A Clinical Study on the Hypercalcemia in Primary Bronchogenic Carcinoma (고칼슘혈증을 동반한 원발성 폐암의 임상적 특징)
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- Journal of Yeungnam Medical Science
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- v.16 no.2
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- pp.208-218
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- 1999
Background: Lung cancer-associated hypercalcemia is one of the most disabling and life-threatening paraneoplastic disorders. Humoral hypercalcemia is responsible for most lung cancer-associated hypercalcemia. Patients with hypercalcemia are usually in the advanced stage with obvious bulky tumor and carry a poor prognosis. Materials and Methods: Total 29 patients satisfied the following criteria: histologically proven primary lung cancer, corrected calcium level
This study assessed the risk of disaster by using QRE(Quick Risk Estimation - UNISDR Roll Model City of Basic Evaluation Tool) tools for three natural disasters and sixteen social disasters managed by the Seoul Metropolitan Government. The criteria for selecting 19 disaster types in Seoul are limited to disasters that occur frequently in the past and cause a lot of damage to people and property if they occur. We also considered disasters that are likely to occur in the future. According to the results of the QRE tools for disaster type in Seoul, the most dangerous type of disaster among the Seoul city disasters was "suicide accident" and "deterioration of air quality". Suicide risk is high and it is not easy to take measures against the economic and psychological problems of suicide. This corresponds to the Risk ratings(Likelihood ranking score & Severity rating) "M6". In contrast, disaster types with low risk during the disaster managed by the city of Seoul were analyzed as flooding, water leakage, and water pollution accidents. In the case of floods, there is a high likelihood of disaster such as localized heavy rains and typhoons. However, the city of Seoul has established a comprehensive plan to reduce floods and water every five years. This aspect is considered to be appropriate for disaster prevention preparedness and relatively low disaster risk was analyzed. This corresponds to the disaster Risk ratings(Likelihood ranking score & Severity rating) "VL1". Finally, the QRE tool provides the city's leaders and disaster managers with a quick reference to the risk of a disaster so that decisions can be made faster. In addition, the risk assessment using the QRE tool has helped many aspects such as systematic evaluation of resilience against the city's safety risks, basic data on future investment plans, and disaster response.
This study was conducted to identify the spacialty, to illuminate the existence and values of Myeongwoldae(明月臺) and Forest Myeongwol, and to suggest the sustainable usage, preservation and management plans with the purpose of ecological and cultural landscaping characteristic and value identification. The result of the study is as follows. Castle Myeongwol and Port Myeongwol shows the status of Hallim-eup Myeongwol District which is the administrative center of western Jeju as well as is the fortress. Building Wolgyejeongsa and School Woohakdang, the head temple of education and culture, located in Myeongwol District represents the spaciality of Myeonwol-ri which was the center of education. Stand Myeongwol is one of the most representative Confucian cultural landscapes in Jeju Island and the field of communion with nature where scholars enjoy poetries, nature, changgi(Korean chess), and go in the Joseon Dynasty period. It was found that the current relics of Myeongwoldae was recovered through the maintenance project conducted by Youth Group Myeongwol composed with Hongjong-si(洪鍾時) as the center during the Japanese colonial era in 1931. It seems that the stonework of Myeongwoldae composed of three levels in the order of square, octagon, and circle based on the heaven-man unity theory of Confucianism and the octagon in the middle is the messenger of Cheonwonjibang(天圓地方), in other words, between the square-shaped earth and the circle-shaped sky. It is assumed that both Grand Bridge Myeongwol and Bridge Myeongwol were constructed as arched bridges in early days. Bridge Myeongwol is the only arched bridge remaining in Jeju Island now, which has the modern cultural heritage value. In Forest Myeongwol, 97 taxa of plants were confirmed and in accordance with 'Taxonomic Group and Class Criteria of Floristic Specific Plants', eight taxa were found; Arachniodes aristata of FD IV and Ilex cornuta, Piper kadsura, Litsea japonica, Melia azedarach, Xylosma congestum, Richosanthes kirilowii var. japonica, Dichondra repens, Viburnum odoratissimum var. awabuki of FD III. Otherwise, 14 taxa of naturalized plants including Apium leptophylihum which is imported to Jeju Island only were confirmed. In Forest Myeongwol, 77 trees including 41 Celtis sinensis, 30 Aphananthe aspera, two Wylosma congestum, a Pinus densiflora, a Camellia japonica, a Melia azedarach, and an Ilex cornuta form a colony. Based on the researched data, the preservation and plans of Myeongwoldae and Forest Myeongwol is suggested as follows. Myeongwoldae, Bridge Myeongwol, and Forest Myeongwol should be managed as one integrated division. Bridge Myeongwol, an arched bridge which is hard to be found in Jeju Island is a high-standard stonework requiring long-term preservation plans. Otherwise, Grand Bridge Myeongwol that is exposed to accident risks because of deterioration and needs safety diagnosis requires measures according to the result of precise safety diagnosis. It is desirable to restore it to a two-sluice arched bridge as its initial shape and to preserve and use it as a representative local landmark with Stand Myeongwol. In addition, considering the topophsis based on the analysis result, the current name of Jeju Special Self-Governing Province Monument No. 19 'Myoengwol Hackberry Colony' should change to 'Myeongwol Hackberry-Muku Tree Colony'. In addition, the serial number system which is composed without distinction of hackberry and muku tree should be improved and the regular monitoring of big and old trees, specific plants, and naturalized species is required.
Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.