• Title/Summary/Keyword: back-up care

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Management of complex surgical wounds of the back: identifying an evidence-based approach

  • Zolper, Elizabeth G.;Saleem, Meher A.;Kim, Kevin G.;Mishu, Mark D.;Sher, Sarah R.;Attinger, Christopher E.;Fan, Kenneth L.;Evans, Karen K.
    • Archives of Plastic Surgery
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    • 제48권6호
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    • pp.599-606
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    • 2021
  • Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4-23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

장애인선수들의 스포츠상해에 관한 연구 (Sports Injuries in Athletes with Disabilities)

  • 정복자
    • 재활복지
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    • 제21권4호
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    • pp.59-75
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    • 2017
  • 본 연구는 장애인운동선수들의 스포츠상해유형에 대하여 알아봄으로써 장애인 운동선수들의 상해 예방 및 치료, 관리, 운영방안에 기초적 자료를 제공하고자 한다. 2015년에 전국장애인체육대회에 참가한 선수 171명을 대상으로 스포츠상해관련 설문을 조사하여 다음과 같은 결과를 얻었다. 상해 부위는 어깨, 손가락, 손목 순으로 상해 빈도가 가장 높았으며, 상해 유형으로는 타박상, 근육통, 염좌 순으로 높게 나타났다. 생해기전으로는 선수들과의 접촉, 기구와의 접촉으로 인한 상해가 가장 많이 발생되었다. 상해발생원인으로는 과도한 승부욕으로 인한 상해 발생가 가장 많았으며, 게임 중에 가장 많이 부상을 당한다고 하였다. 만성적 통증 부위 역시 어깨가 가장 많았으며 다음으로는 대퇴, 손목 순으로 나타났다. 상해 직후 처치는 감독이나 코치, 자가 치료가 순으로 가장 많았으며 치료는 파스나 스프레이를 이용한 치료방법이 가장 많았으며, 치료방법은 물리치료가 가장 많았다. 상해 예방방법으로 준비운동과 정리이 필요하다는 응답이 가장 많았으며 그 다음으로는 체력 훈련이 필요하다고 응답하였다. 이상의 결과를 통해, 장애인 선수들의 상해 예방 및 치료, 관리를 위한 체계적이고, 과학적인 체력관리 및 재활훈련 프로그램 제공을 위한 후속연구가 필요하다.

한국 군 인트라넷 사용이 신세대 장병들의 군복무만족도에 미치는 영향 (Using the Korean troops intranet impacts on satisfaction of new generation soldiers)

  • 소명섭;임재욱;이종구
    • 국제지역연구
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    • 제16권3호
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    • pp.367-390
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    • 2012
  • 본 논문은 20대 병영생활을 하는 인적자원들이 2년의 복무기간동안 보다 효율적인 시간관리와 정신적 육체적 건강관리를 통해 사회에 환원될 수 있도록 군복무에 대한 만족도에 군 인트라넷이 어떤 영향을 미치는 지에 대한 실상을 분석하는데 목적이 있다. 이는 개인적으로나 국가적인 차원에 있어 군복무의 효율적인 운영이라는 차원에서 시사하는 바가 매우 클 뿐만 아니라 향후 신세대 예비 군복무자들에게 있어 자기관리에 필요한 유용한 정보를 제공할 수 있는 지침이 되기 때문이다. 본 연구는 인터넷 세대로 이루어진 20대 초반의 신세대 장병들에게 군 인트라넷이 군복무 만족에 어떤 영향을 미치는지 그 요인을 분석하는 동시에 아울러 이것을 군조직 차원에서 효율적인 활용을 위해 정보를 제시하는데 그 의의를 두고자 한다. 결론적으로 인트라넷은 복무만족에 효과적으로 영향을 미치는 중요한 요인이자, 수단이라는 것이 입증되었으며 나아가 군조직에서 적용되고 있는 인트라넷 망을 단순업무나 전파수단이 아닌 조직의 전략과 목표달성을 위해 보다 한 차원 높은 군 인트라넷 활용으로 발전시켜야 한다는 시사점이 도출되었다.

