• The Korean Nurse
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• v.35 no.3
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• pp.61-76
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• 1996

The purpose of this study was to develop a nursing care delivery system which can provide patient focused care and increase satisfaction for both patients and nurses. This study was a quasi-experimental study to test the effectiveness of direct / indirect nursing care hours, patient satisfaction, nurse's job satisfaction, and the difference of the length of stay between model and control group. Control group data were collected from 100 patients who had lumbar disease in the neuro-surgical unit and model group data were from 66 patients who didn't have family residents from August 21, 1995 to February 29, 1996. Model unit was operated by modified PPM(Professional Practical Model) system for 3 months from December 1, 1995 to February 29, 1996. Working committee empowered nurses to make a decision to provide increased opportunities for autonomy, accountability, and control over the environment in which they deliver care. Satisfaction survey was done twice and analyzed by the SPSS program. The results of the study were as follows; 1. Mean direct nursing care hours of the model group was 90.47 minutes as it was 28.04 in the control group which shows significant statistical difference (t=-18.0, P=0.000). 2. Patient satisfaction to nursing care of in the model group was significantly higher than the control group (t=-6. 77, P=0.000) and it apples to the all subcategories, too. 3. Nurse's job satisfaction shows the significant increase in the model group than the control group(Z=-3.0405, p=0.0024). 4. There was no statistical difference between 2 groups in average length of stay except for the post-op patient which shows 5.4 days less in the model group. This study shows that patient satisfaction and nurse's job satisfaction were increased and length of stay was decreased in the model group. Even though this new developed Patient - Nurse Oriented Model can provide nursing with the opportunity to improve patient care to increase productivity and highly valued, it is very difficult to practice due to the limited nursing resources, higher acuity levels and nursing care cost. It is strongly recommended that the government needs to look at the unreasonable reimbursement system and recognize the nursing care costs to the high acuity level patients. Otherwise, make the patient responsible for the nursing care cost so that we can provide more efficient and patient focused care.

• Asian-Australasian Journal of Animal Sciences
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• v.19 no.12
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• pp.1722-1727
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• 2006

The nutritive value of 4 straws, obtained after thrashing of seeds from fodder crops, was assessed as complete feed for ruminants. Sixteen male Murrah buffaloes (liveweight 365.8${\pm}$19.5 kg), were divided into 4 equal groups and offered ad lib. straw of either Trifolium resupinatum, Trifolium alexandrium, Medicago sativa or Lolium perenne, supplemented with minerals and vitamin A, for 40 days in a completely randomized design. Simultaneously, each straw was offered to 3 rumen fistulated male buffaloes in order to assess the biochemical changes in the rumen. Compared to other straws M. sativa straw had higher (p<0.05) organic matter (OM), crude protein (CP), acid-detergent fiber (ADF) and cellulose content. L .perenne had the highest (p<0.05) hemicellulose and lowest (p<0.05) CP and acid-detergent lignin (ADL) content. T. resupinatum had the lowest concentration of cell wall constituents (CWC). The digestibility of nutrients of T. resupinatum and L. perenne straw was similar, but higher (p<0.05) than that of other straws. M.sativa straw showed highest (p<0.05) digestibility of CP. The highest OM digestibility of T. resupinatum and CP digestibility of M. sativa were responsible for highest (p<0.05) total volatile fatty acids and trichloroacetic acid precipitable nitrogen in the strained rumen liquor. The digestible crude protein (DCP) was highest (p<0.05) in M. sativa followed by that in T. alexandrium. The total purine derivatives excreted in urine varied from 0.22-0.32 mmol/kg $W^{.75}/d$. The efficiency of microbial protein synthesis indicated that OM of straws of M. sativa and that of T. alexandrium was used more (p<0.05) efficiently. The microbial protein synthesized was highest in T. resupinatum, but statistically similar to other groups. The values for N-retention and apparent biological value were highest for L. perenne, though comparable with that of M. sativa and T. alexandrium. The available metabolizable energy (ME) was highest (p<0.05) in T. resupinatum followed by that in L. perenne and lowest in M. sativa. It was concluded that all the straws, supplemented with minerals and vitamin A, could be fed exclusively to adult ruminants with no adverse affect, as animals were able to maintain body weight (372${\pm}$20.1 kg).

