• 대한간호학회지
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• 제53권3호
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• pp.275-294
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• 2023

Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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• pp.5089-5095
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• 2014

Background: As a common and essential contrast medium at present, gadobenate dimeglumine has shown better performance than some other agents when applied to Breast Magnetic Resonance Imaging Screening (Breast MRI Screening). Nevertheless, reports on the diagnostic performance of these two mediums (gadobenate dimeglumine and gadopentetate dimeglumine) are not completely consistent. Objective: To assess the diagnostic value of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening in patients suffering from breast cancer and to provide more convinced evidence to guide clinical practice in terms of appropriate contrast agents. Data Sources and Review Methods: Original articles in English and Chinese published before January 2013 were selected from available databases (The Cochrane Library, PUBMED, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Journal Full-text). The criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis. Then, the area under curve (AUC) of SROC and the spearman rank correlation of sensitivity against (1-specificity) were calculated. Results: Total of 17 researches involving 1934 patients were included. The pooled sensitivity of gadobenate dimeglumine and gadopentetate dimeglumine were 0.99 (0.97, 1.00) and 0.93 (0.88, 1.00) respectively. The pooled specificity for these two contrast agents were 0.924 (0.902, 0.943) and 0.838 (0.817, 0.858) respectively, and the AUC of SROC curve were 0.9781 and 0.9215 respectively. Conclusions: Gadobenate dimeglumine can be regarded as a more effective and feasible contrast medium for Breast MRI Screening. At least 5% differences in diagnostic performance are usually considered as clinically relevant.

• 융합신호처리학회논문지
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• 제21권2호
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• pp.61-66
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• 2020

최근 치과 시술을 위한 국소마취 시 시술자의 피로감을 줄이고 수동 마취기의 단점을 보완한 다양한 전동형 마취액 주입기가 개발되어 임상에서 사용되고 있다. 이러한 전동형 마취액 주입기기에서는 약물 주입을 위한 압력을 정확하고 일정하게 전달하는 것이 매우 중요한 성능 요소이다. 이러한 전달 압력의 정확성을 평가하기 위하여 로드셀을 이용한 소형의 압력계가 많이 사용되는데, 로드셀 내부의 탄성체가 충분한 변위를 수용할 수 없는 경우가 있어 압력 성능 평가 시 오차를 발생시킬 수도 있다. 이에 본 연구에서는 로드셀 방식의 압력측정기를 이용하여 압력 제어형 압력 인가 장치의 성능을 평가할 때 사용 가능한 비교적 큰 변위 수용이 가능한 실리콘-크롬강(Si-Cr강) 스프링 지그를 제안하였으며 유효성을 평가하였다. 제안된 스프링 지그의 압력 전달률과 상용의 치과용 마취액 주입장치를 이용한 반복 측정 결과, 스프링 지그 사용 시 보다 안정적인 결과를 얻을 수 있었으며, 비정상적으로 높게 측정되는 빈도가 줄어드는 것을 확인할 수 있었다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6293-6299
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• 2013

Background: A number of clinicopathologic factors have been found to be associated with pathological lymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensive high resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study was designed to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM in rectal cancer. Methods: A cohort of 469 patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical, laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model, areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used. Results: Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNM by multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominal pain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95% CI, 1.041-3.392; P=0.036), and direct $bilirubin{\geq}2.60{\mu}mol/L$ (OR=1.540; 95% CI, 1.054-2.250; P=0.026). The combination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60 yr and direct $bilirubin{\geq}2.60{\mu}mol/L$ were found to be associated with prognosis. Conclusion: Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.