학년에 따른 청소년의 건강상태와 증상인식에 대한 단면조사 연구 (Cross-sectional Study on Health Status and Symptom Recognition of Adolescents by Grade)

  • 신선미;박정수;고호연;김동수;성현경
    • 동의생리병리학회지
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    • 제32권6호
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    • pp.403-410
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    • 2018
  • Lifestyle of adolescents cause a lot of health effects in the future. Therefore, in Korea, school health law was enacted and relevant business such as school education program is being carried out. This study was conducted to recognize symptom according to grade. A survey of youth health status was conducted at 19 middle and high schools in Seongnam city from May 2015 to December 2015. The survey made up of 14 questions which was about the health status satisfaction on the adolescent was conducted to investigate frequency by year and the respective health status of 6 grades. A total of 9,584 students responded to the survey, 58.22% answered that they were not free of constipation. 25.69% of respondents had no symptoms of headache, consequently over 70% of respondents had headache. 57.06% of respondents had no symptoms of low back pain and 34.7% had no symptoms of neck & shoulder pain, therefore over 50% of respondents had muscular skeletal symptoms. In menstrual history, only 17.95% of respondents said their period was regular and painless. In respiratory history, except cold, no nasal drop & obstruction has appeared in the group of 54.02%. And 62.97% of respondents had persistent cough usually with cold and 23.41% had cough with cold breeze even if not catch cold. In the third grade of high school students, there were many complaints of pain in various parts such as headache, back pain and shoulder pain, neck pain and menstrual pain, and there was a high rate of complaints of digestive system symptom and defecation symptom. More than half of respondent had constipation discomfort, headache and musculo-skeletal symptoms, menstrual problems and cough. In the third grade of high school students, the rate of complaints of pain complaints, digestive system symptoms, and bowel symptoms was high. Therefore, there is a need for measures and management for continuous health care and health promotion in accordance with students' symptoms and age at each grade level.

우리나라 임상방사선종양을 위한 웹 기반 PCS 시스템의 개발과 특성 (A Web-based 'Patterns of Care Study' System for Clinical Radiation Oncology in Korea: Development, Launching, and Characteristics)

  • 김일한;지의규;오도훈;서창옥;김종훈;안용찬;허원주;정웅기;최두호;이재원
    • Radiation Oncology Journal
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    • 제21권4호
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    • pp.291-298
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    • 2003
  • 목적: PCS연구의 목적은 임상 방사선치료 QA의 표준 연구 수단을 구축하고, 방사선치료 과정의 기본 요소를 결정하고, 협동 임상시험의 기반을 제공하고, 외국과의 비교 연구를 위한 기본 자료의 구축에 있다. 우리나라 임상 방사선종양학의 PCS 연구기법으로서 구축한 웹 기반의 PCS 시스템의 개발 및 특성을 보고하고자 한다. 대상 및 방법: 본 시스템은 메인서버와 외부에 구축한 2중 백업서버로 구성되어 있다. 리눅스 운영 체제 및 MySQL데이터베이스를 이용하여 프로그램을 완성하였다. PCS 대상이 되는 종양으로서의 개발 우선 순위는 1989년부터 1999년 사이에서 우리나라 전국의 방사선종양학과에서 치료빈도가 많은 순서를 근거로 결정하였다. 결과: 2003년 초반에 웹 기반의 임상 PCS시스템이 구축되었다. 웹 주소는 www.pcs.re.kr이며, 우선 유방암, 직장암, 식도암, 후두암, 폐암 및 전이성 뇌종양을 대상으로 하였다. 완성된 개발항목의수는 1,000 항목을 상회하였다. 구축된 시스템은 사용자 편의성 충족, 기입 내용 중복 확인, 자료 기밀성, 자료 보존 및 사본 작성, 이중 백업, 통계 분석 지원등을 구현하였다. 문자화된 자료 외에 영상 자료도 입력되도록 시스템을 구축하였다. 아울러, 임상시험승인 관련 양식지원, 무작위 자료 추출, 방사선종양학과의 구조적 요소 파악 기능도 갖추었다. 결론: 본 시스템은 PCS분야에서는 최초로 구축되고 작동되는 웹 기반 시스템이다. 구축한 시스템을 통해서 단시간 내에 표본 자료의 수집이 가능하여 시간 및 비용을 절약할 수 있게 되었으나 구축자료의 신뢰도 확인을 별도의 검증과정은 필수적이다. 본 연구팀이 개발한 본 웹 기반 시스템은 향후 PCS 연구 또는 자료 수집이 필요한 유사 연구 상황에 응용될 수 있는 표준적인 기법으로서의 활용되기를 희망한다.

