치과병원 진료실 내에서 메티실린 또는 반코마이신 저항성 Staphylococcus aureus의 검출 (DETECTION OF METHICILLIN OR VANCOMYCIN-RESISTANT STAPHYLOCOCCUS AUREUS FROM DENTAL HOSPITAL)
-
- Restorative Dentistry and Endodontics
- /
- 제32권2호
- /
- pp.102-110
- /
- 2007
본 연구는 조선대학교 치과병원의 진료환경 및 진료요원으로부터 기회감염성 병원체로 알려진 methicillin 또는 vancomycin 저항성 황색포도상 구균 (methicillin-or vancomycin-resistant Staphylococcus aureus. MRSA or VRSA)의 존재 여부를 조사하여, 이를 광주지역 개원치과와 비교분석을 통해 현재 조선대학교 치과병원의 MRSA와 VRSA의 오염정도를 파악하고자 하였다. 이를 위해 진료실 환경 및 진료요원으로부터 분리한 S. aureus 균주들의 8종 항생제에 대한 감수성 조사를 시행하고, 기존에 알려진 항생제 내성 유전자 존재 여부를 PCR법을 이용하여 확인하였다. 그 결과, 조선대학교 치과병원의 진료요원에서 채취한 샘플 중 1개 (2.3%), 개원 치과에서는 2명 (10%)의 진료요원의 샘플에서 S. aureus가 분리되었으며, 진료환경에서는 두 곳 모두에서 S. aureus가 검출되지 않았다. 조선대학교 치과병원과 개원치과에서 분리된 S. aureus는 amoxicillin, penicillin G, ciprofloxacin clindamycin, vancomycin에 내성을 보이며 oxacillin, cefuroxime에는 균주에 따라 감수성 또는 내성을 보였다. 조선대학교 치과병원에서 분리된 S. aureus는 erythromycin과 clindamycin에 내성 유전자인 ermA가 존재하였으며, 개원치과에서 분리된 3개의 S. aureus 중 2개에서 penicillin과 oxacillin에 내성 유전자 mecA가 존재하는 것으로 나타났다. Vancomycin 내성 유전자인 vanA, vanB는 어떠한 샘플에서도 검출되지 않았다. 이상의 결과를 종합할 때, 본 연구는 조선대학교 치과병원과 개원치과의 S. aurues분포 및 MRSA 또는 VRSA의 존재여부를 조사하여 MRSA와 VRSA의 확산예방을 위한 치과진료 환경의 개선과 적절한 항생제 사용에 대한 기초 자료를 제공할 것으로 사료된다.
주요 수도품종들의 탈립성 정도와 곡립의 인장강도와 탈립성 및 수확작업시 포장손실과의 관계를 밝히므로서 탈립성에 관한 품종개량 및 포장손실의 최소화에 도움을 주고자 본 연구를 수행하였다. 11개 품종을 공시 공시했으며 출수 후 35일부터 63일까지의 기간에 1주일 간격으로 품종 및 수확기 별로 임의 추출한 10이삭 200립씩에 대한 곡립의 인장강도, 탈립정도 및 수분함량을 측정했으며, 탈립정도는 이삭을 수확직후 1.5m 지상에서 콘크리트바닥에 낙하시켰을 때 탈립되는 곡립수의 전곡립수에 대한 비율이었다. 또한 포장손실과 곡립의 인장강도와의 관계는 농가포장에서 2품종을 선정하여 출수 후 40일부터 1주일 간격으로 3-4회 binder harvester를 실제 사용하여 포장에 탈립된 량을 측정하고 이를 같은 재료에 대해 측정한 곡립의 인장강도와 관계를 지었으며 3반복하였다. 그 주요결과는 다음과 같이 요약된다. 1. 공시품종들의 평균 곡립인장강도는 90g(밀양 2003) 정도부터 250g(진흥) 정도까지의 범위에서 품종 및 수확기에 따라 차이가 있었으며, 그 표준편차는 30-60g 정도이었는데 곡립의 평균 인장강도가 큰 품종일수록 편차가 컸다. 2. 낙하검정에 의한 곡립의 탈립정도는 밀양2003 20-30%, 수원 29004 3-16%, 한강찰 13-15%, 이리 348호 1-21%, 금강 및 태백 1% 정도로서 수확기에 따라 다소간 차이를 보였다. 3. 낙하검정에서 탈립하기 시작하는 평균 인장강도는 180g이었고, 공시이삭들의 곡립들 중 인장강도가 98g 이상인 것들은 탈립하지 않았으며 인장강도가 10g 저하하면 탈립율은 3-5% 증가했다. 4. 낙동벼와 이리 348호는 수확기가 늦어지면 곡립의 인장강도가 작아지었지만 그밖의 품종들에서는 반대로 인장강도가 다소간 커지거나 별로 변화하지 않았으며, 탈립율도 이리 348호를 제외하면 수확기의 영향을 크게 받지 않았고, 곡립의 인장강도는 수분함량과 대체로 역상관관계를 보였다. 5. 곡립의 평균 인장강도와 binder 수확시의 포장손실량과는 부의 상관이 있었으며, binder 수확시 포장손실이 일어나지 않게 되는 한계 평균인장강도는 174g이었으며 그 이하에서 평균인장강도가 10g 저하되면 포장손실은 ha당 40kg 정도 증가하였다. 6. 현재 품종들의 탈립성 분류기준으로 사용되고 있는 평균인장강도는 그 분산이 변이가 크고, 환경의 영향을 많이 받으며 이삭의 곡립들 중 수확작업시 실제로 탈립이 잘 되는 곡립은 인장강도가 98g이하이었으므로 품종의 탈립성 판정 및 포장손실의 추정을 위해서는 표본중 인장강도가 100g 이하인 곡립들의 전곡립수에 대한 비율을 기준으로 할 것을 제의한다.
