The Experience of Human Milk Banking for 8 Years: Korean Perspective

Human milk banks are a solution for mothers who cannot supply their own breast milk to their sick or hospitalized infants; premature infants, in particular, are unable to receive a full volume of breast milk for numerous reasons. As of December 2015, there was only one milk bank in a university hospital in Korea. We reviewed the basic characteristics of donors and recipients, and the amounts and contamination of breast milk donated at the Human Milk Bank in Kyung Hee University Hospital at Gangdong in Korea from 2008 to 2015. The donor pool consisted of 463 first-time donors and 452 repeat donors who made 1,724 donations. A total of 10,820 L of breast milk was collected, and 9,541.6 L were processed. Detectable bacteria grew in 12.6% after pasteurization and 52.5% had cytomegalovirus DNA before pasteurization in donated milk. There were 836 infant and 25 adult recipients; among new infant recipients, 48.5% were preterm; the groups received 8,009 and 165.7 L of donor milk, respectively. There was an increase in the percentage of preterm infants among new infant recipients in 2015 (93.1%) compared to 2008 (8.5%). Based on the number of premature infants in Korea, the number of potential recipients is not likely to diminish anytime soon, despite efforts to improve the breastfeeding rate. Sustainability and quality improvement of the milk bank need long-term financial support by health authorities and a nationwide network similar to blood banking will further contribute to the progress of milk banking.

Assessment of Occupational Symptoms and Chemical Exposures for Nail Salon Technicians in Daegu City, Korea / 예방의학회지

OBJECTIVES: This study aimed to evaluate occupational symptoms and chemical exposures of nail salon technicians. METHODS: Work-related symptoms of nail salon technicians in Daegu City were surveyed using a researcher-administered questionnaire, and responses were compared to those of non-exposed office workers as controls. Personal exposure level of airborne volatile organic compounds was also monitored using passive samplers. RESULTS: A total of 159 subjects in 120 salons were interviewed. Average work-shift concentrations of 13 chemicals were measured for 50 workers from 30 salons using personal passive samplers. The most frequently reported respiratory or neurologic symptoms by nail shop technicians compared to controls were nose irritation (odds ratio [OR], 54.0; confidence interval [CI], 21.6 to 134.8), followed by headache (OR, 9.3; CI, 4.7 to 18), and throat irritation (OR, 4.3; CI, 2.2 to 8.5). For eyes and skin, 92% of respondents complained eye irritation (OR, 13.1; CI, 5.7 to 30.1). In musculoskeletal symptoms, workers reported pain or discomfort in shoulders (OR, 20.3; CI, 7.7 to 54) and neck (OR, 19.7; CI, 8.9 to 43.6). From personal measurements, the proportion of exceeding the Korean Occupational Exposure Limit was the highest for acetone with 64%, followed by toluene (50%), butyl acetate (46%), and methyl methacrylate (12%). However, the service was being provided without a proper ventilation system in most surveyed shops. CONCLUSIONS: Based on these findings, it is warranted to have appropriate local exhaust ventilation place to ensure adequate health protection of nail shop technicians as well as customers. At the same time, greater policy interests are warranted in nail care business to protect health of both workers and customers.

Relationship between Perception for Appraisal of Perioperative Nurses and Performance and Organizational Commitment / 간호행정학회지

PURPOSE: This study was an analysis of the relationship between perception for appraisal of staff nurses in operating rooms and performance and organizational commitment. METHOD: The survey was conducted with 176 staff nurses in operating rooms in 2 hospitals in Seoul. Data were analyzed using frequency, one-way ANOVA, Pearson correlation analysis, and stepwise multiple regression. RESULT: 1. Perception for appraisal including accuracy and justice was significantly related to organizational commitment (r=.496, P=.000). Perception for appraisal including accuracy and justice was slightly related to performance (r=.220, P=.003). 2. In order to determine the percentage of the variance of performance and organizational commitment that could be predicted by perception for appraisal, perception for appraisal was entered in the regression equation. Accuracy accounted for 25% of the variance in the organizational commitment. To determine the percentage of the variance of performance that could be predicted by perception for appraisal and organizational commitment, the perception for appraisal and organizational commitment were entered in the regression equation. Organizational commitment accounted for 21% of the variance in the performance. Consequently accuracy predicted organizational commitment. Organizational commitment predicted performance. CONCLUSIONS: Findings indicate the need to increase accuracy of performance appraisal to promote organizational commitment and performance in perioperative nurses.

