• 제목/요약/키워드: Case management

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The Surgical Management of Hypoplastic Left Heart Syndrome and the Results of a Fontan Operation (좌심형성부전증후군의 외과적 치료 및 폰탄수술의 결과)

  • Chung, Eui Suk;Kim, Woong-Han;Jeon, Jae-Hyun;Choi, Chang-Hyu;Lee, Chang-Ha;Lee, Young-Tak
    • Journal of Chest Surgery
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    • 제42권1호
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    • pp.9-13
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    • 2009
  • Background: Hypoplastic left heart syndrome is uniformly fatal if this condition is not properly treated. We reviewed the surgical results of treating hypoplastic left heart syndrome, and we evaluated the hemodynamics and functional status of these patients after they underwent a Fontan operation. Material and Method: To assess the surgical results, we retrospectively reviewed the medical records of 6 (M/F=4/2) patients who underwent a staged operation, including a Norwood procedure, a bidirectional Glenn procedure and a Fontan procedure between October 1997 to May 2005. The mean age of the patients was $17.3{\pm}10.8$ days (range: 9~36 days) at the $1^{st}$ staged operation, $8.9{\pm}7.1$ months (4.6~23.3 months) at the $2^{nd}$ staged operation (the Bidirectional Glenn procedure) and $32.4{\pm}9.8$ months at the final staged operation (the Fontan procedure). During the $2^{nd}$ staged operation, one of the patients received tricuspid valve repair due to regurgitation. All the patients underwent an extracardiac Fontan procedure using Gore-Tex conduit (20 mm: 2 patients, 18 mm: 4 patients) and one of them required fenestration. Result: 21 patients underwented a Norwood procedure. There were 7 early deaths and 4 interstage deaths. Bidirectional cavopulmonary shunt was performed in 10 patients and the Fontan procedure was done in 6 (mortality: 1 patient, Flow up loss: 1 patient, Awaiting a Fontan procedure: 2 patients). After the Fontan procedure, there was no complication except for one case of post operative bleedings. All the patients had good ventricular function and 2 had grade I tricuspid regurgitation, as noted on their echocardiography. The average follow up period after the Fontan procedure was $19.6{\pm}14.9$ months (range: 1.5~39.1 month). All the patients had normal sinus rhythm and they were put on aspirin and cardiac medication. During follow up period, all the patients had a good functional status (NYHA functional class I). Conclusion: All the patients who suffered with hypoplastic left heart syndrome and who underwent a Fontan procedure achieved a good hemodynamic and functional status, even though there was a relatively high operative mortality rate after stage I Norwood palliation. Therefore, thise staged operation should be strongly recommended as an important surgical strategy for treating hypoplastic left heart syndrome.

Systemic Analysis on Hygiene of Food Catering in Korea (2005-2014) (Systemic analysis 방법을 활용한 국내 학교급식 위생의 주요 영향 인자 분석 연구(2005-2014))

  • Min, Ji-Hyeon;Park, Moon-Kyung;Kim, Hyun-Jung;Lee, Jong-Kyung
    • Journal of Food Hygiene and Safety
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    • 제30권1호
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    • pp.13-27
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    • 2015
  • A systemic review on the factors affecting food catering hygiene was conducted to provide information for risk management of food catering in Korea. In total 47 keywords relating to food catering and food hygiene were searched for published journals in the DBpia for the last decade (2005-2014). As a result, 1,178 published papers were searched and 142 articles were collected by the expert review. To find the major factors affecting food catering and microbial safety, an analysis based on organization and stakeholder were conducted. School catering (64 papers) was a major target rather than industry (5 pagers) or hospitals (3 papers) in the selected articles. The factors affecting school catering were "system/facility/equipment (15 papers)", "hygiene education (12 papers)", "production/delivery company (6 papers)", food materials (4 papers)" and "any combination of the above factors (9 papers)". The major problems are follow. 1) The problems of "system/facility/equipment" were improper space division/separation, lack of mass cooking utensil, lack of hygiene control equipment, difficulty in temperature and humidity control, and lack of cooperation in the HACCP team (dietitian's position), poor hygienic classroom in the case of class dining (students'), hard workload/intensity of labor, poor condition of cook's safety (cook's) and lack of parents' monitoring activity (parents'). 2) The problem of "hygiene education' were related to formal and perfunctory hygiene education, lack of HACCP education, lack of compliance of hygiene practice (cook's), lack of personal hygiene education and little effect of education (students'). 3) The problems of "production/delivery company" were related to hygiene of delivery truck and temperature control, hygiene of employee in the supplying company and control of non-accredited HACCP company. 4) The area of "food materials" cited were distrust of safety regarding to raw materials, fresh cut produces, and pre-treated food materials. 5) In addition, job stability/the salary can affect the occupational satisfaction and job commitment. And job stress can affect the performance and the hygiene practice. It is necessary for the government to allocate budget for facility and equipment, conduct field survey, improve hygiene training program and inspection, prepare certification system, improve working condition of employees, and introducing hygiene and layout consulting by experts. The results from this study can be used to prepare education programs and develop technology for improving food catering hygiene and providing information.

