ABSTRACT
PURPOSE: This study was conducted to identify the effects of the critical pathway (CP) on the quality of medical care, and to determine means of reducing costs for lumbar posterolateral fusion in patient with lumbar spinal stenosis. MATERIALS AND METHODS: The subjects were 25 control patients with lumbar posterolateral fusion, and 25 experimental patients with application of CP. We compared the patients' functional status using the Oswestry disability index, patients'satisfaction by quality patient care scale, the length of hospitalization and the medical charges between the two groups. RESULTS: Differences between the Oswestry disability index of the experimental and control groups were not significant. No differences were found between two groups regarding general care, but the experimental group was more satisfied with specific care related to spinal fusion. The mean length of stay of the experimental group was shorter than that of the control group, and the charge of medication and treatment of the experimental group was lower than that of the control group. CONCLUSION: Critical pathway improves the quality of care and reduces medical charges.
Subject(s)
Humans , Critical Pathways , Hospitalization , Length of Stay , Patient Care , Spinal Fusion , Spinal StenosisABSTRACT
It is well recognized that case management is required to survive in the rapidly changing medical environment. One of the case management is the critical pathway(CP) which is assumed to increase the quality of care and at the same time to decrease the length of stay in hospital. The purpose of the study was to develop a CP for the management of patients with postero-lateral fusion for lumbar spinal stenosis. Through review of literature and medical records of patients with spinal stenosis, a pilot CP was designed, including 8 different care components such as medication, laboratory tests, assessment etc., from one day before surgery to 6 days of postoperative care. Every item of the pilot CP was evaluated by a panel of experts to test the content validity. The items not agreed on by more than 4 out of 6 experts were deleted or modified to be integrated in the CP. To apply the modified CP to a clinical environment, the items reflecting treatment, medication and lab work were entered into an order communication system(OCS), and doctors and nurses were taught to use the CP. Finally, the development of CP for the patients with posterolateral lumbar fusion was completed after the application and variance analysis of the CP.
Subject(s)
Humans , Case Management , Critical Pathways , Length of Stay , Medical Records , Postoperative Care , Spinal StenosisABSTRACT
Issues related to the elderly have been recognized in Korea and nursing scholars have tried to study there issues. It is hard to say which the direction we, are going or have to go, since there has been little systemic effort to establish gerontological nursing field yet. Therefore, it is necessary to find out the trend and the guidelines of gerontolotical nursing studies for the future. Dissertation and published articles related to the elderly in the nursing field from 1991 to the February of 1997 were are reviewed. Total 127 studies were analysed in terms of concept, design/methodology, and results, and the nature and issues of the geronotologic nursing studies in Korea were explored. The results are as follows: 1. There was no clear chronological definition of the elderly. 2. The most popular research design was an exploratory/descriptive study. 3. The major concepts studies were physical and mental health. 4. Among those studies using instrument which were developed and modified and /or translated by researchers, the reliability and validity were rarely reported. 5. Theory based studies were rare. We suggest the following issues for future studies : 1. The chronological and other criteria related to the definition of elderly is needed. 2. Physiopsychosocial characteristics of Korean elderly and their managements in terms of intervention studies need to be conducted more synthetically. 3. Social issues from the change of types and function of family such as single elderly family need to be studied. 4. Participation in and collaborate with other disciplines are needed. 5 Development and test of instruments to measure phenomena or concepts is needed. 6. Macroscopic approach such as policy also needed. 7. Theory based studies are needed.
Subject(s)
Aged , Humans , Korea , Mental Health , Nursing , Reproducibility of Results , Research DesignABSTRACT
No abstract available.
Subject(s)
Humans , Dialysis , Kidney Failure, Chronic , Quality of LifeABSTRACT
No abstract available.