진료환경개선을 위한 우선적 전략과제 설정 및 그 적용 (A Strategic Quality Initiative and Its Opportunities to Improve Healthcare Environment)

  • 탁관철;박현주;박창일;강진경
    • 한국의료질향상학회지
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    • 제5권2호
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    • pp.324-334
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    • 1998
  • Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

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척추 압박 골절 환자의 회복에 대한 침 치료의 유효성 및 안전성 평가: 체계적 문헌 고찰과 메타분석 (The Effectiveness and Safety of Acupuncture for Recovery of Patients with Vertebral Compression Fractures: A Systematic Review and Meta-analysis)

  • 배지민;이명수;최지원;양기영;김건형
    • Korean Journal of Acupuncture
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    • 제36권1호
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    • pp.1-18
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    • 2019
  • Objectives : The purpose of this study was to evaluate the effectiveness and safety of acupuncture treatment for recovery of patients with vertebral compression fracture(VCF). Methods : We searched ten English and Chinese and seven Korean database up to April 2018. Randomised controlled trials(RCTs), quasi-RCTs, non-radomised Controlled Trials(CCTs) were eligible. Quasi-RCTs and CCTs were assessed only for safety assessment. Pain and adverse events were primary outcome of this review. Quality of life, dysfunction, patient satisfaction, incidence of new vertebral compression fracture were regarded as secondary outcomes. The risk of bias was assessed by two independent authors using the Cochrane risk of bias tool. Level of evidence was tabulated using the GRADE methods. Results : Of 1656 screened, 15 RCTs, 1 quasi-RCT and 3 CCTs were included. Number of participants per study ranged from 45 to 135. Most of the studies had unclear or high risk of bias and considerable heterogeneity in terms of type of intervention, comparison and time-points for outcome measurement. Compared to usual care alone, acupuncture combined with usual care showed short-term favorable results for pain relief in patients with VCF(5 studies, n=252, MD -1.05 point on a 0 to 10 point scale, 95% CI -1.45 to -0.65, $I^2=74%$). Four studies reported mild and temporary adverse events, and no serious adverse events were reported. One study descriptively reported that acupuncture was effective for improving quality of life without providing numerical outcomes. There were no reports of patient satisfaction and incidence of new VCF. Conclusions : Level of evidence is very low for the effectiveness and safety of acupuncture for pain, harms and other clinical outcomes in patients with VCF. Included studies suffered from incomplete reporting, high or unclear risk of bias and substantial heterogeneity between studies. Future high-quality RCTs are needed to assess whether acupuncture is beneficial for recovery of patients with VCF.

Comparison of Cognitive Loads between Koreans and Foreigners in the Reading Process

