BACKGROUND: The implementation of health care delivery system(HCDS) in 1989 affected the visit pattern of tertiary care hospital. In this study we analyzed the effect of implementation of HCDS in a university hospital. METHODS: We analyzed the yearbook of a university hospital from 1986 to 1992. The clinical departments were divided into three groups of medical departments, surgical departments with application of HCDS and clinical departments without application of HCDS. RESULTS: The total outpatient visits increased after implementation of HCDS. The new outpatient visits decreased after implementation in the medical departments and surgical departments but re-visit patients increased in all clinical departments. The number of emergent patients increased at year 1889, but decreased in 1990, then little changed. Admission rate via emergency room decreased in surgical departments and clinical departments without application of HCDS. The patient from Pusan in which hospital is located was little changed but patients that from other areas increased. So the proportion of patients from Pusan decreased, and from other regions increased. The visit of patients with self pay decreased, but patients with medical insurance increased. CONCLUSIONS: In spite of increased total outpatient visits, the new outpatient visits and patient visits from near place decreased through implementation of HCDS. The new outpatient visits decreased in the medical departments and surgical departments in clinical departments with application of HCDS, but the new outpatient visits increased in clinical departments without application of HCDS.
Busan ; Delivery of Health Care* ; Emergency Service, Hospital ; Humans ; Insurance ; Outpatients ; Tertiary Healthcare

Fractures of the phalanges of the hand are very common. Many are minor and likely to have a good result. However many other phalangeal fractures cause significant and prolonged disability. Non-union of the tubular bones of the hand are uncommon occurrence, but are often associated with functional deficits. The authors have reviewed 7 cases of non-union of the phalanges which were treated in the department of orthopaedic surgery, National Medical Center from 1978 to 1985. The results were summarized as follows: 1. The non-union of phalangeal bone was defined by clinical symptoms and signs and roentgenological examination. 2. The incidence of non-union of phalangeal bone fractures was 0.9% (7/771 cases.) 3. of 7 patients, there were 6 in male and 1 in female. 4. Non-union occurred more commonly in the second decade and the group between 10 and 30 years of age. 5. Seven cases, all were the right handed, but injury was developed in the left hands except two cases. 6. The causes of non-union were thought as open wound (7 cases), type of fracture (simple or comminution:3 cases), inadequate immobilization (4 cases) and overtraction (1 case). 7. of 7 cases, 4 cases were treated with bone peg graft and K-wire fixation and 2 cases with excision of distal fragment. 8. The clinical union was 9 weeks in average.
Clinical Study ; Female ; Fractures, Bone ; Hand ; Humans ; Immobilization ; Incidence ; Male ; Transplants ; Wounds and Injuries

PURPOSE: We performed nerve-sparing robot-assisted radical cystectomy (nsRARC) and compared the operative outcomes of nsRARC and open radical cystectomy (ORC). MATERIALS AND METHODS: The data of 38 patients that underwent ORC or nsRARC for bladder cancer between July 2009 and April 2014 (23 ORC and 15 RARC) were retrospectively analyzed. Data were collected on patient demographics, pathologic stages, perioperative outcomes, and oncologic outcomes as well as on erectile function. Five-year overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Erection function recovery was defined as the ability to achieve penetration ≥50% of the time and to maintain an erection sufficient enough for penetration ≥50% of the time at 12 months after surgery. RESULTS: No significant differences were found between the nsRARC and ORC groups in terms of age, sex, body mass index, American Society of Anesthesiologists physical status, or clinical stage. Mean estimated blood loss was significantly less in the nsRARC group (205.3 mL vs. 394 mL, p=0.011), but mean operative time was significantly greater (520.3 minutes vs. 415.0 minutes, p=0.004). Five-year overall survival and cancer-specific survival were 86.7% and 86.7%, respectively, for nsRARC, and 77.7% and 86.7% for ORC. With respect to erectile function, the overall postoperative potency rate at 12 months was 40.0% in the RARC group and 9.5% in the ORC group, and this difference was significant (p=0.021). CONCLUSIONS: Our clinical experiences indicate nsRARC in selected patients is a feasible procedure in terms of oncologic outcome and that it preserves erectile function relatively effectively.
Body Mass Index ; Cystectomy ; Demography ; Humans ; Methods ; Operative Time ; Recovery of Function ; Retrospective Studies ; Urinary Bladder Neoplasms

No abstract available.
Adenoma* ; Hyperaldosteronism*

PURPOSE: The purpose of this study was to explore the life experiences of patients with a severe Chronic Obstructive Pulmonary Disease (COPD). METHODS: The data were collected through in-depth interviews of six patients suffering from severe COPD. The interviewed data were audio-recorded and transcribed verbatim and checked for accuracy. The Giorgi method of phenomenology was used for analyzing data. RESULTS: Eight themes forming the, units of meaning, were: Repeated and Unpredictable Suffering of Dyspnea, Confidence Loss/Exhaustion Life due to non-efficient breathing, Gradually Deprived Liberty, Absolute Being to Sustaining my life, Source of Burden but Significant Person I am in the Family, Endless Tug-of-War-Capability/Endeavor to Breath, Longing for my Life, and Dead-end of breathing. CONCLUSION: The study results provide an in-depth understanding of life experiences of patients suffering from severe COPD. The findings will be useful to nurses caring for this population.
Dyspnea ; Freedom ; Humans ; Ice ; Life Change Events ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Stress, Psychological

