• Korea Journal of Hospital Management
• /
• v.26 no.3
• /
• pp.68-83
• /
• 2021

Background: It is widely acknowledged that single bedrooms have many potential advantages compared to multiple bedrooms. However, Korea has a reimbursement system that patients have to pay the additional fee if they will use single bedroom or pay-bed (1-3 bedroom). There is little research on patients' bed selection and relationship between patient satisfaction and bed type in the Korean setting. Methods: Using the 2017 Korea Health Panel (KHP) Survey data, we modified bed type by two dichotomous variables: single bedroom vs. multiple bedroom (2+ bedrooms) and pay-bed (1-3 bedroom) vs. reimbursed bed (4+ bedroom). Multivariate logistic regression is performed to determine the factors affecting the patient's choice of room types. Multivariate regression analysis was conducted to examine how hospital room types are affecting patient satisfaction. Results: Single room and pay-bed (1-3 bedroom) use was influenced by patient age (19- years old), male, a person at work, hospitalizing in a clinic, and birth. After controlling variables of the behavioral model of medical utilization, the association between patient satisfaction and use of single bedroom & pay-bed (1-3 bedroom). Cause of hospitalization, major treatment, and recognition of unnecessary care are statistically significant variables on patient satisfaction. Conclusion: Although the single room is about the standard for newly built hospitals in western countries, it remains unclear that single room or pay-bed (1-3 bedroom) has positive effects on patient's outcomes and satisfaction. In this empirical study, the difference in patient satisfaction by bedroom type was not noticeable. In terms of bed management by hospital staff, securing patient credibility in hospital care is an important task. Patients' perception of whether medical staffs have encouraged unnecessary treatment or tests has a significant impact on patient's satisfaction.

• CELLMED
• /
• v.11 no.4
• /
• pp.17.1-17.4
• /
• 2021

Episiotomy is the commonest obstetrics intervention in the world to reduce severe perineal injuries. Its prevalence is 43% to 100% in primiparous women in Asia. Further, worldwide approximately 10-95% of pregnant women undergo episiotomy incision during birth. Delay in wound healing probably increases the risk of wound infection, changes the muscular structure, and ultimately causes muscle tone loss. So, wound care is of specific significance to postnatal maternal outcomes. Hence, this case study aimed to evaluate the effect of Marham-i-Raal in episiotomy wound healing and pain relief. The study was conducted in eleven postpartum primi or multipara pregnant women aged between group 19 and 35 years with term gestational age, singleton pregnancy in a cephalic presentation who had a normal vaginal delivery with mediolateral episiotomy, without a perineal tear, and perineal hematoma. Externally, application of Marham-i-Raal 2g on episiotomy incisional wound, twice a day for 10 days was advised. Wound healing of episiotomy and pain intensity was assessed with REEDA ["redness, oedema, ecchymosis, discharge and approximation of the edges"] scoring and VAS scoring for pain intensity respectively. At one hour (baseline), the REEDA mean score of eleven patients was 3.90±1.04 whereas on day 7-10 it was 0.18±0.40 with statistically significant difference (p<0.001). The VAS mean score at one hour was 6.90±1.22 whereas on day 7-10 it was 0.72±0.78 with a statistically significant difference (p<0.001). Marham-i-Raal would be effective in episiotomy wound healing and reducing pain intensity. Further, randomized double-blind controlled trials in large sample size are recommended.

• Korean Journal of Agricultural Science
• /
• v.49 no.1
• /
• pp.61-75
• /
• 2022

The first purpose of this study is to evaluate the usefulness of pork traceability data, which is monthly time-series data, and to draw implications with regard to its usefulness. The second purpose is to construct a dynamic ecological equation model (DEEM) that reflects the biological characteristics at each growth stage, such as pregnancy, birth and growth, and the slaughter of pigs, using traceability data. With the monthly pig model devised in this study, it is expected that the number of slaughtered animals (supply) that can be shipped in the future is predictable and that policy simulations are possible. However, this study was limited to traceability data and focused only on building a supply-side model. As a result of verifying the traceability data, it was found that approximately 6% of farms produce by mixing great grand parent (GGP), grand parent (GP), parent stock (PS), and artificial insemination (AI), meaning that it is necessary to separate them by business type. However, the analysis also showed that the coefficient values estimated by constructing an equation for each growth stage were consistent with the pig growth outcomes. Also, the model predictive power test was excellent. For this reason, it is judged that the model design and traceability data constructed with the cohort and the dynamic ecological equation model system considering biological growth and shipment times are excellent. Finally, the model constructed in this study is expected to be used as basic data to inform producers in their decision-making activities and to help with governmental policy directions with regard to supply and demand. Research on the demand side is left for future researchers.