Study on Non-Value-Added Nursing Activities in a Tertiary Hospital / 간호행정학회지

PURPOSE: Purposes of this study were to identify non-value-added nursing activities (NVANAs) and to estimate the amount of time spent on NVANAs among total nursing activities. METHODS: Non-value-added nursing activities were identified though the use of a focus group. The nurses in the focus group were nurses working in a tertiary hospital. They discussed possible activities that could be NVANAs. Based on the focus group discussion, a pilot study was done to examine the actual occurrence of NVANAs in clinical settings. RESULTS: The focus group discussion showed that NVANAs occurred in ten categories of nursing performances including communication with physicians, communication with other departments, medications, equipment/supplies, nursing records, tests, admission, discharge, and transfer. Direct nursing activities accounted for 35.5% of total nursing activities while indirect nursing activities accounted for 64.5%. Of indirect nursing activities, 16% were NVANAs. Most NVANAs were related to communication and equipment/supplies. CONCLUSIONS: To improve the quality and efficiency of nursing activities, it is necessary to identify NVANAs and their causes. Results of this study suggest that improvement in the work process and nursing unit structure, support for equipment/supplies, and effective communication are needed to reduce NVANAs in tertiary hospitals in Korea.

A report on operating a nationwide human milk bank in Korea / 소아과

PURPOSE: A human milk bank collects, processes, eliminates, and stores breast milk from donors and provides breast milk to those in need. The authors hereby present the experiences and the objective lessons obtained through operating a nationwide human milk bank over a period of 2 years. METHODS: The characteristics of the donors and the recipients and the amounts of breast milk donated, processed, and received at the East-West Neo Medical Center Human Milk Bank were investigated from August 2007 to August 2009. RESULTS: The donor pool consisted of 131 first-time donors and 39 repeat donors who made 341 and 127 donations, respectively. Seventy-nine percent of the donors resided in the Seoul-Kyunggi area, and 60% of the donors were in their 30s. Most information and motivation came from the Internet (66%) or television (14%). A total of 2,736 L of breast milk was collected, and 1,979 L were processed. The cumulative number of recipients was 160 preterm or full-term infants and 21 adults, each group receiving the breast milk 337 and 41 times, respectively. In total, infants received 1,663 L and adults received 179 L. CONCLUSION: Through the present study, the role and importance of a human milk bank in collecting, pasteurizing, and storing surplus breast milk in through sanitary, medically proven methods and providing this breast milk to recipients could be appreciated and reevaluated. The authors believe that a national support system is necessary to expand this practice to a nationwide scale.

A Study for Evaluating the Performance of a Community-based Home Care Services Model

PURPOSE: This study was aimed to evaluate the performance of a community-based home care services model. METHOD: The subjects were 138 patients who have been enrolled during a 6 month's period, nursing records and nursing service bills. The data was collected by self report and chart review. The mean cost per visit was compared with those of hospitalization & clinic visit in the data from National Health Insurance Corporation. RESULT: A significant number of patients were bed ridden(63.8%) and unconscious(27.5%), and most of the patients had complex chronic diseases. Except nursing assessment, bed sore care was the most frequent nursing treatment(25.1%) in home care services. The mean cost per visit of home care services was 34,665 won, which was lower than those of hospitalization & clinic visit for medical aid. The patients were highly satisfied with the services by visiting nurse specialists. CONCLUSION: Community-based home care services provided cost-effective and satisfied services. Community-based home care services needs systematic supports to expand it's domain for promoting community health.

Developing a Home Care Nursing Information System by utilizing Wire-Wireless Network and Mobile Computing System / 간호학회지

PURPOSE: The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from1999 by adding home care nursing standard guidelines and upgrading the PDA program. METHOD: Method/1 and Prototyping were adopted to develop the main network system. RESULT: The detailed research process is as follows : 1)home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorhythm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.

Development of a Home Care Nursing Network System for Low Income and Vulnerable Health People by Utilizing Wire-Wireless Network and Mobile Computing / 대한의료정보학회지

This study was to develop the home care nursing network system for low income and vulnerable health people by utilizing wire- wireless network and mobile computing in order to record and send patients' data in real time, and connect the headquarter office and four local community health centers. The methods were the Method/1 and Prototyping were adopted to develop the main network system. Results were: 1) home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis, dementia/mental disorder, and chronic arthritis were added in 12 domains of nursing problem field with nursing assessment/intervention algorithms. 2) upgrading PDA system by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX - 1X base construction in order to reduce a transmission hour and the transmission failure.

Validation of Nursing Diagnosis and Intervention Management System based on Medical Diagnosis and Standardized Nursing Classffications / 대한의료정보학회지

The nursing process, composed of diagnosis, intervention and outcome, is practical and scientific approach. In addition, many studies on the nursing process have been performed. However, the nursing process has not applied to clinical fields. Therefore, we developed a nursing information system that supports nurses nursing diagnosis and intervention management. This system provides expected nursing diagnoses and interventions for subjective patients automatically so that nurses can make more accurate diagnoses and perform more adequate interventions. For that purpose, we have analyzed the relations of medical diagnoses and standardized nursing classifications and developed the outputs into a database system. In this study, we performed clinical tests for the system and verify the usefulness of the system with case database accumulated through the tests. We expect the system can be used in many hospitals efficiently after some upgrade based on the results of this study is completed.