• Korean Circulation Journal
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• 제53권7호
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

• Journal of Microbiology and Biotechnology
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• 제34권8호
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• pp.1617-1626
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• 2024

Various antibiotic-resistant bacteria (ARB) are known to induce repeated pulmonary infections and increase morbidity and mortality. A thorough knowledge of antibiotic resistance is imperative for clinical practice to treat resistant pulmonary infections. In this study, we used a reads-based method and an assembly-based method according to the metagenomic next-generation sequencing (mNGS) data to reveal the spectra of ARB and corresponding antibiotic resistance genes (ARGs) in samples from patients with pulmonary infections. A total of 151 clinical samples from 144 patients with pulmonary infections were collected for retrospective analysis. The ARB and ARGs detection performance was compared by the reads-based method and assembly-based method with the culture method and antibiotic susceptibility testing (AST), respectively. In addition, ARGs and the attribution relationship of common ARB were analyzed by the two methods. The comparison results showed that the assembly-based method could assist in determining pathogens detected by the reads-based method as true ARB and improve the predictive capabilities (46% > 13%). ARG-ARB network analysis revealed that assembly-based method could promote determining clear ARG-bacteria attribution and 101 ARGs were detected both in two methods. 25 ARB were obtained by both methods, of which the most predominant ARB and its ARGs in the samples of pulmonary infections were Acinetobacter baumannii (ade), Pseudomonas aeruginosa (mex), Klebsiella pneumoniae (emr), and Stenotrophomonas maltophilia (sme). Collectively, our findings demonstrated that the assembly-based method could be a supplement to the reads-based method and uncovered pulmonary infection-associated ARB and ARGs as potential antibiotic treatment targets.

• 간호행정학회지
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• 제6권2호
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• pp.259-279
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• 2000

This study is a descriptive analytic research measuring nursing service quality, using SERVQUAL model, to make fundamental data and strategies for nursing service improvement. Data were collected by self-reported questionnaire from 202 patients and 142 nurses, from June 7 to 14, 1999. The reliability of instrument were adequate(Cronbach ${\alpha}=.94$). SAS program was utilized for statistical analysis of collected data. The results were as follows; 1. There was a gab between patient's expectation and perception on nursing service(Gap B). Gap D was indicated an affecting factor to decide nursing service quality. Gap C was indicated an indirect affecting factor of nursing service quality. Because it was not statistically significant in total item analysis, but in individual item analysis, 7 items were appeared statistically significant. Gap A was not a gap occurrence factor of nursing service quality. 2. Focuses of nursing service quality improvement strategies were; (1) to direct qualitative improvement of nursing service in order to correspondence patient's nursing service expectation. (2) to make nurse's service activity modified because nurse's practice were not reached patient's expectation level. (3) to need internal, external factor analysis affecting nurse's service activity. 3. Nursing service quality was decided by rather environmental inappropriateness provided nursing service than itself. Therefore, to make nursing service quality improvement, it is required to improve nursing service environment. For this, followings are required; (1) to strengthen nurse's education on lower part of nursing service satisfaction and QI activities. (2) to balance demand and supply of nursing personnel. 3) to fix computerized system for reducing other duties weight except nursing care through analysis of nursing activity. (4) to construct rational cooperating system among related departments. 4. The important parts for nursing service quality improvement were indicated as follows: (1) Gap B: 'prompt reaction', 'examination symptom before patient's complaint', 'hearted nursing service reducing patient's dissatisfaction', 'explanation goals of nursing activities', 'having special Knowledge enough', 'maintenance position comfortably', 'management of patient's physical hygiene'. (2) Gap C: 'maintenance physical safety', 'explanation about hospital rules and facilities'. (3) Gap D: 'tender, safe injection and wound care'. Because above items are mostly improved through nurse's attitude change and quality improvement, it is required to establish nursing standardization and to strengthen nurse's clinical education. As the based on above results, followings are suggested; 1. SERVQUAL model is very useful to make strategies for nursing service quality improvement because it indicates multiple factors affecting hap occurrence. 2. At individual items analysis of Gap C, statistically significant 7 items appeared higher nurse's perception level than patient's perception level on nursing service were trouble perception level on nursing service quality improvement. So. it need further research to analysis about these difference occurring factors. 3. At analysis of Gap D, it is indicated that in nursing service performance process, multiple factors lowing nursing service quality were intruded. So it needs further research to analysis what these factors are and how each factors affect on nursing performance process. 4. nursing service quality measurement is changeable according to sample select time or sampled subject's characteristics. So to develope strategy for nursing service quality improvement is based on the results of periodical analysis.