Subject(s)
Humans , Dialysis , Kidney Failure, Chronic , Quality of LifeABSTRACT
The records of 34 patients with histologically proven pm-gastric cancer were reviewed from Chonnam University Hospital during the recent 6 year period, 1981, to 1986. The male outnumbered female in a ratio of 2.4:1.0. The peak incidence was 6th decade and mean age were 53.8 years in male, 48.7 years in female respectively. pm-gastric cancer was most often seen on the lesser curvature side, eapecially in the lower 1/3 of the stomach. Macroscopically, it can be divided into early-cancer-like type and Borrmann type. Early-cancer-like type was more frequent than Borrmann type. Early-cancer-like type IIc+III was most often seen with a rate of 20.6%, followed in the order of frequency by Borrman type II, early-cancer-like type IIc, IIa+IIc, and Ile+ IIa. The incidence of lymph node involvement was 26.4% and were related to the macroscopic types and/or histologic differentiation degrees. 5 cases out of 34 pm-gastric cancer expired during the follow up period, and their mean survival time was 32.8 months. The type of operation and the extent of resection were closely related to survival. Five year survival rate was 54.0%. These results shows the significance of the pm-gastrie cancer as a early simulating advanced cancer.
Subject(s)
Female , Humans , Male , Follow-Up Studies , Incidence , Lymph Nodes , Stomach , Stomach Neoplasms , Survival RateABSTRACT
The clinical review was done on 15 cases with the foreign body in the upper gastrointestinal tract who visited and underwent endoscopic removal of foreign body at department of lnternal Medicine of Chonnam University Hospital and Namkwang Hospital from June 1982 to August 1987. The results are as follows: 1) The age distribution varied from 32 yeara to 83 years of age, being most prevalent at 6th decade, The ratio between male and femaie was 4:1, more prevelant in male. 2} Among 15 eases, 8 cases were lodged in the esophagus and 7 cases in the stomach. The foreign bodies in the esophagus were meat, pressure-through package, food materials and bone in order of frequency and those in the stomach were bezoar, persimmon seed, brown seaweed, tooth brush and suture materials. 3) Cambined diseases of upper gastrointetinal passage disturbance were 1 case of esophageal cancer and 3 cases of gastric outlet obstruction caueed by duodenal ulcers and gastric malignancy. Other combined diseases were schizophrenia, chronic alcoholism, diabetes mellitus and gastrie polyp. 4) Complications by foreign body were retropharyngeal abscess and phlegmonous esophagitis with esophageal ulcer.
Subject(s)
Humans , Male , Age Distribution , Alcoholism , Bezoars , Cellulitis , Diabetes Mellitus , Diospyros , Duodenal Ulcer , Esophageal Neoplasms , Esophagitis , Esophagus , Foreign Bodies , Gastric Outlet Obstruction , Meat , Polyps , Retropharyngeal Abscess , Schizophrenia , Seaweed , Stomach , Sutures , Tooth , Ulcer , Upper Gastrointestinal TractABSTRACT
Authors came acoss a case of Behcet's syndrome involving cecum. The patient was a 33-year-old female. Her chief complaint was right lower quadrant pain, Colonoscopy revealed several ulcerations the base of which was covered by thick whitish coat, They were surrounded by mulitiple nodular masses. Endoscopic biopsy showed noaspecific ulceration. The patient had a history of aphthous ulceration of mouth and external genitalia. So she was diagnosed to have Behcets syndrome. She underwent right hemicolectomy with tetminal ilectomy. We report this case with literiature review.
Subject(s)
Adult , Female , Humans , Behcet Syndrome , Biopsy , Cecum , Colonoscopy , Genitalia , Mouth , Stomatitis, Aphthous , UlcerABSTRACT
Authors report a case with recurrent epigastric pain who revesled to have chronic pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct. She was a 41-year-old female who favored raw meat. ERCP revealed a living round worm in the pancreatic duct which was also showed by ultrasonegraphy and computed tomography. She underwent distal pancreatectomy and developed glucose intolerance but was well controlled.
Subject(s)
Adult , Female , Humans , Ascaris lumbricoides , Ascaris , Cholangiopancreatography, Endoscopic Retrograde , Glucose Intolerance , Meat , Pancreatectomy , Pancreatic Ducts , Pancreatitis, ChronicABSTRACT
Congential bile duct cysts, the so called "choledochal cysts" occur at all levels of the biliary tree and may be of saccular, diverticular, or fusiform configuration. There are 6 types of choledochal cysts proposed by todani et al based on roentgenologic and operative findings. This disease is usually diagnosed at the childhood or early adult life and predilection for orientals. Clinical manifestations are usually jaundice, right upper quadrant abdominal pain and abdominal mass. Here we are reporting a case of choledochal cyst, type IV-A diagnosed by abdominal ultrasonogram. 99mTc-DISIDA hepatobiliary scan and endoscopic retrograde cholangiopancreatogram.