• 한국산학기술학회논문지
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• 제21권7호
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• pp.510-516
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• 2020

본 연구는 2008년부터 2017년까지의 질병관리본부의 퇴원손상심층조사 자료를 이용하여 입원 아동 중 낙상을 경험한 환자를 대상으로 유·아동·청소년 낙상의 특성과 낙상영향 요인을 규명하고자 하였다. 이를 위하여 입원 중 낙상(한국표준질병사인분류, W00-W19)으로 손상(한국표준질병사인분류, S00-S99)을 경험한 18세 이하 아동 환자 116건의 데이터를 수집·분석하였다. 수집된 자료는 SPSS 23을 이용하여 빈도분석, 교차분석, 다중회귀분석을 실시하였다. 연구결과, 입원 중 낙상을 경험한 아동은 남자가 여자 보다 많았고, 1세 이상 6세 이하의 연령에서 낙상이 가장 많이 발생하는 것으로 나타났다. 낙상을 경험한 아동의 질병유형으로는 호흡기 질환이 가장 많았고 낙상으로 인한 상해유형은 열린 상처나 타박상의 빈도가 가장 높았으며, 낙상 사고 원인으로는 침대와 관련된 낙상이 가장 많았다. 낙상 관련 요인분석 결과 성별을 제외한 연령(β=.318), 주진단명(β=.231), 손상(β=.169)의 순으로 낙상에 영향을 미치는 것으로 나타났다. 이와 같은 연구결과는 아동에 대한 낙상예방 교육이 연령, 질병 유형, 아동의 발달단계에 따른 특성과 연령대를 고려하여 실시되어야 함을 시사하는 결과라 할 수 있다. 또한 비교적 활동에 제약이 적은 경미한 질환의 아동이나 과다행동을 보이는 유아기 아동 등 질병의 유형과 연령별 아동 발달 단계특성을 고려한 낙상 사고 위험군에 대한 스크리닝 및 이와 관련한 섬세한 낙상예방 매뉴얼 개발에 힘써야 할 것이다. 마지막으로, 본 연구결과가 입원을 필요로 하는 아동 환자, 보호자, 그리고 관련 의료진에게 연령별 아동 발달단계의 특성에 따른 낙상예방 교육 및 매뉴얼 개발의 단초로 사용되기를 기대한다.

• 한국의료질향상학회지
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• 제10권2호
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• pp.190-203
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• 2003

Background: Dental hygienists are at risk of acquiring infections through exposure to infectious agents. This study explores the frequency of exposure to infectious agents and infection control practices among dental hygienists. Methods: We undertook a cross-sectional survey to examine the exposure to infectious agents and infection control practices among dental hygienists through questionnaire. Data were obtained from 124 dental hygienists attending educational conferences. A multiple logistic regression analysis was conducted to determine the factors that effect infection control practices in relation to age, completion of infection control education, recognition of their own serum hepatitis Ag/Ab status, the number of one day patients, location of clinics, type of clinics, and career years. Result: Of the 124 dental hygienists, 91.7% were exposed to at least one accident such as needle stick injuries during their practices periods. The health screening coverage rate in dental hygienists was 16.5%. The number of one day patients and career years were important in relation to infection control practices among dental hygienists. The adjusted odds ratio estimates for career years were 5.049 times greater(95% Cl 1.238-20.597) for groups with over 4 career years than under 2 career years. That for the number of one day patients were 0.261(95% Cl 0.071-0.955) lower for through 20 up to 30 patients, 0.531(95% Cl 0.102-2.78) lower for through 30 up to 40 patients and 0.498(95% Cl 0.123-2.017) lower for more than 40 patients than under 20 patients. Conclusion: From these results, prevalence of infection control practices among dental hygienists is related to the number of one day patients and career years. Prevention of cross infection and reduction of future transmission should be a priority to dental hygienists for promotion of infection control and further efforts to educate newcomers on infection prevention should be made.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.6-15
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• 2010

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

• 대한치과보철학회지
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• 제45권4호
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• pp.431-443
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• 2007