• 대한수학교육학회지:학교수학
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• 제15권1호
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• pp.101-120
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• 2013

본 연구에서는 수학과 학습 개선 방안 탐색을 위하여 본 연구에서는 중학교 3학년 학생을 대상으로 함수 영역과 관련된 과제를 기반으로 하는 심층 면담을 실행하여 우리나라 중학생의 학습양식에서 나타나는 경향성을 탐구하였다. 심층면담에서 학생들이 제시된 과제를 해결한 뒤 해결방법에 대해 설명하는 과정에서 연구자는 학생들이 과제 해결에 활용한 수학적 아이디어가 형성된 배경에 대한 추가 질문을 제기하는 방식으로 그들의 학습양식에 관한 자료를 수집하였다. 면담 자료 분석 결과, 우리나라 중학생들의 대표적인 학습양식으로 '사례 중심의 귀납적 학습', '유형 중심의 문제 풀이 학습', '몰입없는 학습', 그리고 '학습태도의 이중성'을 도출하였고 면담 자료에 기초하여 이들 학습양식의 특징을 서술하였으며 수학과 교수-학습 개선을 위한 시사점을 논의하였다.

• 한국산학기술학회논문지
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• 제21권1호
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• pp.223-231
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• 2020

본 연구는 간호학생을 대상으로 HPS를 활용한 뇌경색환자 간호과정 시뮬레이션 시나리오를 개발하고 적용하여 전통적 강의방식과 그 효과를 비교·평가해 보고자 함이다. 본 연구는 2018년 11월 27일부터 12월 26일까지 간호대학의 4학년 학생을 대상으로 하였으며, 실험군 38명, 대조군 39명으로 최종 77명을 대상으로 하였다. 본 연구는 분석단계와 연구 설계단계를 거쳐 개발단계에서 시나리오를 개발하여 적용하는 과정을 거쳤다. 실험군과 대조군의 중재 전, 후의 자신감, 이론적 지식, 임상수행기술은 t-test를 통해 분석하였다. 본 연구결과 뇌경색 환자에 대한 간호과정을 기반으로 한 시뮬레이션 시나리오가 개발 되었으며, 이는 3가지 간호진단을 유추할 수 있도록 설계되었다. 연구결과 두 그룹 모두 임상수행기술을 제외한 사전사후 점수가 통계적으로 유의하였으며, 실험군과 대조군간 사후점수 및 사전, 사후의 차이검증에서 실험군이 유의하게 높게 나타났다. 본 연구는 표준화된 뇌경색환자 간호과정 시뮬레이션 시나리오를 개발하였다는 점에서 의의가 있다. 또한 개발된 시나리오가 실습 뿐 아니라 이론적 학습까지 통합할 수 있는 교수학습방법으로의 가능성을 보여주고 있다.

• 한국방사선학회논문지
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• 제16권5호
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• pp.513-518
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• 2022

전자선의 정도관리(quality assurance, QA)는 정확한 방사선 치료를 위해 정기적으로 이루어져야한다. 하지만 임상에서 사용되는 QA도구는 X선 위주로 설계되어 있어서 전자선 전용의 QA 선량계가 요구된다. 이에 본 연구에서는 방사선 검출 효율이 뛰어난 브롬화탐륨 물질을 전자선 센서로 활용하여 전자선 검출성능을 측정하고 전자선 전용의 QA 선량계로 적용가능할지를 평가하였다. 평가항목은 재현성, 선형성, 선량률 의존성이며, 선형가속기의 6 MeV, 9 MeV 에너지에서 평가하였다. 재현성 결과, 6 MeV에서는 최대 0.92%, 9 MeV에서는 최대 1.15%의 출력변화를 보여주었다. 선형성 결과평가, 결정계수 R²이 0.9998로 제시되었다. 선량률 의존성 평가 결과, 6 MeV에서는 상대표준편차 0.51%, 9 MeV에서는 상대표준편차 1.07%의 선량률 의존성이 제시되었다. 본 연구에서 제작한 TlBr 센서는 재현성, 선형성, 선량률 의존성의 모든 평가기준을 만족하는 검출성능을 보여준다. 이러한 결과들은 TlBr 선량계가 전자선 전용 QA 선량계로 적용 가능한 것을 의미한다.