Hazard Analysis of Tomato Farms at the Growing Stage for the Establishment of the Good Agricultural Practices (GAP) (토마토 농산물우수관리제도(GAP)모델 확립을 위한 재배단계 위해분석)

  • Park, Su-Hee;Kwon, Woo-Hyun;Heo, Rok-Won;Kim, Kyeong-Yeol;Shim, Won-Bo;Shim, Sang-In;Chung, Duck-Hwa
    • Journal of Food Hygiene and Safety
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    • 제27권2호
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    • pp.152-160
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    • 2012
  • The objective of this study was to analyze hazards for the growing stage of 6 tomato farms (A, B, C; soli farms, D, E, F; Nutriculture farms) located in Gyeongsangnam-do to establish the good agricultural practices (GAP). A total of 144 samples for analyzing hazards collected from cultivation environments (irrigation water, soil, nutrient solution, and air) and personal hygiene (hands, gloves, and cloths) were assessed for biological (sanitary indications and major food borne pathogens) and chemical hazards (heavy metals). Total bacteria, coliform, and fungi were detected at levels of 0.2-7.2, 0.0-6.1, and 0.0-5.4 log CFU/g, mL, hand or 100 $cm^2$, respectively. Escherichia coli were only detected in the soil sample from B farm. In case of pathogens, Bacillus cereus was detected at levels of 0.0-4.4 log CFU/(g, mL, hand or 100 $cm^2$), whereas Staphylococuus aureus, Listeria monocytogenes, E. coli O157, and Salmonella spp. were not detected in all samples. Heavy metals as a chemical hazard were detected in soil and irrigation water, but levels of them were lower than the permit limit. In conclusion, chemical hazard levels complied with GAP criteria, but biological hazards at the growing stage of tomato farms were confirmed. Therefore a proper management to prevent microbial contamination is needed.

Analysis on the actual state and plan for improvement for vocational courses are operated consignment in General high school (일반고등학교 직업과정 위탁 운영의 실태 분석 및 개선 방안)

  • Yoon, Kyoung-Suk;Yi, Sang-Bong
    • 대한공업교육학회지
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    • 제36권2호
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    • pp.131-150
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    • 2011
  • The purpose of this study vocational courses in general high schools in each city in order to operate efficiently. Provinces operating status and the general high school vocational courses through the regular high school vocational courses siltae analysis to identify operational problems, and that is to derive ways to improve. Operating in the desired direction, the typical high school vocational courses ilbango select students that meet the purpose of operating as one that students admit you need the correct promotion and career guidance and vocational courses ilbango teachers of vocational courses is operating correctly recognize the purpose and students with career guidance and vocational courses so that you can operate effectively at: Provincial Office-wide need to conduct a systematic study. Vocational courses also target students ilbango sosokgyo (wonjeokgyo) to be completed in the course stated in the plan for the school and the need to practice, and professional students ilbango by configuring a separate class is most preferable to operate. If the person is prime target, with each region run by creating a class needs to definitely consider. Entrusted to the agency's key performance improvements in order to improve the employment rate in the direction of promotional materials for the students selected to take advantage of college enrollment than the employment data for the students and their parents ilbango vocational courses for the purpose and intent is necessary to provide accurate information In addition, the employment rate is relatively low industrial (information) to install the school department employment, and employment representatives (industry-academia co-coordinator), and by placing career paths and industries to ensure the needs of industry, including working conditions and students who wish adjusting to the role, and industrial college (2 years), industrial (information) through the school's agreement to the aggressive promotional schemes seonchwieop hujinhak. Getting the need to encourage. Vocational courses ilbango in the new and the abolition, rather than the case of some popular course when you are away from work and there, so if the course-changing industry, new or repealed to reflect the demands of social work and careful review of how to connect carefully to decide by. Commissioned a systematic quality management in education, in terms of industry (information) schools and public vocational training institutions or private vocational school is better than school. However, 16 cities across the country. Also only five of the major cities around the school has industry information. Ilbango vocational courses at the expected continued demand. Degrees, the operation in terms of comparative advantage in many ways the school's new industry information is necessary to consider.

