• 가정간호학회지
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• 제2권
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• pp.60-76
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• 1995

The purpose of this study was to analysis level on family caregiver's burden for the elderly with senile dementia in a rural area and to choose priority care group, thereby facilitating the development of interventions to reduce the caregiver's burden. For this purpose, data were collected by questionaire from June 10 to October 8, 1994. The instruments for data collection were Caregiver Burden Inventory by Novak(1989) and Zarit et al(1982), severity of dementia by Hughes Scales (1982), ADL by Lawton (1971), patients' family caregiving activity by pre-survey and reference review(Lee, 1993 ; Jang, 1990 ; Yoo, 1982). The subjects were 60 family caregiver of senile dementia in a rural area. The data was analysed by the use of t-test, ANOVA, correlation and multiple regression. The results were as follows : 1. Total burden was evaluated over average, the mean of family burden was 61.24. 2. Significant variables which were correlated to the family caregiver's burden were the severity of dementia(F=30.52, p<0.001), ADL(F=5.43, p<0.01), PADL(F=6.14, p<0.01), caregiver's health status(F=6.05, p<0.01), a view of patient's prognosis(F=4.08, p<0.05), the number of hours per day spent on caregiving(F=19.64, p<0.001), level of intimacy of caregiver and patients(F=7.16, p<0.001), the frequency of caregiving activity(F=5.31, p<0.01). 3. ADL was the most important predictor to family caregiver burden(R2=0.6611). In addition to this, the severity of dementia, level of intimacy of caregiver and patient, relationship with the patient accounted for 79% of family caregiver burden. 4. The criteria of priority care group were as follows ; the mean of family caregiver burden was above 58, above of moderate ADL, the number of hours per day spent on caregiving above of 8 hours, above of moderate dementia. By the the severity of dementia, number of priority care group, mild dementia was 10(43.4%), moderate dementia 23 (92.0%), sever dementia 12(100.0%).

• Safety and Health at Work
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• 제3권1호
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• pp.17-21
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• 2012

Objectives: Asbestos-related diseases (ARDs) have increased globally over the decades, causing an economic burden and increased health care costs. It is difficult to predict the risk of development of ARDs and of respiratory disability among workers with a history of asbestos exposure. Blood based biomarkers have been reported as promising tools for the early detection of malignant mesothelioma. This study investigated whether serum soluble mesothelin-related peptide (SMRP) would reflect severity of disablement in compensable ARDs. Methods: SMRP levels were measured in a cohort of 514 asbestos-exposed subjects. Severity of ARDs was assessed by a Medical Authority comprising four specially qualified respiratory physicians. Severity of ARDs and SMRP levels were compared. Results: Mean (standard deviation) serum SMRP level in the population with compensable ARDs (n = 150) was 0.95 (0.65) nmol/L, and was positively associated with disability assessment (p = 0.01). Mean SMRP level in healthy asbestos-exposed subjects was significantly lower than those with pleural plaques (p < 0.0001) and in subjects with ARDs who received compensation (p < 0.01). Conclusion: This study indicates that serum SMRP levels correlate with severity of compensable ARDs. Serum SMRP could potentially be applied to monitor progress of ARDs. Further prospective work is needed to confirm the relationship between SMRP and disability assessment in this population.

• 약학회지
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• 제59권6호
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• pp.278-283
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• 2015

The computerized prospective Drug Utilization Review (DUR) program supported by the Korean government has provided alerts to physicians and pharmacists since December 2010. This study aims to propose and apply the tiering system in "drug combinations to avoid (DCA)" and "age-precaution" alerts based on severity to improve the compliance of users. To propose the severity and clinical importance of 647 DCA alerts and 140 age precautions, a Delphi evaluation survey was conducted. An expert panel comprising 5 clinical pharmacists and 5 physicians were participated in mail surveys. Based on the results of Delphi survey, DCA pairs were classified into 3 groups; group 1 (70.6%), 2 (26.9%), and 3 (2.8%). Drug-age precaution ingredients were also classified into three groups; group 1 (53.6%), group 2 (40.7%), and group 3 (5.7%). When this grouping was applied to claim data from 2011 to 2013, the majority of alerts had occurred in the groups of high severity. Presenting DUR alerts with severity level is expected to improve the compliance of clinicians. The implementation of tiering system in DUR criteria should be considered.

