임상간호사의 투약오류에 영향을 미치는 요인

김준규 ( Junekyu Kim ),송영숙 ( Yeoungsuk Song ),서순림 ( Soon Rim Suh ) 한국보건정보통계학회 2021 보건정보통계학회지 Vol.46 No.1

The aim of this study was to identify predictive factors (fatigue, labor intensity, quality of sleep, and job stress) of medication errors in clinical nurses to improve patients’ safety. Methods: The participants of this study were 148 female nurses who have clinical experience for more than 1 year at K hospital and pregnant nurses among them were excluded. The data were collected from February 27th to March 20th, 2019. The measurements of medication errors, fatigue, labor intensity, quality of sleep, and job stress were used. Data were analyzed with descriptive statistics, t-test, ANOVA, Scheffé test, Pearson correlation coefficients and multiple regression analysis using IBM SPSS/WIN 23.0. Results: The predictive factors associated with nurses’ medication errors were clinical experience (β=-0.41), fatigue (β=0.31), work department emergency room (β=0.28), work department surgery ward (β=0.25), and job stress (β=0.23). The results showed that the nurses who had less clinical experience and felt more fatigue or job stress, were likely to have more medication errors. Also, the nurses who work in emergency room or surgery units, experience more medication errors. Conclusions: Clinical experience, fatigue, work area-emergency room, work area-surgery word and job stress were the main influential factors on medication errors of clinic nurse. Theses influential factors should be integrally considered in nursing management to decrease medication errors. Especially, it is needed to develop a programs that can indirectly improve clinical experience to prevent medication errors.

Long V-Y advancement technique for large nipple reconstruction in Asian women

Jang, Nam,Kim, Junekyu,Shin, Hyun Woo,Suk, Sang Woo Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.1

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4-5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

Keystone Flap with Omega Variation and Sydney Melanoma Unit Modification to Cover Small- and Moderate-Sized Defects in the Anterior Lower Leg

Kong Yu Taek,Kim Junekyu,Shin Hyun Woo,Kim Kyu Nam 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.2

Background: Covering a small defect on the anterior lower leg is challenging because less soft tissue is available. This study presents the application of a keystone flap (KF) with omega variation (OV) and Sydney melanoma unit modification (SMUM) for small- and moderatesized pretibial defects.Methods: This study included a series of six cases of anterior lower leg defect reconstruction with OV and SMUM KF technique by a single surgeon between December 2017 and June 2020. Records and photographs of the patients were collected and analyzed.Results: The defects’ sizes ranged from 1.5×2.5 to 6×8 cm. All defects were covered with OV KF, SMUM KF, or OV SMUM KF based on the hotspots of surrounding perforators. The flap sizes varied from 3×6 to 8×17 cm. Moreover, all flaps were completely viable. A marginal maceration developed in one case, which was mended with conservative dressing. Outcomes were favorable in all patients during the average follow-up period of 4.83±1.17 months.Conclusion: This study successfully covered small- and moderate-sized anterior lower leg defects with OV and SMUM KF. We therefore suggest the OV and SMUM KF techniques as good alternative modalities for anterior lower leg reconstruction.

A case report of Madelung's disease

Jang, Nam,Shin, Hyun Woo,Kim, Junekyu,Yoon, Kun Chul Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.5

Madelung's disease (MD) otherwise known as Launois-Bensaude syndrome, multiple symmetrical lipomatosis, or benign symmetric lipomatosis, is a rare disease characterized by abnormal diffuse lipomatosis in proximal upper limbs and neck. Here, we report a rare case of MD. A 66-year-old man presented with massive growth of soft tissues in the cervico-occipital region of more than 2 years duration. Physical examination showed diffuse enlargement of the anterior neck (Madelung's collar) and three huge humps at the posterior neck. Under a diagnosis of MD, lipectomy via a single anterior transverse incision and liposuction were performed. This rare case report may be helpful for assessing patients with abnormal diffuse lipomatosis in the neck and proximal upper limbs.

