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Development of the Critical Pathway for Cesarean Section Patient (제왕절개술 환자를 위한 Critical Pathway 개발)

  • Chung Kyung-Hee;Jang Keum-Seung
    • The Journal of Korean Academic Society of Nursing Education
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    • v.4 no.1
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    • pp.66-80
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    • 1998
  • With the opening of healthcare market, the health care environment in Korea is anticipating a drastic change. In this Internationally open market environment, it is necessary to introduce a systematic health care plan and DRG system which offer qualitative medical services as well as reduced cost. Purpose of this study is to develop and test the critical pathway for Cesarean section patient in the way to be possible the integrated inpatient management. It was adopted the process of six phases to develop the critical pathway as the theoretical framework implemented by Johns Hopkins Hospital, Maryland, U.S.A. In the first phase, make a selection of diagnosis/procedures to develop. In the second phase, organize a development team consisted of eight expertises working in maternity nursing area. In the third phase, analyze the overall medical service offered to patient through review medical records and decided the service content and the implementation period for the Cesarean section patient. In the forth phase, make out a preliminary critical pathway after verification of expert group on content validity. In the fifth phase, validity operate to ten Cesarean section patients to test implementation in practice by using the preliminary critical pathway, In the sixth phase, defined the final critical pathway. The result of this study was as follows. 1. There were classified 8 categories as monitoring/assesment, treatment, medication, activity, diet, test, consult, education/discharge plan for vertical axis and showed hospital stayed from admission to discharge for horizontal axis of critical pathway through analysis 68 Cesarean section patients medical records. 2. After critical review 68 medical records to make out a preliminary critical pathway, hospital stays for horizontal axis were showed 6 days, mean hospital stays were 7.5 days, 2.1 days were to be taken operation after admission and 4.2 days were stayed until discharge after operation. 3. After making out a questionare in 90 items of a medical service content of eight categories and verifying the content validity of expertises, the 85 items of the preliminary critical pathway were selected by expertises agreement over 88% and modified or deleted 5 items showing agreement below 75%. 4. After verifying a validity to 10 patients for 4 weeks, hospital stays were 5.9 days. There were deleted 1 item and modified or supplemented the 9 items of the 10 items.

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The Results of Posterior Cruciate Ligament Reconstruction. -Transtibial Two Tunnel Technique vs. Modified Tibial Inlay Technique- (관절경적 후방십자인대 재건술에 있어서 Transtibial Two Tunnel방법과 Modified Tibial Inlay방법의 비교)

  • Jung, Young Bok;Tae, Suk Kee;Yum, Jae Kwang;Koo, Bon Ho
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.2
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    • pp.135-140
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    • 1998
  • From 1989 to 1994, authors have reconstructed the posterior cruciate ligament(PCL) in 51 knees with an autogenous central one-third of the patellar tendon by transtibial two tunnel technique, but there were not a few cases of unfavorable results. So from January 1995, we have reconstructed the PCL deficient knees by "modified tibial inlay technique" to avoid the grafted tendon abrasion at the posterior opening of the tibial tunnel(killer turn). Purpose of this study was to compare the results of two surgical techniques and what its advantages and disadvantages are. We could follow up 39 cases of transtibial two tunnel techique group(group A) more than one year, average being 23.7 months and 21 cases of modified tibial inlay technique group(group B) more than 12 months, average being 14.7 months. The clinical results were evaluated by the OAK knee scoring system ($M{\ddot{u}}ller$'s criteria) and the posteror stress roentgenography (push view) with Telos stress device compared with the uninjured knees. The arthroscopic second-look findings were also evaluated. In group A : The $M{\ddot{u}}ller$'s knee score was average 80.1 points, the posteror displacement in push view was average 4.4mm at the last follow up. There were 17 cases(44%) of unfavorable results which showed unstable posterior displacement more than 4mm compared with the uninjured knee in push view. Among the 19 cases of arthroscopic second look examinations, nearly normal PCL appearances of the grafted tendons were noted only in 9 cases(47%). In group B : The $M{\ddot{u}}ller$'s knee score was average 86.7 points, the posterior displacemnet in push view was average 3.6mm at the last follow up. There were 5 cases(23.8%) of unfavorable results which showed unstable posterior displacement more than 4mm compared with the uninjured knee in push view but 4 out of 5 cases showed 6mm posterior displacement in push views. Among the 7 cases of arthroscopic second-look examinations, 6 cases(86%) showed nearly normal PCL appearances of the grafted tendons. In modified tibial inlay technique of PCL reconstruction, it was easier to pull out the BPTB and in cases of remained laxed meniscofemoral ligament it was easier to preserve the remained structures than transtibial two tunnel technique. We expect the "modified tibial inlay technique" may solve the problem of grafted patellar tendon abrasion at the posterior orifice of tibial tunnel and may contribute to the successful PCL reconstruction.

