• Tuberculosis and Respiratory Diseases
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• 제64권6호
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• pp.445-450
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• 2008

연구배경: 최근 노인 인구가 급격히 증가하면서 중환자실로 입원하는 노인 환자도 증가하는 추세이다. 내과계 중환자실에서 30일 이상 장기간 기계환기를 받은 노인 환자들의 임상적 특징 및 예후에 대하여 알아보고자 하였다. 방 법: 2004년 4월부터 2007년 3월까지 을지대학병원 내과계 중환자실에 입원했던 환자들 중에서 연속해서 30일 이상 기계환기를 받았던 65세 이상 환자 41명을 대상으로 임상적 특징과 예후에 대하여 후향적으로 조사하였다. 결 과: 대상 환자 41명의 평균 연령은 $74.6{\pm}6.0$세이었고, 남자가 27명(65.9%)이었다. 중환자실로 입원한 주된 이유는 급성호흡부전 30명(73.2%)으로 가장 많았고 패혈증 5명(12.2%), 신경계장애 4명(9.8%), 위장관출혈 2명 (4.9%) 순이었다. 평균 APACHE II 점수는 $26.9{\pm}4.5$이었다. 중환자실 평균 입원 기간은 $49.3{\pm}23.0$일 이었으며 기계환기의 평균 기간은 $57.5{\pm}32.8$일이었다. 사망한 환자는 25명(60.9%)이었으며 사망과 관련있는 인자는 APACHE II 점수(p=0.038)와 수혈(p=0.007) 등이었다. 결 론: 장기간 기계환기 치료를 받은 노인 환자들에서 호흡부전이 가장 흔한 중환자실 입원 이유이었으며 사망률은 60.9%이었고 사망에 영향을 주는 인자는 APACHE II 점수와 수혈 등이었다.

• Tuberculosis and Respiratory Diseases
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• 제72권6호
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• pp.493-500
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• 2012

Background: This study investigated the clinical characteristics and risk factors of the severity of pandemic influenza A (H1N1) 2009 infection in pediatric patients in Busan and Gyeongsangnam-do. Methods: Cases of influenza A (H1N1) 2009 in patients under the age of 18 years, confirmed by reverse transcription polymerase chain reaction, at Pusan National University Hospital and Pusan National University Yangsan Hospital from the last week of August 2009 through the last week of February 2010 were retrospectively analyzed. Results: Of the 3,777 confirmed cases of influenza A (H1N1) 2009, 2,200 (58.2%) were male and 1,577 (41.8%) were female. The average age of the patients was $8.4{\pm}4.8$ years. The total cases peaked during 44th to 46th week. Most of the patients were in the 5- to 9-year-old age group. Oseltamivir was administered to 2,959 (78.3%) of the patients. 221 patients (5.9%) were hospitalized, age an average of $6.7{\pm}4.5$ years. The average duration of hospitalization was $7.4{\pm}5.6$ days. One hundred cases (45.2%) had pneumonia. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. Children with asthma were at very high risk of hospitalization, over 20 times the non-asthmatic children (odds ratio [OR], 21.684; confidence interval [CI], 13.295~39.791). Likewise the children with neurologic deficits faced a 16 times higher risk (OR, 15.738; CI, 7.961~31.111). Ten of the patients (4.5%) were admitted to the intensive care unit, and eight (3.6%) required mechanical ventilation. Conclusion: Of the pediatric patients with pandemic influenza A (H1N1) 2009, most of the patients were in the 5- to 9-year-old age group. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. The most common complication was pneumonia. The very high risk of severe morbidity in children with asthma or neurologic disease shows the critical importance of targeted vaccine coverage, special awareness and swift care by both guardians and primary care providers.

