• Title/Summary/Keyword: Case management

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Influence of Total Laryngectomy on Spinal Cord Dose in Advanced Laryngeal Cancers (진행된 후두암 환자에서 후두전절제술에 의한 척수선량 변화)

  • Kim, Jae-Cheol;Kim, Sung-Hwan;Park, In-Kyu
    • Radiation Oncology Journal
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    • v.14 no.2
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    • pp.167-173
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    • 1996
  • Purpose : This analysis was to evaluate the radiation dose around a tracheostoma and spinal cord in the case of advanced laryngeal cancers in which a total laryngectomy was done before radiotherapy. Materials and Methods : The radiation dose around a tracheostoma and spinal cord was measured by thermoluminescence and film dosimetry in the phantom, Radiotherapy treatment planning was done in 12 cases of advanced laryngeal cancer and compared with the measured dose in the phantom. Results : Mean spinal cord doses in the phantom by thermoluminescence dosimetry were $86.4\%$ (with a tracheostoma), $80.1\%$ (without a tracheostoma), and the difference was $6.3\%$. Mean spinal cord doses in the phantom by film dosimetry were $84.7\%$ (with a tracheostoma), $79.0\%$ (without a tracheostoma). and the difference were $5.7\%$. Calculated spinal cord doses in the phantom were $84.0\%$ (with a tracheostoma), $78.0\%$ (without a tracheostoma), and the difference was $6.0\%$. Mean calculated spinal cord doses in 12 patients were $83.1\%$ (with a tracheostoma), $76.9\%$ (without a tracheostoma). and the difference was $6.2\%$. Measured dose of lateral and posterior wall of the tracheostoma by film was low (depth of maximum dose = 12 mm). Conclusion : In the treatment planning of the advanced laryngeal cancers, the radiation dose of the tracheostoma and spinal cord should be evaluated and be followed by an appropriate management such as a bouls or a brachytherapy boost if the dose around the tracheostoma is low.

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A Study of Health Condion and Shift Service of the Nurse in (종합병원 간호사의 교대근무와 건강상태에 관한 연구)

  • Kim, Soon-Ok
    • Journal of Korean Academy of Nursing Administration
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    • v.3 no.1
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    • pp.119-133
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    • 1997
  • Continuing shift service of clinical nurses can be not only the cause of occupational dissatisfaction by being connected with the change of circadian rhythm and the burden of duties to be applicable to such changes. But also of inviting the lowering of nursing quality by being affected to the resignation of the nurses as the threat to the health of the nurses. This study has selected 500 nurses at random under non-probability sampling who have been serving by shift in 7 general hospitals which have over 400 sickbeds for the purpose of cross-sectional survey design from Sep. 7 through 20, 1996. Standardized modification of the CMI has been used which was designed for Koreans with Cornell Medical Index developed by Broadman and his fellow workers as the study device. The structure of the device was composed of 35 questions on physical appeal(Chronbach's ${\alpha}=8507$) and 22 questions of mental appeal(Cronbach's ${\alpha}=.8166$ totalling 57 questions. The collected data has been computerrized by using SPSS. General character, present symptom, perceived symptom and others are sought by practical number and percentage, and the health condition comparison followed by general characters was conducted by t-test and ANOVA. The post test was by Duncan's test by the level of p<.05. 1) The items of the answer that they have the physical symptom presently by 50% or over of the nurses were as "Do you often have spells of severe dizziness", "Are your eyes often red or inflamed", "Does press or pain in the head often make like miserable", "Are your ankles often badly swollen", "Do pains in the back make it hard for you to keep up with your work". 2) The items of the answer by over 50% of the nurses as the mental symptom at present were "do you fell bad when criticized?", "Do you get angry when everything is against your will?", "do you get angry when ordered to do this and that?", "do you feel uneasy by such a trifle thing?", "do you tremble or are you freightened by sudden sound?". The mental and physical symptoms which have appeared presently in connection with the shift service have been agreed with each other. But the physical condition has been worse than the mental one. 3) In the physical health conditions followed by demosociological character, there were the significant differences by sex, religion and place of residence(p<.05), and in the mental health conditions, there were the significant differences by age, marital status, residence place and the required time for attending hospital(p<.05). 4) There was significant difference by the degree of satisfaction about the duty in both the physical and mental health conditions. In short, the higher the degree of duty satisfaction, the better the health conditions. 5) There were the significant difference according to the times of night duty and whether they take the drug or not or the kinds of the drugs in the physical health conditions related with the characters of night shift. Mental health conditions in the night shift case showed significant differences according to their taking drug or not or the kinds of the drugs(p<.05). I can confirm that the nurses have been affected continuously by the shift service mentally and physically. The maintenance of the physical and mental health of the nurses and its promotion are very important problem to guarantee the quality nursing in the performance of the nursing service continuously and effectively, so the hospital should make every effort to improve the duty conditions by finding out the causes affecting to their health. In the nursing management viewpoint, I think that elevating the satisfaction degree about the duty would be a great help to the promotion of physical and mental health conditions. But what is most important is that the nurses themselves should take care of themselves in maintaining the good conditions in their service in the hospital.

