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Respiratory Hospital Infections of Patients with a Tracheostomy (기관절개술 환자의 호흡기계 병원감염양상에 관한 연구)

  • 양숙자;최영희;김문실
    • Journal of Korean Academy of Nursing
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    • v.19 no.3
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    • pp.240-248
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    • 1989
  • The increase in size and numbers of general hospitals in the process of conspicuous development of modem medicine has been accompanied by a serious increase in hospital acquired infections. Hospital aquired infections cause pain and discomfort, may threaten life, adds an economic burden, and delays recovery and return to society. Even though respiratory hospital infection rates resulting for tracheostomy and respiratory inhalation therapy, may be low, they are serious because of their bad prognosis and high mortality rates. This study was designed to assess certain aspects of respiratory infections of patients with a tracheostomy and thus provide baseline data for further research related to preventive or therapeutic nursing interventions. The specific objectives were to determine the incidence of colonization in the trachea, clinical signs, type of colonized bacteria and sensitivity to antibiotics. Data were collected from July 1 to December 10, 1989 at two university Hospital in Seoul. Subjects were 20 patients with a tracheostomy admitted to the Intensive Care Unit or Cerebral Vascular Accident Center. Clinical signs related to respiratory infection were observed using a checklist based on previous study outcomes. Bacterial culture, sensitivity test to antibiotics, WBC counts and chest X-ray were also performed. Cultures were done on the day of tracheostomy, and on the third, fifth and seventh day. Cultures were then done on seventh days after the first colonization. The results were as follows : 1. The incidence of bacteria colonization in a week was 90%(18 patients) 50% (10/20 patients) on the day of tracheostomy, 70%(7/10 patients) on the third day, and 0% on the fifth day, and 33%(1/3 patient) on the seventh day. 3 of 18 patients (16.7%) were colonies of mixed growth isolated. 2. The observed clinical signs related to respiratory infection were high fever 38.9%(7 patients), prulent secretion 16.7%(12 patients) and infiltration seen on chest X-ray 33.3%(6 patients). 3. The total number of types of bacteria isolated among the 18 subjects was 21 ; gram negative 71.4%, gram postive 28.6%. The dominant bacteria type was Staphylococcus aureus(5 cases) for gram(equation omitted) and Pseudomonas aeruginosa(3 cases), Klebsiella (4 cases), Enterobacter(3 cases) for gram (equation omitted). The results of culture on 7th day after the first colonization, 6 cases showed same type of bacteria, 3cases showed different type of bacteria and 1 cases showed no growth. 4. The sensitivity tests to antibiotics showed that Pseudomonas aeruginosa and Staphylococcus were strongly resistant to most kinds of antibiotics, but Klebsiella and the rest of gram negative bacteria were moderately sensitive to antibiotics.

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Patients' Perception of Quality of Health Service and Utilization considering convergence factors: A Survey of Elderly Patients of Public Health Centers, Seoul, Republic of Korea (융합적 요소를 고려한 의료서비스 질 인식도와 의료이용의 관련성: 서울시 보건소를 이용하는 노인을 대상으로)

  • Sohn, Minsung;Kim, Mi Sun;Kim, Joonsik;Moon, Sangsik;Choi, Mankyu
    • Journal of Digital Convergence
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    • v.13 no.8
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    • pp.345-356
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    • 2015
  • Health service quality is increasingly emphasized, and primary care service is no exception in this. This study identified patients' perception of quality considering convergence factors associated with increased utilization among patients over the age of 65 using community health centers. A total of 307 respondents were included in the analysis. The results showed that positive perceptions on facility and environment, patient-centered care, technical knowledge and skills of physicians, and emotional support with nurses and non-medical workers were statistically and significantly associated with higher utilization. In order to increase utilization of primary care service at community health centers, they need to manage and improve these factors.

Influence of Fly Ash Application on Content of Heavy Metal in the Soil II. Content Change by the Successive Application (석탄회(石炭灰) 시용(施用)이 토양중(土壤中) 중금속(重金屬) 함량(含量)에 미치는 영향(影響) II. 운용(連用)에 따른 함량변화(含量變化))

  • Kim, Bok-Young;Lim, Sun-Uk;Park, Jong-Hyun
    • Korean Journal of Soil Science and Fertilizer
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    • v.27 no.2
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    • pp.72-77
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    • 1994
  • This study was conducted to investigate the influence of treatment of fly ash on heavy metal contents of the arable soil. Rice was cultivated on the two types of paddy field clay loam and sandy loam with 0, 12ton/10a of anthracite fly ash and bituminous coal fly ash application. And soybean was cultivated at the same type of upland fields with those ashes of 0, 9ton/10a, yearly for three years. At the harvest time, the heavy metal contents in the different layer were investigated. The results were summarized as follows : 1. The contents of some heavy metal were increased in the surface soils but didn't show the tendency in the deeper layer or soil texture. 2. In the paddy fields, the contents of Cd, Cu, Zn, Cr were increased. Meanwhile and the upland fields, the contents of Cd and Cr were increased with the successive application of Anthracite fly ash, but the others didn't show those tendency. 3. The contents of Cd, Cu and Zn in the paddy field, were increased but the upland field, the contents of Cd, Cr and Ni were increased by the successive application of bituminous coal fly ash.

