• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.55-66
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• 2019

Background: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. Methods: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl $700{\mu}g$ was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. Results: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were $4.4{\pm}2.0$ and $3.7{\pm}1.9$ in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was $10.7{\pm}13.7$ and $8.6{\pm}8.5$, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. Conclusion: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.

• Hip & pelvis
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• v.34 no.1
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• pp.25-34
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• 2022

Purpose: Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(-) tests. Materials and Methods: A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19- tests. The primary outcome was mortality at 30-days and 90-days. Results: COVID-19+ patients had a higher mortality rate than COVID-19- patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion: Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.508-511
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• 2009

Streptococcus pneumoniae is a major cause of serious invasive diseases in children, especially in young infants, but seven- valent pneumococcal conjugate vaccine (PCV7) is believed to prevent invasive pneumococcal pneumonia and meningitis in young children. However, recently, the incidence of non-PCV7 serotype has increased after PCV7 vaccination. A 14-month- old female patient presented at our emergency room with mental change and lethargy. Three days previously, she had developed fever and vomiting. After being admitted, she rapidly progressed to coma and brain death despite prompt and extensive supportive treatment. She expired 20 days after admission with a final diagnosis of pneumococcal 19A (non-PCV7 serotype) meningoencephalitis despite having received PCV7 ($Prevenar^{(R)}$) vaccinations on three occasions. The author reports this first fatality due to pneumococcal 19A meningoencephalitis in Korea and provides a brief review of the literature.

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.106-116
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• 2000

Background : Severance Hospital is an university hospital which has 1,580 beds. A LAN system was installed in the Medical Record Department in 1992 and discharge abstract data have been added to the discharge abstract database(DB) The previous work flow in the Medical Record Department had 5 levels: 1) chart collection from wards, 2) assembling, 3) abstracting data from medical record on worksheet by 2 RRAs, 4) checking deficiencies and coding diagnosis and procedures by 4 RRAs, 5) inputting the data into the discharge abstract data base by 1 RRA. The average processing time took 19.3 days from the patient discharge date. It had the production of monthly statistical report delayed. Besides, it caused the users in the hospital to complain. Methods : A CQI team was organized to find a way to shorten the processing time less than 10 days. The team identified the factors making the processing time long and integrated three levels from the 3rd level into one. Each of 7 RRAs performed the integrated level on her workstation instead of taking one of three separate levels. The comparison of processing time before and after the changes was made with 3'846 discharges of April, 1999 and 4,189 discharges of August, 1999. Results : The average processing time was shortened from 19.3 days to 8.7 days. Especially the integrated level took only 3.6 days, compared with 12.3 days before the change. The percentage of finishing up the whole processing within 10 days from discharge was increased up to 77.6%, which was 2.4% before the integration. The prevalence of error in data input was not increased in the new method. Conclusions : The integrated processing method has the following advantages: 1) the expedition of production of monthly statistical report, 2) the increase of utilizing rate of dischare abstract data by Billing Dept, Emergency Room, QI Dept., etc., 3) the improvement of intradepartmental work follow, 4) the enhancement of medical record quality by checking the deficiencies earlier than before.

• Journal of Korean Academy of Nursing Administration
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• v.4 no.2
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• pp.419-437
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• 1998

Nurses use a nursing process. that is a scientific approach method. in order to understand the clients' condition and to solve their problems. Professional nurses have accepted the nursing process as a standard framework for nursing activities, and the first step of the nursing process is nursing assessment. The purpose of this study was to develop a nursing assessment tool for emergency patients. Assessment is a first step in the nursing process, and scientific assessment helps to better understand the patients. Thus the development of an assessment tool for emergency patients will improve of nursing quality and advance to efficacy of emergency room(ER) management. The study involved the development of a conceptual framework, preliminary tool, content validity verification process. and reliability verification process. The conceptual framework was developed through a review of the literature. and preliminary tool was developed from the conceptual framework that based on care flow sheet' developed James A. Haley. The preliminary tool was evaluated for validity and reliability by seven experts, one ER nurse manager, two ER head nurses, two emergency medicine doctors. and two ER charge nurses and by ten nurses with one to five year careers in ER nursing. The results of this study was as follows 1. The conceptual framework which was developed was composed of three parts. They were triage criteria, first assessment and secondary assessment. 2. The preliminary tool which was developed had 31 items based on the conceptual framework. 3. To test expert validity a 4-point scale was used. items which had gained 3-4 points from six persons of the seven experts were selected. All 31 items from the preliminary tool were selected. 4. The reliability test was done by ten nurses educated in the use of the assessment tool. Two pairs of nurses simultaneously assessed the same patients. A total agreement percentile was calculated and result was 87.3% agreement. 5. After the validity and reliability testing. the final emergency patient nursing assessment tool was finalized with 31 items. and a check-list for the responses. This study concludes that the tool which was developed is both valid and reliable will advance quality care for emergency patients. This emergency nursing assessment tool was also found to be an adequate tool for assessment of emergency patients.

