• Journal of Trauma and Injury
• /
• 제36권4호
• /
• pp.435-440
• /
• 2023

Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.

• 한국콘텐츠학회논문지
• /
• 제10권12호
• /
• pp.1-9
• /
• 2010

당뇨병은 대사질환의 일종으로 고혈당을 특징으로 하며, 고혈당으로 인하여 여러 증상 및 징후와 합병증을 유발하여 삶의 질을 급격히 저하시킨다. 당뇨병의 예방 및 치료를 위해서는 식이, 운동, 약물 처방 등이 있지만 무엇보다도 체계적인 식단 관리가 필수적이다. 본 논문에서는 체계적인 당뇨병 관리를 위해서 스마트폰 기반의 개인 맞춤형 식단 관리 시스템을 제안한다. 현재 대부분의 당뇨병 환자의 식단 서비스는 영양사나 의사의 주관적인 판단으로 식단을 처방하며 상황 및 개인의 선호도는 반영 되지 않는다. 제안하는 시스템은 당뇨식단을 계절, 날씨, 시간, 선호도에 맞추어 제공한다. 특히, 스마트 폰 서비스로 구현하여 언제 어디서나 장소에 제한받지 않고 사용자에게 레시피 및 개인화된 식단을 제공하며, 사용자의 간단한 조작만으로도 손쉽게 식단 변경이 가능하다.

• 디지털융복합연구
• /
• 제11권1호
• /
• pp.349-359
• /
• 2013

본 연구는 중소병원의 간호사의 환자안전인식 및 안전간호활동을 조사하고 안전간호활동에 영향을 미치는 요인들을 분석함으로써 보다 안전한 의료서비스 제공의 기초자료로 삼고자 시행 되었다. 대상자는 2012년부터 4월 1개월 동안 3개의 중소병원 간호사 344명을 대상으로 실시하였다. 미국의 AHRQ에서 개발한 Hospital survey of patient safety culture라는 설문지와 의료기관인증문항 중 안전보장활동을 사용하였다. 자료분석은 SPSS 18.0 통계 패키지를 사용하여 기술통계 t-test 및 ANOVA와 Scheffe 사후 분석, Pearson's correlation coefficents, stepwise multiple regression으로 분석하였다. 환자안전인식 수준은 간호사의 경력, 근무시간, 근무부서에 따라 차이가 있었고, 안전간호활동은 간호사의 나이, 직위, 결혼, 간호사 경력, 근무시간에 따라 차이가 있었으며, 간호사의 안전인식수준이 높을수록 안전간호활동 수준이 높았다. 병원에서 환자안전인식 및 안전간호활동 수준을 개선하기 위해서 환자안전정책 및 근무환경개선제도가 요구된다. 근무조건 개선을 위해서 근무시간, 환자대 간호사의 비율을 정규화하는 정책 등이 요구된다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권8호
• /
• pp.3697-3703
• /
• 2016

Hepatocellular carcinoma (HCC) is the most frequent type of malignant liver tumor and a high impact health problem worldwide. The prevalence of HCC is particularly high in many Asian and African countries. Some HCC patients have no symptoms prior to diagnosis and many of them therefore present at late stage and have a grave prognosis. The well-established causes of HCC are chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection or alcoholic cirrhosis and nonalcoholic steatohepatitis. The Barcelona Clinic Liver Cancer (BCLC) Staging System remains the most widely used for HCC management guidelines. To date, the treatments for HCC are still very challenging for physicians due to limited resources in many parts of the world, but many options of management have been proposed, including hepatic resection, liver transplantation, ablative therapy, chemoembolization, sorafnib and best supportive care. This review article describes the current evidence-based management of HCC with focus on early to advance stages that impact on patient overall survival.

• 한국병원경영학회지
• /
• 제18권3호
• /
• pp.83-105
• /
• 2013

The purpose of this study is to make managerial information regarding outsourcing more concrete by identifying and evaluating how outsourcing as an useful strategic tool for hospitals influences organizational effectiveness. The survey was performed to 311 general hospitals and tertiary hospitals, and 63 questionnaires were recovered and analyzed. As the result of measuring organizational effectiveness after introduction of outsourcing, non-financial performance(3.34) was higher than financial performance(3.25) and satisfaction(3.08). According to the characteristics of organizational structure, financial performance showed statistically significant difference when categorizing the hospitals. It was higher in the general hospitals than in the tertiary hospitals. In addition, the hospitals that outsource the logistic and patient affairs parts have higher financial performances than non-financial ones. Especially, there was statistically significant difference depending on the sub-parts of the logistics, which means the hospitals outsourcing the logistic part have higher financial performance than the hospitals without outsourcing the logistics.

