• Journal of Chest Surgery
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• 제41권3호
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• pp.329-334
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• 2008

배경: 경피적 순환 보조장치는 다른 수단으로는 소생이 불가능한 심인성 쇼크 환자에 있어서 매우 효과적인 생명유지 장치이다. 특히 심근경색 및 고위험군의 관상동맥중재술, 심장수술 후 심인성 쇼크 등 다양한 임상상황에서 사용되며, 사용이 손쉬운 장점을 가지고 있다. 저자들은 급성 심근경색으로 입원한 환자 중 심인성 쇼크가 발생하여 경피적 순환 보조장치를 사용한 환자들의 초기경험을 분석하였다. 대상 및 방법: 2005년 1월부터 2006년 12월까지 급성 심근경색에 의한 심인성 쇼크 환자 8명에게 경피적 순환 보조장치(CAPIOX emergent bypass system, $EBS^{(R)}$, Terumo Inc., Tokyo, Japan)를 적용하였다. Seldinger방법을 사용하여 대퇴정맥에 20Fr의 유입관을 우심방까지 거치하고, 대퇴동맥에 16Fr의 유출관을 거치하면서 동시에 자가 충진을 완료하였다. 혈류량을 $2.5{\sim}3.0L/min/m^2$으로 유지하였고, 헤파린을 정주하면서 ACT를 200초 이상으로 유지하였다 결과: 환자의 평균나이는 $61.1{\pm}14.2$세($39{\sim}77$세)였다. 관상동맥중재술(PCI) 시행 이전에 거치한 경우가 3예, 중재술 도중 발생하여 거치한 경우가 3예, 중재술 후가 1예, 관상동맥우회술 후가 1예였다. 평균 $EBS^{(R)}$가동시간은 $47.5{\sim}27.9$시간$(8{\sim}76$시간)이었으며, 이 중 $EBS^{(R)}$ 이탈이 가능하였던 경우가 5명(62.5%)으로 이들은 모두 퇴원이 가능하였다. $EBS^{(R)}$적용으로 인한 합병증은 모두 3예로 급성 신부전이 2예, 위장관 출혈이 1예 있었다. 사망한 3명의 환자 중 2명은 $EBS^{(R)}$ 적용 전 심정지가 와 있었던 경우였으며, 1명은 난치성 심실세동이 있었던 경우였다. 퇴원한 환자는 모두 생존하여 평균 $16.8{\pm}3.1$개월($12{\sim}20$개월)째 외래 추적관찰 중이다. 결론: 다른 방법으로 소생이 힘든 급성 심근경색으로 인한 심인성 쇼크 환자에게 $EBS^{(R)}$를 적용함으로써 환자의 생명을 구할 수 있었고, 일단 회복된 환자들은 별다른 후유증 없이 생존하였다. 향후 $EBS^{(R)}$의 적절한 적용시기와 적용방법에 대해서는 보다 많은 경험 및 임상연구가 필요할 것으로 생각된다.

• 대한간호학회지
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• 제11권1호
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• pp.65-87
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• 1981

