• Title/Summary/Keyword: Case Study

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Adequacy of Medical Manpower and Medical Fee for Newborn Nursery Care (신생아실 의료인력의 적정성 및 신생아관리료의 타당성 분석)

  • Park, Jung-Han;Kim, Soo-Yong;Kam, Sin
    • Journal of Preventive Medicine and Public Health
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    • v.24 no.4 s.36
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    • pp.531-548
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    • 1991
  • To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1-30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (${\pm}58.6$) minutes; 202.3(${\pm}50.7$) minutes for the university hospitals and 164.2(${\pm}60.5$) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the mar reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430won. Out of the total medical fee, 20,323won(9.3%) was for the newborn nursery care. In case of C-section delivery who stayed six nights and seven days, total medical fee was 732,578won and out of the total fee 76,937won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141won for the tertiary care hospitals and 14,576won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.

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Clinicopathological Analysis of Glomerulonephritis with Asymptomatic Urinary Abnormalities in Children (무증상성 요이상을 동반한 사구체신염 환아의 임상 및 병리학적 분석)

  • Sung Ick-Ho;Yoon Hye-Kyoung;Chung Woo-Yeong
    • Childhood Kidney Diseases
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    • v.1 no.2
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    • pp.136-143
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    • 1997
  • Purpose : To evaluate the prevalence and clinical manifestations of various glomerulonephritis(GN) in children with asymptomatic urinary abnormalities, a clinicopathological analysis of 134 biopsied cases which were subdivided into 3 groups of proteinuria with hematuria, isolated hematuria and isolated proteinuria was done. Methods : We conducted retrospective study with review of histopathologic findings and clinical manifestations of the 134 cases with asymptomatic urinary abnormalities diagnosed by percutaneous renal biopsy which were done between January 1986 and December 1996 at department of pediatrics, Pusan Paik hospital. Results : 1) The proportion of children with asymptomatic urinary abnormalities was 43.2% of all biosied cases. 2) Among these, primary GN were 95 cases and secondary GN were 39 cases, it's ratio was 2.44:1. As a whole, the most common pathologic diagnosis was IgA nephropathy(IgAN, 26.9%), which was followed by $Henoch-Sch\"{o}nlein$ purpura nephritis(HSPN, 17.9%), minimal change lesion(MC, 17.2%), thin GBM disease(12.7%), Hepatitis B associated glomerulonephritis(HBGN, 6.0%), poststreptococcal glomerulonephritis(PSAGN, 3.0%), mesangial proliferative glomerulonephritis(MesPGN, 2.2%), membranoproliferative glomerulonephritis (MPGN, 2.2%), Alport syndrome (1.5%) and Fibrillary nephritis(0.7%). 3) In proteinuria with hematuria, the most common pathologic diagnosis was IgAN(34.6%), which was followed by HSPN(19%), MC(17.7%), thin GBM disease(8.9%), HBGN(6.3%), PSAGN(3.6%), MesPGN(1.2%), MPGN(1.2%) and Alport syndrome(1.2%). 4) Major causes of isolated hematuria were thin GBM disease(19.6%), IgAN(17.6%), HSPN(17.6%), MC(11.8%). 5) Isolated proteinuria was due to of 3 cases of MC and 1 case of HBGN. Conclusion : The prevalence of glomerulonephritis with asymptomatic urinary abnormalities in children were 43.2% of all biopsed cases. When these children were subdivided into 3 groups, proteinuria with hematuria was accounted 58.9%(79 cases) and then isolated hematuria was 38.1%(51 cases), isolated proteinuria was only 3%(4 cases) respectively. The most common pathologic diagnosis was IgA nephropathy in patient with proteinuria and hematuria, and thin GBM disease in patient with isolated hematuria.

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Clinicopathological evaluation of Childhood Henoch-$Sch{\ddot{o}}nlein$ Purpura(HSP) Nephritis with Nephrotic Syndrome (신증후군을 동반한 Henoch-$Sch{\ddot{o}}nlein$ 신염 환아의 임상병리 적 고찰)

