• Korea Journal of Hospital Management
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• v.26 no.2
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• pp.1-16
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• 2021

This study aims to examine the effect of integrated health and welfare(IHW) services on medical use and medical expenses in Korean Veteran Hospitals. Data on the volume of medical use and medical expenses were collected from two patient groups of 5 Veterans' Hospitals: the beneficiary group who has received IHW services and the non-beneficiary group who has not. Each group was composed of 265 patients respectively. The results of the study revealed that the volume of home nursing services, home rehabilitation services, ambulatory services have increased significantly, whereas the average length of stay, number of using emergency services, and average medical expenses have decreased after receiving integrated health services in the beneficiary group. In contrast, the non-beneficiary group showed much more increase both in the volume of inpatient and outpatient services, as well as the average medical expenses, compared to those of the beneficiary group. This results imply that the provision of IHW services have positive impacts on the enhancing the effectiveness of the medical resources utilization for the veteran patients.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.261-267
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• 2022

Purpose: With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center. Methods: Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments. Results: The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department. Conclusions: The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.

• Health Policy and Management
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• v.23 no.2
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• pp.145-151
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• 2013

Background: The objective of this study was to explore patient family's evaluation of emergency department (ED) service satisfaction and to compare these with ED staff perception of patient family's evaluation. Methods: Based on two surveys of the National Emergency Medical Center: the 2008 National Survey for Recognition and Satisfaction towards Emergency Medical Services and the 2008 Opinion Survey of Emergency Medical Service Providers, satisfaction gaps among physicians, nurses, and patient family were evaluated by Kruskal-Wallis tests and Wilcoxon-Mann-Whitney tests. Furthermore, the factors associated with satisfaction of emergency medical service were identified by ordinal logistic regression models. Results: There were statistically significant gaps among physicians, nurses, and patient family in overall satisfaction with ED visit, length of stay in ED, enough explanation, physicians/nurses kindness, and ED facilities. Age and income in the patient family model, the number of beds in hospital, job satisfaction and year of service in the physicians model, and the number of beds in hospital, job satisfaction and the number of patients per duty hour in the nurses model were statistically significant factors associated with evaluation/ perception of ED service satisfaction. Conclusion: Patient satisfaction is an important indicator of the quality of care and service delivery in the ED. To improve and understand satisfaction in ED service, a dyadic view of the evaluation of service quality and satisfaction-that is, from the perspectives of both the patient and the emergency medical service providers-should be concerned.

• Earthquakes and Structures
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• v.14 no.6
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• pp.493-503
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• 2018

With the further increase of span length, the cable-stayed bridge tends to be more slender, and becomes more susceptible to the seismic action. By taking a super long-span cable-stayed bridge with main span of 1400m as example, structural response of the bridge under the E1 horizontal and vertical seismic excitations is investigated numerically by the multimode seismic response spectrum and time-history analysis respectively, the seismic behavior and also the effect of structural nonlinearity on the seismic response of super long-span cable-stayed bridge are revealed. Furthermore, the effect of structural parameters including the girder depth and width, the tower structural style, the tower height-to-span ratio, the side-tomain span ratio, the auxiliary piers in side spans and the anchorage system of stay cables etc on the seismic performance of super long-span cable-stayed bridge is investigated numerically by the multimode seismic response spectrum analysis, and the favorable earthquake-resistant structural system of super long-span cable-stayed bridge is proposed.

• Journal of Korean Clinical Nursing Research
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• v.25 no.2
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• pp.142-150
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• 2019

Purpose: The aim of this study was to evaluate the efficiency of the Humpty Dumpty Falls Scale as one of the falls risk assessment tools, and also to evaluate risk factors as predictors of falls in pediatric patient populations. Methods: In a retrospective, case-control design with data from the electronic medical records of 13 pediatric patients who fell and 1,941 who did not fall before matching and 429 who did not fall after matching by gender, age, diagnosis, and length of stay. Results: All the variables showed no significant differences after matching. At the cutoff score of 13, sensitivity, specificity, negative and positive predictive values were 92.3%, 37.1%, 99.9%, and 0.01%, respectively. The area under the Receiver Operating Characteristics was 0.597. The results from the logistic regression showed that the pediatric inpatient population who had higher risk scores was significantly associated with falls. The odds ratios ranged from 1.31 to 4.71 with 90% confidence interval. Conclusion: The saturation impairments criterion as one of the diagnostic parameter was negatively associated with falls, but the relative risk score was higher than the other criteria. Therefore, it seems that the diagnostic parameter seems to be required to verify results through large sample studies.