The change of society has brought about various health problems which have become to demand comprehensive health services not only for individuals but also for families and communities as the unit. To meet the societal needs W Hospital in a rural Korea established a Department of Community Health Nursing Services and provided nursing services to patients under a early discharge program. This study is to evaluate the community health nursing services carried out the department in general, and has following specific objectives : 1. To learn attitude of the consumers and the "referees" toward early discharge program. 2. To find out attitude toward home care and cure services. 3. To find out the consumers and the "Referees" attitude toward the 15 selected home cue and cure activities by public health nurse. 4. To investigate possibility of charging fee for the 15 selected home care and cure activities by public health nurse. Three different study population were chosen: namely the consumer, the "referee" I and II. Excluding families moved out and not able to be contacted, the total families (77) referred to the department during the study period of September 1974 - December 1975 are defined as the consumer. Thirty seven nurses among 81 nurses who have been working in W Hospital since the inception of the Community Health Nursing Service Program were randomly selected. Thirty two nurses were defined as the "referee"I, because 5 questionnaires were not able to be collected. Twenty four doctors out of 37 who have been working since the Community Health Nursing Service Program started, and who were able to contact were called as the "referee" II. Data collection method employed for the consumers was direct interviewing with preposed interview schedules, and for the "referees"questionnaire method was utilized. x
본 연구는 육안판단이 아닌 엽록소형광 이미지 측정기법을 이용하여 비파괴적으로 수박접목묘 플러그트레이 단일 셀에 대해 건조스트레스를 정량화하고자 수행되었다. 접목 후 6일차 수박접목묘를 3일동안 균일한 관수관리 하에서 재배한 후 건조스트레스를 부여하였다. 이후 플러그트레이 단일 셀 형태의 수분함량센서를 이용하여 D1(53.0%, 충분한 수분상태)단계부터 D9(15.7%, 극심한 건조스트레스)단계까지 9개 그룹으로 분류하고 엽록소 형광을 측정하였다. 또한 건조스트레스에 영향을 받은 묘(D5-D9)에 재관수하여 육안판단으로 확인되지 않은 광합성 및 생육 회복 수준을 측정하였다. 3개의 건조스트레스 단계의 엽록소형광 곡선 형태는 건조스트레스 조기 탐지에 대해 다른 양상을 보였다. 총 16개의 엽록소 형광 지수는 건조스트레스에 노출되면서 지속적으로 감소하였으며, 육안으로 판단 가능한 D5(32.1%)단계에서 크게 감소하였다. 형광감소율(Rfd_Lss)는 초기 건조스트레스 수준(D5-D6)에서 명확하게 감소하기 시작하였으며, 최대 광화학효율(Fv/Fm)은 극심한 건조스트레스 수준(D7-D9)에서 크게 감소하였다. 따라서, Rfd_Lss 및 Fv/Fm 지수를 건조스트레스의 초기 및 이후 단계에서 생육 및 광합성 회복 평가를 위한 지표로 선정하였다. 개별 엽록소형광 지수의 수치값 차이와 엽록소형광 이미지를 통해 건조스트레스 수준이 직관적으로 확인되었다. 이러한 결과는 Rfd_Lss와 Fv/Fm은 각각 초기 및 극심한 건조스트레스를 탐지하지 위한 엽록소형광 지수로 활용될 수 있으며, Fv/Fm은 재관수시 회복 평가를 위한 최적의 엽록소형광 지수로 판단된다.
