일반적 특성, 미용행동, 미용성형수술태도의 관계에 대한 연구

안현경 한국뷰티경영학회 2019 한국뷰티경영학회지 Vol.7 No.1

The purpose of this study is to investigate the relationship of general characteristics, beauty behavior, and cosmetic surgery attitude to provide a database for beauty and cosmetic surgery industry which shows increasing tendency, and to contribute to the development of these industries by Identifying the problems and supplying complements. 370 questionnaires were received from Koreans from August 10 to September 5, 2018. Those were calculated by frequency analysis, factor analysis, and regression analysis, co-relation analysis using SPSS. Results is as follows; ① The effects of general characteristics on beauty behavior were found to have a significant effect on makeup management, skin care, and body shape management factors. The effect of general characteristics on makeup management showed that the more the men, the older, the married, the highly educated, the higher monthly income, the less the makeup management. The effect of general characteristics on the skin care showed that the more the man, the older, the less skin care, and the highly educated, the more skin care. The effects of general characteristics on body shape management showed that the more the older, the highly educated, the higher monthly income, the more the body shape management. ② The effects of general characteristics on cosmetic surgery attitude was found to have a significant effect on all of cosmetic surgery attitude factors. The effects of general characteristics on the need for cosmetic surgery showed that the more the men, the older, the married, the highly educated, the higher monthly income, the less the need for cosmetic surgery. The effect of general characteristics on the pursuit of secrets showed that more the man, less the pursuit of secrets, the older, the married, the highly educated, the more the pursuit of secrets after cosmetic surgery. The effect of general characteristics on the risk taking showed that the more the aged, the married, the highly educated, the higher monthly income, the less the risk taking. ③ The effects of beauty behavior on the cosmetic surgery attitude was found to have a significant effect on the need for cosmetic surgery and risk taking. The effects of beauty behavior on the need for cosmetic surgery showed that the more doing the makeup management, skin care, and hair care, the more the need for cosmetic surgery. The effects of beauty behavior on the risk taking of cosmetic surgery showed that the more doing the brand and professional salon management, makeup management, body shape management, the more the risk taking, the more the skin care, the less the risk taking.

Analysis of Pediatric Surgery Using the National Healthcare Insurance Service Database in Korea: How Many Pediatric Surgeons Do We Need in Korea?

Oh Chaeyoun,이상훈,장혜경,Ahn Soo Min,Chae Kyunghee,Kim Sujeong,Kim Sukil,Seo Jeong-Meen 대한의학회 2021 Journal of Korean medical science Vol.36 No.18

