• Pediatric Infection and Vaccine
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• v.29 no.3
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• pp.147-154
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• 2022

The clinical severity of coronavirus disease 2019 (COVID-19) in children is usually mild. Most of the affected patients completely recovered from COVID-19 before being released from approximately 7-day quarantine. However, children with comorbidities are at risk of more severe disease and adverse outcomes. We report three cases of COVID-19-affected adolescents with underlying chronic respiratory difficulty due to neurologic diseases who showed sudden clinical aggravations at the time of discharge, even after full clinical improvement. Patient 1 is a 17-year-old boy with Ullrich congenital muscular dystrophy who had cardiopulmonary arrest 9 days after the initial COVID-19 symptoms. Patient 2 is a 17-year-old girl with intracerebral hemorrhage with infarction in bed-ridden status who had cardiopulmonary arrest 11 days after the initial symptoms. Patient 3 is a 12-year-old boy with intraventricular hemorrhage with hydrocephalus in bed-ridden status who showed multiorgan failure 10 days after the initial symptoms. Remdesivir, dexamethasone, and empirical antibiotics were administered with mechanical ventilation and intensive unit care. Among the three patients, two (patients 1 and 3) were alive, and one (patient 2) expired. Clinicians caring for adolescents with chronic neurologic and/or pulmonary disease should keep in mind that these patients could have sudden deterioration after recovery from the acute phase of COVID-19 around or after the time of discharge.

• Journal of Digital Convergence
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• v.10 no.3
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• pp.233-240
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• 2012

This study aimed to clarify any factors that may have effect on the appropriateness of hospital admission and hospitalization with the intention of facilitating more efficient occupancy of hospital beds and better medical services in the aspect of their quality, minimizing unnecessary occupancy of beds, and ultimately helping patients requiring acute treatments to use immediately hospitals. This paper selected 154 Stroke patients who left neurology department of one general hospital from March, 1, 2006 to September, 31, 2010 as targets to meet the rate according to medical care security and to see the trend of recent 4 years. As study method, this paper analized medical treatment record with AEP to evaluate the appropriateness of hospital admission and stay and the collected data was computerized through SPSS 12.0. Based upon the results above, the conclusion was drawn that the higher appropriateness of hospital admission and the shorter length of hospital stay will lead to the higher appropriateness of hospitalization. In other words, it is required to provide hospitalized patients with all kinds of behaviors including medical treatments and nursing care service, management of pharmaceuticals, tests, rehabilitation and symptoms, as well as instructions and information for patients. Meanwhile, as it was found that the length of hospital stay may affect the appropriateness of hospitalization, the longer length of hospital stay may result in reduced bed turnover rate. In this light, it is necessary to organize a task force team responsible for evaluation and control of the appropriateness of hospitalization and hospital stay length to improve the quality of medical service in a medical center, so that patients can leave the center timely. Ultimately, governmental supports such as expansion of long-term care facilities will reduce the necessary length of hospital stay so that patients with stroke can receive rehabilitative treatments and long-term care service shortly after completion of acute treatments.

• Quality Improvement in Health Care
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• v.9 no.2
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• pp.116-133
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• 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.

• Journal of Korean Society for Quality Management
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• v.39 no.3
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• pp.391-399
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• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• Journal of Preventive Medicine and Public Health
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• v.38 no.4
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• pp.408-414
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• 2005

Objectives : The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. Methods : We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26,154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. Results : Out-of-pocket health expenditures for those people under the age of 65 averaged 14,800 won per month, whereas expenditures for those people aged 65 and older averaged 27,200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. Conclusions : The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and non-elderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

• Journal of Korean Physical Therapy Science
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• v.2 no.4
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• pp.817-822
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• 1995