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Literature Review on Danggwisayeokgaohsuyusaenggang-tang (당귀사역가오수유생강탕의 문헌적 고찰)

  • Lee, Yong Hyun;Sun, Seung Ho;Jeong, Jong Jin;Park, Jeong Su;Go, Ho Yeon;Jung, Ki Yong;Cha, Yun Yeop;Song, Yun Kyung;Kim, Tae Hoon;Hong, Sung In;Choi, You Kyung;Ko, Seong Gyu;Lim, Eun Mee;Park, Jong Hyeong;Jeon, Chan Yong
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.28 no.1
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    • pp.1-8
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    • 2014
  • The purpose of this study is to review the literature on Danggwisayeokgaohsuyusaenggang-tang. The classic literature review was carried out using "http://www.theqi.com". The journal search was performed using MEDLINE, EMBASE, National Digital Science Links(NDSL), OASIS, Korean studies Information Service system(KISS), RISS, China National Knowledge Infrastructure(CNKI), Japan Science and Technology information Aggreator, Electronic(J-STAGE) from search engine's opening day to November 2013. Searching key words were the various combination of "Danggwisayeokgaohsuyusaenggang-tang", "Danggwisayeok", "Danggwi", "ohsuyu", "saenggang". The inclusion criteria was all kinds of journals except for review, essay, and experiment study. 40 classic literatures and 37 journals(1 chinese randomized controlled trial, 25 chinese case studies, 1 Korean case study, and 10 japanese case studies) were selected finally. The literatures and journals reported that Danggwisayeokgaohsuyusaenggang - tang was used to treat diverse types of diseases with coldness of hands and feet.

Calculation of Pump Light Power in Wideband Optical Phase Conjugator with Highly-Nonlinear Dispersion Shifted fiber (HNL-DSF를 이용한 광대역 광 위상 공액기의 펌프 광 전력 계산)

  • 이성렬;이하철
    • The Journal of Korean Institute of Communications and Information Sciences
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    • v.29 no.5A
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    • pp.473-483
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    • 2004
  • In this paper, we numerically investigated the optimum pump light power best compensating for pulse distortion due to both chromatic dispersion and self phase modulation (SPM) as a function of channel input power in 8 channel ${\times}$ 40 Gbps wavelength division multiplexing (WDM systems. Also we investigated the allowable maximum channel input power dependence on modulation format and fiber dispersion coefficient in the various pump light power of OPC. The considered WDM transmission system is based on path-averaged intensity approximation (PAIA) mid-span spectral inversion (MSSI) compensation method, which has highly-nonlinear dispersion shifted fiber (HNL-SDF) as nonlinear medium of optical phase conjugator (OPC) in the mid-way of total transmission line. We confirmed that optimal pump light power of HNL-DSF OPC depend on modulation format, initial channel input power, total transmission length and fiber dispersion. But optimal pump light power of HNL-DSF OPC must be selected to make power conversion ratio to almost unity. And we confirmed that, if we allow a 1 dB eye opening penalty (EOP), the tolerable maximum channel input power is increased by using RZ than NRZ as modulation format when pump light power of HNL-DSF OPC is not optimal value but another values.

Analysis of Sports Medical Care Utilization during the 24th Seoul Olympic Games (서울올림픽대회 기간중 스포츠의료 이용에 관한 분석)

