• Title/Summary/Keyword: Tertiary System

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A Qualitative Research on the Evaluation of Healthcare and Welfare Network for Vulnerable Populations : Focusing on the Dalgubeol Health Doctor Services (취약계층 대상 보건의료·복지 네트워크 사업 성과에 대한 질적연구 : 달구벌건강주치의사업을 중심으로)

  • Su-Jin Lee;Jong-Yeon Kim;Jae-Wook Kang;Hye-Jin Lee
    • Journal of agricultural medicine and community health
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    • v.48 no.4
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    • pp.262-274
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    • 2023
  • Objectives: This study examined the evaluation and potential improvements of 'Integrated Healthcare and Social Welfare service model' based on the experiences of practitioners from institutions participating in the 'Dalgubeol Health Doctor Services' and the service recipients. Methods: Qualitative research was conducted from September to November 2022 in this study, focusing on 4 providers from the dedicated Dalgubeol Health Doctor Services Team, 5 contact partners from affiliated organizations, and 6 service beneficiaries. The data gathered underwent thematic analysis. Results: The evaluation indicated that Dalgubeol Health Doctor Services has proven to be effective in addressing the complex needs of vulnerable populations. By providing integrated services through quick and simple beneficiary selection and resource linkage, it has contributed to the resolution of complex demands, recovery of positive attitudes towards life, and improvement in quality of life for users who have fear the use of medical and welfare services. Dalgubeol Health Doctor Services has established an integrated health care system involving not only public but also private organizations, from the referral agency to the service provider. Centered around Daegu Medical Center and involving five tertiary hospitals, it has established a model that supports treatment appropriate to the severity of the patient, from mild to severe. Conclusions: These findings indicate an enhancement in health equity, achieved through the active identification and subsequent health and welfare issue resolution of individuals marginalized from medical benefits.

The antioxidant ability of nutmeg ethanolic extract in bulk oil and oil-in-water emulsion matrices (식물성 유지 및 수중유적형 유화계에서 육두구 종자 에탄올 추출물의 항산화활성 평가)

  • Ji-Eun Kim;Ji-Yun Bae;Mi-Ja Kim
    • Food Science and Preservation
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    • v.30 no.2
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    • pp.334-346
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    • 2023
  • The antioxidant ability of 80% ethanolic extract of nutmeg seed (NM80) was evaluated using in vitro assays and bulk oil and oil-in-water (O/W) emulsion matrices. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS) cation radical scavenging, and oxygen radical antioxidant capacity (ORAC) in vitro assays were used to evaluate the antioxidant ability of the extract. The DPPH radical scavenging activities of 25, 50, 100, and 200 ㎍/mL NM80 were 12.5, 20.9, 35.1, and 62.8%, respectively, while the ABTS cation radical scavenging activities were 2.7, 6.5, 30.5, and 29.8%, respectively, demonstrating a dose-dependent effect. The ORAC value was significantly higher at an NM80 concentration of 25 ㎍/mL than the positive control (p<0.05). The conjugated dienoic acid (CDA), ρ-anisidine, and tertiary butyl alcohol values in 90-min-heated corn oil containing 200 ppm of NM80 were significantly reduced by 3.26, 16.94, and 17.34%, respectively, compared to those for the sample without NM80 (p<0.05). However, the headspace oxygen content and CDA value in the O/W emulsion containing 200 ppm of NM80 at 60℃ had 6.29 and 82.85% lower values, respectively, than those for the sample without NM80 (p<0.05). The major volatile compounds of NM80 were allyl phenoxyacetate, eugenol acetate, and eugenol. NM80 could be an effective natural antioxidant in lipid-rich foods in bulk oil or O/W emulsion matrix.

Conventional Versus Artificial Intelligence-Assisted Interpretation of Chest Radiographs in Patients With Acute Respiratory Symptoms in Emergency Department: A Pragmatic Randomized Clinical Trial

  • Eui Jin Hwang;Jin Mo Goo;Ju Gang Nam;Chang Min Park;Ki Jeong Hong;Ki Hong Kim
    • Korean Journal of Radiology
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    • v.24 no.3
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    • pp.259-270
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    • 2023
  • Objective: It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial. Materials and Methods: Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient's medical record at least 30 days after the ED visit. Results: We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70-1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79-1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD. Conclusion: AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.

Functional Aspects of the Obesity Paradox in Patients with Severe Coronavirus Disease-2019: A Retrospective, Multicenter Study

