• Archives of Plastic Surgery
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• v.33 no.6
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• pp.748-752
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• 2006

Purpose:Circular skin lesions between 10 and 35 mm in diameter generate problems often. Direct closure of the lesion risks excessive wound tension or wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. We treated this circular medium-sized skin lesion(10 - 35 mm sized) by reducing opposed multilobed(ROM) flap. Methods: ROM flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. Direction of the semicircular multilobed flap is set parallel to relaxed skin tension line(RSTL) to minimize scar formation. First semicircle is drawn 60% in diameter of the defect. Second semicircles are drawn at the cephalic and caudal aspects of the original semicircles. These semicircles are 60% in diameter of the first semicircle. Additional semicircles are repeatedly drawn until the tension of skin flaps becomes free. ROM flap has a length-to-base ratio of 0.5 resulting in lower theoretical risk of end flap necrosis than a random pattern flap with a large ratio. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. Results: The ROM flap reduces skin tension concerns, lowers the risk of flap necrosis and allows for quicker and more aesthetic healing. Results were generally good and major complications, such as dehiscence, infection, or delayed healing, did not occur. Conclusion: ROM flap repair allows the plastic surgeon an additional option when faced with a circular medium-sized skin lesion.

• Health Policy and Management
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• v.12 no.2
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• pp.115-135
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• 2002

Many tertiary hospitals have started to establish cooperative relationships with small and medium sized hospitals in Korea. But the performance of the relationship is not satisfactory to both of partners. The relationship and performance of cooperation for small and medium sized hospitals are analyzed according to the framework of inter-organizational cooperation. Data are collected by 4 focal hospital and 34 small and medium sized hospitals through interview and questionnaire. The findings are : a) The cooperation is focused on management area, such as healthcare technology transfer and information sharing, rather than patient referral. b) Patient referral is not yet active in cooperative relationship. But some partner hospitals which is located close and managing internal organization for cooperation show a significant number of referrals. c) The characteristics of high performers are positive attitude about cooperation, and recognition of the relationship as flexible, experiences of cooperation, internal and external management activities.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.22 no.1
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• pp.7-15
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• 2015

Purpose: This study was done to investigate the correlation among emotional labor, nursing professional values, and job satisfaction and identify factors that affect job satisfaction of nurses working in small and medium-sized hospitals. Methods: Data were collected from 214 nurses in S city. The following measurement tools were used: Emotional labor by Morris et al. (1996), Nursing Professional Values Scale by Yeun et al. (2005), and Index of Work Satisfaction by Stamps et al. (1978). Collected data were analyzed with SPSS/WIN 18.0 using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression. Results: Participants' scores for emotional labor, nursing professional values and job satisfaction were $3.11{\pm}0.48$, $3.46{\pm}0.39$, and $3.02{\pm}0.29$ respectively. Emotional labor showed a negative correlation with job satisfaction (r=-.33, p<.001), while nursing professional values showed a positive correlation with job satisfaction (r=.58, p<.001). Emotional labor and nursing professional values were identified as factors influencing job satisfaction. The model explained about 39% of the variance in job satisfaction (F=67.40, p<.001). Conclusion: The results of this study suggest that it is important to manage emotional labor as well as to improve professional values and job satisfaction of nurses working in small and medium-sized hospital.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.983-994
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• 2021

