• 보건행정학회지
• /
• 제29권4호
• /
• pp.502-512
• /
• 2019

Background: The purpose of this study was to identify role ambiguity of comprehensive nursing care unit nurses. Methods: A concept analysis method by Walker and Avant was used to understand role ambiguity of comprehensive nursing care unit nurses. Results: The antecedents of role ambiguity of nurses at comprehensive nursing units were shortage of nurses, unclear admission criteria, and demands for customized nursing care according to severity. Attributes include ambiguity in role delegation, patient placement ambiguity, and professional ambiguity among nursing staff. The consequences were diminished job satisfaction due to excessive workload, difficulty in resolving role ambiguity due to the lack of work analysis studies, and poor outcome of nursing indicators. Conclusion: Improvement of nationwide awareness for comprehensive nursing care unit is required. Clear division at scope of practice for nursing staff in accordance of each medical institution's characteristics is essential. Nurses at comprehensive nursing care unit should understand nature of role ambiguity that occurs as they work in large groups. Nurses should promote communications between nursing staff and they must have volition to improve status quo. An additional research of comprehensive nursing care on the causes of role ambiguity in the practice of nursing care for ward nurses is needed, and management measures should be sought at the organizational level.

• Annals of Clinical Neurophysiology
• /
• 제5권1호
• /
• pp.27-33
• /
• 2003

Background: Motor unit number estimation (MUNE) can directly assess motor neuron populations in muscle and quantify the degree of physiologic and/or pathologic motor neuron degeneration. A high degree of reproducibility and reliability is required from a good quantitative tool. MUNE, in various ways, is being increasingly applied clinically and statistical MUNE has several advantages over alternative techniques. Nevertheless, the optimal method of applying statistical MUNE to improve reproducibility has not been established. Methods: We performed statistical MUNE by selecting the most compensated compound muscle action potential (CMAP) area as a test area and modified the results obtained by weighted mean surface-recorded motor unit potential (SMUP). Results: MUNE measures in amyotrophic lateral sclerosis (ALS) patients showed better reproducibility with sizeweighted modification. Conclusions: We suggest size-weighted MUNE testing of "neurogenically compensated"CMAP areas present an optimal method for statistical MUNE in ALS patients.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
• /
• 제12권2호
• /
• pp.69-77
• /
• 2006

Angiography means that a check up to know an abnormal condition in all the blood vessels include from the heart, aortae, cerobrovascular and abdonominal artery to hands and feet. Main examples of this are cerebral angiography, abdominal, liver for urinary anomaly, renovascular angiography, and artery and vein in arms and legs. Angiography uses radial rays or angiography equipment for an image output during interventional procedure and compositive diagnosis. The acts which performed in a projection room have changed drastically. In general, it is performed by using equipment which is attached one or two C-arms and the method of inserting catheter in vein after anesthesia. For this reason, some rooms that consist of angiography room units should be planned not only for expensiveness equipment and facilities also to be germ-free. Nowadays, in the angiography unit case, it is placed independently as the central part of many hospitals. It does not belong to the imaging medical department any more as considering raising filming times and the relation between C.C.U.(coronary care unit) and operation unit. This means the acts performed are diversified and well-organized rooms in support of diagnosis are required. However, it is difficult to plan the angiography room unit due to domestic researches and data on this unit are not enough. Therefore, this study aims at bringing up basic issue for architectural planning of the angiography unit in general hospital.

• Journal of Gastric Cancer
• /
• 제17권1호
• /
• pp.63-73
• /
• 2017

Purpose: Data on operable gastric cancer from India is sparse. The purpose of this study was to investigate the clinical details, histopathological demographics, and 5-year overall survival (OS) and disease free survival (DFS) associated with operable, non-metastatic gastric cancer in a dedicated upper gastrointestinal (GI) surgical unit in India. Materials and Methods: Data for patients diagnosed with operable gastric cancer between January 2006 and December 2014 were retrospectively analyzed. Data were collected from electronic hospital records in addition to mail and telephonic interviews when possible. Results: A total of 427 patients were included. The tumor was located in the pyloro-antral region in 263 patients (61.7%). Subtotal gastrectomy was performed in 291 patients and total gastrectomy in 136 patients. Tumor stage classification revealed 43 patients (10.0%) with stage I, 40 patients (9.4%) with stage IIA, 59 patients (13.9%) with stage IIB, 76 patients (17.8%) with stage IIIA, 96 patients (22.5%) with stage IIIB, and 113 patients (26.4%) with stage IIIC disease. Follow-up data were available for 71.6% of the patients with a mean duration of 32.4 months. Five-year DFS and OS were 39% and 59%, respectively. Conclusions: Despite presenting at an advanced stage, the 5-year DFS and OS of patients with operable gastric cancer treated at a dedicated upper GI unit of a tertiary care center in India was good.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제25권3호
• /
• pp.218-227
• /
• 2022

Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

• KIEAE Journal
• /
• 제15권2호
• /
• pp.19-26
• /
• 2015

Purpose: Maximizing human comfort in design of medical environments depends immensely on specialized architects particularly critical care design; the study proposes Evidence-Based Design as an apparent analog to Evidence-Based Medicine. Healthcare facility designs are substantially based on the findings of study in an effort to design environments that augment care by improving patient safety and being therapeutic. On SPSS (Statistical Package for Social Science) t-test is applied to simulate two independent variables of PDR (Pre Design-Research) and POE (Post- Occupancy Evaluation). PDR is conducted on relatively new hospital Hallym University Dongtan Sacred Heart Hospital to analyse visibility from researchers' point of view, here the ICU is arranged in I-Shape. POE is applied on Dongguk University Ilsan Hospital to simulate walking on LogWare where two NS are designed based on L- Shape and Seoul St. Mary's Hospital, The Catholic University of Korea where five NS are functional for ICU Intensive Care Unit, Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), Critical Care Unit (CCU), Korean Oriental Medical Care Unit which are mostly arranged in U-Shape, and walking pattern is recognized to be in a zigzag path. Method: T-Test is applied on two dependent communication variables: walkability and visibility, with confidence interval of 95%. This study systematically analyses the Nurse Station (NS) typo-morphology, and simulates nurse horizontal circulation, by computing round route visits to patient's bed, then estimating minimum round route on LogWare stop sequence software. The visual connectivity is measured on depth map graphs. Hence the aim is to reduce staff stress and fatigue for better patients care by minimizing staff horizontal travel time and to facilitate nurse walk path and support space distribution by increasing effectiveness in delivering care. Result: Applying visibility graph and isovist field on space syntax on I- Shape, L- Shape and U- Shape ICU (SICU, MICU and CCU) configuration, I-shape facilitated 20% more patients in linear view as they stir to rise from their beds from nurse station compared to U-shape. In conclusion, it was proved that U-Shape supply minimum walking and maximum visibility; and L shape provides just visibility as the nurse is at pivot. I shape provides panoramic view from the Nurse Station but very rigorous walking.

• 한국병원경영학회지
• /
• 제9권1호
• /
• pp.66-94
• /
• 2004

The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제23권2호
• /
• pp.174-179
• /
• 2020

We present an 8 years old girl who was diagnosed at 6 months of age of Progressive Familial Intrahepatic Cholestasis type 2. Although liver transplantation (LT) was classically considered curative for these patients, cholestasis recurrence with normal gamma-glutamyl transpeptidase (GGT), mediated by anti-bile salt export pump (BSEP) antibodies after LT (auto-antibody Induced BSEP Deficiency, AIBD) has been recently reported. Our patient underwent LT at 14 months. During her evolution, patient presented three episodes of acute rejection. Seven years after the LT, the patient presented pruritus with cholestasis and elevation of liver enzymes with persistent normal GGT. Liver biopsy showed intrahepatic cholestasis and giant-cell transformation with very low BSEP activity. Auto-antibodies against BSEP were detected therefore an AIBD was diagnosed. She was treated with Rituximab and immunoadsorption with resolution of the AIBD. As a complication of the treatment she developed a pneumocystis infection successfully treated with corticoids, cotrimoxazol and anidulafungin.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
• /
• 제19권3호
• /
• pp.21-28
• /
• 2013

Purpose: General hospital in korea is getting large-scaled, specialized and upgraded. So, nursing unit of race track type has been advanced along with a spatial organization, building equipment and environmental approach. This study is to search the guidelines for renovation of nursing unit with race track type in the case of K university hospital in Daejeon. Methods: 9 cases of recently opened general hospital has been analyzed for spatial and environmental design solution. Questionnaires and interviews about user needs of nursing staff, patient and visitors, have been conducted for a nursing care system and facility of nursing units in K university hospital. Results: The user needs are represented as followings. Center core public zone in each floor plan and center core nursing station and supporting areas in nursing unit are good for an adjacency and separation of spatial organization. Toilet of group patient room is necessary to equip for easy, safe and infective aspects, and so toilet install will decrease the patient number and increase the nursing care service. Hall type of station front is good for visibility and observation. It is appropriate to renovate into south facing group patient room for privacy, enough space for nursing care facility and supporting area, enough width of door to move portable medical equipment, room for medical doctor and practical student, noise absorbing of day room. Implications: Upgrading the nursing care service and facility equipment is necessary to reflect the user needs and cooperate with hospital management.

• 보건행정학회지
• /
• 제15권3호
• /
• pp.94-113
• /
• 2005

The purpose of this study was to determine the level of appropriateness in hospital stays and factors influencing inappropriate hospital stays. The study was conducted at fifteen general care units in a tertiary university hospital. Appropriateness of hospital stay was assessed using Appropriateness Evaluation Protocol by trained head nurses. The total of 447 patient records were reviewed. Among them, 352 patient data were included in the final data set. A unit of observation was patient day. A rate of appropriate hospital stay was calculated per patient as a unit of analysis. Multiple regression analysis was performed to determine the factors affecting inappropriate hospital stay. The eighty-three percent (2030/2651) of hospital stays were evaluated as appropriate. There were significant differences in appropriateness of hospital stay according to patient's age, type of health insurance, medical specialty, and length of stay(p<0.05). In the multiple regression analysis, medical speciality was the most significant factor to predict the inappropriate hospital stay. The study showed a substantial proportion of hospital stay was found to inappropriate. Level of appropriateness was significantly different from medical specialty. Interdepartmental approach should be required to coordinate and improve appropriate resource utilization.