• Journal of Chest Surgery
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• 제56권2호
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• pp.108-116
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• 2023

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as an adjunct to resuscitation of patients with traumatic shock. However, the effectiveness of REBOA is still debated because of inconsistent indications across centers and the lack of medical records. The purpose of this study was to investigate the effectiveness and feasibility of REBOA by analyzing clinical results from a single center. Methods: This study included 96 patients who underwent REBOA between August 2016 and September 2021 at a regional trauma center according to the center's treatment algorithm for traumatic shock. Medical records, including the time of the decision to conduct the REBOA procedure, time of operation, type of aortic occlusion, and clinical outcomes, were collected prospectively and analyzed retrospectively. Patients were classified by REBOA protocol (group 1, 2, or 3) and survival status (survivor or non-survivor) for analysis. Results: The overall success rate of the procedure was 97.9%, and the survival rate was 32.6%. In survivors, blood pressure was higher than in non-survivors both before the REBOA procedure (p=0.002) and after aortic occlusion (p=0.03). The total aortic occlusion time was significantly shorter (p=0.001) and the proportion of partial aortic occlusion was significantly higher (p=0.014) among the survivors. The non-survivors had more acidosis (p<0.001) and higher lactate concentrations (p<0.001) than the survivors. Conclusion: REBOA may be a feasible bridge therapy for resuscitation of patients with traumatic shock. Prompt and accurate decision-making to perform REBOA followed by damage control surgery could improve survival rates and clinical outcomes.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제27권1호
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• pp.43-52
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• 2024

Purpose: In this study, we investigated the clinical profile, survival at discharge, and proportion of children with acute liver failure (ALF) meeting the criteria for, yet surviving without, liver transplantation (LT). Methods: Medical case records of children aged >28 days to ≤15 years over a period of 7 years, identified from pediatric admission and discharge registers, were screened. Children satisfying the criteria for ALF were included in this study. Results: A total of 71 records meeting the pediatric ALF (PALF) criteria were included. The survival rate at discharge was 61% (n=44). A considerable proportion of children satisfied the King's College Criteria (KCC) (56.3%) and the European Association for the Study of the Liver (EASL) criteria (7%) for LT at admission. Nonetheless, the survival rate in the absence of LT was 42.5% in children who satisfied the KCC and 20% in those who met the EASL criteria. Infection (29.5%) and paracetamol overdose (19.7%) were the major identifiable causes of PALF. Hepatitis A was the most common infection identified. No significant predictors of poor outcomes were identified in multivariable analysis. Conclusion: Our study highlights the changing survival rates and the clinical and etiological profiles of patients with PALF. In areas with poor access to LT services, survival in these children could be improved through early referral to centers with adequate intensive care facilities. Preventing ALF and referring patients to LT services are paramount to reducing mortality.

• 한국기록관리학회지
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• 제3권1호
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• pp.1-21
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• 2003

사경은 남계원(南溪院) 석탑의 출토품으로 1915년 남계원석탑(南溪院石塔)을 개성시(開城市)의 덕암동(德岩洞)의 원 위치로부터 경복궁으로 옮길 때 발견된 감지은니사경(紺紙銀泥寫經)의 염승익발원(廉丞益發願)의 사경(寫經) "묘법연화경(妙法蓮華經)" 7권본 1부는 권자본(卷子本)으로 세로 31.1cm이며, 표지화와 변상화(變相畵)가 안팍을 이루고 있는데 폭은 27.2cm이다. 이 사경은 또한 1행 14자로 쓰여지고 있는데, 이러한 특징은 표지화 변상화의 양식과 더불어 고려국왕별원 금 은자사경의 양식과 같다. 이 사경을 발원한 인물은 충렬왕대의 권신이던 염승익이다. 염승익은 "고려사(高麗史)" "고려사절요(高麗史節要)"에 의하면, 기인을 동원하여 지은 자신의 집을 대장경사경소(大藏經寫經所) 금자대장사경소(金字大藏寫經所)로 내놓았다는 기록이 있다. 그러므로 이 사경은 염승익이 자신과 그 일가권속의 복락을 빌기 위해 "묘법연화경(妙法蓮華經)" 7권부 1부를 금자대장사경소(金字大藏寫經所)에서 제작하고, 충렬왕(忠烈王) 9년 남계원석탑(南溪院石塔)을 수리할 때 탑에 함께 봉안했을 것으로 생각할 수 있다. 그러나 이 사경의 가장 중요한 점은 "고려사절요(高麗史節要)"의 기록처럼 금자대장소로 내놓았다는 점이라 할 수 있다. 금자대장소란 장소적 의미가 강조된 것으로 금경사와 더불어서 금자원과의 차이를 밝힐 수 있는 중요한 단서라고 할 수 있는 점이다. 그러나 이 사경이 충렬왕대 고려국왕발원 금 은자사경의 특징을 그대로 보여주고 있다는 점에서 비록 개인발원사경이라 할지라도 금자대장사경소(金字大藏寫經所)에서 제작되었기 때문에 금자원(金字院)(혹은 은자원(銀字院))의 스타일을 그대로 따르고 있다는 점과 이러한 점을 통해 남겨진 기록들과 발문을 중심으로 사경원 금 은자원의 성격을 밝히는데 힘썼다.

