• Journal of Trauma and Injury
• /
• v.25 no.4
• /
• pp.159-165
• /
• 2012

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was $6.4{\pm}2.0$. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.19 no.11
• /
• pp.126-136
• /
• 2018

The purpose of this study was to develop a severity-adjustment model for predicting mortality in acute stroke patients using machine learning. Using the Korean National Hospital Discharge In-depth Injury Survey from 2006 to 2015, the study population with disease code I60-I63 (KCD 7) were extracted for further analysis. Three tools were used for the severity-adjustment of comorbidity: the Charlson Comorbidity Index (CCI), the Elixhauser comorbidity index (ECI), and the Clinical Classification Software (CCS). The severity-adjustment models for mortality prediction in patients with acute stroke were developed using logistic regression, decision tree, neural network, and support vector machine methods. The most common comorbid disease in stroke patients were hypertension, uncomplicated (43.8%) in the ECI, and essential hypertension (43.9%) in the CCS. Among the CCI, ECI, and CCS, CCS had the highest AUC value. CCS was confirmed as the best severity correction tool. In addition, the AUC values for variables of CCS including main diagnosis, gender, age, hospitalization route, and existence of surgery were 0.808 for the logistic regression analysis, 0.785 for the decision tree, 0.809 for the neural network and 0.830 for the support vector machine. Therefore, the best predictive power was achieved by the support vector machine technique. The results of this study can be used in the establishment of health policy in the future.

• Korean Journal of Radiology
• /
• v.23 no.8
• /
• pp.811-820
• /
• 2022

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

• Journal of Environmental Policy
• /
• v.2 no.1
• /
• pp.31-49
• /
• 2003

It is difficult to examine the causal relation of pollution damages because the time gap between pollution cause and effect is large and new pollutants are continuously being produced. Their many environmental effects are not promptly studied. As both the study of causal relation about pollution and the pollutant treatment are becoming highly advanced by the development of science and environmental technology, both the economy and balance on environmental regulation may be discussed. It is reasonable to decide environmental policy in consideration of close relation between both the generation and resolution of environmental problems and of technological developments because environmental problems are related to complicated social problems and scientific technologies. First item in policy decision about environmental control and management is preferentially to consider the way of prevention. It is necessary to prevent pollution by regulating the installment of environmental pollution facility into the environmentally sensitive areas, like water supply source and to regulate land utilization as a method to achieve pollution prevention. Second is a consideration of environmental technology development. This is a solution which can accomplish the development of environmental technology and the reinforcement of economic competition. Third is the coexistence of environment and economy. It is necessary to consider economy in connection with environmental problems and environment in economic problem. Then, we can enjoy a healthy life as well as economic affluence. Fourth is the enlargement of environmental management means. Environmental management means must be diversified because environmental cause and effect are varied. For Improving the land use regulation system, it is necessary to consider both land use regulation status and pollutant toxicity with the development of environmental technology. Land use must be approached by classifying land to 3 levels; water source protection zone and water front zone, special zone 1 and 2, rancus and other zones. Land regulation policy to prevent any accident in water source protection zone, waterfront zone, and special zone must be continuously upgraded. However, economical consideration in other zones is required by the development of environmental technology.

• Journal of Korean Society for Quality Management
• /
• v.39 no.3
• /
• pp.391-399
• /
• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• Proceedings of the Korea Water Resources Association Conference
• /
• 2006.05a
• /
• pp.1182-1186
• /
• 2006

The decision of design flood in river basins is very important in the aspect of flood control. The design flood of rivers was estimated according to the size and importance of basins. As the damage of floods increases more and more and the importance of defense against floods increases further, the presumption of design flood can be very important. Especially, what influences most greatly flood is rainfall. However, in spite of equal rainfall, the estimated flood differ according to the features of basins. The fact that the features of basins influence greatly the estimation of flood was confirmed by the preceding research results and experiences. However, although many rivers have their own basin features, the research on how these basin features are related to the estimation of design flood, is not yet sufficient. The purpose of this study is to identify how the design flood estimated previously by river arrangement basic plan is correlated with topography factors, and so investigate the correlation between basin topography factors and design flood in order to provide the additional information for the unmeasured basins or the middle/small river basins where their river plan is not established.

