• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

• Health Policy and Management
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• v.18 no.1
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• pp.85-107
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• 2008

This study aims to describe levels and distribution of the continuity of primary care among children and adolescent patients who are 2-19 years old, and analyze the effects of it on the risk of hospitalization. Study population was 2-19 year old child and adolescent patients as of 2002, who had more than three ambulatory care visits in the years of 2002-3 and whose most frequent provider was the primary care practices (189,660 persons). Association of levels of primary care with the risk of hospitalization was evaluated using multiple event survival analysis. Outcome variables were whether the patient had hospitalized or not, and whether the patient had hospitalized due to ambulatory care-sensitive conditions or not. Multiple event survival analysis revealed statistically significant association of the levels of primary care with the risk of hospitalization. Hazard ratio was 1.34 [1.27-1.41] at the medium level of continuity and 1.47 [1.39-1.55] at the lower level where outcome variable was whether the patient had been hospitalized or not. Hazard ratios were 1.35 [1.21-1.50] at the medium level of continuity and 1.60 [1.44-1.78] at the lower level, where outcome variable was whether the patient been had hospitalized due to ambulatory care-sensitive conditions or not. This study produced some evidences on the benefits of continuity of care, which will in turn support the introduction of personal doctor registration program in the future.

• Research in Community and Public Health Nursing
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• v.15 no.2
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• pp.308-322
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• 2004

Purpose: 'The purpose of the present study was to understand students' experiences from their standpoint, to identify relevant variables and to examine into their relations by analyzing and describing what phenomenon 'nursing students' visiting ambulatory bathing service' is, what are the reasons for the phenomenon, and what interactions are in the phenomenon. Method: The subjects were thirteen students. Data were collected through in-depth interviews and analyzed by Strauss and Corbin's analysis method. Result: With regard to ambulatory bathing service, participants responded 'lack of education', 'inexperienced personal relations' and 'disappointment with recipients families'. They recognized 'burden' and 'compassion'. The intensity of generated 'burden' and 'compassion' was determined by volunteering persons, the degree of health care service, recipients' response and interaction of climate. When 'burden' and 'compassion' were generated, participants selected their own coping strategies. Strategies in the situation of 'burden' and 'compassion' were significantly influenced by 'burden' and 'compassion' and structural situation - 'mutual relation structure,' 'volunteers' capability,' 'the degree of volunteering guidance,' 'community participation,' 'recipients' environment,' 'information sharing,' 'special vehicle equipment' and 'economical burden.' Strategies include' service training,' 'receiving volunteering training,' 'preliminary service preparation,' 'volunteering.' 'connection to local medical center,' 'intention,' 'information sharing,' 'passive response to recipients' appreciation' and 'the understanding of publicity'. The results of selected 'burden' and 'compassion' are described with 'worthiness' and 'cohesion' as follows. Conclusion: This study is significantly meaningful in that it examined bathing service welfare in its initial stage. There are not much outcome from previous studies. However. it is meaningful that this study intended to develop theories on the nature of experiences and the relations among concepts derived from the visiting ambulatory bathing service process of nursing students. Professors who taught social volunteering in universities understood the experience of nursing students who did the visiting ambulatory bathing service. Consequently, professors will provide an effective instruction to enable these students to carry out visiting ambulatory bathing services efficiently in order to meet demands when they conduct the services. For the volunteering service activity in major-related fields among college students' social volunteering activities, they recognized the necessity of systematic education and preparation.

• Journal of Preventive Medicine and Public Health
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• v.27 no.2 s.46
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• pp.366-376
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• 1994

Patients' evaluation of hospital care is one of the most important aspects of quality assessment. Survey allows patients to judge sujectively the events that occur during their hospital visit if performed properly. This study describes the result of a research effort to develop outpatient questionnaire that has sufficient validity and reliability to be used to measure patients' perception of satisfaction in Korea and to investigate influencing factors on patients' satisfaction. Self-administered questionnaire was developed for outpatient and the survey was conducted covering 827 outpatients in a tertiary hospital. It was confirmed by factor analysis that patients evaluate several components of ambulatory care distinctly ; hospital environment, administration and ancillary services, and medical care. We found strong evidence of construct validity and internal consistency for the above three dimensions of hospital process. On the contrary, reliability of overall outcome measures was low. It suggests that three items concerning overall outcome measures have some different meanings in patients' perception. Using logistic regression analysis it was found that previous health status, cost evaluation, and improvement in health status have significant influences on the level of patients' overall satisfaction and that patient's sex, experience of previous visit, expectation for improvement, cost evaluation, and improvement in health status are strongly related with intention to recommend hospital. In spite of some limitations the results of this study can be used helpfully as baseline informations for developing self-administered questionnaire and for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the measurement of ambulatory patients' satisfaction and its related factors in current Korean situation.

