• Journal of Gastric Cancer
• /
• v.5 no.2
• /
• pp.95-100
• /
• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Pediatric Infection and Vaccine
• /
• v.14 no.2
• /
• pp.145-154
• /
• 2007

Purpose : Rotavirus is one of the most important etiologic agents of nosocomial infections among the neonates. This study was designed to investigate nosocomial rotavirus infection in neonates who were admitted to a postpartum-care center after birth. Methods : From March 2005 to September 2006, 957 healthy neonates were examined for rotavirus antigen in stool by immunochromatographic method and 216 neonates were rotavirus antigen positive within 24 hours after admitted to a postpartum-care center. We reviewed the nursing charts retrospectively such as characteristics, monthly distribution, birth hospitals, delivery methods, feeding types and clinical manifestations. Results : Among 957 neonates, 216 neonates (22.6%) were rotavirus antigen positive and there were no differences in sex, birth weight, gestational age. Monthly positive rate of rotavirus antigen showed diversity from 10% to 36%. According to birth hospitals, positive rate showed diversity from 3.5% to 53.6%. Out of 957 neonates, 655 cases (68.4%) were born of vaginal delivery and mean hospitalized duration was 2.4 days, 302 cases (31.6%) were born of cesarean section and mean hospitalized duration was 5.7 days. 17.6% of vaginal delivery and 33.4% of cesarean section were rotavirus antigen positive. The positive rate was higher in neonates by cesarean section than vaginal delivery (P<0.001). According to feeding types, positive rate of rotavirus antigen was lower in breast-fed group than formula-fed group (P<0.001). Proportion of symptomatic case among rotavirus antigen positive was 34.7%. Most common clinical manifestation was diarrhea (61.3%), following poor feeding (45.3%), fever (40.0%), vomiting (25.3%), delayed weight gain (12.0%), and decreased urine amount (5.3%). Conclusion : Some neonates were already infected before admission to a postpartum-care center. Without meticulous management, nosocomial rotavirus infection would transmit rapidly in a postpartum-care center spreading to the community. Recommendation of breast-feeding, routine rotavirus screeing test with or without symptom, and isolation of all rotavirus antigen positive neonates in a postpartum-care center seem to be necessary. Also attentive hygiene education and further investigations of rotavirus infection in a postpartum-care center would be needed.

• Journal of Hospice and Palliative Care
• /
• v.8 no.1
• /
• pp.8-17
• /
• 2005

Purpose: This study was performed to investigate burden, job satisfaction and quality of life of nurses who take care of cancer patients. Methods: The subjects were 237 nurses working at the oncology unit of hospitals with over 500 beds in Seoul and Gyeonggi-do. Data were collected using questionnaire from the February to March, 2005. Data were analyzed through t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression using SAS. Results: 1. The item that showed the highest level of burden was 'I feel limited even if I make efforts to reduce patients' pain. 'Burden was high in those group both who were younger than 35 years old and who had clinical experiences caring cancer patients for $3{\sim}4$ years. 2. The item that showed the lowest level of job satisfaction was 'the possibility of promotion'. Job satisfaction was high in those group both who had a spouse and were head nurses or incharge nurses. 3. The item that showed the lowest level of quality of life was 'I am physically exhausted'. Over 35 years old who had a spouse, and over 2,000,000 won monthly income made a high score in the quality of life. 4. There were negative correlations among burden, iob satisfaction and the quality of life. 5. The major factor affecting the quality of life was burden. Conclusion: The results of this study are expected to be utilized as basic data for developing support system to improve nurses' work conditions and quality of life.

