• 대한영상의학회지
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• 제84권3호
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• pp.586-595
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• 2023

제대 정맥 카테터는 미숙아 혹은 위중한 만삭아에게 중심 정맥을 통한 총 비경구 영양 및 약물을 제공하기 위해 흔하게 사용된다. 하지만 제대 정맥 사용은 감염, 문맥 혈전증 및 간 조직 손상을 포함하는 합병증을 유발할 수 있다. 잘못 거치된 제대 정맥 카테터를 통하여 부주의하게 고장성 액체를 투여 시 액체 저류를 동반한 간실질 손상을 유발할 수 있으며, 영상검사에서 이러한 액체 저류는 종양성 병변으로 오인될 수 있다. 초음파와 엑스선 검사는 이러한 제대 정맥 카테터 관련 합병증을 감지하는 데 필수적인 역할을 한다. 이 논문에서는 신생아의 제대 정맥 카테터 관련 간 합병증의 영상 소견에 대해 기술할 것이다.

• Hip & pelvis
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• 제36권1호
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• pp.47-54
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• 2024

Purpose: Venous thromboembolism (VTE) is a major complication for hip fracture patients, and may exist preoperatively. This study aimed to examine the prevalence of VTE after immediate screening in hip fracture patients. Materials and Methods: Hip fracture patients with an elevated level of D-dimer underwent screening for VTE using computed tomography (CT) angiography. Anticoagulation treatments were administered preoperatively to patients diagnosed with VTE, followed by administration of additional anticoagulation postoperatively. Medical records were reviewed to identify risk factors for preoperative VTE and determine the prognosis of the patients. Results: Among 524 hip fracture patients, 66 patients (12.6%) were diagnosed with VTE, including 42 patients with deep vein thrombosis (DVT), 17 patients with pulmonary thromboembolism (PTE), and 7 patients with both DVT and PTE. Of the patients with VTE, 68.2% were diagnosed within 24 hours of injury, and 33.3% of these patients had PTE. VTE patients showed a tendency toward being overweight (P<0.01) and not on anticoagulant medication (P=0.02) compared to patients without VTE. The risk of VTE was higher for femur shaft fractures (odds ratio [OR] 4.83, 95% confidence interval [CI] 2.18-10.69) and overweight patients (OR 2.12, 95% CI 1.17-3.85), and lower for patients who were previously on anticoagulants (OR 0.36, 95% CI 0.18-0.74). Patients with preoperatively diagnosed VTE were asymptomatic before and after surgery. Conclusion: Clinicians should be aware that VTE may be present within 24 hours of injury, and screening for VTE or prophylactic measures should be considered for high-risk patients.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.109-124
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• 2008

연구배경: COPD는 전세계적으로 유병률, 이환율 및 사망률이 급격히 증가하는 질환으로 환자의 삶의 질을 호전 시키고 사회, 경제적인 질병부담을 줄이기 위해 경증 COPD 환자를 조기에 진단하여 적절히 치료하는데 일차진료의사의 역할이 중요하다. 근거중심을 바탕으로 개발된 GOLD와 같은 COPD 진료지침은 이 목적을 위해 유용하나 우리나라의 진료실태가 반영되지 않은 문제점이 있다. 근거중심을 바탕으로 우리나라 진료실정이 반영된 진료지침을 개발하기 위해 우리나라 일차진료의사들의 진료 실태를 조사하여 보고한다. 방법: 진료실태는 웹을 기반으로 COPD의 진단, 치료, 위험인자, 교육, 진료지침에 대한 25개의 설문을 포함 제작하였고 총 217명의 일차진료의사가 설문조사에 동의하고 참여하였다. 참여자의 의사경력은 평균 17.7년이며 76.5%가 내과를 전공하였고 지역적으로는 63.6%가 서울, 경기지역에서 진료를 하고 있었다. 결과: 비교적 높은 비율(61.8%)로 폐기능검사기를 보유하고 있지만 실제 진료 시 활용도는 낮은(35.8%) 편임을 알 수 있었다. 안정 시, 급성악화 시 COPD의 치료에서 경구제제의 처방빈도가 흡입제제에 비해서 모두 높았다. COPD의 주요 위험인자인 흡연에 대해서는 흡연여부 확인율, 금연권유율 등이 90% 이상으로 높았으나 금연을 위한 처방에서 금연 성공률이 높은 니코친대체제와 부프로피온의 병용 처방률이 4.3%로 낮았다. COPD 진료지침에 대한 인지도는 56.7%였고 그대로 따르는 경우는 7.3%로 국내 진료실태를 반영한 진료지침의 개발이 요구되며 진료지침의 보급과 확산을 위해서는 진료지침책자를 포함한 인쇄자료의 보급이 효과적임을 알 수 있었다. 결론: 우리나라 일차진료의사들의 COPD 진료실태는 진단에서 폐기능검사의 보유율에 비해 사용률이 낮고 치료에서 흡입제에 비해 경구제제의 처방을 선호하는 경향을 보였다. GOLD 진료지침에 대한 인지도는 높으나 그대로 따르는 일차진료의사는 적으므로 이번 진료실태조사 결과를 바탕으로 근거중심이지만 국내실정을 반영한 COPD 진료지침의 개발 및 보급이 필요하리라 생각된다.

