• 한국농촌간호학회지
• /
• 제18권1호
• /
• pp.57-71
• /
• 2023

Purpose: This study aims to provide primary data for policy alternatives by identifying the problem of the nursing workforce shortage. Methods: For quantitative data, 446 questionnaires were analyzed. The mean and standard deviation were used for content description. ANOVA analysis and Scheffe? test were used to compare the differences according to the hospital level. For qualitative data, 1:1 in-depth and group interviews were conducted for six participants. Results: The factors nurses prioritized when choosing a workplace were salary, commuting distance, and work-life balance. Clinical nurses cited low wages, heavy workloads, and burnout as the most considerable difficulties in performing their duties. Factors influencing nurse's turnover intention were low wages, unmanageable workload, and rotation to unwanted departments in that order. New nurses tend not to apply to small-medium-sized hospitals, experienced nurses in their 30s-40s leave hospitals due to childcare and shift work difficulties, and nurses in their 50s and older tend to move to nursing homes rather than acute hospital settings. Conclusion: In this study, wage and workload were mentioned as the most critical factors in nurses' workplace selection, job performance difficulties, and turnover intention, so it is necessary to pay attention to this aspect when improving treatment for nurses.

• Neonatal Medicine
• /
• 제28권1호
• /
• pp.22-28
• /
• 2021

Purpose: Meconium obstruction of prematurity (MOP) predisposes premature infants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clinically diagnosed patients with MOP whose obstructions were not relieved via conventional sonography-guided contrast enema. We retrospectively evaluated whether oral nonionic water-soluble contrast media relieves MOP. Methods: Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followed-up radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors. Results: We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27⁺⁵ weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without air-fluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age. Conclusion: Nonionic oral water-soluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

• 융합정보논문지
• /
• 제7권4호
• /
• pp.27-38
• /
• 2017

본 연구는 국내 의료기관인증제도와 미국과 호주의 의료기관인증제도 및 국제의료질향상학회의 국제인증프로그램에 대해 비교 고찰함으로써 우리나라 의료기관인증제도의 발전을 위한 시사점을 제시하고자 시도되었다. 본 연구에서 도출된 시사점은 다음과 같다. 첫째, 환자 및 지역사회 중심의 관점 강화, 인력배치 기준 강화 등 의료기관 인증기준의 개선이 필요하다. 둘째, 의료기관인증제도를 통한 환자안전의 강화가 필요하다. 셋째, 의료기관인증제도와 임상질지표 및 환자경험평가 연계를 강화해야 한다. 넷째, 조사위원의 역량을 강화해야 한다. 다섯째, 중소병원의 인증제도 참여 활성화가 필요하다. 여섯째, 의료 질 평가 결과 공개의 강화가 요구된다. 본 연구 결과는 우리나라 의료기관인증제도의 개선을 위한 기초자료로 활용될 수 있을 것이다.

• Journal of Korean Neurosurgical Society
• /
• 제62권5호
• /
• pp.526-535
• /
• 2019

Objective : While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. Methods : Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. Results : In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p=0.032). Cerebral angiography after SAH was performed on 88 patients ${\leq}3$ hours, 74 patients between 3-6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ${\leq}3$ hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. Conclusion : Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.

• 대한세포병리학회지
• /
• 제4권1호
• /
• pp.45-51
• /
• 1993

말초성 신경아세포종은 예후가 나쁘고 희귀한 종양으로 이 종양의 세침흡인 세포학적 소견에 관한 보고는 세계 문헌상 1988년 Neuhold에 의해 처음 기술된 1례가 있을 따름이다. 최근 저자들은 30세 여자의 우측 상박의 연부조직 종괴로 부터 세침흡인 세포 검사를 시행하여 진단된 말초성 신경아세포종을 경험하여 그 세침흡인 세포학적 소견을 기술하는 바이다. 환자는 1개월전 부터 우측 상박에 서서히 자라는 종괴를 주소로 내원하였다. 우측 상박 X-선 및 초음파 촬영술에서 주위와 잘 경계지어진 방추형의 연부조직 종괴가 관찰되었고 주변조직으로 침윤하는 소견은 관찰할 수 없었으며 상완골은 정상이었다. 종괴의 세침흡인 도말은 세포밀도가 매우 높았고 작고 둥근 세포들이 뭉쳐있거나 산재되어 있었다. 세포간의 크기나 모양의 차이는 아주 미약하였고 유사분열은 거의 관찰되지 않았다. 종양세포들의 집단은 간혹 모세혈관을 중심으로 뭉치거나, 로제트 형태를 보이며 그 세포질은 가늘고 긴 돌기를 보였다. 핵은 뚜렷한 핵막과 미세하게 뭉친 염색질 및 작고 뚜렷한 핵 소체를 갖고 있었다. 이상의 소견은 작고 둥근 세포로 된 악성 종양 중 말초성 신경아세포종에 매우 합당하였으나 골외 Ewing 육종과의 감별은 불가능하였다. 단순 절제술이 시행되었고 종양은 조직학적으로 말초성 신경아세포종임이 확인되었다.

