• Journal of Trauma and Injury
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• 제36권4호
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• pp.362-368
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• 2023

Purpose: Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods: A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results: Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5-18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3-23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3-48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions: Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권5호
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• pp.357-367
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• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.113-118
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• 2010

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was $5.2{\pm}7.1$ hours and the average length of the ED stay was $9.0{\pm}11.5$ hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was $2.1{\pm}1.5$ hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.170-177
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• 2014

Purpose: The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center. Methods: The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013. Results: The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of ${\geq}16$. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital. Conclusion: A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.

• Journal of Chest Surgery
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• 제51권4호
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• pp.247-253
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• 2018

Background: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1-2 hours after surgery, in patients with congenital cardiac disease. Methods: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retrospectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs. Results: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS ($16.3{\pm}28.6$ [UFT] vs. $28.0{\pm}16.8$ [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs ($182.6{\pm}3.5$ [UFT] vs. $187.1{\pm}55.6$ [non-UFT] ${\times}100,000$ Korean won [KRW], p=0.639) and hospital stay expenses ($48.3{\pm}13.6$ [UFT] vs. $54.8{\pm}29.0$ [non-UFT] ${\times}100,000KRW$, p=0.164) did not significantly differ between the groups. Conclusion: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.

• 한국산학기술학회논문지
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• 제18권4호
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• pp.459-468
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• 2017

본 연구는 간호대학생의 다문화 인식과 문화적 민감성이 문화 간 의사소통에 미치는 영향을 파악하고자 실시하였다. 대상자는 1개 광역시와 2개 지역도시에 소재한 3개 대학교의 간호학과에 재학 중이며, 임상실습을 1학기 이상 이수한 간호대학생 3, 4학년으로 총 353명이었다. 자료는 자가보고식 질문지로 수집하였으며, 자료 분석은 t-검정, 분산분석, Pearson의 상관계수 단순회귀분석과 다중회귀분석을 이용하여 분석하였다. 대상자의 문화 간 의사소통능력은 다문화 교육경험 유무, 외국인 친구 유무, 영어능력, 해외 체류경험 유무, 해외 체류기간에 따라 통계적으로 유의한 차이를 나타냈다. 또한 대상자의 문화간 의사소통능력은 다문화 인식과 문화적 민감성과 유의한 상관관계를 나타냈다. 다중회귀분석결과 대상자의 문화 간 의사소통능력에 영향을 미치는 요인은 다문화 인식, 다문화 교육경험, 영어능력이었고 설명력은 41.3%였다. 또한 단순회귀분석결과 해외 체류경험이 있는 대상자의 해외 체류기간의 설명력은 2.5%이었다. 따라서 간호대학생의 의사소통능력을 향상시키기 위해서는 다문화 인식을 증가시킬 수 있는 방안과 해외 체험을 고려한 다문화 교육과 언어능력의 증진방안을 개발하는 것이 필요하다.

• 한국작물학회지
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• 제42권4호
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• pp.466-472
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• 1997

Vegetable perilla, "Ipdlkkae 1"(Perilla frutescens var japonica Hara), was tested about the flowering and maturing responce in summer and winter. In summer season, it was researched about those responses according to the change of seeding date from May 15th to Oct. 15th at one month interval in the field. "Ipdlkkae 1" flowered Oct. 2nd under the day length of eleven hours and fourty-one minutes, compared with Sep. 6th (day length of twelve hours and fourty-three minutes) of "Yepsildlggae". And those responses showed that vegetable perilla was have to seeded before July 15th for two reason. The first is a unique response of perilla to day length. If perilla stay under short-day condition for some days, perilla will flower after four weeks. The second is a weather, especially frost and cold. In the test of latest seeding at Oct. 15th, the plants flowered more late than normal flowering period and they were not able to mature for frost of early winter. And this result showed that any other species, which has the characteristic of later flowering than that of "Ipdlkkae 1", could not able to mature in the field. In winter time, this species was tested about the same responses according to the change of short-day treatments. In the case of the test from May 1st (above fourteen hours day length), even if the test plants were stayed under short-day condition for more than 10 days, they were not able to mature, but flowerd. From the test of Apr. 15th, day length of thirteen hours, the plants were showed variable reaction to the short-day treatment. In this test, 11days for short-day treatment was a basic day to decide whether flowering was delayed or not. In the test from Apr. 1st, perilla seeds were able to harvest at least 5 days short-day treatment. In the final test from Mar. 15th, it had no need to take short-day treatment for harvesting of normal seeds, because the day length of that are twelve hours, which is an enough time to induce flowering and maturing, previously reported.

