• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권5호
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• pp.231-238
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• 2023

Purpose: This systematic review and meta-analysis aimed to compare endoscopy as primary versus secondary prophylaxis to prevent future bleeding in children with esophageal varices. Methods: A systematic literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was conducted using the Scopus, PubMed, and Cochrane databases for relevant studies on the outcome of rebleeding events after endoscopy in primary prophylaxis compared to that in secondary prophylaxis. The following keywords were used: esophageal varices, children, endoscopy, primary prophylaxis and bleeding. The quality of eligible articles was assessed using the Newcastle-Ottawa Scale and statistically analyzed using RevMan 5.4 software. Results: A total of 174 children were included from four eligible articles. All four studies were considered of high-quality based on the Newcastle-Ottawa Quality Assessment Scale. Patients who received primary prophylaxis had 79% lower odds of bleeding than those who received secondary prophylaxis (odds ratio, 0.21; 95% confidence interval [CI], 0.07-0.66; I²=0%, p=0.008). Patients in the primary prophylaxis group underwent fewer endoscopic procedures to eradicate varices than those in the secondary prophylaxis group, with a mean difference of 1.73 (95% CI, 0.91-2.56; I²=62%, p<0.0001). Conclusion: Children with high-risk varices who underwent primary prophylaxis were less likely to experience future bleeding episodes and required fewer endoscopic procedures to eradicate the varices than children who underwent secondary prophylaxis.

• 한국환경보건학회지
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• 제41권5호
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• pp.305-313
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• 2015

Objectives: The objective of this study is to identify toxicants causing acute toxicity in effluents from the aluminum rolling industry that violate the discharge limits in Korea. Methods: Whole effluent toxicity tests (WET) were conducted on effluent discharged from the aluminum rolling industry following the US EPA WET test methods. We collected effluent samples three times and evaluated acute toxicity by using Daphnia magna. We employed toxicity identification evaluation (TIE) procedures to identify toxicants causing toxicity in the effluent. Results: No specific chemical groups were identified in the seven different manipulations applied to the of wastewater effluent samples showing 1.3 toxic units (TU) according to the TIE phase I procedures. Water quality parameters for water hardness, electric conductivity and heavy metals (Mn) were 4,322 mg/l as $CaCO_3$, 11.39 mS/cm, and $5,551{\mu}g/l$, respectively. Considering water hardness and reference toxicity, high concentrations of Mn can be disqualified from the causative toxicants. Consequently, high ionic concentrations of $Na^+$(1,648 mg/l), $Ca^{2+}$(1,048 mg/l), $Mg^{2+}$(1,428 mg/l) and $SO_4{^{2-}}$(7,472 mg/l) were identified to be causative toxicants. Water hardness and electric conductivity exceed the $EC_{50}$ value obtained by biological toxicity tests using Daphnia magna. Conclusion: According to TIE procedures, high salt concentration is determined to be a major toxicant in the effluent of agro-industrial wastewater treatment plants receiving wastewater from the aluminum rolling industry.

• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.145-153
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• 2023

Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

• Journal of Digestive Cancer Research
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• 제11권3호
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• pp.125-129
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• 2023

Appropriate sedation and analgesia are crucial for successful endoscopic procedures, patient safety, and satisfaction. Endoscopic resection for upper gastrointestinal tumors requires a deep sedation level because the procedure is lengthy and induces moderate to severe pain. Continuous patient consciousness assessment and vigilant vital signs monitoring are required for deep sedation. General anesthesia may unintentionally occur even during deep sedation for endoscopic tumor resection, which may cause unexpected complications, especially in high-risk patients. Previous studies have revealed that general anesthesia increases the en bloc resection rate and decreases the procedure time. Complications, such as perforation, aspiration pneumonia, and cardiopulmonary instability, including hypoxemia, hypotension, and arrhythmia, occurred more frequently in patients with sedation compared to those with general anesthesia. Therefore, general anesthesia demonstrated potential benefits in endoscopic treatment results and patient safety. General anesthesia should be considered a useful alternative for sedation in patients undergoing endoscopic gastrointestinal tumor resection. However, more high-quality prospective studies are required to determine the safety and effectiveness of general anesthesia in endoscopic upper gastrointestinal tumor resection because most studies comparing general anesthesia and sedation in these procedures have been retrospectively conducted and the results were inconsistent.

• 통상정보연구
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• 제7권2호
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• pp.75-94
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• 2005

This study is focused on evaluating the computer-integrated just-in-time (CI-JIT) production system of a semi-conductor manufacturing firm in Korea. Approaching the mid-1980s, the emphasis was on low price, low-cost operations, and quality, especially in USA. American companies have shifted output to low-wage countries like the Philippines, Korea, Japan, Malaysia and allied countries that can make quality products at low prices. Korea and other Asian countries forego short-term profits to gain a solid foothold in a product market, recognizing that larger market share leads to lower cost and higher profit in the long run. They bring manufacturers and suppliers together to improve material management and operation management, using project teams that investigate topics, such as Just-In-Time(JIT)manufacturing, among others. The "Kanban" word means "card" in Japanese, and is used to indicate the desired final delivery schedule. The operation for a particular item produced is scheduled for a specific time. The same process is extended to the external suppliers. More recently, the cards are gradually being replaced by electronic procedures that follow the same concept. Its capacity must be capable of handling the various transactions required by the JIT coverage as well as some allowances for expanded applications.

