statistically significant. The results of this study suggest the DEA is a promising tool for evaluating relative human resource efficiency in hospitals which have multiple inputs and outputs and where the efficient production function is not specifiable with any precision. But it is considered that efficiency evaluations may be most effective]y accomplished by Incorporating a combination of methodologies such as ratio analysis and regression analysis.

• The korean journal of orthodontics
• /
• v.19 no.3
• /
• pp.113-122
• /
• 1989

About twenty years ago the computer was introduced into orthodontic, but not in clinics because it was inconvenient in cost, size, capacity and operation. But recent advances in the technology of electronics have produced a personal computer which is suitable for use in clinics. We have developed useful program for cephalometric Ax, model analysis and patient management. The computer program greatly aided in saving time & effort and performed well in the management & searching for patient data. But further studies about three dimensional analysis, S.T.O. and derivation of automatic treatment planning from analysis are needed.

• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.470-474
• /
• 2019

Congenital absent sternum is a rare birth defect that requires early intervention for optimal long-term outcomes. Descriptions of the repair of absent sternum are limited to case reports, and no preferred method for management has been described. Herein, we describe the use of porcine acellular dermal matrix to reconstruct the sternum of an infant with sternal infection following attempted repair using synthetic mesh. The patient was a full-term male with trisomy 21, agenesis of corpus callosum, ventricular septal defect, patent ductus arteriosus, right-sided aortic arch, and congenital absence of sternum with no sternal bars. Following removal of the infected synthetic mesh, negative pressure wound therapy with instillation was used to manage the open wound and provide direct antibiotic therapy. When blood C-reactive protein levels declined to ${\leq}2mg/L$, the sternum was reconstructed using porcine acellular dermal matrix. At 21 months postoperative, the patient demonstrated no respiratory issues. Physical examination and computed tomography imaging identified good approximation of the clavicular heads and sternal cleft and forward curvature of the ribs. This case illustrates the benefits of negative pressure wound therapy and acellular dermal matrix for the reconstruction of absent sternum in the context of infected sternal surgical site previously repaired with synthetic mesh.

• Journal of Korean Clinical Nursing Research
• /
• v.24 no.1
• /
• pp.113-126
• /
• 2018

Purpose: The purpose of this study was to revise the KPCS-1 and to standardize the three patient classification systems for general ward, ICU and NICU. The actual utilization of the KPCS-1 score and each nursing activity was evaluated and the relationships between KPCS-1 score and nursing related variables were reviewed. Methods: The 47,711 KPCS-1 scores of 6,931 patients who discharged from $1^{st}$ to $30^{th}$ April 2017 were analyzed and the statistical significance between KPCS-1 score and nursing related variables was reviewed by Generalized Estimating Equation. The revision of the KPCS-1 was carried out by Partial Least Square model. The 3 patient classification systems (KPCS-1,KPCSC and KPCSN) were standardized by professional reviews. Results: KPCS-1 was a valid instrument to express nursing condition adequately and was revised as a new version which has 34 nursing activity items. The names and terminologies of pre-existing 3 patient classification systems developed by KHNA were standardized as KPCS-GW, KPCS-ICU, KPCS-NICU. Conclusion: KPCS-1 was a valid instrument to represent diverse nursing conditions precisely and was revised as a 34-item KPCS-GW. The terminologies of the other patient classification systems by KHNA were standardized as KPCS-ICU and KPCS-NICU.

• Journal of Korean Academy of Nursing
• /
• v.8 no.2
• /
• pp.79-88
• /
• 1978

Utilizing Foley catheter in therapy of inpatient cause bacteriuria and urinary tract infection that leads to first ranked factor's in hospital infection (nosocomial infection). To protect the patient from such infections, emphasis should be placed on catheterization technique and management of the closed drainage system, this reducing the chances of introducing organisms. This study has been done at Intensive Care Unit of A and B hospitals from May-Oct. 1978 on 20 male and 18 female adult patients. Each patient was screened and found to have nonbacteriuria in clean catch specimen before catheterization. Clean catch specimen via foley catheter were obtained after 48 hours and 96 hours from catheterization. The findings are as follows: A. The occurrence of bacteriuria in patients according to duration of indwelling catheter. 1 213.9% of the patient showed evidence of bacteriuria 48h post catheterization specimen, while 57.9% of the patient showed evidence of bacteriuria 96h post catheterization specimen. 2 25% of male patients had infection 48h post catheterization and 45% displayed bacteriuria post catheterization. 33％ of female patients displayed infection 48h post catheterization and 72.2% having infection 96h post catheterization. Statistically there were significant differences between female patients and the duration of insertion. (P < 0.025) B. The occurrence of bacteriuria with the administration of bacteriuria with the ad-ministration of antibiotic in 24 patients was in 41,7%. The occurrence of bacteriuria without the administration of antibiotic in 14 patients was in 92.3%. Statistically there were very significant difference between the administration of the antibiotis and bacteriuria. (P < 0.005) C. Studies were done according to the consciousness level of the patients, 71.4% of those patient who displayed mental disorder developed bacteriuria, while 30.0% of those patient who displayed non mental disorder developed bacteriuria.

• Journal of Digital Convergence
• /
• v.11 no.3
• /
• pp.305-310
• /
• 2013

To provide medical services to patients who have a terminal illness, recent hospital patients to monitor the state of the device attached to the body, the body insertion device is. U-Healthcare Environment and hospital officials indiscriminately exploited by the patient's vital information, however, could threaten the patient's life problems are appearing. In this paper, depending on the level of authority, hospital officials, Union of ID-based authentication model is proposed to use a patient's vital information. Union proposed model identify different authentication system is used in hospitals that exist in various forms in a number of ID information, health / medical information sharing between hospitals without exposure to unnecessary personal information, you can be assured of the anonymity. In particular, with easy access to patient information, hospital officials about the malicious act to protect patient information to access level for the rights granted by third parties to prevent easy access.

• Journal of Korean Academy of Nursing
• /
• v.52 no.4
• /
• pp.378-390
• /
• 2022

Purpose: This study developed an in-service training program for patient safety and aimed to evaluate the impact of the program on nurses in the operating room (OR). Methods: A pretest-posttest self-controlled survey was conducted on OR nurses from May 6 to June 14, 2020. An in-service training program for patient safety was developed on the basis of the knowledge-attitude-practice (KAP) theory through various teaching methods. The levels of safety attitude, cognition, and attitudes toward the adverse event reporting of nurses were compared to evaluate the effect of the program. Nurses who attended the training were surveyed one week before the training (pretest) and two weeks after the training (posttest). Results: A total of 84 nurses participated in the study. After the training, the scores of safety attitude, cognition, and attitudes toward adverse event reporting of nurses showed a significant increase relative to the scores before the training (p < .001). The effects of safety training on the total score and the dimensions of safety attitude, cognition, and attitudes toward nurses' adverse event reporting were above the moderate level. Conclusion: The proposed patient safety training program based on KAP theory improves the safety attitude of OR nurses. Further studies are required to develop an interprofessional patient safety training program. In addition to strength training, hospital managers need to focus on the aspects of workflow, management system, department culture, and other means to promote safety culture.