• 대한간호학회지
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• 제44권1호
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• pp.21-30
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• 2014

Purpose: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. Methods: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Results: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. Conclusion: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Advances in pediatric surgery
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• 제5권2호
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• pp.141-145
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• 1999

Idiopathic small bowel ulceration distal to the duodenum is rare. Less than 5 % of the reported cases were in children. In the majority of the patients, a single ulcer of unknown cause is found in the jejunum or ileum. The diagnosis is difficult and usually made at the time of surgical exploration for complications, such as perforation, hemorrhage or obstruction. We treated a pediatric patient with perforation of an idiopathic ileal ulceration. The child was an 11-year-old boy who sustained blunt abdominal trauma. The involved ileal segment was resected. Pathologic findings were compatible with idiopathic small bowel ulceration. The clinical and pathological aspects of idiopathic ulcerations are discussed, and the literature reviewed.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.336-340
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• 2009

Purpose: The wound of a patient who has chronic venous insufficiency is easy to recur. Also they develop a complication even after the conservative therapy or skin graft. We have to diagnose the venous stasis ulcer correctly and remove the cause to improve the effectiveness of treatment. We operated endoscopic perforating vein ligation and splitt thickness skin graft on a patient with venous stasis ulceration on right leg. Methods: A 26 year old male patient who had a scalding burn on his right leg in July 2005 checked into our hospital in March 2008. Even though he got three operations - the split thickness skin graft - at different clinics, the wound did not heal. The size of the wound was 12 by $8cm^2$ and granulation with edema and fibrosis had been formed. We kept observation on many collateral vessels and perforating vein through venogram and doppler sonography and firmly get to know that the wound came with chronic venous insufficiency. After a debridement and an application of VAC$^{(R)}$ for two weeks, the condition of granulation got better. So we proceeded with the operation using subfascial endoscopic perforating surgery and split thickness skin graft. Results: Through the venogram after the operation, we found out that the collateral vessels had been reduced compared to the previous condition and the widened perforating vein disappeared. During a follow up of 6 months, the patient did not develop recurrent stasis ulcer and postoperative complications. Conclusion: Subfascial endoscopic perforator ligation is relatively simple technique with a low complication rate and recurrence rate. Split thickness skin graft with subfascial endoscopic perforator surgery can be valuable method for treating severe venous stasis ulcers.

• Parasites, Hosts and Diseases
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• 제52권1호
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• pp.89-92
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• 2014

Myiasis is usually caused by flies of the Calliphoridae family, and Cochliomyia hominivorax is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucum$\acute{a} $n Province for a consultation concerning an ulcer in his right foot, where the larval specimens were found. The identification of the immature larvae was based on their morphological characters, such as the cylindrical, segmented, white yellow-coloured body and tracheas with strong pigmentation. The larvae were removed, and the patient was treated with antibiotics. The larvae were reared until the adults were obtained. The adults were identified by the setose basal vein in the upper surface of the wing, denuded lower surface of the wing, short and reduced palps, and parafrontalia with black hairs outside the front row of setae. The main factor that favoured the development of myiasis is due to diabetes, which caused a loss of sensibility in the limb that resulted in late consultation. Moreover, the poor personal hygiene attracted the flies, and the foul-smelling discharge from the wound favoured the female's oviposition. There is a need to implement a program for prevention of myiasis, in which the population is made aware not only of the importance of good personal hygiene and home sanitation but also of the degree of implication of flies in the occurrence and development of this disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권1호
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• pp.64-69
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• 2009

고립성 직장 궤양 증후군은 흔치 않은 만성 질환으로 소아의 경우에는 보고가 드물며, 대장 내시경과 조직검사를 통해 진단할 수 있다. 저자들은 직장 탈항과 배변 시 점액성 혈변을 주소로 내원한 12세 남아에서 대장 내시경과 병리학적 진단, 항문 직장 내압 검사로 고립성 직장 궤양 증후군으로 진단하여 보고하는 바이다.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.418-424
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• 2018

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

• Journal of Preventive Medicine and Public Health
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• 제32권2호
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• pp.200-205
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• 1999

Objectives: This study was carried out to investigate the aluminum concentrations in blood, urine and drinking water, the factors which affect the concentrations and the role of silicon in patients who were taking antacid containing aluminum. Methods: We selected 122 peptic ulcer patients as cases and 144 healthy examinees as controls. Blood, urine, and drinking water were collected from the each study subject and we measured aluminum concentrations as well as silicon concentrations in the specimens. The factors including silicon affect on the aluminum concentrations were also analyzed, Results: 1. The mean duration of antacid administration was 12 months, and the mean daily and total amount of aluminum administration were 0.9 g and 304 g per each patient, respectively. 2. The blood and urine aluminum concentrations were significantly higher in the case. 3. The blood silicon concentration was significantly lower in the control group, and the urine silicon concentration was significantly higher in the case. 4. Urine aluminum concentration was significantly correlated with blood aluminum concentration (r=0.18), and urine silicon concentration was correlated with blood aluminum (r=0.19) and urine aluminum concentrations (r=0.13). 5. The longer the duration of antacid administration and the larger the total and daily amount of aluminum in the antacid were, the higher urine aluminum and silicon concentrations were, but not to a statistically significant degree. Conclusions: Blood and urine aluminum concentrations were higher in the ulcer patients. The authors suggest that follow-up studies of the patients who administered antacid with high aluminum content for long duration should be done.

• 한국컴퓨터정보학회논문지
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• 제27권12호
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• pp.69-76
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• 2022

본 논문에서는 MIMIC-IV(Medical Information Mart for Intensive Care) v2.0 데이터를 이용한 시계열 데이터의 정제 및 가공 방법을 제안한다. 더불어 해당 가공법을 기반으로 정제한 데이터셋을 활용하여 구축한 기계학습 기반의 욕창 조기 경보 시스템을 통해 해당 가공 방법의 유의성을 검증하였다. 구현된 욕창 조기 경보 시스템은 병변이 발생하기 전 12, 24시간에 미리 의료진에게 경보를 주는 시스템이다. 전자의무기록(Electronic Medical Record; EMR) 시스템과 연동하여 실시간으로 환자의 욕창 발생 위험도를 의료진에게 알려 중환자 의사결정을 지원하고, 나아가 효율적인 의료 자원 배분을 가능하게 한다. 여러 기계학습 모델 중 GRU 모델을 사용하였을 때, AUROC 평가지표를 기준으로 발생 전 12시간이 0.831, 24시간이 0.822로 가장 좋은 성능을 보였다.

• Journal of Chest Surgery
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• 제43권3호
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• pp.340-343
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• 2010

위늑막루는 이전의 폐수술 병력, 위궤양의 합병증, 외상, 악성종양 등에 의해 일어날 수 있는 흔하지 않은 합병증이다. 10년전에 위장천공의 외과적 봉합술을 받았던 62세 여자 환자로 좌측 농흉이 발생하여 개흉하에 흉막 박피술을 시행하였다. 수술 후 4일째, 음식물이 흉관을 통해서 배액 되어서 응급 위식도 조영술을 시행하였다. 위식도 조영술상 위늑막루를 발견하였다. 환자는 위전절제술 및 횡경막 봉합을 시행하고, 이전의 흉부창상을 통해 흉강을 세척하였다. 특별한 문제 없이 수술 후 11일째 퇴원하였다.