  • Im, Jung Nam;Min, Seung Nam;Cho, Sung Moon
    • 대한인간공학회지
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    • 제35권4호
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    • pp.293-305
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    • 2016
  • Objective: This study aims to measure cognitive load levels by analyzing the EEG of Koreans and foreigners, when they read a Korean text with care selected by level from the grammar and vocabulary aspects, and compare the cognitive load levels through quantitative values. The study results can be utilized as basic data for more scientific approach, when Korean texts or books are developed, and an evaluation method is built, when the foreigners encounter them for learning or an assignment. Background: Based on 2014, the number of the foreign students studying in Korea was 84,801, and they increase annually. Most of them are from Asian region, and they come to Korea to enter a university or a graduate school in Korea. Because those foreign students aim to learn within Universities in Korea, they receive Korean education from their preparation for study in Korea. To enter a university in Korea, they must acquire grade 4 or higher level in the Test of Proficiency in Korean (TOPIK), or they need to complete a certain educational program at each university's affiliated language institution. In such a program, the learners of the Korean language receive Korean education based on texts, except speaking domain, and the comprehension of texts can determine their academic achievements in studying after they enter their desired schools (Jeon, 2004). However, many foreigners, who finish a language course for the short-term, and need to start university study, cannot properly catch up with university classes requiring expertise with the vocabulary and grammar levels learned during the language course. Therefore, reading education, centered on a strategy to understand university textbooks regarded as top level reading texts to the foreigners, is necessary (Kim and Shin, 2015). This study carried out an experiment from a perspective that quantitative data on the readers of the main player of reading education and teaching materials need to be secured to back up the need for reading education for university study learners, and scientifically approach educational design. Namely, this study grasped the difficulty level of reading through the measurement of cognitive loads indicated in the reading activity of each text by dividing the difficulty of a teaching material (book) into eight levels, and the main player of reading into Koreans and foreigners. Method: To identify cognitive loads indicated upon reading Korean texts with care by Koreans and foreigners, this study recruited 16 participants (eight Koreans and eight foreigners). The foreigners were limited to the language course students studying the intermediate level Korean course at university-affiliated language institutions within Seoul Metropolitan Area. To identify cognitive load, as they read a text by level selected from the Korean books (difficulty: eight levels) published by King Sejong Institute (Sejonghakdang.org), the EEG sensor was attached to the frontal love (Fz) and occipital lobe (Oz). After the experiment, this study carried out a questionnaire survey to measure subjective evaluation, and identified the comprehension and difficulty on grammar and words. To find out the effects on schema that may affect text comprehension, this study controlled the Korean texts, and measured EEG and subjective satisfaction. Results: To identify brain's cognitive load, beta band was extracted. As a result, interactions (Fz: p =0.48; Oz: p =0.00) were revealed according to Koreans and foreigners, and difficulty of the text. The cognitive loads of Koreans, the readers whose mother tongue is Korean, were lower in reading Korean texts than those of the foreigners, and the foreigners' cognitive loads became higher gradually according to the difficulty of the texts. From the text four, which is intermediate level in difficulty, remarkable differences started to appear in comparison of the Koreans and foreigners in the beginner's level text. In the subjective evaluation, interactions were revealed according to the Koreans and foreigners and text difficulty (p =0.00), and satisfaction was lower, as the difficulty of the text became higher. Conclusion: When there was background knowledge in reading, namely schema was formed, the comprehension and satisfaction of the texts were higher, although higher levels of vocabulary and grammar were included in the texts than those of the readers. In the case of a text in which the difficulty of grammar was felt high in the subjective evaluation, foreigners' cognitive loads were also high, which shows the result of the loads' going up higher in proportion to the increase of difficulty. This means that the grammar factor functions as a stress factor to the foreigners' reading comprehension. Application: This study quantitatively evaluated the cognitive loads of Koreans and foreigners through EEG, based on readers and the text difficulty, when they read Korean texts. The results of this study can be used for making Korean teaching materials or Korean education content and topic selection for foreigners. If research scope is expanded to reading process using an eye-tracker, the reading education program and evaluation method for foreigners can be developed on the basis of quantitative values.

태교 실천에 대한 일상생활 기술적 연구 (An Ethnographic Study about Taegyo Practice in Korea)

  • 김현옥
    • 대한간호학회지
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    • 제27권2호
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    • pp.411-422
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    • 1997
  • The purpose of this study is twofold : (i) to investigate how much effort the married couples are making for the good health of both the pregnant woman and her unborn child from the time of their marriage to and during the period of conception : and (ii) to comprehensive investigate socio-cultural back-grounds which affect prenatal effort. Result of this study provide a basis for the prenatal care program which will be appropriate to our culture. This study has been done by the ethnographic research method. The subjects of this study are 53 people in all consisting of 33 pregnant women and 20 husbands. In order to investigate socio-cultural factors which influence Taegyo, producers of Taegyo music were interviewed. In addition the researcher surveyed the markets of Taegyo music, participated in special courses of prenatal education, analyzed the content of the books and periodicals dealing with Taegyo, and collected the concept of Taegyo distributed by the mass media. The full-fledged study continued for eight months from February to August.1996. The data were analyzed as soon as they were collected. Spradly's(1979, 1980) developmental, sequential method of domain analysis. taxonomic analysis, componential analysis, and theme analysis in this order was adopted as the procedure of analyzing the data. To obtain the exactness of study, Sandelowski's (1986) four criteria, that is, Credibility, Fittingness, Auditability, and Confirmability were applied to all stages of data collection, data analysis, the interpretation of the result, and the description of the result. The following are the result : 1. The couples' Taegyo at the stage of preconception was related to their physical, psychological, spiritual conditions under which a healthy baby will be born. Specific methods they prefer are : "the choice of one's spouse." "physical check-up," "physical good health, " "praying, " and so on. 2. When the marriod couple have sex in order to conceive, their Taegyo was related to the imposition of their physical, psychological, and environmental conditions. Specific methods they prefer are : "having sex at specific time, " "having sex in nice place." "to purify their minds while having sex," and so on. 3. The married couples' Taegyo while they are in pregnancy was related to the imposition of their physical. psychological, emotionmental. environmental, social and spiritual conditions. Specific methods they prefer are : "listening to music. " "reading," "looking at beautiful things only," "to avoid looking at or listening to bad things." "to eat food in good shape, " "to avoid drugs," "eating Korean herbal medicine." "sexual abstinence," "to avoid dangerous places," "to keep emotional tranquility," "moderate exercises and rest." "leading a pure life." "praying." "being aware of their words and behavior." "for the couple to keep a good relationship." "interaction with their unborn child," "to support Taegyo for pregnant women," and so on. 4. The married couple put Taegyo into practice on the basis of the following principles : the principle of respecting an unborn child, the principle of forming a good disposition. the principle of top-down parental love, the principle of synergy between a pregnant woman and her unborn child, the principle of expecting a good child, the principle of forming a good habit, and the principle of acquiring a parental role. 5. The practice of Taegyo is influenced by such factors as the married couple, the supporting system, and the mass media. As the husband -and-wife factor, their information of Taegyo, the degree of importance is assigned to their characters, their time to spare, their healthiness, the age of pregnant woman, their conception plan, their religion, their belief of the Taegyo effects, and the birth of a baby in this order. The factor of the supporting system consists of her husband's support, her family support, and her neighbor's support. The mass media factors include the broadcasting media, books specialized in Taegyo, periodicals for pregnant women, booklets for advertizing powdered milk, Taegyo music of record manufacturing companies, and the teaching materials for gifted children. Among these the mass media is especially taking advantage of Taegyo as its main source of economic profits are leading the public behavior pattern to a prodigal one. Taegyo is a self-control behavior which requires practice for the following : the physical and psychological good health of the pregnant woman and her unborn child, the development of the unborn child's good character, the development of the unborn child's intelligence and talents, the expectation of the unborn child's good features. shape a good habit, the expectation of the unborn child's bright future, and the learning of a parental role, the expectation of male birth. Above all it is a type of our good cultural tradition which pursues a value higher than the one that the prenatal care does. The principles of pregnancy care inherent in the habit of Taegyo will provide us a guideline for the development of the prenatal care.