• Pediatric Infection and Vaccine
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• 제30권3호
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• pp.111-120
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• 2023

목적: 리노바이러스의 감염은 하기도 감염을 일으키기도 한다. 본 연구에서는 리노바이러스에 의한 중증 하기도 감염을 보이는 소아환자의 특성을 알아보고자 하였다. 방법: 2016년부터 2020년까지 삼성서울병원 소아청소년과에 리노바이러스 하기도감염으로 입원한 환자의 의무기록을 후향적으로 분석하였다. 입원 시 연령이 생후90일 이상, 5세 미만인 소아 환자를 대상으로 하였다. 다른 호흡기 병원체와의 동시 감염이 확인된 환자는 제외하였다. 리노바이러스에 의한 중증 하기도감염은 고유량 산소요법 치료가 필요한 경우, 기계 호흡이 필요한 경우 또는 중환자실 입원하는 경우로 정의하였다. 결과: 해당 기간 동안 총 115건의 리노바이러스 하기도 감염 입원이 확인되었다. 연령 중앙값은 17개월 (범위, 3-56개월) 이었으며, 입원 일수 중앙값은 4일 (범위, 2-31일) 이었다. 115 건 중 18건의 입원 (15.7%)은 중증 리노바이러스 하기도 감염 그룹으로 분류되었다. 중증 경과 그룹 환자의 연령 중앙값은 그렇지 않은 그룹에 비해 연령 중앙값이 낮았다 (9.5 개월 vs. 19.0 개월, P=0.001). 18명의 중증 리노바이러스 하기도 감염 그룹 환자 중 11명 (61.1%)는 기저질환을 가지고 있었으며, 만성 폐질환이 가장 많은 비율을 차지하였다 (63.6%). 여섯 명의 환자는 (33.3%) 기계 호흡을 필요로 하였다. 일곱 명의 기저질환이 없는 환자도 중증 리노바이러스 하기도 감염 그룹에 포함되어 있었다. 이들 일곱 명의 환자 중 네 명은 추후에 천식으로 진단되었다. 115건의 입원을 기저질환이 없는 환자군 (n=60)과 기저질환이 있는 환자군 (n=55)으로 나누어 분석하였을 때, 리노바이러스에 의한 중증 하기도 감염을 보이는 비율은 각각 11.7% 와 20.0% 였다 (P=0.219). 결론: 리노바이러스 감염은 중증 하기도감염의 원인이 될 수 있으며, 기저질환자 뿐 아니라 건강한 소아에서도 중증 하기도감염을 일으킬 수 있다.

• International Journal of Quality Innovation
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• 제8권3호
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• pp.46-70
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• 2007

Customer Support Knowledge of Customer Support Organization is one of the important assets of enterprises and "Customer Support Knowledge Management" is also the critical aspect of Business Knowledge Management; however, the attributes of Customer Support Knowledge are complicated, diverse, renewed rapidly and difficult to be managed. Thus, in order to design a successful Customer Support Knowledge Management System, apart from the consideration of "human" and "information technology" aspects, the concerns of attributes and Customer Support Knowledge and industry characteristics should be involved for meeting the requirements of Customer Support Organization and allowing the organization to acquire the competitive advantage of "Differentiation Service". This research used the "Customer Support Knowledge Management System" in a high-tech industry as an example and treated the end users of medical instruments in different types of hospitals in Taiwan which have received the support service of our company in recent six months as the population. The end users were mostly the nursing executives or ultrasonic wave technical personnel in intensive care unit and they had similar educational background and incomes and adopted the medical instruments such as physical supervision system, ultrasonic wave system, heart start or ECG machine produced by our company; the research method was to randomly treat the investigation results of the telephone customers' satisfaction from respective 30 end users in the population three months before and after this system execution as the samples and use hypotheses to validate if the end users' customer satisfaction significantly improved in terms of "Remote Support," "On-site Support," "Service Turn Around time," "Technical Competence" and "Manner" in order to understand the influence and managerial significance of execution of "Customer Support Knowledge Management System" on Customer Support Organization.

• 대한간호학회지
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• 제34권4호
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• pp.625-635
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• 2004