  • Jeongsu Kim;Jin Ho Jang;Kipoong Kim;Sunghoon Park;Su Hwan Lee;Onyu Park;Tae Hwa Kim;Hye Ju Yeo;Woo Hyun Cho
    • Tuberculosis and Respiratory Diseases
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    • v.87 no.2
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    • pp.176-184
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    • 2024
  • Background: Results of studies investigating the association between body mass index (BMI) and mortality in patients with coronavirus disease-2019 (COVID-19) have been conflicting. Methods: This multicenter, retrospective observational study, conducted between January 2020 and August 2021, evaluated the impact of obesity on outcomes in patients with severe COVID-19 in a Korean national cohort. A total of 1,114 patients were enrolled from 22 tertiary referral hospitals or university-affiliated hospitals, of whom 1,099 were included in the analysis, excluding 15 with unavailable height and weight information. The effect(s) of BMI on patients with severe COVID-19 were analyzed. Results: According to the World Health Organization BMI classification, 59 patients were underweight, 541 were normal, 389 were overweight, and 110 were obese. The overall 28-day mortality rate was 15.3%, and there was no significant difference according to BMI. Univariate Cox analysis revealed that BMI was associated with 28-day mortality (hazard ratio, 0.96; p=0.045), but not in the multivariate analysis. Additionally, patients were divided into two groups based on BMI ≥25 kg/m2 and underwent propensity score matching analysis, in which the two groups exhibited no significant difference in mortality at 28 days. The median (interquartile range) clinical frailty scale score at discharge was higher in nonobese patients (3 [3 to 5] vs. 4 [3 to 6], p<0.001). The proportion of frail patients at discharge was significantly higher in the nonobese group (28.1% vs. 46.8%, p<0.001). Conclusion: The obesity paradox was not evident in this cohort of patients with severe COVID-19. However, functional outcomes at discharge were better in the obese group.

A Study on World University Evaluation Systems: Focusing on U-Multirank of the European Union (유럽연합의 세계 대학 평가시스템 '유-멀티랭크' 연구)

  • Lee, Tae-Young
    • Korean Journal of Comparative Education
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    • v.27 no.4
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    • pp.187-209
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    • 2017
  • The purpose of this study was to highlight the necessity of a conceptual reestablishment of world university evaluations. The hitherto most well-known and validated world university evaluation systems such as Times Higher Education (THE), Quacquarelli Symonds (QS) or Academic Ranking of World Universities (ARWU) primarily assess big universities with quantitative evaluation indicators and performance results in the rankings. Those Systems have instigated a kind of elitism in higher education and neglect numerous small or local institutions of higher education, instead of providing stakeholders with comprehensive information about the real possibilities of tertiary education so that they can choose an institution that is individually tailored to their needs. Also, the management boards of universities and policymakers in higher education have partly been manipulated by and partly taken advantage of the elitist ranking systems with an economic emphasis, as indicated by research-centered evaluations and industry-university cooperation. To supplement such educational defects and to redress the lack of world university evaluation systems, a new system called 'U-Multirank' has been implemented with the financial support of the European Commission since 2012. U-Multirank was designed and is enforced by an international team of project experts led by CHE(Centre for Higher Education/Germany), CHEPS(Center for Higher Education Policy Studies/Netherlands) and CWTS(Centre for Science and Technology Studies at Leiden University/Netherlands). The significant features of U-Multirank, compared with e.g., THE and ARWU, are its qualitative, multidimensional, user-oriented and individualized assessment methods. Above all, its website and its assessment results, based on a mobile operating system and designed simply for international users, present a self-organized and evolutionary model of world university evaluation systems in the digital and global era. To estimate the universal validity of the redefinition of the world university evaluation system using U-Multirank, an epistemological approach will be used that relies on Edgar Morin's Complexity Theory and Karl Popper's Philosophy of Science.

A Study of variables Related to Nursing Productivity (간호생산성에 관한 연구: 관련변수의 검증을 중심으로)

  • 박광옥
    • Journal of Korean Academy of Nursing
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    • v.24 no.4
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    • pp.584-596
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    • 1994
  • The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

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A Study on Landscape Evaluation Indicators for Agricultural and Fishery Heritage (농어업유산의 경관 평가 지표 연구)

  • Choi, Woo-Young;Kim, Dong-chan
    • Journal of the Korean Institute of Landscape Architecture
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    • v.43 no.5
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    • pp.74-86
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    • 2015
  • The purpose of this study was to deduce the landscape evaluation indices that can be applied from the preparation for the registration of major national farm/fishery heritages to post-management. For this purpose, the Delphi survey was performed on experts. From August to November in 2014, the primary open survey, secondary open survey, and tertiary closed survey were performed to gather opinions from 28 experts, 25 experts, and 29 experts, respectively. As a result, the landscape evaluation indices for farm/fishery heritage consisted of five areas of evaluation, ten items of evaluation, and 40 indices of evaluation. The areas of evaluation were rurality, authenticity, aesthetics, tourism potentials, and locality. Rurality was classified into rurality of farm/fishery towns and nostalgia. Authenticity was classified into objective authenticity and existential authenticity. Aesthetics was classified into attractiveness and harmony. Tourism potentials were classified into value of resources and value of usability. Locality was divided into physical originality and cultural identity. The study made the following findings: first, the general grounds of farm/fishery landscape evaluation cannot be applied when evaluating the quality of landscapes of farm/fishery heritage, as their value as a cultural heritage should be considered. Second, the new indices valued emotional factors in addition to the physical factors considered by the existing farm/fishery landscapes. The new indices involved a more expanded concept of landscapes as it also considers everyday or temporary activities, including the farm/fishery activities of local people or participation in festivals and experience programs. Third, farm/fishery heritage focuses on the lives of local people, as it involves both the synchronic and the diachronic perspectives to see what is currently visible and what is no longer visible. This brings into consideration not only the farms and the natural environments but also their relationships with the villages, especially the residential areas. Finally, the indices reflected both the farm/fishery heritage's value as cultural heritage and its value for tourism. They derived temporary and dynamic landscapes, including the trading activities of local specialty markets in relation to the production landscapes. However, further studies should be conducted as this study could not rate the relative importance of indices or compare the total scores of landscapes without the weight of each item.