• 대한지역사회영양학회지
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• 제4권2호
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• pp.207-218
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• 1999

The increased number of elderly in Korea presents great challenges for community nutrition programs. Strategies to enhance elderly nutrition are needed, as well as dietary advice that are reality-based and tailored to the need of the elderly. The purpose of this study was to evaluate the overall effectiveness of an elderly nutrition improvement program(ENIP), by assessing changes in nutrition knowledge, attitudes, and behavior after program completion. ENIP was conducted in Suwon for 4 months in 1998 at 5 centers for the elderly. The program provided individual nutrition counseling and brief biweekly group education sessions. To stimulate participation and motivation, the elderly in two centers were served free milk packs(200ml) three time a week during the program(milk＋education group), and the elderly in 3 other centers were served yoghurt on the program day(education group). Altogether, 102 subjects finished the program(milk＋education group 67 ; education group 35). Data about nutrition knowledge, dietary attitudes, diet records(24 hour recall) and dietary habit was collected before(baseline) and after the program(follow-up). The Drop-out rate for the milk＋education group(2.9%) was significantly lower than that for the education group(30.0%)(p<.001). The Nutrition Knowledge fo females milk＋education group increased significantly after the program, but no significant differences were observed in other groups. Over 60% of all the elderly showed positive responses to the healthy eating attitudes. Energy, protein, vitamin A, riboflavin, Calcium and Potassium intakes improved in the male milk＋education group. The Vitamin C intake improved in the male education group. Energy and vitamin A intakes improved in the female milk＋education group and energy, vitamin A, thiamin, riboflavin, niacin, Ca nad P in the female education group. A stepwise multiple regression analysis was performed to examine the effects of food intake changes on overall nutrient quality. For all elderly, the fish intake explained 12.6% of the variance, followed by candy intake and vegetable intake(model $R^2$=19.6%). Dietary habits such as meal time regularity and salty food reduction were markedly improved in both groups. Sixty-one percent of the milk＋education subjects stated their participation was voluntary and active, while 51% of education subjects did. Sixty four percent of the subjects stated their interest on diet increased remarkably through program participation. Considering the results, it is conjectured that ENIP had a great impact on nutrient intake, dietary attitudes and habits. Milk supplement showed no direct effects on elderly nutrition improvement, but it encouraged the program by reducing drop-out rates and inducing voluntary participation. Therefore milk supplement could enhance the community nutrition education program. Moreover it is strongly suggested that the ENIP be expanded to other communities.

• 보건행정학회지
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• 제13권2호
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• pp.67-84
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• 2003