• Clinical Endoscopy
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• v.56 no.1
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• pp.92-99
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• 2023

Background/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. Methods: We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. Results: A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. Conclusions: Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.111-121
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• 2010

Purpose: This meta-analysis was aimed to investigate the evidence of proper period of the ventilator circuit change using existing research. Methods: For this study, 14 published studies between 1995 and 2010 were tested by Macaskill, Funnel Plot, the Odds Ratio of DerSimonian and Laird, Fisher and Liptak analysis. Results: There were no publication bias found in the subjects. The results of the meta-analysis demonstrated no statistically significant differences were observed in neither the Odds Ratio (OR=1.18, 95% CI=0.94-1.47) of the frequency of ventilator-associated pneumonia and the mortality based on the period of the ventilator circuit change (Fisher p=.332, Liptak p=.498), nor the ventilation duration of ventilator (Fisher p=.843, Liptak p=.506), and the hospital length of stay (Fisher p=.254, Liptak p=.480). Conclusion: In order to present more concrete guidelines on the period of the ventilator circuit change, further research is warranted to thoroughly control confounding variables which related to the periods of the ventilator circuit change.

• Journal of the Korean Society of Manufacturing Process Engineers
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• v.11 no.3
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• pp.122-129
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• 2012

This study investigates structural and vibration analyses according to the thickness of bicycle frame tube. The model of bicycle frame has the dimension as length of 862mm, width of 100mm and hight of 402.5mm. There are 3 kinds of models with tubes of top, down and seat at bicycle frame as thicknesses of 10, 15 and 20mm. The maximum displacement and stress occur at the center part of seat stay and at the installation part of rear wheel respectively. Maximum displacements become 0.031936, 0.029159 and 0.027984mm in cases of thicknesses of 10, 15 and 20mm respectively. In case of thickness of 20mm among 3 cases, maximum displacement becomes lowest. But maximum stresses become 10.019, 8.5492 and 9.2511MPa in cases of thicknesses of 10, 15 and 20mm respectively. In case of thickness of 15mm among 3 cases, maximum stress becomes lowest. There is no resonance at practical driving conditions and natural frequency remains almost unchanged along the change of thickness. In case of the displacement due to vibration mode, the displacement difference at thickness between 15mm and 20mm becomes 1/2 times than that between 10mm and 15mm. Design at bicycle frame tube becomes most economical and durable effectively in case of thickness of 15mm among 3 cases.

• Women's Health Nursing
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• v.12 no.4
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• pp.316-325
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• 2006

Purpose: The purpose of this study was to develop a Critical Pathway for Uterine Artery Embolization patients. Method: There were 6 steps that were taken. Step 1 was selecting a diagnosis, and Step 2 was organizing a development team consisting of 7 experts. Step 3 analyzed the medical records, and Step 4 drew up a preliminary Critical Pathway. Step 5 tested the clinical validity of the preliminary Critical Pathway, and Step 6 developed the final Critical Pathway. Result: The contents of the medical practices observed in the medical records were investigated in seven areas: monitoring/assessment, treatment, medication, diet, activity, consults, and education/discharge plan; and a total of 73 items was identified. The validity of the 73 items was examined by a group of specialists. 68 items were adopted, 4 items revised, 1 item removed, and 1 item was added. Using the results, a preliminary Critical Pathway was drawn up. According to the results from examining the clinical validity of the preliminary Critical Pathway with five patients for five weeks, 3 items which showed discrepancy were revised and another 3 items were added. Then, the final Critical Pathway was completed. Conclusion: This Critical Pathway needs to be clinically applied and continuously to measure its effects in terms of the length of stay, cost.effectiveness, and the patients' and staffs' satisfaction.

• Advances in pediatric surgery
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• v.17 no.1
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• pp.51-57
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• 2011

Use of laparoscopic appendectomy (LA) for perforated appendicitis (PA) in children remains controversial because of the development of postoperative intra-abdominal abscess formation. We developed the irrigation method for the prevention of abscess formation after LA performed for PA in children with severe panperitonitis. We called it 'the shaking irrigation'. The object of this study was to analyze the efficacy of this irrigation method. All cases of PA with severe panperitonitis in children that underwent LA with massive shaking irrigation and drainage between June 2003 and December 2007 were studied retrospectively. We included only PA with panperitonitis and large amounts of purulent ascites throughout the abdomen as well as an inflamed small bowel with ileus. Thirty-four children were involved in this study. The mean patient age was eight years. The mean amount of irrigation fluid was 8.2 L (range: 4-15 L), The mean operative time was 89.5 min. The mean length of the hospital stay was 5.1 days. There were no postoperative intra-abdominal abscesses. There was no conversion to open surgery. In conclusion, Use of LA in PA with severe panperitonitis in children is safe and effective. Massive shaking irrigation and abdominal drainage appears to prevent intra-abdominal abscesses after LA for PA with panperitonitis.