The Implementation of Homecare Nursing Network System Using Wireless Network / 대한의료정보학회지

The purpose of this project is to implement "Homecare Nursing Network System" using wireless network which was able to manage homecare service efficiently. Therefore, by completing the project of "Homecare Nursing Network System", the research team connected the headquarter and the local homecare service offices over the Internet, and built the database and application programs to operate the offices. Homecare nurses are using the PDA(personal digital assistant) in order to provide homecare nursing service, to record the patients' data, and to send and receive the data in real time. It results in improving the quality of the homecare service through the computerized knowledge-based assess and intervention algorithms. The team also has implemented the homepage to introduce the homecare office and to provide the homecare service information. "Homecare Nursing Network System" allows us to manage homecare nursing service under the computerized environment, to keep track of the homecare nursing document efficiently, to improve the quality of homecare nursing, and to expand its business territory.

A System for Nursing Diagnosis and Intervention Management using the Nursing Outcome Indicators / 대한의료정보학회지

This paper proposes a system for nursing diagnosis and intervention management that is using nursing outcome indicators to guide the nursing intervention. In Korea, it has been studied on computerization of nursing process, but most of the studies are on the management of nursing records and not on the databases of nursing intervention. So far, the actual nursing processes have been performed by individual nurses' judgement without any supporting programs. Therefore, we provide the system with standardized database for nursing diagnosis and interventions so that nurses can make more accurate diagnoses and perform more adequate interventions. For that purpose, we have developed an algorithm that links nursing outcome indicators to nursing diagnoses and interventions. As a result, we expect the system can be used in many hospitals efficiently in the future after pilot operations.

Development of the Computerized Health Instruction System for the Registered Health Management Members / 대한의료정보학회지

The purpose of this study is to develop the computerized health instruction system to manage the Health Management Members(HMM) of the Gangbook-ku Health center in Seoul who have registered for the life-time health promotion. The HMM have been checked up and classified into 3 groups - healthy, borderline and ill group - based on their health assessment data through the computerized management system. But the computerized supporting programs for intensive management have not been sufficient enough to offer clear health instructions to the HMM and more than one user in the health center have not been able to use the system at the same time. Therefore, we have developed some new health instruction programs and upgraded the system to be used concurrently. For that purposes, we have used Delphi, Microsoft Access, ActiveX Data Objects(ADO) technology as development tools. We expect thi system to be used for health management of other public health centers, schools, and occupational settings, furthermore for evaluation of health promotion services. Additionally, this new computerized health management system supplemented with health instruction programs should be integrated to the computerized health care system at health centers in near future.

Development and Analysis of Community Based Independent Home Care Nursing Service / 간호학회지

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

A Preliminary Study for Evaluating on Demonstration Project of Community-based Home Health Care Nursing Services by the Seoul Nurses Association / 간호학회지

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

Development of a Computerized System for Intensive Care of the Health Management Members in Kangbook-gu Health Center / 대한의료정보학회지

The risk factors of chronic degenerative diseases are related to daily life style such as lack of exercise, obesity, smoking, stress, insufficient sleep, and etc. This study is conducted to develop a computerized system that check-up, guide and manage the residents' health through life-span. The morbidity of chronic degenerative diseases such as hypertension, diabetes mellitus and arthritis has been high in the survey on community health needs. These diseases are selected as the object of the study. The subjects who register as a health management member are over 40 and under 65 years old in the community. The combined approach method to individuals and groups is applied to the health management. The modeling of database for the system is constructed by entity-relationship model and relational data model. The subjects are classified into three groups of health, borderline and disease, on the basis of their clinical test result and daily life style. The intensive health care is provided to the subjects according to the result of analysis. We anticipate the community health promotion through the life style modification of the subjects by this intensive health care system.

Depressive Symptoms in a Korean Rural Sample: Risk Factor and Factor Structure / 신경정신의학

OBJECTIVES: The rates, correlates, and factor structure of depressive symptoms in a Korean rural sample were examined using Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). METHODS: Door to door visiting survey was conducted by trained interviewers. A random cluster sample of 1,315 respondents, aged 30 and over completed the CES-D scale along with additional sociodemographic questionnaires. RESULTS: In this sample, mean CES-D score of male and female were 7.8 and 9.5, respectively, which were lower than those reported previously. Symptoms of depression were most common among the less educated, non-married and female according to ANCOVA. Age was not a significant risk factor for depressive symptoms. Different factor structures emerged from this sample as compared to other studies using this approach. Somatic symptoms and affective symptoms were combined as one factor and emotional hardship emerged as a separate factor. CONCLUSIONS: Symptom scores and risk factors were similar to the results reported in other countries but unique factor structures were found in this study. Further research is needed about the Korean depressive symptomatology and related areas.