Objective : The effectiveness of gamma knife radiosurgery (GKR) in the treatment of brain metastases is well established. The aim of this study was to evaluate the efficacy and safety of maximizing the radiation dose in GKR and the factors influencing tumor control in cases of small and medium-sized brain metastases from non-small cell lung cancer (NSCLC). Methods : We analyzed 230 metastatic brain tumors less than 5 mL in volume in 146 patients with NSCLC who underwent GKR. The patients had no previous radiation therapy for brain metastases. The pathologies of the tumors were adenocarcinoma (n=207), squamous cell carcinoma (n=18), and others (n=5). The radiation doses were classified as 18, 20, 22, and 24 Gy, and based on the tumor volume, the tumors were categorized as follows : small-sized (less than 1 mL) and medium-sized (1-3 and 3-5 mL). The progression-free survival (PFS) of the individual 230 tumors and 146 brain metastases was evaluated after GKR depending on the pathology, Eastern Cooperative Oncology Group (ECOG) performance score (PS), tumor volume, radiation dose, and anti-cancer regimens. The radiotoxicity after GKR was also evaluated. Results : After GKR, the restricted mean PFS of individual 230 tumors at 24 months was 15.6 months (14.0-17.1). In small-sized tumors, as the dose of radiation increased, the tumor control rates tended to increase (p=0.072). In medium-sized tumors, there was no statistically difference in PFS with an increase of radiation dose (p=0.783). On univariate analyses, a statistically significant increase in PFS was associated with adenocarcinomas (p=0.001), tumors with ECOG PS 0 (p=0.005), small-sized tumors (p=0.003), radiation dose of 24 Gy (p=0.014), synchronous lesions (p=0.002), and targeted therapy (p=0.004). On multivariate analyses, an improved PFS was seen with targeted therapy (hazard ratio, 0.356; 95% confidence interval, 0.150-0.842; p=0.019). After GKR, the restricted mean PFS of brain at 24 months was 9.8 months (8.5-11.1) in 146 patients, and the pattern of recurrence was mostly distant within the brain (66.4%). The small and medium-sized tumors treated with GKR showed radiotoxicitiy in five out of 230 tumors (2.2%), which were controlled with medical treatment. Conclusion : The small-sized tumors were effectively controlled without symptomatic radiation necrosis as the radiation dose was increased up to 24 Gy. The medium-sized tumors showed potential for symptomatic radiation necrosis without signifcant tumor control rate, when greater than 18 Gy. GKR combined targeted therapy improved the tumor control of GKR-treated tumors.

• Journal of radiological science and technology
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• v.45 no.3
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• pp.263-272
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• 2022

This study investigated small and medium-sized hospital workers' knowledge of COVID-19, the infection-control-related fatigue and stress levels, and the factors that impacted their performance during the COVID-19 pandemic. Using a cross-sectional design, data were collected from 137 hospital workers from four small and medium-sized hospitals in S and C cities. Data were analyzed using descriptive statistics, a t-test, analysis of variance(ANOVA), Pearson's correlation coefficient, and multiple linear regression analysis. Small and medium-sized hospital workers' knowledge of COVID-19 revealed a correct answer rate of 66%. An average of 3.00 points out of 4 for infection control performance and 3.32 and 3.17 points out of 5 for infection-control-related fatigue and stress, respectively, were found. The level of knowledge regarding COVID-19 significantly differed by age and marriage (p<0.05), while infection control performance significantly differed by age, marriage, and infection control education experience (p<0.05). Infection-control-related fatigue and stress differed depending on the COVID-19 control education experience, economic and social prejudice, and fear of discrimination. There were positive correlations between knowledge and infection control performance, and infection control performance and infection-control-related fatigue and stress (p<0.001). This study showed that the factors that affected small and medium-sized hospital workers' performance included knowledge of "environmental management," "difficulties due to new role requirements," "presence or absence of infection education experience," "job type," and "age." These results suggest that practical and detailed education programs should be systematically developed and implemented for effective infection control.

• The Journal of the Korea Contents Association
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• v.18 no.5
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• pp.191-214
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• 2018

This research empirically analyzed the selection factors and the locational selection factors of the medical service facilities according to the gradual increase of the importance of the selection factors and the locational selection factors regarding the establishments of the small- and medium-sized hospitals according to the rapid changes of the socio-economic conditions. By analyzing the priority order according to the levels of the importance of each evaluation item factor through a research related to the selection factors and the locational selection factors of the small- and medium-sized hospitals and by drawing what the important factors that have the influences on the competitiveness of the pre-existent small- and medium-sized hospitals are through the classification of the real estate locational factors and the non-locational factors, the purpose lies in utilizing them as the basic data and materials for the opening strategies of the small- and medium-sized hospitals considering the special, locational characteristics according to the important factors of the selection factors of the small- and medium-sized hospitals, regarding the medical suppliers that have been preparing, for opening the new, small- and medium-sized hospitals. Based on the results of the preceding researches and the researches on the case examples, 28 evaluation factors were arrived at in terms of the level of the medical treatment, the medical services, the accessibilities of the hospitals, the conveniences of the hospitals, and the physical environment. And, regarding the 28 detailed evaluation factors that had been collected, through the interviews with the related experts, the 5 factors of the medical level, the medical service, the expertise of the hospital, the convenience of the hospital, and the physical environment were selected as the upper class evaluation factors. And, according to each upper class, a total of 28 low-part evaluation factors were selected. Regarding the optimal evaluation factors that were selected, the optimal locational factors were selected by carrying out an AHP questionnaire survey investigation with 200 medical experts as the subjects. Regarding the AHP analysis results, similarly with the case examples of the precedent researches, the levels of the importance appeared in the order of the medical level, the medical services, the accessibility of the hospital, the physical environment, and the convenience. And the factors that were related to the facilities of a hospital appeared low. The results of this research can be applied in providing the basis for the decision-makings regarding the selections of the locations of the small- and medium-sized hospitals in the future.