A Study of Family Caregiver's Burden for the Terminally III Patients (지역사회 말기질환자 가족 부담감에 관한 연구)

  • Han, Sung-Suk;Ro, You-Ja;Yang, Soo;Yoo, Yang-Sook;Kim, Sek-Il;Hwang, Hee-Hyung
    • Journal of Home Health Care Nursing
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    • v.10 no.1
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    • pp.58-72
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    • 2003
  • The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18,

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Frequency of Candida Strains Isolated from Candidiasis Patients at A Tertiary Hospital over the Last 10 Years (최근 10년 동안 일개 상급종합병원의 칸디다혈증 환자에서 분리된 칸디다 균종의 빈도)

  • Hwang, Yu-Yean;Kang, On-Kyun;Park, Chang-Eun;Hong, Sung-No;Kim, Young-Kwon;Huh, Hee-Jae;Lee, Nam-Yong
    • Korean Journal of Clinical Laboratory Science
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    • v.54 no.2
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    • pp.110-118
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    • 2022
  • Candidemia is a major cause of nosocomial infections resulting in increased morbidity and mortality. It remains a serious risk in inpatients and increases medical treatment costs. From 2009 to 2018, Candida strains (3,533) isolated from blood culture tests at the S Hospital were analyzed according to the period, year, sex, age, ward, etc. During the entire period, 54,739 of 717,996 blood culture tests showed a positive rate (7.6%) and the Candida isolation rate was 3,533 (6.4%) out of 1,036 patients. Among the Candida isolates, C. albicans was most common (33.8%), followed by C. tropicalis (28.6%), C. glabrata (19.8%), C. parapsilosis (7.8%), and C. krusei (4.0%). In early (2009~2013)/late (2014~2018) isolation, C. tropicalis decreased by 3.8% and C. glabrata increased by 3.4%. After 50 years of age, the higher the separation frequency. C. parapsilosis (31.3%) in 1~10s, C. tropicalis (30.3%) and C. glabrata (27.6%) in 41~50s, and C. tropicalis (28.6%) in 80s are relatively frequent. has been separated C. krusei was isolated in a relatively high proportion from females (60.9%). Therefore, a systematic and continuous nosocomial infection control system should be established for appropriate treatment as per antifungal treatment guidelines. The system should continuously monitor the distribution of Candida species and provide rapid identification results.

Development and Validation of the Korean Tier 3 School-Wide Positive Behavior Support Implementation Fidelity Checklist (KT3-FC) (한국형 긍정적 행동지원 3차 실행충실도 척도(KT3-FC)의 개발과 타당화)

  • Won, Sung-Doo;Chang, Eun Jin;Cho Blair, Kwang-Sun;Song, Wonyoung;Nam, Dong Mi
    • Korean Journal of School Psychology
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    • v.17 no.2
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    • pp.165-180
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    • 2020
  • As a tiered system of supports, School-Wide Positive Behavior Support (SWPBS) is an evidence-based practice in the educational system of Korea. An important aspect of SWPBS is the ongoing progress monitoring and evaluation of implementation fidelity. This study aimed to develop and validate the Korean Tier 3 School-Wide Positive Behavior Support Implementation Fidelity Checklist (KT3-FC). The preliminary KT3-FC consisted of a 37-item, 6-factor checklist. In the first phase of the study, 10 experts reported that the range of content validity of the KT3-FC was adequate. In the second phase of the study, 185 teachers (52 men and 133 women) who implemented SWPBS completed the KT3-FC, Individualized Supports Questionnaire, School Climate Questionnaire, School Discipline Practice Scale, and PBS Effectiveness Scale. An exploratory factor analysis resulted in a 5-factor structure, with 20 items, instead of 37 items, consisting of: (a) progress monitoring and evaluation of the individualized supports, (b) provision of supports by aligning and integrating mental health and SWPBS, (c) crisis management planning, (d) problem behavior assessment, and (e) establishment of individualized support team. The internal consistency of the KT3-FC was good (full scale α = .950, sub-factor α = .888 ~ .954). In addition, the KT3-FC showed good convergent validity, having statistically significant correlations with the Individualized Support Questionnaire, School Climate Questionnaire, School Discipline Practice Scale, and the PBS Effectiveness Scale. Finally, the confirmatory factor analysis showed that the 5-factor model of the KT3-FC had some good model fits, indicating that the newly developed fidelity measure could be a reliable and valid tool to assess the implementation of Tier 3 supports in Korean schools. Accordingly, the KT3-FC could contribute to implement SWPBS as an evidence-based behavioral intervention for Korean students.