• 대한응급의학회지
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• 제29권6호
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• pp.585-594
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• 2018

Objective: This study was designed to report on the progress of the fire at Jecheon sports complex and to assess the adequacy of Disaster Medical Assistant Team (DMAT)'s activities in response to the fire disaster. Methods: We conducted a retrospective review based on camera recordings and medical records that were recorded at the disaster site for assessment of activities. We cooperated with firefighters, police officers, local hospital medical staffs and public health personnel in Jecheon in order to classify patients in the disaster field and to understand the patients' progress. Results: At 15:53, the first request for emergency rescue came to the 119 general emergency call center, and a request for DMAT activation came at 16:28. DMAT arrived at the site at 17:04 and remained active until the following day at 00:43. The total number of casualties was 60, including 27 minimal (Green) patients, 29 expectant (Black) patients, three delayed (Yellow) patients, and one immediate (Red) patient. There were 32 patients who received on-site care by DMAT. Two patients were transferred from a local hospital to Wonju Severance Christian Hospital for hyperbaric oxygen therapy. Conclusion: Twenty-nine victims were found in the sports complex building, and there were 31 mildly to moderately injured patients in this fire disaster. The main cause of death was thought to be smoke suffocation. Although DMAT was activated relatively quickly, it was not able to provide effective activity due to the late rescue and difficulty with fire suppression.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.191-198
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• 2011

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU), with an incidence ranging from 8% to 38%. Patients who acquire VAP have higher mortality rates and longer ICU and hospital stays. Because there are other potential causes of fever, leukocytosis, and pulmonary infiltrates, clinical diagnosis of VAP is overly sensitive. The only alternative approach to the clinical diagnosis of VAP is the Clinical Pulmonary Infection Score (CPIS). Employing quantitative cultures of respiratory secretions in the diagnosis of VAP leads to less antibiotic use and probably to lower mortality. With respect to microbiologic diagnosis, however, it is not clear that the use of invasive sampling using bronchoscopy is associated with better outcomes. Delayed administration of antibiotic therapy is associated with an increased mortality, and inadequate antibiotic therapy is also associated with higher mortality. Therefore, prompt initiation of adequate antibiotic therapy is a cornerstone of the treatment of VAP. The initial antibiotic therapy should be based on the most common organisms in each hospital and the most likely pathogens for that specific patient. When final cultures and susceptibilities are available, de-escalation to less broad spectrum antibiotics should be done. Since clinical improvement usually takes 2 to 3 days, clinical responses to the initial empirical therapy should be evaluated by day 3. A short course of antibiotic therapy appears to be equivalent to a traditional course of more than 14 days, except when treating non-fermenting gram-negative organisms. If patients receive initially adequate antibiotic therapy, efforts should be made to shorten the duration of therapy to as short as 7 days, provided that the etiologic pathogen is not a non-fermenting gram-negative organism.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3611-3614
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• 2016

Background: Propolis based preparations have a wide range of applications in various specialties of dentistry. The aim of this clinical trial was to test the efficacy of propolis as a mouthwash in the reduction of chemotherapy induced oral mucositis (OM) in a single center. Materials and Methods: In this randomised, controlled study patients undergoing chemotherapy were included consecutively and randomised to an experimental group receiving propolis mouthwash (n = 20) and a control group receiving diluted water (n=20). Oral mucositis, erythema and eating and drink ability were assessed at baseline and after 3 and 7 days using the World Health Organization (WHO) scale and the oral mucositis assessment scale (OMAS). Results: There were significant differences in OM, wound and erythema in propolis group compared to placebo, but no significant difference in eating and drink ability. However, it was interesting that 65% of the patients in the propolis group were completely healed at day 7 of the trial. No significant adverse events were reported by the patients. Conclusions: This study found that oral care with propolis as mouthwash for patients undergoing chemotherapy is an effective intervention to improve oral health. Our findings shouldlencourage health practitioners to apply propolis mouth rinse for the oral care of patients under chemotherapy.

• Clinical and Experimental Pediatrics
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• 제53권3호
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• pp.314-322
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• 2010