• 생물정신의학
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• 제26권1호
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• pp.14-21
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• 2019

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.87-97
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• 2021

Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening. Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test. Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031). Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.177-181
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• 2015

Purpose: Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. Methods: We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. Results: There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. Conclusion: Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients.

• 성인간호학회지
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• 제23권2호
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• pp.180-188
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• 2011

Purpose: This study was to identify nursing diagnosis-outcome-intervention (NANDA- NOC-NIC: NNN) linkages applied to inpatients in general surgical nursing units. Methods: We developed the NNN linkage computerized nursing process program, which consisted of the 107 nursing outcomes and the 190 nursing interventions linked to the 39 nursing diagnoses. This program was applied to 324 patients who admitted to those nursing units from July, 2004 to February, 2005. Results: First, nursing outcomes of each nursing diagnosis were identified as follows: for 'acute pain', pain control, pain level, and comfort level; for 'risk for infection', wound healing: primary intention, wound healing: secondary intention, and infection status; for 'nausea', nutritional status: food & fluid intake, comfort level, symptom severity and hydration. Second, major nursing interventions for each nursing outcome were analyzed as follows: for pain control or comfort level, pain management and medication management; for pain level, pain management and analgesic administration; for wound healing: primary intention, incision site care and wound care; for Wound healing: secondary intention or infection status, infection control; for nutritional status: food & fluid intake, fluid monitoring; for comfort level, nausea management; for symptom severity, nausea management and vomiting management; for hydration, fluid/electrolyte management. Conclusion: This identified NNN linkages will facilitate the use of nursing process in surgical nursing practice and documentation systems.

• 서비스연구
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• 제7권4호
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• pp.109-126
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• 2017

효과적인 서비스실패 회복 전략을 모색하는 기업이 증가하면서 복합적 서비스회복 전략을 사용하는 기업이 종종 목격되고 있다. 그런데 서비스실패 회복 전략에 관한 대부분의 연구는 단일 회복 전략에 집중하고 있어 현실 세계에서 목격되고 있는 보상적 할인과 재서비스 등 서로 다른 비용구조를 지닌 복합적 서비스회복 전략을 충분히 조명하지 못하고 있다. 이러한 문제의식을 토대로, 이 연구에서는 기존고객에 대한 인센티브를 조명한 Biyalogorsky, Gerstner, and Libai(2001) 모형을 서비스실패 회복 인센티브를 조명한 Zhu, Sivakumar, and Parasuraman(2004) 모형과 접목한 게임모형을 통해 서비스실패 상황에서 서비스회복을 위한 보상적 할인과 재서비스 등 서로 다른 인센티브의 적절한 배합구조는 어떻게 형성하는 것이 유리한지, 서비스실패 심각성이나 재구매에 필요한 최소만족요구수준이 달라질 때 이러한 균형은 어떤 영향을 받게 되는지 등을 살펴보는 이론적 연구를 시도하였다. 이 연구의 주요 발견점은 다음과 같다: (1)서비스업체는 서비스실패 회복 전략으로 보상적 할인과 재서비스 함께 고려함으로써 이윤을 증대시킬 수 있다. (2)서비스업체가 서비스실패 회복을 통해 고객 유지를 도모하는 경우, 서비스실패 심각성이 일정 수준 이하일 때는 서비스실패에 따른 효용감소가 심할수록 보상적 할인과 재서비스 수준을 늘리는 것이 바람직하지만, 서비스 실패 심각성이 일정 수준 이상일 때는 서비스실패에 따른 효용감소가 심할수록 보상적 할인만 늘리고 재서비스 수준은 줄이는 것이 바람직하다. (3)고객 유지에 필요한 최소만족수준이 높을수록 총 보상 수준을 높이되, 총 보상 중 보상적 할인 비중을 높이는 것이 바람직하다.

