• Clinical and Experimental Pediatrics
• /
• v.51 no.4
• /
• pp.401-408
• /
• 2008

Purpose : Transcatheter closure of atrial septal defects (ASD) is currently established therapy as an alternative to surgery. But rarely, complications are reported in some studies. We report early and intermediate term complications associated with transcatheter closure of atrial septal defects using the Amplatzer septal occluder (ASO). Methods : From June 2003 to May 2006, 64 patients underwent transcatheter closure of secundum ASD or patent foramen ovale using the ASO. The ratio of male to female was 1:2.4, the median age was 17 years (range: 2.6-64 years) and their median weight was 47.5 kg (range: 2.6-64 kg). Results : The median diameter of ASD measured with transthoracic or transesophageal echocardiography was 15 mm (range: 6-28 mm), the median balloon stretched diameter was 18 mm (range: 6.5-34 mm), and the median size of device was 19.5 mm (range: 6-36 mm), was little difference with balloon stretched diameter. There were 10 cases of complications: arrhythmia (2), device malformation (2), aorta to right atrial fistula (1), hemolytic anemia (1), mitral valve encroachment (1), malposition (1), residual shunt (1), and inferior vena cava perforation (1). Conclusion : Transcatheter closure of ASD using ASO is effective and safe therapy. However, significant complications such as aorta to atrial fistula, atrial erosion, or device embolization can happen, so an appropriate selection of patient and device in relevance to size and anatomy of ASD is important for successful closure.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.7 no.2
• /
• pp.122-127
• /
• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• The Journal of Industrial Distribution & Business
• /
• v.1 no.1
• /
• pp.33-41
• /
• 2010

In the age of globalization, effective and efficient corporate management is becoming more important as domestic and international business circumstances changes. In the middle of endless changes in business circumstances, fast reaction to customers and market, and offering customized goods and service became essential. In this respect, CRM designed to utilize customer information scientifically and systematically, has become an essential system and marketing strategy to enhance corporate competitiveness. CRM has placed the importance of customers in the front of marketing and has focused every process and business minds on customers. Recent change in the market and the trend of establishing and introducing CRM system has lead us to concentrate on the introduction of CRM in the financial institutions. This study searched for several views about CRM in academic and industrial papers. Through theoretical approach on CRM, the background of the introduction of CRM, the purpose of CRM, the characteristic and application of CRM, and the expected effect of CRM will be discussed. This study is focused on financial institutions where CRM is widely used. And through documents about examples of the introduction of CRM, the status of the establishment of domestic CRM and the necessity and trend of CRM will be discussed. Also the problem of CRM in the financial institutions and the improvement of CRM in domestic banks will be analyzed. When discussing CRM in the financial area, customers are the main source of corporate profit and through relationship management with the customers enhancing loyalty and maximizing profit can be obtained. Especially in CRM in financial institutions, maintaining existing customers makes higher profit ratio, so repurchasing and cross selling becomes important for obtaining lifetime value of existing customers who contribute to most of the profit of corporations. As a result, CRM should be completely customer oriented. CRM in financial institutions is not merely marketing work, but organizational competence which is made up of standardized work process through total process integration inside the corporation. Corporations which plan to introduce CRM should analyze the characteristics and conditions of corporations and establish purpose and strategy of CRM. And they need long term view to find out the factors which best fit for the introduction of CRM. To enable this, strategy composed of daily marketing activity and CRM concept is necessary. Also continued improvement through drill and training for operating organization should be followed to maintain CRM well. And corporate culture must settle customer as the center of corporate value. The race for introducing and improving CRM has already begun. CRM should not be regarded as a choice. It should be accepted as something essential. In this reality financial institutions should solve subdivision problem of customers and necessity of customers with the mind of 'customer's profit is my profit'. Customer focused management should not be emphasized only by words. Efforts like viewing from the customer's point must be nurtured to provide methods to help customers. That is, we should not just follow what is done in foreign countries. We should solve the problem of our customers according to the situation of our country, our industry, our corporation. Then we can gain the trust of customers, and the value derived from the customers will become the background of CRM which will lead the corporation to success.

