No abstract available.
Intensive Care Units* ; Critical Care*

BACKGROUND: Rapid progress in medical science and technology has lengthened the average span of life in general population and accelerated the increase in the elderly. This gave rise to the expansion of chronic degenerative disease in the elderly, and then led to an increase in the utilization rate of health care facility and medical fee in sequence. METHODS: In order to grope for an effective control program of chronic degenerative disease and to find out the characteristics of disease structure and utilization patterns of health care facility in the elderly, the author analysed the 6,072,196 cases of insured medical record of Federation of Korean Medical Insurance Societies from January 1st to December 31st of the year 1991. RESULTS: Essential hypertension(5.94%) is the most common disease in the elderly. And what follows are gastritis and duodenitis(4.29%), acute bronchitis and bronchiolitis(3.68%), acute upper respiratory infection of multiple or unspecified site(3.47%) and diabetes mellitus(3.21%). Twenty most frequent diseases constitute the top 50.27% and one hundred constitute over 85% of all frequency of health care facility utilization. There are different patterns of diseases between two sexes. Pulmonary tuberculosis, chronic liver disease and cirrhosis, malignant neoplasm of stomach, chronic obstructive pulmonary disease, occlusion of cerebral arteries, sprains and strains of knee and leg, malignant neoplasm of trachea, bronchus and lung, other open wound of head, erythematosquamous dermatosis are more than 1.5 times higher in male by the standardized frequency ratio. There is a significant dissimilarity of disease structure between primary and other types of health care facility, which presents the point of reinforcement in primary care. The author has also noted elderly patients prefer secondary or tertiary health care facility in case of essential hypertension, diabetes mellitus, pulmonary tuberculosis, heart failure, duodenal ulcer, chronic liver disease and cirrhosis, funtional gastrointestinal disorder, hypertensive heart disease and chronic obstructive pulmonary disease which seems to be not so critical in most cases. CONCLUSIONS: Patients of chronic degenerative disease tend to pursue the high quality of medical care and irregularly utilize health care delivery system.
Aged* ; Bronchi ; Bronchitis ; Cerebral Arteries ; Delivery of Health Care* ; Diabetes Mellitus ; Duodenal Ulcer ; Fees, Medical ; Fibrosis ; Gastritis ; Head ; Heart Diseases ; Heart Failure ; Humans ; Hypertension ; Insurance ; Knee ; Leg ; Liver Diseases ; Lung ; Male ; Medical Records ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive ; Skin Diseases ; Sprains and Strains ; Stomach ; Trachea ; Tuberculosis, Pulmonary ; Wounds and Injuries

The contamination period of the sterilized pack is influenced by the storage environment such as air contamination, temperature, humidity and the quality of the wrapping material. This study was conducted to provide basic data, for the expiration date of the EO gas sterilized pack (which was wrapped with polypropylene / polyester one side and paper the other side) by investigating the storage environment and monthly contamination period. The duration of study was 12 months, from Dec. 1, 1997 to Nov. 30, 1998. A total of 144 EO gas sterilized packs were kept in six storage cabinets of storage area after selecting four Operating Room, the Central Supply Department and General Surgery Clinic of one University Hospital in Taegu city. The samples were cultured in fluid thioglycolate media 30m1 in 37degrees C incubator for 48 hours. Air microbial bioburden in the six storage area and storage cabinet was monitored by exposing blood agar plate for fit teen minutes and culture were observed at 37t incubator for 2 thours. Temperature and Humidity were investigated four times(8 am, 2, 5, & 10 pm) a day and the mean values calculated. The results of this study are as follows 1. There was no contaminations in EO gas sterilized packs for 12 months observation. 2. The mean air contamination rate of storage area and cabinet in Operating Room was 4.9 CFU and 2.4 CPU during observation period. The mean air contamination rate of storage area and cabinet was 4.2 CPU and 2.2 CPU each during observation period. The rate of air contamination in storage room was at least twice than that of storage in Operating Room. The period that showed highest air contamination was in Feb. 98 as 9.2 CPU and the lowest in Mar. 98 as 1.1 CPU. 3. The predominant microorganisms were gram post five staphylococci, gram negative staphylococci in all storage environment, gram positive bacilli, gram negative bacilli in C cabinet of Operating Room and storage area in General Surgery Clinic, Fungi in storage area of Operating Room. 4. The mean temperature was 24.9+/-0.6degrees C(mean standard deviation) in storage area and 24.8+/-0.5degrees C in storage cabinet of Operating Room. The temperature was not differentiated between storage area and cabinet of Operating Room. The mean humidity was 63.6 7.3% (mean standard deviation) in storage area, 663+/-7.9% in cabinet of Operating Room. The humidity was observed high rate in storage area than cabinet of the six area environment. There was no growth of microorganism in sterilized packs during the observation. So we concluded that the contamination period of EQ gas sterilized packs was over 12 months. The high rate of air contamination in storage area might increase the degree of contamination of sterilized packs and the infection rate of operative wound. So the methods which could reduce the air contamination should be developed.
Adolescent ; Agar ; Daegu ; Ethylene Oxide* ; Fungi ; Humans ; Humidity ; Incubators ; Operating Rooms* ; Polyesters ; Polypropylenes ; Wounds and Injuries

