• 한국응급구조학회지
• /
• 제17권1호
• /
• pp.21-39
• /
• 2013

Purpose : The purpose of this study is to provide the basic data to improve pre-hospital phase emergency care for acute myocardial infarction (AMI) patients by analyzing AMI patients' clinical characteristics and emergency care situations. Methods : Data were collected through medical records of 385 AMI patients including ambulance records of 107 AMI patients transferred to the emergency medical center for three and a half years. Results : Regarding emergency care for AMI patients in pre-hospital phase, 47% of the care revealed moderate level or higher, and appropriateness of pre-hospital phase emergency care for cardiopulmonary complaints practiced by paramedics showed statistically significant improvement in recent years (p<.001). The time from onset of symptom to ballooning intervention by 119 emergency services was shorter than that in other cases. However, emergency care by paramedic was mainly basic life support. Conclusion : Since prognosis of AMI shows vast differences depending on prompt detection and medical intervention, cooperation between pre-hospital and in-hospital phase is highly required. 119 paramedics should be trained focusing on the accurate assessment and emergency care, and medical direction should be activated. In addition, regulation on 12-lead EKG, cardiac enzyme analysis, use of analgesics and thrombolytic agents should be legally implemented.

• Kidney Research and Clinical Practice
• /
• 제37권4호
• /
• pp.393-403
• /
• 2018

Background: This study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD. Methods: This cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-week dialysis sessions. Results: Extracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation ($r^2=0.924$, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period. Conclusion: The estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible to predict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.

• Korean Journal of Radiology
• /
• 제19권6호
• /
• pp.1066-1076
• /
• 2018

Objective: The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. Materials and Methods: The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Inter- and intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. Results: Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (-6.1-5.7 mm), followed by PVP (-7.9-7.1 mm) and AP (-8.5-7.4 mm) images. Intra-observer agreement showed the same trend: -2.8-2.9 mm and -2.9-2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, -2.8-2.9 mm and -3.0-3.2 mm, respectively, on PVP, and -3.2-4.2 mm and -3.4-3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. Conclusion: There was better inter- and intra-observer agreement in size measurements of NET liver metastases on pre-contrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.

• 한국항행학회논문지
• /
• 제15권4호
• /
• pp.646-654
• /
• 2011

최근 구급차에 탑승하는 응급 구조사의 인원이 턱없이 부족하여 소방관 한 사람만이 구급차에 타고 환자를 이송하는 일이 종종 문제시 되곤 한다. 응급환자가 발생 시 신속하고 정확한 조치가 무엇보다도 필요하며 특히, 환자에게 적합한 의료기기가 있는 전문적인 병원으로 이송해야한다. 본 논문은 스마트 폰을 이용하여 병원 전 단계의 응급의료 시스템을 구현한다. 구현된 시스템은 환자 이송 중에 환자의 심박동을 실시간적으로 모니터링이나, 과거 환자의 병력 정보 등을 파악할 수 있으며, 환자가 필요로 하는 응급 병원 정보도 제공하여 병원 전 단계에서 응급 환자에게 신속하고 효율적인 처치가 가능한 환경을 제공한다.

• 한국병원경영학회지
• /
• 제22권3호
• /
• pp.144-156
• /
• 2017

Purpose: Crisis is inevitable to every organization and therefore, successful crisis management is critical to the organizations' survival and prosperity. With the understanding, this study aims to draw propositions for successful crisis management of hospitals when facing infectious disease outbreak. For the purpose, a case of a small and medium sized hospital's experience of crisis management during 2015 Middle East Respiratory Syndrome outbreak was analyzed. Methodology/Approach: The detailed internal circumstances and experiences of the hospital during the MERS outbreak were identified by in-depth interview as well as the extensive material review, and analyzed under the view of the theories of accident, error, and crisis in relation of organization management Findings: Overall, nine propositions are drawn by the phase of crisis. In pre-crisis phase, for example, 'the hospital preparedness has positive influence on the effective responding to the crisis'. In detection phase, 'the mindfulness of the hospital organizations' as well as the individuals' has positive influence on detecting the crisis signals'. In crisis phase, for example, 'improvising naturally occurs in crisis by the unknown disease, therefore, a component site supervisor coordinating such improvision is important'. Lastly, in post-crisis phase, 'successful crisis responding experience facilitates the positive hospital culture'. Practical implication: From the experience of a small and medium size hospital, it is suggested that proactive system approach oriented by safety is beneficial for effective crisis management.