• 간호행정학회지
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• 제7권2호
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• pp.265-284
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• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• 간호행정학회지
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• 제1권1호
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• pp.132-146
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• 1995

Even though Korean medical law stipulates that number of patients attended by a nurse is 2.5 for hospitalization and 30 for ambulatory care, the number of patients cared by a nurse per day is much greater than the standard prescribed by the medical law. Current productivity of nurses is not desirable unless the quality of care is considered. And nursing manpower staffing based on neither current nurses' productivity nor standard of medical law cannot respond properly to dynamic situation of the medical services. Under this background, the necessity of more efficient management of nursing manpower occupying 1/3 of total hospital workers has been recognized by many nursing administrators. Many nursing researchers have studied to foretell the nursing manpower objectively on the basis of measured nursing workload according to patient classification as well. Most of These researches, however, have been conducted in the tertiary hospitals, so it is imperative to conduct other researches to predict necessary nursing manpower in the secondary and the primary hospitals. The study was performed to measure nursing workload and predict pertinent nursing manpower to a secondary hospital with 400beds. Nursing workload was surveyed using measuring tool for direct and indirect care hours in a surgical unit and a medical unit. Survey was conducted from Sep.10 to Sep.16 and from Oct.5 to Oct.11, 1994 respectively by two skilled nurses, Subjects were patients, patients' family members and nursing personnels. Results are follows : 1. Patient classification distributed as 22% of class I (mildly ill patient), 57% of class II (moderately ill patient), and 21% of class III (acutely ill patient) in the medical nursing unit, while 23% of class I, 29% of class II, 12% of class III, and 36% of classIV (critically ill patient) in the surgical nursing unit. There was no difference of inpatient number between weekday and weekend. Bed circulation rate was 89% in both units and average patients number per day was 37.4 (total 42beds) in the medical nursing unit, 32.9 (total 37beds) in the medical nursing unit. 2. Direct care hours per day measured as 2.8hrs for class I, 3.3hrs for class II, and 3.5hrs for class III in the medical nursing unit, while 3.1hrs for class I, 3hrs for class II, 2.7hrs for class III, and 2.2hrs for classIV in the surgical nursing unit. Meanwhile, hours for nursing assistant activities per patient by patients' family members were 11mins and 200mins respectively. Direct care hour rate by shift was day 36%, evening 25%, and night 39% in the medical nursing unit, while 40%, 29%, and and 31% respectively in the surgical nursing unit. 3. Measurement and observation activity held 44.2% of direct care activities of nurses and medication 36.7%, communication 11.7%, exercise 1.8%, treatment 1.3%, hygiene 1.3%, elimination and irrigation 1.1%, suction 1%, nutrition 0.5%, thermotherapy 0.3%, oxygen therapy 0.1% in order. 4. Indirect care hours per day were 294.2mins in the medical nursing unit, and 273.9mins in the surgical nursing unit. By shift, evening was the highest in both units. Indirect care hours for each patient were 44.5mins in the medical nursing unit and 46mins in the surgical nursing unit. 5. checking activities including doctor's order, medication, and delivering patients to the next shift occupied 39.7% of indirect care activities, and preparation 26%, recording 23.8%, communication and conference 6.7%, managing equipments 2.1%, messenger activity 1.7% in order. 6. On the ground of these results, nursing manpower needed in a secondary hospital was estimated ; 27 nursing personnels for the medical nursing unit of 37beds, and 20 nursing personnels for the surgical nursing unit of 33beds.

• The Korean Journal of Physiology
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• 제8권2호
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• pp.45-48
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• 1974

