• 간호행정학회지
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• 제1권2호
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• pp.338-348
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• 1995

We need to continuously evaluate for nursing quality and the outcome to reflect nursing, to repair and improve of nursing. The first problem for nursing quality improvement is development of evaluation tool for the quality of nursing care. We need a system for quality assurance evaluation that is, development and framework of evaluation tool for nursing care quality. The purpose of this study was attempted to develop an evaluation tool for the quality of nursing care in musculoskeletal disorder patients. The approach method of nursing quality for the development of the tool in this study was process evaluation framework. The study were devided dvelopment process and reliability, validity verification process. The subjects of development process of this tool are three nursing export groups, and the subject of reliability, validity verification process are 20 samples of two university hospital in seoul, who were within discharge 3 months after admission treatment in musculo-skeletal disorder. Data for this study was collected from March 10 to April 13, 1995. The development process of the tool were as follows : 1. Make preliminary list of the tool by focal group were constituted 12 clinical nurses. 2. Modify and add preliminary list by 4 nursing expert panel. 3. Calculate content validity of the tool by 25 nursing expert panel of judge. 4. Verify reliability and validity of the tool. 5. Finalize an evaluation tool for the quality of the nursing care in musculo-skeletal disorder. The results of this study were as follows : 1) Development an evaluation tool for the quality of nursing care in musculo-skeletal disorder. (1) The evalution tool of this study was developed 5 standards, 33 criterias and 133 indicators. (2) 5 standards were divided according to Nursing Process. from standard 1 to standard 5, involved criterias were each 6(18%), 3(9%), 3(9%), 15(46%), 6(18%). 2) Verify reliability and validity of the tool. (1) Score of adequate degree for content validity of 33 criterias and 133 indicators were every average 2.82. (2) Inter-rater reliabilities(consentaneity score) of the tool by pearson correlation coefficient between three raters were : r=.7506, r=.8934, r=.6695. and Inter-rater reliabilities by single-facet crossed design were : r=.7464. (3) The alpha coefficient relating to internal consistency was .8524 over all 30 items of 33 criterias of developed tool. (4) Score of the quality of nursing care following to generaal characteristics of this study subjects were stastically significant differences according to educational level (F=2.93, p=.029)and diagnosing classification (F=2.50, p=.042). Through this study, I'm sure that the developed tool for the quality of patient care in musculo-skeletal disorder will show the way of more improvement of the quality of nursing care and effective nursing interventions.

• 대한한방부인과학회지
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• 제25권3호
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• pp.117-131
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• 2012

Objectives: This study was designed to observe the effect of chuna manupulation in alleviating the symptoms of postpartum patients with low back pain and pelvic girdle pain. Methods: Targeted by outpatient 30 postpartum patients, A group was patients who were treated with acupuncture, traditional Korean medicine, physical therapy, B group was patients who were treated with acupuncture, traditional Korean medicine, physical therapy, and chuna manupulation. After 2-months, the progress of symptoms was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI) and Pain drawing. Results: 1. Group A and B were analyzed for general characteristics, with an average age of both groups, average weeks at admission after delivery, parity and method of delivery, weight gain and BMI during pregnancy were no significant differences in. 2. VNRS improvement in the rate of group A was $2.84{\pm}4.73$, VNRS improvement in the rate of group B was $4.85{\pm}1.49$. Between the two groups was statistically significant. 3. ODI improvement rate in group A was $10.14{\pm}4,39$, ODI improvement rate in Group B was $15.16{\pm}3.41$. Between the two groups was statistically significant. 4. Patients who received acupuncture, traditional Korean medicine, physical therapy, and chuna manupulation. in group B compared pubis, thighs, buttocks showing more effective in pain relief than group A, who received only acupuncture, traditional Korean medicine, physical therapy. Conclusions: In case of postpartum patients with low back pain and pelvic girdle pain, it is more effective to treat with Integrated traditional Korean therapy and chuna manupulation than to treat with only integrated traditional Korean therapy.

• 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.