• The Korean Nurse
• /
• v.30 no.3
• /
• pp.49-65
• /
• 1991

This study was carried out to assess the problems with the pregnant women, and check out the risk-factors in the high-risk pregnancies, using a simplified antepartum risk-scoring system, which was revised from Edwards' scoring system to be suitable for Korean situaition. This instrument was included 4 categories, demographic, obstetric, medical and miscellaneous factors. This survey was based on the 1300 pregnant women who were admitted, $x^2$-test, F-test, Pearsons correation, using statistical package SAS in NAS computer system, KIST. The results of the study were as follows; 1. 1313 infants were deliveried of these 560 infants(42.7%) were born to mothers with risk-scores > 7, and 753 infants(57.3%) were born to mothers risk-scores <7. 2. Maternal age" parity, education level, of the demographic factors were significant relation statistically to identify the high risk pregnancies($X^2$=20.88, 42.87, 15.60 P < 0.01). 3. C-section, post term, incompetent cervix, uterine anomaly, polyhydramnios, congenital anomaly, sensitized RH negative, abortion, preeclampsia, excessive size infant, premature, low birth weight infanl, abnormal presentation, perinatal loss, multiple pregnancy, of the obstetric factors were significant relation statistically to identify the high risk-pregnancies. ($X^2$ = 175.96, 87.5, 16.28, 21.78, 9.46, 8. 10, 6.75, 22.9, 64.84, 6.93, 361.43, 185.55, 78.65, 45.52, P < 0.01). 4. Abnormal nutrition, anemia, UTI, other medicalcondition(pulmonary disease, severe influenza), heart disease, V.D., of the miscellaneous and medical factors, were significant relation statistically to identify the high risk-pregnancies. 5. Premature, low birth weight infant, contracted pelvis, abnormal presentation, of the risk factors were significantly related with Apgar score at 1 '||'&'||' 5 minute after birth and neonatal body weight. 6. Apgar score at 1 '||'&'||' 5 minute after, birth and neonatal body weight were significantly negative correlated with risk-score. 7. There were statistically significant difference between risk-score and Apgar score at 1 '||'&'||' 5 minute after birth, 3 group(0-3, 4-6, above 7), and neonatal body weight, 2 group(below 2.5kg, the other group) (F=104.65, 96.61, 284.92, P<0.01). 8. Apgar score at 1 '||'&'||' 5 minute after birth(below 7), and neonatal body weight(below 2.5kg), were significant relation statistically with risk score.($x^2$=65.99, 60.88, 177.07, P<0.01) were 60.8 %, 60% . 9. Correct classifications of morbid infants(l '||'&'||' 5 minute Apgar score < 7) were 77.8%, 83.8% and that of nonmorbid infants(l '||'&'||' 5 minute Apgar score > 7) were 60.8%, 60%. 10. There were statistically significant difference between dislribution of maternal risk-score among the morbid infants(l '||'&'||' 5 minute Apgar score < 7) and non morbid infants(l '||'&'||' 5 minute Apgar score> 7) ($x^2$=64.8, 58.8, P < 0.001). 11. There were statistically significant difference between distribution of morbid infants(l '||'&'||' 5 minute Apgar score < 7) and fetal death. 12. The predictivity for classifying high.risk cases was 12 % and for classifying low-risk cases was 98.3 % in 5 minute Apgar score. Suggestions for further studies are as follows; 1. Contineous prospective studies, using this newly revised scoring system are strongly recommended in the stetric service. 2. Besides risk facto~s used in this study, assessmenl of risks by factors in another scoring system and paralled studies related to perinatal outcome are strongly recommended.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.13 no.6
• /
• pp.2607-2616
• /
• 2012

This study was designed to figure out patient safety culture of medical institutions and try to utilize the study results as basic data for analyzing doctor's awareness of patient safety culture. To this end, questionnaire survey was conducted from August 1st to September 5th, 2011, targeting doctors working at senior general hospitals located in G city, and 194 questionnaires were utilized for final analysis. The research results are as follows. First, there was a difference in awareness of deployment of staffs depending on gender, age, term of service in the hospital, contact with patients and working hours per week in relationship between subjects, wards and hospital safety culture, and organizational learning and teamwork in the ward turned out to be significant in accordance with working hours per week, and all sub-areas of the ward safety culture by departments. Second, feedback about the malpractice, communication, report on malpractice frequency and overall safety awareness were found to be significant by departments in relationship of subjects, medical incident reporting system, patient safety evaluation and overall level of consciousness, and the overall safety awareness showed significant results according to contact with patients and working hours per week. Third, there was a positive corelation in sub-areas of the ward and hospital safety culture awareness, overall recognition and patient safety evaluation, and a positive corelation with medical incident reporting system was found in all areas except for attitude of managers/immediate supervisors and that of hospital executives. Fourth, sub-areas of patient safety culture which has a effect on patient safety showed significant results in organizational learning, openness of communication, overall safety awareness, systematic cooperation between departments, feedback/communication and non-punitive response. In conclusion, to increase the level of the ward and hospital patient safety culture of doctors and implement medical incident reporting system faithfully, it is necessary to activate teamwork through organizational learning in the ward based on the adequate staffing and working hours, promote open communication between departments and provide feedback on medical malpractice, thereby establishing a cooperative system by departments and active support of hospital executives for patient safet.