• Journal of Welding and Joining
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• 제19권1호
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• pp.40-48
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• 2001

An ultrasonic test method, as a nondestructive test is applied to ensure the clad interface quality assessment. According to the reference codes and standards, not only korea Industrial Standard(KS) but also American Society for Testing and Materials (ASTM) Standard, ultrasonic examination procedures use the pulse-echo, A-scan, back reflection signal drop method and/or side drilled reference hole used to establish the acceptance criteria of clad material test. But the variety of bonding materials and sizes makes it difficult to produce the reference blocks, or thus the criteria. In order to overcome these practical difficulties, new ultrasonic testing criterion is suggested. In this new method, the theoretical interface reflection signal amplitude level is calculated and suggested as an acceptance criteria with the back reflection signal set to 100% FSH(Full Screen Height) which is based on acoustic impedance mismatch at the clad interface for the explosive clad ultrasonic inspection. Applicability of suggested criterion, for the explosive clad Fe-Naval Brass with different bonding quality is confirmed to the pre-existed KS and ASTM specifications and verified by using SEM (Seanning Electron Microscope) micrograph. The results obtained by the suggested method is more conservative than the results according to the KS B 0234 and ASTM A 578 specifications The suggested method could be applicable to any other combination of explosive clad ultrasonic inspection.

• 한국컴퓨터정보학회논문지
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• 제11권6호
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• pp.261-267
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• 2006

원자력발전소의 정량적 위험성 평가를 위해서 확률론적 안정성 평가 기법이 이용되고 있는데, 이를 위해서는 여러 가지 분야의 다양한 신뢰도 데이터가 필요하다. 이러한 신뢰도 자료 중에 인간의 지각 행위 및 수행 행위로부터 발생하는 인적 오류 확률은 그 특성상 실제 오류 확률을 얻기가 매우 어렵다. 따라서 인적 오류 확률을 구하기 위해서는 인간 신뢰도 분석 분야의 전문가들이 제안한 인간 신뢰도 분석 방법을 이용하여 인적 오류 확률을 추정한다. 한국 원자력 연구소에서는 이를 위해 인간의 지각 및 수행 행위에서 야기되는 인간 오류 사건을 관리하고 인적 오류 확률을 추정하기 위한 인간 신뢰도 분석 시스템을 개발하고 있다. 본 연구에서는 인간 신뢰도 분석 방법론 개발 및 이를 이용한 인간 신뢰도 분석 전산 지원 시스템의 개발 과정에 관하여 기술하였다.

• 보건행정학회지
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• 제21권4호
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• 한국건축시공학회지
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• 제23권5호
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• pp.595-605
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• 2023

모듈러 건축 사례가 많아지면서 모듈러 건축에 관한 관심이 높아지고 적용 대상 범위가 확대되고 있다. 모듈러 건축의 장점 중 하나는 공장제작을 통한 우수한 품질의 건축물을 안정적으로 공급할 수 있는 것이다. 이를 위해, 현장 양중 및 설치 단계까지 품질관리를 위한 노력과 방법 적용이 필수적이다. 본 연구는 현재 현장 양중 및 설치 단계에서 품질유지 및 관리에 적용하고 있는 방안들의 중요도와 예방효과를 프로젝트 참여자들을 대상으로 설문조사를 실시하고, 이를 IPA 방법으로 분석하였다. 그 결과, 대부분의 품질 유지 및 관리 방법이 잘 적용되고 있으나, 프로젝트 참여자들간 일부 항목들에 대한 인식 차이가 있음을 확인하였고, 이에 대한 개선방안을 제시하였다. 본 연구 결과는 추후 프로제트 참여자들의 현장설치단계 품질관리 인식개선을 위한 연구에 활용할 수 있다.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.238-244
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• 2023

Background: Many patients use online resources to educate themselves on surgical procedures and make well-informed healthcare decisions. The aim of our study was to evaluate the quality and readability of online resources exploring shoulder arthroplasty. Methods: An internet search pertaining to shoulder arthroplasty (partial, anatomic, and reverse) was conducted using the three most popular online search engines. The top 25 results generated from each term in each search engine were included. Webpages were excluded if they were duplicates, advertised by search engines, subpages of other pages, required payments or subscription, or were irrelevant to our scope. Webpages were classified into different source categories. Quality of information was assessed by HONcode certification, Journal of the American Medical Association (JAMA) criteria, and DISCERN benchmark criteria. Webpage readability was assessed using the Flesch reading ease score (FRES). Results: Our final dataset included 125 web pages. Academic sources were the most common with 45 web pages (36.0%) followed by physician/private practice with 39 web pages (31.2%). The mean JAMA and DISCERN scores for all web pages were 1.96±1.31 and 51.4±10.7, respectively. The total mean FRES score was 44.0±11.0. Only nine web pages (7.2%) were HONcode certified. Websites specified for healthcare professionals had the highest JAMA and DISCERN scores with means of 2.92±0.90 and 57.96±8.91, respectively (P<0.001). HONcode-certified webpages had higher quality and readability scores than other web pages. Conclusions: Web-based patient resources for shoulder arthroplasty information did not show high-quality scores and easy readability. When presenting medical information, sources should maintain a balance between readability and quality and should seek HONcode certification as it helps establish the reliability and accessibility of the presented information. Level of evidence: IV.