• Journal of The Korea Institute of Healthcare Architecture
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• v.23 no.3
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• pp.57-69
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• 2017

Purpose: This study aims to emphasize interrelation between healthcare policies, design standards and hospital architecture of the United States since 1950s; to examine spatial characteristics of inpatient care facilities through case studies; and to consider the social implication of these spatial changes. Methods: In this study, reviewing the overall healthcare system, design standards and inpatient care facilities of the United States since 1950s, a total of five inpatient care facilities, one for each period, were selected in order to analyze the spatial characteristics. The spatial maps of Space Syntax were employed for analyzing five case studies. Results: The distance between the nursing station, the support service, and inpatient room were getting closer. The spatial structure of inpatient care facilities is transformed from tree structures to annular tree structures. This result shows that the efficiency between patient, staff and support service is higher and the depth of the spaces is getting deeper, which indicates that efficiency for improving healthcare quality affect the spatial structure of inpatient care facilities. Implications: In the future, if Korea's health policy is changed to a demand-oriented health care policy, this conclusion predicts medical planning of hospital will be focused on the efficiency.

• Journal of Genetic Medicine
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• v.11 no.2
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• pp.74-78
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• 2014

Sotos syndrome (SS, OMIM 117550) is characterized by prenatal and postnatal overgrowth with multiple congenital anomalies. However, there have been few cases of growth retardation caused by renal failure from infancy. We report a case of dysplasia of the bilateral kidneys with renal failure and poor postnatal growth. A 2-month-old boy visited the emergency room owing to poor oral intake and abdominal distension. He was born at the gestational age of 38 weeks with a birth weight of 4,180 g. After birth, he had feeding difficulty and abdominal distension. Upon physical examination, his height and weight were in less than the 3rd percentile, while his head circumference was in the 50th percentile on the growth curve. He also showed a broad and protruding forehead and high hairline. Blood laboratory tests showed severe azotemia; emergent hemodialysis was needed. Abdominal ultrasonography revealed bilateral renal dysplasia with multiple cysts and diffuse bladder wall thickening. A posterior urethral valve was suggested based on vesicoureterography and abdominal magnetic resonance findings. Results of a colon study to rule out congenital megacolon did not reveal any specific findings. The conventional karyotype of the patient was 46, XY. Array comparative genomic hybridization study revealed a chromosome 5q35 microdeletion including the NSD1 gene, based on which SS was diagnosed. We describe a case of SS presenting with end stage renal disease due to posterior urethral valve. The typical somatic overgrowth of SS in the postnatal period was not observed due to chronic renal failure that started in the neonatal period.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.261-266
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• 2008

We established a model to calculate radioactive waste from sewage disposal tank of hospitals to optimize the number of patients receiving inpatient radioiodine therapy within the safety guideline in our country. According to this model and calculation of radioactivity concentration using the number of patients per week, the treatment dose of radioiodine, the capacity and the number of sewage tanks and the daily amount of water waste per patient, estimated concentration of radioactivity in sewage waste upon disposal from disposal tanks after longterm retention were within the safety guideline (30 Bq/L) in all the hospitals examined. In addition to the fact that we could increase the number of patients in two thirds of hospitals, we found that the daily amount of waste water was the most important variable to allow the increase of the number of patients within the safety margin of disposed radioactivity. We propose that saving the water amount be led to increase the number of patients and they allow two patients in an already furnished hospital inpatient room to meet the increasing need of inpatient radioiodine treatment for thyroid cancer.

• Annals of Coloproctology
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• v.34 no.6
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• pp.312-316
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• 2018

Purpose: Anemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC. Methods: This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals' patient management systems. Results: We identified 103 patients with a median age of 63 years (range, 36-84 years). The median overall survival was 39 months (range, 9-90 months), and the disease-free survival was 36 months (range, 2-90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival. Conclusion: In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.101-106
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• 2019

Purpose: The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures. Methods: A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization. Results: The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was $27.3{\pm}10.9$ with 50% having an $ISS{\geq}25$. The mean time to angio-embolization from arrival was $173.6{\pm}89minutes$. Type B ($180.1{\pm}72.3minutes$) and type C fractures ($174.7{\pm}91.3minutes$) required more time to angio-embolization than type A fractures ($156.6{\pm}123minutes$). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%). Conclusions: It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

• Journal of Trauma and Injury
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• v.31 no.3
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• pp.117-124
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• 2018

Purpose: This study was to analyze clinical and epidemiological characteristics of elderly patients who were admitted to the emergency department (ED) due to falls by separating male and female. Methods: We retrospectively analyzed the fall patients aged 65 years or older from the data of the in-depth surveillance study of injured patients visit to the ED under the supervision of the Korea Centers for Disease Control and Prevention (KCDC) from 2011 to 2016 by separating male and female. Results: A total of 361,588 elderly fall patients were analyzed and, among them, 14,429 (37.3%) were males and 24,208 (62.7%) were females. Male and female showed similar frequency of damage happening season. However, they showed falling accident mostly on winter. The time of injury occurrence is mostly from 12:00 to 18:00 with 4,949 (34.3%) male and 8,564 (35.4%) female. Most falls occurred in daily activities, accounting for 7,614 (52.8%) in males and 14,957 (61.8%) in females, respectively. Unintentional damage accounted for the most part and 7,395 (51.2%) of male and 15,343 (63.4%) of female were injured indoors. Head and neck were the most common site of injuring, with 8,392 (58.2%) in males and 7,851 (32.4%) in females. According to ED examination outcomes, most of the patients were discharged, while the majority of the hospitalized patients were admitted to the general patient room. Conclusions: The elderly falls occurred mostly from 12:00 to 18:00, during winter and to elderly women. Also, they happened unintentionally indoors in everyday life, mostly. Proved clinical, epidemiological characteristics from this research will be used as useful indicator at validity research of development of prevent program of falling accident for elderly people.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.667-674
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• 2019