• 한국병원경영학회지
• /
• 제13권4호
• /
• pp.1-26
• /
• 2008

This study examines the statistical relationship between medical specialists and managerial performance, using regression analysis with the number of medical specialists per 100 beds as the independent variable and the managerial performance index as the dependent variable. Managerial performance index incorporated the number of out-patients per specialist, the number of in-patients per specialist, the volume of revenue per specialist, the number of beds per specialist, and the average length of stay. To compare different groups of hospitals, dummy variable was applied to five groups of hospitals according to size: 100-299 beds, 300-599 beds, 600-899 beds, 900-1199 beds, and more than 1200 beds. The data consisted of 181 general hospitals with more than 100 beds, which included 28 public hospitals, 73 corporate hospitals, 64 university hospitals and 16 private hospitals. Of those, 87 hospitals were located in big cities and 94 hospitals in medium to small cities. This study used hospitals from the Korean Hospital Association, and data published in 2004. The collected data sample was analyzed using the SPSSWIN 12.0 version, and the study hypothesis was tested using regression analysis. The findings of this study are summarized as follows: Hypothesis 1 predicting a negative effect of the number of medical specialists on the number of out-patients per specialist was supported with statistical significance. The analysis of dummy variable showed causality in all the hospital groups larger than the group of 100-299 beds. Hypothesis 2 predicting a negative effect of the number of medical specialists on the number of in-patients per specialist was supported with statistical significance. The analysis of dummy variable showed causality in the hospital group of 300-599 beds when compared to the group of 100-299 beds. Hypothesis 3 predicting a negative effect of the number of medical specialists on the volume of revenue per specialist was not supported. However, the analysis of dummy variable showed that the volume of revenue per specialist increased in the hospital groups of 600-899 beds, 900-1199 beds, and over 1200 beds, when compared to the group of 100-299 beds. Hypothesis 4 predicting a negative effect of the number of medical specialists on the average length of stay was supported with statistical significance. The analysis of dummy variable showed causality in the hospital group of 300-599 beds, when compared to the group of 100-299 beds. Results of this study show that the number of the medical specialists per 100 beds is an important factor in hospital managerial performance. Most hospitals have tried to retain as many medical specialists as possible to keep the number of patients stable, to ensure adequate revenue, and to maintain efficient managerial performance. Especially, the big hospitals with greater number of beds and medical specialists have shown greater revenue per medical specialist despite the smaller number of patients per medical specialist. Findings of this study explains why hospitals in Korea are getting bigger.

• Journal of Korean Neurosurgical Society
• /
• 제30권11호
• /
• pp.1308-1313
• /
• 2001

Object : The goals of radiosurgery include preservation of neurological function and prevention of tumor growth. We document the results of gamma-knife radio-surgery for vestibular schwannoma. Method & Object : Eighty-two patients underwent stereotactic radiosurgery for an vestibular schwannoma from October, 1994 to December, 2000. Sixty-five of these patients were followed up for radiological and clinical evaluation. As pregamma-knife modality, surgical resection were done in 23 patients,and V-P shunt in 2 patients. Initial symptoms were headache(n=45), dizziness(n=16), tinnitus(n=17). While normal facial function(House-Brackmann grade 1) was present in 48 patients(73.8%), other patients showed grade 2 function in 8, grade 3 function in 7,and grade 4 function in 2. The Gardner/Robertson scale was used to code hearing function. Male to female ratio was 1:3. Mean tumor volume was $7.98cm^3$. Mean dose delivered to the tumor margin was 14.2Gy,and mean maximal dose was 28.3Gy. Results : Mean follow-up duration of 19.9 months. Thirty-five showed decrease(53.8%) in size, 19 patients(29.2%) stationary, 3(4.6%) initial decrease follow up increase, 5(7.6%) initial increase follow up decrease,and 59 patients (90.8%) were well controlled. Two patients experienced transient facial neuropathy, one transient trigeminal neuropathy, and one transient hearing deterioration. After gamma-knife radiosurgery, ventriculoperitoneal shunt was done in 4 patients. Conclusions : Gamma-knife radiosurgery can be used to treat postoperative residual tumors as well as in patients with concomitant medical problems in patients with preserved hearing function. Gamma-knife radiosurgery is safe and effective method to treat small, medium sized(less than 3cm in extracanalicular diameter), intracanalicular vestibular schwannoma, associated with low rate of cranial neuropathy.