• Korean Journal of Agricultural Science
• /
• v.49 no.1
• /
• pp.11-18
• /
• 2022

A disrupted immune system during pregnancy is involved in pregnancy complications, such as spontaneous abortion, preeclampsia, and recurrent pregnancy loss. This study examined the role of toll-like receptor (TLR) 4 and ASC (apoptosis-associated speck-like protein containing a CARD [c-terminal caspase recruitment domain]) in pregnancy complications using a lipopolysaccharide (LPS)-induced miscarriage mice model. Incidences of miscarriage and embryonic resorption were examined at 9.5 days of pregnancy in wild-type (WT), ASC knockout (KO), and TLR4 KO mice after injecting them with LPS. The fetuses and placenta were obtained after sacrifice at 15.5 days of pregnancy. A significantly lower frequency of fetus absorption was found in TLR4 KO mice, whereas corresponding absorption outcomes were strongly induced in the WT and ASC KO mice upon an LPS injection. As expected, TLR4 KO mice were resistant to LPS-induced abortion. A histological analysis of the miscarried placenta showed increasing levels of the eosin staining of spongiotrophoblast cells without any obvious difference between WT and ASC KO mice. These results suggest that TLR4 KO mice are resistant to LPS, which affects pregnancy persistence, whereas WT and ASC KO mice show high miscarriage rates due to LPS. Moreover, the ASC adaptor is not directly involved in LPS-induced miscarriages, and the NLRP3 inflammasome can be activated by other proteins in the absence of ASC.

• Journal of Genetic Medicine
• /
• v.6 no.1
• /
• pp.74-80
• /
• 2009

Purpose: To assess the value of first-trimester pregnancy-associated plasma protein-A (PAPP-A), nuchal translucency (NT) and second-trimester alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A in predicting pregnancy complications other than fetal aneuploidy. Materials and Methods: A retrospective study in 3,121 singleton pregnancies with integrated testing was performed at Kangnam CHA hospital between January 2005 and December 2006. Baseline characteristics, pregnancy outcomes, and serum marker levels were obtained by review of the medical records. We analyzed the data to identify associations between the integrated screening markers and adverse pregnancy outcomes. Statistical analyses were performed with the SPSS program. Results: In preterm labor and preeclampsia, high AFP, hCG, and inhibin-A levels and low PAPP-A and NT levels were found to be significantly correlated (P<0.05). Elevated second-trimester inhibin-A levels were associated with preeclampsia (odds ratio 2.843), low birth weight (odds ratio 1.446), and preterm labor (odds ratio 1.287), and while decreased first-trimester PAPP-A levels were associated with preeclampsia (odds ratio 0.51) and preterm labor (odds ratio 0.75). Conclusion: First- and second-trimester maternal serum markers screening can be used for predicting high-risk pregnancies.

• Neonatal Medicine
• /
• v.16 no.1
• /
• pp.47-54
• /
• 2009

Purpose: Present evidences suggest that Ureaplasma urealyticum is a cause of pneumonia, septicemia, and bronchopulmonary dysplasia (BPD) in newborn infants, particularly those born prematurely. The purpose of this work was to examine the relationship between Ureaplasma urealyticum in the tracheal aspirates and adverse outcomes, such as BPD and early onset neonatal sepsis in premature infants. Methods: A polymerase chain reaction (PCR) was performed on tracheal aspirates collected within 24 hour after birth in 176 premature infants less than 35 weeks of gestation and admitted to the neonatal intensive care unit of Bundang CHA Hospital. Results: U. urealyticum was detected in 37 of 176 preterm infants (21.0%). Gestational age ($29^{+5}{\pm}2^{+5}$ wk vs. $30^{+6}{\pm}2^+{-5}$ wk, P=0.0l3) and birth weight (1.39${\pm}$0.44 kg vs. 1.59${\pm}$0.55 kg, P=0.037) were lower in the U urealyticum-positive group compared to the control group. The incidence of early onset neonatal sepsis (16.2% vs. 6.5%, P=0.045) and BPD (45.9% vs. 29.5%, P=0.047) was higher in the U urealyticum-positive group compared to the control group, but the severity of BPD was not different between two groups. However, multiple logistic regression analysis revealed that the presence of U. urealyticum was not independently related to the development of early onset neonatal sepsis and BPD. Conclusion: The results suggest that colonization of the lower respiratory tract by U. urealyticum might not be related to the development of neonatal sepsis and BPD directly in preterm infants.

• Clinical and Experimental Pediatrics
• /
• v.51 no.5
• /
• pp.474-480
• /
• 2008

Purpose : Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods : In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results : There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion : Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.

