• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.6
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• pp.2668-2676
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• 2011

In order to analyze the variation in length of stay(LOS) of injury inpatients, we developed severity-adjusted LOS model using Korean National Discharge In-depth Injury Survey data of Center for Disease Control. Appling this model, we calculated predicted values and, after standardizing LOS using the differences from the actual values, analyzed the variation in LOS. Major factors affecting severity-adjusted LOS of injury inpatients were found to be severity, surgery(or no surgery), age, injury mechanism and channel of hospitalization. Result of analysis of the differences between the actual values and predicted values adjusted by decision tree model suggested that there were statistically significant differences by hospital size(number of beds), type of insurance and location of institution. In order to reduce the variation in LOS, efforts should be exerted in developing nationwide treatment protocol, inducing medical institutions to utilize it, and furthermore systematically evaluating it to reduce the variation continually.

• Clinical and Experimental Pediatrics
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• v.58 no.8
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• pp.288-293
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• 2015

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was $4.4{\pm}1.7days$ of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.230-235
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• 2010

Objective : The aim of this study is to compare the surgical outcome of the initial and recent surgical cases, during our 15-years experience, in terms of the surgical strategies and the prognostic factors for surgically remediable epilepsy. Methods : We retrospectively reviewed and compared the surgical outcomes between the initial 256 (Group I) and recent 139 (Group II) patients according to the time period of operation for a total of 518 consecutive epilepsy surgeries at our institution since 1992. The patients of the middle intermediate period, which were subjected to changed surgical strategies, were excluded. Results : The surgical outcome data from the initial and recent groups showed a much improved outcome for patients who underwent temporal lobe epilepsy (TLE) surgery over time. The number of patients with a good outcome (Engel class I-II) was much increased from 87.7% (178 TLE cases of Group I) to 94.8% (79 TLE cases of Group II) and this was statistically significant (p = 0.0324) on univariate analysis. Other remarkable changes were the decreased performance of intracranial invasive studies from 43.5% in Group I to 30.9% in Group II due to the advanced neuroimaging tools. The strip/grid ratio was reduced from 131/32 in Group I to 17/25 in Group II, because of a markedly reduced mesial TLE surgery and an increased extratemporal epilepsy surgery. Conclusion : Our results show that surgical outcome of epilepsy surgery has improved over time and it has shown to be efficient to control medically intractable epilepsy. Appropriate patient selection, comprehensive preoperative assessments and more extensive resection are associated with good postoperative outcomes.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.19-25
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• 2013

Objective : We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. Methods : During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. Results : No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. Conclusion : Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.

• Journal of the Korea Safety Management & Science
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• v.10 no.3
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• pp.29-33
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• 2008

According to statistics released by the Ministry of Labor for the past 6 years, work-related accidents in the construction industry have been on the continued increase, resulting in social and economic losses that are difficult to determine at an exact amount. However, the number will likely get much bigger if unreported cases are included, considering the fact that the aforementioned statistics are based soley on the applications filed with Korea Workers' Compensation and Welfare Service. The practice of businesses choosing not to report and dealing with industrial accidents in an unauthorized manner is defined as "concealment of industrial accident". The reason the employers tend to engage in the concealment practice even at their huge cost is a "pre-qualification" scheme for the applicants in the government procurement process. Under the pre-qualification scheme, the applicants with a high rate of industrial accidents receive a low grade and become less attractive candidates in the procurement process, thus losing an opportunity to win a contract. Such failure relates directly to the fate of business organizations, to survive or not. That is why they are making all-out efforts to obtain a high grade in the pre-qualification evaluation. With regard to the accident-concealment problem, the following can be mentioned as preventive measures: (1) To exclude a rate of industrial accidents from the pre-qualification scheme; (2) To strengthen the institution of imposing penalties on the occurrence of industrial accidents; (3) To introduce private insurance system to the current industrial accident compensation insurance; and (4) To give non-recognition treatment to industrial accidents that were not reported upon occurrence. In conclusion, the concealment problem can be resolved if the aforementioned measures are to be taken continuously along with corrective measures against institutional deficiencies.