• Clinical and Experimental Pediatrics
• /
• v.48 no.9
• /
• pp.946-952
• /
• 2005

Purpose : Vancomycin-resistant enterococci(VRE) are now nosocomial pathogens in Korea. But little is known about the prevalence of stool colonization with VRE in neonates in Korea. So we studied the prevalence and risk factors of VRE colonization in the Neonatal Intensive Care Unit(NICU). Methods : From January 2000 to December 2004, the medical records of 294 neonates(127 cases of VRE group and 167 cases of non-VRE group, according to the results of stool culture) were reviewed retrospectively. We studied the annual prevalence of VRE and risk factors of VRE colonization in neonates. Results : From 2000 to 2003, the prevalence rate of VRE in NICU increased. After preventing VRE transmission, the prevalence rate of VRE has decreased. Conclusion : VRE colonization increased recently. Risk factors of VRE colonization were prematurity, lower birth weight, longer hospitalization and use of vancomycin or 3rd generation cephalosporin, compared with the non-VRE group. To prevent VRE transmission among newborns, aggressive infection control strategies by NICU staffs must be implemented immediately for all babies.

• Tuberculosis and Respiratory Diseases
• /
• v.66 no.4
• /
• pp.300-308
• /
• 2009

Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months' August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

• KOREAN JOURNAL OF CROP SCIENCE
• /
• v.37 no.2
• /
• pp.178-184
• /
• 1992

The changes in contents of chlorophyll and free proline in the seedling leaves of ten rice cultivars as affected by salt stress were checked in order to obtain the basic information on the judgement of the degrees of salt injury. The difference in salt injury among the cultivars was clearly observed about 25 days after 6% salt treatment. Chlorophyll content was decreased in both Gayabyeo and Taebaegbyeo for 14 days after different salt treatment as salt concentration was increased and the decreased tendency was much higher in Taebaegbyeo than in Gayabyeo over 0.4% salt concentration. Chlorophyll content in Gayabyeo after 0.6% salt treatment was decreased slowly, while in Taebaegbyeo, deminished very rapidly as time progressed, therefore it decreased by about 16% in Gayabyeo and 67% in Taebaebyeo compared to the control at 20 days, respectively. The relationship between chlorophyll content and the degrees of salt injury in ten rice cultivars showed significant negative correlation at 10 day after 0.6% salt treatment. Free proline content in Gayabyeo was increased gradually for 14 days after different salt treatment as salt became higher, while in Taebaebyeo, it was increased rapidly under 0.6% but rather decreased under 0.8% salt concentration. Particularly, it was much higher Taebaegbyeo than in Gayabyeo under salt concentration from 0.4 to 0.6%. Free proline content in Gayabyeo after 0.6% salt treatment was increased from 15 days, on the other hand in Taebaegbyeo, it was increased from 5 days, but rather decreased from 20 days, and it was 6 times higher in Taebaegbyeo than in Gayabyeo at 10 days. There was significant positive correlation between free proline content and the degrees of salt injury in ten rice cultivars at 10 days after 0.6% salt treatment. From the above results, chlorophyll and free proline content may be used as an indicative character of intensity of salt stress as well as varietal difference in resistance to salt stress in the seedling stage.

• Journal of the Korean Society of Safety
• /
• v.7 no.2
• /
• pp.63-70
• /
• 1992

The aim of this research is to obtain a basic quantitative understanding of the effect of a noncondensable gas on the absorption of water vapor by a $H_2O$ / LiBr combination with n-octanol as the surfactant. Nonflowing aqueous solutions of LiBr (40,45,50 mass％) were exposed to saturated water vapor following the addition of an n-octanol sufactant (0.01 and 0.6 mass％). A small amount of a noncondensable gas (air) was allowed into the absorber (0.03 volume％) and its effect was analyzed by measuring the amount of water vapor absorbed. This study will aid to predict the performance of heat pump and safety operating condition when the noncondensable gas is not allowed in the absorber The results indicate that, in the presence of small amounts of a noncondensable gas, vapor absorption enhancement ratios are less than half o( those obtained under the same experimental conditions when a noncondensable gas is not present (1). The presence of a noncondensable gas causes the partial vapor pressure of air to increase at the vapor / liquid interface, which results in an instability of vapor absorption rate nd. hence, in an inhibition of interfacial disturbance.