Kim, Hye Sook;Chae, Young-Moon;Tark, Kwan-Chul;Park, Hyun-Ju;Ho, Seung-Hee
Quality Improvement in Health Care
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v.8
no.2
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pp.186-207
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2001
Background : This study presented an analysis of healthcare quality indicators using data mining and a development of decision support system for quality improvement. Method : Specifically, important factors influencing the key quality indicators were identified using a decision tree method for data mining based on 8,405 patients who discharged from a medical center during the period between December 1, 2000 and January 31, 2001. In addition, a decision support system was developed to analyze and monitor trends of these quality indicators using a Visual Basic 6.0. Guidelines and tutorial for quality improvement activities were also included in the system. Result : Among 12 selected quality indicators, decision tree analysis was performed for 3 indicators ; unscheduled readmission due to the same or related condition, unscheduled return to intensive care unit, and inpatient mortality which have a volume bigger than 100 cases during the period. The optimum range of target group in healthcare quality indicators were identified from the gain chart. Important influencing factors for these 3 indicators were: diagnosis, attribute of the disease, and age of the patient in unscheduled returns to ICU group ; and length of stay, diagnosis, and belonging department in inpatient mortality group. Conclusion : We developed a decision support system through analysis of healthcare quality indicators and data mining technique which can be effectively implemented for utilization review and quality management in a healthcare organization. In the future, further number of quality indicators should be developed to effectively support a hospital-wide Continuous Quality Improvement activity. Through these endevours, a decision support system can be developed and the newly developed decision support system should be well integrated with the hospital Order Communication System to support concurrent review, utilization review, quality and risk management.
The authors investigated 131 nonpsychiatric physicians' attitudes toward psychiatric consultation, using questionnaires. A comparison was made as regards psychiatric consultation from nonpsychiatric physicians over position(staffs vs. residents) and department(medical vs. surgical). These findings are as follows ; 1) 51.9 percent of nonpsychiatric physicians estimated that less than 30 percent of their patientshadpgychiatricproblems. 2) The percentage of the patients referred for psychiatric consultation were 30 or less than 30 percent 3) Staffs tried to refer their patients to psychiatric department for psychiatric consultation more frequently than residents. 4) Medical physicians tried to refer their patients to psychiatric department for psychiatric consultation more frequently than surgeons. 5) Psychiatric consultation was estimated to be most frequently requested for overt psychiatric symptoms(23.0%) and past history of psychiatric treatment(20.8%). 6) The most frequent causes of not referring to department of psychiatry were found to be the patients' rejection(46.8%) and non-psychiatric physicians' dissatisfaction with the results of consultation (22.2%). 7) Medical physicians tended to explain the reasons for psychiatric consultation more adequately than surgeons. 8) Residents more specifically wrote the reasons for psychiatric consultation on the chart than staffs. The results suggest that staffs are more active in psychiatric consultation than residents, whereas medical physicians are more active than surgeons. Thus, education should be more emphasized for surgeons and residents, especially for the latter for effective consultation-liaison activity. On the other hand, psychiatrists should try to improve nonpsychiatric physicians' dissatisfactions with the results of psychiatric consultations, which will positively change their attitudes toward psychiatric consultation.
Kim, Yong-Soon;Park, Jee-Won;Park, Yon-Ok;Cho, Eun-Sook;Kim, Myung-Wook
Quality Improvement in Health Care
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v.2
no.2
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pp.32-45
/
1996
Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.