Because examination with technegas produces images through simple diffusion accumulation, the examination room can become contaminated after scan. Therefore, radiation workers and patients awaiting examination will be affected by internal exposure from technegas inhalation. Before and after gravity ventilation, I am trying to find a way to reduce the exposure dose of waiting patients according to a comparative analysis of horizontal spatial dose rates over time. Spatial dose ratio were measured for 10 minutes from various distances and angles around ventilator's location before and after gravity ventilation. Then, mean values, standard deviation and reduction ratio were calculated. The highest reduction rate of gravity ventilation was 95.31% and the highest reduction ratio was 1 to 3 minutes. Therefore, the gravity ventilation could reduce the exposure dose of radiologic technologists, waiting patients, patient guardians and nurses. In conclusion, the reduction of the exposure dose during the technegas ventilation study through gravity ventilation will play a role in optimiging the protection and it is in accordance with the recommended reduction of the medical exposure by ICRP 103.

• Journal of Home Health Care Nursing
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• v.26 no.1
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• pp.91-101
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• 2019

Purpose: The purpose of this study was to identify factors associated with stress related to home mechanical ventilator (HMV) care in general ward nurses. Methods: The study participants were 110 general ward nurses. Data on participant characteristics, level of knowledge, education needs, coping ability in emergency situations, confidence, and stress were collected from August 1 to 30, 2018 using a structured questionnaire by web-based surveys. Data were analyzed using SPSS/WIN 20.0 for descriptive statistics and independent t-test, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis. Results: Significant factors associated with stress related to HMV care were ward career, intensive care unit (ICU) career, intensive care room (ICR) career, education experience, and satisfaction level of HMV education. Stress had negative correlations with confidence and positive correlations with education needs. The determining factors affecting stress related to HMV care in the general ward were confidence (${\beta}=-.31$, p=.004), ICR career (${\beta}=-.27$, p<.001), education needs (${\beta}=.24$, p=.005), education frequency (${\beta}=-.18$, p=.040), and ICU career (${\beta}=-.18$, p=.025); their explanation power was about 41.8%. Conclusions: It is necessary to develop HMV care training manuals and guidelines and consider ICU or ICR careers for patient safety.

• The Korean Journal of Health Service Management
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• v.12 no.2
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• pp.125-134
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• 2018

Objectives : The purpose of this study was to analyze factors related to the functional state of stroke patients after discharge from hospital. Methods : The data was provided from a hospital in Wonju, Gangwon-do. The subjects of the analysis were those who were admitted to the emergency room due to stroke from July to December 2016. The dependent variable was the patient's functional status as measured by the modified Rankin Scale(mRS). Independent variables were demographic factors (age, sex, and marriage status), transportation and distance factors (transportation, travel distance), inpatient factors (lengths of stay, Charlson Comorbidity Index (CCI), Tissue plasminogen activator, National Institute of Health Stroke Scale (NIHSS). Hierarchial regression analysis was applied for the analysis. Results : In the hierarchical regression analysis, Model 3, including socio-demographic factors, transportation, distance factors, and inpatient factors, was the best fitted model. It showed that functional status of stroke patients was positively associated with age, length of stay, CCI, NIHSS, and negatively associated with unmarried status. Conclusions : Results indicated that management of stroke requires care from the pre-disease stage, and a customized education program policy is needed for high-risk stroke patients who are older and have comorbid illness.

• Archives of Obesity and Metabolism
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• v.1 no.2
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• pp.78-82
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• 2022

Liraglutide (Saxenda^R) is prescribed to induce and sustain weight loss in obese patients. The starting dose of liraglutide is 0.6 mg/day for 1 week, which is increased by 0.6 mg/day every week until the full maintenance dose of 3 mg/day is achieved. Such dose titration is needed to prevent side effects, which primarily include gastrointestinal problems such as nausea, diarrhea, constipation, vomiting, dyspepsia, and abdominal pain. A 35-year-old, reportedly healthy obese man receiving liraglutide treatment for obesity visited the emergency room complaining of generalized weakness and dizziness accompanied by repeated diarrhea and vomiting. He reported over 20 episodes of diarrhea starting the day after liraglutide dose escalation from 1.2 mg/day to 1.8 mg/day. Laboratory findings suggested pre-renal acute kidney injury, including serum creatinine 4.77 mg/dl, blood urea nitrogen (BUN) 37 mg/dl, estimated glomerular filtration rate (eGFR) 15 ml/min/1.73 m², and Fractional excretion of sodium 0.08. After volume repletion therapy, his renal function recovered to a normal range with laboratory values of creatinine 1.08 mg/dl, BUN 14 mg/dl, and eGFR 88 ml/min/1.73 m². This case emphasizes the need for caution when prescribing glucagon-like peptide-1 receptor agonists, including liraglutide, given the risk of serious renal impairments induced by volume depletion and dehydration through severe-grade diarrhea and vomiting.