No abstract available.
Hip

Tureta and his colleagues have stressed the important role that vessels play in osteogenesis. Numerous arthors attempted to provide new bone formation by placing vascular pedicles into the bone. Some reports are convining, but experimental model and histological investigation leave something yet to learn. We conducted an experiment to demonstrate the feasibility of using a vascular bundle to create new bone formation in medullary canal. Vasculsr bundle of the femoral artery and vein was transplanted in same side of the femoral canal of rabbits. The transplanted vascular bundle was studied histologically for eight weeks. At 3 weeks transplanted artery started proliferation of intima and media, and its lumen was obliterated completely at 6 weeks. Transplanted vein collapsed from begining, and didn't involve in revascularization and new bone formation. At 2 weeks the proliferation of capillaries promoting revascularization originated from the adventitia of the transplanted artery, and peaked at 6 weeks. New osteoid appeared around the transplanted vessel at 2 weeks, and surrounded the entire vessel in 5 weeks, and had no more progression in amount at 6 weeks. Cortical hypertrophies showed in the vascular bundle transplanted group from 3 weeks. Examination of control group revealed no sign of new osteoid formation around the hole during the whole study period.
Adventitia ; Arteries ; Capillaries ; Femoral Artery ; Hypertrophy ; Models, Theoretical ; Osteogenesis ; Rabbits ; Veins

A large mass as a sign of an infection is rare, and it might convince a physician that it had the appearance of a malignancy. The patient in this case visited our clinics after attending several hospitals, with a mass that had the appearance of a malignancy, based on the severe destructive findings observed on plain radiographs. We report the first documented case of a patient with a large mass (12×7×20 cm) and a low-grade infection, which developed at the proximal thigh after a hip arthroplasty. It is important to realize that an infection accompanied by a large mass, can mimic a highly destructive malignant lesion on plain radiographs.
Arthroplasty* ; Hip* ; Humans ; Thigh*

PURPOSE: The main purpose of this critical ethnography was to examines the process and discourses through which family caregivers experience while caring for their sick family member in a hospital. METHODS: This was achieved by conducting in-depth interviews with 12 family caregivers, and by observing their caring activities and daily lives in natural settings. The study field was a unit for neurologic patients. Data was analyzed using taxonomy, discourse analysis, and proxemics. All research work was iteratively processed from March 2003 to December 2004. RESULTS: Constant comparative analysis of the data yielded the process of becoming a successful family caregiver: encountering the differences and chaos as novice; constructing their world of skilled caregivers; and becoming a hospital family as experienced caregivers. During the process of becoming an experienced hospital family, the discourse of family centered idea guided their caring behaviors and daily lives. CONCLUSION: The paternalistic family caregivers struggled, cooperated, and harmonized with the patriarchal world of professional health care system. During this process of becoming hospital family, professional nurses must act as cultural brokers between the lay family caring system and the professional caring system.
Socialization ; *Professional-Patient Relations ; Nuclear Family/*psychology ; Male ; Korea ; Humans ; *Hospitalization ; Female ; Caregivers/*psychology ; Anthropology, Cultural ; *Adaptation, Psychological

No abstract available.
Abortion, Induced* ; Contraception* ; Female

PURPOSE: This study aimed to explore the discourses and the patterns of problem solving behaviors among the nurse managers. The focus of the study was the difficult situations in caring with patients and their families. METHODS: Field study was performed at a for-profit hospital from March, 2004 to March, 2007. The participants of the study were 5 head nurses and 2 nurses in charge. The data were collected with iterative interviews and participant- observations. For the analysis of the data, taxonomy and critical discourse analyzing were applied. RESULTS: The nurse mangers who showed wholistic patterns of behavior took the role of a broker among the client system, professional nursing system, medical system, and other allied health system. The nurse managers whose approach was profession-centered took the role of protector of nursing system. The nurse manager who practiced nurse-oriented pattern of behavior tried not to have harm against other members of health system. The experiences of nurse managers were effected from the discourses of patriarchal and market mechanism. CONCLUSION: The situation that provoke conflict between clients and nurses become more common with the changes to the health care system and to society. Nurse managers take the role of these conflict problems. The successful solving of conflict in a nursing care setting promotes the quality of care and satisfaction of clients. Programs for enhancing nurse's problem solving competency should anchored be in their practices.
Classification ; Delivery of Health Care ; Humans ; Nurse Administrators* ; Nursing ; Nursing Care ; Nursing, Supervisory ; Problem Solving

BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care