PURPOSE: The Korea Veterans Health Service (KVHS) implemented the ‘designated hospital system’ so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the ‘nearest group’ (those who chose the hospital closest to their residences) and the ‘non-nearest group’ (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. RESULTS: Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. CONCLUSION: Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.
Comorbidity ; Emergencies ; Hip Fractures* ; Hip* ; Hospitals, Veterans ; Humans ; Korea ; Veterans Health ; Veterans*

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.
Hospitals, Veterans ; Humans ; Korea ; Sigmoidoscopes ; Sigmoidoscopy*

BACKGROUND: This study was done to estimate the size of long-term care in-patients in one Veterans Hospital. Using KADL and KIADL (developed in 2002, verified validity & reliability), we evaluated the activities of daily living among in-patients in Daegu Veterans Hospital. METHODS: During the two months in June and July 2003, interviews were conducted by two interviewers. Daegu Veterans Hospital is 300-bed hospital and 257 in-patients were interviewed. Information from patients, care-givers, nurses and others were obtained. We classified a patient as severely disabled reguiring long-term care if one's total-KADL score over 16. RESULTS: The patients studied were representative of in-patients of Daegu Veterans Hospital. Their characteristics were males, old aged, slightly lower education but with high income compared to community based people. Among the total, 34% were classified as severe disabled (total-KALD score over 16) needing long-term care. The distribution of total-KADL was bi-modal (both the independent group and the dependent group occupied a high percentage). But the distribution of total-KIADL was more skewed to the independent group and we were able to estimate that the real long-term care need might be over 34%. Average admission period during the recent six months was 83.3 days in all-covered patients and 55.3 days in partial-covered patients. There was no significant correlation between the total-KADL/KIADL score and the admission period. It was suggested that Daegu Veterans Hospital was utiliged as a long-term care hospital. CONCLUSION: Among the total, 34% of admitted patients was classified as a long-term care group. Considering KIADL, the percentage of patients needing long-term care may be greater than those studied.
Activities of Daily Living ; Daegu ; Education ; Hospitals, Veterans* ; Humans ; Long-Term Care* ; Male ; Veterans

PURPOSE: This study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up. RESULTS: There were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups. CONCLUSION: The results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.
Comorbidity ; Follow-Up Studies ; Hip Fractures ; Hip ; Hospitals, Veterans ; Humans ; Length of Stay ; Mortality ; Survival Rate ; Veterans

BACKGROUND: It is expected that the number of families who provide caregiving for hospice patients will be increased in this society. Family caregiver will have fi nancial, psychological, social burden and stress related to this responsibility. Hospice patients, facing death, need not only biomedical therapy, but also systematic and continuous treatments such as mental or psycho-social intervention. The purpose of this study was to investigate the family caregiver's depression level and the associated factors. METHODS: The survey was conducted with 62 family caregivers of the hospice patients who had been hospitalized at the Gwangju Veterans Hospital from December 2005 to May 2006. The questionnaire consisted of the general characteristics of the subjects, Beck's depression inventory (BDI) evaluating the depression level and family APGAR score evaluating the family function. RESULTS: The mean age of the subjects was 58.2 years. The relationship with patients as 'spouse' accounted for 42 individuals (67.7%). The mean (+/- SD) BDI score was 25.3 (+/- 10.1) points and 58 percent of the subjects were suggested to have depression tendency (> or = 21 point). There was no relationship between the caregiver's depression level and their gender, religion, household income and Family APGAR score. However, the depression level was signifi cant related to the total caregiving duration (P = 0.001), visiting frequency of visitors (P = 0.004) and caregiving hours per day (P = 0.005). CONCLUSION: More than half of the family caregivers were suggested to have depression tendency. The depression level was infl uenced by the burden of caregiving and the visiting frequency of visitors. There is a need to activate social resources to share the burden of caregiving and to develop continuous and comprehensive care for hospice patients and their families.
Apgar Score ; Caregivers ; Depression ; Family Characteristics ; Hospices ; Hospitals, Veterans ; Humans

This was a statistical observation of paraplegia patients who underwent operation at National Veterans Hospital from January 1975 to Mary 1981. The data was analyzed according to anesthetic technique, anesthetic agents, site of injury and etiology of injury. The results were as follows: 1) Only 24 cases or 21 % of the total needed anesthesia during operation. 2) The most common anesthetic technique was inhalation with circle absorption method.(32 cases, 29%) 3) Halothane was used as the main anesthetic.( 17 cases, 53%) 3) The most common etiology of injury was vertebral fracture( 35 cases, 59%) 5) The most common site of injury was lower thoracic.(T2-T1) (33 cases, 56%) 6) The total number of surgical operations performed numbered 59 out of 112 cases as classified in Table 1.
Absorption ; Anesthesia ; Anesthetics ; Halothane ; Hospitals, Veterans ; Humans ; Inhalation ; Paraplegia*