  • Yu, Seung-Hum;Sohn, Myong-Sei;Lee, Young-Doo;Park, Eun-Cheol;Kim, Chun-Bae
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.1 s.25
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    • pp.136-145
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    • 1989
  • This study made a descriptive analysis of the cumulative amount and rate of sports medical care utilization during the 24th Seoul Olympic Games by the participating athletes, officials, etc. The sports medical care utilization was a component of the total medical care use and was basically caused by the prevention and treatment of sports injuries. The analytic data were derived from the Olympic Health Management Information System(OHMIS) of the SLOOC and the Korea Athlete Trainer Association(KATA). These were analyzed according to the quantity of physician visits and the utilization rate, which was the amount of utilization divided by the total number of participating persons. The results were as follows: Firstly, the sports medical care utilization by the persons participating in the Seoul Olympics amounted to 17.9% of the total medical care utilization. The venue medical services utilization accounted for 54.7% of the total physician visits, which was larger than the village medical center's utilization. The number of physician visits per hundred persons during the 2 week period in the venue clinic was 3.03 and that of the village medical center was 2.51, therefore, the total was 5.54. Secondly, athletes accounted for 82.3% and officials 12.2% in the sports medical care utilization by participants. These results were because athletes, who were directly related to the games, called extremely often on the physicians. The utilization rate of sports medical care by athletes was 34.29. Thirdly, the sports medical demand according to type of therapy could be ranked from high to low in the following order: sports massage, thermal therapy, and electrical stimulation treatment, etc. The department of physical therapy in the village medical center was used a great deal. Fourthly, the trend of daily sports medical care utilization by the athletes showed a bell shape centering around the opening day of the Seoul Olympic Games. The utilization rate of athletes was 2.3; however, that of officials was 0.6. Lastly, the sports medical demand was calculated according to the continents, and Central America, Africa and Middle-East Asia proved to have a higher rate of sports medical care utilization than the more powerful and industrialized continent or regions.

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Analyses of Plantar Foot Pressure and Static Balance According to the Type of Insole in the Elderly

  • Bae, Kang-Ho;Shin, Jin-Hyung;Lee, Joong-Sook;Yang, Jeong-Ok;Lee, Bom-Jin;Park, Seung-Bum
    • Korean Journal of Applied Biomechanics
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    • v.26 no.1
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    • pp.115-126
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    • 2016
  • Objective: The purpose of this study was to investigate plantar foot pressure and static balance according to the type of insole in the elderly. Methods: Thirteen elderly (mean age: $67.08{\pm}2.25years$, mean height: $159.63{\pm}9.64cm$, mean body weight: $61.48{\pm}9.06kg$) who had no previous injury experience in the lower limbs and a normal gait pattern participated in this study. Three models of insoles of the normal, 3D, and triangle types were selected for the test. The Pedar-X system and Pedar-X insoles, 3.3 km/h of walking speed, and a compilation of 20 steps walking stages were used to analyze foot-pressure distribution. Static balance test was conducted using Gaitview AFA-50, and balance (opening eyes, closing eyes) was inspected for 20 s. One-way ANOVA was conducted to test the significance of the results with the three insoles. p-value of less than .05 was considered statistically significant. Results: The mean foot pressure under the forefoot regions was the lowest with the 3D insole during treadmill walking (p<.05). The mean value under the midfoot was the highest with the 3D insole (left: p<.05, right: p<.01). The mean value under the rearfoot was the lowest with the 3D insole (p<.001). The maximum foot pressure value under the foot regions was the lowest on both sides of the forefoot with the 3D insole. A statistically significant difference was seen only in the left foot (p<.01). The maximum value under the midfoot was the highest with the 3D insole (p<.001). No statistically significant difference was detected on the values under the rearfoot. In the case of vertical ground reaction force (GRF), statistically significant difference was seen only in the left side rearfoot (p<.01). However, static balance values (ENV, REC, RMS, Total Length, Sway velocity, and Length/ENV) did not show significant differences by the type of insole. Conclusion: These results show that functional insoles can decrease plantar pressure and GRF under the forefoot and rearfoot. Moreover, functional insoles can dislodge the overload of the rearfoot and forefoot to the midfoot. However, functional insoles do not affect the static balance in the elderly.

'Study on Oui-Ga-Sil( 胃家實 )' (위가실(胃家實)에 관(關)한 연구(硏究))