Background: Emphasis in healthcare during the 1990s has been to provide both optimal wellness and function with quality in a Cost-effective manner. Critical pathway was developed to meet the need to guide clients along the continunm of care and to achieve continuity of care. The purpose of this study is to review and analyze articles related to the critical pathway that had developed and applied in Korea and abroad from 1995 to 1999. Methods: Total 39 studies were analyzed in terms of group of application, need of development, horizontal axis: time frame, vertical axis : items of care, task force team, identification of preliminary critical pathway, validation of preliminary critical pathway, types of final critical pathway, a person who coordinates and effects on critical pathway. Results: In the aspect of group of application, there were various diseases in the overseas than in Korea. In domestic and overseas, the horizontal axis included mainly the time from the start of hospitalization to discharge and vertical axis of the critical pathway included commonly the following nine items : tests, diet, medications, consultations, activity, assessments, treatments, education, discharge planning. Preliminary critical pathway was mainly drawn up through chart review in both. Types of final critical pathway were mostly for medical team use in Korea and were for medical team and patient use in abroad. A person who coordinates critical pathway was mostly nurse in abroad. There was positive effects on critical pathway in both. Conclusion: Staff education and information about critical pathway are needed to use it effectively.
This paper highlights a case study that investigates the behaviour of existing bridge, West Terrace Bridge, induced by horizontal seismic loading. Unfortunately the lack of past information related to seismic activity within the NSW region has made it difficult to understand better the capacity of the structure if Earthquake occurs. The research was conducted through the University of Western Sydney in conjunction with Railcorp Australia, as part of disaster reduction preparedness program. The focus of seismic analyses was on the assessment of stress behaviour, induced by cyclic horizontal/vertical displacements, within the concrete slab and steel truss of the bridge under various Earthquake Year Return Intervals (YRI) of 1-100, 1-200, 1-250, 1-500, 1-800, 1-1000, 1-1500, 1-2000 and 1-2500. Furthermore the stresses and displacements were rigorously analysed through a parametric study conducted using different boundary conditions. The numerical analysis of the concrete slab and steel truss were performed through the finite element software, ABAQUS. The field measurements and observation had been used to validate the results drawn from the finite element simulation. It was illustrated that under a YRI of 1/1000 the bottom chord of the steel truss failed as the stress induced surpassed the ultimate stress capacity and the horizontal displacement exceeded the allowable displacement measured in the field observations whereas the vertical displacement remained within the previously observed limitations. Furthermore the parametric studies in this paper demonstrate that a change in boundary conditions alleviated the stress distribution throughout the structure allowing it to withstand a greater load induced by the earthquake YRI but ultimately failed when the maximum earthquake loading was applied. Therefore it was recommended to provide a gap of 50mm on the end of the concrete slab to allow the structure to displace without increasing the stress in the structure. Finally, this study has proposed a design chart to showcase the failure mode of the bridge when subjected to seismic loading.
Purpose: The purpose of this study was to analyze related factors for major nursing diagnoses used in caring for institutionalized elders. Method: This study was a descriptive study. The participants were 92 residents in a long-term care facility in Wonju, selected by convenience sampling. The instrument was a checklist designed on the basis of the related factors suggested by NANDA (1997) and a literature review. Data was collected by chart review, observation, and interviews with the participants. Data was analyzed using descriptive statistics with the SPSS WIN program. Result: The most frequent nursing diagnosis was 'risk for injury', 'self-esteem disturbance', 'activity intolerance', 'impaired phyical mobility', and 'powerlessness'. The most frequent component for related factors for the five component for each nursing diagnosis was the physical component, followed by the social component. Common related factors for the nursing diagnoses were 'pain', 'change of emotional state/disorder', 'cognitive disorder', 'change of physical structure and function', and 'physical impairment', and 'immobility'. Conclusion: The results of this study can contribute to the development of appropriate nursing intervention programs for elders (eg. 'Injury Prevention Programs', 'Self-esteem Improvement Programs' etc.). Clinical guidelines that gerontological nurses can use to accurately assess health problems and select appropriate nursing interventions may be developed.