It was planned to investigate, in mice that received ACTH, the influence of Panax Ginseng upon DNA synthesis of submandibular gland by observing incorporation of $[^3H]$ thymidine into the tissue cells. Thirty male mice $(body\;weight:\;18{\sim}20\;g)$ were divided equally into the ginseng-ACTIH and the saline-ACTH groups. Each animal of the ginseng-ACTH and the saline-ACTH groups received every day (subcutaneously) 0.05 m1/10 g body weight of ginseng extract(4 mg of ginseng alcohol extract in 1 ml of saline) and the same amount of saline, respectively, for 5 days. On the 5th experimental day, all animals received 0.01 unit of ACTH intraperitoneally one hour after the last medication, and $1\;{\mu}Ci/g$ body weight of $[^3H]$ thymidine after one more hour. Five animals, at a time, of each group were sacrificed 1, 10, and 24 hr after $[^3H]$ thymidine administration, and the radioactivity of cells in their mandibular gland was measured autoradiographically in terms of the % number of radioactive cells in 1,000 cell counts (Radioactive Index, R.1.). Results obtained were as follows: 1. The radioactive indices obtained from submandibular gland of the saline-ACTH group 1, 10 and 24 hr after $[^3H]$ thymidine administration were $15.2{\pm}0.32,\;20.1{\pm}0.30,\;and\;24.5{\pm}0.52(mean{\pm}S.D.)$ in the mucous cells, $13.0{\pm}0.22,\;10.2{\pm}0.05,\;and\;7.5{\pm}0.42$ in the serous cells. and $10.5{\pm}0.40,\;13.6{\pm}0.32,\;and\;15.9{\pm}0.42$ in the duct cells, while the $mean{\pm}S.D.$ of the values obtained from the 3 cell types 1, 10 and 24 hr after $[^3H]$ thymidine were $10.9{\pm}0.28,\;12.4{\pm}0.31,\;and\;10.0{\pm}0.39.$ Thus the radioactive indices obtained from the ginseng-ACTH group were generally lower than those obtained from the saline-ACTH group. It is inferred from the above results that the ginseng tends to promote the suppressive action of ACTH upon DNA synthesis of cells in the mandibular gland.

• 간호행정학회지
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• 제5권2호
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• pp.209-224
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• 1999

I have practiced this reserch for the purpose of proposition of basic data for amendment and addition of computer system after I surveyed the degree of abilities and satisfaction on the computerization in nursing\ practice. Subjects were collected from September 1 to September 30, 1998. Study subjects are 151 clinical nurses who are working at university hospital in Chonbuk area. Study instrument consists of 116 questionnaire which was developed by Kim H. K(1998). The data were analized number, mean ,t-test, ANOVA by using SPSS. The study results are as follows: 1. Most of the nurses who answered the questions were educated computerizing(96%). The abilities of computer program utilities were the most in inputting data(74%). The program nurses wanted computerizing education was wordprocess, dealing internet and statistics. 2. As for applying parts of computer system in nursing, the most nurses were Dr's order check (96%), treatment activity(91.4%), medication(89.4%), lab. test(87 .4%), transfering department(85.4%), transfering room(79.5%), diet(71.8%), discharge (70.2%), Barcord Sticker(70.2%) , reservation(62.2%) in order that were all conected order system mutually to other part. It showed that computer system was not applied for treating the original nursing work such as nursing record (13%), duty scheduling(6.0%) , nursing process(4.6%) , Q.I(1.3%), nursing research(1.3%), education(1.3%), 3. As for the benefit when computer system is applied for, the most respondence was promptness of work and convenience(90.6%) , exactness of work (82.8%), offering information exactily and efficiently(36.3%), offering good quality of nursing (6.0%) in order. 4. The degree of contentment on computerizing in nursing practice showed average 3.24%. The best marking item is that they are eager to participate in the computer education. Next, the automatic output of label and giving the number automatically is to prevent loss and mentioned items of patient registration from being changed(3.95) and to prevent mistakes possibly happening because of doctor's difficult order(3.85). 5. The problems which may happen to in nurses' utilization of computerization for the nursing practice showed average 3.18. The most problem is that the practice may stop because of the problem of computer itself(3.67), and the next, the indication of act can be imperfect(3.66) , manual training may overlap because of incomplete computerization (3.60), practical education for the computerizing is lack(3.41), and the computer literate nurses are lack(3.40) . 6. Study subject's contentment by age was significant difference(F=3.10,P=0.0119). Study subject's contentment by job posision was significant difference(F=6.001P=0.0034) I will propose the following according to the above results. The domain of original nursing practice is urgernt. Manual and indication of act should be made before long in computer obstacle. Nursing department should support the nurses so that they could receive the education needed for the nurses themselves.