Immunization has been one of the most effective measures preventing from infectious diseases. However, children routine vaccination rate of Korea was 68.2% and it was not higher than expected. Korean government revised the School Health Law for every primary school children to submit the vaccination certificate record from 2005. It is quite important national Infectious disease prevention policy to keep the immunizations rate high and monitor the immunizations rate continuously. To do this, National Institute of Health introduced the National Immunization Registry(NIR) Program at 2000. Objective : The aims of this study was to evaluate the Immunization Registry program which has been implementing since 2000 at the Public Health Centers(PHC). Methods : The mail survey was done from November 2001 to January 2002. 169 (69%) Public Health Centers among 244 PHC were responded. Results : The respondents of PHC sud the Immunization Registry(IR) program had reduced the workload (18.5%). 69.2% said they inputted the immunization data into the IR program after the shots were given. 86.5% said they hadn´t checked or retrieved the children lists who had missed the scheduled immunization. Only 17.2% said the speed of internet for the R program was good. It showed that 20% of respondents hadn´t written down documents, records on immunization any more. Even there were a lot of negative results, the respondents of PHC thought that the IR program was effective. They especially agreed that the IR program could make the job accurate (81.5%), convenient (71.3%), and reduced the chances of making mistakes (71.3%), increase the service quality (78.5%). And they were well adapting the job process of the IR (79.63%). Bivariate analysis showed that the software program was the important determinants of IR success. The only Bit Computer software program has been evaluated to be less satisfactory than the Integrated (Posdata operating system + Bit software) program. Other variables, such as age, duration of present job, and location of PHC (metropolitan, small city, rural area) were not significantly related. Conclusion : It seemed that the success of NIR might depend on the software program. Because Integrated program, which has been developed from 1994, include not only the general operating and management program for PHC but also IR program. It was natural to prefer Integrated program to Bit software program. So we can suggest that it is essential for the NIR to be successful that not only the immunization software program but also hardware equipments and public health information system should be further improved.

• 지역사회간호학회지
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• 제13권2호
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• pp.280-291
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• 2002

Objectives: This study was conducted to evaluate the maternal child health services provided by public health centers in Pyungtaek city. Methods: Data were collected based on multiple sources of official records. A questionnaire survey was obtained from 50 mothers with premature babies, and 89 mothers with full- term babies, in order to compare their demographic factors, and physical, obstetrical, and emotional status. In addition, the investigators collected data on pre and post follow-up care for the remature group to evaluate the effects of home visiting services on them. Moreover, additional data were collected from 135 pregnant women and 315 mothers with infants, to assess their degree of satisfaction for prenatal education course and breast feeding practices. Results: 1) The pregnant women's satisfaction for the prenatal education course, knowledge, and practices on self care were considered to be high. 2) Of the mothers with infants, 62.9% experienced breast feeding, but only 35.9% of them did it for six months. 3) Premature birth rate in the region was 5.6%, and 75.6% of all premature babies received follow-up care. 4) The mothers with premature babies experienced premature rupture of membrane. placenta previa, preeclampsia, and cesarean section more frequently than the mothers with full-term babies. 5) At the pre-intervention data collection point. mothers with premature babies experienced significantly less social support than mothers with full-term babies. In addition, mothers with premature babies reported higher levels of stress and care-giving burdens, and lower level of self esteem, than mothers with full-term babies, although the differences were not statistically significant. 6) In the premature group, stress, care giving burdens, and postpartum depression decreased after the intervention, whereas maternal self esteem, and the husband's support were increased after the intervention. Social support from significant others were somewhat decreased. 7) Satisfaction for the home visiting service in the mothers with premature babies was very high. Conclusion: These results showed a possibility that the recently started maternal child health services provided by the public health centers may be efficient. Although statistically significant differences were not found, the investigators found a potential for changes in a positive direction. Long-term effects of the health services on maternal child health needs should be addressed in future studies.

• 한국산학기술학회논문지
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• 제11권6호
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• pp.2078-2087
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• 2010

본 연구는 수술환자의 타지역 의료이용과 관련된 요인을 규명하기 위하여 2004년부터 2006년도의 퇴원손상 환자조사뿐 아니라, 인구센서스 및 보건의료자원 실태조사자료를 이용하여 교차분석, 로지스틱 회귀분석을 실시한 결과 다음과 같다. 첫째, 수술환자의 의료이용은 수도권 중심으로 집중화 현상이 뚜렷하다. 이를 개선하기 위해서 정부에서는 의료기관 및 병상수를 공급하는 일 뿐만 아니라 의료의 지역화를 위해 지방에서의 의료의 질적 수준을 올리는 정책이 필요하다. 둘째, 눈 및 부속기 질환 및 암환자의 타지역 수술률이 높으므로 질병에 따른 의료의 지역화를 위한 특정 질환의 지역화 정책추진이 요구된다. 셋째, 산재환자 수술환자의 타지역 진료율이 시간이 갈수록 증가하므로 손상환자를 위한 지역화 정책도 필요하다 할 것이다.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.188-195
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• 2012

