• Archives of Plastic Surgery
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• 제42권2호
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• pp.131-142
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• 2015

Literature indicates an increased risk of suicide among women who have had cosmetic breast implants. An explanatory model for this association has not been established. Some studies conclude that women with cosmetic breast implants demonstrate some characteristics that are associated with increased suicide risk while others support that the breast augmentation protects from suicide. A systematic review including data collection from January 1961 up to February 2014 was conducted. The results were incorporated to pre-existing suicide risk models of the general population. A modified suicide risk model was created for the female cosmetic augmentation mammaplasty candidate. A 2-3 times increased suicide risk among women that undergo cosmetic breast augmentation has been identified. Breast augmentation patients show some characteristics that are associated with increased suicide risk. The majority of women reported high postoperative satisfaction. Recent research indicates that the Autoimmune syndrome induced by adjuvants and fibromyalgia syndrome are associated with silicone implantation. A thorough surgical, medical and psycho-social (psychiatric, family, reproductive, and occupational) history should be included in the preoperative assessment of women seeking to undergo cosmetic breast augmentation. Breast augmentation surgery can stimulate a systematic stress response and increase the risk of suicide. Each risk factor of suicide has poor predictive value when considered independently and can result in prediction errors. A clinical management model has been proposed considering the overlapping risk factors of women that undergo cosmetic breast augmentation with suicide.

• 한국간담췌외과학회지
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• 제28권2호
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• pp.248-261
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• 2024

Backgrounds/Aims: This study aimed to investigate patterns and factors affecting recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC). Methods: Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection (Barts Pancreas Tissue Bank) were followed up until May 2023. Clinico-pathological variables were analysed using Cox proportional hazards model. Results: Of 91 people (42 males [46%]; median age, 71 years [range, 43-86 years]) with a median follow-up of 51 months (95% confidence intervals [CIs], 40-61 months), the recurrence rate was 72.5% (n = 66; 12 loco-regional alone, 11 liver alone, 5 lung alone, 3 peritoneal alone, 29 simultaneous loco-regional and distant metastases, and 6 multi-focal distant metastases at first recurrence diagnosis). The median time to recurrence was 8.5 months (95% CI, 6.6-10.5 months). Median survival after recurrence was 5.8 months (95% CI, 4.2-7.3 months). Stratification by recurrence location revealed significant differences in time to recurrence between loco-regional only recurrence (median, 13.6 months; 95% CI, 11.7-15.5 months) and simultaneous loco-regional with distant recurrence (median, 7.5 months; 95% CI, 4.6-10.4 months; p = 0.02, pairwise log-rank test). Significant predictors for recurrence were systemic inflammation index (SII) ≥ 500 (hazard ratio [HR], 4.5; 95% CI, 1.4-14.3), lymph node ratio ≥ 0.33 (HR, 2.8; 95% CI, 1.4-5.8), and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.2-0.7). Conclusions: Timing to loco-regional only recurrence was significantly longer than simultaneous loco-regional with distant recurrence. Significant predictors for recurrence were SII, lymph node ration, and adjuvant chemotherapy.

• 한국직업건강간호학회지
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• 제24권2호
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• pp.114-121
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• 2015

Purpose: The purpose of this study was to assess the psychosocial work environment of hospital nurses to identify influences of psychosocial work environment on stress, depression, sleep disorder, and burnout. Methods: A total of 219 nurses working in one hospital were surveyed by using the Korean version of the Copenhagen Psychosocial Questionnaire (COPSOQ-K) mental health and psychosocial work environment. The impact of the psychosocial work environment on mental health was analyzed using multiple regression. Results: Mental health variables are correlated with each other. The psychosocial work environment variables and mental health variables are mostly correlated. To assess the psychosocial work environment that affects mental health the most, multiple regression was used. Work-family conflict was the most powerful explanation of all the mental health variables. Work pace, social community at work, mutual trust among employees, predictability, and influence were found to be affecting some mental health variables. Conclusion: To improve the mental health of nurses, it is necessary to consider work pace, social community at work, mutual trust among employees, predictability, influence focus on work-family conflict.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.153-159
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• 2020

Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates. Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers. Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

• 한국유통학회지:유통연구
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• 제13권2호
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• pp.29-57
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• 2008

본 연구는 유통경로 상에서 서비스기업의 공급업체에 대한 신뢰 및 충성도 구축과정에서 공급업체의 유대관계전략과 서비스기업의 점포 운영기간 사이에 상호작용효과를 실증적으로 분석하였다. 실증을 위해 한국동물병원협회 소속의 214개 동물병원을 표본으로 하여 설문을 수집한 후, 구조방정식 모델을 활용하여 가설을 검증하였다. 실증분석의 결과는 다음과 같다. 첫째, 유통경로 구성원인 공급업체의 서비스기업에 대한 유대관계 전략에 따라 서비스기업이 구축하고자하는 신뢰의 유형에 대해 서로 다른 영향을 주는 것을 확인하였다. 즉, 공급업체의 사회적 유대전략은 서비스기업의 두 가지 유형의 감정적 신뢰 및 인지적 신뢰구축에 모두 영향을 주지만, 구조적 유대전략은 서비스기업의 감정적 신뢰에 영향을 주지만 인지적 신뢰에는 영향을 주지 않았다. 둘째, 공급업체의 사회적 유대전략은 서비스기업의 공급업체에 대한 충성도 구축에 직접적인 영향을 미치지만, 구조적 유대는 충성도 구축에 직접적으로 영향을 미치지 않고 감정적인 신뢰를 통하여 영향을 미쳤다. 셋째, 서비스기업의 감정적 신뢰는 그들의 공급업체에 대한 충성도 구축에 직접적인 영향을 주지만, 서비스기업의 인지적 신뢰는 공급업체에 대한 충성도 구축에 직접적인 영향을 주지 않고 감정적 신뢰를 통하여 형성되었다. 넷째, 서비스기업의 점포 운영기간이 길수록 공급업체는 사회적 유대를 활용하여 서비스기업의 신뢰 및 충성도를 직접적으로 구축하나, 점포 운영기간이 짧을수록 사회적 유대 및 구조적 유대를 부분적으로 활용하여 신뢰를 먼저 구축하고 그런 다음 충성도를 간접적으로 구축하였다. 따라서 유통경로 구성원들 사이에 서비스기업이 그들의 사업파트너인 공급업체에 대한 신뢰의 유형 및 충성도를 구축하기 위해서 서로 다른 유대관계 전략을 활용하며, 공급업체는 서비스 기업의 점포 운영기간에 따라 공급업체에 대한 서비스기업의 신뢰 및 충성도를 구축하는 과정에서 해당점포의 운영기간에 대한 상호작용효과를 고려할 필요가 있다. 마지막으로 연구의 시사점, 한계점 그리고 향후 연구방향에 대해 논의하였다.

• 한국콘텐츠학회논문지
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• 제13권3호
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• pp.278-286
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• 2013

본 연구는 의사의 환자중심 커뮤니케이션(촉진요인, 금지요인)이 환자 참여(행동적 참여, 감정적 참여, 정보적 참여)에 미치는 영향을 분석하기 위한 것이다. 구체적인 연구목적으로는 첫째, 환자중심 커뮤니케이션이 환자참여에 미치는 영향, 둘째, 환자중심의 커뮤니케이션과 환자참여간의 관계에서 신뢰의 조절효과 확인이며, 이를 위하여 국내 종합병원의 환자 301명을 대상으로 SPSS 19.0을 통계패키지를 사용하여 요인분석과 조절회귀분석을 수행하였다. 연구결과, 커뮤니케이션 촉진요인은 행동적 참여, 감정적 참여, 정보적 참여 모두에 유의한 정(+)의 영향을 미치는 것으로 확인되었으나, 금지요인은 영향을 미치지 않는 것으로 나타났다. 또한 신뢰의 조절효과는 촉진요인과 감정적 참여간, 촉진요인과 정보적 참여간에서 발견되었으며, 신뢰의 수준이 높은 집단에서 촉진요인은 감정적 참여와 정보적 참여에 더 큰 영향을 미치는 것으로 확인되었다. 마지막으로 이러한 연구결과를 토대로 환자중심의 커뮤니케이션과 성공적인 의료서비스 제공에 필요한 이론적이고 실무적인 시사점을 제공하였다.