Background: In the past, general surgeons (GSs) without a pediatric surgical subspecialty often performed surgery on children and, even now, GSs are performing many pediatric surgeries. We aimed to investigate the involvement of pediatric surgeons (PSs) and GSs in pediatric surgery, compare the outcomes of surgery in the neonatal intensive care unit (NICU), and estimate the appropriate PS workforce in Korea. Methods: We used surgical data from the National Health Insurance Service database that was collected from patients under the age of 19 years in hospitals nationwide from January 2002 to December 2017. In this database, we found 37 hospitals where PSs worked by using the index operation (congenital diaphragmatic hernia, esophageal atresia, hypertrophic pyloric stenosis, Hirschsprung's disease, abdominal wall defect, jejunoileal atresia, malrotation, anorectal malformation, and biliary atresia). It was assumed that the surgery in the 37 hospitals was performed by PS and that the surgery in other hospitals was performed by GS. Mortality was analyzed to compare the outcomes of acute abdominal surgery in the NICU. We estimated the number of PS currently needed in Korea for each situation under the assumption that PS would perform all operations for the index operation, main pediatric diseases (index operation + gastroesophageal reflux disease, choledochal cyst, inguinal hernia, and appendicitis), acute abdominal surgery in the NICU, and all pediatric surgeries. Additionally, we estimated the appropriate number of PS required for more advanced pediatric surgery in the future. Results: The number of pediatric surgeries from 2002 to 2017 increased by 124%. Approximately 10.25% of the total pediatric surgeries were performed by PSs, and the percentage of the surgery performed by PSs increased from 8.32% in 2002 to 15.92% in 2017. The percentage of index operations performed by PSs annually was 62.44% in average. It was only 47.81% in 2002, and increased to 88.79% in 2017. During the last 5 years of the study period, the average annual number of surgeries for main pediatric diseases was approximately 33,228. The ratio of the number of surgeries performed by PS vs. GS steadily increased in main pediatric diseases, however, the ratio of the number of surgery performed by PS for inguinal hernia and appendicitis remained low in the most recent years. The percentage of the number of acute abdominal surgery performed by PS in the NICU was 44% in 2002, but it had recently risen to 89.7%. After 30 days of birth, mortality was significantly lower in all groups that were operated on by PS, rather than GS, during the last 5 years. In 2019, 49 PSs who were under the age of 65 years were actively working in Korea. Assuming that all pediatric surgeries of the patients under the age of 19 years should be performed by PS, the minimum number of PS currently required was about 63 if they perform all of the index operations, the main pediatric surgery was about 209, the NICU operation was about 63, and the all pediatric surgeries was about 366. Additionally, it was determined that approximately 165 to 206 PS will be appropriate for Korea to implement more advanced pediatric surgery in the future. Conclusion: The proportion of the pediatric surgery performed by PS rather than GS is increasing in Korea, but it is still widely performed by GS. PSs have better operative outcomes for acute abdominal surgery in the NICU than GSs. We believe that at least the index operation or the NICU operation should be performed by PS for better outcome, and that a minimum of 63 PSs are needed in Korea to do so. In addition, approximately 200 PSs will be required in Korea in order to manage main pediatric diseases and to achieve more advanced pediatric surgery in the future.

급성 복증 환자에서 이상적인 수술 시간

김마루,김지훈,김성집,조항주 대한외상중환자외과학회 2016 Journal of Acute Care Surgery Vol.6 No.1

Timing of surgery is important for prognosis. In patients with acute abdomen, the urgency means timing of surgery is even more important. However early emergency surgery is often logistically daunting because of constraints on resources such as operating room, supporting anesthesiologist, and nurses. Therefore it is worthwhile reviewing the timing of surgery in the patient with acute abdomen. The authors discuss the ideal time to surgery based on their experience and a review of the literature. For appendicitis and for peptic ulcer perforation, the authors recommend surgery within 24 hours from symptom onset. However, for other acute abdomen disease, evidence for a consensus is not as strong. If a surgeon faces a large number of emergent patients, if resources are limited, the surgeon must decide priorities for surgery. Therefore, an emergency triage system is needed, based on expert opinion and evidence. Although several triage systems are described in the literature, there is some controversy. If we follow a triage system, utilization of resources will be more efficient and acute care surgery might be performed within the ideal time. (J Acute Care Surg 2016;6:7-10)

The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery

두아람,강세린,김예솔,이태원,이준래,김동찬 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.1

Background: Although the quality of postoperative recovery may be affected by factors, there are few investigations whether the type of anesthesia also affects it. In this single-blinded, prospective, observational study, we compared the quality of postoperative recovery in patients undergoing orthopedic forearm surgery under general or regional anesthesia (brachial plexus block). Methods: Ninety-seven subjects, aged 18–65 years and American Society of Anesthesiologists physical status I or II, undergoing orthopedic forearm surgery, were allocated to general or regional anesthesia group. The quality of postoperative recovery was assessed using a validated Korean version of Quality of Recovery-40 (QoR-40K) questionnaire. Patients were surveyed three times, the day before surgery (baseline) and 1st and 7th day after the surgery, and the scores of both groups were compared. Results: We analyzed 47 and 50 patients in general and regional anesthesia, respectively. The global QoR-40K score and those of each of its five dimensions were not significantly different between the two groups at baseline, 1st and 7th day postoperatively. In two-way RM ANOVA, the global QoR-40K score at postoperative 1st day was significantly lower than that of baseline (P < 0.001) and postoperative 7th day (P < 0.001), respectively, in both general and regional anesthesia groups. However, there was no significant difference at each timepoint between the two groups. Conclusions: The present study suggests that brachial plexus block with intravenous dexmedetomidine infusion does not improve the quality of postoperative recovery compared to sevoflurane inhalation anesthesia with remifentanil infusion in patients undergoing orthopedic forearm surgery.