Purpose: An increase in the demand for specialized Trauma Centers led to a government-driven campaign, that began in 2009. Our hospital was selected as one of the Trauma Centers, and we reviewed data on trauma patients in order to correlate the mortality at a regional Trauma Center with its contributing factors, such as the severity of the injury, the means of arrival, and the time duration before arrival at our center. Methods: Data on the patients who visited our Trauma Center from January 2010 to November 2011 were retrospectively reviewed using electronic medical records. The patients who had revised trauma scores (RTSs) less than 7 or injury severity scores (ISSs) greater than 15 were included. The patients were categorized as survivors and non-survivors, and the means of arrival as transferred or visited directly. Time durations before arrival of less than one hour were also taken intoconsideration. Results: Two hundred(200) patients were enrolled, and the mortality rate was 36.5%. The most common cause of the accident was an automobile accident, and the most common cause of death was brain injury. The RTSs and the ISSs were significantly different in the non-survivor and the survivor groups. The mortality rate of the patients who were transferred was not statistically different from that of patients who visited directly. However, a time duration before arrival of less than one hour was statistically meaningful. Conclusion: The prognosis of the trauma patients were correlated with the severity of the trauma as can be expected, but the time between the incidence of accident and the arrival at hospital and whether the presence of transfer to trauma center were not statistically significant to the prognosis.

• Journal of Hospice and Palliative Care
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• 제18권4호
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• pp.329-334
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• 2015

목적: 본 연구는 보건소에 등록된 재가 호스피스 완화돌봄 대상자의 특성과 증상을 분석하는 것이다. 방법: 부산광역시 소재 6개구 보건소에 등록된 호스피스 완화돌봄 대상자 144명의 초기 방문기록지(호스피스대상자 등록카드, 초기 통증평가지, 초기 통증 외 증상평가지)를 후향적으로 분석하였다. 결과: 대상자의 평균 연령은 67.7세이었으며, 혼자 사는 대상자가 46.2%, 교육정도는 중졸 이하가 65%였다. 종교는 불교가 36.3%로 가장 많았고, 47.5%가 의료급여 대상자였다. 진단명은 폐암, 위암, 간암의 순이었고, 기능 상태는 일상생활이 어려운 경우가 48.9%로 나타났다. 등록 당시 암 치료 중인 대상자는 39.6%이었고, 84.5%가 말기상태를 인지하고 있었다. 대상자들의 83.6%에서 통증을 호소하였으며, 그 중 36.5%에서 중간정도 이상의 통증을 호소하였다. 통증 외 증상에서 가장 많은 대상자가 호소하는 증상으로는 피로(84.7%)였으며, 피로를 호소하는 대상자의 49.3%가 중증의 증상을 호소하는 것으로 나타났다. 결론: 본 연구결과 재가 호스피스 완화돌봄 대상자들은 사회경제적 취약군으로, 중간정도 이상의 통증과 통증 외 증상을 호소하는 대상자가 많았다. 따라서 재가 호스피스 완화돌봄 대상자의 효율적인 관리를 위해서는 대상자 특성에 따른 차별화된 통합적 전략이 필요하다.

• 사회복지연구
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• 제47권4호
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• pp.255-280
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• 2016

성폭력 경험자들을 위한 통합적 지원체계의 구축과 효과적 서비스 모델 개발에 있어서 피해사례들의 유형화와 지원 서비스 이용양태에 대한 파악은 중요한 과제이다. 그러나 이러한 문제의식에 대한 답은 그간 2013년의 전국 성폭력 실태조사를 위시한 회고적 자기보고자료와 성범죄 관련 통계자료 등을 통해 다소 제한적인 정보로만 남아 있었다. 이에 본 연구는 성폭력 피해자 지원기관들에 기록되어 있는 실제 사례관리 데이터를 활용하여 성폭력 피해특성에 따른 유형화를 시도하였고, 해당 유형들과 성폭력 지원 서비스 이용 간의 관계를 살펴보는 것을 목적으로 삼았다. 이를 위해 전국의 피해자 지원 기관 29개소로부터 수집된 총 1077개 피해 사례가 분석에 활용되었다. 분석결과, 피해 유형 및 연령과 가해자와의 관계에 따른 개별 피해특성들의 차이를 발견하였고, 피해특성을 바탕으로 한 총 6개의 하위 유형을 확인할 수 있었다. 또한 해당 유형들에 따라 다양한 성폭력 지원 서비스 이용에 차이가 있음을 알 수 있었다. 본 연구는 이러한 연구결과를 바탕으로 기존 전국 성폭력 실태조사의 결과 및 성폭력 관련 범죄 통계와의 차이를 논하였고 실천적 함의와 향후 연구방향을 제시하였다.