Even though back pain therapy has greatly improved as spinal bio-mechanics is introduced, many patients still have difficulties due to low back pain. At the initial therapeutic stage, the aim of rehabilitation therapy for low back pain is pain control, but, at the later therapeutic stage, the prime aims are to reduce the late complication and to prevent the recurrence of low back pain. Accurate diagnosis should be a first step before any therapy is planned. Thus, accurate physical, neurologic, E.M.G. and radiologic tests are required to give prescription for therapeutic exercise to the patients. In addition to this, the roles of theraphists and therapeutic exercise should be re-evaluated after the therapeutic exercise is performed. Fist of all, the most important things are to educate the patients to understand the low back pain and to let the patients join the therapeutical planning. 1. Bed rest and muscle relaxing exercise for releasing the muscle tention are required for the treatment of acute low back pain. An active exercise is recommended rather than a passive exercise. If the therapeutic exercise depravate the low back pain, the exercise should be immediately terminated and the therapeutical exercise should be replanned. 2. For the treatment of the chronic back pain, stretching exercise and para-spinal muscle strengthening exercise should be performed steadily and actively to prevent the recurrence of low back pain and the low back injury due to minor damage. The patients should be educated to do proper exercise and to maintain good posture in everyday life. 3. As the low back pain is released and the body function is recovered, control of whole body function is necessary. Swiming, bicycling and walking for $30\sim40$ minutes a day and $3\sim4$ days a week are recommended. Other exercise could be recommended depending on the patients condition.

• The Journal of Internal Korean Medicine
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• v.22 no.3
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• pp.453-458
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• 2001

Guillain-Barre syndrome, or acute inflammatory demyelinating Polyradiculoneuropathy, is frequently accompanied by cardiac and autonomic dysfunction. We report a patient who had tachycardia, orthostatic hypotension, hypertension, pronounced blood pressure fluctuations, abnormal sweating, constipation and urinary frequency as well as qudriparesis. We thought that the GBS was incurred by Damp-Heat, used Heat-Clearing and Dampness-Transforming decoction(Chongjoo-tang) in the early stage. In the later stage, fortifying the Spleen and Boosting Qi plus Supplementing the Kidney decoction(Palmultang+chongawon) was used to remove low back pain and boost recovery. The patient reached the nadir 14 days after onset. He became bed-bound and autonomic dysfunction was very severe. From 3rd week, abnormalities of autonomic function and paresis impoved gradually and he could walk above 5m without walker or equivalent support at the 5th week after onset.

• Journal of English Language & Literature
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• v.57 no.2
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• pp.191-215
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• 2011

This paper aims at investigating Dorothy Wordsworth's later conversation poetry, which has not been the focus of critical discussions on her literary works. While many critics have been emphasizing Dorothy Wordsworth's journals and the tendency of self-effacement in her prose, this paper argues that her later poetry often reveals acute self-consciousness about the circumstances that condition this self-annihilation and searches for a creative way to endorse her own identity. In "Lines Intended for My Niece's Album," she expresses anxiety and uncertainty about the inclusion of her poetic piece in Dora Wordsworth's album, which contains poems by prominent male writers of the contemporary period. "Irregular Verses" presents Dorothy Wordsworth's self-conscious narrative of her girlhood and shows how her own ambition to become a "Poet" has been stifled by external circumstances, including the ideology that instills the idea of proper womanhood into aspiring girls. While these poems examine contemporary gender discourse and the frustrated poethood resulting from it, other poems activate conversations with William Wordsworth's poems and thereby provide a revisionary re-writing of her brother's texts. For example, in "Lines Addressed to Joanna H." Dorothy Wordsworth becomes "a woman addressed who herself addresses others." Her scrupulous approach to her own addressee refuses to subordinate the other to the self's will, and through this revision of "Tintern Abbey," Dorothy Wordsworth vicariously liberates her own self confined in her brother's poems. "Thoughts on My Sick-Bed," which echoes "Tintern Abbey" through borrowed phrases and direct address to William Wordsworth, foregrounds her own poetic identity in the form of the first-person pronoun "I." Dorothy Wordsworth's continual illness during this period of her life paradoxically allows her the time for personal reflection formerly denied to her in her busy life constantly occupied by physical and spiritual labor for others. Instead of earning satisfaction from the subsumption of her creative energy under William Wordsworth's poetical endeavor, Dorothy Wordsworth finally starts to affirm her own poetic identity that can properly express her inner vision and artistic talent. Although this final affirmation remains largely incomplete due to her later mental collapse bordering on madness, it powerfully conveys the hidden literary aspiration of the formerly frustrated female poet.