Statement of problem: Injuries along with discomfort may result on the oral mucosa when non-rigid material is used as the major connector in construction of RPD, since nonrigid major connectors transmit unstable forces throughout the appliance. Titanium which recently draws attention as a substitute of Co-Cr had a difficulty in fabricating due to high melting temperature but the development of casting technique makes it possible to apply to the clinical case. Purpose: The purpose of this study was to investigate the rigidity and the castability of titanium upper major connector by design and make a comparison with Co-Cr major connectors which are widely used in clinical cases now. Material and methods: Casting was done using CP-Ti(Grage 2) (Kobe still Co., Japan) for the experimental groups, and 4 various designs namely palatal strap, U-shaped bar, A-P strap, and complete palatal plate were casted and 5 of each designs were included in each group. For the experimental group, Universal testing machine (Model 4502; Instron, Canton, Mass) was used to apply vertical torsional force vertically to the horizontal plane of major connector. In the second experiment, Vertical compressive force was applied to the horizontal plane of major connector. As a comparative group, Co-Cr major connector was equally manufactured and underwent the same experimental procedures Strain rate was measured after constant loading for one minute duration, and statistical analysis was done with SPSS ver.10.0 for WIN(SPSS. Inc. USA). From the one-way ANOVA and variance analysis (P=0.05), Scheffe's multiple comparison test implemented. Results: 1. Least amount of strain was observed with complete palatal plate followed by A-P bar, palatal bar, and the U-shaped bar having most amount of strain. 2. In all designs of titanium major connector, less strain rate was observed under compressive loading than under torsional loading showing more resistance to lateral force. 3. For titanium major connector, less strain rate was observed when the force is applied to the first premolar area rather than to the second molar area indicating more strength with shorter length of lever. 4. In Comparison of Co-Cr major connector with titanium major connector, palatal strap and U-shaped bar designs showed higher strength under torsional force that is statically significant, and under compressive force, no significant difference was observed expert for U-shaped bar. 5. In titanium major connector, complete palatal plate showed lowest success rate in casting when compared with the Co-Cr major connector. Conclusion: Above results prove that when using titanium for major connector, only with designs capable of generating rigidity can the major connector have almost equal amount of rigidity as Co-Cr major connector and show lower success rate in casting when compared with the Co-Cr major connector.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.96-100
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• 2007

Purpose: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. Methods: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. Results: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. Conclusion: If the mortality rate of trauma patients is to be reduced, the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.126-132
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• 2014

Purpose: The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated. Methods: This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated. Results: During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged. Conclusion: Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.

• Journal of Chest Surgery
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• 제13권1호
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• pp.60-65
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• 1980

We have experienced 2 cases of the hunshot wound sof the chest involving cardiac injuries at department of the thoracic surgery, Capital Armed Forces General Hospital during I year from April I 1979 to Jan. 1980. In one case of two patients , he was a 22 years old man who was transported to this emergency room 4 hour 10 minutes after having gunshot wound of the left chest by helicopter. Physical examination showed small inlet in left 3rd ICS and left parasternal border, large outlet in left 8th ICS and left scapular line, no breath sound on left side and distant heart sound. chest roentgenography demonstrated marked pleural effusion in left side and mediastinum shifted to right. As soon as chest X-ray was taken, the bleeding through penetrating wound became profuse and cardiac arrest ensued. Closed chest cardiac massage was started and vigorous transfusion continued, but no effective cardiac activity could not be obtained. The patient was pronounced dead due to exsanguinating hemorrhage from wuwpected cardiac wounds. In this critically injured patient with evidence of intrathoracic hemorrhage and suspected cardiac penetration, only emergency thoracic exploration and immediate surgical control of bleeding points might offer the maximum possibility of survival. The other case was a 23 years old man who was transferred to the emergency room 4 hours 50 minutes after having kmultiple communicated fractures of sternum and linear fracture of right mandible by a missile. Examination revealed about 30% skin loss of the anterior chest wall, weak pulse of 96 beats/min., distant heart sound and decreased breath sounds bilaterally. finding on the chest X-ray films showed multiple sternal fractures, marked pericardial effusion indicating hemopericardium. So, the patient was moved immediately to the operation room where, after endotracheal tube inserted, a median sternotomy was performced. A hemorrhagic congestion of the right upper lobe and marked bulging pericardium were disclosed. The pericardium was opened anterior to right phrenic nerve and exsanguinating hemorrhage ensued from the 0.5cm lacerated wound in the auricle of right atrium. The rupture site of right atrium was occluded with non-crushing vascular clamps and then was over sewn with interrupted sutures. It was thought to be highly possible that he was alive long enough to have cardiorrhaphy because of cardiac tamponade, which prevented exsanguinating hemorrhage. He was taken closed reduction for linear fracture of right mandible 2 weeks after repair of ruptured right auricle in dental clinic. This patient's post-operative course was not eventful.