  • Kang Hyeon-Ho;Yoon Kyung-Leem;Cho Byoung-Soo
    • Childhood Kidney Diseases
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    • v.4 no.2
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    • pp.111-119
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    • 2000
  • Purpose : Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP) is a common pediatric discase presenting most frequently with skin, gastrointestinal, joint and renal manifestations. The prognosis of HSP is mainly determined by the involvement of the kidney, but prognostic markers have not been established. We evaluated the patients who have HSP nephritis with nephrotic syndrome. Method : Clinical manifestations and laboratory findings were observed and analyzed in 34 cases with HSP which were manifested by nephrotic syndrome hospitalized at Kyung Hee university Hospital during the period from Jan. 1990 to Dec. 1998. Results : 1) Male to female ratio was 1.3:1, and mean age at onset was 8.3 year. 2) Mean duration from symptom onset to renal biopsy was 10.5 weeks. 3) Proportion of patients presenting with acute nephritis was 32.4$\%$, gross hematuria 17.6$\%$, microscopic hematuria 50$\%$. 4) The findings of renal biopsy were 20 cases of grade II, 11 cases of grade III, 2 cases of grade I, 1 case of grade IV according to classification by ISKDC. 5) Patients with grade I were recovered with no residual defect, but patients with grade IV shows active renal disease(states C). Conclusion : Among the 디le patients with Henoch-$Sch{\ddot{o}}nlein$ purpura accompanying nephrotic syndrome, more aggressive treatment might be needed in patients showing crescents formation on renal biopsy. A prospective study will be needed to explore the progression of this disease.

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Analysis of Postnatal Acquisition Factors of the Normal Flora in Infants with Urinary Tract Infection (영아 요로감염에서 정상 세균총의 생후 획득 요인에 관한 분석)

  • Shim, Yoon-Hee;Kim, Hee-Jung;Lee, Seung-Joo
    • Childhood Kidney Diseases
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    • v.11 no.2
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    • pp.195-202
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    • 2007
  • Purpose : The normal flora, which was suggested to prevent infection, is acquired first from the birth canal and develops by dietary factors. Here presents a case-control study, aimed to evaluate the postnatal acquisition factors relating to the achievement of the normal flora in infants with urinary tract infection (UTI). Methods : 115 UTI infants, admitted at Ewha Womans University Mokdong Hospital from 2004 to 2005 and 116 age-matched control infants, who had visited well baby clinic, were evaluated. The suggested postnatal acquisition factors of the normal flora such as vaginal delivery, breast feeding, probiotics and yogurt intake and their relationship with UTI were evaluated. Results : The rate of vaginal delivery was 50%(58/l15) in UTI infants, which was not significantly different from 60%(69/116) in control infants(P>0.05). In the infants with UTI, the feeding pattern(breast milk 19%, mixed 26%, formula 55%) was significantly different from that(44%, 19%, 37%) in control infants(P<0.05). This significant difference was shown only in infants less than 6 months of age, but was not in infants over 6 months of age. The rate of probiotics intake in UTI infants was 4%(4/115), which was significantly lower than 27% (32/116) in control infants(P<0.05). The rate of regular intake of yogurt in UTI infants over 6 months of age was 27%(6/23), which was not significantly different from 35%(8/23) in control infants(P>0.05). The odds ratios of breast feeding and probiotics intake against UTI were significantly low as 0.30 (95% Cl 0.17-0.55)(P<0.01) and 0.03 (95% Cl 0.01-0.07)(P<0.01). Conclusion : The significantly lower rates of breast feeding and probiotics intake in UTI infants suggest that these dietary factors might have preventive effects in infants with UTI.

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Evaluation of Effective Dose in Dental Radiography (치과 방사선 검사에서 유효선량 평가)

  • Han, Su-Chul;Lee, Bo-Ram;Shin, Gwi-Soon;Choi, Jong-Hak;Park, Hyok;Park, Chang-Seo;Chang, Kye-Yong;Kim, Bo-Ram;Kim, You-Hyun
    • Journal of radiological science and technology
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    • v.34 no.1
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    • pp.27-33
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    • 2011
  • Along with the developments of science technology, up-to-date medical radiation equipments are introduced. Those equipments has brought many progresses in diagnosing patients not only in the quantitative aspects but in the qualitative ones. Especially, in the case of dental radiography, patients can be exposed more than CT, cone beam computed tomography (CBCT). In this study, we used human phantom and TLD-100H to measure the organ dose in each dental radiography and computed the effective dose according to ICRP (International Committee for Radioactivity Prevention) 60, 103. We measured the effective dose to be 5.1 and $29.5{\mu}Sv$ in the panoramic radiography and 11.2 and $14.4{\mu}Sv$ in the cephalometric radiography respectively. We also executed the CBCT and CT test on the maxillaries and the mandibles and found the amounts of effective dose were 53.7, 209.6, 129, and $391.5{\mu}Sv$ respectively in the CBCT and $93.3{\mu}$, 139.5, 282.7 and $489.7{\mu}Sv$ in the CT test. Consequently, it was shown that the effective dose in the CBCT test was lower than one in the CT test, but was higher in both panoramic and cephalometric radiography.

Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia (편마비 환자에서의 견관절 아탈구 진단에 유용한 촬영법)

  • Cho, Kwang-Ho;Kang, Yeong-Han
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.253-259
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    • 2009
  • Purpose : The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. Methods : A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. Results : When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine($49.90{\pm}13.6\;mm$) and sitting position($60.72{\pm}16.3\;mm$) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected $35.92{\pm}6.2\;mm$, Unaffected $28.76{\pm}5.4\;mm$. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was $23.01{\pm}9.0\;mm$, $22.45{\pm}8.2\;mm$ each). Conclusion : Radiological projection of shoulder subluxation has diagnostic value when it goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation. But in axial projection, there wasn't meaningful differences.

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A Model to Measure the Success of a Web-based Information System at a Government Agency - the Chungwadae Case (공공기관 업무관리시스템 성과평가 모형 개발에 관한 연구: 청와대 업무관리시스템(e지원시스템)을 중심으로)

  • Bae, Lee-Chul;Hong, Il-Yoo
    • Asia pacific journal of information systems
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    • v.18 no.1
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    • pp.97-115
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    • 2008
  • Introduction The e-government is concerned with using Internet and Web technologies to exchange information and services with citizens, businesses and other related organizations, and it centers on three functions, namely informational, interactive, and transactional [UN, 2001]. Many developed countries like the U.S. have been actively involved in e-government projects, since they enable both more effective public services for citizens and more efficient internal operations. Korea is among these leading countries that are planning to leverage computer and communication technologies to provide for integration of work processes and information as well as convenient access to information and services. For this reason, evaluating e-government projects is becoming a crucial issue for both researchers and policy-makers. However, most research to date has primarily focused on a model of success of an e-government system designed for citizens, overlooking internal systems specifically created for employees working in a public organization. This paper is intended to propose a model to measure the success of a Web-based information system designed for use by internal users at Chungwadae, the executive branch of Korea's central government. The paper is also aimed at applying the model to the assessment of the present system being used at Chungwadae in comparison with the preceding system. Evaluating an e-Government System The most widely cited model of information systems success today is that of DeLone and McLean[1992, 2003, 2004]. The original model states that the success of an information system can be measured using six dimensions, including system quality, information quality, use, user satisfaction, individual impact, and organizational impact. Although the ultimate success of an information system may be reflected in the impact that the system has upon individuals as well as an organization, aspects of using the system such as system use and user satisfaction can play an important role in determining the system success, because the system would be a sheer failure if users don't like and use the system. As a response to criticisms given by numerous researchers, the authors adapted their model to fit the emerging Web-based environment. The revised model[DeLone and McLean, 2003] they offered included an additional quality dimension, namely service quality, and combined individual and organizational impacts into net benefits which can also influence user satisfaction. The e-government system success model can be built around this updated model. Our model incorporates information quality, system quality, and service quality as in the DeLone and McLean model. However, the 'system use' dimension has been replaced by perceived usefulness, as suggested by Seddon[1998]. In addition, because the e-government systems that this paper focuses on are internal public systems used in government agencies, the 'net benefits' dimension has been replaced by perceived work efficiency. Based on the proposed model, a total of nine hypotheses have been formulated which we tested using an empirical analysis. Methods A questionnaire form has been created with items that are designed to examine the relationships among the variables in the model. The questionnaire has been handed over, in person, to 65 members of Chungwadae staff who are now actively using the E-Support System, the present information system created to support internal work at Chungwadae. We made arrangements to meet with each individual who agreed to participate in our survey, and helped to fill out the survey form with explanations. Of the 65 copies that were delivered, only 33 were returned, and 30 responses of these have been adopted for our analysis, since three were not valid. The extremely small sample size was due to the limited number of staff members who had adequate experience required of this study. Results We gathered data from the questionnaire survey and analyzed them using a regression analysis to test the hypotheses. As shown in the table below, the results indicated that all three dimensions of an information system’s quality are positively related to user satisfaction. However, information quality and system quality were found to be positively related to perceived usefulness, while service quality was not. In addition, perceived usefulness is not positively related to user satisfaction, implying that a user may find a system useful, but may not be satisfied with it. Finally, user satisfaction and perceived usefulness both are positively related to perceived work efficiency. This suggests that workers' positive experience with the system is important to guarantee favorable work efficiency. Conclusions We conclude that the proposed model proved useful in measuring the success of an internal information system used by a government agency. To demonstrate the applicability and usefulness of the model in the paper, we applied the model to the assessment of the present internal system used at Chungwadae in comparison with the preceding system. The results showed that the present system outperforms the preceding one in a statistically significant way. Future research will have to focus on applying the model to Korea's governmental agencies other than Chungwadae and examine whether it proves applicable in different types of governmental organizations.