• Journal of Korean society of Dental Hygiene
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• v.17 no.3
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• pp.449-463
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• 2017

Objectives: The objective of this study was to identify the relationship between emotional labor and occupational stress of the dental hygienists, and the effects of emotional labor on their occupational stress and health problems including depression, anxiety and sleep. Methods: The survey was conducted using the questionnaires about dental hygienists' working in medical institutions in Busan, Gyeongsangnam-do from August 19th and October 7th, 2016. Total of 225 participants were selected for data analyses. Frequency analysis, t-test, ANOVA, Pearson's correlation coefficient analysis, and regression analysis were conducted using SPSS Windows ver. 21.0 program(SPSS Inc., Chicago, IL. USA). Results: The analysis of the factors affecting emotional labor, occupational stress, anxiety, and sleep by participants' characteristics showed that those with higher education level, work position and annual salary had higher emotional labor. In addition, participants who worked 5 days every other week and were responsible for patient consultation had higher emotional labor. The analysis of correlations among emotional labor occupational stress, anxiety, and sleep showed positive correlations between emotional experience and emotional expression, occupational stress and emotional expression, and anxiety and emotional expression. On the other hand, negative correlation was found between anxiety and emotional experience. Regression analysis was conducted to examine the effect of emotional labor on job stress. Emotional labor was a factor affecting job stress and anxiety. Conclusions: In order to improve emotional control and vulnerability to stress among dental hygienists, intra-organizational training opportunities and mental health care strategies are needed. Additional broad-based studies are required to identify the factors affecting the occupational stress and emotional labor and to develop relevant intervention measures.

• Quality Improvement in Health Care
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• v.10 no.1
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• pp.28-41
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• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• Journal of Physiology & Pathology in Korean Medicine
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• v.24 no.1
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• pp.143-151
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• 2010

In Vivo and In vitro antispasmodic effects of Jun-Si-Baek-Chul-San, a Traditional Korean Polyherbal Medicineconsisted of 7 types of herbs were observed in the present study. To clarify the effects of Jun-Si-Baek-Chul-San, on accelerating small intestinal movement induced by the stimulation of cholinergic neurotransmission, we evaluated the effects of Jun-Si-Baek-Chul-San on In vivo carbachol (an acetylcholinergic agent)-accelerated mice small intestinal transit and on In vitro contractions induced by low-frequency electrostimulation, KCl, histamine or acetylcholine using isolated guinea pig ileum. To induce the acceleration of mice small intestinal transit, Carbachol 1 mg/kg was once subcutaneously dosed 15min before last administration of the test drugs. In the present study, Jun-Si-Baek-Chul-San 500, 250 and 125 mg/kg or domperidone 20 mg/kg were orally pretreated on the carbachol-accelerated mice small intestinal transit once a day for 7 days and the small intestinal transit rateof activated charcoal powder were monitored. In vitro assays, Jun-Si-Baek-Chul-San1, 0.1, 0.01 and 0.001 mg/ml or domperidone $2{\times}10^{-5}M$ were treated 10min before ileal contraction was induced by filed stimulation, acetylcholine, KCl and histamine, and the % changes of contractions were observed compared to the treatment of inducer alone. In spontaneous contraction, the % changes of contractions were observed compared to treatment of vehicle alone at 10min after Jun-Si-Baek-Chul-San or domperidone treatment. The efficacy of Jun-Si-Baek-Chul-San was compared to those of domperidone. High concentration, 1 mg/ml of Jun-Si-Baek-Chul-San was found to decrease the spontaneous contraction of the isolated guinea-pig ileum. In addition, Jun-Si-Baek-Chul-San decrease contractions induced by electrostimulation, acetylcholine, histamine and KCl in the isolated guinea-pig ileum. In addition, Jun-Si-Baek-Chul-San effectively inhibited the accelerated small intestinal movement induced by carbachol stimulation of cholinergic neurotransmission in In vivo. Based on the results, although the exact molecular or action mechanism and which herbs or compound in Jun-Si-Baek-Chul-San are responsible for actions, it was concluded that Jun-Si-Baek-Chul-San normalization in the accelerated intestinal motility might be interfere with a variety of muscarinic, adrenergic and histaminic receptor activities or with the mobilization of calcium ions required for smooth muscle contraction non-specificly. Therefore, it is expected that Jun-Si-Baek-Chul-San will be promising as a prescription of clinical treatment of digestive tract disorders such as accelerated the motility of intestine, diarrhea or intestinal painful contractions.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Fire Science and Engineering
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• v.30 no.3
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• pp.138-147
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• 2016