• 한방안이비인후피부과학회지
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• 제32권1호
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• pp.16-31
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• 2019

Objective : The purpose of this study is to analyze the charcateristics of inpatients in Ophthalmology, Otolaryngology & Dermatology Clinic by gender, age, season, and department of medical care after hospitalization from March, 2012 to February, 2018. Method : From March 1, 2012 to February 28, 2018, patients who were admitted to the Ophthalmology, Otolaryngology & Dermatology Clinic of Korean Medical Hospital were classified by gender, age, department, and season, and their relationship, hospitalization period, number of outpatient visits Differences were analyzed objectively using various statistical methods using IBM SPSS 18.0. Results : 1. The number of inpatients was 432, including duplication. Of these, 317 were female and 115 were male. The number of female patients was 2.8 times higher. 2. The average age of the inpatients was 43.9 years and the number of middle-aged 40-50 patients was 48.6%. 3. The number of inpatients in the departments was in the order of dermatology, otology, laryngology, rhinology, and ophthalmology. The most hospitalized diseases were eczema in the dermatology department, sudden hearing loss in the otology department, tonsillitis/peritonsillar abscess, rhinitis in the rhinology department, and dry eye syndrome in ophthalmology. 1) The effect of gender on the difference in the number of inpatients by subdivision was statistically significant. 2) The effect of age on the difference in the number of inpatients by subdivision was statistically significant. 3) The effect of seasons on the difference in the number of inpatients was not statistically significant. 4. The number of inpatients by season was in the order of winter, spring, summer, autumn, and the number of inpatients decreased significantly in autumn. 1) The effect of gender on the difference in the number of hospitalized patients by season was not statistically significant. 2) The effect of age on the difference in the number of hospitalized patients by season was not statistically significant. 5. The average length of hospital stay for inpatients was 10.7 days. 1) The effect of gender on length of hospital stay was not statistically significant. 2) The effect of age on hospital stay was not statistically significant. 3) The effect of the subdivision on hospital stay was statistically significant. 4) The effect of the season on hospital stay was not statistically significant. Conclusion : As a result of this study, the most distinctive feature of the present study was the high rate of inpatients with otic disease like idiopathic hearing loss and Meniere 's syndrome and the high rate of female patients. This may be related to the increased prevalence of the disease and the severity of the disease. In addition, the high rate of female patients suggests that women are more likely to be affected by illnesses, as well as to have more medical use and severe symptoms requiring hospitalization. In the future, it would be better to provide various treatment plans and policies for patients with otic diseases and female patients. Also it would be good if studies on these fields are made in the future.

• 기본간호학회지
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• 제22권2호
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• pp.149-157
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• 2015

Purpose: The objectives of this study were to assess the influence of family presence in the PACU (Post Anesthesia Care Unit) on anxiety, emergency delirium, pain and length of stay in the recovery room for elderly patients undergoing surgery for which general anesthesia has been used. Methods: The study was a nonequivalent control group pre-post test design. Eighty elderly patients over 65 years who underwent surgery under general anesthesia were recruited. Forty were assigned to the experiment group, patients together with a family member and 40 to the control group, with no family member present. Patients' anxiety, emergency delirium, pain and length of time in the recovery room were evaluated at 10 minute and 30 minute after arrival in the PACU. Results: Patients with family members in the PACU showed significantly decreased levels of anxiety at 10 and 30 minutes and significantly lower levels of emergency delirium and pain at 30 minutes. However there was no difference between the 2 groups for length of time in the recovery room. Conclusion: The results of this study indicate that being with family members in the PACU after surgery under general anesthesia is effective for reducing elderly patients' anxiety, delirium and pain during time in the recovery room.

• Journal of Community Nutrition
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• 제8권3호
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• pp.147-152
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• 2006

This study was conducted to define dietary patterns among 227 Korean American adults and 151 teenagers living in California using frequency of intake of major food groups and to examine associations of dietary patterns with selected demographic and acculturation variables. Three dietary patterns, 'healthful', 'Korean', and 'western', were identified using factor analysis. For both groups, 'healthful' pattern was characterized by high loading on milk/milk products, fruit, fruit juice, and bean/bean products. 'Korean' pattern had high loading on rice and kimchi. 'Western' pattern was characterized by high loading on meat/meat products, soda, and noodle/pasta. Among Korean American adults, women tended to have higher scores of 'healthful' pattern but lower scores of 'western' pattern, while there was no association of 'Korean' pattern with gender. The older adults were likely to have higher 'Korean' pattern score. Length of stay in the US and English levels were negatively associated with 'Korean' pattern. Korean American female adolescents had lower 'western' pattern scores than did male adolescents. Age was inversely associated with 'healthful' pattern in adolescents. The adolescents who had felt more proud of being a Korean descendant had higher scores on 'Korean' dietary pattern. The study findings support that dietary patterns are associated with acculturation variables such as length of residence in the US, English fluency, and particularly pride in ethnicity for adolescents. Further studies are needed to understand associations of dietary patterns and acculturation with health risk of ethnic groups.