• 한국식품위생안전성학회지
• /
• 제5권3호
• /
• pp.99-110
• /
• 1990

서울시내 종합병원 병상 규모를 3 group으로 분류하여 5개병원을 대상병원으로 선정한 후 완자전과 육개장을 대상 음식으로 하여 각 생산 단계의 소요시간, 온도 상태 및 미생물적 품질평가를 실시하여 HACCP 방법으로 위험요인 분석을 실시하였다. 기본재료의 미생물적 품질상태가 저조한 것으로 평가되었고, 배달과정 및 검수 후 저장단계에서 냉장고의 철저한 온도관리가 요구되었다. 음식생산 과정에서의 소요시간-온도상태의 기준이 적절히 시행되고 있지 못하였다. 음식 생산과정에서 사용되는 기구, 기기, 및 용품에 대한 미생물 검사 결과 즉각적인 시정이 요구되었다. 완자전 생산과정에서의 각 병원별 criticla control point는 A병원: 기본재료, 전처리단계, 조리단계, 조리후 보관단계 ; B병원 : 기본재료, 전처리단계 ; C병원: 기본재료, 전처리단계, 조리후 보관단계 및 급식단계 ; D병원 : 기본재료 전처리단계 , 조리후 보관 단계 및 급식단계 ; E 병원: 기본재료, 전처리 단계 , 조리후 보관단계 및 급식단계로 지적되었다.

• 한국전문물리치료학회지
• /
• 제1권1호
• /
• pp.83-87
• /
• 1994

The purpose of this paper is to provide an overview of the clinical physical therapy program used at the University of Yonsei Rehabilitation Hospital, for the practicing university trained physical therapists who may be unfamiliar with patients who have suffered a myocardial infarction. The four primary phases of the cardiac physical therapy graded exercise program are: 1) coronary care unit program (phase I), 2) general ward program (phase II), 3) convalescence program (phase III), 4) maintenance program (phase IV). The exercise prescription defines the exercise intensity, duration, frequency, and mode of exercise a after pre- discharge low level graded exercise test(LL-GXT) or symptom limited maximum graded exercise test. A typical exercise routine consists of preparation warm-up exercise, therapeutic exercise, cool-down exercise. Physical therapy is involved in the acute care and rehabilitation of the patient after a myocardial infarction. Therefore, the physical therapist must throughly comprehened the cardiac anatomy, cycle, performance, conduction system, pathogenesis, risk factors, and exercise benefits.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제37권
• /
• pp.21.1-21.8
• /
• 2015

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

• 한국응급구조학회지
• /
• 제26권2호
• /
• pp.7-18
• /
• 2022

Purpose: This study aimed to develop a pre-hospital subarachnoid hemorrhage (SAH) prediction tool by analyzing the extant predictive factors of patients with non-traumatic SAH who visited the hospital through the 119 emergency medical services. Methods: We retrospectively reviewed pre-hospital care reports (PCRs) and electronic medical records (EMRs) of 103 patients with non-traumatic SAH who were transported to the emergency department of two national hospitals via the 119 emergency medical service from January 1, 2017 to December 31, 2020. Variables required to apply the Ottawa SAH Rule and EMERALD SAH Rule, which are early prediction tools for SAH, were extracted and applied. Results: The most common symptoms-which were found in 94.1% and 97.0% of all patients according to PCRs and EMRs, respectively-appeared in the following order: headache, altered state of consciousness, and nausea/vomiting. When the variables used for the EMERALD Rule, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and blood sugar test (BST), were applied, the sensitivities of EMR and PCRs were 99.9% and 92.2%, respectively. Conclusion: For the timely prediction of SAH at the pre-hospital phase, patient age and symptoms should be assessed, and SBP, DBP, and BST should be measured to transport the patient to an appropriate hospital.

• 대한물리치료과학회지
• /
• 제13권3호
• /
• pp.41-54
• /
• 2006

The purpose of this study was to analyze various forms of musculoskeletal pain during different stages such as antenatal, pregnancy, delivery, and postpartum. The data for this study were collected through a self-administered survey with a structured questionnaire to 113 subjects. The survey was administered from May, 2003 to March, 2004 with subjects selected from postpartum centers in 3 different areas: Kangnam, Kangbook, and Bucheon. Analytical tools used for this study were frequency analysis, crosstabulation, percentage analysis, independent t-test, chi-square, and multiple response analysis. The findings of this study were as follows: 1. Comparison study of musculoskeletal pain according to variables including a pregnant woman's age, delivery techniques, different types of delivery such as primiparity, multiparity, dystocia, easy delivery, shows that these relationships are statistically not significant (p>0.05). 2. A total of 61.9% gave positive responses for the question about the relationship between musculoskeletal pain during postpartum and that in preparation of labor, but shows that this relationship was statistically not significant (p>0.05). 3. Relationships between forms of musculoskeletal pain in different phases are significant (p<0.05). The compared phases are: premarriage and pre-pregnancy, premarriage and antenatal, premarriage and postpartum, premarriage and lactiferous phase, pre-pregnancy and antenatal, pre-pregnancy and postpartum, and pre-pregnancy and lactiferous phase. However, results for the comparison between antenatal and postpartum, antenatal and lactiferous phase, and postpartum and lactiferous phase show that these relationships are statistically not significant (p>0.05). According to this study, musculoskeletal pain which occurred during antenatal is significantly related to the pain occurring during postpartum. Results produced from this study might be used as a helpful tool for developing educational programs aiming at teaching self pain-detection performable at home or at the workplace and body maintenance during the course of antenatal and postpartum.