• 보건행정학회지
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• 제19권3호
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

• 한국의료질향상학회지
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• 제22권2호
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• pp.43-73
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• 2016

Purpose: The aims of this study were to assess the presence of core patient safety practices in Korean hospitals and assess the differences in reporting and learning systems of patient safety, infrastructure, and safe practices by hospital characteristics. Methods: The authors developed a questionnaire including 39 items of patient safety staffing, health information system, reporting system, and event-specific prevention practices. The survey was conducted online or e-mail with 407 tertiary, general and specialty hospitals. Results: About 90% of hospitals answered the self-reporting system of patient safety related events is established. More than 90% of hospitals applied incidence monitoring or root cause analysis on healthcare-associated infection, in-facility pressure ulcers and falls, but only 60% did on surgery/procedure related events. More than 50% of the hospitals did not adopted present on admission (POA) indicators. One hundred (80.0%) hospitals had a department of patient safety and/or quality and only 52.8% of hospitals had a patient safety officer (PSO). While 82.4% of hospitals used electronic medical records (EMRs), only 53% of these hospitals adopted clinical decision support function. Infrastructure for patient safety except EMRs was well established in training, high-level and large hospitals. Most hospitals implemented prevention practices of adverse drug events, in-facility pressure ulcers and falls (94.4-100.0%). But prevention practices of surgery/procedure related events had relatively low adoption rate (59.2-92.8%). Majority of prevention practices for patient safety events were also implemented with a relatively modest increase in resources allocated. Conclusion: The hospital-based reporting and learning system, EMRs, and core evidence-based prevention practices were implemented well in high-level and large hospitals. But POA indicator and PSO were not adopted in more than half of surveyed hospitals and implementation of prevention practices for specific event had low. To support and monitor progress in hospital's patient safety effort, national-level safety practices set is needed.

• Journal of Trauma and Injury
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• 제31권2호
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• pp.51-57
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• 2018

Purpose: Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients. Methods: From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings. Results: For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness. Conclusions: This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

• 디지털융복합연구
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• 제17권1호
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• pp.259-267
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• 2019

본 연구는 임상실습을 경험한 간호대학생의 임파워먼트, 표준주의지침 인지도 및 수행도의 관련성을 파악하고, 간호대학생의 표준주의지침 수행도에 미치는 영향요인을 규명하기 위해 시도되었다. 연구 대상자는 전남지역 2개 대학의 임상실습을 경험한 간호대학생 168명을 대상으로 하였다. 수집된 자료는 IBM SPSS Statistics 20.0 프로그램을 이용하여 기술통계, t-test, ANOVA, Scheffe, Pearson's correlation coefficient, stepwise multiple regression을 통해 분석하였다. 단계적 다중회귀분석결과 표준주의지침 수행도에 영향을 미치는 요인은 인지도였으며 이들의 설명력은 77.7%였다(F=579.84, p<.001). 본 연구결과를 바탕으로 임상실습을 경험한 간호대학생의 표준주의지침 수행도를 증진시키기 위한 표준주의지침 인지도를 높이기 위한 방안이 필요할 것으로 생각된다.

• 한국초지조사료학회지
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• 제42권3호
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• pp.201-207
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• 2022