  • Han, Gyu-Eon;Ryu, Bong-Ha;Park, Dong-Won;Ryu, Gi-Won;Jang, In-Gyu
    • The Journal of Internal Korean Medicine
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    • v.10 no.1
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    • pp.65-80
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    • 1989
  • About Oui-Ga-Sil(胃家實) in order to considerate the contents recorded in Nai-Gyung Sang-Han-Lon and latter literature, definition, etiopathology, syndrome, differential diagnosis, therapy, Prognosis and prevention were classified. And the results were as follows: 1. Oui-Ga(胃家)was a term which indicated the whole digestive system such as stomach, small intestine, large intestine, rectum and anus. Sil(實)could be defined as the peculiar concept pertaining to the acute and last stage which was invaded to inside bowels because of abundance with evil influence. 2. Eliology of Oui-Ga-Sil was abunt gastric fever originally, injured mucus because of mistreatment, the invasion to inside of outside evil influence through meridian. Pathology was the opening and shutting appearance of gastric abundance with intestinal emptiness, and intestinal abundance with gastric emptiness, Oui-Ga-Sil could be occurred because of gastric abundant dryness and splenic humidifying capacity decrease. 3. Symptom of Oui-Ga-Sil was classified as for the sunlight outside syndrome and the inside abundant syndrome. The sunlight outside syndrome was body fever, sweating, no chilling, on the contrary hatred of fever. The chief complaint of inside abundant syndrome was daily fever, talking in delirium, hand and foot sweating, abdominal distention, difficult defection and those could be pertained to sunlight bowel syndrome. 4. Diagnostic views of Oui-Ga-Sil were that pulse was descending abundant large strong and smooth quick, a coated tongue was yellow, deep yellow, old yellow, thick, scorching dry rough or gray black. On abdominal diagnosis, pressing by hand, patient was conscious of pain, excessive pain, rejection against press, impossible press or intermittent abdominal pain and bowel cutting pain without press. 5. Differential diagnosis was that the sunlight of Nai-Gyung-Fever-Theory was outside desease making meridian the prime object, Baik-Ho-Tang syndrome was making figureless abundant fever the pivotal point. And important differential standard of splenic shrink syndrome was that a daily fever, an irritation with fever were not occurred. 6. Theory of Oui-Ga-Sil was that Seng-Gi-Tang classes had been used in attacking downward or making balance, and moxibustion on Jung-Wan, honey boiling induction theory had been also used. Attacking downward therapy was invigorating method to preserve mucus, and if mucus had been exausted with complicating emptiness prognosis had been appeared badly. 7. Preventing from Oui-Ga-Sil diet by rule, fitness to cold and warmth may be needed to prevent outside evil influence attack and inside evil influence occurrence. Prudence with being very busy, fatigue, wine and woman may be also needed not to be an injury to splanic and gastric spirit.

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The Evaluation on the Governance of Andong International Mask Dance Festival (안동국제탈춤페스티벌의 거버넌스 특성과 평가)

  • Hwang, Hwa-Seok;Lee, Chul-Woo
    • Journal of the Korean association of regional geographers
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    • v.18 no.2
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    • pp.141-160
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    • 2012
  • This paper evaluates the governance of the Andong International Mask Dance Festival. The evaluation focuses on mutual cross-assessment of agents engaging in governance relating to four elements: social justification, reliability, professionalism and transparency. Governance based on co-operative partnership was the essential factor leading to the mask festival's success. Governance of the Andong International Mask Dance Festival in 2011 was privately initiated governance having horizontal and open partnership among festival specialists, civil society organizations, regional business organizations, volunteers and local government, with the Andong Festival Tourism Foundation as the central figure. Three of governance elements were successfully carried through; the exception was transparency. The agents who gave more positive evaluations were those who played leading roles in planning and conducting events, as well as in assessing those events. The reasons for positively assessing the elements are the significance of the festival and the guarantee of agents' participation in social justification; the ability of agents, as well as cognitional and institutional trust in reliability; expert knowledge, capacity to suggest alternatives and duality of business in professionalism; and effective communication, the guarantee of opening of information and information sharing in transparency. To improve the effectiveness of governance, the system for allowing passive agents to contribute usefully should be strengthened. Mutual communication and sharing of information among agents, as well as between agents and residents, also should be more strongly reinforced.

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수학적 모폴로지의 경계치 변화에 의한 도시환경 지형지물 추출 및 분리응용