The parents have much expectation upon the pregnancy and child birth, and in most cases, they expect the healthy parturient child. However, we can be placed on the high-risk conditions which have the physical, social and immature infant, due to the unexpected results, among the new-born. Accordingly, these high-risk newborn and premature infants will be mostly in NICU, which the concentrated medical treatment can be given, upon their conditions. After their birth and during these periods, they will be divided from the parents, and the nurse will accomplish the bringing-up activities which they can take care of the infant, expected by the parents after their birth. The hospitalization of high-risk newborn including these premature infants is the shocking experience to the parents of family, and thus they can feel the fear and uneasiness, and these reactions of parents are troubled in the behavior at the usual days, and cause the disorder and spiritless status, and these results break the supporting ability of parents, and cause the obstruction. Also, the unavoidable division between the parents and the children as like hospitalization of children can make the parents to feel the alienation emotionally, and this causes the results which the pride on the bringing-up ability of baby gets to be lost. These problems can cause the difficulties on the bonding or the parenting in the further days, and can be related to the neglect and abuse of children. Also, it is gradually increased to study and report which the emotional division by the physical division between the mother and the baby obstructs the normal affection course between the parent and the infant. The stress caused by the birth and the hospitalization of high-risk newborn, as like this, is important in the points which it can uncertainly affect the potential energy for the relationship of parent-child who are finally healthy. Accordingly, the significance and purpose of this study are to understand the contents and degree of stress which the parents of high-risk newborn including the immature child can be experienced from the hospitalization of ICU for their new borns, and thus to offer the basic program to the nursing intervention program for these. The subject of this study is the mother of newborn in NICU of 10 General Hospitals located at the 3one of Pusan, Korea from September 1997 to October 1997, and thus makes the subject of 95 person of parents who agreed to take part in the study and it is descriptive study related to the stress of mother having the newborn in NICU. The method is based on the preceding study related to the stress of mother having the experience of child hospitalization and chronic disease child, and then acquires the advice of specialists group as like 5 nursing professors, and then is amended and supplemented. Total number of questions is 43 items and consists of 5 factors as like medical treatment &nursing procedures, disease status & prognosis, role of parents, communication & inter-personal relationships, hospital environment, and is 5 point Likert Scale. The reliability of this study method is very highly shown to be Cronbach α=0.95. The collected data is analysed as Average, Frequency, Standard Deviation, T-test, ANOVA, Pearson Correlation Coefficient, Duncan multifulrange test by use of SPSS /PC (V7.5). The results of this study is summarized as under. 1. Every characteristics of subject is which the party of mother is 28.70age(±7.48) in the average ages, 51% in the high-school graduate, 38.5% in the christianity, total monthly income is 212.55 thousand won(±1.971), 74.5% in the housewife, 72.9% in the parents and children together living and the number of children to be 1.48person(± 0.6) in average, the recognition on the prognosis of baby is 74.0% in 'Don't know', the relationship with the husband after the hospitalization of babyis 37.3% in 'More Intimate', the relationship with the family of husband to be 48% in 'No-change', and the degree which is consulted with the husband about the baby is 55% in 'very frequently' and the visiting number per week is 4.59(±1.63) in average and the accompanying person in the time of visiting is which the number of husband is 56.3% and thus is the highest. The characteristics of baby is which the age is 21.88days(±16.47) after the birth in average, the sex to be 50 person in the female 52.1% and the order of birth to be 54.2% in the first chid, and the weight in the birth to be 2770gm(±610) and the height in the birth to be 46.26cm(±7.62) in aver age. The medical diagnosis is 37.5% in the premature infant, the career of hospitalization is 96.9% in 'None', and the operation plan is 90.6% in 'None' and the execution of operation is 88% in 'None' and the nursing of incubator is 55.2% in 'Yes', and the method of feeding is 50.5% in 'Oral' and the contents of feeding is 46.9% in the 'Milk'. 