Medicolegal Problems in Pediatric Area (소아과 영역에서 의료분쟁)

  • Kwon, Soo Jeong;Jang, Ji Young;Kim, Nam Su;Yum, Myung Kul;Seol, In Joon;Jung, Ku Won
    • Clinical and Experimental Pediatrics
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    • 제48권8호
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    • pp.813-819
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    • 2005
  • Purpose : Medicolegal problems start when the patient asserts the mistake of doctor and doctor does not accept it. The purpose of this study is to assess the actual condition of medicolegal problems and to provide solutions of medicolegal problems in the pediatric field. Methods : There is not official statistical data about medicolegal problems in our country. We gathered data of legal insurance program of Korean Medical Association(KMA) and court cases and other fragmentary data. Results : Between 1981 and 1995, of total 2,338 cases reported to legal problem insurance program of KMA, most common ones were 748 cases of obstetrics and gynecology. Pediatric case was ranked at the 5th, 74 cases(3.1%). According to analysis of 41 medicolegal cases' after 1990, maltreatment of patient had the highest incidence of 14 cases, injection and medication were related to 12 cases, misdiagnosis was 9 cases, patient management were related to 4 cases, and others were 2 cases. The trial result of the medicolegal cases was that 31 cases were compensated, and 8 cases were defeated, and 2 cases were still in the process. Conclusion : The aspect of medical legal problem has the tendency of radicalism and systematization. This brings an economic destitution in the patient and gives damage to a doctor. In order to reduce medicolegal problem, doctor should offer a duty of explanation and efforts to his best to satisfy patient and endeavor to make an intimate doctor-patient relationship.

Remanufacturing of Commercial $V_2O_5-WO_3/TiO_2$ Catalyst used in the SCR Process of Incinerator (소각장 SCR 공정에서 사용되는 상용 $V_2O_5-WO_3/TiO_2$ 촉매의 재제조에 관한 연구)

  • Yoon, Goan-Gu;Yoo, Man-Sik;Lim, Jong-Sun;Kim, Tae-Won;Park, Hea-Kyung
    • Journal of Korean Society of Environmental Engineers
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    • 제27권9호
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    • pp.970-977
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    • 2005
  • The commercial $V_2O_5-WO_3/TiO_2$ catalysts which had been exposed to the off gas from incinerator for a long time were remanufactured by washing with distilled water and arid solution and reimpregnation with catalytic active components($V_2O_5-WO_3$). The catalytic properties and NOx conversion reactivity of those catalysts were examined by analysis equipment and NOx conversion experiment. Under the experimental condition used in this study, the remanufactured catalysts activated by distilled water ultra sonic cleaning, the catalytic activity was recovered in the range of $66{\sim}93%$ of that of the fresh and the maximum activity was showed when the ultra sonic cleaning time was more than 3 minutes. The remanufactured catalysts by acid solution ultra sonic cleaning, the catalytic activity was recovered in the range of $81{\sim}97%$ of that of the fresh catalyst and the maximum catalytic activity was shooed when the pH of the acid solution was 5. The remanufactured catalysts by reimpregnation with $V_2O_5$ and $WO_3$, the catalytic activity was recovered in the range of $87{\sim}100%$ of that of the fresh catalyst. Maximum catalytic activity was showed when the $V_2O_5$ was reimpregnated more than 1.0 wt %. In this case, the catalytic activity was recovered 97% of that of the fresh catalyst especially at the $150^{\circ}C$ of the experimental temperature.

Psychopathology, Self Esteem and Quality of Life in Cancer Patients with Radiotherapy (방사선 치료 중인 암환자의 정신병리, 자아존중감 및 삶의 질)