The study is aimed at exploring concept held by clinical nurses of nursing. The data were collected from 225 nurses conviniently selected from the population of nurses working in Kang Won province. Findings include. 1) Nurse's Qualification. The respondents view that specialized knowledge is more important qualification of the nurse. Than warm personality. Specifically, 92.9% of the respondents indicated specialized knowledge as the most important qualification while only 43.1％ indicated warm personality. 2) On Nursing Profession. The respondents view that nursing profession as health service oriented rather than independent profession specifically. This suggests that nursing profession is not consistentic present health care delivery system nor support nurses working independently. 3) On Clients of Nursing Care The respondents include patients, family and the community residents in the category of nursing care. Specifically, 92.0％ of the respondents view that patient is the client, while only 67.1％ of nursing student and 74.7％ of herself. This indicates the lack of the nurse's recognition toward their clients. 4) On the Priority of Nursing care. Most of the respondents view the clients physical psychological respects as important component of nursing care but not the spiritual ones. Specially, 96.0% of the respondents indicated the physical respects, 93% psychological ones, while 64.1% indicated the spiritual ones. This means the lack of comprehensive conception on nursing aimension. 5) On Nursing Care. 91.6% of the respondents indicated that nursing care is the activity decreasing pain or helping to recover illness, while only 66.2% indicated earring out the physicians medical orders. 6) On Purpose of Nursing Care. 89.8% of the respondents indicated preventing illness and than 76.6% of them decreasing 1;ai of clients. On the other hand, maintaining health has the lowest selection at the degree of 13.8%. This means the lack of nurses' recognition for maintaining health as the most important point. 7) On Knowledge Needed in Nursing Care. Most of the respondents view that the knowledge faced with the spot of nursing care is needed. Specially, 81.3% of the respondents indicated simple curing method and 75.1%, 73.3%, 71.6% each indicated child nursing, maternal nursing and controlling for the communicable disease. On the other hand, knowledge w hick has been neglected in the specialized courses of nursing education, that is, thinking line among com-w unity members, overcoming style against between stress and personal relation in each home, and administration, management have a low selection at the depree of 48.9%,41.875 and 41.3%. 8) On Nursing Idea. The highest degree of selection is that they know themselves rightly, (The mean score measuring distribution was 4.205/5) In the lowest degree,3.016/5 is that devotion is the essential element of nursing, 2.860/5 the religious problems that human beings can not settle, such as a fatal ones, 2,810/5 the nursing profession is worth trying in one's life. This means that the peculiarly essential ideas on the professional sense of value. 9) On Nursing Services. The mean score measuring distribution for the nursing services showed that the inserting of machine air way is 2.132/5, the technique and knowledge for surviving heart-lung resuscitating is 2.892/s, and the preventing air pollution 3.021/5. Specially, 41.1% of the respondents indicated the lack of the replied ratio. 10) On Nurses' Qualifications. The respondents were selected five items as the most important qualifications. Specially, 17.4% of the respondents indicated specialized knowledge, 15.3% the nurses' health, 10.6％ satisfaction for nursing profession, 9.8% the experience need, 9.2% comprehension and cooperation, while warm personality as nursing qualifications have a tendency of being lighted. 11) On the Priority of Nursing Care The respondents were selected three items as the most important component. Most of the respondents view the client's physical, spiritual: economic points as important components of nursing care. They showed each 36.8%, 27.6%, 13.8% while educational ones showed 1.8%. 12) On Purpose of Nursing Care. The respondents were selected four items as the most important purpose. Specially,29.3% of the respondents indicated curing illness for clients, 21.3% preventing illness for client 17.4% decreasing pain, 15.3% surviving. 13) On the Analysis of Important Nursing Care Ranging from 5 point to 25 point, the nurses' qualification are concentrated at the degree of 95.1%. Ranging from 3 point to 25, the priorities of nursing care are concentrated at the degree of 96.4%. Ranging from 4 point to 16, the purpose of nursing care is concentrated at the degree of 84.0%. 14) The Analysis, of General Characteristics and Facts of Nursing Concept. The correlation between the educational high level and nursing care showed significance. (P < 0.0262). The correction between the educational low level and purpose of nursing care showed significance. (P < 0.002) The correlation between nurses' working yeras and the degree of importance for the purpose of nursing care showed significance (P < 0.0155) Specially, the most affirmative answers were showed from two years to four ones. 15) On Nunes' qualification and its Degree of Importance The correlation between nurses' qualification and its degree of importance showed significance. (r = 0.2172, p< 0.001) 0.005) B. General characteristics of the subjects The mean age of the subject was 39 ; with 38.6% with in the age range of 20-29 ; 52.6% were male; 57.9％ were Schizophrenia; 35.1% were graduated from high school or high school dropouts; 56.l％ were not have any religion; 52.6% were unmarried； 47.4% were first admission; 91.2% were involuntary admission patients. C. Measurement of anxiety variables. 1. Measurement tools of affective anxiety in this study demonstrated high reliability (.854). 2. Measurement tools of somatic anxiety in this study demonstrated high reliability (.920). D. Relationship between the anxiety variables and the general characteristics. 1. Relationship between affective anxiety and general characteristics. 1) The level of female patients were higher than that of the male patient (t = 5.41, p < 0.05). 2) Frequencies of admission were related to affective anxiety, so in the first admission the anxiety level was the highest. (F = 5.50, p < 0.005). 2, Relationship between somatic anxiety and general characteristics. 1) The age range of 30-39 was found to have the highest level of the somatic anxiety. (F = 3.95, p < 0.005). 2) Frequencies of admission were related to the somatic anxiety, so .in first admission the anxiety level was the highest. (F = 9.12, p ＜ 0.005) 0. Analysis of significant anxiety symptoms for nursing intervention. 1. Seven items such as dizziness, mental integration, sweating, restlessness, anxiousness, urinary frequency and insomnia, init. accounted for 96％ of the variation within the first 24 hours after admission. 2. Seven items such as fear, paresthesias, restlessness, sweating insomnia, init., tremors and body aches and pains accounted for 84% of the variation on the 10th day after admission.