목 적 : 경남권역 응급의료센터인 마산삼성병원을 내원한 소아청소년 응급환자들을 후향적 방법으로 내원 양상을 분석하여 향후에 지역 응급 진료의 질 향상에 기여하고자 본 연구를 시행하였다. 방 법 : 2007년 1월 1일부터 2008년 12월 31일까지 2년 동안 마산삼성병원 응급센터로 내원하였던 19세 미만 소아청소년 환자 14,065명 의 의무 기록지를 통해 연구하였다. 결 과 : 남녀비는 1.5:1로 남자가 더 많았고, 연령은3세 미만이 49.6%였다. 내원 환자는 5월, 일요일, 하루 중에는 20시에서 21시 사이가 가장 많았다. 기후와의 관련에서 하루 내원 환자 수는 황사가 있을 때 3배, 맑은 날 또는 10 mm 미만의 비가 내린 경우는 10 mm 이상 비가 내렸을 때보다 4배 더 많았다. 주된 진료담당과는 전체의 62.0%가 소아과였다. ICD-10 질병 분류에서 손상 중독 및 외인에 의한 경우 22.4%, 단일 증상 및 질환으로는 발열이 13.1%로 가장 많았다. 최종 진료 처리 형태로는 퇴원이 73.8%, 입원은 25.7%였다. 15세 이상 19세 미만의 청소년인 경우 전체 연령과 다른 점은 응급의학에서 50.0%를 담당하였고, 손상 중독 및 외인에 의한 경우 36.9%, 단일 증상 질환으로는 복통이 10.9%로 가장 많았다. 또 최종 입원한 경우는 30.6%로 전체 연령보다는 더 많았고 내원 환자수가 일교차가 클수록 비례하여 더 많았다. 결 론 : 응급센터를 내원한 소아 환자 수는 남자, 3세 미만, 5월, 일요일, 20-21시 사이, 황사가 없는 맑은 날, 손상 중독 및 외인에 의한 경우 및 발열인 경우가 가장 많았다. 청소년이 소아환자와 다른 점은 일교차가 클 수록, 복통으로 내원하는 경우가 더 많았다.

• 여성건강간호학회지
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• 제6권2호
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• pp.234-257
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• 2000

At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

• Preventive Nutrition and Food Science
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• 제16권4호
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• pp.394-407
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• 2011

Better understanding of the complex factors leading to human diseases will be necessary for both long term prevention and for managing short and long-term health problems. The underlying causes, leading to a global health crisis in both acute and chronic diseases, include finite global health care resources for sustained healthy human survival, the population explosion, increased environmental pollution, decreased clean air, water, food distribution, diminishing opportunities for human self-esteem, increased median life span, and the interconnection of infectious and chronic diseases. The transition of our pre-human nutritional requirements for survival to our current culturally-shaped diet has created a biologically-mismatched human dietary experience. While individual genetic, gender, and developmental stage factors contribute to human diseases, various environmental and culturally-determined factors are now contributing to both acute and chronic diseases. The transition from the hunter-gatherer to an agricultural-dependent human being has brought about a global crisis in human health. Initially, early humans ate seasonally-dependent and calorically-restricted foods, during the day, in a "feast or famine" manner. Today, modern humans eat diets of caloric abundance, at all times of the day, with foods of all seasons and from all parts of the world, that have been processed and which have been contaminated by all kinds of factors. No longer can one view, as distinct, infectious agent-related human acute diseases from chronic diseases. Moreover, while dietary and environmental chemicals could, in principle, cause disease pathogenesis by mutagenic and cytotoxic mechanisms, the primary cause is via "epigenetic", or altered gene expression, modifications in the three types of cells (e.g., adult stem; progenitor and terminally-differentiated cells of each organ) during all stages of human development. Even more significantly, alteration in the quantity of adult stem cells during early development by epigenetic chemicals could either increase or decrease the risk to various stem cell-based diseases, such as cancer, later in life. A new concept, the Barker hypothesis, has emerged that indicates pre-natal maternal dietary exposures can now affect diseases later in life. Examples from the studies of the atomic bomb survivors should illustrate this insight.

• 종양간호연구
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• 제11권3호
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• pp.210-220
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• 2011

Purpose: The aims of this study were to describe and interpret the nature of the experience inherent in the sex life of female breast cancer patients after treatment and understand the meaning behind it. Methods: The participants were 10 female breast cancer patients who were married. Data were collected from March to September 2010. Van Manen's hermeneutic phenomenology was adopted in this qualitative study as a research method. Results: There were 4 essential topics in the participants' experience of sex life; 'Sex life alert' was a result of negative changes in sexual relationships with spouse that they had never experienced before the breast cancer diagnosis; 'Precarious situation for pending divorce' was an experience of deteriorated sex life because of the failure to overcome 'sex life alert'; 'Sublimation of the difficulties by discovering an alternative solution' was an experience of discovering a solution to overcome the 'sex life alert'. 'Leaving it as unsettled' was an experience of a condition in which the participants did not have any intension to resolve the difficulties in sex life due to the lack of appropriate support, thus tried to ignore the challenges faced. Conclusion: This study illustrates the necessity to develop proper nursing intervention on the issues related to sex life among breast cancer patients. Given the fact that the sexual topics are often considered taboo in day to day nursing practice, special attention and efforts need to be given in this area to build up nursing knowledge and evidence-based practice.