  • Jeong, Chan-Young;Yang, Jong-Chul;Shin, Il-Seon;Choi, Young;Yoon, Jin-Sang;Lee, Moo-Seok;Lee, Hyung-Young;Nah, Byung-Sik
    • Korean Journal of Psychosomatic Medicine
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    • 제10권2호
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    • pp.92-100
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    • 2002
  • Objectives : As medical science develops, survival rate of cancer patients rises. Therefore, psychologic understanding and improving quality of life in cancer patients is getting greater significance. The Object of this study is to investigate sociodemographic and clinical characteristics, psychopathology, self esteem and quality of life in cancer patients and to provide useful information for therapeutic approach to cancer patients. Methods : The subjects were 41 patents who had been treated by radiotherapy and 20 normal people. Sociodemographic information and clinical characteristics of cancer patients were investigated, and SCL-90R for psychopathology, Rosenberg Self-esteem Scale for self esteem, WHOQOL-BREF for quality of life were administered to subjects. The results of both groups were compared and analysed, and correlation between variables were evaluated. Results : 1) The tendency of Somatization, obsession-compulsion, depression, anxiety, hostility, phobia, psychosis in cancer group were higher than normal group. Especially, somatization and anxiety in cancer group were significantly higher than normal group. 2) Self esteem and quality of life in cancer group were significantly lower than normal group. 3) No significance were found in comparison of psychopathology, self esteem and quality of life according to sociodemographic variables. Among clinical characteristics, higher somatization was shown in case of more weight loss, and higher somatization and lower quality of life was shown in the presence of pain. 4) Higher anxiety was significantly associated with lower self esteem, and Higher somatization and anxiety was significantly associated with lower quality of life. Conclusion : Cancer patients had various kinds of psychopathology, low self esteem and low quality of life. In particular, somatization and anxiety, self esteem and pain were found to be important factors to quality of life of cancer patients. Therefore, management of psychopathology, improving self esteem, pain control is necessary to improve quality of life in cancer patients.

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Drainage Performance of Various Subsurface Drain Materials- (배수개선공법개발에 관한 연구(I) -각종 지하배수용 암거재료의 배수성능-)

  • 김철회;이근후;유시조;서원명
    • Magazine of the Korean Society of Agricultural Engineers
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    • 제21권3호
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    • pp.104-120
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    • 1979
  • I. Title of the Study Studies on the Development of Improved Subsurface Drainage Methods. -Drainage Performance of Various Subsurface Drain Materials- II. Object of the Study Studies were carried out to select the drain material having the highest performance of drainage; And to develop the water budget model which is necessary for the planning of the drainage project and the establishment of water management standards in the water-logged paddy field. III. Content and Scope of the Study 1. The experiment was carried out in the laboratory by using a sand tank model. The drainage performance of various drain materials was compared evaluated. 2. A water budget model was established. Various parameters necessary for the model were investigated by analyzing existing data and measured data from the experimental field. The adaptability of the model was evaluated by comparing the estimated values to the field data. IV. Results and Recommendations 1. A corrugated tube enveloped with gravel or mat showed the highest drainage performance among the eight materials submmitted for the experiment. 2. The drainage performance of the long cement tile(50 cm long) was higher than that of the short cement tile(25 cm long). 3. Rice bran was superior to gravel in its' drain performance. 4. No difference was shown between a grave envelope and a P.V.C. wool mat in their performance of drainage. Continues investigation is needed to clarify the envelope performance. 5. All the results described above were obtained from the laboratory tests. A field test is recommended to confirm the results obtained. 6. As a water balance model of a given soil profile, the soil moisture depletion D, could be represented as follows; $$D=\Sigma\limit_{t=1}^{n}(Et-R_{\ell}-I+W_d)..........(17)$$ 7. Among the various empirical formulae for potential evapotranspiration, Penman's formular was best fit to the data observed with the evaporation pans in Jinju area. High degree of positive correlation between Penman;s predicted data and observed data was confirmed. The regression equation was Y=1.4X-22.86, where Y represents evaporation rate from small pan, in mm/100 days, and X represents potential evapotranspiration rate estimated by Penman's formular. The coefficient of correlation was r=0.94.** 8. To estimate evapotranspiration in the field, the consumptive use coefficient, Kc, was introduced. Kc was defined by the function of the characteristics of the crop soil as follows; $Kc=Kco{\cdot}Ka+Ks..........(20)$ where, Kco, Ka ans Ks represents the crop coefficient, the soil moisture coefficient, and the correction coefficient, respectively. The value of Kco and Ka was obtained from the Fig.16 and the Fig.17, respectively. And, if $Kco{\cdot}Ka{\geq}1.0,$ then Ks=0, otherwise, Ks value was estimated by using the relation; $Ks=1-Kco{\cdot}Ka$. 9. Into type formular, $r_t=\frac{R_{24}}{24}(\frac{b}{\sqrt{t}+a})$, was the best fit one to estimate the probable rainfall intensity when daily rainfall and rainfall durations are given as input data, The coefficient a and b are shown on the Table 16. 10. Japanese type formular, $I_t=\frac{b}{\sqrt{t}+a}$, was the best fit one to estimate the probable rainfall intensity when the rainfall duration only was given. The coefficient a and b are shown on the Table 17. 11. Effective rainfall, Re, was estimated by using following relationships; Re=D, if $R-D\geq}0$, otherwise, Re=R. 12. The difference of rainfall amount from soil moisture depletion was considered as the amount of drainage required. In this case, when Wd=O, Equation 24 was used, otherwise two to three days of lag time was considered and correction was made by use of storage coefficient. 13. To evaluate the model, measured data and estimated data was compared, and relative error was computed. 5.5 percent The relative error was 5.5 percent. 14. By considering the water budget in Jinju area, it was shown that the evaporation amount was greater than the rainfall during period of October to March in next year. This was the behind reasonning that the improvement of surface drainage system is needed in Jinju area.