2. The total stress degree of subject is almost highly shown to be as 3.36(±0.86). If it is compared upon each cause, 'stress on disease status & prognosis' is highest 3.79(±1.28), and it is in the order of 'stress on medical treatment & nursing procedures' 3.70(±0.93), 'stress on hospital environment' 3.14(±0.86), 'stress on role of parents' 3.18(±0.92) and 'stress on communication & inter personal relationship' 2.62(± 0.77) 3. As the results of checking the notworthiness of stress degree upon each variable of subject, the variable showing the noted difference was the birth weight(γ=-0.16, P=0.04), birth height(γ=-0.23, P=0.03), nursing in the incubator(F=8.93, P=0.04), feed method(F=2.94, P=0.04). That is to say, it is shown which the smaller the birth weight is, the higher the stress degree of mother is noteworthily. Also, the smaller the birth height baby is, the higher the stress of mother is. In the incubator, it os shown which the mother whose baby is nursing in the incubator is higher in the stress degree than other mothers. Upon the feeding method of baby, that is to say, TPNis the highest, and it is shown in the order of NPO, Tube feeding, and P.O. feeding. When we review the above-mentioned results, as the status is serious, it is thought which we include the supporting nursing for coping with the stress of parents in the setting-up od nursing plan for the baby in the NICU.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
Hemodialysis is essential treatment for the chronic renal failure patient's long-term cure and for the patient management before and after kidney transplantation. It sustains the endstage renal failure patient's life which didn't get well despite strict regimen and furthermore it becomes an essential treatment to maintain civil life. Bursing implementation in hemodialysis may affect the significant effect on patient's life. The purpose of this study was to obtain the basic data to solve the hypotension problem encountable to patient and the blood loss problem affecting hemodialysis patient'a anemic states by incomplete rinsing of blood in coil through all process of hemodialysis. The subjects for this study were 44 patients treated hemodialysis 691 times in the hemodialysis unit, The .data was collected at Gang Nam 51. Mary's Hospital from January 1, 1981 to April 30, 1981 by using the direct observation method and the clinical laboratory test for laboratory data and body weight and was analysed by the use of analysis of Chi-square, t-test and anlysis of varience. The results obtained an follows; A. On clinical laboratory data and other data by dialysis Procedure. The average initial body weight was 2.37 ± 0.97kg, and average body weight after every dialysis was 2.33 ± 0.9kg. The subject's average hemoglobin was 7.05±1.93gm/dl and average hematocrit was 20.84± 3.82%. Average initial blood pressure was 174.03±23,75mmHg and after dialysis was 158.45±25.08mmHg. The subject's average blood ion due to blood sample for laboratory data was 32.78±13.49cc/ month. The subject's average blood replacement for blood complementation was 1.31 ±0.88 pint/ month for every patient. B. On the hypotensive state and the coping approaches occurrence rate of hypotension was 28.08%. It was 194 cases among 691 times. 1. In degrees of initial blood pressure, the most 36.6% was in the group of 150-179mmHg, and in degrees of hypotension during dialysis, the most 28.9% in the group of 40-50mmHg, especially if the initial blood pressure was under 180mmHg, 59.8% clinical symptoms appeared in the group of“above 20mmHg of hypotension”. If initial blood pressure was above 180mmHg, 34.2% of clinical symptoms were appeared in the group of“above 40mmHg of hypotension”. These tendencies showed the higher initial blood pressure and the stronger degree of hypotension, these results showed statistically singificant differences. (P=0.0000) 2. Of the occuring times of hypotension,“after 3 hrs”were 29.4%, the longer the dialyzing procedure, the stronger degree of hypotension ann these showed statistically significant differences. (P=0.0142). 3. Of the dispersion of symptoms observed, sweat and flush were 43.3%, and Yawning, and dizziness 37.6%. These were the important symptoms implying hypotension during hemodialysis accordingly. Strages of procedures in coping with hypotension were as follows ; 45.9% were recovered by reducing the blood flow rate from 200cc/min to 1 00cc/min, and by reducing venous pressure to 0-30mmHg. 33.51% were recovered by controling (adjusting) blood flow rate and by infusion of 300cc of 0,9% Normal saline. 