• The Korean Journal of Health Service Management
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• v.6 no.3
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• pp.39-52
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• 2012

Main purpose of this study is to provide some managerial suggestions for local small and medium-sized hospitals that are in poorer business environment than large hospitals such as university hospitals, in managing the manpower efficiently, improving business performance and enhancing competitiveness, by empirically investigating the relationship among competency, organizational structure and business performance. Major results are as follows: First, regression analysis for the effects of hospital competency on nonfinancial performance revealed that marketing competency, intangible resource competency and financial resource competency, in that order of importance, had significant influence on nonfinancial performance. Second, regarding the analysis of the effects of hospital competency on financial performance, financial resource competency, marketing competency and intangible resource competency, in that order of importance, significantly affected financial performance. Third, as for the moderating effect, significant result was obtained in an interaction between hospital competency and organizational structure. Financial resource competency had a positive significant impact on nonfinancial performance. However, it had negative significant impact on it by interactive effect with organizational structure.

• Journal of Korean Clinical Nursing Research
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• v.24 no.1
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• pp.67-73
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• 2018

Purpose: This study was done to explore the relationship between expectations of the clinical ladder system (CLS), career commitment and turnover intention in nurses employed in small-medium sized hospitals. Methods: Participants were 154 nurses from 3 small-medium sized hospitals in Gyeonggi Province and Gwangju City. From February, 8 to April, 14, 2017, self-report questionnaires were collected and analyzed using frequency, t-test, ANOVA, $Scheff{\acute{e}}$ test, and Person correlation coefficients. Results: Of the participant nurses, 61% perceived the CLS as needed. The mean score for expectation of CLS, career commitment, and turnover intention on 5-point scale were 3.38, 3.17, 3.21, respectively. There were no significant differences in expectation of CLS according to general characteristics, but career commitment and turnover intention did show significant differences depending on age, position, type of work shift. Expectation of CLS correlated positively with career commitment (r=.23, p=.005), and career commitment correlated negatively with turnover intention (r=-.49, p<.001). Conclusion: The results of this study show that there is a need to adopt the clinical ladder system to improve career commitment.

• Journal of Home Health Care Nursing
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• v.29 no.2
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• pp.216-224
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• 2022

Purpose: This study aimed to investigate the influence of the perception of the importance of patient safety management and culture on employees' safety performance in small and medium -sized hospitals. Methods: The participants comprised 119 hospital employees, including nurses, doctors, and medical technicians. Data were analyzed through descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression analysis using the SPSS program. Results: The mean safety performance was 4.09±0.34, mean safety compliance was 4.12±0.44, and safety participation was 4.06±0.38. There were significant differences in safety performance by gender and job. Safety performance and its assocation with both perception of importance on patient safety management and, perception of patient safety culture showed a positive correlation. Safety performance was influenced by the perception of patient safety culture. The explanatory power was 15.7%. Conclusion: Based on these results, improving the perception of patient safety culture is necessary to increase safety performance. To this end developing and applying an interprofessional safety performance education program for employees in small and medium-sized hospitals is vital.

• Journal of Korean Clinical Nursing Research
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• v.15 no.2
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• pp.103-114
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• 2009

Purpose: The purpose of this study was to investigate factors which affect the quality of nursing services and intention to revisit as perceived by hospitalized patients and nurses in medium sized urban hospitals. Methods: The SERVQUAL scale, a measurement of overall nursing services and intention to revisit a medical institution, was used. The sample consisted of 223 patients and 239 nurses from four medium sized hospitals in I city. Frequencies, t-test, One-way ANOVA, Pearson correlation coefficient and Stepwise method regression were used to analyze the data. Results: For expectation, nurse and patient perceptions were similar, but for performance, patient perception was significantly higher than nurse perception for five factors. The factors affecting intention to revisit the hospital were those recommending, satisfaction with medical and nursing services. Conclusion: The findings indicate that differences between expectations and performance for both patients and nurses need to be reduced in order to elevate patient satisfaction. A precondition for intention to revisit and increased satisfaction is the development of marketing strategies as well as intervention programs in nursing.