• Journal of Hospice and Palliative Care
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• v.10 no.4
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• pp.184-189
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• 2007

Purpose: This study was to explore barriers to effective pain management in general population. Methods: Total 163 Participants completed the Barrier Questionnaire-II (BQ-II), a 27-item on a six point scale, from May to June in 2007. BQ-II consisted of four subscales which were 1) physical effects (PE) addressing beliefs that side effects of analgesics are inevitable and concerns about tolerance, fatalism (Fa) addressing fatalistic beliefs about cancer pain and its management, Communication (Co) addressing the beliefs of 'good patient' and concerns of distracting physician from underlying disease, and harmful effects (HE) addressing fear of addiction and harmful effect to immune system of pain medicine. Results: The BQ-II total had an internal consistency of 0.877 in this study. HE was the biggest barrier (3.03) followed by PE (2.73), Fa (2.15), and Co (1.71). Items appeared as great concerns were 'there is a danger of becoming addicted to pain medication'(3.58), 'using pain medicine blocks your ability to know if you have any new pain' (3.18), 'pain medicine is very addictive' (3.09), 'when you use pain medicine your body becomes used to its effects and pretty soon it won't work any more' (3.09), and 'drowsiness from pain medicine is difficult to control' (3.09). Only 12 respondents (7.4%) reported that they took any type of pain education, however, those who took pain education represented significantly lower barriers to pain management than who did not (P=.029). Conclusion: This result suggests the strategies for public education to surmount cancer pain.

• The Korean Journal of Physiology
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• v.2 no.2
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• pp.33-43
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• 1968

Histamine, 0.5 mg as histamine base in 4 ml of normal saline solution, was injected into rabbits anesthetized with nembutal and the mean blood pressure was kept in the range of $52{\sim}80\;mmHg$ for over one hour by supplemental additions. Following the injection of the test substances, 300 mg of urea and 200 mg of antipyrine intravenously, serial blood samples were obtained from the femoral artery and the internal jugular vein at $0.5{\sim}3$ minutes interval. The decreasing patterns in the concentrations of arterial and venous blood plasma samples were compared with each other. The ratio of the concentration of brain tissue to that of the final arterial plasma was also studied. By these measures the degrees of penetration of the test substances in the brain in the control and in the histamine treated rabbits were observed. The concentrations of antipyrine and urea in the arterial blood plasma were decreasing exponentially with respect to the time elapsed. The venous concentrations were anticipated to increase initially and to cross the arterial concentration curve in the point of equlibrium between the plasma and the tissue. On the contrary to the expectation venous concentration also revealed the decreasing tendency similar to that of arterial plasma. The similarity between these two curves, arterial and venous, would be atributable to the fact that the cerebral blood flow rate was large enough and the rising phase in the venous concentration curve was instantly over before serial blood samples were taken. Inspite of some similarity in the decreasing tedency in both concentration curves there were appreciable discrepancies between the arterial and venous plasma which would reflect the situation far from the equlibria among several compartments in the brain. Changes in plasma potassium levels caused by the injection of histamine or bleeding were observed, too. Using 8 rabbits as the control and 12 rabbits for the histamine treated group following results were obtained: 1. Both of the concentration curves, arterial and venous, declined rapidly at_first and slowly later on and approached same equilibrium concentration with the passage of time after a single injection. The time at which attained the same concentration was $2.0{\pm}0.54\;min.$ in the control and $4.3{\pm}1.92\;min.$ in the histamine treated group with respect to antipyrine. On the other hand in the case of urea they were $2.4{\pm}0.59\;min.$ in the control and $4.4{\pm}1.31\;min.$ in the histamine group, respectively. In the histamine treated group enlarged spaces for distribution of test substances were postulated. 2. The concentration of antipyrine in the brain tissue water revealed no significant differences between the control and experimental groups, showing $212{\pm}40.2\;mg/l$ in the control and $206{\pm}64.1\;mg/l$ in the histamine treated group. On the other hand urea revealed higher value in the histamine treated group than in the control, showing an enhanced penetration of urea into the tissue after injection of histamine. Urea concentration in the brain water was $32.3{\pm}3.36\;mg%$ in the control and $39.2{\pm}4.25\;mg%$ in the histamine treated group. 3. The distribution ratio of antipyrine in the brain tissue was very close to unity in the histamine treated animals as well as in the control. 4. The average of the distribution ratio of urea in the control animals was 0.77 and it showed the presence of blood-brain barrier with regard to urea. However in the histamine treated animals the distribution ratios climbed up to 0.86 and they were closer to unity than in the control animals. Out of 12 cases 5 were greater than 0.9 and 8 exceeded 0.85. It appeared that histamine enhanced the penetration of urea through the barrier. 5. Histamine injection and or hemorrhage caused an elevation of the concentration of potassium in plasma. In the event that histamine and hemorrhage were applied together the elevation of potassium exceed the elevation seen at the histamine alone. There was no evidence that the leakage of potassium from the brain tissue was dominant in comparison with the general leakage from the whole body.