• The Journal of Industrial Distribution & Business
• /
• v.8 no.6
• /
• pp.51-60
• /
• 2017

Purpose - This study aimed to investigate the correlation between the social activity of the elderly and recognition of family cohesion of the elderly who are exposed to the current aging society. In addition, the study has delved into the method of family cohesion improvement through the differences between groups based on the mediator effect of how the results have effects on the elderly's self-control capabilities. Research design, data, and methodology - This study has targeted the elderly who are attending the elderly university among users in seven community centers located in Seoul and Gyeonggi-do area. The study has also conducted a survey by the format of a half-structured questionnaire. It is aiming to investigate the elderly's family cohesion with children and their self-control capability, and understand their satisfaction of social activity to help successful elderly life. The study has suggested the following as mentioned. First, the study analyzed that the perceptual factor of family cohesion with children would be deducted based on advanced researches. Second, the influencing relationship would be analyzed through the relational analysis between the elderly's family cohesion and social activity. Results - The family cohesion with children has a significant effect on psychological happiness and it showed the influencing relationship with improvement of the elderly's self-control capability. Therefore, creating fellowship through meaningful conversation with children would be needed. In addition, various programs and consultant service would be offered to build healthy relationship between aged parents and their children. Through this, the elderly will be able to have not only better relationships with their family, but also increased psychological health and well-being as well. Conclusions - It is needed that not only supporting policies for children who take care of aged parents but also that the elderly who need long-term care could meet their children whenever they want through increased numbers of sanatoriums operated by cities and countries. In addition, the nation would offer financial and administrative support continuously so that people receive the benefits from sanatoriums located in the locality of children's residence beyond the elderly's residence. Moreover, social infra would be established as well.

• Journal of Chest Surgery
• /
• v.30 no.7
• /
• pp.670-676
• /
• 1997

The structural failure of the glutaraldehyde-treated xenograft valves has been the primary concern about the limited durability as predicted from the begimling of clinical use, and long-term follow-up has shown a significant incidence of primary tissue failure(PTF) from both biological and mechanical reasons. Twenty-seven patients with the low-profile lonescu-Shiley valves explanted from mitral position for PTF(Group III) were studied on the patient characteristics and valve pathology, and the results were compared with the matched observations of the Haycock(Group I) and of the standard-profile lonesiu-Shiley valves(Group II). Patients were aged 16 to 56 years(mean, 38.0$\pm$ 11.0 years), and the size of the failed mitral bioprosthesis was 30.8$\pm$ 1.3 mm. The hemodynamic consequences were stenosis in 29.6%, insufficiency in 44.4%, mixed steno-insufficiency in 14.8%, together with normal function for the rest of patients of prophylactic re-replacement. Pathology revealed calcification with or without tissue damage in 63.0% and tissue damage with or without calcification in 58.l%, in contrast with the observations of predominant tissue damage(76.8%) over calcification in Group I and of calcification(76.1%) over tissue damage in group II. Although dystrophic calcification has long and repeatedly dealt with patient's young age as a determinant of valve durability, such a characteristic evidence was not reached even in patients with calcified valves. Moreover, the prolonged explantation p riods from the studied on the previous report suggested strongly yet possibly evolving destructive processes among the valves in the remaining patients, and awaits further follow-up. In conclusion, PTF of the xenograft valves seems to result from more complicated biologic and metabolic reasons as well as more complex mecharical factors than the reported, and newer generation prostheses, with tissue preservation with glutaraldehyde, do not likely to provide decisive improvement in the occurrence of structural failurebioprostheses is generally limited to the highly aged.