• Corrosion Science and Technology
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• v.15 no.3
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• pp.141-146
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• 2016

By using Ni-Cr and Co-Cr alloys, porcelain fused to metal (PFM) samples were prepared to examine the interface and the surface corrosion behavior. The potentiodynamic polarization analysis showed that the corrosion current density of Co-Cr alloy ($1.61{\times}10^{-6}A/cm^2$) was three times lower than that of Ni-Cr alloy ($4.83{\times}10^{-6}A/cm^2$) at room temperature. A dental prosthesis consisting of the porcelain fused to Ni-Cr alloy extracted from a patient after approximately four years of usage was examined to assess its resistance to corrosion. OM and SEM images of the metal part revealed a typical pitting corrosion. As compared to porcelain fused to Ni-Cr alloy having a thick layer (${\sim}10{\mu}m$) of oxide at the interface, a relatively thin oxide layer (less than $5{\mu}m$) was formed on Co-Cr alloy, indicating that the interface between Co-Cr alloy and porcelain may have a better adhesion strength than the interface between Ni-Cr alloy and porcelain.

• Journal of the Korea Convergence Society
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• v.8 no.1
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• pp.97-106
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• 2017

The purpose of this convergence study was to identify the effects of favorite music therapy on anxiety, fatigue, and vital signs of patients undergoing prostatectomy with spinal anesthesia. This study used a nonequivalent control group design. A sample of 45 patients was included. The experimental group was given music therapy during operation. The data were collected using a structured questionnaire and monitoring at 30 min before operation, at 20 min and 40min undergoing operation, and at arrival recovery room after operation. Data were analyzed using descriptive statistics, ${\chi}^2-test$, Fisher's exact test, t-test, repeated measures ANOVA. The experimental group reported significantly lower anxiety and lower fatigue than the control group(p=.001; p=.020). However there were no significant differences in the systolic blood pressure, diastolic blood pressure and pulse rate between groups(p=.821; p=.473; p=.782). This findings indicate that the tailored favorite music therapy can be an effective nursing intervention for patient undergoing prostatectomy with spinal anesthesia to reduce anxiety and fatigue related to operation.

• Journal of Korean Dental Science
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• v.8 no.1
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• pp.10-15
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• 2015

Purpose: The aim of the present study is to assess the importance of proper treatment timing for dental emergency patients by characterizing current patient care in the emergency room. Materials and Methods: A retrospective chart review of 3,211 patients who visited the Chosun University Hospital's dental emergency department (Gwangju, Korea) was conducted from January 1, 2011 to May 31, 2014. Information regarding age, gender, onset date, main causes, and diagnoses were collected and analyzed. The main causes were divided into six categories: assault, household/play, sports, traffic, work, and others. Result: Emergency visits were more common for men (69%), and the ratio of males to females was 2.2:1 On average, the major cause was household/play (49.8%), followed by others (18.9%), traffic (16.6%), assault (9.1%), sports (2.9%), and work (2.6%). The most frequent diagnosis on average was dental trauma with 82.4%, followed by infection (10.7%), others (4.7%), and bleeding (2.2%). Conclusion: The main reasons for visits to the dental emergency department are dental trauma, dental infection, bleeding, and others. The most frequent reason for dental emergency patients to visit the emergency department was dental trauma (82.4%).

• Tuberculosis and Respiratory Diseases
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• v.68 no.1
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• pp.29-33
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• 2010

Strongyloides stercoralis is an intestinal nematode that is a parasite to humans. The infecting filariform larvae of S. stercoralis enters the host body via the bloodstream, passes through the lungs, penetrates the alveoli, and then ascends the airway to transit down the esophagus into the small bowel. The infection can persist for decades without causing major symptoms and can elicit eosinophilia of varying magnitudes. Of note, this infection can also develop into a disseminated, often fatal, disease (hyperinfection) in patients receiving immunosuppressive corticosteroids. A 65-year-old man who was receiving corticosteroid therapy for the treatment of spinal stenosis was admitted to the emergency room with complaints of abdominal pain and severe dyspnea. We detected many S. stercoralis larvae in the sputum and in the bronchoalveolar-lavage sample collected by bronchoscopy. Here, we report a fatal case of strongyloidiasis with acute respiratory failure and intestinal perforation. In addition, we provide a brief review of the relevant medical literature.

• Health Policy and Management
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• v.23 no.2
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• pp.103-111
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• 2013

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.