• Perspectives in Nursing Science
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• v.6 no.1
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• pp.77-83
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• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• Journal of Preventive Medicine and Public Health
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• v.20 no.2 s.22
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• pp.287-300
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• 1987

Island regions suffer from a shortage of health care in part because they are less developed, they cover a widespread area relative to the population, and due to transportation barriers. The purpose of this study was to assess the level of illness and the magnitude of medical care utilization, and to investigate the determinants of utilization in these area. The data were collected by means of a household survey conducted from February 16 to 25, 1987 on S islands which were selected in consideration of the size of the population, the distance from the main land, and the distribution of health care facilities. The household response rate was 89.1% (491 of 551 households), and 1971 persons were surveyed. The major findings of this study are as follows: 1) The morbidity rate of the island inhabitants was 27.7% during the two weeks, and 25.5 chronic illnesses and 9.1 acute illnesses per 100 persons, were noted. Differences in the magnitude of illness were statistically significant by sex, age, education, and family size. 2) The magnitude of total ambulatory carl utilization was 16.8 visits per 100 persons during the two weeks, which was less than that of other regions; and differences in the magnitude of total ambulatory care were statistically significant by sex, age, education, occupation, and family size. 3) Unmet needs were classified as 56.0% in chronic illnesses and 19.6% in acute illnesses; and differences in unmet needs were statistically significant by sex, age, education, occupation, income, and family size. 4) Statistically significant determinants in medical care utilization included the frequency of acute illness and chronic illness, and income in total utilization; the frequency of chronic illness and acute illness, and medical care insurance in physician visits. 5) According to the results of the path analysis, need factors had the greatest effect on utilization, and predisposing factors had more indirect effects through enabling or need factors than direct effects.

• The Journal of Internal Korean Medicine
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• v.21 no.3
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• pp.369-376
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• 2000

Purpose : Cerebrovascular disease is the most frequent cause of death in Korea and it remains severe disabilities disturbing normal life, According to the previous studies, mortality of the stroke in the first one week is up to the 20% and 95% of stroke patients in the acute stage are accompanied by more than one complications. These complications affect not only the acute stage mortality but also the late stage rehabilitations. In Korea the oriental medicine is preformed in the treatment of stroke. Therefore it is important to recognize thoroughly the complications in the acute stage of stroke and to prevent them. But studies about complications of acute stage stroke is rarely presented in the fields of oriental medicine. So this study is prepared for investigating the characteristics and frequency of complications in the acute stage of stroke. And we are to assess the importance of theses acute complications by systemic reviewing the previous studies. Methods : Fifty one patients are included who had been admitted to ICU(intensive care unit) of Chenju Hospital of Wonkwang Oriental Medicine. Twenty nine patients are diagnosed as ischemic stroke and twenty one patients are diagnosed hemorrhagic stroke. Medical and neurological complications were investigated retrospectively based on medical notes excluding primary symptoms of stroke Le. motor weakness, sensory disturbance and speech disorder. And risk factors of stroke such as D.M. or hypertension are excluded. Results : Medical complications are more frequent than neurological ones. Most frequent medical complication is dysuria(61%) and constipation(45%), fever(30%) and aspiration pneumonia(22%) are followed in order of frequency. In Neurological complication dysphagia(56%), the exacerbation of infarction due to increased intracranial pressure(24%), irritability or insomnia(21%) is most frequently complicated in order of frequency. Conclusions : These complications are mostly caused by bed rest state in acute stage stroke. It is supposed that more aggressive management can prevent theses ones. And it is possible to improve the medical and neurological conditions by sticking theses study results.

• Acute and Critical Care
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• v.33 no.4
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• pp.252-259
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• 2018

Background: The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time ($26.7{\pm}25.1$ vs. $12.1{\pm}16.0days$, P=0.003), length of stay in the general ward ($70.6{\pm}89.1$ vs. $40.5{\pm}42.2days$, P=0.008), length of total hospital stay ($107.5{\pm}95.6$ vs. $74.7{\pm}51.2days$, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

• Clinical and Experimental Vaccine Research
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• v.12 no.2
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• pp.143-155
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• 2023

Purpose: An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. Materials and Methods: We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to "SARS-CoV-2 vaccination" and "GBS". Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. Results: We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. Conclusion: There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.

• Journal of Korean Academy of Nursing
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• v.39 no.6
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• pp.888-898
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• 2009

Purpose: This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and ${\geq}65\;yr$ with first-time acute coronary syndrome (ACS). Methods: A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008. Results: Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only. Conclusion: Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.

• Quality Improvement in Health Care
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• v.27 no.1
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• pp.43-50
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• 2021

Purpose: The aim of this study was to determine the effect of side walking on balance confidence, falls efficacy and fall risk in acute stroke patients. Methods: The study included 14 patients with acute stroke who were randomly allocated to a side walking group (Experimental group, N=7) and a forward walking group (Control group, N=7). Both groups performed the exercise 5 times a week for 2 weeks. Outcomes were assessed using Korean-Activities-specific Balance Confidence Scale (K-ABC), Korean-Fall Efficacy Scale (K-FES), Korean-Fullerton Advanced Balance Scale (K-FAB). Results: After 2 weeks of training, both groups showed significantly improved ABC, FES, FAB (p<.05 in both groups). However, the ABC, FES, FAB in the experimental group was significantly better than in the control group (p<.05). Conclusion: These findings indicate that side walking training may be effective at improving balance confidence and decreasing fall down risk in early stroke patients. Therefore, side walking training may be recommended as an intervention in reducing the incidence of falls in acute stroke patient.

• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.106-110
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• 2015

The prevalence of pneumothorax cases among Intensive Care Unit patients who require mechanical ventilation ranges from 4%-15%. A pneumothorax remains one of the most serious complications of positive pressure ventilation. It can be diagnosed in a critically ill patient through a physical examination or radiographic studies that include chest radiographs, ultrasonography, or computed tomography scanning. However, in a critically ill patient, the diagnosis of a pneumothorax is often complicated by other diseases and by difficulties in imaging sick and unconscious patients. Although electrocardiogram changes associated with a pneumothorax have been described for many years, there has been no report of such among patients who require mechanical ventilation. In this paper, we report 2 cases of a spontaneous pneumothorax with paroxysmal supraventricular tachycardia in patients who required invasive mechanical ventilation due to acute respiratory failure.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.214-233
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• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

• 대한예방의학회:학술대회논문집
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• 2004.10a
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• pp.47.1-47.1
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• 2004