• Archives of Plastic Surgery
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• 제41권6호
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• pp.661-667
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• 2014

Background Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area. Methods A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos. Results The average skin expansion rate was $10.54%{\pm}6.25%$; take rate, $88.89%{\pm}11.39%$; and contraction rate, $4.2%{\pm}2.28%$ after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer. Conclusions This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

• 대한방사선기술학회지:방사선기술과학
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• 제44권3호
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• pp.183-187
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• 2021

The field size of the lumbar spine X-ray examination, which belongs to the most frequent examination in general radiography, is 5 times wider than the width of the lumbar spine. Exposure index (EI) as per International Electrotechnical Commission has a proportional relationship with the dose incident on the image receptor for clinical protocols in addition to RQA5, which is a calibration beam quality. In this study, the effectiveness of the set field size was evaluated through the change of EI according to the size of field during lumbar spine X-ray examinations. Lumbar anterior-posterior and lateral examinations was performed using a whole-body phantom, and the national average exposure conditions of Korea investigated in 2017 were introduced for the X-ray exposure. As a result of comparing the EI displayed on the console of digital radiography system for the three field size in ① 18 × 36 cm2 ② 25 × 36 cm2 ③ 36 × 36 cm2, the EI values showed a tendency to increase as the field size increased. Since the patient dose, such as organ dose around the lumbar spine, increases as the field size becomes larger, thus, if the EI obtained from the field size at a level that does not interfere with diagnosis is set as a reference, the effectiveness of the field size can be evaluated through the EI displayed on the console when the lumbar spine X-ray examination is conducted.

• 한국직업건강간호학회지
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• 제26권3호
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• pp.160-171
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• 2017

Purpose: This review aimed to integrate the results of studies related to presenteeism in clinical nurses and to suggest directions for future research. Methods: The search for relevant studies was conducted using six data bases according to predetermined index terms, "$nurs^*$" and "presenteeism." Thirteen studies that met the inclusion criteria were selected and analyzed. Results: This review found that the conceptual use and scope of presenteeism were not consistent among the studies. Most studies investigated the nurses' health-related variables as the most important factors and reported their positive association with presenteeism. Presenteeism was also found to be associated with job stress, job satisfaction, social support, and organizational culture and had a negative impact on nursing outcomes such as patient safety. Conclusion: The research on presenteeism can be used as a way to explain outcomes in the field of nursing where direct measurement of productivity is difficult. Presenteeism is a multidimensional problem, and a theoretical foundation is needed to explain the presenteeism of clinical nurses.

• Tuberculosis and Respiratory Diseases
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• 제44권1호
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• pp.114-123
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• 1997

연구배경 : 기관지내시경 검사는 중환자실의 폐렴이 동반된 환자에서 원인균 동정을 위한 매우 유용한 검사법이다. 내시경적 약식의 기관폐포세척한 검체의 결과를 맹검적인 기도세척의 결과와 비교분석함으로써 폐렴을 가진 중환자실 환자에서의 기관지경 검사의 임상적 의의를 평가해 보고자 하였다. 방법 : 1993년 9월부터 1996년 8윌까지 이화의대부속 목동병원 중환자실에 입원치료를 받았던 환자중 임상적 소견상 폐렴으로 진단적 또는 치료적 목적하에 기관지경 검사를 받았던 28명의 환자를 대상으로 내시경적 기관폐포세척을 포함한 임상적 결과에 대해 후향적으로 조사하였다. 결과 : l. 중환자실에 입원한 주 이유는 호흡부전 및 호흡부전 절박상태가 가장 많았다. 폐렴은 그 유형상 원내폐렴이 16예로 가장 많았고 지역획득폐렴 및 면역타협폐렴이 각 6예씩 있었다. 기관지경 목적상 진단적 목적이 20예 71%를 차지하였고 치료적 목적의 분비물제거가 8예 있었다. 내시경 검사에 따른 합병증의 발생은 미미하였다. 2 맹검적 검체와 내시경적 검체간 균주배양 일치율은 39.3 %에 불과하였고 내시경적 검사로 국균증 및 결핵이 각 2예씩 진단되었다. 3 내시경적 검체결과를 기준할때 다제약제내성 폐렴은 기타균주에 의한 폐렴과 비교시 기계호흡의 적용이 유의하게 빈번히 말생하였다. 4 원내폐렴군은 타군에 비해 기계호흡 적용이 유의하게 많았다. 결론 : 이상의 결과로 폐렴이 동반된 중환자실 환자에서 기관지경을 통한 선택적인 기관폐포세척물 검사 및 치료적 기관분비물의 제거는 진단 및 치료상의 매우 유용한 방편이 될 수 있으며 동정된 균주가 다제약제내성균이거나 원내폐렴형인 경우 기계호흡의 사용과 밀접한 관련이 있을 것으로 생각된다.

