• Journal of Korean Foot and Ankle Society
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• v.16 no.4
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.599-606
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• 2021

Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4-23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.10 no.2
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• pp.158-169
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• 2003

Purpose: This study is to investigate the recognition regarding Hospital - Based Home Care Service among physicians and nurses in a G University Hospital. Method: Data were gathered from 92 physicians and 257 nurses. working at G University Hospital. from January 15 to January 22. 2003 by questionnaire. The data were analyzed by using the SPSS/PC +. Result: 1) As to the previous information about a hospital based home care service. those who have been familiar to it were 85.9% of the physicians. and 98.8% of the nurses. 55.4% of the physicians and 55.1% of the nurses responded that they are willing to refer their patients to the home health care only if their patients and families want to. 47.8% of the physicians and 44.4% of the nurses perceived the present cost of a hospital based home care service to be moderate. 2) Most of the physicians and nurses reported that the most available service was 'wound dressing' (98.4%, 92.6%) and the least available service was 'incision and drainage'(1l7.4%, 42.8%). 3) As to the necessity of home nursing business and the anticipated effects. nurses perceived higher than physicians($3.46\pm.74$). and both showed a significant difference according to age of subjects. Conclusion: For the stabilization and successful implementation of a hospital based home care service. it should be accompanied with education programs about home care for physicians. in particular junior staff.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.50-63
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• 1997

Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.18 no.2
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• pp.195-200
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• 2011

Purpose: The purpose of this study was to assess rates for handwashing adherence before and after nursing contact in intensive care units (ICU). Methods: The participants included 90 nurses working in intensive care units of an 800-bed university-affiliated hospital in Gyeonggi Province and 2000-bed university-affiliated hospital in Seoul. Time for handwashing was calculated using the average number of handwashings during an 8-hour day shift. Nursing contact was based on indications as defined by the Centers for Disease Control and Prevention (CDC, 2002). Data were analyzed using frequency, percent, t-test and ${\chi}^2$-test. Results: During an 8-hour day shift, the average number of times that hands were washed was 25.0. The rates were significantly lower before the nursing contact than after the nursing contact when it involved sectioning, observation or contact with a wound, cleaning enteric feeding bag, physical exam, use of gloves, or contact with contaminants. Conclusions: The results indicate that as handwashing rates were significantly lower before nursing contacts than after nursing contacts, there is need to develop strategies to address this deficiency in handwashing.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.16 no.4
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• pp.506-514
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• 2009

Purpose: This study was conducted to define factors influencing psychosocial adaptation of patients with a permanent colostomy. Independent variables including perceived stress, stoma care self-efficacy, self-care behavior, self-esteem and family support were used to predict psychosocial adaptation. Method: The data was analyzed using the SPSS pc program window version 12.0 for descriptive statistics, Pearson correlation coefficients and stepwise multiple regression. Ninety patients with a permanent colostomy were recruited between September 2007 and May 2008. The reliability of the instruments was tested with Cronbach's alpha which ranged from .78 to .92. Result: The results were as follows: The mean psychosocial adaptation score was 3.05. There were significant correlations between all the predictive variables and psychosocial adaptation (r= .63~ -.43, p<.001). Stepwise multiple regression analysis showed that self-esteem (40%), stoma care self-efficacy (7%), perceived stress (2%), and self-care behavior (2%) accounted for 51% of the variance in psychosocial adaptation. Conclusion: These findings indicate that to improve psychosocial adaptation of patients with permanent colostomy, the major related factors identified in this study should be considered.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.2
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• pp.265-282
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• 2003

Purpose : This study was conducted to provide for a basic resource, which can be used to set up a efficient management system in Cardiac Surgery Intensive Care Units(CSICU). Method: 1) Questionnaires were administered and observation methods were used, to examine the nursing activities performed in the CSICU after having reviewed related literatures and a review by the experts. Thus, the nursing activities were designating 254 activities and classified into 28 categories. 2)The 22 nurses in the 2 CSICUs filled out questionnaires about nursing activities from 12 April, 2002 to 17 April, 2002. The frequency of the nursing activities in the 28 categories counted and new nursing activities added by directly observing 12 nurses by two trained research staffs for 4 day. 3)In terms of validity, the 264 nursing activities were analysed by the 25 experts. As a result, 231 nursing activities were found valid and remained as appropriate nursing activities to be used for the careful analysis of the nursing activities in CSICUs. Result: The 22 categories are as below: assessment, monitoring, respiration management, nutrition management, elimination/drainage management, mobility management, sanitation management, safety management, temperature management, specimens collection, preparation and assistance of treatment, skin/wound management, infection management, medication management, education/support, dying patient care, recording/keeping, supplies management, environment management, communications, evaluations, professional development Conclusion : The manifest job description of the staff nurse will contribute to improving the efficiency of the nursing activities and to reducing the role conflicts among the medical staffs.

• Journal of Korean Critical Care Nursing
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• v.3 no.2
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• pp.1-11
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• 2010

Purpose: This study was designed to identify the factors affecting healing of Stage 2 pressure ulcer in an acute care facility in Korea. Methods: 286 Stage 2 pressure ulcers of 145 patients were examined. Data were collected in the period between October $1^{st}$, 2006 and September $30^{th}$, 2007. Data were analyzed with Kaplan-Meier survival analysis for cumulative recovery rate of Stage 2 pressure ulcers. Cox proportional hazard model was used to examine effects of multiple variables simultaneously. Results: Out of 286 initial Stage 2 pressure ulcers, 204 (71.3%) pressure ulcers healed completely. The median time to heal was 15 days according to Kaplan-Meier survival analysis. Cox proportional hazard model showed that the Stage 2 pressure ulcers healed more quickly when pressure redistribution surfaces were used (p<.001, HR=2.184), patients were administered with vitamins (p= .038, HR=1.451), and the size of the pressure ulcers were small (${\leq}3.0cm^2$, p= .006, HR=1.765). Conclusion: The factors contributing to the healing of Stage 2 pressure ulcer in an acute care setting were the application of pressure redistribution surface, small ulcer size (${\leq}3.0cm^2$), and the administration of vitamins.

• Journal of Radiation Protection and Research
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• v.5 no.1
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• pp.11-25
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• 1980

The increasing utilization of radioactive isotopes in industry, medicine and research has raised the question, 'How should hospitals deal with radiation injuries when they occur?' A system for initial management of radiation injuries has been developed by Radiation Management Corporation. Radiation injuries are classified and a treatment plan outlined for each at the emergency and short term medical care phase. This system includes clinical prognosis as well as a detailed plan for quick set up or a Radiation Emergency Area in any hospital. Procedures for patient admission, preparation of the facility, general decontamination, sample taking, and wound decontamination are included.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.851-854
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• 1987

Congenital diaphragmatic hernia remains a disease with high neonatal mortality rate despite recent advance in neonatal intensive care. We experienced one case of the congenital diaphragmatic hernia with acute respiratory distress and left pulmonary hypoplasia in the neonate. The simple closure was performed through left paramedian approach after diagnosis. The postoperative course was uneventful except wound disruption. The patient was follow-up with good general condition.