• Journal of Korean Biological Nursing Science
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• 제25권4호
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• pp.276-284
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• 2023

Purpose: The purpose of this study was to investigate the levels of fatigue, social support, and burnout among nurses caring for coronavirus disease 2019 (COVID-19) patients, and to identify factors that affect burnout. Methods: Data were collected from 115 nurses who were caring for COVID-19 patients in Gyeonggi Province and Seoul from December 2021 to February 2022. Results: The mean scores for fatigue, social support, and burnout were 63.31 ± 11.48 (of 95), 48.34 ± 6.97 (of 60), and 81.90 ± 15.50 (of 132) points, respectively. The level of burnout of nurses caring for patients with COVID-19 was high. Fatigue (β = .49, p < .001) and social support (β = -.21, p = .012) were significantly associated with burnout. Conclusion: Higher levels of fatigue and lower levels of social support were associated with higher levels of burnout. Reducing fatigue among nurses and strengthening their social support can be a strategy to reduce nurse burnout.

• Journal of Yeungnam Medical Science
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• 제16권2호
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• pp.277-282
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• 1999

1998년 4월 1일부터 7일까지 1주일간 영남대학교 의과대학 부속병원 응급의료센터를 방문하는 환자 464명을 대상으로 응급 환자 조사 대장을 작성하여 환자의 일반적인 정보 내용과 현황에 대하여 전향적으로 조사 분석한 결과를 요약하면 다음과 같다. 1. 조사 기간중 내원 환자수는 일 평균 66.3명이었으며, 대기 환자수는 평균 17.3명으로 당일 총진료 환자수는 83.6명이었다. 2. 내원 방법은 걸어서 내원한 환자가 57.3%로 가장 많았고, 교통편은 자가용이 58.0%, 구급차가 26.3%였으며, 발생 장소는 거주지가 85.3%로 가장 많았고, 지역별로는 대구 지역이 81.5%였다. 타 병원을 경유하여 내원한 환자는 2.6%, 직접 내원한 환자는 97.4%였다. 3. 내원 원인 분류상 질환이 74.6%로 가장 많았고, 사고 환자가 71명(15.3%)이었으며 이중 교통 사고가 49명(10.6%)을 차지하였다. 4. 진료를 의뢰한 임상과는 내과가 26.6%로 가장 많았고, 다음이 소아과 16.8%, 정형외과 8.6%, 신경과 8.2%, 신경외과 7.8% 순으로 많았으며 응급의학과를 포함한 기타 과는 8.2%를 차지하였다. 5. 진료 결과 입원이 38.4%, 퇴원이 61.0%, 도착시 사망 환차가 0.6%였으며 타 병원으로의 전원은 1례도 없었다. 결론적으로 3차 의료기관의 응급의료센터에서의 진료는 질병 환자 중심의 진료와 당일 진료후 퇴원가능한 경한 환자 중심의 "fast tracking"을 이용한 신속한 진료 및 외상 환자 및 중환자 중심의 진료 등의 다원적인 진료 형태가 요구되며 이러한 진료형태의 개발과 확립이 필요할 것으로 사료된다.

• 대한정형외과학회지
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• 제53권6호
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• pp.466-477
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• 2018

정형외과는 인체의 모든 근골격계를 담당하기 때문에 3차원(3-dimensional, 3D) 프린팅 기술을 가장 많이 활용할 수 있는 분야이다. 구체적으로 관절염, 척추, 외상, 기형, 종양 등의 다양한 정형외과 질병에 대해 해부학적 모델, 수술용 가이드, 금속 임플란트, 바이오-세라믹 재건, 보조기 등의 형태로 활용될 수 있다. 특히 정형외과 종양 영역은 환자마다 종양의 발생 위치와 크기가 다양한 데 반하여 사지 보존 수술에 활용할 수 있는 기존의 수술 방법이 제한적이었기 때문에 3D 프린팅 기술의 활용이 매우 절실한 분야였다. 최근에 3D 프린팅 환자 맞춤형 임플란트를 짧은 시간 내에 쉽게 제작할 수 있게 되면서 기존 방법으로 골 재건이 어려웠던 부위에 대해서도 해부학적 재건이 가능하게 되었다. 3D 프린팅 기술을 의료 영역에서 더욱 폭넓게 사용하기 위해서는 디자인, 출력, 검증 과정에 필요한 많은 전문가들과 함께 수평적 위치에서 긴밀히 협력해야 한다. 의료계에서 3D 프린팅을 활용을 선도함으로써 다른 분야의 전문가 양성 및 3D 프린팅 관련 산업의 발달을 촉진시킬 수 있다고 판단한 정부도 규제보다는 활성화에 역점을 두고 적극적으로 지원하고 있는 추세이다. 앞으로 정형외과가 전체 의료계에서 3D 프린팅 기술의 도입과 활용을 선도해 가기를 기대하면서 골종양 수술에서 3D 프린팅 기술을 활용하였던 저자의 경험을 소개하고자 한다.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.118-124
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• 2011