• 보건행정학회지
• /
• 제32권4호
• /
• pp.347-355
• /
• 2022

Background: Since November 2019, long-term care hospitals have been able to provide patients with discharging programs to support the elderly in the community. This study aimed to identify both patient- and hospital-level factors that affect successful community discharge from long-term care hospitals. Methods: A multilevel logistic regression model was performed using hospitals as a clustering unit. The dependent variable was whether a patient stayed in the community for at least 30 days after discharge from a long-term care hospital. As for the patient-level independent variables, an agreement between a patient and the family about discharge, length of hospital stay, patient category, and residence at discharge were included. The number of beds and the ratio of long-stay patients were selected for the hospital-level factors. The sample size was 1,428 patients enrolled in the discharging program from November 2019 to December 2020. Results: The number of patients who were discharged to the community and stayed at least for 30 days was 532 (37.3%). The intraclass correlation coefficient was 22.9%, indicating that hospital-level factors had a significant impact on successful community discharge. The odds ratio (OR) of successful community discharge increased by 1.842 times when the patients and their families agreed on discharge. The ORs also increased by 3.020 or 2.681 times, respectively when the patients planned to discharge to their own house or their child's house compared to those who didn't have a plan for residence at discharge. The ORs increased by 1.922 or 2.250 times when the hospitals were owned by corporate or private property compared to publicly owned hospitals. The ORs decreased by 0.602 or 0.520 times when the hospital was sized over 400 beds or located in small and medium-sized cities compared to less than 200 bedded hospitals or located in metropolitan cities. Conclusion: The results of the study showed that the patients' and their family's willingness for discharge had a great impact on successful community discharge and the hospital-level factors played a significant role in it. Therefore, it is important to acknowledge and support long-term care hospitals to involve active in the patient discharge planning process.

• Physical Therapy Rehabilitation Science
• /
• 제7권3호
• /
• pp.95-101
• /
• 2018

Objective: To determine if the provision of visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) enhances the acquisition and retention of diaphragm muscle recruitment during exercise. Design: Two group pretest posttest design. Methods: Thirty healthy subjects were randomly assigned to the verbal feedback group (VG, n=15) or the visual and verbal feedback group (VVG, n=15). The VG performed breathing exercises 10 times with verbal feedback, and the VVG also performed breathing exercises 10 times with verbal feedback and visual feedback with the use of RUSI to measure changes in diaphragm thickness (DT). For DT, the mid-axillary lines between ribs 8 and 9 on both sides were measured in standing, and then the chest wall was perpendicularly illuminated using a linear transducer with the patients in supine to observe the region between rib 8 and 9 and to obtain 2-dimensional images. DT was measured as the distance between the two parallel lines that appeared bright in the middle of the pleura and the peritoneum. After one week, three repetitions (follow-up session) were performed to confirm retention effects. Intra- and between- group percent changes in diaphragm muscle thickness were assessed. Results: In the VVG, the intervention value had a medium effect size compared to the baseline value, but the follow-up value decreased to a small effect size. In the between-group comparisons, during the intervention session, the VVG showed no significant effect on percent change of DT but had a medium effect size compared to the VG (p=0.050, Cohen's d=0.764). During the follow-up session, retention effect did not persist (p=0.311, Cohen's d=0.381). Conclusions: RUSI can be used to provide visual biofeedback and improve performance and retention in the ability to activate the diaphragm muscle in healthy subjects. Future research needs to establish a protocol for respiratory intervention to maintain the effect of diaphragmatic breathing training using RUSI with visual feedback.

• Clinical and Experimental Reproductive Medicine
• /
• 제46권4호
• /
• pp.147-151
• /
• 2019

Objective: The aim of this study was to investigate DNA fragmentation status in human spermatozoa according to specific tail swelling patterns determined via hypo-osmotic swelling test (HOST). Methods: Frozen semen samples from 21 healthy donors were thawed and prepared by the swim-up technique for use in intracytoplasmic sperm injection. The semen samples were treated for 5 minutes as part of the HOST procedure and then underwent the sperm chromatin dispersion test using a Halosperm kit. DNA fragmentation status (large halo, medium halo, small halo, no halo, or degraded) and the specific tail swelling pattern ("a"-"g") were assessed at the level of a single spermatozoon. A total of 42,000 spermatozoa were analyzed, and the percentage of spermatozoa without DNA fragmentation (as evidenced by a large or medium halo) was assessed according to the specific tail swelling patterns observed. Results: The HOST examinations showed that > 93% of spermatozoa across all types displayed no DNA fragmentation. The percentage of spermatozoa without DNA fragmentation was 100% in type "d", 98.67% in type "g", and 98.17% in type "f" spermatozoa. Conclusion: We found that the type "d" spermatozoa displayed no DNA fragmentation, but the other types of spermatozoa also displayed very low rates of DNA fragmentation. This result may be associated with the processing of the spermatozoa by density gradient centrifugation and the swim-up technique.