• Journal of Korean Academy of Nursing Administration
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• v.4 no.2
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• pp.351-361
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• 1998

The purpose of this study was to explore whether there is a point within the range of physical impairment after which the cost of home care exceeds the cost of nursing home care among the elderly who require long-term care. The provision of long-term care for the elderly is a major health policy issue, in part due to the aging of the American population and dramatic increase in health care costs. The framework for this study was guided by Pollak's(1973)model of costs of alternative care settings for the elderly. This study used a retrospective, descriptive correlational design. Physical impairment was measured by the modified Index of Activities of Daily Living(Katz et al. 1963). Cost of care was measured by the average cost per patient per day. The sample for this study included 67 patients receiving long-term care at home from the Long-term Home Health Care Programs (LTHHCPs) and 67 patients receiving long-term care in nursing homes. Data were collected on patient characteristics. including activities of daily living and cognitive impairment. and on the number of physician visits. emergency room visits. and hospitalization from the patient records. For each patient. Medicaid cost data for home care services/or nursing home services were collected from the financial department of each home care agency or nursing home. The living costs and informal care costs were estimated for home care patients. The results indicated that the home care sample and the nursing home sample were similar in terms of gender. ethnic background. and marital status. The elderly patients in the home care sample were: however. younger and less physically impaired than those in the nursing home sample. The hypotheses of this study were supported: For elderly persons with physical impairment scores below 12(possible range of 0 to 14), cost of care was lower in home care than in the nursing home care setting. However, for elderly persons with physical impairment scores above 12. the cost of care was higher in home care than in the nursing home care setting. Thus. in this sample for elderly patients with extreme physical impairment, the cost of home care exceeded the cost of nursing home care.

• Journal of the Korean Society of School Health
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• v.9 no.2
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• pp.197-204
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• 1996

Based generally on the socio-economic status of the surrounding areas of Seoul daily health records from 6 randomly sampled primary schools were analyzed to evaluate the health problems of school children in 1992. Diseases were classified into 11 categories according to ICD-9. The mean number of visits to health care rooms during school per student was 0.95 during 215 school days from February to December in 1992 and the mean number of daily visits was 10.12. Female students visited health rooms more frequently than male students. The total spell base incidence rate was 947.3 per 1,000 students in a year; the incident rate from digestive diseases was 342.1; from injuries it was 333.6; and from respiratory diseases, it was 243.9. 85% of all diseases were from trauma, gastric symtoms, and common colds. The most frequent diseases for male students resulted from trauma and for female students from gastric symtoms. The average incident rate was highest in the Kangnam area, and the lowest in the Kangbuk area and this result is statistically significant. The incident rates of 5th and 6th graders were significantly higher than the rest. Emergency cases refered to hospital were 140(1.07%), and drugs used for treatment consisted of digestives, drugs for common colds, analgesics and antipyretics, eye drops, and external ointments for trauma. In conclusion the above results suggest that the school health service program and health education program should be based on the health status of school children.

• Restorative Dentistry and Endodontics
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• v.48 no.3
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• pp.31.1-31.11
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• 2023

Objectives: This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods: Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results: Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82-2.15; p = 0.249). Conclusions: Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.

• Journal of agricultural medicine and community health
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• v.45 no.3
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• pp.154-161
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• 2020

Purpose: The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. Methods: A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. Results: Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). Conclusion: Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

• Tuberculosis and Respiratory Diseases
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• v.77 no.5
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• pp.209-214
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• 2014

Background: Bronchiectasis and asthma are different in many respects, but some patients have both conditions. Studies assessing the effect of bronchiectasis on asthma exacerbation are rare. The aim of this study is to investigate the effect of bronchiectasis on asthma exacerbation. Methods: We enrolled 2,270 asthma patients who were followed up in our hospital. Fifty patients had bronchiectasis and asthma. We selected fifty age- and sex-matched controls from the 2,220 asthma patients without bronchiectasis, and assessed asthma exacerbation and its severity based on the annual incidence of total asthma exacerbation, annual prevalence of steroid use, and frequency of emergency room visits and hospitalizations due to asthma exacerbation in each group. Results: Fifty patients (2.2%) had bronchiectasis and asthma. The annual incidence of asthma exacerbation was higher in patients with asthma and bronchiectasis than in patients with asthma alone ($1.08{\pm}1.68$ vs. $0.35{\pm}0.42$, p=0.004). The annual prevalence of steroid use ($0.9{\pm}1.54$ vs. $0.26{\pm}0.36$, p=0.006) and the frequency of emergency room visits ($0.46{\pm}0.84$ vs. $0.02{\pm}0.13$, p=0.001) due to asthma exacerbation were also higher in patients with asthma and bronchiectasis than in patients with asthma alone. Conclusion: Bronchiectasis is associated with difficult asthma control.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• The Korean Journal of Emergency Medical Services
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• v.15 no.1
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• pp.47-63
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• 2011

