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Application of Patient Safety Indicators using Korean National Hospital Discharge In-depth Injury Survey (퇴원손상심층자료를 이용한 환자안전지표의 적용)

  • Kim, Yoo-Mi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.5
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    • pp.2293-2303
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    • 2013
  • Objective: This study aims to determine whether national patient safety indicators (PSIs) can be calculated. Methods: Using PSI criteria from Organization for Economic Co-Operation and Development (OECD) Health Technical Papers 19 based on the Agency for Healthcare Research and Quality (AHRQ), PSIs were identified in the Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) database for 875,622 inpatient admissions between 2004 and 2008. Logistic regression was used to estimate factors of variations for PSIs. Results: From 2004 to 2008, 3,084 PSI events of 8 PSIs occurred for over 80 thousands discharges. Rates per 1,000 events for decubitus ulcer (PSI3, 4.88), foreign body left during procedure (PSI5, 0.05), postoperative sepsis (PSI13, 1.32), birth trauma-injury to neonate (PSI17, 7.92) and obstetric trauma-vaginal delivery (PSI18, 32.81) are all identified between ranges from maximum to minimum of OECD rates, respectively. However, rates per 1,000 events for selected infections due to medical care (PSI7, 0.22), postoperative pulmonary embolism or deep vein thrombosis (PSI12, 0.90) and accidental puncture or laceration (PSI15, 0.71) are below the minimum of OECD range. 7 PSIs except PSI 18 showed statistically significant relationship with number of secondary diagnoses. When adjusting patient characteristics, there are statistically significant different rates according to bed size or location of hospitals. Conclusion: This is the first empirical study to identify nationally number of adverse events and PSIs using administrative database. While many factors influencing these results such as quality of data, clinical data and so on are remain, the results indicate opportunities for estimate national statistics for patient safety. Furthermore outcome research such as mortality related to adverse events is needed based on results of this study.

EFFECT OF ULTRASONIC VIBRATION ON ENAMEL AND DENTIN BOND STRENGTH AND RESIN INFILTRATION IN ALL-IN-ONE ADHESIVE SYSTEMS (All-in-one 접착제에서 초음파진동이 법랑질과 상아질의 결합강도와 레진침투에 미치는 영향)

  • Lee, Bum-Eui;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Chong-Chul;Hahn, Se-Hyun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.1
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    • pp.66-78
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    • 2004
  • The objective of this study was to apply the vibration technique to reduce the viscosity of bonding adhesives and thereby compare the bond strength and resin penetration in enamel and dentin achieved with those gained using the conventional technique and vibration technique. For enamel specimens, thirty teeth were sectioned mesio-distally. Sectioned two parts were assigned to same adhesive system but different treatment(vibration vs. non-vibration). Each specimen was embedded in 1-inch inner diameter PVC pipe with a acrylic resin. The buccal and lingual surfaces were placed so that the tooth and the embedding medium were at the same level. The samples were subsequently polished silicon carbide abrasive papers. Each adhesive system was applied according to its manufacture's instruction. Vibration groups were additionally vibrated for 15 seconds before curing. For dentin specimen, except removing the coronal part and placing occlusal surface at the mold level, the remaining procedures were same as enamel specimen. Resin composite(Z250. 3M. U.S.A.) was condensed on to the prepared surface in two increments using a mold kit(Ultradent Inc., U.S.A.). Each increments was light cured for 40 seconds. After 24 hours in tap water at room temperature, the specimens were thermocycled for 1000cycles. Shear bond strengths were measured with a universal testing machine(Instron 4465, England). To investigate infiltration patterns of adhesive materials, the surface of specimens was examined with scanning electron microscope. The results were as follows: 1. In enamel the mean values of shear bond strengths in vibration groups(group 2, 4, 6) were greater than those of non-vibration group(group 1, 3, 5). The differences were statistically significant except AQ bond group. 2. In dentin, the mean values of shear bond strengths in vibration groups(group 2, 4, 6) were greater than those of non-vibration groups(group 1, 3, 5). But the differences were not statistically significant except One-Up Bond F group. 3. The vibration group showed more mineral loss in enamel and longer resin tag and greater number of lateral branches in dentin under SEM examination.