  • O, Se-Gyeong;Lee, Gi-Won
    • 한국공간정보시스템학회:학술대회논문집
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    • 2004.12a
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    • pp.139-143
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    • 2004
  • 최근 고 해상도 위성영상정보의 민간 활용에 대한 수요가 증가하면서 기존의 공간 정보를 다루는 여러 응용분야에서 이에 관련된 많은 연구를 하고 있다. 도시교통 환경 분석을 위하여 위성영상정보를 처리하는 과정에 있어서 도로, 건물, 기타 선 구조와 같은 지형지물을 분석하는 과정은 사용자에 따라 주관적일 수 있다. 이러한 배경에서 수학적 그레이 레벨 모폴로지는 하나의 효과적인 접근으로 간주된다. 본 연구에서 지형지물 추출을 위해 윈도우 운영체제에서 실행되는 실질적인 응용 프로그램을 구현하였다. 이 프로그램에서 주요한 지형지물은 그레이 레벨 영상을 이용하여 개방(opening), 폐쇄(closing), 침식(erosion), 팽창(dilation)의 순차적 처리를 통하여 자동적으로 추출된다. 결과적으로, GDPA, 허프 변환 또는 다른 알고리듬들과 비교시 하나의 이점이 된다. 모폴로지 처리와 같이 본 프로그램은 그레이 레벨 값의 범위에 기반하여 지형지물을 추출을 위한 density slicing 기능 또는 주어진 경계치 보다 작은 화소 군집을 제거하는 처리인 'sieve filtering'을 제공한다. 이러한 기능들은 형태학적으로 처리된 결과를 증대하고 지형지물 종류들을 분리하는데 유용하다. 또한 배경의 제거, 잡음 탐지, 도시 환경 원격 탐사에서의 지형지물 특성화에 기여한다. 본 프로그램을 이용하는데 있어서 IKONOS 위성영상을 이용하여 시험 구현하였다. 결과, 다중 경계치 또는 steve filtering을 이용한 그레이 레벨 모폴로지 처리는 복잡한 지형지물과 많은 데이터로 구성된 고해상도 영상 내의 주어진 대상에서 자동적인 처리와 사용자 정의 sieve filtering으로 인한 효과적인 지형지물 추출 방법으로 간주 된다. 시안을 작성 표준화를 위한 첫 단계 시도를 소개하였다.분석 결과는 문장, 그림 및 도표, 장 끝의 질문, 학생의 학습 활동 수 등이 $0.4{\sim}1.5$ 사이의 값으로 학생 참여를 적절히 유도하는 발견 지향적 인 것으로 조사되었다. 그러나 장의 요약은 본문 내용을 반복하는 내용으로 구성되었다. 이와 같이 공통과학 과목은 새로운 현대 사회에 부응하는 교과 목표와 체계를 지향하고 있지만 아직도 통합과학으로서의 내용과 체계를 완전히 갖추고 있지 못할 뿐만 아니라 현재 사용되고 있는 7종의 교과서가 교육 목표를 충분히 반영하지 못하고 있다. 따라서 교사의 역할이 더욱더 중요하게 되었다.괴리가 작아진다. 이 결과에 따르면 위탁증거금의 징수는 그 제도의 취지에 부합되고 있다. 다만 제도운용상의 이유이거나 혹은 우리나라 주식시장의 투자자들이 비합리적인 투자형태를 보임에 따라 그 정책적 효과는 때로 역기능적인 결과로 초래하였다. 그럼에도 불구하고 이 연구결과를 통하여 최소한 주식시장(株式市場)에서 위탁증거금제도는 그 제도적 의의가 여전히 있다는 사실이 확인되었다. 또한 우리나라 주식시장에서 통상 과열투기 행위가 빈번히 일어나 주식시장을 교란시킴으로써 건전한 투자풍토조성에 저해된다는 저간의 우려가 매우 커왔으나 표본 기간동안에 대하여 실증분석을 한 결과 주식시장 전체적으로 볼 때 주가변동율(株價變動率), 특히 초과주가변동율(超過株價變動率)에 미치는 영향이 그다지 심각한 정도는 아니었으며 오히려 우리나라의 주식시장은 미국시장에 비해 주가가 비교적 안정적인 수준을 유지해 왔다고 볼 수 있다.36.4%)와 외식을 선호(29.1%)${\lrcorner}$ 하기 때문에 패스트푸드를 이용하게 된 것으로 응답 하였으며,

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A Study of Internet Filtering for Public Information Resources (공공정보자원에서의 인터넷 필터링에 관한 연구)

  • Kim, You-Seung
    • Journal of the Korean Society for Library and Information Science
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    • v.41 no.2
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    • pp.111-133
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    • 2007
  • Illegal and harmful information on the Internet have been a great concern not only for regulatory authorities, but also all the public institutes, such as public libraries and schools, that provide Internet access service. In particular, for public libraries which play an important role in organizing, opening and providing information resources in the information society, providing Internet access service are indispensible. Therefore, any changes of Internet content regulatory system may have direct effects on services of public libraries. Due to unique characteristics of the Internet, content refutation on the Internet has made a best use of various regulatory methods, ranging from governmental regulation to self-refutation and technical regulatory methods. However, nation by nation. technical regulatory methods on the Internet have been developed in quite different ways. Applying them on public library has been strongly criticised for violating freedom of expression and rights of access to information. This article begins with a theoretical discussion about free speech rights and refutation on Internet. Then it examines filtering software which is one of the most popular technical regulatory methods based on both technical and socio-humanities' prospects and analyses several governments' regulatory approaches to Internet filtering. As a conclusion, issues concerning Internet filtering at public institutes are critically apprised.