• 한국보육학회지
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• 제18권4호
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• pp.227-245
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• 2018

본 연구는 자연재해의 발생이 급증하는 현상을 반영하여 자연재해 안전교육의 중요성을 강조하고자 교육 활동을 구성하였으며, 유아의 안전문제해결사고와 환경 친화적 태도를 향상 시키는데 목적이 있다. 행정안전부와 충청북도 교육청에서 다루고 있는 자연재해 종류를 참고하여 지진, 황사, 폭염, 홍수, 태풍, 낙뢰, 화재, 폭설, 지구온난화를 교육내용으로 포함시켜 자연재해 안전교육 활동을 20회기로 계획하였다. 연구대상은 충청북도 C시에 위치한 K병설 유치원 만 4세 유아 20명을 실험집단으로, N병설 유치원 만 4세 유아 20명을 통제집단으로 선정하였다. 실험집단의 경우 본 연구 활동을 진행하였고 통제집단의 경우 누리과정 생활주제에 기초한 일상적인 활동을 실시하였다. 연구결과 자연재해 안전교육을 실시한 실험집단 유아들이 통제집단 유아들보다 안전문제해결사고와 환경 친화적 태도가 향상되었다. 이를 통해 본 연구에서 이루어진 자연재해 안전교육이 유아의 안전문제해결사고와 환경 친화적 태도 향상에 효과를 줄 수 있는 교육활동으로 밝혀졌다. 따라서 본 연구는 실제로 유아교육현장에서 자연재해 안전교육을 실시하고자 하는 현장 교사들에게 구체적인 정보를 제공할 수 있을 것으로 기대된다.

• International Journal of Computer Science & Network Security
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• 제22권10호
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• pp.322-332
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• 2022

The current research aimed to ascertain the effectiveness of the early intervention program based on electronic games in developing the visual perception of children with intellectual disabilities within the age group of (2-5) years, using the quasi-experimental approach with one group, and the study sample consisted of (11) children with disabilities. Simple and medium intellectuals enrolled in the early intervention program at the Successful Communication Center for Day Care in Makkah Al-Mukarramah and were deliberately selected. To achieve the research objectives, the researchers prepared and applied the visual perception scale after ensuring its validity and stability. Three electronic games were also designed and applied to the sample for (17) sessions. The results showed the effectiveness of the electronic games program in developing the visual perception of children with intellectual disabilities within the age group (2-5) years and maintaining this improvement over time. Where the results showed that there were statistically significant differences at the level (α = 0.05) between the grades of the group children in the pre and post-measurements on the visual perception skills scale for children with intellectual disabilities in the post-measurement after applying the program, in favor of the post measurement. The results also showed that there were no statistically significant differences at the level (α = 0.05) between the grades of the group children in the two post and follow-up measurements on the visual perception skills scale for children with intellectual disabilities in the follow-up measurement which indicates the long-term impact of the program. The researchers recommend the necessity of activating educational programs based on various electronic games to develop the visual perception of children with intellectual disabilities and employ them effectively in the educational process for children with intellectual disabilities.

• 임상간호연구
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• 제28권2호
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• pp.122-136
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• 2022

Purpose: This study attempted to recommend a revision of inpatient nursing fees based on analyzing current and appropriate staffing levels. Methods: Staffing grades and their inpatient nursing fees as of the first quarter of 2022 were analyzed. Nurse managers and staff nurses answered surveys about the current and appropriate staffing levels, working days, and monthly salary. A total of 101 nurse managers and 588 staff nurses working in general wards at tertiary hospitals and general hospitals participated in the study. Results: The results showed that grade 1 staffing was found in 73.3% of tertiary hospitals and 63.7% of general hospitals. The current staffing ratios of tertiary hospitals and general hospitals were 1:9.3 and 1:10.4, respectively. The appropriate staffing ratios according to nurse managers and staff nurses at tertiary hospitals were 1:7.6 and 1:7.0, respectively, and 1:8.7 and 1:8.8 in general hospitals, respectively. The average estimated annual working days of staff nurses were 235.2 days in tertiary hospitals and 240.0 days in general hospitals. The median monthly salary for staff nurses was 4.957 million won in tertiary hospitals and 4.140 million won in general hospitals. The new staffing grade system was suggested from 1:6 (Grade 1) to 1:12 (Grade 5). The new inpatient nursing fee schedules were recommended to be paid based on nursing hours per patient day of each grade. Conclusion: The new staffing grade and inpatient nursing fee schedules are expected to increase staffing levels, improve the quality of nursing care, and provide a better work environment for nurses.