• Journal of the Korean Society for Library and Information Science
• /
• v.51 no.2
• /
• pp.237-253
• /
• 2017

There are many systematic approaches to manage Interlibrary loan (ILL) efficiently. In this paper, we propose an operating method reducing user-waiting in ILL. Users are usually informed to wait around two to three days in a regional ILL service. The reason of the waiting is that there is inefficiency in running material-delivery vehicles. A mixed integer programming is employed to resolve this issue. It provides an optimal vehicle-route maximizing material-deliveries subject to time availability. We used an actual data of a regional ILL system to provide optimal vehicle routes under different time settings.

• Journal of Neurocritical Care
• /
• v.11 no.2
• /
• pp.71-80
• /
• 2018

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

• Journal of Hospice and Palliative Care
• /
• v.15 no.3
• /
• pp.147-154
• /
• 2012

Purpose: The purpose of this study is to understand family members' experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. Methods: Data were collected by performing an in-depth interview with eight terminally-ill patients' family members who decided to withdraw life-sustaining treatments. Colaizzi's phenomenological method was used for data analysis. Results: Questions were classified into 12 groups and finally into five categories. The five categories were about family members' frustration with patient's condition, emotional preparation for the patient's death upon medical professionals' recommendation, patient's wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. Conclusion: Using the five categories, hospice and palliative professionals could better understand family members' decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention.

• Nutrition Research and Practice
• /
• v.5 no.5
• /
• pp.450-454
• /
• 2011

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 ${\pm}$ 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9${\pm}$7.1. The subjects received 2.3${\pm}$1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: <140 mg/dl vs ${\geq}$ 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P=0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.

• Journal of Korean Academy of Nursing
• /
• v.38 no.6
• /
• pp.874-880
• /
• 2008

Purpose: The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission. Methods: The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test. Results: 1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didn't affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf on the 8th day after admission to the ICU compared to the day of admission. Conclusion: Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator.

• Child Health Nursing Research
• /
• v.12 no.3
• /
• pp.405-416
• /
• 2006

Purpose: The purpose of this study was to explore health behavior and perception of therapeutic restrictions in chronically ill children and their parents in Korea. Method: Nine children with chronic disease and of six of their parents were interviewed using semi-structured a questionnaire. The data were analyzed using explorative content analysis. Results: Health behaviors related to therapeutic restrictions was classified into four domains, and the perceptions of therapeutic restrictions into two domains. The domains regarding compliance in health behavior with therapeutic restrictions included control-centered restrictions (maintaining food limitations, avoiding harmful environments, restriction on physical activity, restriction on social activity, restriction on learning activity), and everyday pursuit of balance(preference for healthy diet, maintaining a regular life style, maintaining a standard body weight, pursuing psychological well-being, family participation). Domains regarding perception of therapeutic restrictions included obstacles to growth and development (bridled life, opportunity deprivation, prevented from playing proper role), origin of conflict (tenacity, conflict, stressor, cover-up), task for normal life (doing proper duty), and everyday affairs (becoming ordinary, familiarity). Conclusion: This study will help to enhance understanding the behavior and perception of therapeutic restrictions by chronically ill children and their families and to establish educational programs and counseling for these children and their families.

• Journal of Korean Society of Occupational and Environmental Hygiene
• /
• v.28 no.3
• /
• pp.319-329
• /
• 2018

Objectives: The object of this paper is to analyze difference of general and occupational characters, risk exposure and ill health symptom depending on the special type of employment. Methods: 50,007 participants from Fourth Korean Working Condition Survey conducted in 2014 was analyzed. Cross-tabulation analysis was conducted for deriving difference in general and occupational characters, mulitvariate logistic regression analysis was conducted after controlling general and occupational characters for deriving difference in risk exposure and ill health symptom depending on the special type of employment. Results: In the special type of employment, female, ages of 50, education levels of high school, monthly income of 2,000-3,000 thousand won, job types of sales person, enterprises of less than 100 workers, working duration of 2-10 years and long working hours worker's proportion was higher than general employment. Physical(OR: 0.84, 95% CI: 0.76-0.94) and ergonomic (OR: 0.48, 95% CI: 0.42-0.55) risk exposure was lower, psychological(OR: 1.77, 95% CI: 1.54-2.04) risk exposure was higher than general employment, and there was no significant difference between the special type of employment and general employment in chemical/biological risk exposure(OR: 1.06, 95% CI: 0.94-1.20) and ill health symptom(OR: 0.98, 95% CI: 0.89-1.09). Conclusions: This article offers the analysing difference between the special type of employment and general employment using huge size cross sectional data represent Korean employees.

• Healthcare Informatics Research
• /
• v.24 no.4
• /
• pp.317-326
• /
• 2018

Objectives: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.

• The Mathematical Education
• /
• v.60 no.2
• /
• pp.133-157
• /
• 2021

Ill-structured problems have drawn attention in that they can enhance problem-solving skills, which are essential in future societies. The purpose of this study is to analyze and evaluate students' spatial reasoning(Intrinsic-Static, Intrinsic-Dynamic, Extrinsic-Static, and Extrinsic-Dynamic reasoning) and problem solving abilities(understanding problems and exploring strategies, executing plans and reflecting, collaborative problem-solving, mathematical modeling) that appear in ill-structured problem-solving. To solve the research questions, two ill-structured problems based on the geometry domain were created and 11 lessons were given. The results are as follows. First, spatial reasoning ability of sixth-graders was mainly distributed at the mid-upper level. Students solved the extrinsic reasoning activities more easily than the intrinsic reasoning activities. Also, more analytical and higher level of spatial reasoning are shown when students applied functions of other mathematical domains, such as computation and measurement. This shows that geometric learning with high connectivity is valuable. Second, the 'problem-solving ability' was mainly distributed at the median level. A number of errors were found in the strategy exploration and the reflection processes. Also, students exchanged there opinion well, but the decision making was not. There were differences in participation and quality of interaction depending on the face-to-face and web-based environment. Furthermore, mathematical modeling element was generally performed successfully.

• Clinical Nutrition Research
• /
• v.13 no.1
• /
• pp.1-7
• /
• 2024

Nutritional support in critically ill patients is an essential aspect of treatment. In particular, the benefits of enteral nutrition (EN) are well recognized, and various guidelines recommend early EN within 48 hours in critically ill patients. However, there is still controversy regarding EN in critically ill patients with septic shock requiring vasopressors. Therefore, this case report aims to provide basic data for the safe and effective nutritional support in septic shock patients who require vasopressors. A 62-year-old male patient was admitted to the intensive care unit with a deep neck infection and mediastinitis that progressed to a septic condition. Mechanical ventilation was initiated after intubation due to progression of respiratory acidosis and deterioration of mental status, and severe hypotension required the initiation of norepinephrine. Due to hemodynamic instability, the patient was kept nil per os. Subsequently, trophic feeding was initiated at the time of norepinephrine dose tapering and was gradually increased to achieve 75% of the energy requirement through EN by the 7th day of enteral feeding initiation. Although there were signs of feeding intolerance during the increasing phase of EN, adjusting the rate of EN resolved the issue. This case report demonstrates the gradual progression and adherence to EN in septic shock patient requiring vasopressors, and the progression observed was relatively consistent with existing studies and guidelines. In the future, further case reports and continuous research will be deemed necessary for safe and effective nutritional support in critically ill patients with septic shock requiring vasopressors.