BACKGROUND: An evaluation was performed to assess the performance of continuously monitoring VITAL automated blood culture system (bio-Merieux, Marcy-l'Etoile, France) and to investigate the value of performing final subcultures at the end of the protocol. METHODS: A retrospective study was conducted over a period of one year (October 1996 to September 1997) with 7,078 blood culture bottles sent to Microbiology Department of Korea Veterans Hospital. Not only VITAL positive bottles but also all the VITAL negative bottles were observed under a microscope after Gram staining and subcultured aerobically and anaerobically at the end of 5-day protocol. All isolates were identified by the conventional method and ATB system. RESULTS: Among total 7,078 bottles, 688 bottles (9.72%) were declared positive by the system, of which 68 (0.96%) proved to be false positive. The final blind subculture permitted the detection of 96 falsely negative bottles (1.38%). The average time to detection was 38h 08, and 20% of 444 samples having microorganisms were detected during the first 12 h, 45% during the first 24 h, 63% within 48 h, and 87% within 120 h. 58 samples (13%), which contained 20 cases of Gram positive cocci and 20 cases of yeasts- especially 65% of C. parapsilosis, were declared negative by the system but gave a positive subculture. Among the positive bottles, 86.3% were detected by the slope algorithm, 10.6% by the delta algorithm, and 3.1% by the threshold algorithm. CONCLUSIONS: I conclude that the VITAL system must be modified to improve the detection of staphylococci and yeasts and a more sensitive computer algorithm may be required so that the terminal subcultures will not be necessary. Each laboratory must decide the value of terminal blind subcultures on the basis of patient population and the microorganisms that are most frequently isolated in their institution.
Gram-Positive Cocci ; Hospitals, Veterans ; Humans ; Korea ; Retrospective Studies ; Yeasts

During ten years from Mar. 1973 to Feb. 1982, 2410 amputations of limbs have been experienced in Korea Veterans Hospital. 240 painful neuromas, which developed in 203 amputated limbs of 191 patients were treated with four different methods 1) Stretching and simple transection, 2) Transection and ligation, 3) Ligation and absolute alcohol injection and 4) Implantation into bone. After following up for average 5 years and 7 months, the following results were obtained. 1. The painful neuroma occured in 191 (7.9%) out of 2410 amputees. 2. The painful neuroma developed averege 2 years and 9 months after the first amputation. 3. After transection and ligation of the nerves, the painful neuroma recurred in 19.2% of the cases. The average interval taken to recur was 2 years and 6 months. 5. After ligation and absolute alcohol injection into the nerves, the painful neuroma recurred in 14.8% of the cases. The average interval taken to recur was 2 years and 6 months. 6. After implantation of the nerve into the bone, the painful neuroma recurred in 5.7% of the cases. The average interval taken to recur was 2 years and 2 months. 7. The best results were obtained after implantation of the nerves into the bone.
Amputation ; Amputees ; Ethanol ; Extremities ; Hospitals, Veterans ; Humans ; Korea ; Ligation ; Neuroma

Chronic osteomyelitis continue to be a therapeutic challenge. The osteomyelitis also implies chronic ischemia of the diseased bone ; thus systemic antibiotic treatment may not be as effective as we want. In 1972, Klemm developed a new procedure to supplement saucerization in the treatment of chronic osteomyelitis, alternative to irrigation and suction-drainage, i.e., Gentamicin-PMMA Beads. The authors analysed 35cases of the chronic osteomyelitis which were admitted and treated by sauceriztion and Gentamicin-PMMA Beads in Department of Orthopaedic Surgery, Korea Veterans Hospital from Aug. 1984 to Jan. 1988.
Gentamicins ; Hospitals, Veterans ; Ischemia ; Korea ; Osteomyelitis ; Polymethyl Methacrylate

Nonunion of fractures of forearm bone occurs frequently. These patients usually suffer from pain and functional disturbance of the hand and forearm. With the introduction of compression plate for the treatment of nonunion at the Campbell Clinic in 1959, a modification of the Nicoll graft was advised. The authors analysed 23 cases of the nonunion of forearm bone, in which military injured patients were admitted and treated by bone graft with internal fixation using various devices in Department of Orthopaedic Surgery of Korea Veterans Hospital from Sep. 1983 to Aug. 1988.
Forearm ; Hand ; Hospitals, Veterans ; Humans ; Korea ; Military Personnel ; Transplants