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Tourism and Cultural Landscape at the Tengger, East Java, Indonesia: The Implications for Ecotourism Planning (인도네시아 동자바의 텡거마을의 문화경관과 관광 -생태관광계획에 대한 영향-)

  • Hakim, Luchman;Hong, Sun-Kee;Kim, Jae-Eun;Nakagoshi, Nobukazu
    • Korean Journal of Environment and Ecology
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    • v.22 no.3
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    • pp.207-220
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    • 2008
  • Tourism in the natural environment grows significantly and in many tropical countries it becomesthe important earning of the nations. Nevertheless, tourism impact to environment and cultural values has become the threats to the sustainability and competitiveness of such industry. Therefore, the appropriate planning and management of tourism destination sites where environmentally and culturally fragile are needed in order to increase economic benefits, sustain local culture and conserve environment in balance. The aims of the paper are to examine tourism practices, to determine socio-cultural and natural resources, and to assess local people perception to cultural landscape and its future tourism development in order to formulate the appropriate strategies to achieve sustainable tourism. A case study was carried out at Tengger highland, Bromo Tengger Semeru National Park(BTSNP) East Java. Official documents were gathered and interviews with several key persons had conducted to determine recent status of tourism, resources capital and the existence of local people. Semi-structured interviews and questionnaires were carried out at Tenggerese villages to explore local people perspectives to tourism development, culture preservation, and cultural landscape conservation issues. It is followed by descriptive analysis of vegetation to assess the recent status of environments based on vegetation information. Our findings reveals that tourism grows significantly at BTSNP, and Tengger Caldera as spiritual and cultural sites for local people become the centre for tourism activities. The abundance cultural and natural resources are the significant capital for sustainable tourism. Tenggerese argues that tourism should be planned to provide benefits to local people, preserve tradition and able to conserve nature in order to ensure the living sustainability of Tenggerese. The overall result of the study provide general feature of recent status of the cultural and natural resources as well as positive society perception in order to establish a strategy for sustainable tourism in cultural landscape.

Analysis of Safety Education Contents of 『Field of home life』 in Technology·Home Economics Textbook developed by the revised curriculum in 2009 (2009 개정 기술·가정 교과서 『가정생활영역』의 안전교육 내용 분석)

  • Kim, Nam Eun
    • Journal of Korean Home Economics Education Association
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    • v.29 no.2
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    • pp.23-39
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    • 2017
  • The Purpose of this study is to present the basic data for selecting and improving the safety education contents which help practically middle school students through analysis of contents of safety education in 'field of home life' of 2009 revised middle school textbooks. The subjects of analysis are 12 types of middle school textbooks: in total 24 books written by 12 publishers in terms of the revised curriculum in 2009. The analysis criteria is developed by the researcher referring to preceding studies regarding safety education based on the seventh safety education standard presented by the Ministry of Education (2015). With such analysis criteria, all words related to the contents of the safety education of analysis criteria were extracted from each textbook, such as words directly mentioned as 'safety', words mean as 'psychological safety' and 'happy life', words related to 'attention', 'note', 'stability' etc. Under the analytic frame of safety education contents according to a home economics textbook, content analysis method was used for producing the frequency and percent of those words. The textbook analysis shows that the number of pages regarding safety education is 336.3 pages, as 9.8% in total 3,412 pages of 12 types of technology and home economics textbooks. As following the analysis of each textbook volume of the proportion in the contents related to safety education, 224.9 pages are on the first volume and 111.9 pages are on the second volume. As grades increase from year one to year three, the proportion of safety education in home economics textbooks is decreased. The highest number of safety education contents unit is 'Self-management of youth' which includes three parts of safety education. In the case of a unit for emphasizing practice, experience and practical exercise such as 'Life of youth' and 'Practice of eco-living', safety education content in the area of 'life safety' are mostly contained. Safety accidents related to the most student experienced, Household accidents (1.4%) and experiment or practice accidents (0.3%) are presented in a low figure. The contents of universal housing and school violence are duplicated on first and second volume of text. The most presented safety education content in the 12 types of textbooks are proper sexual attitude, dietary problems, family conflict and food choice. The least common contents are dangerous drugs, family welfare, internet addiction and industrial accident compensation insurance. As this study is to analyze 12 textbooks developed in 2009 revision curriculum, it is necessary to compare it with the textbook written by the revised curriculum in 2015 and to clarify the contents system of safety education and to avoid duplication of contents. In addition, it is necessary to develop and distribute a safety education program that can support textbooks.