• 품질경영학회지
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• 제37권4호
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• pp.87-99
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• 2009

Medical tourism is a contemporary phenomenon which has its root in both tourism and health service. Especially, Korea's medical tourism market has grown dramatically after activation of foreign patient attraction law. The purpose of this study is to find out which is the most influential factors among political, economic, relative and national image in case of Japanese tourists when they purchase Korean medical tourism. This study estimates the Japanese tourists' Trust in the Korean health service quality and tourism service quality. It means perception of medical tourism. The results are as follows; The political, relative and economic image not have any significant influences on tourism service and trust in health service quality. And just the national image has a positive influence on tourism service and trust in health service quality. Tourism service quality is related with trust in the health service quality. Trust in health service quality is only related with purchase intention of medical tourism. The implications of this study are: First, the national image factors such as thoughtfulness, high education and polite attitude should be utilized as a Korea medical tourism marketing strategy to differentiate itself from the other foreign country in Japan. Next, the differentiated national image in Japan will be the most important factors for Korean hospital and tourism companies to attract medical tourists.

• 한국의료질향상학회지
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• 제28권1호
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• pp.34-44
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• 2022

Purpose:We investigated physicians' responses to a series of clinical vignettes consisting of patient safety incidents, with and without disclosure of patient safety incidents (DPSI). Methods: An anonymous survey was conducted to investigate physicians' responses to the DPSI via online communities of physicians, and additional participants were recruited using a snowballing sampling method. We evaluated physicians' responses to the DPSI using eight hypothetical scenarios (HS) from the following perspectives: thoughts regarding medical errors, revisiting the physician, recommendation, lawsuit, criminal prosecution, trust score, and compensation amounts. We used the chi-square test to evaluate the overall differences in response rates among the scenarios. Statistical analyses were performed using the Student's t-test to compare the trust scores and compensation amounts. Results: A total of 910 physicians participated in this survey. An overall comparison of trust scores among HS showed that HS 1 (unclear medical errors, minor harm, and DPSI) had the highest trust score. In contrast, in the opposite scenario, HS 8 (clear medical errors, major harm, and DPSI not conducted) received the lowest scores. Cases with minor harm to patients (HS 1, 2, 5, and 6) showed lower compensation amounts than the others (HS 3, 4, 7, and 8). Physicians were more likely to think of situations with DPSI as not having medical errors (53.1% vs. 55.2%). In addition, the scenarios with DPSI were evaluated favorably in terms of intention to revisit, recommend, suit, and engage in criminal proceedings. Physicians showed higher trust scores (6.2 vs 5.4) and gave lower compensation amounts ($27.7 million vs $28.1 million), although there was no significant difference in terms of compensation amounts to the physician conducting DPSI. Conclusion: Our study showed overall positive perceptions regarding DPSI among Korean physicians.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.270-276
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• 2022

Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.

• 한국병원경영학회지
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• 제17권4호
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• pp.32-57
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• 2012

This paper explored that medial consumers' trusts in both hospitals and doctors are developed by and during investigating hospital websites and that these trusts directly build the consumers' purchase intentions of the hospitals' offline medical services. 208 questionnaires based on the websites of two virtual hospitals, captured on survey brochures, were collected and analyzed. This research indicated information quality of hospital websites affected more on developing consumers' trusts than service quality.