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Prediction of Dietary Protein-Energy Balance by Milk Urea Nitrogen and Protein Contents in Dairy Cow (젖소의 우유 중 단백질과 요소태질소 측정에 의한 사료의 에너지와 단백질 균형 상태 예측)

  • Moon, J.S.;Joo, Y.S.;Kang, H.M.;Jang, G.C.;Kim, J.M.;Lee, B.K.;Park, Y.H.;Son, C.H.
    • Journal of Animal Science and Technology
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    • 제44권5호
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    • pp.573-584
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    • 2002
  • Milk urea nitrogen (MUN) and Milk protein (MP) are being used as indicators of the protein-energy balance and for actual farm feeding practices. The purpose of this study was to investigate the MUN and MP concentrations of individual cows and bulk tank milk to evaluate the dietary protein-energy balance from lactating Holstein cows. Mean MUN and MP concentrations in the milk samples obtained from 132,636 cows of 4,856 herd during Jan. 1999 to Dec. 2001 were 16.2 5.2mg/dl and 3.30 0.35%, respectively. The highest values were found during summer and lowest valued during winter in MUN. But, the average contents of MP were the highest during winter and the lowest during summer. In order to evaluate protein-energy balance for feeding, we set the level of recommended MP range of 2.90${\sim}$3.29% in early lactation considering a negative energy balance. The recommended level of MP in mid-lactation and late lactation were set as 3.10${\sim}$3.49%, and 3.30${\sim}$3.69%, respectively. Recommended MUN range of 12${\sim}$18 mg/dl was determined through the whole lactation period. Individual cows milk were analyzed by the 9 types based on this levels of MP and MUN in this study. Among the total cows investigated, 26.8%, 25.8%, and 22.2% have shown the recommended criteria of MP and MUN values, respectively. Also, of total herds surveyed, 11.6% had MUN values lower than 12.0 mg/dl and 32.9% had values higher than 18.0 mg/dl and 44.5% of total herd have not met with the recommended criteria of MP values in bulk tank milk. In case of MP, out of the total herd surveyed, 26.0% had MP values lower than 3.10% and 24.0% had values higher than 3.30% and 50.0% had MP values outside the recommended interval (3.1${\sim}$3.3%). This study has indicates that many dairy farms are under improper feeding management practice of the dietary protein-energy balance.

Baby Food Knowledge, Attitudes and Practices of Multi-cultural Families in a Rural Area (일개 농촌지역 다문화가정의 이유식에 대한 지식, 태도 및 실천)

  • Kim, Min-Seo;Kim, Keon-Yeop;Kim, Kyeong-Na;Kim, Kwang-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • 제18권7호
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    • pp.500-509
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    • 2017
  • This study was conducted from December 2015 to March 2016 to investigate the knowledge, attitude, and practice of baby foods in rural multi-cultural families. The survey included the general characteristics of households and infants, knowledge, attitude, and practice of baby food. The results indicated that the mean score of baby food knowledge was 3.79, 4.07 for attitudes, and the practice group was 25.0%. In the knowledge of baby food, the groups with a total number of two or more children, high educational background for both the father and mother, Chinese or Japanese nationality, high Korean language ability, and marriage for at least 6 or more years was higher (p<0.05). In the attitude of baby food, the groups with a total number of two or more children, a higher mother's Korean language, and the mother in charge of the baby food were higher (p<0.05). In the case of baby food practice, the groups the baby mother was from Japan and Cambodia, there was no occupation, and the mother was in charge of the baby food were higher (p<0.05). Knowledge and attitude according to the practice of baby food showed a higher knowledge (p <0.001) and attitude in the weaning practiced group than unpracticed. To produce baby food for infants in multi-cultural families, it is important to improve the Korean language ability of infant mothers who are in charge of baby food, and it is necessary to provide correct information related to infant formula utilizing the supporters of the neighboring mothers. In addition, it is necessary to provide customized education and support that is contingent upon the nationality of the native people while remaining mindful of the cultural implications of multi-cultural families.