• Tuberculosis and Respiratory Diseases
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• v.40 no.3
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• pp.236-249
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• 1993

Background: Among the injurious agents to which the lung airspaces are constantly exposed are reactive species of oxygen. It has been widely believed that reactive oxygen species may be implicated in the etiology of lung injuries. In order to elucidated how this oxidant causes lung cell injury, we investigated the effects of exogenous $H_2O_2$ on alveolar epithelial barrier characteristics. Methods: Rat type II alveolar epithelial cells were plated onto tissue culture-treated polycarbonate membrane filters. The resulting confluent monolayers on days 3 and 4 were mounted in a modified Ussing chamber and bathed on both sides with HEPES-buffered Ringer solution. The changes in short-circuit current (Isc) and monolayer resistance (R) in response to the exogenous hydroperoxide were measured. To determine the degree of cellular catalase participation in protection against $H_2O_2$ injury to the barrier, experiments were repeated in the presence of 20 mM aminotriazole (ATAZ, an inhibitor of catalase) in the same bathing fluid as the hydroperoxide. Results: These monolayers have a high transepithelial resistance (>2000 ohm-$cm^2$) and actively transport $Na^+$ from apical fluid. $H_2O_2$(0-100 mM) was then delivered to either apical or basolateral fluid. Resulting indicated that $H_2O_2$ decreased Isc and R gradually in dose-dependent manner. The effective concentration of apical $H_2O_2$ at which Isc (or R) was decreased by 50% at one hour ($ED_{50}$) was about 4 mM. However, basolateral $H_2O_2$ exposure led to $ED_{50}$ for Isc (and R) of about 0.04 mM. Inhibition of cellular catalase yielded $ED_{50}$ for Isc (and R) of about 0.4 mM when $H_2O_2$ was given apically, while $ED_{50}$ for basolateral exposure to $H_2O_2$ did not change in the presence of ATAZ. The rate of $H_2O_2$ consumption in apical and basolateral bathing fluids was the same, while cellualr catalase activity rose gradually with time in culture. Conclusion: Our data suggest that basolateral $H_2O_2$ may affect directly membrane component (e.g., $Na^+,\;K^+$-ATPase) located on the basolateral cell surface. Apical $H_2O_2$, on the other hand, may be largely degraded by catalase as it passes through the cells before reaching these membrane components. We conclude that alveolar epithelial barrier integrity as measured by Isc and R are compromised by $H_2O_2$ being relatively sensitive to basolateral (and insensitive to apical) $H_2O_2$.

• Proceedings of the Technology Innovation Conference
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• 1997.07a
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• pp.222-223
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• 1997

By analyzing the successful innovation case of potato microtuber mass production technology, a representative case of technology-push type creative innovation in an imitation oriented research culture, this paper attempts to figure out conceptual model of creative innovation that is initiated by the public laboratories in catching-up country, Stages of creative innovation can be divided into the internal R&D stage and the external commercialization stage. Success of the internal R&D stage depended on autonomy to secure creative research idea and commitment of individual researchers. Psychological pressure evoked from sportlights of mass media and commitment of sponsor increased the intensity of research efforts of the researcher Recognition of research problem and its significance was intensified by site visits of agricultural fields, and the recognized higher impacts of expected research results and knowledge creation achieved were a fundamental source of self-motivation. In the stage of commercialization stage, various legal, socio-economic, and psychological barriers were confronted. In a catching-up country lacking of experiences of creative innovation, creative innovation process can be regarded as a barrier elimination and cultural revolution process. Among the barriers, psychological refusal of farmers to corn-sized potato seeds was critical, which finally enforced to further researches to enlarge the size of potato seeds. In addition, the researcher has concentrated his research efforts in one specialized research area by getting a series of similar research project funds rather than diversification. It was lucky for him to have a chance to carry out a series of similar researches in one research area during the last 10 years. In getting research funds from government and private companies continuously in one research area, both internal and external promoters played significant roles.

• Quality Improvement in Health Care
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• v.3 no.2
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• pp.86-97
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• 1997

Background : It is a primary goal for hospital personnel to improve the quality of patient care. In Korea the concept of quality assurance has been spread over the last five years. Many hospitals have implemented quality assurance programs that fit their own philosophy and needs. As a result, they are supposed to have different experiences and attitudes toward quality assurance. To investigate their diversity will be helpful to have a direction to the future and to enhance the quality assurance activities in Korean hospitals. Objectives : The aim of this study is to obtain information about hospital personnel's attitude and opinion toward quality assurance in hospitals. Methods : A questionnaire was developed which consisted of five parts; the general characteristics of respondent, the concepts of quality assurance, need for quality assurance program, current status of quality improvement activities, and participation in programs. Using the registry of Korean hospitals, 102 hospitals with more than 400 beds were selected. Questionnaires were mailed to hospital staffs of each hospital; top managers, clinical department heads, registered nurses, medical recorders, and administrators. Results : Of 2038 questionnaires sent, 877 were returned, giving response rate of 44%. Most respondents(70%) regarded quality assurance as efforts to provide patient with care in highest quality and to improve effectiveness or resource utilization. Ninety-nine percent of respondents agreed to need for quality assurance in their hospitals. There were current quality improvement programs implemented in the department of 553 respondents(62%), and most of the(85%) have participated in at least one program. Lack of motivation was pointed out as a barrier to implement the programs. Conclusion : Although most respondents have known of the concept and need for quality assurance, this study suggests that education and motivation of hospital personnel be needed to activate the quality assurance programs in hospitals.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• Food Science and Preservation
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• v.6 no.2
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• pp.137-142
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• 1999