Fescues, which are widely cultivated as grasses and forages around the world, are often naturally infected with the endophyte, Epichloë. This fungus, transmitted through seeds, imparts resistance to drying and herbivorous insects in its host without causing any external damage, thereby contributing to the adaptation of the host to the environment and maintaining a symbiosis. However, some endophytes, such as E. coenophialum synthesize ergovaline or lolitrem B, which accumulate in the plant and impart anti-mammalian properties. For example, when livestock consume excessive amounts of grass containing toxic endophytes, problems associated with neuromuscular abnormalities, such as convulsions, paralysis, high fever, decreased milk production, reproductive disorders, and even death, can occur. Therefore, pre-inoculation with non-toxic endogenous fungi or management with endophyte-free grass is important in preventing damage to livestock and producing high-quality forage. To date, the diagnosis of endophytes has been mainly performed by observation under a microscope following staining, or by performing an immune blot assay using a monoclonal antibody. Recently, the polymerase chain reaction (PCR)-based molecular diagnostic method is gaining importance in the fields of agriculture, livestock, and healthcare given the method's advantages. These include faster results, with greater accuracy and sensitivity than those obtained using conventional diagnostic methods. For the diagnosis of endophytes, the nested PCR method is the only available option developed; however, it is limited by the fact that the level of toxic alkaloid synthesis cannot be estimated. Therefore, in this study, we aimed to develop a triplex real-time PCR diagnostic method that can determine the presence or absence of endophyte infection using DNA extracted from seeds within 1 h, while simultaneously detecting easD and LtmC genes, which are related to toxic alkaloid synthesis. This new method was then also applied to real field samples.

• 한국임상수의학회지
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• 제27권3호
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• pp.252-256
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• 2010

소 유방염은 주로 세균 감염에 의한 유선조직에 염증이 생기는 질병으로 유방염의 치료와 억제를 위해서는 1차적으로 세균을 사멸시키는데 있다. 본 연구에서는 소 유방염의 원인이 되는 다양한 세균들에 대한 은 이온의 항균효과와 적용 농도를 측정하였다. 유방염 원인균에 대한 은 이온의 최소 억제 농도 (minimal inhibitory concentrations, MICs)와 최소 살균 농도 (minimum bactericidal concentrations, MBCs)를 측정하였으며, 주사전자현미경 (scanning electron microscopy, SEM)을 이용하여 은 이온에 의한 세균의 형태 변화를 확인하였다. 다양한 유방염 원인균에 대한은 이온의 최소 억제 농도와 최소 살균 농도는 1.9에서 15.6 ${\mu}g$/ml로 세균에 따라 차이가 보였으며, 은이온 처리 후 주사전자현미경 촬영 결과 Staphylococcus aureus와 Escherichia coli의 세포벽이 함몰되거나 파괴되는 것을 볼 수 있었다. 이러한 결과는 유방염 원인이 되는 다양한 원인균에 대해 은이온의 살균 효과와 그 적용 농도를 보여주는 것으로, 소 유방염의 치료와 방어를 위한 임상적인 적용 가능성을 보여주는 것이다.

• Parasites, Hosts and Diseases
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• 제55권5호
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• pp.523-532
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• 2017

A field survey studying intestinal parasites in humans and microbial pathogen contamination at environment was performed in a Laotian rural village to identify potential risks for disease outbreaks. A parasitological investigation was conducted in Ban Lak Sip village, Luang Prabang, Lao PDR involving fecal samples from 305 inhabitants as well as water samples taken from 3 sites of the local stream. Water analysis indicated the presence of several enteric pathogens, i.e., Aeromonas spp., Vibrio spp., E. coli H7, E. coli O157: H7, verocytotoxin-producing E. coli (VTEC), Shigella spp., and enteric adenovirus. The level of microbial pathogens contamination was associated with human activity, with greater levels of contamination found at the downstream site compared to the site at the village and upstream, respectively. Regarding intestinal parasites, the prevalence of helminth and protozoan infections were 68.9% and 27.2%, respectively. Eight helminth taxa were identified in fecal samples, i.e., 2 tapeworm species (Taenia sp. and Hymenolepis diminuta), 1 trematode (Opisthorchis sp.), and 5 nematodes (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, trichostrongylids, and hookworms). Six species of intestinal protists were identified, i.e., Blastocystis hominis, Cyclospora spp., Endolimax nana, Entamoeba histolytica/E. dispar, Entamoeba coli, and Giardia lamblia. Questionnaires and interviews were also conducted to determine risk factors of infection. These analyses together with a prevailing infection level suggested that most of villagers were exposed to parasites in a similar degree due to limited socio-economic differences and sharing of similar practices. Limited access to effective public health facilities is also a significant contributing factor.