• Water for future
• /
• v.20 no.4
• /
• pp.267-278
• /
• 1987

This study aims at the decision of geomorphologic instantaneous unit hydrograph(GIUH) model parameter fore the ungaged or the data deficiented Basin, to analyze rainfall runoff relation in river basin by applying queueing theory with geomorphologic factors.The concept of GIUH model is based upon the principle of queueing theory of rain drops which may follow many possible routes during rainfall period within watershed system to ist outlet. Overland flow and stream flow can be simulated, respectively, by linear reservoir and linear channel conceptual models. Basically, the model is a mon-lineal and time variant hydrologic system model. The techniques of applying are adopted subarea method and mean-value method, the watershed is divided according to its stream number and order. To prove it to be applicable, the GIUH model is applied to the Wi-Stream basin of Nak-Dong River(Basin area; 475.53$\textrm{km}^2$), southen part of Korea. The simulated and the observed direct runoff hydrographs are compared with the peak discharge, times to peak and coefficients of efficiency, respectively, and the results show quite satisfactory.Therefore, th GIUH model can be extensively applied for the runoff analysis in the ungaged and the data deficiented basin.

• Journal of Korea Water Resources Association
• /
• v.40 no.4
• /
• pp.313-324
• /
• 2007

An irregular cell-based numerical model was developed to analyze underground space flooding. In this model, the flow characteristics in underground space were computed by link-node system. Also, the model can simulate the underground flood flow related to the influence of stairs and wall-structures. Empirical discharge formula were introduced to analyze weir-type flow for shopping mall, and channel-type flow for subway railroad respectively. The simulated results matched in reasonable range compared with the observed depth. The dual-drainage inundation analysis model and the underground space flood analysis model were integrated using visual basic application of ArcGIS system. The developed model can help the decision support system of flood control authority for redesigning and constructing flood prevention structures and making the potential inundation zone, and establishing flood-mitigation measures.

• Journal of Korean Public Health Nursing
• /
• v.4 no.2
• /
• pp.15-23
• /
• 1990

This study was carried out to explore the illness-related activities of the menopaused women. To achieve such a purpose, sixty-six cases of the middle aged women were sampled the naturally and the artificially menopaused group respectively from 1st, Aug. to 31th, Aug. in 1988. For the collection of data, 1, 140 women aged between 45-54 were selected through stratified sampling techniques in urban and rural area. Among them the final subjects for analysis were restricted to only those who had experienced menopause naturally or artificially. And then, after control for age and education analysis was performed. The data was analysed by use of frequency, percentage, $X^2-test,$ t-test, Pearson correlation coefficiency and stop-wise multiple regression. The obtained results were as follows. I. As for the se1f-perception on menopausal symptoms, it was revealed than Korean women, neithe in naturally and artificially, accepted the change of menstruation itself as serious. This shows us that middle-aged women had positively receptive attitudes that the change of menstruation is follwed by amenorrhea. 2. The artificially menopaused group scored more than the naturally one: (I) on the self-control activities such as self-assessment, lay-consultation, fever check, pulse check and observation of vagina discharge, (2) on the self-decision activities such as hospital and pharmacy utilization, (3) on the self maintenance activities such as walking, aerobic, weight check, skin care, skin protect, calori control diet control, milk intake, vegetable intake, cold water drinking before meal, parasol use and BP check The above results lead us that the self care practices of the menopaused women revealed' coping wit I menopausal symptoms at the first level in community and must be developed by the adequate nursin intervention.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.2
• /
• pp.217-221
• /
• 2000

Objective : Brainstem hemorrhages usually result in much higher mortality and morbidty than any other intracranial vascular lesions. The purpose of the study is to evaluate the relationship of the radiological classification of the lesions and the clinical outcomes, and to evaluate the value of such classification on the choice of management modality. Method : Thirty seven patients with primary brainstem hemorrhage were managed medically or surgically between Oct. 1995 and Mar. 1998. The lesions were classified as two groups based on radiological findings as follows : Focal subependymal hematoma(group I, n＝7) and diffuse tegmentobasilar hemorrhage(group II, n＝30). The outcomes at discharge were retrospectively reviewed according to such classification. Result : The most common clinical pictures and radiological findings in each group were as followings : 1) Group I : focal compressive lesion which displaces rather than destroys brain tissue. It occurs in a younger age group and causes neurological deficits which are often partially reversible. Operative hematoma evacuation was performed in 43.3%. Their mean improved Glasgow Coma Scale(GCS) score was 4.7. 2) Group II : hypertensive brain stem hemorrhage. It usually causes a diffuse lesion occurring in an older age group and most often associated with profound irreversible neurological deficits which are often fatal. Operative hematoma evacuation was performed in 16.7%. Their mean improved GCS score was 1.4. In both conservatively treated group I and II has no siginificant clinical improvement. Conclusion : Although there is an overlap among them and the size of the group is small, the pathophysiologic classification of this lesion based on clinical features and radiological findings may be useful for decision of treatment method.