Purpose: The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center. Methods: From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed. Results: Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous. Conclusion: Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.6-15
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• 2010

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.188-195
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• 2012

Purpose: An increase in the demand for specialized Trauma Centers led to a government-driven campaign, that began in 2009. Our hospital was selected as one of the Trauma Centers, and we reviewed data on trauma patients in order to correlate the mortality at a regional Trauma Center with its contributing factors, such as the severity of the injury, the means of arrival, and the time duration before arrival at our center. Methods: Data on the patients who visited our Trauma Center from January 2010 to November 2011 were retrospectively reviewed using electronic medical records. The patients who had revised trauma scores (RTSs) less than 7 or injury severity scores (ISSs) greater than 15 were included. The patients were categorized as survivors and non-survivors, and the means of arrival as transferred or visited directly. Time durations before arrival of less than one hour were also taken intoconsideration. Results: Two hundred(200) patients were enrolled, and the mortality rate was 36.5%. The most common cause of the accident was an automobile accident, and the most common cause of death was brain injury. The RTSs and the ISSs were significantly different in the non-survivor and the survivor groups. The mortality rate of the patients who were transferred was not statistically different from that of patients who visited directly. However, a time duration before arrival of less than one hour was statistically meaningful. Conclusion: The prognosis of the trauma patients were correlated with the severity of the trauma as can be expected, but the time between the incidence of accident and the arrival at hospital and whether the presence of transfer to trauma center were not statistically significant to the prognosis.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.37-43
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• 2009

Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.5-11
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• 2009

Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2 : 1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treatement, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a 'ritical pathway'to improve the outcomes of patients with blunt abdominal vascular injury.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.184-192
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• 2009

Purpose: This study was conducted to evaluate the effectiveness of the treatment strategy of transcatheter arterial embolization after pelvic CT angiography (CTA) in cases of traumatic pelvic hemorrhage. Methods: This is a retrospective analysis of pelvic hemorrhage patients who underwent transcatheter arterial embolization after pelvic CTA at our regional emergency center during a 31-month period. We reviewed the medical records and imagings of all these patients. Results: Transcatheter arterial embolization was performed in 17 patients (M:F=7:10, mean age=53.9) who underwent pelvic CTA for the evaluation of traumatic pelvic hemorrhage. Arterial bleeding was demonstrated on pelvic CTA in all patients, and the combined injury was also noted in 13 patients. The admission-to-CTA time was $84.53{\pm}66.92$ minutes, and the CTA-to-embolization time was $147.65{\pm}99.97$ minutes. Extravasation of contrast media or pseudoaneurysm was demonstrated on conventional angiography in all patients. Unilateral iliac artery embolization was performed in 8 patients, and bilateral iliac artery embolization was performed in 9 patients. Additional embolizations other than in the iliac arteries were performed in 7 patients. Initial hemostasis was achieved in 16 patients. One patient died of ongoing pelvic bleeding. Rebleeding occurred in only one patient and hemostasis was achieved with the second embolization. Another patient died of intracranial and facial bleeding in spite of pelvic hemostasis. The overall mortality was 11.8%, and there was no significant adverse effects in the other patients. Conclusion: Transcatheter arterial embolization after pelvic CTA is an effective treatment strategy in the management of traumatic pelvic hemorrhage patients.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.170-177
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• 2014

Purpose: The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center. Methods: The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013. Results: The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of ${\geq}16$. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital. Conclusion: A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.