• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.970-975
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• 2001

Objective : By conducing a review of clinical outcomes for patients with aneurysm treated using current microneurosurgical techniques and intensive care unit management, we speculated that grading systems based only on clinical condition or CT finding after admission failed to provide a significant stratification of outcome between individual grades of patients, because these systems did not include the factor for postoperative vasospasm. We hypothesized that postoperative blood flow velocity could have a significant impact on outcome prediction for patients surgically treated for intracranial aneurysms. Methods : We conducted a analysis on patient- and lesion-specific factors that might have been associated with outcome in a series of 55 aneurysm operations performed with measurements of blood-flow velocity with transcranial Doppler ultrasonography(TCD). In the new scale(NS) score system, 1 point is assigned additionally for the case with Hunt and Hess(H-H)/World Federation of Neurological Surgeons(WFNS) Grade IV or V, Fisher Scale(FS) score 3 or 4, aneurysm size greater than 10mm, patient age older than 60 years, blood-flow velocity higher than 120cm/sec, and posterior circulation lesion. By adding the total points, a 6-point scale score(score 0-6) is obtained. Results : Age of patient, size of aneurysm, clinical condition(H-H grade and WFNS), FS score, and blood flow velocity(TCD 1day after operation) were independently and strongly associated with long-term outcome. When NS scores were applied to 55 patients with at least 6 months follow-up, the correlation of individual scores with outcome was strongly validated the retrospective findings. Conclusion : It was speculated that TCD could be used to assess postoperative vasospasm and to monitor noninvasively the patients with aneurysmal SAH. This NS score system is easy to apply, divide patients into groups with different outcome, and is comprehensive, allowing for more accurate prediction of surgical outcome.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.39 no.5
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• pp.443-448
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• 2015

Obstructive sleep apnea (OSA) is a syndrome characterized by the repetitive episodic collapse of the upper airway. Maxillomandibular advancement surgery is one of the most effective surgical treatment methods in treating obstructive sleep apnea. The advancement of both maxill and mandible can enlarge the cross-sectional areas and volumes of the postero-superior airway. The purpose of this study is to analyze flow patterns in the upper airway before and after maxillomandibular advancement surgery. Here, we analyzed flow phenomena of inspiration and expiration to prevent obstructive sleep apnea patient from happening side effect. Modeling of the upper airway carried out from clinical CT scanned images. We used time-dependent values for boundary condition. CFD analyses were performed and evaluated section of minimum area (SMA), compared with patient inside upper airway before and after maxillomandibular advancement surgery in SMA, and negative pressure effects. The study showed the greatest enlargment of the section of minimum cross-sectional area. Moreover, the velocity and the negative airway pressure were decreased. According to the result of this study, the maxillomandibular advancement surgery stabilizes the airflow in the postero-superior airway of OSA patients.

• Journal of Korean Academy of Nursing
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• v.45 no.2
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• pp.280-292
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• 2015

Purpose: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. Methods: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. Results: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. Conclusion: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.

• The Journal of the Korea Contents Association
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• v.17 no.6
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• pp.98-105
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• 2017

The medical institution considers liability management problems as a direct factor in managerial risks, such as bankruptcy. Cash Flow provides useful information to necessary funds and predicting bankruptcy. The study for 24 general hospitals and 23 hospitals, a regression analysis was performed to determine the impact of cash flows on the debt repayment capability, a multivariate discrimination analysis was conducted to find out how to manage cash flow for the risk posed by debt. The analysis results, For general hospitals, the level of debt repayment capability was done to net income, increase of payables from operating activities and decrease of patient receivables and inventories from operating activities. If there is no dept repayment capability, it is necessary to increase the net income, increase the expenses not involving cash outflows, decrease of patient receivables and increase of payables from operating activities. For hospitals, the level of debt repayment capability was done to net income, increase of expenses not involving cash outflows and payables from operating activities, decrease of income not involving cash inflows, decrease of patient receivables and inventories from operating activities. If there is no dept repayment capability, it is necessary to increase of payables from operating activities.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1019-1023
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• 2000

Objective : Endoscopic third ventriculostomy is gaining popularity as a minimally invasive surgical option for certain types of hydrocephalus as an alternative to shunting. The authors have tried to fenestrate down to the subdural space passing through the prepontine cistern to lessen or avoid the chance of redoing due to healing. Materials and Method : A 48-year-old male patient with several years of intractable headache was presented. Magnetic Resonance Image(MRI) of the brain revealed marked ventricular dilatation with stenotic cerebral aqueduct. A 2.3mm flexible steerable endoscope($Neuroview^{(R)}$) was introduced via precoronal route and accessed to the third ventricular floor. Using 3-French Fogarty balloon catheter, thin third ventricular floor and the arachnoid membrane of the prepontine cistern were fenestrated, so called "double fenestration". To confirm the fenestration, subdural compa-rtment of the left abducens nerve was identified during the procedure. Forceful pulsating flow through the orifice convinced the patency of the opening. Results : The patient was discharged on the third postoperative day without any postoperative complications. The postoperative follow-up MRI of the brain, at second and sixth months, clearly demonstrated the flow void through the third ventricular floor. Conclusions : Endoscopic third ventriculostomy was successfully performed on an adult hydrocephalus patient with aqueduct stenosis. The third ventricular floor and arachnoid membrane of the prepontine cistern were fenestrated to achieve double fenestration to minimize the chance for failure. The details of this procedure and results are described.