• 간호행정학회지
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• 제5권2호
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• pp.389-400
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• 1999

The purpose of this study is to examine a possibility of applying the ABC system to analyze the cost of nursing service on one obstetrics and gynecology (OB/GYN) unit in a major medical center. The activities of nurses on an OB/GYN unit were analyzed for 4 days for 96 hours. 2 week days and 2 days on weekend. Total cases included in the study were activities of 12 charge nurses and 12 staff nurses. Activities were categorized into direct and indirect activities in order to calculate the cost of activities. Nursing activities were defined multidimesionally in order to utilize the ABC system. The 60 nursing activities were classified into the direct nursing activities and the indirect nursing activities based on a literature review, interview, and survey results. The direct activities were further categorized into the single nursing activities and the multiple nursing activities. The indirect activities were classified into the indirect nursing service activities and the general management activities. The major findings of this study were as follows : 1. There were differences in activities according to the positions and duties of the nurses. The charge nurses mostly performed the indirect nursing service activities and the general management activities. Almost all of their indirect nursing activities spent on each patient were similar. The staff nurses performed the single nursing activities and the multiple nursing activities. 2. The activities of staff nurses included medication, patient assessment, rounding and organizing the unit. patient education, nursing treatment, admission and discharging of patients. There was no differences in types and amount of time spent between the nurses on day-time duty and evening-time duty, but the patient assessment activity increased during the night-time. 3. The cost of post partum nursing services for women who had a normal vaginal delivery using the ABC system included the cost incurred by direct nursing activities provided by the staff nurses (85.9%), indirect nursing activities incurred by the staff nurses(19.0%) and the nursing activities by the charge nurses and the head nurse(14.1%). The ABC system is a relatively new method of cost analysis. The results of this study can provide the nursing and hospital managers with useful information on cost control. It is suggested that more studies should be done using the ABC system and extend the scope of studies to include value analysis to aid the Activity-Based Management(ABM) and/or the reengineering of hospital process.

• Journal of Chest Surgery
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• 제8권2호
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Journal of Chest Surgery
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• 제35권12호
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• pp.876-881
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• 2002

대동맥박리증은 사망률이 매우 높은 질환으로 조기 진단 및 치료가 되지 않으면 예후가 매우 불량한 질환이다. 최근 컴퓨터단층화촬영과 심초음파 기술의 발달로 진단률이 높아지고 조기수술이 가능하게 되었으며 술전 응급실에서 적극적인 약물투여로 사망률이 낮아지고 있는 상태이다. 따라서 이 연구는 후향적으로 응급실에서의 처치 및 수술 결과를 분석하였다. 대상 및 방법: 1991~2001년까지 외과적 교정술을 시행받은 급성 대동맥박리증 환자 42명을 대상으로 하였다. 남자가 18례, 여자가 24례였으며 연령은 평균 51.1세였다. 또한 응급실을 경유한 경우가 34례, 외래를 통한 입원이 8례였다. 결과: 수술은 상행대동맥치환술이 26례였으며 이중 대동맥판막 치환술을 병행한 경우가 7례였다. 하행대동맥치환술은 7례였으며 Bentall술식은 9례에서 시행하였다. 응급실 내원시 혈압강하제와 $\beta$-수용체차단제를 20례에서 투여하였으며 이중 6111(30%)에서 사망하였다. 이런 약물을 투여하지 않은 22례환자중 10례(45.5%)에서 사망하였다. 전체 사망은 16례(38%)였다. 결론: 대동맥박리증은 응급실이나 외래에서 조기진단이 필요하며 가능한한 비침습적 검사방법을 택하고 환자상태에 따라 적극적인 술전 약물처치가 이루어져야 할 것으로 생각된다.

• 가정∙방문간호학회지
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• 제9권2호
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• pp.103-113
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• 2002

Purpose: This study was conducted to explore the relationship among health belief. health locus of control and patients sick-role behavior compliance of diabetic mellitus patients visiting public health center. Method: The subjects of this study were 193 of the diabetic patients who were visiting 4 Public Health Center in B city. The instrument used for measuring health belief was Park's(1985). for health locus of control was Wallston. et al's(1978) and for sick-role behavior compliance was Park's(1984). The data were collected with structured questionnaires; total 58 items contained about health belief. health locus of control and sick-role behavior compliance from 1st to 31st July. 2001. The data was analyzed by the SPSS/PC programs using t-test. Pearson's correlation coefficient. ANOVA and Scheffe-test. Result: The average score of the health belief was $57.99\pm9.45$ health locus of control was $66.83\pm9.48$ and sick-role behavior compliance was $42.81\pm7.00$. Statistically significant factors influencing the health belief among social demographic characteristics were family number(F=3.818. p=0.024), monthly income(F=5.153, p=0.002), time of diagnosis(F=3.937. p=0.002) and difficult to control disease(F=5.803. p=0.000). The significant factors influencing the health locus of control were marital status(F=4.669. p=0.010). Also significant factors influencing the sick-role behavior compliance were monthly incomes(F=5.245, p=0.000). the time of diagnosis(F=4.424. p=0.001) and admission to hospital with diabetes(F=9.031. p=0.000). There was negative mild correlation comparatively between health belief and sickrole behavior compliance(r=-0.142, p<0.05) but no correlation in sensitiveness/severity, barrier, benefit(p<0.05). There was no correlation between internal. external. chance health locus of control and sick-role behavior compliance (P>0.05). Conclusion: There was a negative weak relationship between health locus of control and patient's sick role behavior compliance. Therefore further study to investigate the relating factor of the sick role behavior compliance among above of middle aged diabetes mellitus patients is necessary.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.47-53
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• 2001