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Numerical Analysis on the Behavior of Revetment Reinforced by Sand Compaction Pile According to Area Replacement Ratio (수치해석을 이용한 모래다짐말뚝 치환율에 따른 호안 구조물의 거동 분석)

  • Kim, Byoung-Il;Bong, Tae-Ho;Han, Jin-Tae;Jang, Young-Eun
    • Journal of the Korean Geosynthetics Society
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    • v.17 no.3
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    • pp.1-8
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    • 2018
  • Sand compaction pile (SCP) is a ground improvement method which is used to secure the stability of the soft ground by using a type of replacement pile filled with coarse grained material. The behavior characteristics of the SCP, which is frequently used for improving both the onshore and offshore ground, is governed by the ground condition, the installation method, and replacement ratio. Therefore, the stability of the SCP in terms of the bearing capacity and displacement needs to be evaluated considering both the design values and in-situ conditions of construction site. In this study, numerical analysis is carried out based on the conditions of 00 revetment construction site in South Korea where unexpected displacement occurred during construction of SCP. Based on the analysis results, the displacement of the revetment structure according to the replacement ratio of the SCP was compared to the result calculated from design formulas. The results showed that the lateral displacement can be exceeded the reference value from proposed criteria regardless of increased replacement ratio of SPC. It is also confirmed that the behavior of the structure according to the replacement ratio of SPC in not reflected in the existing calculation methods. Therefore, the stability of the SCP composite ground should be examined through the site inspection after the SCP construction.

A study of morphology of mandibular symphysis and location of lower incisor under the influence of the craniofacial skeleton in skeletal Class III malocclusion (골격성 III급 부정교합자의 두개안면형태에 대한 하악이부의 형태 및 하악절치의 위치에 대한 연구)

  • Kim, Seong-Sik;Park, Je-Uk;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.28 no.5 s.70
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    • pp.763-774
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    • 1998
  • The purpose of this study was to evaluate the morphology of mandibular symphysis and location of lower incisor under the influence of the craniofacial skeleton in skeletal Class III malocclusion. The sample consisted of 132 adults who have severe Class III malocclusion(prognathism group, 33 males and 33 females), and who have normal occlusion(normal group, 33 males and 33 females). They had not received any orthodontic treatment or orthognathic surgery. The lateral cephalograms were evaluated. The results were as follows : 1. Prognathism group were larger than normal group in comparison of facial skeleton (p<0.05) with the exception of ${\angle}FH-Pal$, ${\angle}SNA$. 2. In the morphology of symphysis, measurements of anteroposterior width(LaABBW, LiABBW, SW) of prognathism group were significantly less than that of normal group(p<0.001). 3. In the correlative analysis between the craniofacial skeleton and symphysis measurements of prognathism group, vertical measurements in relation with cranial base and mandibular plane showed reverse correlationship with anteroposterior width of symphysis(LiACBW, LaACBW, LiABBW, SW)(p<0.05). But, there was not distinct difference between horizontal skeletal measurements and symphysis measurements(p>0.05). 4. The probability by regression test between vertical measurements(${\angle}SN-Mn,\;{\angle}FMA,\;{\angle}Pal-Mn,\;{\angle}LFH$) and symphysis measurements(LiACBW, LiABBW, SW, ${\angle}LISA$) were very high(p<0.001).

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Primary neurofibroma of the Diaphragm (횡격막에 발생한 신경섬유종 1례)

  • 유회성
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.149-152
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    • 1975
  • In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

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A Study on the Educational Effects on Child-Raising Knowledge and Satisfaction with Out-Patient Care of Mothers with Ill-Child (환아 어머니 교육이 육아지식 정도 및 외래간호 만족도에 미치는 영향)

  • Lee So Yeon;Choi Mi Hye;Kwon Hye Jin
    • Child Health Nursing Research
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    • v.3 no.1
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    • pp.83-98
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    • 1997
  • The purpose of this study were to find out the practical way to enlarged child-raising knowledge and to enhance their satisfaction with out-patient care by evaluating how effectively the education is done by nurses for mothers with ill-child and how their satisfaction with out-patient care changed. This study was designed as a Nonequivalent Control Group study. The subjects studied were consisted of the experimental and control group. Each consisted of 50 mothers with ill-child in pediatric department at one university hospital in Seoul. The period of this study is from May 20, 1996 to J one 28, 1996. The first data were collected from both of experimental and control groups in which mothers with ill-child come to the hospital for the first time. After this being done, the experimental group had been educated by the planned program and then the second data were collected from them. On the contrary, as for the control group, there had been no education and the second data were col looted on the same method. The data analysis was done by SPSS program. The results of this study are as follow, 1 The child-raising knowledge level of mothers with education was higher than that of with no education. (t=18.84, df=49, p=0.000) 2. The satisfaction with out-patient care level of mothers with education was higher than that of no education. (t=10.51, df=49, p=0.000) Based on these results, I suggest as follow, 1. The research on the patients and their family should be made not only in pediatric department, but in every out-patient department. 2. For more effective education, it is required for all out-patient nurses to research the education demand of patients and their family. 3. To increase the effect of education, there must be the consultation room in out-patient department. 4. The meetings with the mothers with ill-child of the same illness have to be established and periodical education must be executed. 5. Audio-visual education programs like video tapes are needed to make use of waiting time for the medical treatment. 6. On-line consulting programs are needed.

