• 한국시뮬레이션학회논문지
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• 제18권4호
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• pp.107-116
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• 2009

병원 응급실의 환자 과밀 현상이 점점 더 심해지고 있는 상황이다. 본 연구에서는 응급실의 치료 서비스 수준 및 시스템 효율을 개선하는 방안의 일환으로 간호사에게 치료 테스크를 할당하는 규칙을 개발하고자 한다. 제시하는 규칙에서는 매 치료 테스크 할당 시에 4개 속성 즉 1)태스크의 수행시간, 2)치료 요청 후의 흐른 시간, 3)모든 치료가 다 끝날 때까지의 총 남은 시간, 4)남은 치료단계의 개수를 동시에 고려한다. 각 치료 치료태스크의 기준별 긴급도를 계산하고, 기준별 중요도를 반영한 전체긴급도 값을 계산한 후 이 값이 가장 큰 태스크에 간호사를 할당한다. 컴퓨터 시뮬레이션을 통하여 M 병원 응급실의 간략화 모형을 대상으로 기존규칙과 비교실험을 수행하였다. 환자가 응급실에 머문 평균시간 및 단위시간 동안 처리한 환자 수를 평가기준으로 실험한 결과 제시한 규칙이 두 기준 모두에서 우수한 성능을 보였다.

• 한국학교보건학회지
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• 제24권2호
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• pp.141-154
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• 2011

Purpose: The purpose is to provide basic information for establishing improvements on performance-based pay's evaluation method of health teachers. Methods: For subjects, 200 teachers at public elementary schools and 200 health teachers at public elementary schools in Gyeonggi-do were conveniently sampled, and then surveyed through a questionnaire. The questionnaire was to recognize recognition of teachers working under the teacher's performance-based pay system, which was quoted in the questionnaire of Choi ji-hye (2005) and Lee mi-gyeong (2008). Inquiry for the recognition of teachers on evaluation of health teacher's performance-based pay system and improvements on the performance-based pay's evaluation method of health teachers were used after consultation with five incumbent health teachers and a review with the thesis director. Results: The performance-based pay's evaluation method of health teachers has the same method with general teachers in schools, so it is not fair to evaluate the performance of health teachers. The ways to improve the performance-based pay evaluation method of health teachers is as follows: first, the approval on improving 'the number of class hours' which is a detailed item of a teacher's performance evaluation criterion to 'the number of health lesson hours per week and the number of students visiting the school infirmary per week'; second, improving 'life guidance' into 'counseling results of medically-treated students, parents of students and personal hygiene guidance'; third, improving 'a teacher in charge' into 'awarding of points by being recognized as a health teacher in charge of all students and considering the economic situation of the region,; forth, improving 'difficulty of position' into 'the number of health-teacher's annual promotion task items and the treatment number of issuing and receiving of official documents', and improving the 'task difficulty' into 'importance and urgency of emergency patient management, risk level and urgency of infectious diseases and avoiding work in charge' appeared to be more than 90% respectively. Conclusion: The performance-based pay system of teachers being carried out every year should be executed by preparing fair evaluation criteria suitable for task properties and the role of health teachers with different evaluation criteria compared to general teachers.

• 대한간호학회지
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• 제29권1호
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• pp.34-47
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• 1999

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows : 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P＝0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P＝0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P＝0.000). 3. The lower urinary symptoms Daily frequency(P＝0.000), nocturia(P＝0.000), urgency(P＝0.000), bladder pain(P＝0.000), unexplained incontinence(P＝0.048), wearing protection(P＝0.022), changing outer clothing(P＝0.005), hesitancy(P＝0.008), intermittent stream(P＝0.000), abnormal strength of stream(P＝0.004), retention(P＝0.000), incomplete emptying(P＝0.000), and inability to stop mid stream(P＝0.006) of the lower urinary symptoms in the biofeedbatk group were significantly decreased. 4. The sexual matters The dry vagina (P＝0.004) and pain during sexual Intercourse (P＝0.002) in the biofeedback group was significantly decreased. 5. The life style The fluid intake restriction(P＝0.007), affected daily task(P＝0.003), avoidance of places & situation(P＝0.003), interference in Physical activity (P＝0.002), interference in relationship with other people(P＝0.01), and feeling about the rest of life with urinary symptom(P＝0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.

• 한국응급구조학회지
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• 제15권3호
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• pp.31-44
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• 2011

Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.