• Journal of Chest Surgery
• /
• v.43 no.4
• /
• pp.364-374
• /
• 2010

Background: We assessed the early and mid-term results of the modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome (HLHS) and its variants to identify the risk factors for hospital mortality. Material and Method: Between March, 2003, and December, 2009, 23 patients (18 males and 5 females) with HLHS or variants underwent the modified Norwood procedure. The age at operation ranged from 3 to 60 days (mean, $11.7{\pm}13.2days$) and weight at operation ranged from 2.2 to 4.8 kg (mean, $3.17{\pm}0.52kg$). We used a modified technique that spared the anterior wall of the main pulmonary artery in 20 patients. The sources of pulmonary blood flow were RV-PA conduit in 15 patients (group I) and RMBTS in 8 (group II). Follow-up was completed in 19 patients (19/20, 95%) in our hospital (mean $26.0{\pm}22.8months$). Result: Early death occurred in 3 patients (3/23, 13%), of whom 2 had TAPVC. Fourteen patients underwent subsequent bidirectional cavopulmonary connection (BCPC, stage 2) and seven underwent the Fontan operation (stage 3). Three patients died between stages, 2 before stage 2 and one before stage 3. The estimated 1-year and 5-year survival rates were 78% and 69%, respectively. On multivariate regression analysis, aberrant right subclavian artery (RSCA) and associated total anomalous pulmonary venous connection (TAPVC) were risk factors for hospital mortality after stage 1 Norwood procedure. Conclusion: HLHS and its variants can be palliated by the modified Norwood procedure with low operative mortality. Total anomalous pulmonary venous connection adversely affects the survival after a stage 1 Norwood procedure, and interstage mortality rates need to be improved.

• Journal of Chest Surgery
• /
• v.41 no.6
• /
• pp.742-746
• /
• 2008

Background: The surgical treatment of pectus carinatum is usually a modified Ravitch operation that consists of complete costal cartilage resection and sternal wedge osteotomy. We tried a simple and easy technique that is resection of only deformed, protruded costal cartilage and pre-sternal compression with using a stainless steel bar and this is done without sternal osteotomy. Therefore, we performed partial cartilage resection and pre-sternal compression with a stainless steel bar and we observed the effects and the efficiency of treatment. Material and Method: From July, 2006 to June, 2008, 10 patients with pectus carinatum underwent our modified technique of pectus carinatum surgery. The effects of surgery and the complications were reviewed. Result: 5 patients with only pectus carinatum underwent our modified technique of pectus carinatum surgery. 5 patients with pectus carinatum and pectus excavatum underwent our modified technique of pectus carinatum surgery and Nuss surgery. The mean patient age was 13.4+3.3 years old. The mean operation time was 137.6+22.9 minutes for the pectus carinatum patients and 234.0+36.5 minutes for the pectus carinatum and pectus excavatum patients. The mean length of hospitalization was 11.8+1.0 days. The Haller pectus index of pectus carinatum was $2.10{\pm}0.21$ preoperatively and this was increased to $2.53{\pm}0.07$ postoperatively. The only complication was simple partial wound disruption in 1 patient. Conclusion: We performed partial cartilage resection and pre-sternal compression with a stainless steel bar in 10 patients with pectus carinatum and its effects were good. Our modified technique of pectus carinatum is easy and simple as compared with the Ravitch operation. But removal of the stainless steel bar has not yet been performed for these patients and long-term follow up is needed to accurately evaluate the. effects of this surgery in many surgical cases.

• Journal of Chest Surgery
• /
• v.41 no.6
• /
• pp.695-702
• /
• 2008

Background: The choice between a bioprosthetic and a mechanical valve is an important decision in cardiac valve surgery, and the durability of the tissue valve is a major decision factor. We retrospectively evaluated the midterm results of bioprosthetic valve replacement in the mitral position. Material and Method: The subjects were all patients who had undergone mitral bioprosthesis replacement between July 1989 and August 200.7. Among the 216 patients, there were 236 surgical cases. The mean age was $63{\pm}15$ years, and the male to female ratio was 1 : 3. We retrospectively analyzed hospital and outpatient records such that the total follow-up duration amounted to 760.2 patient-years, and the mean follow-up duration was $41.9{\pm}40.7$ months (range $0{\sim}212$ months). Result: Early death occurred in 18 patients (8.3%), and 13 of these underwent concomitant cardiac procedures. The survival rate after 5 years was $79.9{\pm}3.5%$, and the survival rate after 8 years was $65.5{\pm}5.5%$, while freedom from structural valve deterioration (SVD) was $96.2{\pm}2.2%$ at 5 years and $85.9{\pm}5.3%$ at 8 years. Freedom from reoperation was $90.6{\pm}1.7%$ at 5 years and $90.4{\pm}4.2%$ at 8 years, while freedom from reoperation for SVD was $98.1{\pm}1.2%$ at 5 years and $92.3{\pm}4.1%$ at 8 years. On multivariate analysis of preoperative risk factors, small valve size (between 25mm and 27mm) was a significant risk factor for reoperation, and low LV ejection fraction (<40%) was a significant risk factor for SVD and mortality. Conclusion: Survival and freedom from reoperation for SVD in mitral bioprosthesis replacement had acceptable midterm results, but freedom from SVD Was relatively low. In particular, since SVD increased sharply at the eighth postoperative year, frequent follow-up and echocardiograms around that time will be helpful for the early detection of SVD. It will be necessary to conduct further studies involving long-term follow-up and more patients.