As services for citizens' security and protection offered at the national and social levels become more widely recognized across society, the more frequent use of ambulances by patients with both minor and major injuries is being observed. However, the number of safety accidents during transport by ambulances, which are responsible for the prompt transport of patients, has been rising in tandem with the increase in their use. This is due not only to their inconspicuousness both on the road and in other environments where these vehicles are exposed, but also to the high chance of secondary accidents, putting the lives of both patients and emergency responders at risk. It is important to study and develop designs that guarantee protection against safety accidents, noting that ambulances are completely exposed and unprotected on the road on cloudy days and at night-time. In addition, by identifying colors and design motives that enhance the conspicuity of ambulances from a distance and increase their security, emergency responders and patients can be safely protected, the identity of the ambulances can be reinforced and modernized, and the sense oppression which can be visually imposed on patients in a psychologically unstable condition can be eased. Against this backdrop, this study presents the process involved in deriving the exteriors of ambulances in Korea, including their colors and patterns, by examining the established global best practices and identifying the need for more studies into colors, even unconventional ones, that improve their safety.

• Korean Journal of Environmental Biology
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• v.19 no.1
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• pp.79-86
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• 2001

The apicomplexan parasite, Perkinsus sp., has been reported as a causative pathogen responsible for the mass mortality of the Manila clams, Ruditapes philippinarum in European countries as well as in Korea. Prevalence, infection intensity, histopathologic features and zoosporulation of Perkinsus found in the Manila clams distributed along the coast of Cheju Island were investigated in this study. Clams were collected from nine different beaches along the Cheju Island from May to July in 2000. Ray's Fluid Thioglycollate Medium (RFTM) and Choi's NaOH lysis methods were applied in the diagnosis and quantification of the Perkinsus infection. Prevalence, percentage infection of the parasite examined was 100% in Pyosun, 70% in Sungsan, 63% in Kumneong, 33% in Jongdalri, 21% in Iho, 17% in Moslpo, and 14% in Seogwipo. No Perkinsus was found in the clams collected from Kimnyong and Yongmeo-ri. Infection intensity as a number of Perkinsus cells per gram tissue wet weight (twwt), was 98,430 cells/g twwt in Pyosun, 78,553 cells/g twwt in Sungsan, 18,980 cells/g twwt in Kumneong, 4,290 cells/g twwt in Jongdalri, 1,527 cells/g twwt in Iho, 1,069 cells/g twwt in Moslpo, and 853 cells/g twwt in Seogwipo. Histological preparation of the infected tissues revealed trophozoites of Perkinsus sp., ranged from 5 to 10 ${\mu}{\textrm}{m}$, in diameter mostly distributed in the digestive gland and the gill filaments. Zoospores were discharged from the hypnospore via discharging tube about 2 days after incubated in filtered and aerated seawater. In general, the prevalence and infection intensity of Perkinsus in Cheju Island were much lower than that reported from the western and southern coast of Korea.