Immediate surgical treatment for massive extravasation of computed tomography contrast medium in the hand: a case report

Byung Woo Yoo,Kap Sung Oh,Junekyu Kim,Kyu Nam Kim,Hyun Woo Shin 대한수부외과학회 2023 대한수부외과학회지 Vol.28 No.1

There are no treatment guidelines for the extravasation of contrast medium. A 71-year-old man underwent coronary artery computed tomography. When contrast medium (iohexol) was injected through the right cephalic vein, massive leakage into the surrounding tissues occurred. A physical examination showed severe swelling of the hand and a prolonged capillary refill time. X-rays showed a massive accumulation of contrast medium in the hand. We immediately performed surgical treatment, including four skin incisions on the hand, subcutaneous dissection, and squeezing, which led to the removal of 50 mL of liquid. The immediate postoperative radiographic findings showed dramatic fading of most of the contrast medium. Four days postoperatively, radiography showed complete dissolution of all contrast medium, and a physical examination revealed full recovery of skin color and capillary refill time. We successfully managed massive extravasation of contrast medium in the hand with immediate surgical treatment. An immediate surgical approach for massive extravasation should be considered to achieve favorable outcomes.

Single-Stage Peninsula-Shaped Lateral Tongue Flap Reconstruction for Buccal Defects in Two Patients: Revisiting a Simple and Safe Reconstructive Option

Kong Yu Taek,Lim Soo Yeon,Kim Junekyu,Shin Hyun Woo,Kim Kyu Nam 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.2

Intraoral defects are increasingly reconstructed using free flaps. However, certain situations may render free flap reconstruction difficult. This study presents two cases with underlying comorbidities that underwent reconstruction of buccal defects involving the retromolar trigone (RMT), using a single-stage peninsula-shaped lateral tongue flap (pLTF). A 58-year-old woman and a 75-year-old man were diagnosed with left buccal squamous cell carcinoma and right buccal adenoid cystic carcinoma, respectively. The buccal defects extending to the RMT area were detected and covered with an ipsilateral posteriorly based pLTF after wide excision of the lesion. All flaps survived without any postoperative complications. Moreover, no tumor recurrences or functional problems were observed during the final follow-up. A single-stage pLTF is believed to represent a good alternative to free flaps in buccal and RMT defects.

Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years

Heejae Won,Seung-Hoon Baek,Junekyu Kim,Won Kee Lee,Yeon Soo Lee,Shin-Yoon Kim 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.3

Background: The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years. Methods: A total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision. Results: The HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision. Conclusions: THA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.

Early postoperative treatment of mastectomy scars using a fractional carbon dioxide laser: a randomized, controlled, split-scar, blinded study

Shin, Hyun Woo,Suk, Sangwoo,Chae, Seoung Wan,Yoon, Kun Chul,Kim, Junekyu Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.4

Background Mastectomy leaves unsightly scarring, which can be distressing to patients. Laser therapy for scar prevention has been consistently emphasized in recent studies showing that several types of lasers, including fractional ablation lasers, are effective for reducing scar formation. Nonetheless, there are few studies evaluating the therapeutic efficacy of ablative CO₂ fractional lasers (ACFLs). Methods This study had a randomized, comparative, prospective, split-scar design with blinded evaluation of mastectomy scars. Fifteen patients with mastectomy scars were treated using an ACFL. Half of each scar was randomized to "A," while the other side was allocated to group "B." Laser treatment was conducted randomly. Scars were assessed using digital photographs of the scar and Vancouver scar scale (VSS) scores. Histological assessments were also done. Results The mean VSS scores were 2.20±1.28 for the treatment side and 2.96±1.40 for the control side. There was a significant difference in the VSS score between the treatment side and the control side (P=0.002). The mean visual analog scale (VAS) scores were 4.13±1.36 for the treatment side and 4.67±1.53 for the control side. There was a significant difference in VAS score between the treatment side and the control side (P=0.02). Conclusions This study demonstrated that early scar treatment using an ACFL significantly improved the clinical results of the treatment compared to the untreated scar, and this difference was associated with patient satisfaction.

Aggressive cutaneous squamous cell carcinoma of the scalp

Suk, Sangwoo,Shin, Hyun Woo,Yoon, Kun Chul,Kim, Junekyu Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.6

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, and its incidence is increasing globally. In Korea, there were 12,516 diagnosed cases of cSCC between 1999 and 2014. Surgical treatment, for which several options are available, is the standard of care for cSCC and securing a sufficient surgical resection margin is always important. cSCC of the scalp sometimes exhibits unusually aggressive behavior. In this article, we report a case of cSCC of the scalp with invasion into the skull and dura mater.