• Archives of Plastic Surgery
• /
• v.48 no.3
• /
• pp.254-260
• /
• 2021

Background Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps. Methods We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed. Results A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures. Conclusions The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

• Journal of Home Health Care Nursing
• /
• v.30 no.2
• /
• pp.183-193
• /
• 2023

Purpose: This study was aimed at identifying the factors influencing the practice of taegyo in pregnant women. Methods: A descriptive survey-based study design was used. The study included 210 married pregnant women aged 19 years or higher, excluding pregnant women from multicultural families, who attended the outpatient obstetrics and gynecology departments of a general hospital and a tertiary hospital in C City, from June 29, 2022, to September 8, 2022. Independent t-test, analysis of variance, and multiple regression analysis were used to determine the factors influencing the practice of taegyo. Results: The mean of the subjects' practice of taegyo was 3.49 ± 0.47. The factors influencing the practice of taegyo among pregnant women were perception of taegyo and spousal support. The higher the perceptions of taegyo and the greater the spousal support, the higher the practice of taegyo. The explanatory power of the regression model was approximately 49.2%. Conclusion: The factors influencing the practice of taegyo among pregnant women were confirmed to be the perception of taegyo followed by spousal support. The findings of the study confirmed that efforts to improve the perception of taegyo and spousal support are necessary to improve the adoption of the practice of taegyo among pregnant women.

• Journal of Korean Clinical Nursing Research
• /
• v.17 no.2
• /
• pp.228-238
• /
• 2011

Purpose: The purpose of this study was to investigate parent expectation and satisfaction with respect to pediatric inpatient care and to identify the variables related to parent satisfaction. Methods: The study was conducted in pediatric wards of a tertiary children's hospital in Korea. The participants were 361 parents of children who were inpatients. Data were collected using a structured questionnaire (The Pediatric Family Satisfaction Questionnaire) at the time of discharge. Results: The highest parent expectation domain was medical service. The parents were most satisfied with nursing service and least satisfied with general hospital service and accommodation. The parents expressed lower satisfaction with hospital facilities, equipment, noise, cleanliness, and communication by health care professionals. Parents with younger children reported higher expectation from the complete hospital service and those who had a longer length of stay reported higher expectation from the nursing service. Conclusion: To improve the quality of hospital services, we need to understand parent expectation and improve and provide clear communication. In addition, the general hospital service and accommodation should not be overlooked for improvement.

• Journal of Trauma and Injury
• /
• v.32 no.2
• /
• pp.93-100
• /
• 2019

Purpose: Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India. Methods: A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed. Results: There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries. Conclusions: Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

• Journal of Korean Academy of Nursing Administration
• /
• v.19 no.5
• /
• pp.565-577
• /
• 2013

Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

• Health Policy and Management
• /
• v.15 no.3
• /
• pp.94-113
• /
• 2005

The purpose of this study was to determine the level of appropriateness in hospital stays and factors influencing inappropriate hospital stays. The study was conducted at fifteen general care units in a tertiary university hospital. Appropriateness of hospital stay was assessed using Appropriateness Evaluation Protocol by trained head nurses. The total of 447 patient records were reviewed. Among them, 352 patient data were included in the final data set. A unit of observation was patient day. A rate of appropriate hospital stay was calculated per patient as a unit of analysis. Multiple regression analysis was performed to determine the factors affecting inappropriate hospital stay. The eighty-three percent (2030/2651) of hospital stays were evaluated as appropriate. There were significant differences in appropriateness of hospital stay according to patient's age, type of health insurance, medical specialty, and length of stay(p<0.05). In the multiple regression analysis, medical speciality was the most significant factor to predict the inappropriate hospital stay. The study showed a substantial proportion of hospital stay was found to inappropriate. Level of appropriateness was significantly different from medical specialty. Interdepartmental approach should be required to coordinate and improve appropriate resource utilization.

