• 대한기관식도과학회지
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• 제5권2호
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• pp.191-197
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• 1999

Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.

• 대한후두음성언어의학회지
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• 제15권1호
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• pp.16-20
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• 2004

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.

• 대한지역사회영양학회지
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• 제11권1호
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• pp.39-51
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• 2006

This study was conducted to investigate the differences in daily nutrient intakes, dietary habits and nutrition knowledge between male and female college students. Male undergraduate students 004 subjects) and female undergraduate students (229 subjects) , enrolled at H University in Daejeon, were recruited for this study. The mean age of the subjects was 22.9 year in male and 20.4 year in female students. Daily intakes of energy and nutrients were calculated from the records of one day of dietary food intakes by 24-hour recall method, and general information, dietary habits and attitudes, food intake frequency and food preferences and knowledge for food and nutrition were surveyed through a questionnaire. About $70.1\%$ of male and $66.1\%$ of female students were in the normal range of BMI (18.5 - 23), and $25.2\%$ of male students were over-weighted in contrast to $27.7\%$ of female students were underweight. Males and females were taking $77.2\%$ and $77.9\%$ of RDA for energy, respectively, and $54.8\%$ of male and $48.0\%$ of female students were taking energy under $75\%$ of RDA. Many of them showed deficient intakes of calcium, iron, vitamin A and riboflavin. Average of MAR was 0.75 in male and 0.72 in female students. NAR for calcium, iron, vitamin A and riboflavin in male students were 0.55, 0.69,0.75 and 0.61, respectively, compared to 0.53, 0.51, 0.70 and 0.67 in female students. The nutrients, which have INQ less than 1, were calcium and riboflavin in male, compared to calcium, iron, and riboflavin in female students. There were no gender differences in meal regularity and meal skipping rates, but female students showed higher rates of skipping dinner than males (p < 0.001) About $50.8\%$ of female students were ingesting snacks 1 - 2 time/day, compared to $27.1\%$ of male students. For the food intake frequency, fruit group was significantly eating more for female than male students (p< 0.001) Though female students got higher scores for nutritional knowledge test (p < 0.001) than male students, they did not show better dietary habits or dietary attitudes than male students actually. Therefore, a more active and actual education program accustomed to the different genders and ages with focus on real changing of dietary behaviors needs to be developed and run in schools and local departments.

• 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.

• Asian-Australasian Journal of Animal Sciences
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• 제26권9호
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• pp.1237-1246
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• 2013

The objective of this study was to estimate variance components and genetic parameters for lactation milk yield (LY), lactation length (LL), average milk yield per day (YD), initial milk yield (IY), peak milk yield (PY), days to peak (DP) and parameters (ln(a) and c) of the modified incomplete gamma function (MIG) in an Ethiopian multibreed dairy cattle population. The dataset was composed of 5,507 lactation records collected from 1,639 cows in three locations (Bako, Debre Zeit and Holetta) in Ethiopia from 1977 to 2010. Parameters for MIG were obtained from regression analysis of monthly test-day milk data on days in milk. The cows were purebred (Bos indicus) Boran (B) and Horro (H) and their crosses with different fractions of Friesian (F), Jersey (J) and Simmental (S). There were 23 breed groups (B, H, and their crossbreds with F, J, and S) in the population. Fixed and mixed models were used to analyse the data. The fixed model considered herd-year-season, parity and breed group as fixed effects, and residual as random. The single and two-traits mixed animal repeatability models, considered the fixed effects of herd-year-season and parity subclasses, breed as a function of cow H, F, J, and S breed fractions and general heterosis as a function of heterozygosity, and the random additive animal, permanent environment, and residual effects. For the analysis of LY, LL was added as a fixed covariate to all models. Variance components and genetic parameters were estimated using average information restricted maximum likelihood procedures. The results indicated that all traits were affected (p<0.001) by the considered fixed effects. High grade $B{\times}F$ cows (3/16B 13/16F) had the highest least squares means (LSM) for LY ($2,490{\pm}178.9kg$), IY ($10.5{\pm}0.8kg$), PY ($12.7{\pm}0.9kg$), YD ($7.6{\pm}0.55kg$) and LL ($361.4{\pm}31.2d$), while B cows had the lowest LSM values for these traits. The LSM of LY, IY, YD, and PY tended to increase from the first to the fifth parity. Single-trait analyses yielded low heritability ($0.03{\pm}0.03$ and $0.08{\pm}0.02$) and repeatability ($0.14{\pm}0.01$ to $0.24{\pm}0.02$) estimates for LL, DP and parameter c. Medium heritability ($0.21{\pm}0.03$ to $0.33{\pm}0.04$) and repeatability ($0.27{\pm}0.02$ to $0.53{\pm}0.01$) estimates were obtained for LY, IY, PY, YD and ln(a). Genetic correlations between LY, IY, PY, YD, ln(a), and LL ranged from 0.59 to 0.99. Spearman's rank correlations between sire estimated breeding values for LY, LL, IY, PY, YD, ln(a) and c were positive (0.67 to 0.99, p<0.001). These results suggested that selection for IY, PY, YD, or LY would genetically improve lactation milk yield in this Ethiopian dairy cattle population.