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Histopathological Study of Cartilage in the Bone Bruise of the Lateral Femoral Condyle Associated with Anterior Cruciate Ligament Rupture (전방 십자 인대 파열시 손상된 대퇴골 외과 연골의 병리조직학적 연구)

  • Bae, Dae-Kyung;Yoon, Kyoung-Ho;Kim, Hee-Seon
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.154-161
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    • 2005
  • Purpose: to describe the histologic appearance of the type III bone bruise in knees which had sustained an acute anterior cruciate ligament (ACL) rupture. Materials and Method: Twenty-five patients who sustained acute ACL rupture were prospectively enrolled in this study. On MRI, 14 patients demonstrated type III bone bruise on lateral femoral condyle, and 11 patients didn't demonstrated bone bruise. Arthroscopic evaluation and biopsy of the articular cartilage and subchondral bone wert performed before ACL reconstruction. Histologic and immunohistochemical evaluations were done. Results: There was no difference between the bone bruise and control group in the hematoxylin-eosin staining for cell distribution, Masson's trichrome staining for collagen and immunohistochemical staining for type I and type II collagen (p>0.05). But in the safranin-O staining for glycosaminoglycan distribution, the bone bruise group had an evidence of decreased staining at the superficial and middle layers, compared with the control group (p<0.05). We also found fatty change of bone marrow in calcified zone of the bone bruise group with safranin-O staining. Conclusion: We suggest that the type III bone bruise found on MRI indicates a substantial damage to normal articular cartilage homeostasis, and may induce further damage of the articular cartilage.

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Estimation of Humidifier Disinfectant Amounts Inhaled into the Respiratory System (가습기 살균제 피해자 호흡기로 흡입된 가습기 살균제 양 추정 - 호흡기 외부(external) 및 내부 노출(internal exposure) 추정 방법과 사례 -)

  • Park, Dong-Uk;Ryu, Seung-Hun;Lim, Heung-Kyu;Kim, Sun-Kyung;Roh, Hyun-Suk;Cha, Won-Seok;Park, Dooyong
    • Journal of Environmental Health Sciences
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    • v.42 no.3
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    • pp.141-146
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    • 2016
  • In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objectives of this study are to estimate both airborne HD concentration in the room where HD was used and the amount of humidifier disinfectant absorbed into the respiratory system. Information and data on the HDs were collected using a structured questionnaire and home environmental investigations include the volume of HD (ml) and hours used per day, concentration of disinfectants contained in the HD brand (${\mu}g/ml$), volume of the room ($m^3$), assumed ventilation rate ($m^3/hr$) and breathing rate assumed ($m^3/hr$). We used children aged under five years old as a sample and estimated both airborne HD concentrations and amount of HD absorbed into the respiratory system. The estimated airborne concentration of HD in the room ranged from 68 to $369{\mu}g/m^3$ for PHMG (polyhexamethylene guanidine phosphate) and from 16 to $239{\mu}g/m^3$ for PGH (oligo (2-(2-ethoxy) ethoxyethyl guanidine). The amount of HD absorbed in the respiratory system per day was estimated to range from 227 to $1,225{\mu}g$ for PHMG and from 53 to $794{\mu}g$ for PGH. In conclusion, a great amount of HD was likely absorbed into respiratory system, likely beyond the level of the capacity of the immune system to remove the HD absorbed.

A Study on the Improvement of Legal Policies for Activating Public Open Space in Urban Environment Improving Project of Seoul City (서울시 도시환경정비사업 내 공개공지 활성화를 위한 제도개선에 관한 연구)

  • Kim, Do-Kyong;Kim, Kun-Young
    • Journal of the Korean Institute of Landscape Architecture
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    • v.39 no.5
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    • pp.21-32
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    • 2011
  • The district units planning suggests not only detailed standards of building as parts of the whole plan in the district but also a guideline of the arrangement, shape and pavement of the public open space, in order to move away from the rigid image of an institution which causes the formal creation of it. This triggered various problems. While the basic plan for adjustment of urban environments(established in 2005) was being reorganized in order to reflect changed conditions of the city center, the sector of public open space was subdivided according to the guidelines of development by district. We conducted a comparative analysis of conditions before and after the adjustment, so as to examine whether or not the reorganized institution is effective for the plan of public open spaces. The analysis showed that there was no remarkable change between the basic plan and the reorganized institution in that items which were not any different from the existing building codes were established due to lack of guidelines related to public open space under the law of urban and residential environmental improvement. Low regulations should set up criteria for establishment from a concrete, effective microscopic aspect appropriate to the significance of public open space by the linking of public open space and the surrounding environment, whereas high regulations such as building codes should specify essential components.