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당뇨병 환자의 민간요법 시행에 대한 실태조사 (A Study of the Application of Folk Medicine in Patients with Diabetes Mellitus)

  • 엄동춘;이영신
    • 동서간호학연구지
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    • 제1권1호
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    • pp.72-81
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    • 1997
  • Korean society is a mix of western and traditional cultures. Even though the patients try to recover through both aspects, hospital only utilizes a western approachs. When they have suffered from a chronic disease, especially diabeties meliitus(DM), application of folk medicine is more varied but the nurses are unaware of the practices. This study was done to describe the current use of the folk medicine with which the patients with DM have had an experience and to identify the relationships between the westernized medical care and folk medicine application. The 244 patients with non-insulin dependent diabetes millitus who participated were interviewed at a DM education clinic in a 1500-bed hospital. The results of the study are as follows: 1. 54.1%(N=133) of the participated patients in this study have had a folk medicine. 2. 44 kinds of folk medicine were used for the treatment of DM. Among them 14 items were used by more than two people and the rest were used by one person. Among the used items, 70.4% consisted of various types of plants, 11.4% was animal material and 18. 2% was the mixed group. As a single item, Commelina Communis(Dalgaebi) was the most frequently used(62.8%), followed by the root of Rosa rugosa(Haedangwha) 14.3%, and Youngi mushroom 13.6%. 3. In the analysis of the relationships between the general characters of the patients with regular fol1ow-up(F-U), self blood sugar test(BST) and folk medicine usage: 1) The higher the educational back ground patient had, the lower the folk medicine usage was ($X^2$=14.265, P=.003). 2) The more complex their treatment was($X^2$=24. 016. P=.000). and the longer they had suffered from DM($X^2$=75.739, P=.000), the fewer they visited regular F-U. On the other hand, they did self-BST well($X^2$=7.722, P=.021 : $X^2$=14. 775, P=.002) and had more folk medicine($X^2$=33.382, P=.000 ; $X^2$=43.410, P=.000). 3) If they had suffered many symptoms, they had fewer regular F-U ($X^2$=13.192. P=.001). On the other hand, they had more folk medicine($X^2$=6.070, P=.048). 4) The group of family history($X^2$=6.801. P=.009) and the group of DM education experience($X^2$=15.678, P=.000) carried out self BST well. DM education group used more folk medicine($X^2$=8.680, P=.003). In conclusion, DM education should be grouped according to the treatment type and suffering period. Then the management of DM would be effective and the vague application of folk medicine would be decreased.

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