• 한국산학기술학회논문지
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• 제17권4호
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• pp.332-339
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• 2016

본 연구는 유해 화학 물질 방출에 의해 손상 받은 환자들을 대상으로 중증 화상에 관하여 연관된 요인들의 강도를 밝힘을 목적으로 하였다. 2010년 1월 1일부터 2014년 12월 31일 까지 화학 손상으로 본원 응급실을 방문했던 총 446명의 환자를 조사 하였다. 중증 화상은 화학 손상의 중증도를 대변하는 종속변수로 사용되었다. 중증 화상과 관련이 있는 독립변수들을 밝혀내기 위한 통계 방법으로 카이 제곱 검정(Chi-square test, CST)과 이분형 로지스틱 회귀분석(Binary logistic regression test, BLRA)이 사용되었다. CST상, 중증 화상에 관하여 여성과 사고 현장에 있던 군, 다발 부위 손상 군이 동시에 연관성을 보였다(p<0.05). BLRA상 사고 현장에 있던 군과 폭발 군에 비하여 누출 군과 입원 군에 비하여 퇴원 군이 동시에 중증 화상과 관련 있었다(p<0.05). 본 연구에서는 사고 현장에 존재 여부가 중증 화상에 관하여 가장 중요한 요인 이었다. 뿐만 아니라 성별과 손상의 개수, 사고 노출 기전(폭발에 비해 누출), 응급실 진료 후 배치(입원에 비해 퇴원)가 또한 중증 화상과 관련이 있었다.

• 대한간호학회지
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• 제29권1호
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• pp.117-126
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• 1999

Accidents involving children are an important cause of death and disability. They also have enomorous financial implications. In order to prevent childhood accidents, research and education for safety should be strengthened. The purpose of this study was to determine how often young children have accidents and what factors affect the accident rate. The sample consisted of 771 children who were in the second, third and forth grades of two elementary schools located in Kyung-gi Province. One school had students from middle class families living in apartment complexes and the other, students from lower income families mainly living in single houses. The questionnaires included items on the occurance of accidents and the parents' attitudes regarding accidents during the academic year from March 1997 to February 1998. The Questionnaires were distributed to conventiently selected students to be compeleted by their parents and collected during the period of May 28, to June 6, 1998. The data were analyzed using SAS PC statistical package. The results of the study are as follows ; 1. Of 771 student subjects, 393 had 887 accidental injuries during the study period. 2. The month, the day and the time with the highest accident rate were May, Sunday, and between 1 and 4 p. m. each. 3. In the analysis of the location where the injury took place, the most frequent place was on around their homes followed by school and, then, inside the home 4. Most of the accidents were caused by carelessness on the part of the children and the most frequent type of injury was an abrasion. 5. Children most injured their legs 6. They were treated at home most often and usually emergency treatment was performed by family members with, disinfection being the main type of first aid. Cost of the treatment ranged from 8,000 to 20,000 won in most cases. 7. House type and parents' education level were statistically significant in chi-square analysis. 8. Parents educate their children about traffic safety most frequently followed by fire safety and, then, prevention of violence. 9. Parents think that prevention of violence should be the most important part of injury prevention education both at school and home. 10. To identify factors related to accident occurrence, multiple logistic regression was performed and the main factors were birth order and house type.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.561-566
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• 2008

This is a retrospective clinical study on 2,955 patients who had visited the Emergency Room of Sang-gye Paik Hospital and then been treated in the Department of Oral and Maxillofacial Surgery during recent 4 years from Aug. 2002 to Dec. 2006. The obtained results were as follows. The total number of patients was 2,955 and the ratio of male to female was 1.72:1. The age distribution peak was the 1st decade (30.8%), followed by the 3rd decade (14.3%) and the 4th decade (14.0%). Trauma (62.3%) was the most frequent cause in dental emergency patients, pulpitis (13.0%) and infection patients were next in order of frequency. In trauma patients group, facial bone injury, tooth injury, soft tissue injury were included and soft tissue injury group was most prevalent, followed by tooth injury group and facial bone group. In total patient, the ratio of admission was 3.5%. We obtained the results of the distribution of primary emergency care in the traumatic injury, causal distribution of the jaw fracture, distribution of related medical department in multiple associated injuries, distribution of emergency care in infection, causal distribution and control methods of oral bleeding, distribution of TMJ disorder. The trauma patient group was major in the dental patients who had visited the emergency room, but other various groups were included. So we should analyze the pattern and the variation of the dental emergent patient to provide the proper treatment.