• Journal of Oral Medicine and Pain
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• 제31권4호
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• pp.297-316
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• 2006

의료분쟁 증가는 하나의 사회현상으로 특히, 인터넷을 통한 의료사고와 관련된 정보의 생산과 유통이 급속도로 증가되고 있는 현상을 간과해서는 안 된다. 본 연구는 2006년 3월 기준으로 인터넷 야후 포털 사이트에서 '의료사고'를 검색어로 하여 검색된 의료사고 관련 정보를 제공하는 웹사이트 28개를 사이트 개설자별로 분류하고 사이트 구성내용을 분석하여 의료사고 관련 사이트들의 현황과 개선되어야 할 문제점들을 비교 점검한 후 올바른 의료분쟁 해결을 위한 발전 방향을 모색하는 것을 연구목적으로 하여 분류항목별 전체 개수에 대한 비율을 조사한 결과 다음과 같은 결과를 얻었다. 1. 용어의 선호도에서 의료인, 일반인, 법조인 모두 '의료사고'라는 용어에 가장 익숙하거나 이를 선호하는 것으로 나타났다. 2. '의료사고' 검색어로 검색된 개설자별 사이트 개수를 비교한 결과 28개 사이트 중 의료인 4개, 일반인 7개, 법조인 17개였다. 의료인 중 치과의사가 개설한 사이트는 단지 1개였다. 3. 진료기록부 분석원을 따로 둔 일반인과 법조인 개설 사이트의 비율은 높았으며 치과관련 부분은 전무하였다. 4. 일반인은 의료사고 예방법에, 법조인은 의료사고 발생 이후 처리 과정에 주된 관심을 갖고 있는 것으로 보였으며, 이에 반해 의료사고 대책에 관해서 의료인 개설 사이트는 비중이 적은 것을 관찰할 수 있었다. 5. 일반인은 의료사고 발생시 대책으로 정부가 주도하는 공정한 제3자의 개입을 희망하는 것으로 조사되었다. 6. 개설자별 비교에서 의료인 개설 사이트는 의료사고에 대한 실례를 다른 개설 사이트에 비해 적게 다루는 것으로 나타났다. 7. 의료사고 상담글에서 치과 관련 내용이 많은 것에 비해 실제 판례 소개는 미미한 것으로 나타났다. 8. 국내 치과 판례 중 관혈적인 치과 치료에 대한 판례글이 많았던 반면 국내 공개 상담글은 비보험관련 치과 치료에 대한 상담글이 많았다. 9. 개설자별 의료사고 관련 정보 제공 게시판 글의 비교에서 일반인은 관련 용어, 의료인은 관련 의학지식, 법조인은 관련 법률에 대한 내용이 많았다. 10. 의료인, 일반인, 법조인 개설 사이트 모두 국내 의료사고 현황을 제공하는 형태로 언론보도 자료를 주로 사용하였으며, 일반인 개설 사이트 중 특히, 시민단체에서는 의료사고 관련 통계자료를 비중있게 다루고 있었다. 11. 적기는 하지만 의료사고 관련 사건을 수집하는 배너가 존재하는 사이트도 있었다. 이상의 결과를 볼 때 범람하는 정보들 속에서 제3자의 그릇된 정보로 의료분쟁 발생률이 증가될 소지가 크지만 의료인은 의료사고에 대해 가장 소극적인 것으로 나타나 이에 대해 향후 법조인-의료인, 환자-의료인, 일반인-의료인간의 상호대화와 정보교류를 통한 올바른 이해를 바탕으로 의료분쟁을 보다 적극적이고 능동적으로 조정, 해결하려는 노력을 보여야 할 것으로 사료된다.