• The Journal of Korean Physical Therapy
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• v.20 no.1
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• pp.41-47
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• 2008

Purpose: This study aimed to assess the effectiveness of gait training with the use of an electromechanical gait trainer with functional electrical stimulation (FES) for patients that had undergone subacute stroke. Methods: The study subjects included nine subacute stroke patients of the Korea National Rehabilitation Center in Seoul, Korea. Outcome was measured using the timed Up and Go test, Fugl-Meyer-L/E assesment, with determination of the comfortable maximal gait speed, composite spasticity score, functional ambulatory category and Berg balance scale. All measured scores were recorded before, during, and after rehabilitation and at an eight-week follow-up. Results: Patients who received electromechanical-assisted gait training in combination with FES after subacute stroke were more likely to achieve independent walking, functional activities, balance and gait speed. Conclusion: The outcome of our gait-training program demonstrates that it may be practical to integrate FES into electromechanical gait training without any adverse effects. However, further randomized controlled studies are needed to evaluate if patient outcome after combined training is superior to outcome after the use of electromechanical gait trainer treatment alone or conventional gait training alone.

• Quality Improvement in Health Care
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• v.5 no.2
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• pp.176-189
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• 1998

This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.

• Physical Therapy Korea
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• v.22 no.4
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• pp.71-78
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• 2015

Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.357-367
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• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• PNF and Movement
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• v.20 no.3
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• pp.359-370
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• 2022

Purpose: Physical therapists are required to properly choose the most appropriate treatment for each patient within the framework of the International Classification of Functioning, Disability, and Health (ICF model). The aims of this study were to determine whether neurological physical therapists in clinical settings in South Korea know about the ICF model and to investigate the current trends of outcome measures (OMs) used by them. Methods: Two hundred and one physical therapists who worked with patients with neurological disorders participated in this study. The survey was conducted via e-mail and asked about commonly used OMs and the considerations for selecting OMs. Results: All physical therapists involved in this study responded completely, and 45.8% of participants learned about the ICF model, while 37.3% understood the detailed information related to the ICF model. The rest of the participants did not know or just heard about the ICF model. The most frequently used tools at the body function/structure level were the Range of Motion (98%), Manual Muscle Test (97%), Berg Balance Scale (83.1%), and Modified Ashworth Scale (70.6%) when allowing repetition. At the activity level, the 10-meter walk test (71.1%), 6-minute walk test (54.2%), and Functional Ambulatory Category (43.3%) were used, while the Activity-Specific Balance Confidence Scale (23.9%) was used at the participation level. There was a positive relationship between the number of tools used and years of work, as well as the level of understanding of the ICF model. Conclusion: The results of this study suggest that it is necessary to learn the ICF model in a clinical setting. In addition, the medical system needs to be modified to encourage physical therapists in South Korea to use proper OMs within the ICF model.

• Physical Therapy Korea
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• v.22 no.4
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• pp.79-86
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• 2015

This study examined the effects of trunk stabilization exercise on balance and trunk control in children with spastic diplegia. Four children with ambulatory spastic diplegia participated in the trunk stabilization exercise program using a Both Sides Utilized (BOSU) ball, 30 minutes a day, two times a week for eight weeks. Outcome variables included the pediatric balance scale, trunk control movement scale and multifidus thickness using ultrasound image. After trunk stabilization exercise, there was statistically no significant improvement in pediatric balance scale, trunk control movement scale and multifidus thickness. However, individual outcomes were observed with some positive changes. Balance, trunk control movement, and thickness of multifidus were found to be improved. Trunk stabilization exercise using a BOSU ball could improve trunk control and increase the thickness of multifidus in children with spastic diplegia. Further investigation is needed to evaluate subjects according to type of cerebral palsy and to understand the relationship between postural control and gait.