• Journal of Trauma and Injury
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• v.33 no.2
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• pp.96-103
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• 2020

Purpose: In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes. Methods: This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows. Results: Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130-1.386), pH level (OR, 0.006; 95% CI, 0.000-0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140-7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111-2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cut-off NLR value of 3.64 was the best for predicting RM. Conclusions: In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.125-131
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• 2014

Purpose: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. Materials and Methods: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Results: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Conclusion: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.205-208
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• 2011

Objective : Retrospective analysis to compare the effect and complication of epidural patient-controlled analgesia (epidural PCA) with intravenous patient-controlled analgesia (IV PCA) for the treatment of the post-operative pain after posterior lumbar instrumented fusion. Methods : Sixty patients who underwent posterior lumbar instrumented fusion for degenerative lumbar disease at our institution from September 2007 to January 2008 were enrolled in this study. Out of sixty patients, thirty patients received IV PCA group and thirty patients received epidural PCA group. The pain scale was measured by the visual analogue scale (VAS) score. Results : There were no significant difference between IV PCA group and epidural PCA group on the PCA related complications (p=0.7168). Ten patients in IV PCA group and six patients in epidural PCA group showed PCA related complications. Also, there were no significant differences in reduction of VAS score between two groups on postoperative 2 hours (p=0.9618) and 6 hours (p=0.0744). However, postoperative 12 hours, 24 hours and 48 hours showed the significant differences as mean of reduction of VAS score (p=0.0069, 0.0165, 0.0058 respectively). Conclusion : The epidural PCA is more effective method to control the post-operative pain than IV PCA after 12 hours of spinal fusion operation. However, during the first twelve hours after operation, there were no differences between IV PCA and epidural PCA.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9471-9473
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• 2014

Background: Since 2002, from October till December of each year, the Lebanese Ministry of Public Health conducts a mammogram based breast cancer screening campaign in the whole country for women over 40 years of age. These mammograms are performed free of charge in governmental hospitals or for reduced fees in private hospitals. The aim of this study is to analyze the direct impact of this campaign on cancer detection and subsequent treatment. Materials and Methods: Radiologic records of women screened with a mammogram during the campaign period from October till December 2012 at Saint Joseph Hospital, Baouchrieh, Beirut, were reviewed. Results of mammograms were reported using the ACR score. Women with ACR score ${\geq}4$ were tracked and investigated. Results: 900 screening mammograms were performed; median age was 55.2 years (range:31-81 years). Some 826 (91.8%) had an ACR score of ${\leq}2$; 66 (7.3%) an ACR =3 and only 8 (0.89%) an ACR=4. Thus, less than 1% (8/900) of all screened women were considered at high risk and needed a close follow-up. Among these 8 women, 4 underwent surgery for an early breast cancer, one had synchronous metastatic breast cancer and two were lost to follow-up. Conclusions: To coclude, Among 900-screened women for BC, less than 1 % (8 out of 900) were at high risk of hiding a BC (ACR=4), half of them benefited from early therapy (4 women out of 900) and one was a false positive. Larger studies on national level should be accomplished to have a complete data on breast cancer screening in Lebanon. The results of these studies can affect the Lebanese health policy regarding BC.

• Korean Journal of Occupational Health Nursing
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• v.9 no.2
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• pp.121-131
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• 2000

This study was conducted to acquire data in order to institute an effective industrial accident compensation insurance(IACI) system. The subjects were employers and employees in small scale industries which have less than 5 employees. The questionnaires consisted of questions on perception and need for IACI. A total of cases were 181 employers and 105 employees participated in the study. Perception and need of employers and employees were assessed using the ANOVA, t-test. The results were as follows ; 1. Workplaces examined mostly in manufacturing(78.9%), industries with one employee(44.1%). Beneficiary rate of IACI 4.4%. 2. 60.0% of employees had experienced an industrial accident and in most cases employers paid the cost of medical treatment. 45.0% of employers nd 50.0% of employees were not aware that IACI had been put into effect starting July, 1, 2000. 52.0% of employers had no type of industrial accident compensation. 3. The need of outcome measures, especially of employers and employees who had an IACE, were higher than those without an IACI. Employers and employees who had experienced an industrial accident outnumbered those who hadn't. The results of this study reveal that there is a great need for the institution of an IACI and health promotion policy in small scale industries.