Effect of Vermicast Application of Earthworm Feeding Food Waste in Vegetable Plants (Radish and Chinese Cabbage) Growth (음식물 쓰레기를 먹이로 한 지렁이분립이 채소류(열무와 엇갈이배추) 생육에 미치는 영향)

  • Choi, I-Jin;Kwon, Hyuk-Hyun;Lee, Han-Ho;Son, Hyoung-Gi;Hong, Sang-Kil;Park, Yu-Soon;Kang, Jong-Woon
    • Korean Journal of Organic Agriculture
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    • v.20 no.4
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    • pp.715-725
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    • 2012
  • This study was performed to make the method of food waste manufacturing for feeding to earthworm and different ratio of earthworm cast was investigated for applying vegetable plants that cultivated in a family or roof garden. We made conventional treatment of gardening soil and prepared soils with earthworm cast (the only fertilizer) at 30, 50, 70 and 100% for planting vegetable plants and then we studied its growth feature. The treatment was repeated three times with 12 weeks for each time. The cultivation of radish and chinese cabbage were managed at the same cultivation level for RDA standard cultivation method, and each sample of soils and plants was analyzed by appropriate analysis method. The growth investigation was performed 12 week after planting, and as for growth characteristics, height, leaf diameter, leaf number, leaf length, fresh weight and dry weight were investigated. The chemical characteristics, soils and plants, were surveyed. As for the growth characteristics investigated, radish and chinese cabbage showed the biggest growth in 70% and 50% treatment with average growth of all characteristics, height, leaf diameter, leaf number, leaf length, fresh weight and dry weight, respectively. Applying these results, a new equation for vermicast recommendation for radish and Chinese cabbage in summer (June-August) was presented. The earthworm cast 50% level with the gardening soil showed the high production in chinese cabbage. In case of radish, earthworm cast 70% with gardening soil level showed great growth, significantly.

Result of Tracheal Resection and End-to-end Anastomosis (기관 절제 및 단단문합술의 성적 고찰)

  • 유양기;박승일;박순익;김용희;박기성;김동관;최인철
    • Journal of Chest Surgery
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    • v.36 no.4
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    • pp.267-272
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    • 2003
  • Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

Effect of Rice Bran and Barley Bran Application on Growth and Yield of Chinese Chive (Allium tuberosum Rottler) and Taro (Colocasia esculenta) and Weed Control (쌀겨, 보릿겨 처리가 부추와 토란의 생육과 수량 및 잡초방제에 미치는 영향)

  • Ryu, Deok-Kyo;Yun, Young-Beom;Kwon, Oh-Do;Shin, Dong-Young;Hyun, Kyu-Hwan;Lee, Do-Jin;Kuk, Yong-In
    • Korean Journal of Weed Science
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    • v.31 no.3
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    • pp.260-270
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    • 2011
  • This study was carried out to examine the effect of rice bran, barley bran, burned rice bran, and burned barley bran on the growth and yield of Chinese chive (Allium tuberosum Rottler), taro (Colocasia esculenta), and weed control. When the above 4 brans were examined 13, 27, 41 and 57 days respectively after application, the plant height of Chinese chive applied with burned barley bran was significantly higher than non-treated control, whereas the other brans did not have any distinct effect on the plant height or population number of Chinese chive. However, when examined 57 days after the application of the above 4 brans, all the plants applied with brans showed more than twice the improvement in shoot fresh weight compared with non-treated control. A chemical analysis of soil 57 days after the application of the above 4 brans showed that the soils were richer in available phosphate and organic matter. Shoot fresh weight of Chinese chive at 2 weeks after cutting was significantly higher in barely bran treated plot than in non-treated plot. In the case of taro, only taro plots transplanted when 10 cm tall and applied with barley bran showed an improvement in growth increment of both the underground and above parts. However, when sowed seeds after the application of the 4 brans, the yield of taro was reduced by the brans. Thus this research indicates that the effect of brans is differ based on the amount of bran application as well as crops. The effect of weed control on Echinochloa crus-galli, Digitaria clliaris, Chenopodium album, and Solanum nigrum as affected by brans was very low in pot conditions. Weed efficacy of the brans was also very low in field conditions. Growth of Chinese cabbage and garland chrysanthemum was inhibited 63% and 37% by rice bran at $4,000kg\;ha^{-1}$, respectively, but other crops such as maize, squash, cucumber, and Chinese chive were inhibited by 0-20%. These results were similar to that of barley bran except for Chinese cabbage.