• Journal of Chest Surgery
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• 제40권12호
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• pp.837-842
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• 2007

배경: 미숙아는 흔히 동맥관의 폐쇄가 지연되어 혈역학적으로 의미 있는 좌우단락을 초래함으로 환아의 성장 및 정상 발육에 악영향을 미친다. 저자들은 액와 소개흉술을 통한 미숙아 동맥관 개존증 폐쇄의 효과에 대해 알아보고자 하였다. 대상 및 방법: 2002년 4월부터 2006년 10월까지 동맥관 개존증을 동반한 재태기간 37주 미만의 미숙아 중 인도메타신 부적응증 또는 치료 실패 등으로 수술적 교정을 받은 20명을 대상으로 하였다. 출생 당시 재태기간은 25+3에서 34+6주 사이로 평균 28.8+3.4주이었고, 출생 후 평균 $15.6{\pm}6.3$일째에 수술하였다. 수술 당시의 체중은 680에서 2,100 g 사이로 평균 $1,174{\pm}416\;g$이었는데 이 중 1,500 g 미만은 16명이었고 1,000 g 미만은 9명이었다. 수술은 모두 신생아 중환자실에서 이루어졌는데 측와위에서 왼팔을 현수시킨 자세로 길이 $2{\sim}3\;cm$의 액와 소개흉술을 통하여 접근하였다. 동맥관 크기는 평균 $3.8{\pm}0.3\;mm$로 동맥관의 폐쇄는 주로 클립을 사용하였는데, 2예에서 박리 중 동맥관 파열로 동맥관 분리술(division)을 시행하였다. 결과: 술 전부터 인공호흡기에 의존해 온 환아 12명 중 10명이 술 후 호흡기 증상의 호전과 함께 평균 9.7일 사이에 인공호흡기 이탈이 가능하였다. 수술과 직접적으로 연관된 사망이나 합병증은 없었으나 병원 내 만기 사망이 2예에서 있었는데 1예는 술 후 41일째 폐렴으로, 나머지 1예는 술 후 131일째 패혈증으로 사망하였다. 결론: 액와 소개흉술을 통한 미숙아 동맥관 개존증의 폐쇄는 혈역학적 불안정성을 개선하여 미숙아의 성공적인 성장 및 정상 발달에 도움이 되었다. 수술의 침습도 및 이에 따른 위험성은 매우 적어 조기에 적극적인 외과적 요법이 권장된다.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.58-63
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• 2010