• 한국식품영양과학회지
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• 제24권4호
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• pp.510-516
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• 1995

체지방이 30% 이상으로 비만이라 판정되는 20~62세의 지원자들에게 저열량 균형식, 무리하지 않은 유산소 운동 및 개인별 비만의 원인을 교정하고 평생체중을 조절하기 위한 영양상담과 교육을 포함한 행동수정을 통해 5주 동안 비만을 치료하고 성인병과 관련된 위험 요인들의 변화를 살펴보았다. 활동량, 식습관, 식이섭취조사를 실시하여 개인별 비만의 원인을 진단한 후 잘못된 식생활을 교정할 수 있도록 주 3회의 영양상담과 매주 1회의 영양교육을 실시하였다. 식이요법은 1일 1끼의식사와 3회의 조제식이를 통해 열량이 1200kcal 정도가 되고, 양질의 단백질, 비타민, 무기질은 성인 권장량의 100~150% 이상이 되도록 하였다. 식전에 식이섬유와 물을 복용하고 식사 기간은 20분 이상으로 천천히 섭취하도록 하였으며, 투긴음식, 가공식품, 패스트 푸두, 술, 청량음료, 달고 기름진 음식, 짜고 자극적인 음식 등은 제한하였다. 주당 3~5일간 1시간 정도의 가벼운 유산소 체조를 실험대상자 저원이 모여서 실시하였다. 먹은 식품, 활동, 운동, 감정상태, 피로여부 등을 일지로서 기록하게 하여 삼담을 통해 교정하고 관찰하여 긍정적인 내적동기를 갖도록 교육하였다. 비만치료 기간 중 탈락한 수는 총 16명 중 5명 (31.3%)이었으며, 비만도는 대상자의 대부분이 경증이고, 불규칙적인 식사, 빨리 먹는 습관, 과식, 짜게 먹는 습관, 야식, 음주 등의 비만의 원인이 되는 습관들을 가지고 있어 식습관 점수는 개선이 요구된다고 진단되었다. 5주동안의 비만치료로 체중은 평균 4.8kg(주당 0.96kg)이 감량 되었으며, 체지방, body mass index, 허리, 팔, 둔부의 둘레가 유의적으로 감소되었다. 혈압, 공복시의 혈당, 혈액증의 중성지방, 총콜레스테롤, HDL-콜레스테롤은 변화가 없었으나, LDL-콜레스테롤은 유의적으로 감소하였다.

• Clinical and Experimental Pediatrics
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• 제50권9호
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• pp.848-854
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• 2007

목 적 : 최근 모유 수유에 대한 관심이 증가되고 있으나 모유 수유를 위한 충분한 교육과 여건이 성숙되지 못한 상황에서 이를 고집하여 조기 모유 황달이 증가하는 경향이 있다. 본 연구는 이러한 황달의 원인과 위험인자, 핵황달의 조기 예측도구로서 ABR 검사의 유용성을 알아보고자 시행하였다. 방 법 : 2005년 9월부터 2006년 5월까지 신생아 황달로 입원치료 받은 환아 중 임신과 분만 시 관련 합병증이 없었던 출생체중 2,500 g 이상, 재태 주령 37주에서 42주의 36명을 대상으로 하였다. 이 중 전적으로 모유 수유만을 시행한 환아 23명을 모유 수유군으로 하였고, 모유 수유를 우선으로 하였으나 부족분을 조제유로 보충한 13명을 혼합 수유군으로 하였다. 결 과 : 두 군간 임상적 특성은 통계학적 차이가 없었고 다만 외래 방문 시 일령은 모유 수유군($8.7{\pm}3.6$일)이 혼합 수유군($6.0{\pm}1.9$일)에 비해 유의하게 늦었으며(P=0.009), 1주 이후인 경우에서 혈청 빌리루빈이 높은 경향이 관찰되었다. 모유 수유군이 23명(63.9%), 혼합 수유군 13명(36.1%)으로 조사되었고, 혼합 수유의 경우 산모가 적극적으로 모유 수유를 원했으나 모유량의 부족으로 인한 선택이었으며, 모유 수유군에서 혼합 수유군에 비해 유의하게 체중 감소가 심하였다(P<0.05). 비정상 ABR은 혈청 빌리루빈 33.5 mg/dL(외래 방문 시 일령 9일), 32.1 mg/dL (외래 방문 시 일령 7일), 20.3 mg/dL(외래 방문 시 일령 13일) 의 3례에서 V 파형의 소실이 관찰되었고 추적검사가 이루어진 경우 회복을 보였다. ABR 검사 상 70 dB 자극에서 III 파형이 혈청 빌리루빈 값의 증가에 따른 잠복기 연장이 유의한 상관관계를 보였고(P=0.002), 연령을 포함한 다중회귀분석에서도 혈청 빌리루빈 값과 유의한 결과를 확인할 수 있었다(P<0.01). 결 론 : 신생아 황달에서 핵황달의 조기 예측도구로서 ABR 검사를 이용하기 위해서는 향후 지속적인 연구를 통해 파형의 소실 외에도 유의한 잠복기의 연장이나 파형의 변형에 따르는 분석을 위해 검사방법과 정상치를 표준화함으로써 도움이 될 수 있을 것으로 생각된다. 또한 모유 수유의 경우 조기 모유 황달을 예방하려면 산모에 대한 충분한 교육 및 생후 1주 이내의 외래 방문을 권할 필요가 있으며, 혈청 빌리루빈 및 ABR 검사를 시행하면 교환 수혈의 시행 여부에도 도움이 될 수 있을 것으로 생각된다.