Transcatheter Arterial Embolization in the Treatment of Massive Hemoptysis (대량 객혈 환자에서 동맥 색전술의 치료 효과)

  • Choi, Wan-Young;Choi, Jin-Won;Lim, Byung-Sung;Shin, Dong-Ho;Park, Sung-Soo;Lee, Jung-Hee;Seo, Heung-Suk
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.1
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    • pp.35-41
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    • 1992
  • Background: Massive hemoptysis is a major clinical and surgical problem related to high motality. Bronchial and nonbronchial systemic arteries are considered to be the main source of hemoptysis. Embolization of these arteries has become an accepted treatment in the management of massive hemoptysis. Herein we evaluate the effect of arterial embolization in immediate control of massive hemoptysis and investigate the clinical and angiographic characteristics and the course of patients with recurrent hemoptysis after initial successful embolization. Method: 21 patients (15 men & women, aged 21 to 74 years) underwent transcatheter arterial embolization for the treatment of life-threatening massive hemoptysis from Jan 1988 to July 1991. Seven patients had inactive residual pulmonary tuberculosis, 5 cases aspergilloma, 4 cases active pulmonary tuberculosis, 3 cases bronchiectasis and 2 case lung cancer. Arteriography was done by percutaneous catheterization via the femoral artery, and at the same time, arterial embolization was done with gelfoam particle. Result: Immediate control of massive hemoptysis was achieved in all 21 cases by arterial embolization. Hemoptysis recurred in nine of 21 patients. Four cases were aspergilloma, two inactive tuberculosis, two lung cancer, and one bronchiectasis. The initial angiographic findings revealed that nonbronchial systemic arterial supply, bronchial-pulmonary arterial shunt, and marked vascularity were more frequently, but statistically insignificant, in recurred patients. The following complications occured: fever, chest pain, cough, voiding difficulty, paralytic ileus, paraplegia, and splenic infarction. The course of the recurred patients was as follows: Three patients were died due to recurred massive hemoptysis. one was aspergilloma and two lung cancer. Surgical resection could be performed successfully in two patient with relatively good lung function, one aspergilloma and the other inactive tuberculosis. In 4 patients with poor lung function, repeated embolization or medical conservative treatment was continued. Conclusion: Arterial embolization as initial treatment of massive hemoptysis is most useful and relatively safe, although this is a palliative procedure and the potentiality for recurrence exists. Repeated embolization in inoperable patient with recurrent bleeding may improve the lengthening of life.

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Bronchoscopy and Surgical Lung Biopsy for the Diagnosis and Management of Pulmonary Infiltrates in Immunocompromised Hosts (면역저하환자에서 발생한 폐침윤에서 기관지내시경과 수술적 폐생검의 유용성)

  • Park, Sang-Joon;Kang, Soo-Jung;Koh, Young-Min;Suh, Gee-Young;Kim, Ho-Joong;Kwon, O-Jung;Lee, Hong-Ghi;Rhee, Chong-H.;Chung, Man-Pyo
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.2
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    • pp.195-208
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    • 1999
  • Background: Pulmonary infiltrate in immunocompromised hosts has many infectious and non-infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. Methods: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. Results: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F=46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantation(n=11), solid tumor(n= 12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchiallung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. Conclusion: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.

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A Study of variables Related to Nursing Productivity (간호생산성에 관한 연구: 관련변수의 검증을 중심으로)

  • 박광옥
    • Journal of Korean Academy of Nursing
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    • v.24 no.4
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    • pp.584-596
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    • 1994
  • The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

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Derivation of Success Elements for the Sustainability of Landscape Agreements - A Case Study on Ongjin-gun Mungab Island and Suwon Gobuk Market - (경관협정의 지속성을 위한 성공요소 도출 - 옹진군 문갑도와 수원시 거북시장길 사례분석을 통하여 -)