4.1% were recovered by infusion of over 300cc of 0.9% normal saline. 3.6% by substituting Nor-epinephiine, 5.7% by substituting blood transfusion, and 7,2% by substituting Albumin were recovered. And the stronger the degree of symptoms observed in hypotention, the more the treatments required for recovery and these showed statistically significant differences (P=0.0000). C. On the effects of the changes of blood pressure and osmolality by albumin and hemofiltration. 1. Changes of blood pressure in the group which didn't required treatment in hypotension and the group required treatment, were averaged 21.5mmHg and 44.82mmHg. So the difference in the latter was bigger than the former and these showed statistically significant difference (P=0.002). On the changes of osmolality, average mean were 12.65mOsm, and 17.57mOsm. So the difference was bigger in the latter than in the former but these not showed statistically significance (P=0.323). 2. Changes of blood pressure in the group infused albumin and in the group didn't required treatment in hypotension, were averaged 30mmHg and 21.5mmHg. So there was no significant differences and it showed no statistical significance (P=0.503). Changes of osmolality were averaged 5.63mOsm and 12.65mOsm. So the difference was smaller in the former but these was no stitistical significance (P=0.287). Changes of blood pressure in the group infused Albumin and in the group required treatment in hypotension were averaged 30mmHg and 44.82mmHg. So the difference was smaller in the former but there is no significant difference (P=0.061). Changes of osmolality were averaged 8.63mOsm, and 17.59mOsm. So the difference were smaller in the former but these not showed statistically significance (P=0.093). 3. Changes of blood pressure in the group iutplemented hemofiltration and in the Uoup didn't required treatment in hypotension were averaged 22mmHg and 21.5mmHg. So there was no significant differences and also these showed no statistical significance (P=0.320). Changes of osmolality were averaged 0.4mOsm and 12.65mOsm. So the difference was smaller in the former but these not showed statistical significance(P=0.199). Changes of blood pressure in the group implemented hemofiltration and in the group required treatment in hypotension were averaged 22mmHg and 44.82mmHg. So the difference was smatter in the former and these showed statistically significant differences (P=0.035). Changes of osmolality were averaged 0.4mOsm and 17.59mOsm. So the difference was smaller in the former but these not showed statistical significance (P=0.086). D. On the changes of body weight, and blood pressure, between the group of hemofiltration and hemodialysis. 1, Changes of body weight in the group implemented hemofiltration and hemodialysis were averaged 3.340 and 3.320. So there was no significant differences and these showed no statistically significant difference, (P=0.185) but standard deviation of body weight averaged in comparison with standard difference of body weight was statistically significant difference (P=0.0000). Change of blood Pressure in the group implemented hemofiltration and hemodialysis were averaged 17.81mmHg and 19.47mmHg. So there was no significant differences and these showed no statistically significant difference (P=0.119), But in comparison with standard deviation about difference of blood pressure was statistically significant difference. (P=0.0000). E. On the blood infusion method in coil after hemodialysis and residual blood losing method in coil. 1, On comparing and analysing Hct of residual blood in coil by factors influencing blood infusion method. Infusion method of saline 200cc reduced residual blood in coil after the quantitative comparison of Saline Occ, 50cc, 100cc, 200cc and the differences showed statistical significance (p < 0.001). Shaking Coil method reduced residual blood in Coil in comparison of Shaking Coil method and Non-Shaking Coil method this showed statistically significant difference (P < 0.05). Adjusting pressure in Coil at OmmHg method reduced residual blood in Coil in comparison of adjusting pressure in Coil at OmmHg and 200mmHg, and this showed statistically significant difference (P < 0.001). 2. Comparing blood infusion method divided into 10 methods in Coil with every factor respectively, there was seldom difference in group of choosing Saline 100cc infusion between Coil at OmmHg. The measured quantity of blood loss was averaged 13.49cc. Shaking Coil method in case of choosing saline 50cc infusion while adjusting pressure in coil at OmmHg was the most effective to reduce residual blood. The measured quantity of blood loss was averaged 15.18cc.