한국에서 Acute Care Surgery의 확립

박찬익,김재훈,박성진,김선희,김호현,홍석경,박치민 대한외상중환자외과학회 2018 Journal of Acute Care Surgery Vol.8 No.2

The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emer-gency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. How-ever, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the develop-ment and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.

Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study

Subhabrata Ghosh,Kirthi Kumar Rai,Hosadurga Rudraswamy Shivakumar,Amarnath P,Upasi,Vinayak Gourish Naik,Avijit Bharat 대한구강악안면외과학회 2020 대한구강악안면외과학회지 Vol.46 No.2

Objectives: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient’s sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.

악교정 수술 후에 발생한 기관 삽관성 육아종의 증례보고

하지원,윤성환,이상민,정광,정승곤,국민석,박홍주,유선열,오희균,Ha, Jiwon,Yoon, Sunghwan,Yi, Sangmin,Chung, Kwang,Jung, Seunggon,Kook, Minsuk,Park, Hongju,Ryu, Sunyoul,Oh, Heekyun 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.3

Three patients who underwent orthognathic surgery under general anesthesia complained about difficulty in vocalization and hoarseness after surgery. Intubation granuloma was diagnosed by the department of otorhinolaryngology in our hospital and the masses were excised by laryngoscopy assisted surgery. Chief complaints and symptoms of patients were relieved after surgery. These cases report with review of articles is presented, and the etiology, diagnosis, treatment and prognosis of intubation granuloma after orthognathic surgery are evaluated.

개복 및 복강경 등 외과 수술에서 정맥 통증자가조절 펌프를 이용한 술후 통증 관리에 대한 전향적 코호트 관찰 연구

이관우 대한마취통증의학회 2015 Anesthesia and pain medicine Vol.10 No.1

Background: An electrical patient-controlled analgesia (PCA) pumpenabled us to collect infusion history of opioid analgesic and otherefficacy parameters of PCA, including delivery-to-attempt (D/A) ratio. This study evaluated the effectiveness of PCA in a large populationof surgical patients using numerical rating scale (NRS) for pain andD/A ratio. Methods: A total of 6,847 patients were enrolled in this study. Allpatients received intravenous bolus of fentanyl (0.2 μg /kg) one hourbefore the end of the surgery. Basal infusion rate, demand bolus,and lockout time of the PCA pump was set as 1 ml/h, 1 ml, and15 minutes, respectively. The concentration of fentanyl in theanalgesic solution was 15 μg/ml. Results: NRS scores for pain and D/A ratios for the first 6 hoursafter operations were as follows (median, 25–75%): open colorectalsurgery (NRS: 6.5, 5.0–8.0; D/A: 62.5, 46.2–77.8%), laparoscopiccolorectal surgery (NRS: 6.0, 4.5–7.0; D/A: 69.2, 50.0–81.9%), openhepato-biliary-pancreas surgery (NRS: 6.0, 4.5–7.0; D/A: 59.2, 38.7–75.0%), open stomach surgery (NRS: 5.0, 4.0–6.7; D/A: 58.1, 41.2–75.0%), open abdominal vascular surgery (NRS: 5.0, 3.5–6.5; D/A:58.3, 40.0–81.3%), laparoscopic stomach surgery (NRS: 5.0, 4.0–6.0; D/A: 63.6, 45.5–80.0%), laparoscopic hepato-biliary-pancreassurgery (NRS: 5.0, 4.0–6.0; D/A: 66.7, 50.0–80.8%), vascular bypasssurgery (NRS: 4.0, 3.0–6.0; D/A: 64.5, 42.7–84.0%), anal surgery(NRS: 4.0, 3.0–5.8; D/A: 71.4, 60.0–100%), and breast surgery(NRS: 3.0, 3.0–4.0; D/A: 86.6, 67.2–100%). Conclusions: Mean D/A ratios for the first 6 hours after alloperations except anal and breast surgeries were below 70%,suggesting that a higher amount of fentanyl should be administeredduring this period.

Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions

Dong Jin Kim,Sung Geun Kim 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.5

Purpose: In Korea, the working-hour limitation regulation has been implemented in December 2017. We aimed to define the difference in operative experience of surgical residents before and after implementing this policy in 2 hospitals among 8 affiliated hospitals of the Catholic Medical Center where implemented the 80 working-hour limitation policy since March 2015. Methods: All the operation records were reviewed, and the number of resident-participated surgeries between March and August in 2002 and 2017 were compared. Operations performed or participated in by residents as first assistants were defined as resident participated surgery. Results: After 2 years from the initiation of the resident work-hour limitations, the number of resident participated surgery has slightly decreased in both hospitals (Yeouido St. Mary’s Hospital [YSM]: 317 to 302, St. Paul Hospital [SPH]: 635 to 461). For each resident, changes were like followings: 0 → 21 cases for R1, 65 → 72 cases for R2, 83 → 192 cases for R3, and 169 → 17 cases for R4 in YSM. In SPH, number of resident participating surgery was changed like followings: 4 → 32 cases for R1, 222 → 100 cases for R2, 317 → 300 cases for R3, and 92 → 29 cases for R4. In both hospital, while, total number of resident participating oncologic surgery has been decreased, number of resident participating appendectomy has been far increased. Activity of each grade resident is different according to hospital. Conclusion: Although total number of resident participating surgery decreased, variable changes were observed in each grade of resident according to each type of surgery and different hospitals. It is believed that comparisons of experiences from more hospitals in the future would be helpful in establishing the guidelines for surgical experience requirement of residents in Korea.

Feasibility of the Gastrografin Challenge for Adhesive Small Bowel Obstruction

정기상,최경진,윤경원,유기상,길은미,박치민 대한외상중환자외과학회 2021 Journal of Acute Care Surgery Vol.11 No.2

Purpose: This retrospective study investigated the feasibility, diagnostic, and therapeutic advantages of the gastrografin challenge on patients with adhesive small bowel obstruction (ASBO). Methods: There were 125 patients reviewed who were admitted to the Department of General Surgery at a single institution (September 2018 to August 2019) with a diagnosis related to ASBO. The study population included 100 patients (114 cases) who had received initial conservative management. Patient characteristics and operation rates were compared between the gastrografin challenge success group and failure group, and operation rates and length of hospital stay were compared between the gastrografin challenge group and “non-challenge” group. Results: During the study period, 21 patients with ASBO underwent the gastrografin challenge. The challenge was successful in 17 patients where the bowel obstruction was resolved without the need for surgery. Among patients who failed the challenge, 2 patients underwent adhesiolysis and 2 patients were able to progress their diet avoiding surgery. In patients who underwent surgery (<i>n</i> = 2), the length of hospital stay was significantly shorter in the gastrografin challenge group compared with the “non-challenge” group sub analysis (<i>n</i> = 13 cases; 10.5 vs. 20 days, <i>p</i> = 0.038), indicating that the gastrografin challenge assisted rapid decision-making for surgery. No adverse events were reported for the 21 gastrografin challenges. Conclusion: In patients with ASBO, the gastrografin challenge is an accurate, safe method to determine the need for surgery. In addition, the gastrografin challenge may reduce the length of stay in patients who required surgery for ASBO resolution.