Journal of the Korean Society of Clothing and Textiles
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v.29
no.8
s.145
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pp.1146-1157
/
2005
As individual family has fewer children, market sectors targeting children's goods upgrade their products quality and price. Children's wear used to be for casual activity or going to school. Recently, occasions in which children are dressed up are getting increase, such as wedding, concert or family gathering. Therefore, the industry sector of formal wears for school boys are growing. The purpose of this study is to research and grading of formal wears for school boys to improve their fit and comfort. The selected items as formal wear were tailored jacket, tuxedo, tail coat and pants. Based on the grading increments of the industry, grading was done far 7 years and 11 years old school boy for each item. Like the pattern alteration, grading increments were tested and altered through wearing tests. The final increments were suggested as the 'researched grading increments'. The results and conclusions are: 1. Appropriate size allowance, ease amount and lengths for boys are different from those far adults. The difference should be applied for boy's wear. 2. Grading increments for an age group are different from other age group. For example increments of 7 from 9 are different from that of 11 from 9. It is because a certain part grows faster during a certain age whereas other part grows faster during different period. Therefore grading for children should reflect their growth rather than same size increments which is common in adult size chart.
The purpose of this study is to identify the effect of sexual rehabilitation education on the knowledge and adjustment of sexual of spinal cord injury clients by the method of nonequivalant control group pretest-posttest group. The data were collected from Jan. 19 though Feb. 16, 2000. The experimental group was 26 spinal cord injury client from one rehabilitation center, and the control group was 26 spinal cord injury client from two rehabilitation center. Sexual rehabilitation education was done with manuals, videotapes and chart. Education time was 120 minutes a week for 2 weeks. The study tool was about Sexual Knowledge, designed Song, Chung Sook(1990) and SIAC(Sexual, Interest, Activity, & Satisfaction) designed Kruter, Sullivan, Siosteen(1994) translated by Kang, Hyun Sook, Koh, Jung Eun, Suh, Yeon Ok, Yee, Oon Hee(1999). The collected data were analyzed SPSS program. The Data were analyzed descriptive statistics and $X^2$ test, Pearson's Correlation Coefficient, t-test, F-test (ANOVA), Duncan's multiple comparison test. The result were as follows. 1. The first hypothesis was accepted : The group educated about sexual rehabilitation has more sexual knowledge than those of the uneducated group(t = 7.412, p = .001). 2. The second hypothesis was accepted : The group educated about the sexual rehabilitation has more adjustment of sexual than those of the uneducated group(t = 5.524, p= .001). 3. The third hypothesis was accepted: The higher sexual knowledge state, the higher sexual adjustment(r= .449, p= .003). According to results, sexual rehabilitation education helps Spinal cord Injury Clients to gain knowledge and adjustment of sexual.
Kim, Soo-Byung;Min, Choong-Ki;Lee, Na-Ra;Lee, Seung-Wook;Shim, Tae-Kyu;Yim, Yun-Kyoung;Lee, Yong-Heum
Korean Journal of Acupuncture
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v.26
no.4
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pp.1-11
/
2009
Objectives : The object of this study is measuring energy (skin capacitance) distribution on the specific acupionts and analyzing change patterns of meridian energy according to time or synchronous time. Methods : To check energy distribution using the meridian energy measurement system(DMM-1000), ten specific acupoints(ST34, ST36, ST40, ST41, ST42, ST43, ST44, ST45, BL21, CV12) were chosen. We checked the energy distribution and analyzed the change patterns before and after meal. We checked the state of the energy of ST meridian which is considered to have relation to stomach organ activity. Based on the hypothesis regarding energy difference due to Qi flowing, we compared energy potential on 10 specific acupoints. Results and Conclusions : Electric energy of each specific acupoint was different according to subjects and time. Through this study, we proposed an indispensable condition of energy difference due to Qi flowing through meridian.
In order to elucidate growth characteristics, physiological responses and leaf color changes of leaf-variegated Arundinaria munsuensis and Carex ciliato-marginata for variegata, These experiments were performed under four different light ragimes control(full sun), 40%, 70% and 85%. Plant height and leaf area became promoted as shading level increases in leaf-variegated Arundinaria munsuensis. Photosynthetic effect was the highest in 85% shading of the full sun. Thus, this plant could be growing in the deep shade condition. Plant growth and the leaf color changes were most obviously shown in the 40% shading level. In the Carex ciliatomarginata for. variegata growth status was the best and green or strong greenish yellow leaf color turned out to be much clearer in the 40% shading treatment. And photosynthetic activity was enhanced as the light intensity decreases.
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