• 보건행정학회지
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• 제21권2호
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• pp.195-212
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• 2011

Objectives: This study investigates the relationship between nurse staffing levels and differences in patient outcomes in terms of average length of stay, in-hospital mortality rate and 30-day death rate in order to evaluate the effectiveness of a policy that differentiates fees for inpatients on the basis of nurse-to-bed ratios. Methods: We obtained information on inpatients from health insurance claims data published by the Health Insurance Review and Assessment Service(HIRA) in 2008, organizational factors(type of hospital, ownership) from the records of the hospital report system in 2008, and nurse staffing levels, which were graded on a scale of 1 to 7, from data compiled between December 15, 2007, and September 20, 2008. The data were segregated according to type of hospital and quarter and finally 3,517 records of 1,182 hospitals were analyzed using multi-level analysis. Results: The average length of stay in grade 1~6 hospitals was lower than that in grade 7 ones, but the difference was much below one day. No significant difference was found among different grades in tertiary hospitals. Further, variations in staffing levels did not result in any significant difference in the in-hospital mortality rate and 30-day death rate. Conclusions: High nurse staffing levels did not result in better patient outcomes compared with low staffing levels. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving patient outcomes.

• 보건행정학회지
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• 제23권3호
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• pp.260-265
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• 2013

Background: The aim of this study was to examine the seasonal variation of death from intentional self-harm by hanging, strangulation and suffocation (HSS: Korean Standard Classification of Diseases-6 code: X70) using the 2011 death registry data. Methods: The analysis was based on data of 8,359 HSS deaths from 2011 national vital statistics in Korea. Daily, weekly, and monthly death pattern on HSS were used to examine the relationship seasonal variation and HSS deaths. Results: A total of 8,359 HSS deaths occurred in 2011, with a mean age of 50.6 years. The HSS death rate (per 100,000) was 25.5 in male and 10.8 in female. In one day 17.6 males and 8.0 females occurred HSS death on average. The number of HSS death per day was the highest on 8th June (45 deaths), and lowest on 1st February (7 deaths) during the period. The variations of daily HSS death showed wide fluctuation from a peak of 34 to 45 deaths (29th May to 9th June) to a trough of 17-26 deaths (10th-13th September: the Korean thank-giving consecutive holidays), 13-20 deaths (2nd-5th February: the new year's day by the lunar calendar) and 8-9 deaths (24th-25th December: Christmas holidays). There were no significant difference between gender and seasonal variation (month, season, and week). Conclusion: The mean number of HSS death per day was highest in June (30.6 deaths), and months with the lowest number of deaths was January and December (range, 19.4 to 19.6 deaths). HSS death were more prevalent during summer and spring and were less likely to occur during winter. On Saturdays (21.0 deaths), the number of HSS death per day was the lowest, and Monday (27.9 deaths) was the highest. HSS death was less likely to occur on holidays (21.4 deaths). There was significant seasonal variation in HSS death by weekly and monthly (p<0.01).

• 대한간호학회지
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• 제9권2호
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• pp.73-83
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• 1979

The objectives of this study have been conducted to establish effective clinical teaching program to I.C.U in terms of proper assignment of the clients for the students, proper rotation schedule, priorities in critical nursing problems and selection of the teaching and learning. We have analyzed statistically 1,850 patients who have been admitted during a period from January 1977 to October 31 1979 in Ewha Woman's University Hospital. The results are as follows: 1. The proportion to the total inpatients number was 6.5% and mortality rate was 16.3%. 2. The average hospitalized days were 5.8 days in I.C.U and the total death was occured from 1 st hospital day to 5th hospital day. So it shows a certain difficulties for clinical experiences of the senior students in I.C.U. 3. In the age of the death, 41.3% of the patients were in the 41-60 year age group. It shows highest mortality rate in socially active and productive age groups. 4. The mortality rates of the departments of the medicine was 18.7%, general surgery 18.5%, and neurosurgery 14.7%. 5. The number of patients admitted to the department of neurosystem was 30.6%, cardiovascular system 22.6%, respiratory system 11.1 ％ and urinary system 2.9%. 6. On utilizing instruments and machine for diagnosis and client's assessment in I.C.U, they have utilized everything a usual. But they never utilize angiogram and cardiac catheterization in cardiovascular system, and retroperitoneal pneumography in the urologic system. Further more we would recommend as follows 1. In consideration of the average hospital days and the date of death, the rotation program for clincal experience need to be adjusted as continuing practice program in apposite to current alternative practice program for comprehensive nursing care. 2. Socioeconomic needs for the patient's families and himself should be emphasized by the students in addition to physical needs. 3. Course content for critical care might be built up in considering of core disease centered nursing problems. 4. The diagnostic procedures and client's assessment items which could not experience in our university hospital by the students might be considered and refilled as filled trips to another hospital and visual aids.