• 마케팅과학연구
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• 제20권2호
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• pp.188-198
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• 2010

此研究旨在考察负口碑(即NWOM)对在线行销的影响, 着重分析服务失败的描述以及通信服务商的意向是如何影响消费者对企业竞争力的评估, 对企业的态度, 以及积极的口碑行销和行为意向. 对通信说服力的研究着重于 "谁说了什么; 对谁;通过何渠道;有何影响(Chiu 2007)". 在此我们研究了电子网络发布, 尤其是 "什么" 的两个方面: 通信服务失败的等级以及个人发布的知觉意向. 电子负口碑看似正在毁掉产品或企业的声誉, 这也就不难理解为什么人们总对它带有偏见, 认为其不可靠. 根据归因理论, 人们总会寻求事件的原因, 尤其是那些消极的意外的事件(Weiner 2006). Hennig-Thurau和Walsh (2003)提出 "既然读者的知识和对在线信息的作者信任度都很有限, 可以把电子口碑当做是表达-行为关系的有效调节. 此据此我们提出以下假设: 假设1. 在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 面临高等级服务失败电子负口碑的对象得分低于面临低等级服务失败电子负口碑的对象. 假设2. 在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 面临警告意向电子负口碑的对象得分低于面临报复意向电子负口碑的对象假设3. 在电子负口碑中, 服务失败的等级和知觉意向互相影响, 因此在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 警告意向的电子负口碑的平均反应值大于报复意向的电子负口碑. 主要研究包括一个2 (服务失败的严重性) x 2(警告意向VS报复意向的负口碑)的析因实验. 将通过模拟的在线网络发布信息刺激在线对象. 这一方案描述的服务失败是在传统的零售机构不接受礼物卡, 通过一家在线的研究公司从全国抽样. 共有113个对象参与此研究, 共分析了104份调查问卷. 研究对象认为该方案很现实, 92.3%对此反应强烈. 方案的运作相当令人满意, 所有的措施都经预先的测试验证, 各个项目也经分析证实可靠并有效. 多变量方差分析结果显示多变量间无明显的互相影响, 因此我们只研究主要影响-后倾向和服务失败的严重性. 后倾向主要影响对企业的态度, 积极的口碑和行为意向. 服务失败的严重性主要影响4个因变量: 企业的竞争力, 对企业的态度, 积极的口碑和行为意向. 需特别指出的是, 当电子负口碑描述为严重的服务失败时, 企业的竞争力低于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 对企业的态度差于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 企业的口碑差于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 行为意向低于电子负口碑描述为较轻的服务失败时. 因此, 假设1中的abcd都得到了支持. 另外, 衡量对企业的态度时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 衡量企业的口碑时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 衡量行为意向时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 因此与假设2中的a项不符, 尽管结果指向的是假设方向. 除此之外, 在假设的三个变量中, 后倾向对服务失败的严重性无明显的多变量或单变量影响. 因此, 假设3被推翻. 此研究有研究和管理的双重蕴涵, 如之前的研究一样, 此研究结果证实了服务失败的严重性影响消费者知觉, 态度, 积极的口碑以及行为意向(Weun et al. 2004). 关于进一步的相关性, 在线内容证实了该反应, 这意味着企业需要努力进行服务补救. 至于电子负口碑的知觉意向, 如之前的研究一样, 此研究结果意味着读者对原始资料的意向影响其对知觉, 态度, 积极口碑和行为意向的作用大小. 对管理者的蕴涵在于, 当消费者发现在线交流可靠且有影响力时, 不是所有的交流都同等重要. 电子口碑的好处在于它可以监测潜在的问题并提供纠正的可能性, 即使有潜在的危害.

• 대한응급의학회지
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• 제29권5호
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• pp.509-518
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• 2018

Objective: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. Methods: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH <7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. Results: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. Conclusion: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.