• Journal of Korean Critical Care Nursing
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• v.14 no.1
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• pp.28-39
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• 2021

Purpose : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. Methods : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematological-related factors. Results : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

• Journal of The Korea Institute of Healthcare Architecture
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• v.28 no.1
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• pp.23-30
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• 2022

Purpose: Health examination centers of regional public hospitals are essential facilities for strengthening preventive medical services in local communities. This study is to organize architectural planning data related to function, space, and area composition of health examination center by the size of the regional public hospitals. Methods: The literature review on the function and spatial composition of the health examination center and the drawings of the regional public hospitals were analyzed. Results: The result of this study can be summarized into several points. 1) The function of the health examination center consists of a diagnostic area, patient area, and staff area based on general examination and comprehensive examination. 2) The type of spatial composition of the 300-bed public hospital examination center is a spatial linkage type with examination rooms of the other departments where general examination and comprehensive examination are undifferentiated. 3) The examination center of public hospitals with 500 beds or more is composed of an independent space-separated type with self-installed examination rooms, and general examination and comprehensive examination are divided. 4) The examination center of public hospitals with 300 beds around, the diagnostic area occupies most of the total area, around 80%, but in public hospitals with 500 beds or more, the proportion of diagnostic area drops to 50-60%, and patient area increases to 30-40%. Implications: The examination center planning of public hospitals requires an architectural planning approach to the function and spatial composition according to the size of the hospital.

• Journal of the Health Care and Life Science
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• v.10 no.2
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• pp.275-283
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• 2022

This study aims to identify the factors affecting medical use in Seoul metropolitan region (SMR) by patients with a congenital malformation in the Jeollabuk-do region and suggest methods to improve equity in regional healthcare utilization. The study conducted the chi-square test and logistic regression analysis using Korean National Hospital's in-depth injury survey data from 2016 to 2020. The results are as follows. First, medical utilization in SMR was high in the age group of 19-44. Second, the bigger the bed size, the higher the medical utilization in SMR. Third, in the case of the principal diagnosis, the medical utilization in SMR was high in the patients with congenital Anomaly of the Tracheobronchial System. Fourth, the medical utilization in SMR was high in the group of inpatients with higher severity after surgery. Based on these results, government-run healthcare policies and planning should be established to achieve regional equity of medical utilization.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.50-63
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• 1997

Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

• Radiation Oncology Journal
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• v.24 no.3
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• pp.171-178
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• 2006

[ $\underline{Purpose}$ ]: To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. $\underline{Materials\;and\;Methods}$: From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range $34{\sim}74$) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follows: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of $45{\sim}50.4\;Gy$ (median: 50.4 Gy) over $5{\sim}5.5$ weeks. Ir-192 HDR intracavitary brachytherapy (ICBT) was given after a total dose of 41.4 Gy. HDR-ICBT was performed twice a week, with a fraction point A dose of 4 Gy and median dose to point A was 28 Gy (range: $16{\sim}32\;Gy$) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT+ICBT) was $88\;Gy_{10}$ (range: $77{\sim}94\;Gy_{10}$). The median cumulative BED at ICRU 38 reference point (EBRT+ICBT) was $131\;Gy_3$ (range: $122{\sim}140\;Gy_3$) at point A, $109\;Gy_3$ (range: $88{\sim}125\;Gy_3$) at the rectum and $111\;Gy_3$ (range: $91{\sim}123\;Gy_3$) at the urinary bladder. Cisplatin ($60\;mg/m^2$) and 5-FU ($1,000\;mg/m^2$) was administered intravenously at 3 weeks interval from the first day of radiation for median 5 (range: $2{\sim}6$) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range: $8{\sim}50$ months). $\underline{: The complete response rate after concurrent chemoradiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic complications (RTOG grade 1-2) occurred in 3 patients (10%) and one patient had suffered from severe leukopenia (RTOG grade 4) during concurrent treatment. Acute minor enterocolitis (RTOG grade 1-2) occurred in 11 patients (37%) and one patient (3%) was suffered from colon perforation during radiation therapy. Late colitis of RTOG grade 1 occurred in 5 patients (15%). Acute cystitis of RTOG grade 1 occurred in 12 patients (40%) and late cystitis of RTOG grade 2 occurred in one patient (3%). No treatment related death was seen. $\underline{Conclusion}$: The results of this study suggest that the concurrent chemoradiation therapy with HDR brachytherapy could be accepted as an effective and safe treatment for cervical cancer.