• Journal of Chest Surgery
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• 제49권1호
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• pp.22-28
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• 2016

Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

• Journal of Chest Surgery
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• 제25권6호
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• pp.661-671
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• 1992

From March 1988 to May 1991, 140 CarboMedics cardiac valve prostheses[75 mitral, 9 aortic and 28 double aortic-mitral] were implanted in 112 consecutive patients[mean age 36.7$\pm$11.6 years, male/female 48/76] by one surgical team operating on adult cardiac patients at Kyoungpook University Hospital Associated Surgical procedures were performed in 19 patients[16.9%]. Total follow up represented 2,345 patient-months[mean 22.4 months] and was 100% complete. Eighty-two patients[73%] were in NYHA functional class IIIor IV preoperatively and 102 patients [95%] were in class I or II postoperatively. Hospital[30 day] mortality was 4.4%, [3/75 mitral, 1/9 aortic, 1/28 double valve replacement] and late death was 1.7%. [1 /74 mitral, 1 /28 double valve replacement] The actuarial survival at 36 months was 94.0% after mitral, 80% after aortic, 92% after double valve replacement, and 93.2% for the total group. The linearized incidence of valve relater death, prosthetic valve thrombosis, anticoagulant related hemorrhage, and reoperation was 1.00%/pt-yr, 0.51%/pt/yr, 0.51%/pt-yr, and 0.51%/pt-yr respectively. The 36 month rates of freedom from valve replated death, thromboembolism, endocarditis, anti-coagulant related hemorrages, and reoperation were 98.75%, 99.08%, 100%, 99.04%, and 99.08% respectively. The 36 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.2%. These fact suggest that the CarboMedics heart valve has excellent short-term result, low incidence of valve-related complications and valve dysfunction, and additional long term follow up study is necessary.

• 대한임상독성학회지
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• 제18권1호
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• pp.26-33
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• 2020

Purpose: Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. Methods: This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. Results: A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. Conclusion: Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.

• Journal of Preventive Medicine and Public Health
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• 제17권1호
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• pp.75-83
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• 1984

A retrospective study has been made of 170,026 cases of motor vehicle accidents which had been reported to the National Police Headquarters of Republic of Korea, 1983. Also a study has been made of 264 cases of road traffic casualties who were treated at the Eul-ji General Hospital from Jan. 1, 1983 to Dec. 31, 1983. This study was conducted to find out the nature and pattern of the traffic accidents from the clinical and epidemiological view points. In additions, the modes of injury from the road accidents were persued which might help to reduce the traffic accident rate. The results of the study were summarized as follows; 1. In this study, the highest incidence was in the age group between $21{\sim}30$ years (21.29%). And the age group of highest death rate was under 10 years (7.28%). 2. In the comparison of sexual differences, male was dominated in accidents number and death rate. (Casualty rate; 61.66%). 3. In the comparison of each hour differences, the accident was mostly occured during afternoon from 16:00 to 18:00(12.23%). 4. The most common day of week was Sunday (14.74%). 5. The most common season of year was Autumn (27.92%). 6. In the comparison of occupational differences, the high incidences were showed in labor men (31.06%) and business men (12.12%). 7. In the comparison of accidental vehicles, the most common vehicle were cars and the next were trucks and buses. 8. The most common mechanism of accidents was collision (57.41%). 9. In the comparison of clinical differences, orthopaedic and neurosurgical injuries were most common types of the hospitalized casualties. 10. In the comparison of anatomical fracture sites, the most common site was tibia (15.81%) and the next site was femur (12.56%).

• 운동영양학회지
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• 제13권2호
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• pp.147-153
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• 2009

Effect of whole body vibration exercise on intracerebral hemorrhage in rats. Intracerebral hemorrhage is one of the most devastating types of stroke. This disease is known to cause severe neurological damage and also has a very high mortality rate. In the present study, the effects of whole body vibration exercise on memory capability and apoptotic neuronal cell death in the hippocampal CA1 region following intracerebral hemorrhage in rats were investigated. Intracerebral hemorrhage was induced by injection of collagenase into the hippocampal CA1 region using a stereotaxic instrument. The rats were divided into 5 groups: the sham-operation group, the hemorrhage-induction group, the hemorrhage-induction and 8 Hz vibration exercise group, the hemorrhage-induction and 16 Hz vibration exercise group, and the hemorrhage-induction and 24 Hz vibration exercise group. The animals in the whole body vibration exercise groups received whole body vibration at 8 Hz, 16 Hz, and 24 Hz, respectively for 30 min once a day during 14 consecutive days. In the present results, the apoptotic neuronal cell death in the hippocampal CA1 region was significantly increased following induction of intracerebral hemorrhage, resulting in memory impairment. Whole body vibration exercise suppressed hemorrhage-induced apoptosis in the hippocampal CA1 region. This suppressive effect of whole body vibration exercise also alleviated hemorrhage-induced memory impairment. Here in this study, we have shown that whole body vibration exercise inhibited intracerebral hemorrhage-induced apoptotic neuronal cell death and thus facilitated recovery of brain function following intracerebral hemorrhage.