Purpose. The purpose of this study was to explore the experiences of gastric cancer couples in Korea and to generate a substantive theory integrating the experiences of gastric cancer survivors and their spouses as a whole. The specific aims of this study were to explore major problems gastric cancer couples faced and how they resolved these problems, focusing on inter-relational dynamics within the couples and on similarities and differences between the couples. Methods. This was a secondary analysis study using grounded theory techniques. The study used the data of 11 married couples which was collected from in-depth interviews from two primary studies. The unit of analysis was dyads of gastric cancer survivors and their spouses. Results. The basic social psychological process that emerged from the analysis was 'taking charge of their health.' Major categories involved in this process were identified as 1) adjusting to new diets, 2) reinforcing physical strength, 3) seeking information, 4) strengthening Ki, 5) lowering life-expectations, and 6) going their separate ways. These six categories represent major strategies in overcoming critical problems that occurred in day-to-day experiences. In terms of the process, the first five categories characterize the earlier stage of the process of 'taking charge of their health,' while 'going their separate ways' indicates the later stage and also the beginning of their separate ways: 'pursuing spiritual life' for the survivors, and 'preparing for the future' for the spouses. Conclusions. The results of this study will help design family care for the people with gastric cancer by providing in-depth understanding and insight on the lives of gastric cancer couples.

• Journal of Chest Surgery
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• 제33권2호
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• pp.139-145
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• 2000

Background: The purpose of this study is to review the clinical course after the correction of noncomplicated ventricular septal defect and to analyze the morbidity and risk factors of postoperative complications and evaluate residual defect during the follow-up period. Material and Method: From September 1994 to June 1998 24 patients(median age 10 months) underwent surgery under the diagnosis of ventricular septal defect. We made a retrospective review of the clinical records including the operation notes critical care unit records echocardiography results and the follow-up records. Result: There was no early mortality nd late mortality. There was no postoperative complete conduction block. Respiratory complication was the most common complication. The body weight age type of ventricular septal defect associated anomalies and operative procedure were not related to the incidence of complications. residual ventricular septal defects aortic valve regurgitation and tricuspid valve regurgitation were insignificant in postoperative hemodynamics, Conclusions: Correction of the noncomplicated ventricular septal defect was done without mortality and complete heart block. Aggressive preoperative medical treatment and early surgical treatment may decrease postoperative complications. Postoperative residual shunt and tricuspid regurgitation were not problematic during the follow-up

• 간호행정학회지
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• 제6권3호
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• pp.333-345
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• 2000

The health care environment becomes more competitive every day. It has fallen to nurse managers - from vice presidents of patient care to nurse managers and their assistants - to recruit and develop a workforce that successfully meets the needs of both patients and the organization. This means employees who demonstrate advanced critical thinking skills, creative problem solving, and sound decision making skills combined with clinical skills and patient advocacy. The environment which nurse managers create and the way they relate to their workforce, are pivotal to organizational viability. Especially leadership of first -line nurse managers contributes to the success of their organizations. First-line nurse managers are deserved to be one of the most administrative supervisors through the middle stratum in a hospital organization as being a manager in the field service if assessed from the overall aspects of hospital, as being an interim managers in the nursing department as well as being a supreme supervisor in a unit in terms of an organizational structure in the hospital. Similarly, as a compete leader, the first-line nurse managers have not only a professional which is qualified to perform a role of appropriate coordination with medical staff and key personnel but also hold an important key position a being responsible for performing his or her given role. The first-line nurse manager is expected to manage human and fiscal resources in ways not required before. While an identified need for well-prepared first-line nurse manager continues to plague the profession, first-line nurse managers often have difficulty providing the leadership required. The need leadership training to function effectively in their positions. But we hardly find a useful leadership training program for first-line nurse managers, therefore the purpose of this study was to developed the leadership training program for them. The steps of leadership program development were below: 1st step, 2 studies were done before develop a leadership program. One was done to ask to first-line nurse managers what they want to learn through leadership training, the other one was to ask the staff nurses what their opinions are for their first-line nurse managers leadership. 2nd step was searching other leadership programs contents. The results of this study were below: The total amount of hours is 24. Leadership training program contents are : Future of nursing profession (210min), understanding basic factor's of leadership and leadership theories(310 min), self understanding as first- line nurse managers(320 min), basic principle and practice of interpersonal relationship(210 min), assertiveness training, conflict management (180min), and group study(210min). This is challenging time to be a leader, especially in nursing. As nurse managers look toward the new millennium, it seems as through the same struggles are ahead that are behind. So nurse managers need to embrace change with a positive attitude. They need to demonstrate risk taking and support it in their staffs. All these things are possible that after they participate the leadership training program.