• Journal of Physiology & Pathology in Korean Medicine
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• v.18 no.1
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• pp.279-284
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• 2004

Excluding an operation remedy about an example of Traumatic Cervical Stenosis patient, by doing pattern identification such as blood stagnation in hospitalization for the early days and such as the stagnation of Oi for the middle days and such as Eum deficiency of liver and kidney for the last. We have done treatment by being based on method of therapy to promote blood flow to remove blood stasis and to promote the normal flow of Oi and to nourish the liver and the kidney. In result, we had remarkable conclusion and considered that we had to treat a patient like that appropriately by distinguishing & making a diagnosis correctly from now on. If we apply clinically by thinking of Oriental Medicine through more example of symptoms, we have considered that it will serve as a momentum that we can sympathize with the excellency of Oriental Medicine. In the future, we have considered that have to be necessary to make more researches and reports upon it.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.455-458
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• 2015

Excessive dynamic airway collapse (EDAC) is a disease entity of excessive reduction of the central airway diameter during exhalation, without cartilage collapse. An 80-year-old female presented with generalized edema and dyspnea at our hospital. The patient was in a state of acute decompensated heart failure due to pneumonia with respiratory failure. We accordingly managed the patient with renal replacement therapy, mechanical ventilation and antibiotics. Bronchoscopy confirmed the diagnosis of EDAC. We scheduled extubation after the improvement of pneumonia and heart condition. However, extubation failure occurred due to hypercapnic respiratory failure with poor expectoration. Her EDAC was improved in response to high flow nasal oxygen therapy (HFNOT). Subsequently, the patient was stabilized and transferred to the general ward. HFNOT, which generates physiologic positive end expiratory pressure (PEEP) effects, could be an alternative and effective management of EDAC. Further research and clinical trials are needed to demonstrate the therapeutic effect of HFNOT on EDAC.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.413-417
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• 2024

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.46-50
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• 2018

Purpose Generally, a collimator that installed in front of detector set a direction of gamma ray and remove a scatter ray. By the way, a lateral or oblique scatter ray is detected into crystal through collimator. At this study, we will evaluate a mount of count and spectrums of lateral scatter ray. Materials and Methods We used the SKY LITE (philips, netherlands) as a gamma camera, and $^{99m}Tc$, 1.11 GBq point source as a phantom. we put this point source at backside 50 cm of detector. After acquiring this for 1 min, we turned a detector next 10 degrees. Likely this, we acquired images at every 10 degrees from $0^{\circ}$ to $360^{\circ}$, analyzed images and spectrums. In case of patient study, we choose a 3 phase bone scan patient who had a hand disease, because scatter rays from body would detect on crystal. After acquiring blood flow and blood pool images, we analyzed images and spectrums. Additional, we put a lead gown on patient's hand, body. And then we compared and evaluated 3 type blood pool images (non lead gown, lead gown on a hand and on body). Results In case of phantom study, scatter ray counts at backside ($270^{\circ}-90^{\circ}$) are same with a background count. By the way, counts of scatter ray of oblique side ($0^{\circ}-50^{\circ}$, $220^{\circ}-270^{\circ}$) are 100-600 cps, furthermore, counts at frontside are over 4 Mcps. In case of patient study, a counts of hand blood pool scan are 1510 cps. But counts of hand with lead gown on hands and on body are each 1554 cps, 1299 cps. Conclusion Therefore, even though there is a collimator in front of detector, lateral scatter rays detect on crystal and affect to images and spectrums. Especially, if there is a high activity source at outside of detector when we examine low activity organs like hands or foot, we have to shield and remove the source at outside for a good image.

• Journal of Korean Public Health Nursing
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• v.6 no.2
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• pp.58-69
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• 1992

The purposes of this study were 1) to assess the currunt documentation system 2) to identify the problems in communication regarding to documentation 3) to develop new documentation system 4) to suggest effective communication channel using new documentation system Research was conducted by direct observation, chart review, staffs interview and servey. Results were as follows: 1) nursing care plans were not used in ongoing care 2) documentation format was primarily narrative and charting was time consuming 3) documentation did not reflect the nursing process 4) patient records were not used as effective communication tool between case manager and part time nurse 5) difficult access to patient record for nurse manager created inefficiency in coordinating 6) documentation of patient education did not describe the precise contents of education, and the responses of the patients and evaluation To solve these problems, new documentation format was developed. With new formats nurses : 1) use standardized care plan which contains nursing diagnosis, ecpected outcome, time frame for evaluation, flow sheet for updating the plans 2) leave one copy of care plan at patient home for mutual agreement with patent and communication among nursing staffs 3) carry one copy of care plan for updating 4) document and evaluate the patient education using education check list keeping in patient's home 5) document nursing process in focus charting visit report 6) carry one copy of visit report 7) have one copy of visit report which was deligated to part time nurses 8) use documentation in direct communication with part time nurse 9) use beeper and memo to promote communication