• Archives of Plastic Surgery
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• v.48 no.6
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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.

• Archives of Craniofacial Surgery
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• v.16 no.1
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• pp.17-23
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• 2015

Background: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.19-24
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• 2022

Purpose: The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. Methods: We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Results: Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. Conclusions: While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

• Journal of Korean Society for Quality Management
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• v.39 no.1
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• pp.15-23
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• 2011

The biggest change in the current medical service market is the shift from producer-based approach to customer-based approach. Thus, there is a high necessity for an introduction of market-oriented and customer-oriented marketing activities in medical institutions. Especially, revisitation and positive word-of-mouth of customers are the most effective marketing methods of consistently obtaining customers and drawing new loyal customers. Hence, the factors influencing the reuse of medical services and word-of-mouth are demonstrated using SERVQUAL, and the results show that the service factors influencing reuse intentions on medical services are assurance, responsiveness, and tangibles and the factors strengthening word-of-mouth are empathy and assurance on the services provided by medical institutions. This study has determined that revistation and word-of-mouth of customers are not only influenced by satisfaction on medical services but by the quality itself as well. Therefore, medical service providers need to pursue standardized strategies in order to enhance the quality of medical services simultaneously in addition to simply increasing the customer satisfaction level.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.175-182
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• 2019

Objective : Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. Methods : CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. Results : Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. Conclusion : It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.

• International Journal of Computer Science & Network Security
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• v.22 no.6
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• pp.400-407
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• 2022

Innovations significantly affect the efficiency of the socioeconomic systems of the regions, acting as a system-forming element of their development. Modern models of economic development also consider innovation activity, intellectual potential, knowledge as the basic factors for stimulating the economic growth of the region. The purpose of the study is to develop methodological foundations for evaluating the effectiveness of a regional innovation system based on a multidimensional analysis of its effects. To further study the effectiveness of RIS, we have used one of the methods of multidimensional statistical analysis - canonical analysis. The next approach allows adding another important requirement to the methodological provision of evaluation of the level of innovation development of industries and regions, namely - the time factor, the formalization of which is realized in autoregressive dynamic economic and mathematical models and can be used in our research. Multidimensional Statistical Analysis for RIS effectiveness estimation was used to model RIS by typological regression. Based on it, multiple regression models were built in groups of regions with low and relatively high innovation potential. To solve the methodological problem of RIS research, we can also use the approach to the system as a "box" with inputs and outputs.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.30-36
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• 2024

Objective: This study aims to investigate the efficacy of microsurgery with intraoperative indocyanine green (ICG) angiography as a treatment approach for ethmoidal dural arteriovenous fistula (DAVF). Methods: Between January 2010 and July 2021, our institution encountered a total of eight cases of ethmoidal DAVF. In each of these cases, microsurgical treatment was undertaken utilizing a bilateral sub-frontal interhemispheric approach, with the aid of intraoperative ICG angiography. Results: ICG angiography identified bilateral venous drainage with single dominance in four cases (50%) of ethmoidal DAVF, a finding that eluded detection during preoperative transfemoral cerebral angiography (TFCA). The application of microsurgical treatment, in conjunction with intraoperative ICG angiography, resulted in consistently positive clinical outcomes for all patients, as evaluated using the Glasgow Outcome Scale (GOS) at the 6-month postoperative follow-up assessment; six patients showed GOS score of 5, while the remaining two patients attained a GOS score of 4. Conclusions: The use of intraoperative ICG angiography enabled accurate identification of both dominant and non-dominant venous drainage patterns, ensuring complete disconnection of the fistula and reducing the risk of recurrence.

• Child Health Nursing Research
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• v.23 no.1
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• pp.28-36
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• 2017

Purpose: This paper is a report on the concept analysis of family-centered care for hospitalized children. Methods: The concept analysis approach of Walker and Avant was used. A search of multidisciplinary literature published between 1960 and 2016 was undertaken using the keyword 'family centered care' or 'family centered nursing' combined with hospitalized children. Attributes, antecedents, and consequences were inductively derived from the citations analyzed (n=19). Results: The attributes of family-centered care included (1) family respect, (2) collaboration, (3) family support, and (4) information sharing. These attributes are influenced by the 'willingness of family to participate', 'competency and willingness of staff,' and 'institution policy and system.' Additionally, family-centered care does significantly impact 'the health of the children', 'family empowerment' and 'work satisfaction and self-confidence of staff'. Conclusion: Family-centered care of hospitalized children as defined by the result of this study will contribute to the theoretical foundation for application in pediatric nursing practice.

• Communications for Statistical Applications and Methods
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• v.27 no.2
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• pp.255-268
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• 2020

A mixture of multivariate canonical fundamental skew t-distribution (CFUST) has been of interest in various fields. In particular, interest in the unsupervised learning society is noteworthy. However, fitting the model via EM algorithm suffers from significant processing time. The main cause is due to the calculation of many multivariate t-cdfs (cumulative distribution functions) in E-step. In this article, we provide an approximate, but fast calculation method for the in univariate fashion, which is the product of successively conditional univariate t-cdfs with Taylor's first order approximation. By replacing all multivariate t-cdfs in E-step with the proposed approximate versions, we obtain the admissible results of fitting the model, where it gives 85% reduction time for the 5 dimensional skewness case of the Australian Institution Sport data set. For this approach, discussions about rough properties, advantages and limits are also presented.

• The Journal of Korean Academic Society of Nursing Education
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• v.28 no.2
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• pp.127-136
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• 2022

Purpose: The purpose of this study was to describe the career choice experiences of nursing students. Methods: A phenomenological approach was used for the study. Data were collected from September 1 to October 1, 2021, using open-ended questions in-depth interviews. Ten nursing students who had decided to find a job or complete an application to an employment institution participated in this study. Results: The four categories obtained as results were "Preparing myself," "Chosen after conflict," "Going through a tough tunnel and settling down," and "Waiting with anticipation and worry." Conclusion: This study explored the meaning and essence of the career choice experiences of nursing students. These results will provide basic data that can help nursing students make career choices.