• The Korean Journal of Physiology and Pharmacology
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• v.2 no.4
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• pp.435-441
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• 1998

We examined effects of interleukin $1{\alpha}$ ($IL1{\alpha}$) and phorbol 12, 13 dibutyrate (PDB), an activator of protein kinase C, on mRNA for Prostaglandin H synthase (PGHS) and prostanoid production in cultured ovine meningeal fibroblasts. Immuno- and morphologically-identified fibroblasts were derived from cerebral cortex and white matter from fetal lambs (approximately 120 days gestation) and grown to confluence on glass coverslips in 12 well plates. Levels of prostaglandin $F_{2{\alpha}}$ and the stable hydrolysis product of prostacyclin (i.e., $6-keto-PGF_{1{\alpha}}$) were determined using enzyme immunoassay. Relative amounts of mRNA were determined by in situ hybridization using ovine cDNA for PGHS1. $IL1{\alpha}$ (10 ng/ml) increased mRNA levels over baseline by $62{\pm}19%$ (p＜0.05) at 60 min., $37{\pm}12%$ (NS) at 120 min., and $36{\pm}18%$ (NS) at 240 min (n=12). Levels of $6-keto-PGF_{1{\alpha}}$ were $148{\pm}18%$ pg/ml during baseline, $246{\pm}41%$ pg/ml at 60 min., $248{\pm}40%$ pg/ml at 120 min., and $259{\pm}62%$ pg/ml at 240 min (all p＜0.05) (n=12). $PGF_{2{\alpha}}$ was increased although it wasn't statistically significant. However, $IL1{\alpha}$ decreased $PGE_2$ level significantly (all p＜0.05). PDB $(10^{-6}M)$ increased mRNA levels over baseline by $25{\pm}6%$ after 30 min., $40{\pm}6%$ after 60 min., and $20{\pm}8%$ after 90 min. (n=9) (all p＜0.05). Levels of $6-keto-PGF_{1{\alpha}}$ were $200{\pm}43%$ pg/ml during baseline, $202{\pm}43%$ pg/ml after 30 min. (NS), $268{\pm}58%$ pg/ml after 60 min. (p＜0.05), and $296{\pm}60%$ pg/ml after 90 min. (p＜0.05) (n=9). Levels of $PGF_{2{\alpha}}$ were $178{\pm}26%$ pg/ml during baseline, $300{\pm}30%$ pg/ml after 30 min., $299{\pm}35%$ pg/ml after 60 min., and $355{\pm}32%$ pg/ml after 90 min (all p＜0.05) (n=6). Actinomycin-D (1 mg/ml) prevented increases in mRNA, $6-keto-PGF_{1{\alpha}}$, and $PGF_{2{\alpha}}$ at 60 min. for both $IL1{\alpha}$ and PDB. We conclude that cerebral fibroblasts are avid producers of prostanoids, and that enhanced production of PGHS is responsible for augmented $PGF_{2{\alpha}}$ and prostacyclin production in the presence of an activator of protein kinase C and for decreased $PGE_2$ and increased prostacyclin production in the presence of $IL1{\alpha}$.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.432-436
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• 2010

Transient neonatal diabetes mellitus (TNDM) has been associated with paternal uniparental isodisomy of chromosome 6, paternally inherited duplication of 6q24, or a methylation defect at a CpG island of the ZAC or HYMAI gene. We experienced a case of TNDM in which the patient presented with hyperglycemia, macroglossia, and intrauterine growth retardation, caused by a paternally derived HYMAI. An 18-day-old female infant was admitted to the hospital because of macroglossia and recurrent hyperglycemia. In addition to the macroglossia, she also presented with large fontanelles, micrognathia, and prominent eyes. Serum glucose levels were 200-00 mg/dL and they improved spontaneously 2 days after admission. To identify the presence of a maternal methylated allele, bisulfite-treated genomic DNA from peripheral blood was prepared and digested with BssHII after polymerase chain reaction (PCR) amplification with methylation-specific HYMAI primers. PCR and restriction fragment length polymorphism analysis showed that the patient had only the paternal origin of the HYMA1 gene. TNDM is associated with a methylation defect in chromosome 6, suggesting that an imprinted gene on chromosome 6 is responsible for this phenotype.