Physicochemical properties were evaluated for stored garlic bulbs during 9 months under different conditions, such as low-temperature condition (3${\pm}$1$^{\circ}C$, 80${\pm}$5% RH, LT), pit-temperature condition (9${\pm}$6$^{\circ}C$, 80${\pm}$5% RH,PT) and ambient-temperature condition (14${\pm}$11$^{\circ}C$, 67${\pm}$5% RH, AT). The internal sprout development was more significant in pit and ambient conditions than in low temperature and thus certain means for sprout control is required for long-term storage of garlic bulbs under such conditions. The rates of rotting and weight loss were appreciable especially after 7 months of storage (next March) in the order of PT, AT and LT, when external sprouts were observed in PT and AT. Moisture content of stored samples were relatively constant in LT until next May, but that in W and AT was significantly reduced after next January. Total sugars showed a decreasing tendency with the prolonged period, whereas an apparent increase was found in the contents of reducing sugar and vitamin C along with external sprouting of garlic bulbs from the 7th month of storage (next March). Based on the results that around March is a limiting point in garlic storage at such conditions from the physiological and physicochemical points of view, improved storage condition should be applied to overcome the storage barrier.

• Journal of Korean Society of Coastal and Ocean Engineers
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• v.12 no.3
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• pp.139-148
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• 2000

In this paper, the interaction of oblique incident waves with a bottom-mounted and fluid-filled flexible membrane structure is investigated in the frame of linear hydro-elastic theory. The static shape of a membrane structure containing the fluid of a specific density is initially unknown and must be calculated before the hydrodynamic analysis. To solve hydrodynamic problem, the fluid domain is divided into the inner and outer region. The inner solution based on discrete membrane dynamic model and simple-source distribution over the entire fluid boundaries is matched to the outer solution ba~ed on an eigenfunction expansion method. The numerical results were compared to a series of Ohyama's experimental results. The measured reflection and tran¬smission coefficients reasonably follow the trend of predicted values. Using the computer program developed, the performance of a bottom-mounted and fluid-filled flexible membrane strocture is tested with various system parameters (membrane shape, internal pressure, density ratio) and wave characteristics (wave frequencies, incident wave angle). It is found that a bottom-mounted and fluid-filled flexible membrane structure can be an effel;tive wave barrier if properly designed.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.9 no.2
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• pp.103-113
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• 2002

Purpose: This study was conducted to explore the relationship among health belief. health locus of control and patients sick-role behavior compliance of diabetic mellitus patients visiting public health center. Method: The subjects of this study were 193 of the diabetic patients who were visiting 4 Public Health Center in B city. The instrument used for measuring health belief was Park's(1985). for health locus of control was Wallston. et al's(1978) and for sick-role behavior compliance was Park's(1984). The data were collected with structured questionnaires; total 58 items contained about health belief. health locus of control and sick-role behavior compliance from 1st to 31st July. 2001. The data was analyzed by the SPSS/PC programs using t-test. Pearson's correlation coefficient. ANOVA and Scheffe-test. Result: The average score of the health belief was $57.99\pm9.45$ health locus of control was $66.83\pm9.48$ and sick-role behavior compliance was $42.81\pm7.00$. Statistically significant factors influencing the health belief among social demographic characteristics were family number(F=3.818. p=0.024), monthly income(F=5.153, p=0.002), time of diagnosis(F=3.937. p=0.002) and difficult to control disease(F=5.803. p=0.000). The significant factors influencing the health locus of control were marital status(F=4.669. p=0.010). Also significant factors influencing the sick-role behavior compliance were monthly incomes(F=5.245, p=0.000). the time of diagnosis(F=4.424. p=0.001) and admission to hospital with diabetes(F=9.031. p=0.000). There was negative mild correlation comparatively between health belief and sickrole behavior compliance(r=-0.142, p<0.05) but no correlation in sensitiveness/severity, barrier, benefit(p<0.05). There was no correlation between internal. external. chance health locus of control and sick-role behavior compliance (P>0.05). Conclusion: There was a negative weak relationship between health locus of control and patient's sick role behavior compliance. Therefore further study to investigate the relating factor of the sick role behavior compliance among above of middle aged diabetes mellitus patients is necessary.

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.10-21
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• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.