• CELLMED
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• v.13 no.6
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• pp.4.1-4.10
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• 2023

Background and objective: Cervicitis are an inflammatory condition of the cervix. This may be acute, chronic, active & specific or non-specific, which may cause various sign & symptoms. Abnormal vaginal discharge, lower abdominal pain, lower backache, post coital bleeding. If not treated timely it causes various complications viz PID, infertility, endometritis, ectopic pregnancy etc. Hence it has been decided to conduct a clinical trial for its management. Method: This study was an open observational study. The entire patients were allocated by considering the criteria of inclusion & exclusion. Marhame dakhilyun with roghane sausan is given 10 mg as ḥamūl at bed time, after menses for 21 days. All the patients were assessed by primary outcome of abnormal vaginal discharge, lower abdominal pain, lower backache, post coital bleeding & secondary outcomes of vaginal symptoms scale score (VSS) which score the vaginal discharge with QOL in cervicitis patients and vaginal analogue scale (VAS) for pain. Result: In this present study, marked improvement is observed in cervicitis. The mean ± SD of vaginal discharge before & after treatment is 2.57±0.050, 0.33±0.48 respectively which is highly significant with p value of<0.0001^**. VSS score before & after treatment is 21.27±6.12, 7.47±2.48 respectively with p<0.0001^** which is highly significant. VAS score used for LAB & LPA before & after treatment is 6.63±1.09, 1.90±1.29 respectively with p<0.0001^** which is highly significant. Interpretation & Conclusion: The study revealed that the formulation has been found effective in healing congestion, hypertrophied of the cervix and discharge and relieving the others associated symptoms of cervicitis. It is useful and provided immediate and effective treatment for cervicitis. Hence, the trial drug can be recommended for its management.

• Proceedings of the Korea Water Resources Association Conference
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• 2021.06a
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• pp.153-153
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• 2021

Storm Storm event is one of major issues in South Korea due to devastating damage at its landfall. A series of statistical study on the historical typhoon records consistently insist that the typhoon translation speed (TS) is on slowdown trend annually, and thus provides an urgent topic in assessing the extreme storm surge under future climate change. Even though TS has been regarded as a principal contributor in storm surge dynamics, only a few studies have considered its impact on the storm surge. The landfall angle (LA), another key physical factor of storm surge also needs to be further investigated along with TS. This study aims to elucidate the interaction mechanism among TS, LA, coastal geometry, and storm surge synthetically by performing a series of simulations on the idealized geometries using Delft3D FM. In the simulation, various typhoons are set up according to different combinations of TS and LA, while their trajectories are assumed to be straight with the constant wind speed and the central pressure. Then, typhoons are subjected to make landfall over a set of idealized geometries that have different depth profiles and layouts (i.e., open coasts or bays). The simulation results show that: (i) For the open coasts, the maximum surge height (MSH) increases with increasing TS. (ii) For the constant bed level, a typhoon normal to the coastline resulted in peak MSH due to the lowest effect of the coastal wave. (iii) For the continental shelf with different widths, the slow-moving typhoon will generate the peak MSH around a small LA as the shelf width becomes narrow. (iv) For the bay, MSH enlarges with the ratio of L/E (the length of main-bay axis /gate size) dropping, while the greatest MSH is at L/E=1. These findings suggest that a fast-moving typhoon perpendicular to the coastline over a broad continental shelf will likely generate the extreme storm surge hazard in the future, as well as the slow-moving typhoon will make an acute landfall over a narrow continental shelf.