• 센서학회지
• /
• 제15권4호
• /
• pp.291-296
• /
• 2006

We focus on the solutions to prevent fatal risk to patient's life caused by transfusing blood which is wrong type or has exceeded norm temperature. Also, this study gives priority to the verification of medical safety of using blood, of which management is applied advanced sensor tag technology adopted RFID(Radio Frequency Identification) temperature sensor and USN(Ubiquitous Sensor Network) for temperature management of blood. Therefore, this study can contribute to protect of health of patients who take blood transfusion through construction of basis of new process of blood management.

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

• 보건의료생명과학 논문지
• /
• 제8권2호
• /
• pp.83-93
• /
• 2020

본 연구에서는 보건의료정보관리사 양성을 위한 대학에서 EMR 교육시스템을 활용하여 교육할 수 있는 실습모델을 연구하였다. 현재 보건의료정보관리사의 직무역량 강화를 위해 도입된 보건의료정보관리교육 평가·인증 기준에 보건의료정보관리를 위한 실습과정이 제시되어 있지 않다. 이에 따라서 보건의료 정보관리교육 평가·인증 편람에서 교육환경으로 제시한 실습프로그램을 EMR 교육시스템에서 실습할 수 있도록 프로그램을 구성였다. 또한 프로그램별로 보건의료정보관리 현장실습지침서에 따라 수행할 수 있는 실습모델을 연구하였다. 보건의료정보관리 교육용 EMR시스템을 이용하여 마스터데이터관리, 환자 등록, 의사처방, 진료비 수납, 건강보험청구관리, 서식관리, 퇴원등록, 암등록, 미비기록관리, 보건의료데이터관리, 보건의료통계, 정보보호/보안관리에 대한 실습을 수행할 수 있도록 실습모델을 연구하였다. 대학에서 체계적이고 표준화된 보건의료정보관리 실습과정을 수행하여 보건의료정보관리 교육의 질적 수준을 높임으로써 보건의료정보관리 전문가로써 역할을 수행할 수 있을 것이다. 이에 따라서 보건의료정보관리사의 실습교육을 통하여 의료데이터 분석을 기반으로 의료서비스를 개발하고 관리하는 보건의료 정보관리 전문가를 양성할 수 있도록 해야 할 것이다.

• 성인간호학회지
• /
• 제25권4호
• /
• pp.365-376
• /
• 2013

Purpose: The purpose of this study was to construct, develop, and apply a nursing information system (NIS) using NANDA-NOC-NIC linkage in medical-surgical nursing units. Methods: This study consisted of three phases which were the construction of the database, development of the NIS, and application of the NIS. To construct the database, a questionnaire and nursing record review by an expert group were used. Collected data were analyzed by the SPSS/WIN 13.0 program. Results: In first phase, the database was made up of 50 nursing diagnoses, 127 nursing outcomes and 300 nursing interventions. In the second phase, NIS was developed according to its flow diagram and then tested. In the third phase, the developed NIS was applied to 130 inpatients. Nursing diagnoses frequently used were acute pain, delayed surgical recovery, and deficient knowledge (specify). Nursing outcomes for a nursing diagnosis of 'acute pain' were identified as pain control, pain level and comfort level. Nursing interventions for the nursing outcome 'pain control' were pain management, patient controlled analgesia assistance and medication management. Conclusion: The results of this study will facilitate the use of the newly proposed NIS in nursing practice and provide a guideline for evidence-based nursing.

• 경영과학
• /
• 제27권1호
• /
• pp.17-31
• /
• 2010

Patients entering an emergency care center in a hospital usually visit medical processes in different orders depending on the urgency level and the medical treatments required. We formulate the patient flows among diverse processes in an emergency care center using the Jackson network, which is one of the queueing networks, in order to evaluate the system performances such as the expected queue length and the expected waiting time. We present a case study based on actual data collected from an emergency care center in a hospital, in order to prove the validity of applying the Jackson network model in practice. After assessing the current system performances, we provide operational strategies to reduce waiting at the bottleneck processes and evaluate the impact of those strategies on the entire system.