• Pediatric Infection and Vaccine
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• 제27권3호
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• pp.158-170
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• 2020

목적: 이 연구의 목적은 우리 나라 소아에서 Clostridioides difficile 감염(CDI)의 발생률 및 임상양상을 확인하는 것이다. 방법: 2009년 1월부터 2018년 12월까지 세브란스 어린이병원에 입원한 2세 이상 18세 미만의 환자 중 CDI로 진단된 환자들의 의무기록을 확인하였고 환자를 세 군(community acquired [CA], community onset-health care facility associated [CO-HCFA], and health care facility onset [HO] CDI)으로 나누어 임상양상을 비교하였다. 결과: 2009년부터 2018년까지 CDI유병률은 입원환자 10,000명당 1.00명에서 10.01명까지 증가하였다(P<0.001). HO CDI 군은 CA CDI 군에 비해 수술(40.4% vs. 0.0%, P=0.001)과 악성종양(27.7% vs. 0.0%, P=0.027)이 선행된 경우가 많았고 CDI 진단 전 항생제의 사용 빈도(97.9% vs. 31.3%, P<0.001) 및 항생제 개수의 중앙값이(2 vs. 0, P<0.001) 높았으며 CDI진단 이후 재원일수(13일 vs. 5일, P=0.008) 가 길었다. CO-HCFA 군은 CA CDI 군보다 연령의 중앙값이 낮았고(5세 vs. 13세, P=0.012) 악성종양이 선행된 경우가 많았다(30.8% vs. 0.0%, P=0.030). CA CDI 군은 HO CDI 군에 비해 복통(56.3% vs. 10.6%, P=0.001)과 혈변(50.0% vs. 10.6%, P =0.002)이 동반된 빈도가 높았고, 염증성 장질환이 동반된 경우가 많았으며(68.8% vs. 2.1%, P =0.001), 치료로서 정주 metronidazole을 더 자주 사용하였다(37.5% vs. 2.1%, P =0.001). 결론: 국내 소아의 CDI 발생률이 증가되고 있어 이에 대해 경각심을 가지고 역학과 임상적 특징을 파악하는 것은 병원 감염관리를 위하여 중요하다.

• 대한임상검사과학회지
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• 제49권4호
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• pp.420-426
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• 2017

메치실린 내성 포도알균(methicillin resistant Staphylococci, MRS)는 인체 여러 부위에서 집락화 될 수 있으며 의료기관과 연관된 사람에서 흔히 분리된다. 이 연구는 밀접한 단체생활을 하는 일개 고등학교 한 개 반의 학생들 손과 그들이 사용하는 책상에서 MRS 균의 오염 정도를 평가하고자 하였다. Staphylococcus aureus가 28명의 학생의 손 중에서 2 균주가 분리되었으며 모두 메치실린에 감수성이었다. 응고인자 음성 포도알균(coagulase negative Staphylococci, CoNS)는 26 균주가(26/28, 92.9%) 분리되었으며 이들 균주 중 14 균주는 메치실린 내성균(MRCoNS)이었다. 14 MRCoNS 중 S. warneri가 가장 흔하였으며(8/14, 57%), 이들은 대부분의 $non-{\beta}-lactam$ 항생제에 감수성 이었다. 31개의 책상에서는 S. aureus는 분리되지 않았으나 26 CoNS (26/31, 83.9%)가 분리되었다. 손과 책상에서 분리된 포도알균 이외의 균은 Micrococcus와 Bacillus spp.이었다. 결론적으로 MRSA는 이번 연구에서 분리되지 않았으나 mecA 유전자를 갖고 있는 MRCoNS는 학생들의 손에서 높은 비율로 분리되었다. 손씻기와 같은 예방 교육을 강화할 뿐만 아니라 이들 균의 오염 및 보균율 등의 조사와 같은 능동적 감시 등이 이들 균의 감염예방과 전파 차단을 위해 필요할 것으로 사료된다.