Objective : This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. Methods : We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. Results : 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th & 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. Conclusion : Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.851-860
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• 2011

Purpose: Reduction by simply assembling bones is recognized as treatment for a zygoma fracture. However, in patients who originally had a protruding zygoma, the fractured parts look like malarplasty after the edema subsides, giving a soft impression which patients notice. Thus, we created symmetry through simultaneous contralateral malar reduction in a unilateral zygoma fracture. Methods: In this study, the patients who had surgery between July, 2008 and December, 2009 with admission were object. In 76 patients with a zygoma fracture, the patients with bilateral zygoma fractures were excluded. Among 48 patients who had a reduction only after a unilateral zygoma fracture, the patients hoping for a reduction of their rough protruding zygoma were analyzed with front cephalometry. The study progressed on 22 patients who had simultaneous contralateral malar reduction in a unilateral zygoma fracture with consent. After fixing the fracture, we did a straight zygoma osteotomy through a 1.5 cm intraoral incision. After that, we created symmetry with a special ruler and fixed the broken zygomatic arch with a screw and plate. We evaluated the facial index and satisfaction with a statistical analysis before and after the surgery. Results: In 22 patients, there was no reoperation except for 1 patient who had a zygoma fracture. None of the patients were treated for infection or hematoma. Two patients complained of paresthesia after the malar reduction operation, but this subsided in 4 months. Most of them were satisfied with the malar reduction, especially the women, and we obtained a better mid facial contour with decreased facial width ($p$ <0.05). Conclusion: Existing zygoma fracture surgery focuses on anatomical reduction. However, we need to have a cosmetic viewpoint in fractures as interests of face contour arise. Thus, contralateral malar reduction got a 4.7 (range 0~5) from patients who had malar reduction surgery in our hospital. Although adjusting to all zygoma fractures has limitations, it can be a new method in zygoma fractures when there are limited indications of protruding zygoma and careful attention is given to patients' high demands.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.668-674
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• 2000

Objective : The classic and accepted surgical method of compound comminuted depressed skull fractures (FCCD) involves total resection of all the contaminated bone and fragments at the fracture site. A second operation for cranioplasty is then performed at a later date. However, we have believed that primary repair of these bony defects can be achieved by the replacement of bone fragments at the time of the initial debridement, and this can be accomplished without danger to patient. The authors retrospectively reviewed the surgical results to assess the advantages and disadvantages, and also propose the selection criteria of replacement of fractured bone fragments as a primary procedure in FCCD. Materials and Methods : The authors analyzed the data extracted from medical records, and radiological findings in 22 of 71 patients with FCCD, who underwent immediate replacement of fractured bone fragments between April 1993 and October 1998. The mean follow-up period was 13.7 months. The selection criteria for the operation included the patients with mild to moderate severity, regardless of the degree of contamination or dural violation, which presented in hospital within 24 hours of injury. Results : The ages of the patients varied from 4 to 63 years, and there were 20 males and 2 females. Seventeen of 22 patients were fully conscious on admission and the others also had relatively good Glasgow coma scales. Sixteen fractures were located in the frontal area, 9 with involvement of the frontal sinuses, and 6 in the parietal and temporoparietal areas. Of the 22 patients, 8(36.3%) had dural lacerations with 3 of these requiring patching with pericranium, and 12(54.5%) had intracranial hematoma requiring wide craniotomy. The degree of wound contamination was also variable. Fifteen patients had relatively clean wounds, while seven(31.8%) had seriously contaminated wounds with soil, sand, hair, and wood. Only one patient(4.5%) developed infection, and the bone fragments were removed. All wounds healed primarily without pulsatile defect, the skull has remained solid, and no complications have occurred, except the infected case. Conclusion : It is proposed that bone fragments removal for FCCD, regardless of the degree of contamination or dural violation, is not necessary and that primary bone fragments replacement avoids a second operation for cranioplasty.