• 한국보건간호학회지
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• 제9권2호
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• pp.33-42
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• 1995

The purpose of this study is to identify the smoking patterns and their relevant factors of the public officials who are placed to guide people's way of thinking as conservative middle-income group and thereupon, provide for basic data which can be used to reduce the diseases and death rate caused by smoking in terms of preventive medicine. For this purpose, 170 public officials working for the government agencies located in seoul were surveyed for Jan. 10-Jan. 20, 1995. The results of survey can be analyzed/summarized as follows; 1. In terms of daily smoking frequencies, 50 officials $(29.4\%)$ are driven by stress to smoke. Among these offcials, 250nes $(50.0\%)$ smoke 20-30 times a day. Meanwhile, 22 officials $(12.9\%)$ answered that they smoke for pleasure and comfort, and among them 6 officials $(21.4\%)$ smoke 20-30 times a day. 26 officials $(15.3\%)$ are found to be nicotine­addicted physically or psychologically, and to 10 of them $(35.7\%)$ smoke 20-30 times a day. On the other hand, 10 officials $(5.9\%)$ have habit of smoking and 4 of them $(40.0\%)$ smoke 20-30 times a day. 2. Out of 50 officials $(24.9\%)$ who began smoking on impulse, 44 actually stopped smoking, and the rest 6 officials did not even implement their plan. In view of successful cigarette-stopping, only 8 officials $(15.4\%)$ out of 44 impulse-driven smokers succeeded in stopping cigarettes, while the rest 36 failed all. Meanwhile, out of those 84 officials $(64.6\%)$. Who smoked for reduced stress, 28 ones succeeded, while the rest 56 ones failed. Out of 20 officials who were nicotine-addicted but attempted to stop smoking, only 2 smokers succeeded and the rest 18 were all failures. 3. Factors involving smoking and Their patterns 1) By age group (30's, 40's and 50's), the smoking patterns can be grouped into stress-removing, nocotine-addictive and habitual ones, respectively. 2) By acadeic background, our officials smoke on impulse or due to nocotine addition. 3) The length of career is co-related with nicotine addition. 4) The ownership of house is related with smoking for comfort or less stress. 5) The number of children is related with impulse-driven smoking or smoking for comfort.

• 한국가금학회지
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• 제27권2호
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• pp.109-114
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• 2000

The objective of these experiments was to develop an attenuated thermostable Newcastle disease virus(NDV), CBP-1 strain isolated from infected pheasants. Safety, pathogenicity and protective effects against velogenic NDV were also investigated to evaluate if the attenuated NDV, CBP-1 strain could be a candidate for a new NDV vaccine strain. CBP-1 strain was passaged up to the 173 times by nine days old embryonated eggs and chicken embryo fibroblast(CEF) cell cultures. Its sensitivitly to lipid solvents and low pH, thermostability, mean death time(MDT), intracerebral pathogenicity index(ICPI) of one day old chicks and intravenous pathogenicity index(IVPI) of four weeks old chicks were examined. Safety, boosting and protective effects were tested by chicks mortality. CBP-1 NDV strain had significant thermostability at 56$\^{C}$ for 30 minutes. by hemagglutinin activity and egg infectivity test, but was not resistant to lipid solvent. It showed possibility to use as a feed or water vaccine because of the resistance to low pH. MDT, ICPI and IVPI of CBP-1 were attenuated from 51.5, 1.96, 2.60 to 112.4, 1.12, 1.45. These results implied that the 173rd passages in embryonated egg and CEF cell cultures induced a substantial attenuation of the pathogenicity of the parent virus, changing the virulence from velogenic to intermediate between mesogenic and lentogenic. After vaccination with CBP-1 at one day old by drinking water mortality was 17.5%. However, spray vaccination with B1 at one day old, CBP-1 at two weeks ild and challenge with velogenic Kyojeongwon strain at four weeks old showed 93.5% survival rate. Mortality of chicks, vaccination with 173rd passaged CBP-1 strain at one day old, two weeks old and challenge with Kyokeongwon strain at four weeks old, was 20.0%. The results of these studies indicated that partial attenuated CBP-1 strain tended to be a low safety for ND of broiler chicks and would need to be more successive attenuation.