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Pattern of Hospital-Associated Infections in Children Admitted in the Intensive Care Unit of a University Hospital (일개 대학병원 중환자실에 입원한 소아 환자에서 발생한 원내감염의 양상)

  • Kim, Su Nam;Won, Chong Bock;Cho, Hye Jung;Eun, Byung Wook;Sim, So Yeon;Choi, Deok Young;Sun, Yong Han;Cho, Kang Ho;Son, Dong Woo;Tchah, Hann;Jeon, In Sang
    • Pediatric Infection and Vaccine
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    • v.18 no.2
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    • pp.135-142
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    • 2011
  • Purpose : Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. Methods : We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. Results : In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patientdays. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. Conclusion : ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.

Anomaly Detection for User Action with Generative Adversarial Networks (적대적 생성 모델을 활용한 사용자 행위 이상 탐지 방법)

  • Choi, Nam woong;Kim, Wooju
    • Journal of Intelligence and Information Systems
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    • v.25 no.3
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    • pp.43-62
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    • 2019
  • At one time, the anomaly detection sector dominated the method of determining whether there was an abnormality based on the statistics derived from specific data. This methodology was possible because the dimension of the data was simple in the past, so the classical statistical method could work effectively. However, as the characteristics of data have changed complexly in the era of big data, it has become more difficult to accurately analyze and predict the data that occurs throughout the industry in the conventional way. Therefore, SVM and Decision Tree based supervised learning algorithms were used. However, there is peculiarity that supervised learning based model can only accurately predict the test data, when the number of classes is equal to the number of normal classes and most of the data generated in the industry has unbalanced data class. Therefore, the predicted results are not always valid when supervised learning model is applied. In order to overcome these drawbacks, many studies now use the unsupervised learning-based model that is not influenced by class distribution, such as autoencoder or generative adversarial networks. In this paper, we propose a method to detect anomalies using generative adversarial networks. AnoGAN, introduced in the study of Thomas et al (2017), is a classification model that performs abnormal detection of medical images. It was composed of a Convolution Neural Net and was used in the field of detection. On the other hand, sequencing data abnormality detection using generative adversarial network is a lack of research papers compared to image data. Of course, in Li et al (2018), a study by Li et al (LSTM), a type of recurrent neural network, has proposed a model to classify the abnormities of numerical sequence data, but it has not been used for categorical sequence data, as well as feature matching method applied by salans et al.(2016). So it suggests that there are a number of studies to be tried on in the ideal classification of sequence data through a generative adversarial Network. In order to learn the sequence data, the structure of the generative adversarial networks is composed of LSTM, and the 2 stacked-LSTM of the generator is composed of 32-dim hidden unit layers and 64-dim hidden unit layers. The LSTM of the discriminator consists of 64-dim hidden unit layer were used. In the process of deriving abnormal scores from existing paper of Anomaly Detection for Sequence data, entropy values of probability of actual data are used in the process of deriving abnormal scores. but in this paper, as mentioned earlier, abnormal scores have been derived by using feature matching techniques. In addition, the process of optimizing latent variables was designed with LSTM to improve model performance. The modified form of generative adversarial model was more accurate in all experiments than the autoencoder in terms of precision and was approximately 7% higher in accuracy. In terms of Robustness, Generative adversarial networks also performed better than autoencoder. Because generative adversarial networks can learn data distribution from real categorical sequence data, Unaffected by a single normal data. But autoencoder is not. Result of Robustness test showed that he accuracy of the autocoder was 92%, the accuracy of the hostile neural network was 96%, and in terms of sensitivity, the autocoder was 40% and the hostile neural network was 51%. In this paper, experiments have also been conducted to show how much performance changes due to differences in the optimization structure of potential variables. As a result, the level of 1% was improved in terms of sensitivity. These results suggest that it presented a new perspective on optimizing latent variable that were relatively insignificant.

Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage (한 대학병원에서 조사된 재택산소요법을 받고 있는 환자의 특성과 재택산소요법 처방에 대한 순응도: 건강보험급여전환 후 조사)

  • Koo, Ho-Seok;Song, Young Jin;Lee, Seung Heon;Lee, Young Min;Kim, Hyun Gook;Park, I-Nae;Jung, Hoon;Choi, Sang Bong;Lee, Sung-Soon;Hur, Jin-Won;Lee, Hyuk Pyo;Yum, Ho-Kee;Choi, Soo Jeon;Lee, Hyun-Kyung
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.3
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    • pp.192-197
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    • 2009
  • Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.