PURPOSE: The purpose of this study was to investigate the experience and perception of sexual harassment during the clinical practice among nursing students and to identify the relationship between these variables and self-esteem. METHODS: Participants included 191 senior nursing students who voluntarily participated. Sexual harassment experiences and perceptions were measured using the tools developed by the researcher. Self-esteem was measured using self-esteem inventory developed by Rogenberg. RESULTS: 50.8% of the participants experienced sexual harassment. Physical harassment was the most common, followed by verbal, visual and gender-role related sexual harassment. ‘Blocking the way’ and ‘Brushing one's body on purpose’ were the most common behaviors. The perception of sexual harassment severity was 3.35 out of 5 points. There were negative correlation between sexual harassment experience and self-esteem (r=-.17, p=.013). The subjects who experienced sexual harassment showed lower self-esteem score than those who did not (t=-2.10, p=.037). The main offender was a male patient in 40s, and the psychiatric ward was the most vulnerable to sexual harassment. CONCLUSION: Results showed that sexual harassment in clinical practice among nursing students were serious. It is necessary to develop an educational program to prepare them for sexual harassment in clinical practice.
Criminals ; Education ; Humans ; Male ; Nursing* ; Sexual Harassment* ; Students, Nursing*

PURPOSE: This study was done to explore the lived experience of pregnancy, childbirth, postpartum and early child rearing in married immigrant women in urban areas. METHODS: Data were collected from February to April, 2011 through in-depth interviews. Nine immigrant women were selected in a metropolitan area through the purposive and snowball sampling method. After obtaining IRB permission and informed consent from the participants, all interviews were recorded with MP3 recorder and transcribed for analysis. Using the phenomenological approach, data collected through in-depth interviewing were analyzed following Colaizzi style. RESULTS: Data analysis revealed 4 categories and 10 themes related to pregnancy, childbirth, postpartum and early child rearing of married immigrant women in urban areas. These four categories were 'A clumsy foreigner's life with nostalgia', 'Crisis in the crisis', 'Unprepared for motherhood', and 'Living together with new family without regrets'. It was a common finding that they were not ready to be mothers because of the very short time for adjustment in Korea. Compared to rural, immigrant women urban women had various in social support systems. CONCLUSION: The results indicate that adequate education is needed for immigrant women regarding motherhood, and that this education should be culturally appropriate for these women.
Child ; Child Rearing ; Emigrants and Immigrants ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Korea ; Mothers ; Parturition ; Postpartum Period ; Pregnancy ; Qualitative Research ; Statistics as Topic

BACKGROUND: There are many rating scales for assessment of geriatrics. But each of these scales were not sufficient to evaluate comprehensive geriatric assessment, physical and psychologic efforts for care. METHODS: We developed new scales to comprehensive geriatric assessment for care of geriatric patients. The Geriatrics Physical Support Scale(GPSS) evaluates physical effort consists of 10 areas and the Geriatrics Global Support Scale(GGSS) evaluates general condition of patients consist of 6 areas. Eighty probable and possible AD patients received the Clinical Dementia Rating Rating Scale(CDR), Korearn version of Mini-Mental State Examination(K-MMSE), Barthel Activity of Daily Living Index(B-ADL) GPSS, GGSS. We tested internal consistency, correlation among dementia rating scales. RESULTS: The GPSS correlated to CDR -0.63(p<0.01), B-ADL -0.90(p<0.01) and the GGSS correlated to CDR -0.60(p<0.01), B-ADL -0.75(p<0.01). The internal consistency were 0.69(GGSS), 0.92(GPSS). CONCLUSION: The Geriatrics Global Support Scale evaluate general condition of patients and the Geriatrics Physical Support Scale evaluate physical efforts needed for care of geriatric patients. These scales an also brief and easy rating scales to grade degree of caregiver`s burden.
Dementia ; Geriatric Assessment ; Geriatrics* ; Humans ; Physical Exertion ; Reproducibility of Results* ; Weights and Measures

PURPOSE: The purpose of this study was to identify health promotion behavior and contraception in married immigrant women. METHOD: Seventy-three immigrant women who were married with Korean men were recruited in October 2008. Data was collected by using questionnaires through a personal interview. The collected data was analyzed by descriptive statistics, Pearson's correlation, t-test, and ANOVA. RESULT: The lowest scoring part among health promotion behaviors was exercise. Stress management, eating habits and personal relationships followed. Health promotion behaviors were influenced by the age at marriage, frequency of going out, and health education experiences. Only 35.6% of subjects used contraception. The popular contraceptive methods were IUD, condom, and coitus interruptus. Most subjects got information about contraception from family and friends. 18.1% of subjects had no source of information. The women's education level had a significant influence on their contraceptive knowledge. CONCLUSION: Programs for exercise and contraception are needed to improve health promotion behaviors in married immigrant women. Nurses are an important part in health promotion. The role of nurses must be expanded in all communities through various intervention programs.
Coitus Interruptus ; Condoms ; Contraception ; Eating ; Emigrants and Immigrants ; Female ; Friends ; Health Education ; Health Promotion ; Humans ; Male ; Marriage ; Surveys and Questionnaires

No abstract available.
Femur* ; Fracture Fixation, Intramedullary* ; Tibia*