목적: 주관절 외상과염은 주관절 동통을 유발하는 대표적인 질환 중 하나로 이에 대한 치료 방법은 여러 문헌에서 보고 된 바 있다. 본원에서는 외상과염에 대한 혈소판 풍부 혈장 (Platelet-Rich-Plsma) 주입 치료를 시행한 후 그 임상적 결과를 평가해 보고자 하였다. 대상 및 방법: 2009년 1월부터 2009년 12월까지 본원에서 외상과염으로 진단받은 환자 15명 (남자 5명, 여자 10명)을 대상으로 하였으며, 평균 연령은 43.5세 였다. 모든 환자는 타 병원에서 1년 이상의 물리치료, 약물치료 등의 보존적 치료를 시행 받았으나, 증상호전을 보이지 않아 수술적 치료를 고려하는 환자였다. 대상 환자는 주관절 외상과에 경피적 혈소판 풍부 혈장 농축액 3cc를 1회 주입하였으며, 치료효과의 판정은 휴식 시와 작업 시의 visual analogue scale (VAS), The Patient-Rated Tennis Elbow Evaluation (PRTEE)를 시술 후 4, 12주 후 측정하고 치료 전후를 비교평가 하였다. 결과: 치료 4주, 12주 단기 추시에서 휴식시 통증의 VAS 평균 값은 치료 전 4.6에서 치료 4주째 2.5 12주째 1.8로 개선 되었고, 작업시 통증의 경우 치료 전 7.8에서 치료 4주째 6.2 치료 12주째 4.25로 개선 되었다. PRTEE score 평균 값은 치료 전 60.13에서 치료 4주째 46.12, 12주째 24.6으로 개선 되었다. 결론: 보존적 치료에 반응을 보이지 않는 불응성 주관절 외상과염의 치료에 있어 혈소판 풍부 혈장 주입을 이용한 치료는 효과적인 치료법이며, 수술적 치료를 시행 전 고려 되어야 한다고 사료 된다.

• 가정간호학회지
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• 제3권
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• 여성건강간호학회지
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• 제4권2호
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• pp.217-230
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• 1998

The purpose of this descriptive correlational study was to define the relationship between the experience of Sanhuujori, Korean traditional non-professional postpartal care after delivery and abortion and present health status of chronic arthritis female patient who visited to outpatient clinic of rheumatic internal medicine at a hospital located in Seoul, Korea. A convenience sample of 64 women who orally agreed to be a participant and data were collected form October 1996 to May, 1997 for sis months by way of interview with semistructured questionnaire. The data were analyzed by the SPSS pc program using t-test, ANOVA and Scheffe test as a post hoc and Pearson Correlation Coefficient. The results of the study were as follows ; Mean age of participants was 53.2 years and mean number of children was 3.1. Mean frequency of abortion was 2.1 times per woman. Seventy four percentage of respondents did not have Sanhujori after abortion. The mean period of Sanhujori after delivery was 17.7, 15.2, 13.8 days from the first child to third child and shorter than that of general woman such as 20.0, 19.0, 17.3 days in the previous study. On the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori wrongly' was the highest rank in each child where as general woman 'did Sanhujori well' at the first child, 'moderate' at the second and third child and 'did Sanhujori wrongly' at the 4th and fifth child. The health status implies both subjective health status women perceived and the rate of complaints of physical symptom distress women are experiencing presently. The respondents of 82.5% perceived them as unhealthy or sick and 68.9% of women complained more than two symptoms. Mean number of physical symptom distress women complained was 2.33. The main sites of physical symptom distress were upper & lower extremities 69.1% including knee and hand, whole body 19.1%, neck 3.7%, waist & shoulders 2.7% respectively. The characteristics of the symptoms were mostly pain 60%, swelling 19.8%, rigidity & deformity 7.9% respectively, sensation of heat 6.8% and weakness 1.7%. Women perceived the etiology of the chronic arthritis as stress 25.8%, 'did Sanhujori wrongly' & overwork 23.4% respectively, genetic 12.9%, malnutrition, 4.8%, and aging process 3.2%. There were significant positive correlation between subjective health status and the period of Sanhujori after delivery of the second child(r=-0.22) and negative correlation with the number of child at the level of 5% of significance statistically(r=0.27). There were significant negative correlation between the rate of complaints of physical symptom distress and the subjective evaluation whether she did Sanhujori well or not at the level of 5% of significance statistically(r=-0.23). And the rate of complaints of physical symptom distress in the group of women who experienced abortion was significantly higher than that of women who did not experience it at the level of 5% significance statistically(t=2.00) In conclusion, this finding reconfirmed the possible relationship between health status of chronic arthritis female patient and the experience of Sanhujori after delivery & abortion. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the crosssectional and longitudinal research for the refinement of the reality of not only as cultural phenomenon but as conceptual model for the appropriateness of intervention and quality of care for desirable health outcomes.