• 기본간호학회지
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• 제22권3호
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• pp.249-257
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• 2015

Purpose: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. Methods: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. Results: The mean age was 57.5 (${\pm}15.7$) and 61.4 % were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. Conclusion: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.503-510
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• 2005

If we could predict the necrosis of the flap caused by reperfusion injury, we can minimize the necrosis of the flap by taking appropriate action before necrosis begins. In this study, we examined whether we can predict the survival of flap under reperfusion injury or not, by measuring laser doppler flow meter values. We divided the group into the control and experimental groups corresponding to 6, 8, 9, 10, and 12hours after reperfusion(hours after ligation of auricular central artery). In each group, we examined necrotic change, perfusion unit (PU), serum superoxide dismutase (SOD), glutathione peroxidase, angiography and pathologic findings. No necrosis was observed in the 6 and 8 hours group but 8, 18, 20 hours after ligation, necrosis was observed, Also in each of 9, 10 and 12 hours group (each group consisted of 20 flaps), necrosis were noted. According to the above data, the critical time of necrosis in the auricular skin flap model lies between about 8 to 9 hours. Comparing the PU between the necrosis and non-necrosis groups, the former group showed a mean 39.57 PU increase after 60 min of reperfusion, and the latter group showed a mean increase of 21.21 PU. We can conclude that better flow can dilute oxygen free radical into systemic circulation, and this means less injuries are caused on vessels. Our study implies that if blood flow increase is less than 30 PU, intensive care is needed to save the flap. Additionally, we found significant decrease of serum SOD and glutathione peroxidase in the necrotic group. Therefore, monitoring these serum markers will be helpful in predicting reperfusion injury and supplementing these enzymes could be helpful to save the flap. The laser doppler flow meter is thought to be helpful in clinical circumstances for evaluating the circulation of the flap after the operation. However, more accumulation of clinical studies should be necessary establishing useful clinical data.

• Tuberculosis and Respiratory Diseases
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• 제45권6호
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• pp.1277-1283
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• 1998

연구배경 : 외과적 기관절개술(surgical tracheostomy, ST)은 수술장에서 외과의에 의해 시행되며 중환자의 경우 수술장으로 이동은 위험을 수반하고, 또한 수술장과 외과의가 확보되지 않아 적기에 시행되지 못하는 경우도 흔하다. ST에 대한 대안으로 최근 경피적 확장 기관절개술(percutaneous dilational tracheostomy, PDT)이 구미에서 많이 시행되고 있으나 국내에서는 아직 보편화되지 않아 PDT의 시술 용이성 및 합병증을 ST와 비교해 보고자 하였다. 방 법 : 7일 이상 기계 환기 중이거나 인공 기도 확보가 요구되는 중환자 38명을 대상으로 ST(n=18) 또는 PDT(n=20)를 시행하였다. PDT군에 비해 ST군의 여성 비가 높은 것 외에 양 군 간에 임상적 특성은 차이가 없었다. ST군은 이비인후과 전공의에 의해, PDT군은 내과 전공의 또는 호흡기내과의에 의해 각각 기관절개술이 시행되었다. PDT는 기관지경 보조하에 Ciaglia Percutaneous Tracheostomy Set(Cook Critical Care, Bloomington, USA)를 사용하였다. 양 군에서 시술 의사 미확보 등으로 당일 기관절개술이 이루어지지 못한 건수, 기관절개술 시술 소요 시간 및 기관절개술과 관련된 합병증 발생율 등을 비교하였다. 결 과 : 기관절개술이 결정된 후 당일 시행되지 못한 예는 ST군에서 11예(61%), PDT군에서는 3예(15%)였다(P<0.05). 시술 소요 시간은 ST군 $29.1{\pm}11.6$ 분, PDT군 $15.6{\pm}7.1$ 분이었다(P<0.0001). 기관절개술의 합병증은 ST군에서 T-cannula의 우발적 발관 l예, 피하기종 2예, 소량 출혈 2예, PDT군에서 기관내 관의 조기 발관 1예, 소량 출혈 2예 및 피하기종 1예가 발생하였다(P>0.05). 결 론 : PDT는 중환자에서 수술장 이동이나 외과의 확보의 필요 없이 즉시 시행할 수 있고, 술기 습득이 용이하며 합병증은 ST와 비교하여 차이가 없었다.