• 대한수사과학회지
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• 제3권1호
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• pp.60-73
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• 2008

응급의료체계(Emergency Medical System)의 목적은 응급환자에게 신속하고 적절한 응급처치를 제공함으로써, 환자의 생명을 구하고 환자의 상태를 최단 시간 내에 정상상태로 회복시켜서 사회로 복귀시키는 것이며 교정행정(矯正行政)의 목적은 범죄자를 사회로부터 격리하여 이들 수형자에게 형기동안 교육, 교화활동 및 직업훈련 등을 실시함으로써, 이들이 출소 후 사회에 복귀하여 다시는 범죄를 저지르지 않고 성공적으로 사회에 정착하도록 하는 것이다. 이렇듯 교정행정과 응급의료체계의 목적이 국민을 안전하게 사회에 복귀시키는 것으로 상호 부합된다 할 것이다. 따라서 본 연구는 교정시설 내 하위문화의 특수성으로 인한 신체적 손상과 질병에 노출될 기회가 많은 수용자와 그 곳에서 근무하고 있는 직원들의 안전을 위해 교정시설 내 다양한 응급상황 발생요인과 제도, 인력, 시설, 장비, 예산현황 및 문제점 등을 통해 효율적인 교정시설 내 응급의료체계 발전방안을 다음과 같이 제시하고자 한다. 첫째, 각 교정시설 보안근무체계에 맞게 적정인원의 응 급구조사의 채용을 확대하여야 한다. 둘째, 수용자의 중증도분류에 따른 이송체계를 완비하고 응급의료장비를 갖추어야 한다. 셋째, 교정공무원과 수용자에 대해 실습 위주의 현실적이고 체계적인 응급처치교육을 실시하여야 한다. 넷째, 1339응급의료정보센터와 같은 사회 내 응급의료체계와 협력체계를 구축하여야 한다. 다섯째, 보건복지부는 응급의 료기금의 지원을 교정시설로 확대하여야 한다.

• 간호행정학회지
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• 제16권4호
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• pp.517-526
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• 2010

Purpose: The purpose of this study was to identify the major trends of research in the Journal of Korean Nursing Administration from 2007 to 2009. Method: Research designs, participants, research domains, and key words were analyzed from the Journal of Korean Nursing Administration. Results: Job satisfaction, organizational commitment, job stress, turnover intention, nursing performance, self-efficiency, leadership, empowerment, nursing informatics, and quality control were the major key words commonly listed in the journal articles. Of the research in the Nursing Administration Journal, quantitative methods were used in 94.5% of the research studies and qualitative methods in only 5.5%. The major participants in the research were nurses, nurse managers, and patients. Statistical methods like ANOVA, correlation, t-test, regression, chi-square test, LISREL were the dominant method of analysis used in the research. The primary domains in the journal articles were directing, organizing, control, planning, and informatics. Conclusion: Through this study, the trend of research in nursing administration can be identified. We recommend that collaboration, nurse work environment, evidence-based practice, scheduling, coaching, patient falls and safety, and positive culture should be included as topics for the future research.

• 대한간호학회지
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• 제49권5호
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• pp.631-642
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• 2019

Purpose: This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory. Methods: A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program. Results: For the fitness of the hypothetical model, the results showed that $x^2$ ($x^2=258.50$, p<.001) was not fit, but standardized $x^2$ ($x^2/df=2.35$) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (${\beta}=-.29$ p<.001), patient safety culture (${\beta}=-.20$, p=.041), and work load (${\beta}=.18$, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (${\beta}=-.06$, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (${\beta}=-.25$, p=.001). Conclusion: These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

• 간호행정학회지
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• 제6권3호
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• pp.357-374
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• 2000

The purpose of this study was to validate knowledge outcomes included Nursing Outcomes Classification(NOC) developed by Johnson and Maas at the University of Iowa. A sample of 71 nurse experts working in university affiliated hospitals participated in this study. They were asked to rate indicators that examplified the outcomes on a scale of 1(indicator is not all characteristic) to 5(indicator is very characteristic). A questionnaire with an adaptation of Fehring's methodology was used to establish the content validity of outcomes. The results were as follow: 1. All indicators were considered to be 'supporting' and no indicators were considered to be 'nonsupporting'. 2. 'Knowledge: Treatment Regimen' attained and OCV score of 0.816 and was the highest OCV score among outcomes. 3. 'Knowledge: Energy Conservation' attained an OCV score of 0.748 and was the lowest OCV score among abuse outcomes. 4. 'Knowledge: Breastfeeding' attained an OCV score of 0.790 and was the highest indicator was 'description of benefits of breastfeeding'. 5. 'Knowledge: Child Safety' attained an OCV score of 0.778 and was the highest indicator was 'demonstration of first aids techniques'. 6. 'Knowledge: Diet' attained an OCV score of 0.779 and was the highest indicator was 'performance of self-monitoring activities'. 7. 'Knowledge: Disease Process' attained an OCV score of 0.815 and was the highest indicator was 'description of signs and symptoms'. 8. 'Knowledge: Health Behaviors' attained an OCV score of 0.800 and was the highest indicator was 'description of safe use of prescription drugs'. 9. 'Knowledge: Health Resources' attained an OCV score of 0.794 and was the highest indicator was 'description of need for follow-up care'. 10. 'Knowledge: Infection Control' attained an OCV score of 0.793 and was the highest indicator was 'description of signs and symptoms'. 11. 'Knowledge: Medication' attained an OCV score of 0.789 and was the highest indicator was 'description of correct administration of medication'. 12. 'Knowledge: Personal Safety' attained an OCV score of 0.804 and was the highest indicator was 'description of measures to reduce risk of accidental injury'. 13. 'Knowledge: Prescribed Activity' attained an OCV score of 0.810 and was the highest indicator was 'proper performance of exercise'. 14. 'Knowledge: Substance Use Control' attained an OCV score of 0.809 and was the highest indicator was 'description of signs of dependence during substance withdrawl'. 15. 'Knowledge: Treatment Procedure(s)' attained an OCV score of 0.795 and was the highest indicator was 'description of appropriate action for complications'. 16. 'Knowledge: Treatment Regimen' attained an OCV score of 0.816 and was the highest indicator was 'description of self-care responsibilities for emergency situations'. More outcomes need to be validated and outcomes sensitive to Korean culture need to be developed.