• Journal of Preventive Medicine and Public Health
• /
• v.26 no.3 s.43
• /
• pp.457-468
• /
• 1993

This study was conducted to investigate the repeat test rate for diagnosis at a tertiary hospital for the outpatients who were referred themselves to the hospital by the clinics and other medical facilities. The study population consisted of 498 patients who visited outpatient department of internal medicine, general surgery, orthopedic surgery and neurosurgery in the hospital between March 16 and April 11, 1992. This study was surveyed by the questionnaire about the tests for diagnosis at first level medical facilities, and then, was investigated by the medical record about the tests for diagnosis at a tertiary hospital. The proportion of test among the patients who utilized the first level medical facilities was 20.9% for the X-ray test, 10.6% for the urinalysis, 9.0% for the electrocardiogram, 3.4% for the computer tomogram and 6.4% for the ultrasonogram. At the tertiary hospital, the X-ray test was 45.2%, the liver function test was 24.1%, the urinalysis was 19.1%, and the electrocardiogram was 15.7%. The proportion of patients who possessed results of test for diagnosis at the first level medical facilities was 76.5% for the computer tomogram, and 31.3% for the ultrasonogram. As the repeat test rate between the first level medical facilities and the tertiary hospital, the thyroid function test was the first rank as 71.4%, the second rank was the routine CBC as 67.9%, and the third rank was the X-ray test as 64.4%. But among the patients that brought the result for tests at the first level medical facilities, the repeat test rate was as follow : the routine CBC was 75.0%, the liver function test was 72.1%, and the computer tomogram was 15.4%.

• Journal of Yeungnam Medical Science
• /
• v.40 no.2
• /
• pp.156-163
• /
• 2023

Background: Interest in digital medical information has increased because it allows doctors to easily access a patient's medical records and provide appropriate medical care. Blockchain technology ensures data safety, reliability, integrity, and transparency by distributing medical data to all users over a peer-to-peer network. This study attempted to assess pediatricians' thoughts and attitudes toward introducing blockchain technology into the medical field. Methods: This study used a questionnaire survey to examine the thoughts and attitudes of 30- to 60-year-old pediatricians regarding the introduction of blockchain technology into the medical field. Responses to each item were recorded on a scale ranging from 1 (never agree) to 7 (completely agree). Results: The scores for the intentions and expectations of using blockchain technology were 4.0 to 4.6. Pediatricians from tertiary hospitals responded more positively (4.5-4.9) to the idea of using blockchain technology for hospital work relative to the general population (4.3-4.7). However, pediatricians working in primary and secondary hospitals had a slightly negative view of the application of blockchain technology to hospital work (p=0.018). Conclusion: When introducing the medical records of related pediatric and adolescent patients using blockchain technology in the future, it would be better to conduct a pilot project that prioritizes pediatricians in tertiary hospitals. The cost, policy, and market participants' perceptions are essential factors to consider when introducing technology in the medical field.

• Journal of Korean Clinical Nursing Research
• /
• v.29 no.3
• /
• pp.238-248
• /
• 2023

Purpose: This study aimed to examine the relationships between positive nursing organizational culture, organizational communication satisfaction, and the level of work engagement among nurses working in tertiary hospitals, as well as to identify influencing factors on work engagement. Methods: This study used a descriptive research design. Data were collected from 184 general nurses working in four tertiary hospitals in Seoul using self-report questionnaires from March 13 to 30, 2023. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, Pearson correlation, and hierarchical regression. Results: In the hierarchical regression analysis, the variables that significantly influenced work engagement in Model 1 were marital status (β=.26, p=.002), graduate or higher degree (β=.41, p<.001), more than 1 year and less than 3 years (β=.18, p=.030) and 3 years or more but less than 5 years of clinical experience in present hospital (β=.17, p=.023), and satisfaction (β=.27, p=.002) and moderate satisfaction with pay (β=.18, p=.033). In model 2, adding the subdomains of positive nursing organizational culture and organizational communication satisfaction to the Model 1, the variables that had a significant effect on work engagement were trust-based organizational relationships (β=.50, p<.001) and organizational communication satisfaction (β=.25, p=.005). Conclusion: The results suggest that education level, clinical experience, and satisfaction with pay should be considered to improve nurses' work engagement. In addition, it was identified that organizational relationship based on trust and organizational communication satisfaction are the main influencing factors for improving work engagement.

• Journal of Society of Preventive Korean Medicine
• /
• v.10 no.2
• /
• pp.147-158
• /
• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.