  • Park, Hye-Eun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.47 no.6
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    • pp.24-36
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    • 2019
  • This study shows that the role of residents in landscape management is becoming increasingly important. The purpose of this study is to suggest elements that can continue the operation of landscape agreements and directions for promoting them. Therefore, 1)the operational elements considering the sustainability of the landscape agreements were proposed by way of literature research, expert interviews, and surveys. 2)The sustainable operation of elements of the landscape agreement were applied and best practices were developed through interviews with participants and literature analysis. 3)The final plan operational elements considering the sustainability of the landscape agreements and the directions for implementation were presented. As for the results, it was first presented that the elements of continuous operation of the landscape agreement, consisted of 3 major categories, 10 subcategories, and 25 details. These include resident awareness, practical applicability, effectiveness of administrative means, securing the budget, maintenance, public relations, expert support, dedicated support organization, sustainability of participation, and resident participation and communication methods. It is a detailed list of items that should be considered in the preparation phase, maintenance phase, and conclusion phase. Second, it suggested the direction for the sustainable operation of the landscape agreements be highly backed by the residents, and after reaching consensus on a landscape agreement, it is necessary that the agreement is based on contents that the residents can execute themselves. In addition, it was found that there is a need for a system to prepare the basis for securing the budget for the continuity of work, preparation of the landscape agreements, and consultation and activity costs during the maintenance phase. In addition, continuous exchanges and capacity building among residents have signed landscape agreements, and step-by-step support from experts in accordance with the level of involvement of residents is necessary. Third, even if a landscape agreement is concluded in connection with public projects, it is understood that the residents have the capacity to participate and can continue to support the administration and experts to enable the continued operation of the landscape agreement.

Effect of Health Promotion and Characteristics of Elderly used Day Care Service in Community Health Practitioner's Post (보건진료소의 주간보호실 이용노인의 특성과 건강증진 정도)

  • Jeong, In-Suk;Cho, Yoo-Hyang;Park, Yoon-Chang
    • Journal of agricultural medicine and community health
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    • v.27 no.2
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    • pp.127-136
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    • 2002
  • This study was taken to provide data for the approaches of day care service for the elderly in community health practitioner's post through the study on the utilization rate, characteristics and health promotion that the elderly used the day care services. Data collection used three records that case management in take sheet, dementia check list and ADL record during the one year, from June 21, 2001 to June 30, 2002. During the one year, the elderly used day care services were 119 persons that 26.9% of the total elderly population, 1.5 time per used the elderly, and female elderly(88.9%) more used than male elderly. 39.5%of the elderly user have chronic diseases that was arthritis and hypertension and etc. 41.2% of the elderly users have dementia state that score was $17.39{\pm}7.17$(handicapped elderly), $18.43{\pm}7.36$(healthy elderly), but statistically not significant PADL score was $2.18{\pm}0.55$(handicapped elderly), $2.78{\pm}0.30$(healthy elderly), IADL score was $1.78{\pm}0.51$(handicapped elderly), $2.47{\pm}0.60$(healthy elderly) that were statistically significant. One year later, PADL and IADL of the elderly users were improved that statistically significant(p=0.01). The elderly users were wanted rehabilitation service(22.2%), talking service(20.6%), bath service(12.7%), food service(9.5%) of day care services in CHP's post. We are recommended that day care service for the elderly in CHP's post was very useful and contributed to promote ADL functions.

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The Status of Nursing Ethics Education in Korea 4-year-College of Nursing (간호윤리 교육현황 - 4년제 대학교육을 중심으로 -)

  • Han Sung-Suk;Kim Yong-Soon;Um Young-Rhan;Ahn Sung-Hee
    • The Journal of Korean Academic Society of Nursing Education
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    • v.5 no.2
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    • pp.376-387
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    • 1999
  • Purpose : To provide fundamental data to present further direction of education on Nursing Ethics by investigating the status of Nursing Ethics education performed at 4-year-Colleges of Nursing. Korea. Methods : A descriptive survey study The data collected from 28 universities through a questionnaire to examine the status of Nursing Ethics education in Korea. Results : I. Teaching Nursing Ethics class as a independent subject-6(21.4%) universities. 1) The average of 23.67 hours(2 credits) in the total educational hours. 2) Teaching method-theoretical class, discussion of case study, discussion of related issues, presentation of video tapes and discussion, team education, role play, and submission of reports. 3) Education contents-Nursing profession and ethics, the dignity of human life, necessity of bioethics, ethical theory and refutation, code for nurses, ethical issues between nurses and patients, nurses and co-workers, and nurses and nurses 6 universities 4) 5 universities-Included ethical decision making, artificial insemination, external insemination, artificial abortion, organ transplantation, brain death, human subject of study suicide, and euthanasia. II. Teaching Nursing Ethics as an inclusive theme in other subjects-22 (78.57%) universities. 1) Educated in Introduction of Nursing (14 universities), Nursing Management, Nursing Ethics and Philosophy, Special Nursing, Nursing and Law, and Professional Nursing. 2) Educational course-Taught in freshman level at 14 universities, average 9.32 education hours. Conclusion: Showed not only that universities, not operating Nursing Ethics as a independent class, unreasonably operate and assign too many contents in comparing with its education hours and are likely to become only a cramming education but also professors whose major is not Nursing Ethics presently in charge need to take a chance to supplement their knowledge and teaching method.

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