• 간호행정학회지
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• 제7권2호
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• pp.265-284
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• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• Journal of Hospice and Palliative Care
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• 제19권4호
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• pp.303-309
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• 2016

목적: 말기 암환자에서 악성 복수는 흔하게 발생하며, 그 자체가 나쁜 예후를 시사한다. 악성 복수에 대한 효과적이고, 최소한의 침습적인 방법으로 복수배액관 삽입이 제안되었다. 본 연구는 복수배액관 삽입을 시행한 말기 암환자들을 대상으로 복수배액관 시술의 효과와 부작용에 대하여 분석하고 시술 후 예후에 영향을 미치는 요인을 알아보기 위하여 시행되었다. 방법: 서울 소재 일개 3차 의료기관 호스피스 병동에 2010년 1월 1일부터 2013년 12월 31일까지 입원한 말기 암환자 2,608명 중 복수배액관 삽입을 시행한 67명의 환자들의 의무기록을 조사하였다. 인구학적 정보, 완화의료 수행지수, 혈액검사, 복수 배액관 유지 기간, 시술 합병증의 종류와 빈도, 항생제 사용 여부와 기간, 시술 후 생존기간을 분석하였다. 복수 배액관 삽입 후 생존기간에 영향을 미치는 요인을 평가하기 위해 단변량 및 다변량 콕스 비례위험 회귀분석을 실시하였다. 결과: 총 67명의 연구대상자 중 원발암은 간암 및 담도암과 위암이 가장 흔하였다. 복수배액관 시술 후 복수관련 증상의 호전은 55명(82.1%)에서 있었다. 시술 후 합병증은 통증(19.4%), 누수(14.9%), 배액관 빠짐(7.5%), 배액관 막힘(6%), 발열(4.5%)이었다. 복수배액관 시술 후 생존기간에 영향을 주는 인자는 다변량 콕스 비례위험 회귀분석 결과 완화의료 수행지수(HR 0.73; P=0.045), 저나트륨혈증(HR 2.77; P=0.003)이었다. 결론: 복수를 동반한 말기 암환자에서 복수 배액관 시술 시, 완화의료 수행지수와 저나트륨혈증은 예후 인자로 사용될 수 있을 것이다. 추후 대규모의 전향적 연구가 요구된다.

• Advances in pediatric surgery
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• 제9권1호
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• pp.45-51
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• 2003

본 조사 결과는 32개 병원의 39명의 회원에 의해 수술받은 환자 348명의 기록과 회원 37명의 설문 응답자를 분석한 것으로 많은 수의 기록지가 내용이 불충분하거나 일치되지 않은 기술로 인해 자료로서의 한계가 있었다. 특히 췌담관합류 이상에 대한 기록 중 약 절반이 미상으로 기록된 것에서 알 수 있드시 자료가 매우 미흡하였고, 담관낭종의 유형을 정하는 것 예후 인자 및 산 전 진단된 담관낭종의 수술 적기등에 대하여도 회원마다 견해 차이가 있으나 심도있는 토론이 이루어지지 않았다. 따라서 이 결과를 외국의 통계 분석과 비교하는 것 보다는 회원들의 향 후 진료와 연구에 참고가 될 수 있다는 것에 의미를 두고자 하며, 회원들이 동일한 등록지를 작성하는 전향적 연구로 우리나라 담관낭종에 대한 분류, 췌담관 합류이상, 예후 인자들에 대한 재 논의의 출발점이 되기를 기대한다.