• 임상간호연구
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• 제19권3호
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• pp.432-442
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• 2013

Purpose: The purpose of this study was to describe restraint use in care of patients with psychiatric disorders in an attempt to avoid unnecessary restraint use and provide information for developing standards regarding restraint use as a therapeutic maneuver. Methods: For this descriptive study, discharge records from N National Mental Hospital in the year 2009 were reviewed by trained nurses during Dec. 24, 2010 and Mar. 31, 2011. There were 596 restrains applied on 232 of 1,322 discharges. Data collected include general characteristic of patients, the frequency of restraint use, time since admission when restraint was applied, time of the day when restraint was applied, duration of restraint application, place of occurrence, reasons for restraint use, and degree of damage to the patent. Work experience of nurses who applied restraints, number of workforce at the time of restraint, and season of the year was also identified. Descriptive statistics, Chi-square test, t-test, ANOVA, $Scheff{\grave{e}}$ and Jonckheere-Terpstra were applied using SPSS 14.0 to analyze the data. Results: There were 596 restraint uses among 232 patients. Restraints were applied most frequently on males in their 40s, patients diagnosed with schizophrenia, and patients repeating admissions more than 6 times. Restraints were frequently applied within first week following admission, between 16:00 and 20:00, and the average duration of restraint was 5 hours. There were significant differences according to diagnoses of patients in the season restraint occured, time, place of occurrence, reason for restraint, and duration of restraint. Patients with alcoholism received longer restraint application. Conclusion: In order to avoid unnecessary restraint use in patients with psychiatric disorders, nurses and other health care team members need to acknowledge a group of patients such as patients with schizophrenia and alcoholism who relatively frequently restrained or receiving longer restraint. Reasonable and careful decision need to be made when applying restraint in the care of patients with alcohol problem.

• Journal of Animal Science and Technology
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• 제55권1호
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• pp.1-6
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• 2013

본 연구는 국내 국가단위 평가결과의 문제점을 해결하면서 유전 능력평가시스템을 고도화하고 우리나라가 국제유전평가에 참여하기 위하여 국제평가기구에서 요구하는 검증작업을 통과하기 위하여 수행하였다. 본 연구에 이용된 자료는 농협중앙회 젖소개량부에서 수집한 분만일이 2001년부터 2009년까지의 검정성적으로 총 1,416,589개이며 산차는 5산으로 제한하였으며, 누적착유일은 75~305일로 제한하였고, 전체 혈통자료는 2,279,741개이며 부모를 갖는 개체는 535,409개이고 아비소는 2,467두로 구성되어 있는 기록들을 이용하였다. 유량, 유지방, 유단백에 대한 육종가는 신규로 개발한 다형질모형(Multiple traits model)을 이용하여 육종가를 구하였으며 기초작업은 SAS version 9.2와 R프로그램을 이용하였으며 유전모수를 추정하기 위하여 VCE 6.0을 이용하였다. 전반적으로 유전적 추세는 꾸준히 지속되어 오고 있으며 산차별 차이가 두드러지게 나타나지는 않았다. 유지방을 제외하고 유량과 유단백 형질의 추세가 잘 추정되었음을 알 수 있다. 유전평가분석결과 상위 1000두의 랭킹안에 최근의 생년을 갖는 딸소가 기존에 사용한 모수로 분석한 결과보다 딸소가 증가했음을 알 수 있다. 국제유전평가모형을 통해 새로 평가한 결과 씨수소상위 100두를 기존 평가모형에 의한 평가결과와 비교했을 때, 2006년생은 23두에서 28두로 2007년생은 12두에서 20두로 2008년생은 2두에서 8두로 증가하였다. 이는 최근의 딸소나 씨수소의 유전능력이 우수함에도 불구하고 상위에 랭크되지 못했던 결과가 새 모형의 적용으로 보완하여 새로운 평가분석에 적용할 수 있을 것으로 판단된다. 따라서 기존의 단형질 모형 대신 다형질 모형을 이용한 분석방법으로 평가를 실시하고 국제유전평가에도 다형질 모형을 이용한 육종가를 제시함으로써 다형질 선발의 정확도가 향상될 수 있을 것이다.

• 가정∙방문간호학회지
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• 제7권1호
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• pp.58-72
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• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.