• Fire Science and Engineering
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• v.22 no.3
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• pp.293-299
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• 2008

From January, 2004 to July, 2007, 97 patients were diagnosed with Acute coronary syndrome(ACS) in Emergency Medical Center in Jecheon City in Korea. Among 97 patients, the prehospital assessment rates were as follows ; blood pressure check(27.80%, pulse rate check(33.0%), respiration check(23.7%). In hospital emergency care, oxygen supply was 52.6%, absolute bed rest was 12.4%, electrocardiogram(EKG) check was 4.1%, and nitroglycerin and intravenous fluid therapy was 0%. Therefore, ACS patients have not received sufficient prehospital cares till now. In order to improve the proficiency of the first aid emergency medical technicians(EMTs), it is necessary to provide the continuing On-the-job training(OJT) programs for prehospital emergency care.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.344-349
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• 2015

Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.

• Journal of Acupuncture Research
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• v.21 no.4
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• pp.217-223
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• 2004

Objective: The aim of this research was to investigate the depressive effect of Sa-am Acupuncture(膀胱正格) in stroke patients. Methods: We measured the blood pressure of the patients who were admitted in the Oriental Medical hospital of Dae-Jeon University from June. 2003. to September. 2003. If systolic blood pressure was over 160mmHg or diastolic blood pressure was over 100 mmHg, 40 patients were treated by Sa-am Acupuncture(膀胱正格) and the other 20 patients were taken a rest in bed. Then 30 minutes and 60 minutes later, systolic, diastolic blood pressure were measured. Results: After 30 minute treatment, Sa-am Acupuncture(膀胱正格) significantly depressed the systolic and diastolic blood pressure, but bedrest can't do it. After 60 minute treatment, both Sa-am Acupuncture(膀胱正格) and bedrest significantly depressed the systolic and diastolic bood pressure. Conclusion: These results suggest that Sa-am Acupuncture(膀胱正格) is effective in depressing the systolic and diastolic blood pressure.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.113-116
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• 1997

Sensorineural hearing loss(SNHL) is defined as a sudden hearing impairment which was develope over a period of hours to days. The definitive cause of SNHL is unknown in most cases. Disturbance of the blood flow of the inner ear is a main causal hypotheses. Most symptomatic treatment is focusing to improving the blood flow of the inner ear. At our hospital, most patients are recommended to bed rest, vasodilators(nicotinic acid, antihistamines) and stellate ganglion block(SGB) for two weeks. We experienced two cases of recurrence immediately after recovery from SNHL. They discontinued SGB after initial recovery. due to associated pain with operation and or psychologic stress. One patient resumed SGB and medication treatment, but the second who gave up treatment was not recovered. Therefore, we recommend to continuance of treatment of stellate ganglion blocks to improve recovery rate of SNHL and avoid further trauma and psychologic stress during the recovery period of SNHL.

• Journal of Chest Surgery
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• v.25 no.9
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• pp.955-961
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• 1992

In this study, 237 cases of spontaneous pneumothorax experienced at the department of Thoracic and Cardiovascular Surgery, Kosin Medical College during from January 1986 to December 1990 were analysed retrospectively. 1. The ratio of male to female was 4.6: 1, predominent in male. The incidence of age group was highest as 36% between 21 and 40 years old. 2. The associated diseases of pneumothorax were 27 cases, in which pyothorax were 8 cases, and hydrothorax were 19 cases. 3. The site of pneumothorax was as follows: right side was 53%, left side was 45%, and both side was 2%, so right side was slight high. 4. The empolyed managements were as follows: bed rest with oxygen inhalation in 13 cases, closed thoracostomy in 155 cases, open thoracotomy in 69 cases. 5. The operative procedures of thoracotomy were as follows; simple pleurodesis in 2 cases, blebectomy & bullectomy in 38 cases, parietal pleurecttnny in 4 cases, segmentectomy in 12 cases, lobectomy in 9 cases. 6. The indication of open thoracotomy were as follows, recurrent history in 35 cases, contralateral pneumothorax history in 2 cases, continuous air leakage in 24 cases, bilateral pneumothorax in 2 cases, and visible blebs & bullaes on the chest X-ray in 6 cases. 7. The hospital duration after management was as follow, open thoracotomy in 13.2 days, closed thoracostomy in 22.4 days. The recurrent pneumothorax after closed thoracostomy was 25 cases, about 15%.