• 간호행정학회지
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• 제5권2호
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• pp.389-400
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• 1999

The purpose of this study is to examine a possibility of applying the ABC system to analyze the cost of nursing service on one obstetrics and gynecology (OB/GYN) unit in a major medical center. The activities of nurses on an OB/GYN unit were analyzed for 4 days for 96 hours. 2 week days and 2 days on weekend. Total cases included in the study were activities of 12 charge nurses and 12 staff nurses. Activities were categorized into direct and indirect activities in order to calculate the cost of activities. Nursing activities were defined multidimesionally in order to utilize the ABC system. The 60 nursing activities were classified into the direct nursing activities and the indirect nursing activities based on a literature review, interview, and survey results. The direct activities were further categorized into the single nursing activities and the multiple nursing activities. The indirect activities were classified into the indirect nursing service activities and the general management activities. The major findings of this study were as follows : 1. There were differences in activities according to the positions and duties of the nurses. The charge nurses mostly performed the indirect nursing service activities and the general management activities. Almost all of their indirect nursing activities spent on each patient were similar. The staff nurses performed the single nursing activities and the multiple nursing activities. 2. The activities of staff nurses included medication, patient assessment, rounding and organizing the unit. patient education, nursing treatment, admission and discharging of patients. There was no differences in types and amount of time spent between the nurses on day-time duty and evening-time duty, but the patient assessment activity increased during the night-time. 3. The cost of post partum nursing services for women who had a normal vaginal delivery using the ABC system included the cost incurred by direct nursing activities provided by the staff nurses (85.9%), indirect nursing activities incurred by the staff nurses(19.0%) and the nursing activities by the charge nurses and the head nurse(14.1%). The ABC system is a relatively new method of cost analysis. The results of this study can provide the nursing and hospital managers with useful information on cost control. It is suggested that more studies should be done using the ABC system and extend the scope of studies to include value analysis to aid the Activity-Based Management(ABM) and/or the reengineering of hospital process.

• 간호행정학회지
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• 제12권1호
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• pp.76-93
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• 2006

Purpose: The purpose of this study was to define the core components required of nurses to provide quality nursing care to patients and analyze the significance of these components in the hospital's various units to maintain a high level of competence among nurses. Method: The study evaluated 3 categories included 35 subcategories with 148 core components that were derived from literature review and interviews of nursing professionals. The nursing professional category included 18 subcategories with 98 components, the organizational culture category included 4 subcategories with 16 components, and the temperament-attitude category included 13 subcategories with 34 components. The study included 335 nurses with more than one year of hospital experience and measured disparities among different hospital units. The data was analyzed with SPSS-Win 10.0, differing perceptions of the importance of general traits among the participants were measured using standard deviation, and differing perceptions of the importance of professional traits among the participants were assessed using ANOVA and subsequently with the Bonferroni Test. The reliability of the aforementioned research tools were evaluated using the Cronbach's ${\alpha}$. Result: The results of the study were as follows: 1. Among the three categories, temperament-attitude category was perceived to be the most important, followed by nursing professional category and organizational culture category. Among the ten most important subcategories within the three categories, safety and infection prevention as well as responsibility were perceived to be the most important, followed by promotion of physiologic adaptation, document management and presentation, self-control, ethics, observance law, coping with emergency, humanity, and medication. 2. The relative importance of category associated with the core competencies within the hospital unit were as follows : 1) The units that rated nursing professional category as being the most significant were: internal medicine, surgical unit, mother-child unit, emergency room, intensive care unit, and operating room, in that order. 2) The units that rated the organizational culture competencies as being the most significant were: mother-child unit, internal medicine, surgical unit, emergency room, operating room, and intensive care unit, in that order. 3) The units that rated temperament-attitude category as being the most significant were: internal medicine, surgical unit, emergency room, mother-child unit, operating room, and intensive care unit, in that order.

• 대한한방소아과학회지
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• 제27권4호
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• pp.57-67
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• 2013

Objectives The purpose of this study is to investigate the safety and effect of Biman-tang (BMT) on two different administration periods in the treatment of childhood overweight and obesity. Methods In retrospective study, 39 overweight and obese ($85^{th}$ percentile ${\leq}$ Body Mass Index (BMI)) children were treated with BMT from January 2006 to April 2013 at Korean Medical Clinic in Suwon, Korea. The primary outcomes were the changes in BMI and Obesity Index (OI) from baseline to the treatment groups. Secondary outcomes included the changes in height, weight and safety of the medicine. Comparisons of BMI, OI, height and weight between the short-period (SP) treatment group and the long-period (LP) treatment group were done by using ANCOVA. Results The change of the mean of BMI ($-0.5{\pm}0.6kg/m^2$ vs $-1.4{\pm}0.8kg/m^2$, respectively; p=0.003) and OI ($-3.6{\pm}3.9%$ vs $-9.7{\pm}4.7%$, respectively; p<0.001) showed significant reduction both in SP (n=16) and LP treatment group (n=23). The mean height showed no significant difference in both groups. The mean weight of LP treatment group showed significant reduction compared to SP treatment group ($-0.2{\pm}1.3kg$ vs $-1.6{\pm}1.6kg$, respectively; p=0.006). Most of the children were compliant to the medication and no serious adverse events were found in two groups. Conclusions These findings emphasize that BMT is effective in the treatment of childhood obesity and it requires at least 45 days of treatment for the best result.