• Neonatal Medicine
• /
• v.15 no.2
• /
• pp.134-141
• /
• 2008

Purpose : This study examined the occurrence of oxygen desaturation events during nutritive sucking in premature infants with bronchopulmonary dysplasia (BPD) and its effects on feeding and growth outcomes until 4 months of corrected age (CA). Methods : Thirty-four premature infants with BPD free from major cardiac, gastrointestinal, respiratory anomalies were included. By reviewing medical records, clinical characteristics, feeding conditions at 36 weeks of postmenstrual age (PMA), we focused on oxygen desaturation, and short-term outcomes in 14 infants with no or mild desaturation (group A) and in 20 infants with moderate or severe desaturation (group B). Results : Group B had lower birth weight and shorter gestational age at birth, longer duration of hospitalization, was discharged at higher weeks of PMA, and needed ventilatory assist and oxygen supplementation longer than group A (P<0.05). Group B started nutritive sucking later, with a greater decrease in $SpO_2$ during sucking, being more indicative of feeding problems at 40 weeks of PMA, but not at 4 months of CA. Percent of infant needing oxygen supplementation and percent of infants with growth failure were not different between groups at 40 weeks of PMA and 4 months of CA. Body weight and growth velocity differences noted at 40 weeks of PMA became insignificant at 4 months of CA. Conclusion : The severity of desaturation during nutritive sucking in premature infants with BPD influenced the infant's feeding and growth at 40 weeks of PMA. However, it disappeared at 4 months of CA.

• Clinical and Experimental Pediatrics
• /
• v.48 no.12
• /
• pp.1342-1347
• /
• 2005

Purpose : Among perinatal risk factors, neonatal seizures are one of the strongest independent discriminators of adverse outcome, representing high risks of mortality and neurologic morbidity. This study was undertaken to evaluate the neurologic outcome of neonatal status epilepticus according to underlying etiology, seizure pattern, onset time, and duration. Methods : We reviewed retrospectively 36 neonates(19 males, 17 females) with status epilepticus who were admitted to the neonatal intensive care unit, Inha Hospital between July, 1988 and June, 2003. They were evaluated with neurologic examination, laboratory data, EEG findings, and neuroimaging studies etc. Results : The mean gestational period of the patients was $37.0{\pm}3.6$ weeks and birth weight was $2.70{\pm}0.82$ kilogram. Fifty two point eight percent of the neonates were male and 66.7 percent were born at term. The most common cause of neonatal status epilepticus was hypoxic-ischemic encephalopathy. In preterm babies, intracranial hemorrhages showed an especially high frequency(P=0.034). Gestational age and birth weight did not show a correlation with neurologic complications. The incidence of neurological sequelae were significantly related to prolonged seizures lasting more than 1 hour(P=0.002). Neonates with seizures within the first 72 hours tended to be more frequent among those who developed adverse outcomes(P=0.016). Generalized tonic seizures had the worst prognosis, whereas those children who had subtle seizures had better outcomes than any other type(P<0.05). Generalized tonic seizures were primarily represented on EEG by abnormal background, whereas subtle seizure showed a significantly more normal EEG than any other seizures(P<0.05). Conclusion : Our results indicate that neonatal status epilepticus with early onsets, prolonged durations. And generalized tonic types can predict an increased risk for neurologic sequelae. So, those seizures must be perceived as medical emergencies and treated aggressively with antiepileptic drugs.

• Clinical and Experimental Pediatrics
• /
• v.46 no.3
• /
• pp.224-229
• /
• 2003

Purpose : To examine various neonatal outcomes and perinatal factors resulting from assisted reproduction compared to that of spontaneous conception. Methods : This is a retrospective study. The control cases were all twins of spontaneous conception born between periods from January 1995 to June 2000. The study cases were identified from twins conceived by assisted reproduction in the same time peried. A total of 460 sets of twins consisted of 250 twins of spontaneous conception and 156 twins of assisted reproduction were studied. The primary outcomes were neonatal morbidity and mortality and the secondary outcomes were perinatal factors including number, length and cost of hospitalization for the delivery. Results : No differences were seen in various neonatal factors including gestational age, birth weight and incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, hyperbilirubinemia, sepsis, intraventricular hemorrhage and the length of hospitalizations. Lower one minute and five minute Apgar scores and frequently encountered electrolyte abnormalities were observed in neonates of assisted reproduction. In general, the second twin of assisted reproduction had increased incidences of respiratory distress syndrome, sepsis and necrotizing enterocolitis than the first twin. Increased frequencies of preterm labor, hospitalization and elective cesarean section were seen among mothers who underwent artifical conception. However, overall hospital costs in terms of mothers hospitalization for the delivery and neonates hospitalization did not show differences. Conclusion : Assisted reproduction twins had similar neonatal morbidities, mortalities and perinatal morbidities compared to those born by spontaneous conception.