Purpose : This research is to examine the work and job satisfaction of paramedics in the emergency room of university hospitals. This research is done to provide basic data needed for establishing work realms of paramedics in hospitals and to enhance their degree of satisfaction. Methods : Research questionnaire survey was conducted on 141 paramedics working in the emergency room of 32 university hospitals from August 24, 2010 to September 30, 2010 through direct visits and telephone interviews or email to explain the purpose of this research and assurance of confidentiality of responses on the questionnaires. As the tool for the degree of job satisfaction, 'The Index of Work Satisfaction' developed by Slavitt, et al(1978) and revised and supplemented by Soon-shim Kim and Hye-ran Kwon(2002) was used. The collected data were analyzed by evaluating frequency, percentage, mean, standard deviation, t-test and ANOVA, Cronbach's $\alpha$ by using SPSS WIN 18.0 program. Results : 1. Investigating the work and role of paramedics in the emergency room of university hospitals, electrocardiogram(EKG) was found to be highest with $\alpha$ was widely used with the rate of patient evaluation and test area. In the medical treatment for patients area, cardiopulmonary resuscitation(CPR) with 95%(134 persons) and ventilation assistance through ambu bagging(BVM) with 95%(134 persons) were found to be high. $\alpha$ were performed. In the role within the hospital and other areas, a member of CPR team in the hospital accounted for 78%(110 persons). 2. In the measurements of the job satisfaction of paramedics working at university hospitals, the total mean score was 2.91. The mean score in each question area indicated: section on job 3.48, autonomy 3.05, interaction 3.01, organizational demand 2.85, working conditions 2.67, salaries 2.40. This result obviously demonstrates the work of paramedics itself was most satisfied but the salaries were most dissatisfied. 3. In the measurements of the job satisfaction of paramedics working at university hospitals, job satisfaction based on the general characteristics showed significant difference in age (F=6.547, p=.002), gender (F=4.436, p=.000) marital status (F=-3.270, p= .001), religion (F=2.041, p= .043), motive for application (F=3.603, p= .015), and salary (F=6.658, p= .000). 대학병원 응급실 내 1급 응급구조사의 업무와 직무만족도 The Journal of the Korean Society of Emergency Medical Technology Vol. 15 (1) 63 4. In the measurements of the job satisfaction of paramedics working at university hospitals, job satisfaction based on the working environmental characteristics showed significant difference in total number of paramedics (F=3.779, p= .012), form of employment (F=5.601, p= .001), existence or non-existence of intention to change jobs (F=-4.037, p= .000). Conclusion : The work of paramedics in the emergency room of university hospitals consists of lots of treatment processes after specialized diagnosis and performance of professionally subdivided works. However, current legislation does not reflect such circumstances to which paramedics are exposed; thus, it should be considered for further revision and modification. The degree of job satisfaction of paramedics in the emergency room of university hospitals was high but low in salaries and working conditions were the weak points. The measures to enhance their degree of job satisfaction should be taken though improvement of labor conditions such as consideration of the rate of increase in salaries, compensation for overtime work, providing rest areas, improvement of current employment system, and conversion of temporary employees into regular employees.

• Tuberculosis and Respiratory Diseases
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• v.70 no.5
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• pp.416-422
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• 2011

Background: Inhaled corticosteroids (ICSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting. Methods: We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years. Results: The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively. Conclusion: The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.

• Journal of Korean Clinical Nursing Research
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• v.23 no.3
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• pp.376-387
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• 2017

Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

• Journal of Trauma and Injury
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• v.33 no.4
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• pp.248-255
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• 2020

Purpose: Trauma incidence and hospitalizations of trauma patients are generally believed to be affected by season and weather. The objective of this study was to explore possible associations of the hospitalization rate of trauma patients with weather and time variables at a single regional trauma center in South Korea. Methods: Trauma hospitalization data were obtained from a regional trauma center in South Korea from January 1, 2017 to December 31, 2019. In total, from 6,788 patients with trauma, data of 3,667 patients were analyzed, excluding those from outside the city where the trauma center was located. Hourly weather service data were obtained from the Korea Meteorological Administration. Results: The hospitalization rate showed positive correlations with temperature (r=0.635) and wind speed (r=0.501), but a negative correlation with humidity (r=-0.620). It showed no significant correlation (r=0.036) with precipitation. The hospitalization rate also showed significant correlations with time of day (p=0.033) and month (p=0.22). Conclusions: Weather and time affected the number of hospitalizations at a trauma center. The findings of this study could be used to determine care delivery, staffing, and resource allocation plans at trauma centers and emergency departments.